» Conquer. Cholesterol Toolkit. Better health. for those you love. 1. B r o u g h t t o y o u b y.

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1 » Conquer Cholesterol Toolkit to B r o u g h t t o y o u b y Raymond Wells, LLC Better health for those you love. 1

2 Contents» 1 Why Care about Your Cholesterol?» 2 The on Cholesterol» 3 Know Your Numbers» 4 Game Plan for Conquering Cholesterol Eating Right Moving It Use a Health Coach Living Smart» 12 Additional Resources» 13 Track Your Progress Conquer Cholesterol So, you recently found out you have high cholesterol (also known as hyperlipidemia ). You re not alone. Forty-two million Americans have high cholesterol, and another 63 million have borderline high cholesterol. High cholesterol is a silent health risk that can be deadly if ignored. The good news is that it is NOT too late to do something about lowering your cholesterol. You ve already taken the first step by completing your HealthCheck and meeting with your Nurse Practitioner (NP) or other health coach. Use this toolkit to design your personal Game Plan to conquer your high cholesterol so you can remain BUiLT to Last. Look inside for:» A basic understanding of what cholesterol is and why it is important to get a handle on it.» Specific steps you can take to reduce your cholesterol.» Helpful tools and online resources, such as a Daily Health Log and a worksheet to track your cholesterol over time.

3 Why Care about Your Cholesterol? Too much cholesterol in your blood can cause a build-up of plaque (a thick, hard deposit) in your arteries. If your arteries get too clogged, it can make it difficult for blood to flow through your body properly which can cause heart disease or even a heart attack. Or, if an artery to your brain is blocked it could cause a stroke. It s best to start reducing cholesterol immediately. Your annual HealthCheck can alert you to the problem long before symptoms show up. And that s when you have the best opportunity to make a difference. Fast Fact Heart disease is America s #1 killer Stroke is the #3 killer If you don t fix it, it could kill you. But with today s medicine and some small changes in your eating habits and activity level, acting now can give you a longer, more enjoyable life helping ensure you ll be there for your family. 1

4 Total Cholesterol The on Cholesterol Cholesterol is a waxy, fat-like substance made by the liver to help meet the body s need for hormones and bile acids that help digest fat. It is essential to body functions, so the liver automatically makes the amount of cholesterol that the body needs (about 1000 mg of it daily). LDL: The Lousy Cholesterol Reduce This HDL: The Healthy Cholesterol Increase This The problem is that cholesterol also enters the body when we eat animal fat. And on top of that, a diet high in saturated fats (see page 5) causes the liver to make even more cholesterol. This means you could have more cholesterol floating through your bloodstream than you should which leads to clogged arteries. Not all cholesterol is created equal. There are two different forms of cholesterol. LDL is the unhealthy or Lousy cholesterol that clogs arteries. HDL, the Healthy cholesterol actually helps your body by carrying bad cholesterol back to the liver. In doing so, it cleanses cholesterol from the bloodstream. When your cholesterol is checked through a blood test, you get a number for the HDL level and a number for the LDL level. Your total cholesterol is a number that comes from adding the HDL and LDL numbers. Your NP, doctor, or other health coach will review these results with you to determine if you should take steps to change either number. What to Know about LDL:» LDL can harm your heart.» It can clump up and clog your arteries.» The more LDL you have in your blood, the greater the risk of heart disease and stroke. What to Know about HDL:» HDL can protect your heart.» It helps carry away the LDL build-up.» The higher the levels of HDL the better.» Think of HDL as a drain cleaner unclogging your arteries.» Or think of HDL as the garbage truck driving through your bloodstream, carrying away LDL. HDL LDL LDL 2 Kick the Killer 5: Conquer Cholesterol

5 Know Your Numbers Everyone over the age of 20 should have their cholesterol checked at least once every five years. If your LDL is too high or your HDL is too low, you need to fix it. Here are the numbers to look for: HDL (the Healthy Cholesterol) LDL (the Lousy Cholesterol) Good to Know In addition to measuring LDL and HDL, your annual HealthCheck also checks other important facts about the fat in your blood. Your NP, doctor, or other health coach will tell you if your levels are too high. LDL-P: A measure of the number of particles that carry cholesterol in your bloodstream (more particles means more build-up). Small LDL-P: A measure of the number of small particles that carry cholesterol in your blood (small particles get into artery walls easier). Triglycerides: Another type of fat in your blood that increases your risk for disease. FIX Below 40 Above 130 Watch OK Above 59 Below 100 Top 6 Factors that Kick Cholesterol into High Gear These can make your cholesterol worse: 1 Being overweight 2 Having diabetes 3 Eating foods high in saturated fats (such as fried foods and red meats) 4 Eating an overall diet that s high in total fats 5 Having high blood pressure 6 Not getting enough physical activity Top 3 Signs of a Serious Problem High cholesterol is known as a silent killer because most people don t feel sick or have any obvious symptoms from it, until they have a heart attack or stroke. However, some symptoms you may experience include:» Chest pain when you exert yourself, which could be cholesterol buildup near your heart.» Leg pain when you walk, which may be blockage in your leg.» Male impotency. Think of it as a plumbing problem: If you try to turn on the faucet and there s no flow, your pipes are clogged. Don t wait for these symptoms the earlier you take action to reduce your cholesterol, the more you ll stay BUiLT to Last. But if you do have these symptoms, ask your NP or doctor whether you need advanced treatment. 3

6 Game Plan for Conquering Cholesterol What You Can t Control Your gender. Men make more LDL (the Lousy kind) and less HDL (the Healthy kind) than women. Your age. Problems increase with age for men and women. For women, menopause can bring on cholesterol problems. Your genes. If your parents had cholesterol problems (or heart attack or stroke), you re more likely to have problems too. However, with the medical knowledge and medications available today, you have a better opportunity to control the condition and stay BUiLT to Last. What You Can Control Together, you and your NP, doctor, or other health coach can develop a game plan to help you conquer cholesterol. Generally, a good game plan will include four basics for good health, which we call the Core4. Eat right. A nutritious diet with lots of fruits, veggies, and whole grains can increase your HDL and reduce your LDL. If you re overweight, it s also the most important step in losing weight. Move it. You ll increase your HDL, reduce your LDL, and lose weight if you need to. Get going at least 30 minutes, five times a week. Use a Health Coach. Your NP, doctor, or other health coach can help you with your game plan. Get regular updates from your coach, and be sure to follow the game plan, including taking any medicine as directed. If you have a history of high cholesterol, get your numbers checked again at least once a year. Live smart. Don t smoke. Smoking decreases your healthy cholesterol levels, but this can be reversed by quitting. Good to Know Don t sweat the small stuff. Stress makes cholesterol worse, so avoid stressful things or learn to cope better. If you drink, enjoy alcohol in moderation. Having 1 or 2 drinks per day can increase your healthy cholesterol. As in most areas, moderation is key! Lose the gut. Extra weight, especially around your waist, makes your cholesterol worse. PCheck the box above for each step that your health coach recommends. Then get more information on the following pages about specific actions to take for each step. Throughout these pages, use the check-boxes and make other notes to create the best game plan for your specific needs. 4 Kick the Killer 5: Conquer Cholesterol

7 PEating Right Getting the right foods can make a positive impact on your cholesterol levels. Eat more fruits and veggies. Try to fit a fruit or vegetable into every meal and snack. Eat whole grains. Each day, enjoy 2 to 8 servings (depending on your body size and whether you need to lose weight) of bread, cereal, rice, or pasta especially those made with whole grain. Choose the right milk products and meats. It s best to have some protein with every meal and snack (even if just a half-serving) for a total of 3 or 4 full servings per day. Pick fat-free or low-fat milk, cheese, and other dairy. Stick to lean meats, fish, and chicken/turkey without skin. Enjoy nuts and seeds in limited amounts (up to 4 or 5 servings per week). Eat less bad fat. Limit meat, cheese, and butter. Avoid trans fats that often appear in fried foods and bakery goods. Peanuts, olive oil, canola oil, fish, and other seafood have fats that are liquid at room temperature. These unsaturated fats are the best fats to include in your diet. But be moderate too much of any food type can make you gain weight. Animal fats in meat, cheese, and butter are naturally solid at room temperature. These are saturated fats. Enjoy these foods in small amounts. Trans fats are the worst. Most are fats that should be liquid but have been transformed into solids by the food industry. Check labels. If it says partially hydrogenated vegetable oil or trans fat, don t eat it. For more help on eating right, ask your NP or other health coach for Your Guide to the Core4 and the Daily Health Log. 5

8 Questions to Ask Your NP or Doctor» How much exercise can I do each day?» How often can I exercise each week?» What types of exercise should I do?» What types of activities should I avoid?» Should I take my medication(s) at a certain time around my exercise schedule?» Should I take my pulse while exercising? 6 Moving it Regular exercise can do many good things for you, including: Lower LDL (lousy) and increase HDL (healthy) cholesterol Strengthen your heart, improve your circulation, and help your body use oxygen better Increase energy levels so you can do more activities without becoming tired or short of breath Increase endurance and improve muscle strength, bone strength, balance, and flexibility Reduce body fat and help you reach a healthy weight Reduce stress, tension, anxiety, and depression Boost self-image and self-esteem Improve sleep and make you feel more relaxed and rested Make you look fit and feel healthy Kick the Killer 5: Conquer Cholesterol

9 Exercise can be divided into three basic types: 1 2 3» Aerobic exercise (such as walking, jogging, jumping rope, bicycling, hiking, and swimming) is steady physical activity using large muscle groups. Aerobic (also called cardio ) exercise has the most benefits for your heart.» Strengthening exercises usually include the use of weights. These exercises improve muscle and bone strength, and they can boost your metabolism which can make it easier to lose weight or stay in shape.» Stretching is the slow lengthening of the muscles. Regular stretching increases your range of motion and flexibility, and helps prevent injury. Focus on aerobic exercise, but also work in some strengthening and stretching exercises. Experts recommend that most people build up to exercise lasting 30 minutes or more, at least five days every week. Your health coach may recommend a specific plan for physical activity. For more help with designing your exercise plan, see Your Guide to the Core4. Lose the Gut If you re carrying around extra weight, simply trying to eat better and moving more may not cut it. You probably need a special focus on getting to a healthy bodyweight which may include setting a goal, defining a specific eating and exercise plan, and having a weight-loss buddy or group to help you. Set a realistic goal. Choose a one-month goal and/or a three-month goal. Generally, 1 or 2 pounds per week is achievable and you ll be losing weight fast enough to keep you excited. Define your eating plan. It has been estimated that the key to losing weight is 75% eating right. Plan the types and amounts of food you will eat but be sure to create a plan that you can stick with for good. If you choose a fad or crash diet, chances are you will quickly gain back any weight you lose. Define your exercise plan. If losing weight is 75% eating right, it is also 25% moving more. That means it is difficult to lose weight without enough physical activity. Choose activities you enjoy and can do consistently, and build up to 30 to 60 minutes a day, 5 to 7 days a week. For more help with losing weight, see the Building a Healthy Bodyweight Toolkit. 7

10 Using a Health Coach Why don t we take better care of ourselves? Part of the reason is the way we re brought up. As kids, we re taught to be tough not to cry, not to complain, and not to show any signs of weakness. We ignore our aches and pains and play through our injuries. In our 20s, we think we re indestructible and see going to the doctor as a waste of time and money. In our 30s, we re too busy with our career and family to go. Helpful Tool By the time we re in our 40s, we don t go because we re afraid of what we ll find out. Being tough has advantages. But if toughness keeps us from getting medical care until it s too late, the result can be disability or an early grave. To be truly BUiLT to Last, it s critical to partner with a health coach such as your NP or doctor. If your game plan includes one or more medications, use the handy Medicine Tracker on the back cover of Your Guide to the CORE4. Taking Medications If your cholesterol levels don t respond enough to changes in your diet and activity levels, your NP or doctor may prescribe a cholesterol-lowering medicine, such as a statin. Statins keep the liver from making cholesterol and are most effective when combined with a low-cholesterol diet. de fine Stat in The most safe and successful group of medications available to decrease LDL (lousy) levels while also increasing HDL (healthy) levels. It also helps decrease death by heart disease. Examples of statins: Simvastatin, Pravastatin, Lipitor, Zocor, Pravachol Through your Health Center, currently you can get certain cholesterol-lowering medicines at no copay. That s so that more people will use them now to prevent future problems, rather than waiting until after having a heart attack or stroke. To qualify for these no-copay medications, you simply need to have a HealthCheck each year. HealthCheck Even if you take a medication, you should still follow the other parts of your game plan, such as diet and exercise. This will keep your cholesterol as low as possible. If you have diabetes or high blood pressure, be sure to let your NP or doctor know so they can check that your medications are all working together rather than against each other. Some medications make cholesterol worse. 8 For more about partnering with a health coach, see Your Guide to the Core4. Kick the Killer 5: Conquer Cholesterol

11 Good to Know If you ve had older relatives who suffered heart problems or stroke, they likely did not have the benefit of statins. Even if dying young runs in your family, you don t have to these modern medicines can change your family tree! 9

12 Living Smart By making a handful of changes in your lifestyle, you can make a difference in your cholesterol levels. Quitting Smoking According to the American Heart Association, tobacco smoke lowers HDL (healthy) cholesterol levels and increases the tendency for blood to clot. PTop 5 tips to Quit Smoking 1 Understand that smoking is bad for your health. 2 Make the decision to quit and then talk with your NP or doctor to see what they can offer to support your efforts to quit, such as smoking-cessation medication. Fast Fact The risk for developing coronary heart disease is 2-4 times greater for smokers than non-smokers. Gum infection can lead to heart disease. 3 Use available resources, such as the Triumph Over Tobacco Toolkit available from your NP or other health coach. 4 Set a quit date and tell people about it. Publicly sharing your quit date adds a sense of accountability. 5 Stop smoking cold turkey. According to WhyQuit.com, that s how 80% to 90% of all successful long-term nicotine addicts quit. For more help to stop smoking, see the Triumph Over Tobacco Toolkit. 10 Kick the Killer 5: Conquer Cholesterol

13 Enjoying Alcohol in Moderation According to the American Heart Association, drinking moderate amounts of alcohol can help raise your HDL (healthy) cholesterol. Moderate means an average of one to two drinks per day for men or one drink per day for women. Coping with Stress According to WebMD, if stress is bothering you, it s making your cholesterol worse. And if you can learn to avoid stress or deal with it better, your LDL (lousy) will likely go down and your HDL (healthy) will go up. Here are six tips for managing stress: Identify the sources of stress then focus on solving one source at a time. Prioritize and say no when necessary. Take time for activities that recharge you. Get more physical activity. However, because alcohol brings other risks (such as alcoholism, overweight, liver disease, and others), the benefit isn t great enough to recommend drinking alcohol if you don t do so already. And if you cannot stop at one to two drinks, you should avoid alcohol due to the increased health risks. Also, if you re taking medications, be aware that alcohol can worsen side effects like drowsiness. For more on alcohol, see Your Guide to the Core4. Get enough sleep every night. Make and keep friends you can lean on when you need to. Visit your NP or doctor for additional help on handling stress. For more help to manage stress, see Your Guide to the Core

14 Additional Resources Organization American Heart Association Description Provides brochures and information about support groups and community programs. AHA s web site also has information on physical activity, diet, and various heart-related conditions. Contact Information AHA-USA1 ( ) National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute(NHLBI) WebMD Provides information on high cholesterol as a risk factor for heart disease and stroke, as well as on cholesterol-lowering diets, recipes, exercise, weight loss, and lifestyle changes. Provides a wealth of information about cholesterol. Includes helpful articles, videos, and FAQs Kick the Killer 5: Conquer Cholesterol

15 Track Your Progress Game On! If you haven t had a HealthCheck this year, get one. You can do this right at work through your Health Center. If your numbers aren t good, work with your NP, doctor, or other health coach on a game plan. If you feel intimidated by your game plan, just pick one step to focus on this week, and then pick a new step each week. If that still seems too hard, just add one step each month. After a month or two, get another blood test to check your progress. Celebrate your success and keep up the good work. Or talk to your health coach if your numbers aren t improving. Goal Checkup Date: Checkup Date: Checkup Date: LDL (lousy) HDL (healthy) Weight Helpful Tool Extra copies of this worksheet are available at your Health Center and at How d you do? Quiz answers from back cover are: 1e, 2e, 3a, 4a 13

16 Quick Quiz 1. What are the steps you can take to reduce your cholesterol? a) Eat a nutritious diet with lots of fruits and veggies. b) Get more exercise. c) Lose weight if you are overweight. d) Take your cholesterol-lowering medication if prescribed. e) All of the above. 2. Which food does not have a lot of saturated fat? a) Coconut oil b) Whole milk c) Chicken, with skin d) Butter e) Whole-wheat bread 3. True or False: Through your Health Center, currently you can get cholesterol-lowering medication at no copay. a) True b) False 4. Which of the following is a recommended LDL (lousy) cholesterol level? a) Less than 100 mg/dl. b) Less than 130 mg/dl. c) Less than 150 mg/dl. For answers, see inside back cover. This booklet provides information for purposes of general education. It is not a substitute for professional medical advice, diagnosis, or treatment from your nurse practitioner (NP) or doctor. 14 Kick the Killer 5: Conquer Cholesterol