Know Your Numbers Agenda l l Understanding

Know Your Numbers

Agenda l l Understanding blood pressure and risk factors Understanding cholesterol and risk factors Dietary approaches to lower blood pressure and cholesterol Lifestyle behaviors that support lowering blood pressure and blood cholesterol levels

What is Blood Pressure? l The force of the blood pushing against the walls of the blood vessels. l Each time your heart beats, about 60– 70 times a minute at rest, it pumps blood into the arteries. l Similar to the pressure of water running through a garden hose.

How it is Measured Blood pressure consists of two measurements: l Systolic Pressure The pressure in your arteries during your heartbeat. The first number in a blood pressure reading is the systolic pressure. If the reading is 120/80, then the systolic pressure is 120. l Diastolic pressure The pressure in your arteries when your heart is relaxing between beats. The second number in a blood pressure reading is the diastolic pressure. If the reading is 120/80, then the diastolic pressure is 80.

Know Your Numbers! Blood Pressure Readings Categories for Blood Pressure Levels in Adults (in mm. Hg, millimeters of mercury) Category Normal (√’d every 2 years) Prehypertension High Blood Pressure Systolic (top number) Diastolic (bottom number) Less than 120 Less than 80 120– 139 80– 89 (√’d more frequently – work closely with your doctor) Stage 1 140– 159 90– 99 Stage 2 160 or higher 100 or higher These ranges are high. If you have consistently high readings, you should obtain medical treatment to reduce your blood pressure.

Blood Pressure Facts l l l Nearly 1 in 3 American adults has high blood pressure Usually lasts a lifetime Can be treated and controlled Called the “Silent Killer” Leads to trouble with heart, brain, kidneys or eyes

Fixed or Uncontrollable Risk Factors l l Heredity Race Gender Age

Controllable Risk Factors l l l Overweight or obese Inactive lifestyle Excess alcohol Excess sodium Tobacco use l l Stress Oral Contraceptives and some medications Low Potassium intake Pregnancy

Dietary Approaches to Stop Hypertension (DASH) Diet l Low in saturated fat, cholesterol and total fat l High in fruits and vegetables l Emphasizes fat-free or low-fat milk and milk products l Includes whole grain products, fish, poultry and nuts l Reduced lean red meat, sweets, added sugars and sugar-containing beverages l Rich in potassium, magnesium and calcium l Rich in protein and fiber l Reduced sodium (salt) www. nhlbi. nih. gov/health/public/heart/hbp/dash/index. htm

Cholesterol Facts l l l A colorless, waxy substance that travels in your blood stream, resembles hardened grease Builds cells, produces hormones, makes vitamin D, digests fats Body makes all it needs Only found in foods of animal origin Key risk factor for heart disease Cholesterol and excess saturated fats form a substance called plaque.

Types of Cholesterol LDL (Low Density Lipoprotein) l Known as the “bad cholesterol” l High LDL increases your risk for heart disease HDL (High Density Lipoprotein) l Known as the “good cholesterol” l Helps carry cholesterol out of the body l Low HDL increases your risk for heart disease

What About Triglycerides? High triglycerides can increase your risk for heart disease. Triglyceride levels are affected by: l Overweight/obesity l Physical inactivity l Smoking l Excess alcohol l Diet high in carbohydrates

Know Your Numbers! Cholesterol Levels Total Cholesterol Less than 200 mg/dl Desirable 200– 239 mg/dl Borderline high 240 mg/dl and above High (√’d every 5 years) LDL Cholesterol Less than 100 mg/dl Optimal (ideal) 100– 129 mg/dl Near optimal 130– 159 mg/dl Borderline high 160– 189 mg/dl High 190 mg/dl and above Very High

Know Your Numbers! Cholesterol Levels HDL Cholesterol Less than 40 mg/dl Low (major heart disease risk factor) 40 -59 mg/dl Medium 60 mg/dl and above High (gives some protection against heart disease) Triglycerides Less than 150 mg/dl Desirable 150– 199 mg/dl Borderline high 200 mg/dl and above High

What Affects Cholesterol? Things You Can’t Change l Heredity l Gender l Age Things You Can Change l Diet l Weight l Physical Activity

Types of Fats SATURATED FATS l Animal products: dairy – whole milk, cream, regular ice cream; lard, egg yolk, butter, beef, pork, sausage, hot dogs, bologna, pastries, cookies l Tropical oils: palm oil, cocoa butter in chocolate, coconut and coconut oil

Types of Fats TRANS FATS l Shortening, stick margarine, baked goods - like french fries, doughnuts, pastries, cookies, crackers UNSATURATED FATS l Polyunsaturated: Oils (sunflower, safflower, corn, soybean), margarine, walnuts, sunflower seeds, fish l Monounsaturated: Olive oil, avocados, peanut oil, canola oil, peanuts, peanut butter, almonds, walnuts, cashews, pecans

What About Dietary Cholesterol? l The cholesterol in your diet raises the cholesterol in your blood but not as much as saturated fats and trans fats. l Cholesterol can only come from animal foods: egg yolks, organ meats, cheeses, beef, pork, lamb, butter, ice cream, whole milk, sausage l American Heart Association recommends eating less than 300 mg/day; less than 200 mg/day is recommended if you have a high LDL.

Sample Meal l l l l Roast Beef - 3 oz. (deck of cards) Chicken – 3 oz. Pasta w/tomato sauce – Potatoes – no cholesterol Vegetables – no cholesterol Salad dressing – minimal to none Rolls – no cholesterol Butter – 1 Tbsp Cookies & Brownies – 80 mg 70 mg 10 mg 0 mg 0 mg 30 mg 10 mg Total = 200 mg

Dietary Strategies to Lower Cholesterol l Total fat intake should be between 25– 35% of total calories with most fats in the form of unsaturated fats (2500 calories = 625 -875 calories = 70 -95 grams) l Reduce intake of saturated fat to <7% of total calories (2500 calories = <175 calories = <20 grams ) l Trans fats should be <1% of total calories (2500 calories = <25 calories = <3 grams)

Diet Strategies to Lower Cholesterol l Dietary Fiber (soluble type) - 10 -25 grams/day – Blocks cholesterol and fat from being absorbed into the bloodstream – Oatmeal, oat bran, beans, peas, fruits, vegetables Increase dietary fiber gradually to avoid abdominal discomfort – l Plant Stanol or Sterols - 2 servings/day – They work similar to soluble fiber by blocking cholesterol from being absorbed into the bloodstream – Found in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources – Margarines such as Benecol® Spread and Promise activ® (formerly known as Take Control®)

Dietary Strategies to Lower Cholesterol l Don’t deny yourself today only to binge tomorrow. Enjoy fatty foods in moderation. l To be moderate, fill up on healthy foods - enjoy fruits and vegetables, whole grains, poultry, and fish. l Read nutrition labels on food packages to choose foods that are lower in fat, saturated fat, and cholesterol. l Select skim milk or 1% milk instead of 2% milk or whole milk. l Select low-fat cheese instead of full-fat cheese. l Buy lean cuts of meat such as round, sirloin, and loin.

Strategies for reducing Blood Pressure and Cholesterol l l Losing weight (waist circumference and BMI) Long-term weight management Benefits of physical activity Stress Reduction Quit Smoking

Weighing In Losing extra weight can: l Improve cholesterol, lower triglycerides, lower LDL and raise HDL l Reduce your risk for developing high blood pressure, diabetes, heart disease, and some cancers

Know Your Numbers! Waist Circumference Waist circumference measures the amount of abdominal fat a person has and is one method of determining one's risk for heart disease and other diseases. • • A waist measurement greater than 40 inches in men A waist measurement greater than 35 inches in women

Know Your Numbers! What is a Healthy Weight?

What Does Your BMI Mean? l l A BMI less than 18. 5 indicates a weight that is too low for good health. A BMI of 18. 5 to 24. 9 indicates a healthy weight and carries little health risk. A BMI of 25 to 29. 9 is considered overweight and carries some increased health risk. A BMI of 30 or higher is considered obese and poses the greatest risk to your health.

Set your Weight Management Goal l l Use BMI Chart to help determine a healthy weight that is consistent with a healthy BMI for your height. For a safe rate of weight loss, plan to lose no more than one to two pounds per week. Losing weight and maintaining a healthy weight requires your commitment to a lifestyle of healthy eating and regular physical activity.

It’s a Matter of Balance The Key to Successful Weight Management Calories In – Consumption Carbohydrate Calories Out – Burn Exercise Lifestyle Protein Fat RMR

Lose Weight Safely and Effectively l l l Rate of Weight Loss 0. 5 lbs per week 1. 0 lbs per week 1. 5 lbs per week 2. 0 lbs per week Calories Per Day - 250 Calories - 500 Calories - 750 Calories - 1, 000 Calories For example, if you want to lose one pound per week, you need to adjust your calories by 500 per day. You can achieve that weekly one pound loss by eating 250 calories/day less AND burning 250 calories/day through physical activity.

Heart Healthy Benefits of Physical Activity l l l Strengthens your heart Raises HDL levels (good cholesterol) Develops the smaller coronary arteries Helps you lose weight Helps keep blood pressure down Reduces stress, depression, and fatigue

Physical Activity l l All adults in the United States should accumulate 30 minutes or more of moderateintensity physical activity on at least five days of the week. Vigorous-intensity physical activity for at least 20 minutes at a time on three days of the week will also give you the same health and fitness benefit. Talk to your doctor before starting any exercise program. Your doctor can tell you which activities are right for you.

Examples of Moderate Activities l Walking briskly (about 3. 5 miles per hour) l Hiking Gardening/yard work Dancing Golf (walking and carrying clubs) Bicycling (less than 10 miles per hour) Weight training (general light workout) l l l

Examples of Vigorous Activities l l l l Running/Jogging (5 miles per hour) Bicycling (more than 10 miles per hour) Swimming (freestyle laps) Aerobics Walking very fast (4½ miles per hour) Heavy yard work, such as chopping wood Weight lifting (vigorous effort) Basketball (competitive)

Stress Reduction l l l l Relaxation techniques Recognize sources of stress and potential actions you can take or move to acceptance of things you cannot change Doing things purely for enjoyment, fun and recreation Get a massage; do yoga or tai chi Listen to relaxing music Using humor Giving and receiving emotional support Getting plenty of sleep

Benefits of Quitting Smoking The long-term effects of smoking on blood pressure are unknown; however, smoking lowers HDL cholesterol in your blood. Your body starts experiencing immediate benefits when you stop smoking: l l l Reduced risk of having a heart attack, stroke, lung cancer, emphysema, and other lung diseases Reduces blood pressure and your pulse rate after only 20 minutes Within 24 hours, oxygen and carbon monoxide levels return to normal

Benefits of Quitting Smoking Benefits of quitting: l l l l Circulation starts improving – your hand feet body temperature increases Within a few days your sense of smell and taste return Nerve endings start regrowing Breathing becomes easier and easier HDL cholesterol increases Elimination of second hand smoke exposure to your family Monetary rewards

Small Steps Can Add Up – blood pressure Reduce LDL by: Lifestyle Factor Recommendation: ↓ Weight Normal BMI of 18. 5 – 24. 9 Follow DASH eating plan Diet high in fruits, vegetables, low-fat dairy, and low in fat ↓ Sodium and salt reduction Limit sodium to 2, 400 milligrams per day 2 -8 points ↑ Exercise 30 minutes of physical activity most days of the week 4 -9 points ↓ Moderate drinking Limit alcohol to no more than two drinks per day for men and no more than one drink per day for women 2 -4 points 5 -20 points per 22 lbs. lost 8 -14 points 20 -40 point reduction in blood pressure

Small Steps Can Add Up - Cholesterol Reduce LDL by: Lifestyle Factor Make This Change: ↓ Saturated Fat Decrease to less than 7% ↓ Dietary Cholesterol Decrease to less than 200 mg/day 3– 5% ↓ Weight Lose 10 pounds, if overweight 5– 8% ↑ Soluble Fiber Add 5– 10 grams/day 3– 5% ↑ Plant Sterols/Stanols Add 2 servings/day 8– 10 % 5– 15% 20 -30% total LDL reduction Increase HDL by: Lifestyle Factor Make This Change: ↑ Physical Activity 30 minutes a day 3 -9% ↓ Weight 10 pounds 2 -3% ↓ Smoking Quit 4 -5% 10 -15% total HDL increase

Take Steps to Manage Your Numbers Today The best way to make a change is one small step one day at a time. Each step takes you closer to your health management goals and healthy vision.

THANK YOU!