Lifestyle Changes to Lower LDL Cholesterol Levels (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 So what can we do about lowering the LDL? Let's go after these risk factors that we can do something about.

    00:07 Here's what the current diet recommendations are to help the patient lower their LDL if you're making some food changes.

    00:14 I want them to reduce their intake of saturated fats to less than 7% per day.

    00:19 So that means out of 100% of their food intake, we want less than 7% of that to be saturated fat.

    00:26 Okay, that's gonna be a big change for some people, if we can get them just to do that, that would be a huge lifestyle change.

    00:33 That knocks out a lot of fast food drive-thru types of restaurants or prepared foods that are hyperpalatable, that term means means they just taste really really good.

    00:47 The companies that produce these types of products have worked very hard to make these foods hyperpalatable.

    00:54 After you eat them, your brain lights up, it makes you very very happy up here.

    00:59 Kinda makes you brrr down here but that's why it's a difficult habit for your patient to change.

    01:05 So we want them to reduce their intake of saturated fats, want to minimize their intake of those hyperpalatable foods that are processed like crackers and commercial baked goods and fried foods.

    01:17 Now you see our meddling? We want to reduce cholesterol to 200 mg a day or less and considering adding things like nuts particularly walnuts, beans, legumes and some vegetables increase that fiber.

    01:32 so take a look at this slide.

    01:34 This would be earth-shattering to some patients.

    01:37 So don't gloss over this, don't act like, "Ahh, it's no big deal", Just sit down and have a conversation with them and ask them, "which of these things would be the most difficult for you to implement? why do you think that?" So start the conversation, be open, be non-judgemental just like everything we've talked about.

    01:56 Food to some people is just like a drug so they use it for emotional coping, they use it to feel better, they use it when they're happy, they use it when they're sad so don't brush this off as a lack of self-discipline, it's a really difficult change for those patients to match.

    02:13 So, let's look at cholesterol, sources of cholesterol we've got dietary sources and cholesterol that's made by cells in our body cause this cholesterol keeps getting kind of a bad rep but I want you to see it's not all bad, it's just when it's out of balance.

    02:31 So two ways our body gets this cholesterol: we have exogenous souces, that's from intake of saturated fats that causes the most significant increase in cholesterol and then it's primarily in the liver, we'll talk about endogenous.

    02:44 That's why when we get to the statins, a lot of its activity takes place at night and we recommend that patients take those statins at night time.

    02:53 So two sources of cholesterol, we know there's dietary and our body even makes it for itself.

    02:59 But cholesterol is part of every cell membrane okay so it's part of all cell membranes So if I eliminated cholesterol, you'd be eliminating me because I need it in my cell membranes.

    03:11 I need it to make hormones, right so estrogen, progesterone, testosterone.

    03:16 So cholesterol is good and that's we're gonna spend some time talking about.

    03:20 It has a really important role in our body, it's just when it's out of balance that things become a problem.

    03:27 So I need it for hormones, you got it.

    03:30 I need it to make bile salts and I need it in the skin.

    03:34 See it decreases evaporation of water and absorption of some water-soluble compounds, it's pretty cool.

    03:40 So it helps my skin.

    03:42 Three main reasons cholesterol is good: hormones, bile salts and I use it in my skin.

    03:50 So it's not all bad, we just kinda make it the bad guy when it's out of balance.

    03:56 No I want to break down the cholesterol into two terms that you're probably pretty familiar with.

    04:01 HDL versus LDL.

    04:03 Now these are two types of cholesterol, they're in my body sometimes people call HDL the happy cholesterol.

    04:09 I want you to understand why they give it that crazy nickname.

    04:13 Now we've broken it down into a chart which I think is a great study tool.

    04:17 Comparing and contrasting things that are similar will help you really clarify what you know about that topic.

    04:24 So we're looking at LDL.

    04:26 Percentage of total cholesterol is usually 60 to 70% because what its job is - LDL delivers cholesterol to the tissues.

    04:36 If I have higher LDL levels, it's believed that I have an increased risk of atherosclerosis.

    04:42 So that's why it's called the "bad cholesterol".

    04:45 Now there's lot of research going on in cholesterol in size of particles, stay tuned.

    04:50 There are some cool stuff coming but for right now we're going to take this theory where we think it's the LDL.

    04:55 We know that it delivers cholesterol to the tissues and when it comes to the exact role its playing in atherosclerosis, We believe that elevated levels of this are not great for your blood supply.

    05:07 Now HDL, the one that's the good cholesterol or the happy cholesterol is about 20 to 30%.

    05:14 That's why we're looking at lab values wanting patients usually to have higher HDL levels because they carry cholesterol just the opposite of LDL.

    05:23 They carry cholesterol from the tissues back to the liver.

    05:28 So we think right now that elevated levels of HDL equals a decreased risk of atherosclerosis.

    05:35 That's why it's the good one.

    05:37 Now you can do things that'll impact that HDL level, right? Exercises are fantastic intervention to help someone to raise their HDL.

    05:46 But for right now, I want you to focus on what we consider the good cholesterol and why.

    05:52 What do we consider the bad cholesterol and why.

    05:57 Cool, because you want to have that straight in your mind when you're evaluating lab work and with your working with your patients.

    About the Lecture

    The lecture Lifestyle Changes to Lower LDL Cholesterol Levels (Nursing) by Rhonda Lawes, PhD, RN is from the course Coronary Artery Disease: Atherosclerosis (Nursing) .

    Included Quiz Questions

    1. Less than 7%
    2. Less than 30%
    3. At least 15%
    4. More than 7%
    1. Endogenous cholesterol is made in the liver.
    2. Endogenous cholesterol is made in the heart.
    3. Exogenous cholesterol is made in the kidneys.
    4. Exogenous cholesterol is made in the bile duct.
    1. LDL delivers cholesterol to the tissues.
    2. LDL carries cholesterol away from the tissues and to the liver.
    3. LDL makes up 20–30% of total cholesterol.
    4. LDL increases the risk of atherosclerosis.
    5. LDL makes up 60-70% of total cholesterol.

    Author of lecture Lifestyle Changes to Lower LDL Cholesterol Levels (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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