1. UNIT TWO LESSON 6 Cholesterol

2. Objectives At the end of the lesson, participants should be able to: 1. Describe the relationship between diabetes and heart disease 2. Explain good and bad cholesterol 3. List foods that are high in cholesterol 4. Describe ways to lower LDL cholesterol and raise HDL cholesterol 5. Set goals to lower LDL cholesterol and raise HDL cholesterol 6. Describe feelings and experiences about living with diabetes 7. Identify ways to modify everyday recipes to fit into the diabetes meal plan

3. L-esson

4. Diabetes and Cholesterol If you have diabetes what should you know about cholesterol? High levels of blood cholesterol can lead to heart disease Heart disease is more common in people with diabetes People with diabetes and heart disease are two to four times more likely to die from heart disease You should have your blood cholesterol level checked by your doctor at least once a year

5. The Good News A person with diabetes who lowers his or her LDL cholesterol can reduce cardiovascular complications by 20-50%.

6. What You Should Know about Cholesterol The body makes cholesterol It is found in all cells of the body It is only found in animal products

7. What You Should Know about Cholesterol Foods high in cholesterol: Beef Veal Lamb Pork Liver and other organ meats Egg yolk

8. Types of Cholesterol LDL “bad” cholesterol HDL “good” cholesterol

9. LDL “bad” Cholesterol LDL stands for low density lipoprotein It is called the “bad” cholesterol because it carries cholesterol to your arteries and increases the risk of a heart attack

10. LDL “bad” Cholesterol The higher the level of LDL cholesterol in the blood, the greater your risk for heart disease Lowering your level of LDL cholesterol lowers your risk of heart disease The goal for a person with diabetes or heart disease is to have a blood cholesterol level below 100 mg/dL

11. Diabetes and High LDL Cholesterol 1. People with diabetes generally have excess glucose in the blood 2. The excess blood glucose sticks to the LDL cholesterol 3. This glucose-coated LDL stays in the blood longer and forms plaque, beginning the process of heart disease

12. Ways to Lower LDL “bad” Cholesterol Control body weight Excess weight raises your level of LDL “bad” cholesterol and increases your risk for developing heart disease Being overweight also makes it difficult for your body to use the insulin it makes and to remove glucose from the blood

13. Ways to Lower LDL “bad” Cholesterol Limit or eat less of foods that are high in trans fat, saturated fat, and cholesterol Trans and saturated fat raise blood levels of LDL cholesterol more than cholesterol from the food we eat It is important to read food labels carefully so that you are aware of the foods that provide trans fat and saturated fat

14. Trans Fat and Saturated Fat Foods that contain trans fat: Doughnuts, cookies, cakes, French fries, onion rings Foods that contain saturated fat: Fatty meats, chicken skin, whole milk and whole milk products, butter, lard

15. Ways to Lower LDL “bad” Cholesterol Include oats, oatmeal, dried peas and beans, and fruits and vegetables in your diet daily These foods are good sources of soluble fiber that have been shown to lower LDL cholesterol Use fat-free or low-fat (1%) milk, milk products, and cheeses

16. Ways to Lower LDL “bad” Cholesterol Increase your intake of good oils, such as canola and olive oil, and good fats, such as avocado and walnuts Decrease your intake of solid fats, such as butter, lard and shortening

17. Ways to Lower LDL “bad” Cholesterol Take medication as prescribed by your doctor Sometimes making changes in your diet and increasing exercise is not enough to lower your level of “bad” cholesterol Your doctor will decide which type of medication is best to lower your cholesterol

18. HDL “good” Cholesterol HDL stands for high density lipoprotein This is called the “good” cholesterol because it moves cholesterol from tissues to the liver. Good cholesterol does not clog up the arteries of the heart The higher the level of HDL in the blood, the lower your risk for heart disease

19. HDL “good” Cholesterol People with diabetes tend to have low HDL cholesterol levels in the blood which increases their chances of getting heart disease You want your level of HDL to be “high,” or greater than 60 mg/dL

20. Ways to Raise HDL “good” Cholesterol Take part in 30 minutes or more of physical activity on five or more days of the week Avoid smoking Smoking lowers your level of HDL Lose excess weight

21. Ways to Raise HDL “good” Cholesterol Use olive and canola oils in cooking Use soy-based products, such as tofu and soy milk Add more fiber to your diet The fiber found in oats, fruits, vegetables, and peas and beans can raise HDL cholesterol and lower LDL cholesterol

22. What You Should Know about Triglyceride Most of the fats in food and in our bodies are in the form of triglycerides When diabetes is not controlled triglyceride levels are high People with high triglyceride levels also have high LDL and low HDL cholesterol levels

23. What is normal triglyceride level? People with diabetes should have a blood triglyceride level less than 150 mg/dL

24. Ways to lower Triglyceride Level Lose weight Be involved in physical activity such as walking, biking, dancing, and swimming for at least 30 minutes on five or more days of the week

25. Ways to Lower Triglyceride Level Eat less beef, beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole and 2 % milk

26. Ways to Lower Triglyceride Level Use olive and canola oils and liquid margarine Limit alcohol. Even small amounts can raise triglyceride levels

27. Ways to lower Triglyceride Level Improve blood glucose control

28. Putting it together Share what you learned about diabetes and cholesterol

29. E-mpowerment Diabetes Education Series: Cholesterol

30. Diabetes Education Series How would you describe your experiences and feelings living with diabetes and cholesterol? What was most difficult for you? What are ways that you could overcome some of these difficulties?

31. A-ction Did you accomplish the goal you set last week? Your goal is to have your LDL, HDL cholesterol and triglyceride levels checked. This is a goal on your Diabetes Checklist.

32. R-eal-Life Problem Solving Monica’s Story

34. Questions about Monica’s Story What is Monica’s problem? What are some ways in which she can solve her problem? What do you think would work best for her and why? What would you do if you were in Monica’s situation?

35. Questions about Monica’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Monica’s story

36. N-utrition Menu Vegetable Fried Rice Fresh Peaches in Yogurt

37. See you next week! Topic: The Diabetes Food Pyramid

38. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors