A Guide to Low-Cholesterol Living

You Can Control Your Cholesterol

High Cholesterol Can Sneak Up On You.
High Cholesterol. You cant see it or hear it. You may feel just fine. But when your cholesterol sneaks up above a desirable level, it puts you at increased risk for heart attack, heart disease, stroke and other cardiovascular disease. Combine high cholesterol with other heart risks (such as having a family history of heart disease, being a man over 45 or a woman over 55 years old, being a smoker, or having a high blood pressure or diabetes), and you could be in for even more trouble. What you can do? Keep this yellow, waxy molecule called cholesterol under control by following this guide for low-cholesterol living.

A Guide for Low-Cholesterol Living

After you understand cholesterols role in your body, you can keep your cholesterol at a desirable level by having a cholesterol test, making changes in what you eat, and taking other steps to control your cholesterol. The sooner you start, the better, because a decrease in your cholesterol level leads to an even greater decrease in your risk for heart disease. Testing Your Cholesterol Level A simple blood test shows what your cholesterol level is and whether you are at increased risk for heart disease. Changing Your Diet Reduce your weight and your cholesterol level by making wise food choices and by using low-cholesterol cooking techniques. Exercise and Other Steps A Cholesterol-lowering diet can be even more effective When combined with weight control, regular aerobic exercise and reduction of other heart risks. Do You have A High- Cholesterol Lifestyle? If youre living a high-cholesterol lifestyle, your cholesterol level may be too high or it may become high in the future, increasing your risk of heart disease. Read the statements below to find out how you may be contributing to high cholesterol levels. Check the box next to each statement that applies to you. The food you buy You buy a lot of prepared, Convenience, and fast food. You buy butter and other whole-fat dairy products such as whole milk and cheese. You buy a lot of chops, ribs, and other fatty meats. The Food You Eat You eat a lot of fried or breaded food. You like food with gravy and sauces. When eating out, you choose food for taste-not your health. The Way You Live

 Youve been putting off losing those extra pounds. You dont make time to exercise regularly. Youve never had your cholesterol level checked- or it has been five years or more since your last test. The More Boxes Youve checked, the greater your risk of having high cholesterol, and the greater your benefits if you follow this guide for low-cholesterol living. UNDERSTANDING CHOLESTEROL Cholesterols most important job is to help carry fat through your blood vessels, since fat cant travel through blood vessels by itself (fat cant mix with water, the major ingredient in blood). Usually this transport system works well. But when you eat too much fat and your body has to move it throughout your body, too much cholesterol may accumulate. Serious problems-even heart attacks-can occur. Where Does Cholesterol Come From? Your liver makes most of your bodys cholesterol to help carry fat to parts of your body that need fat for energy and repairs, or to fat storage sites such as your hips or belly. Some cholesterol in your body comes from eating high-cholesterol food such as eggs. (Photo to be included) Fat from the food you eat is digested and sent to the liver. Where its processed for distribution throughout your body. (Photo to be included) Your liver makes almost all the cholesterol your body needs to help move the fat to other parts of your body. Types Of Cholesterol Your liver places cholesterol into packages called lipoproteins, made From lipids (fat and cholesterol) and protein. Three kinds of lipoprotein packages are VLDL (very low-density lipoprotein), LDL (low-density lipoprotein), and HDL (high-density lipoprotein). Each has a different job in the body. (Photo to be included) VLDL carries fat from the liver to other parts of your body. VLDL becomes LDL after it unloads fat. (Photo to be included) LDL is called bad cholesterol because pieces of it easily become stuck along blood vessel walls. (Photo to be included) HDL is called good cholesterol. It finds and rescues stuck LDL pieces and brings them back to the liver. HOW CHOLESTEROL WORKS Cholesterol helps carry digested fat from the liver to destinations throughout your body, using the blood vessels as a highway. After making its delivery, cholesterol returns to the liver and repeats its job over again.

(Photo to be included) 1. Fat goes to the liver. After you eat fat, it passes through your stomach, is digested and absorbed in your small intestine, and is sent to the liver for processing and shipping throughout your body. (Photo to be included) 2. The liver loads fat into VLDLs. VLDL travel through your blood vessels to unload fat throughout your body. The empty VLDLs become LDLs. (Photo to be included) 3. LDL pieces may become stuck. Some LDL pieces become stuck along the blood vessel walls, narrowing the blood vessels. (Photo to be included) 4. HDLs rescue stuck LDL pieces and bring them back to the liver, where the LDL pieces are either recycled into new VLDLs or broken down and excreted. (Photo to be included) If you eat too much fat, your liver makes extra VLDLs to carry the fat. More LDL pieces become stuck if there are not enough HDLs to rescue them all. The blood vessel may become blocked. If this happens in a blood vessel in your heart, a heart attack may result. TESTING YOUR CHOLESTEROL LEVEL The first step in following your guide for low-cholesterol living is to check your cholesterol level. Cholesterol screenings are done at health fairs, your company health services, doctors offices, shopping malls, and drugstores. Often the test is free or inexpensive. Once you know what your cholesterol level is, you can see if youre at increased risk of heart disease and begin to control your cholesterol. Cholesterol Testing Cholesterol testing usually requires no preparation. Sometimes, however, you may need to fast (not eat) before a cholesterol test. A blood sample is taken and sent to a lab. It may take a few days to receive your results. Your Cholesterol Numbers All cholesterol tests will give you a number for your total cholesterol. You may also see numbers for HDL and LDL cholesterol. You probably wont get a number for VLDL. Fill in your numbers in the space below. What the Numbers Mean Use the chart below to find out what your cholesterol numbers mean. Desirable Borderline Danger Total Less than 200 200-239 240 or higher HDL 35 or higher ---------Less than 35 LDL Less than 130 130-159 160 or higher If all your numbers are desirable, great! Keep up the good work by following the suggestions in this booklet.

If any of your numbers fall in the borderline or danger columns, or if youre at risk for heart disease, talk to your health provider. Together, you can tailor a cholesterol-lowering plan to meet your needs. Start by reading this booklet to see where you can make changes. Changing Your Diet Changing your diet is often the most effective way to lower or maintain your cholesterol at a desirable level, though it may take a few months to begin to see the results. The most helpful change you can make is to lower the amount of fat you eat. This helps lower your cholesterol and helps you lose weight. For more information about changing your diet, ask your doctor to refer you to a qualified dietitian. From this.. ..to this Eat Less Fat Many of us eat almost half our daily calories in fat-and our bodies respond by making more cholesterol. Your goal is to limit fats to less than one-third of your total calories-and to reduce the amount of saturated fat you eat. Do this by avoiding obvious fats such as butter and hidden fats used in processed foods. Eat Less Cholesterol Eating high-cholesterol food may raise your cholesterol level. Limit your use of highcholesterol food such as eggs and fatty meats from all animals, especially organ meats. Eat More Fiber One kind of fiber (soluble fiber) lowers your cholesterol level by keeping the cholesterol you eat from being absorbed by your body. Oats, beans and fruit are rich in soluble fiber. Eat More Starches Starches (complex carbohydrates) arent fattening and can lower your cholesterol level by diluting the fat you eat. Eat more starches such as grains, beans and root vegetables. Drink Less Alcohol Drink too much alcohol may raise your cholesterol level by raising the fat levels in your blood. Try to limit yourself to no more than two alcoholic beverages each day. CHOOSING FOOD TO REACH YOUR GOAL Changing your diet and losing excess weight to reach or maintain a desirable cholesterol level begin with making changes in the food you buy. Shopping for the right food doesnt have to be confusing or overwhelming. With a little practice, you can develop skills for reducing fats, reading labels, and making good selection at the market. Pick Your Fats Wisely The fat you eat can be divided into three types: monounsaturated, polyunsaturated and saturated fat and to eat less fat overall. Use very small portions of monounsaturated and polyunsaturated fats instead of saturated fat. Choose monounsaturated fat from vegetable sources such as olive and canola oil. Monounsaturated fats lower LDL (bad) cholesterol without lowering HDL (good) cholesterol. Choose polyunsaturated fat from vegetable sources such as safflower, sunflower or corn oil. It may lower both LDL (bad) and HDL (good) cholesterol. Many margarines are high in polyunsaturated fat.

Avoid saturated fat from animal sources such as butter, lard, and fatty meats. Vegetable sources are coconut, palm and partially hydrogenated oils, which are found in many processed foods. Too much saturated fat can raise your cholesterol level. Shop for the Best Foods Poultry, fish, seafood and lean cuts of meat ( such as beef sirloin tip, pork tenderloin or leg of lamb) are good low-fat choices. When buying meat, ask your butcher to trim off excess fat. Fresh fruits and vegetables are practically fat-free and contain no cholesterol. Starchy foods such as potatoes, yams, grains, breads and cereals are all good choices. Beans and oats can help lower your cholesterol. Choose low-fat food products containing these ingredients. Frozen entrees made with little cheese or sauce and frozen desserts such as ice milk, low-fat frozen yogurt, or light ice cream can be good low-fat choices. Nonfat or skim milk, cheeses made with part-skim milk (such as part-skim mozzarella) and nonfat yogurt are good dairy choices. Spreads made with liquid oil, such as tub margarine or light mayonnaise, are good choices. Read the lablels to find the fat. The best way to find the fat in processed foods is to read the labels. You can ak yourself these four questions to help you choose products that are low in fat-especially products low in saturated fat. Do too many calories come from fat? In this case, yes. This product has 225 calories or 60% come from fat. Ideally, less than 30% of your days total calories should come from fat. Is the serving size appropriate? This label says there are four 1d-cup servings-a serving size that may be less than what you would normally eat. When keeping track of fat, be sure to use a serving size that is close to what you would really eat. Is fat a major ingredient? The label lists all ingredients by weight. In this product, the heaviest ingredient is butter. Cheese and hydrogenated oil are listed next, so this is likely to be a high-fat product. Are there several fats in the product? When you see several high-fat ingredients listed on the label (such as butter, cheese, hydrogenated oil and cream) then the product probably contains too much fat. Low-Fat Cooking These cooking techniques can lower fat while preserving taste: Microwave, broil, grill, bake, or steam food without adding fat. Use nonstick sprays or cookware. Remove extra fat from meat and skin from poultry before eating. Great Seasoning Use seasoning creativelyand youll probably forget about the missing fat: Sprinkle low- salt herbal blends on meats. Try butter-flavoured (fat-free) powders on potatoes, vegetables and noodles. Use low-fat dressings and light or diet mayonnaise on salads and sandwiches. Whats for Breakfast? Rather than skip breakfast, plan to eat it and reduce the amount you eat at dinner. Try these easy-to-prepare ideas: Oat meal or oat bran, Skim milk, 1 piece of fruit whole-wheat toast with no-sugar-added jam. Egg whites or egg substitute whole-wheat toast. No sugar-added jam juice. Whats for Lunch?

When lunch time is rushed, you can be tempted to grab anything thats fst. Try one of these meals instead : 1 pita bread 1 small can of water-packed tuna (plain or with 1 tablespoon light mayonnaise) raw vegetables non-fat yogurt 1 piece of fruit. Broth based vegetable soup Tossed salad with 1 tablespoon light or diet dressing Bagel low-fat cottage cheese 1 piece of fruit. COOKING UP HEALTHY MEALS Making cholesterol-lowering changes in your diet goes beyond shoppingyoull also wantto learn some cooking techniques that can eliminate a little and put all of your food choices and cooking techniques together into meals that taste great, lower your cholesterol, and may even help you lose weight. Recipe Adjusting Rather than give up favorite recipes, try some low-fat, low-cholesterol substitutes: Use vegetables oil in place of lard or shortening and try using less of it. Substitute margarine for butter and use less. Try replacing each egg with two egg whites. Smaller Portions Reduce your calories by making several small changes ; Serve food on the plates and immediately put leftovers away. Use a smaller plateit looks fuller. Eat at the table-not in front of the TV-so youll pay attention to how much youre eating. Whats for dinner? Lighten up dinner by serving less meat and more vegetables, fruits and starches. Here are some suggestions: Spaghetti with tomato sauce. Lean meatballs (ground turkey breast or lean beef). Steamed vegetables French roll 1 piece of fruit. Steamed vegetables Brown rice Whole-wheat roll Baked yam, Non-fat milk, 1 piece of fruit. Whats to snack on? What should you eat when you want to munch? Try some of these low-fat, low-cholesterol snacks: Air-popped popcorn, plain or with low-salt seasoning. Non-fat yogurt. All-juice frozen fruit bar. Low-salt pretzels Fresh, frozen, canned or diet fruit. Raw vegetables. Bowl of high fiber, low-fat cereal. Low-fat crackers. EATING WELL WHILE EATING OUT Its easy to feel that you cant control your cholesterol or your weight when you eat out a lot. But you can still choose food that helps keep you cholesterol level and weight under control. Start by picking from the lists below. Be assertive and ask for food to be prepared in healthy waysmost restaurants will accommodate your special requests. American many American restaurants now offer low-fat, low-cholesterol alternatives to highfat fast food. Here are some good choices: Salad bar (avoid bacon and too much dressing) Broiled, grilled or baked chicken, fish, seafood, lean beef or lean pork (not breaded) Turkey sandwich without cheese or mayonnaise. Small hamburger with lettuce and tomato (no cheese or mayonnaise).

Mexican Mexican cooking can be healthy if you avoid fried or refried food, guacamole, sour cream, or cheese. Here are some good choices: Chicken tostada, Chicken enchilada, Burrito without cheese, Steamed tortillas, Beans (not fried) and rice Baked cornmeal tamale, ceviche (marinated raw seafood) Fish a la Veracruzana Salsa (as a condiment). Italian Starchy Italian food cooked with just a little olive oil can be healthy, if you avoid lots of meat, cheese and cream sauces. Here are some good choices: Pasta with marinara or clam sauce(not cream sauce) Spaghetti with tomato sauce (no sausage) Pizza (less cheese and add only vegetable toppings) Ravioli,Tortellini, Potato gnocchi, Minestrone soup. Asian Asian food can be low-fat and low-cholesterol, as long as you avoid stir-fried, breaded and deep fried food. Here are some good choices: Steamed vegetarian pot stickers or dumplings, steamed rice and entrees, Noodle dishes (not fried)< Sushi or sashili, Tofu items(not fried) Chicken or fish, broiled, cooked in broth, or steamed. Hot- and -sour soup. Fortune cookies. European European cuisineespecially saucescan be loaded with added fat, so always ask for sauces on the side. Here are some good choices: Fresh oysters and clams, Broth-based soup, Chicken stewed in tomatoes or wine sauce, Poached, steamed or broiled entrees. Filet of sole(not fried) steamed lobster or shrimp Ratatouille, Poached Pears or fresh fruit. Middle Eastern Most Middle Eastern food is healthy, made from ingredients such as rice and yogurt, here are some good choices: Stuffed grape leaves, Tandoori(oven) cooked chicken breast, Grilled lamb, Curries (made without coconut milk) Legume (dal) dishes Pita bread, Chapati (roti) Chutneys (made without coconut). Treating or Cheating? Turn your natural desire to cheat into a treatoccasionally. Give yourself a reward for following your plan for low-cholesterol living by occasionally allowing yourself a higher-fat snack or meal. Then return right away to your low-fat-dietwithout feeling guilty for the splurge. EXERCISE AND OTHER STEPS TOWARD CHOLESTEROL CONTROL Along with your diet, there are other steps you can take to help lower your cholesterol level: Lose that extra weight, exercise regularly, and reduce your other heart risks. Also, get your cholesterol level rechecked periodically, so you can be sure youre maintaining a desirable cholesterol level. Watch Your Weight If you weigh too much, your body stores more fat and cholesterol. This may cause your blood cholesterol level to rise. Since fat has many more calories(9 per gram) than protein (4 per gram) and starches (4 per gram) the quickest way to lose weight is to reduce the amount of fat in your diet. Why Exercise? A regular exercise program can help raise your HDL (good) cholesterol level, can help you lose weight and can even help lower other heart risks. Exercise aerobically (such as walking, jogging or swimming) at least four times a week for at least half an hour each time. Before

you begin an exercise program, work with your health care provider to plan a program thats right for you. The Pinch Test. Grasp your skin at the side of your waist and measure the fold. If its more than an inch, you have some extra fat to lose. Warm up for 5 minutes or so. Mild stretching, simple calisthenics or slow walking helps warm up your muscles and joints. Exercise vigorously for 20 to 30 minutes. Cool down by repeating your warm-ups for 5 to 10 minutes.

Reduce Other Heart Risks

High cholesterol is only one of the many risk factors for heart disease. You have no control over such factors such as your familys history of heart attacks or your age. Stop smoking. Smoking lowers your HDL (good0 cholesterol and increases your risk of heart attack, stroke and cancer. Control high blood pressure and diabetes through diet, weight loss, medication (if prescribed) and regular monitoring. Reduce the stress in your life. Ask your company health services or your health care provider for information about managing stress.

Get Regular Checkups. Visit your health care provider periodically to be sure that your
cholesterol level-and your other risks for heart disease-are under control. Rechecking your cholesterol level. Whatever your cholesterol is now. You should have it periodically rechecked. If all your cholesterol levels are desireable and youre not at risk for heart disease, have your heart cholesterol level checked every five years. Otherwise, your doctor may ask you to have more frequent cholesterol tests. Taking Medication. If your cholesterol levels dont become desirable after making changes in your lifestyle and diet for at least six months, your doctor may ask you to take cholesterol lowering medication. If you have other heart risks or extremely high cholesterol levels, you may be put on medication sooner. Even if you take medication, continue with your guide for low cholesterol living, which helps make the medication work better.

FEELING GOOD AND IN CONTROL

You can feel great knowing your cholesterol is under controlnot only because lowering your cholesterol level will greatly reduce your risk of heart attack, heart desease, stroke and other serious cardiovascular diseases, but also because you have the satisfaction of knowing that your actions have put you back in charge of your own well-being.

Keeping Track of Your Choesterol

Date of Test Total Cholesterol Level HDL Level LDL Level