So what can we do about lowering the LDL?
Let's go after these risk factors
that we can do something about.
Here's what the current diet recommendations are to help the
patient lower their LDL if you're making some food changes.
I want them to reduce their intake of
saturated fats to less than 7% per day.
So that means out of 100% of their food intake,
we want less than 7% of that to be saturated fat.
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.
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.
The companies that produce these types of products
have worked very hard to make these foods hyperpalatable.
After you eat them, your brain lights
up, it makes you very very happy up here.
Kinda makes you brrr down here but that's
why it's a difficult habit for your patient to change.
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.
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.
so take a look at this slide.
This would be earth-shattering
to some patients.
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.
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.
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.
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.
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.
So two sources of cholesterol, we know there's
dietary and our body even makes it for itself.
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.
I need it to make hormones, right so
estrogen, progesterone, testosterone.
So cholesterol is good and that's we're
gonna spend some time talking about.
It has a really important role in our body, it's just
when it's out of balance that things become a problem.
So I need it for hormones, you got it.
I need it to make bile salts and I need it in the skin.
See it decreases evaporation of water and absorption
of some water-soluble compounds, it's pretty cool.
So it helps my skin.
Three main reasons cholesterol is good:
hormones, bile salts and I use it in my skin.
So it's not all bad, we just kinda make
it the bad guy when it's out of balance.
No I want to break down the cholesterol into
two terms that you're probably pretty familiar with.
HDL versus LDL.
Now these are two types of cholesterol, they're in my
body sometimes people call HDL the happy cholesterol.
I want you to understand why
they give it that crazy nickname.
Now we've broken it down into a
chart which I think is a great study tool.
Comparing and contrasting things that are similar will
help you really clarify what you know about that topic.
So we're looking at LDL.
Percentage of total cholesterol is
usually 60 to 70% because what its job is -
LDL delivers cholesterol to the tissues.
IfI have higher LDL levels, it's believed that
I have an increased risk of atherosclerosis.
So that's why it's called the "bad cholesterol".
Now there's lot of research going on in
cholesterol in size of particles, stay tuned.
There are some cool stuff coming but for right now
we're going to take this theory where we think it's the LDL.
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.
Now HDL, the one that's the good cholesterol
or the happy cholesterol is about 20 to 30%.
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.
They carry cholesterol from the tissues back to the liver.
So we think right now that elevated levels of
HDL equals a decreased risk of atherosclerosis.
That's why it's the good one.
Now you can do things that'll
impact that HDL level, right?
Exercises are fantastic intervention
to help someone to raise their HDL.
But for right now, I want you to focus on
what we consider the good cholesterol and why.
What do we consider the bad
cholesterol and why.
Cool, because you want to have that straight
in your mind when you're evaluating lab work
and with your working with your patients.