High Cholesterol Self-Management Plan and Care Plan I understand the following items will be beneficial to the treatment of my high cholesterol, have discussed this with my provider and I agree to implement the following plan of care.

1. My goal LDL is < 70 100 130 (Circle One) 2. I will eat a diet low in saturated fats, especially work to avoid fast food and fried food 3. On days I am coming in to check my cholesterol I will come in fasting. Eat nothing for the previous 8 hours, though you may take your usual medications (except diabetes meds or medications that have to be taken with food) as well as a small amount of water or BLACK coffee. 4. I will exercise at least 20 – 30 minutes 5 – 7 days per week.

www.cvmgonline.org also offers additional self-help resources under the Resources & Forms tab

FOODS TO USE

FOODS TO AVOID

MEATS, FISH

Choose lean meats (chicken, turkey, veal, and lean cuts of beef with excess fat trimmed; one serving = 3 oz of cooked meat). Also, fresh or frozen fish, canned fish packed in water, and shellfish (lobster, crabs, shrimp, oysters). Limit use to no more than one serving of one of these per week. Shellfish are high in cholesterol but low in saturated fat and should be used sparingly. Meats and fish should be broiled (pan or oven) baked on a rack.

Marbled beef, pork, bacon, sausage and other pork products; fatty fowl (duck, goose); skin and fat of turkey and chicken; processed meats; luncheon meats (salami, bologna); frankfurters and fast-food hamburgers (they're loaded with fat); organ meats (kidneys, liver); canned fish packed in oil.

EGGS

Egg substitutes and egg whites (use freely). Egg yolks (limit two Limit egg yolks to two per week. per week) Eat three servings of fresh fruit per day (1 serving = 1/2 cup). Be Coconut (rich in saturated fats). sure to have at least one citrus fruit daily. Frozen or canned fruit with no sugar or syrup added may be used.

FRUITS

VEGETABLES

Most vegetables are not limited. One dark-green (string beans, escarole) or one deep-yellow (squash) vegetable is recommended daily. Cauliflower, broccoli, and celery as well as potato shins are recommended for their fiber content. (Fiber is associated with cholesterol reduction). It is preferable to steam vegetables but they may be boiled, strained or braised with polyunsaturated vegetable oil.

BEANS

Dried peas or beans (1 serving = 1/2 cup) may be used as a bread substitute. NUTS Almonds, walnuts and peanuts may be used sparingly (1 serving = 1 tablespoonful) Use pumpkin, sesame, or sunflower seeds. BREADS, GRAINS One roll or one slice of whole-grain or enriched bread may be used, or three soda crackers or four pieces of melba toast as a substitute. Spaghetti, rice or noodles (1/2 cup) or 1/2 large ear of corn may be used as a bread substitute. In preparing these foods do no use butter or shortening, use soft margarine. Also use egg and sugar substitutes. Choose high-fiber grains, such as oats and whole wheat. CEREALS

Use 1/2 cup of hot cereal or 3/4 cup of cold cereal per day. Add a sugar substitute if desired with 99% fat-free or skim milk.

Avoid avocados. Starchy vegetables (potatoes, corn, lima beans, dried peas, beans) may be used only if substitutes for a serving of bread or cereal. (Baked potato skin however is desirable for its fiber content.)

Commercial baked beans with sugar and/or pork added. Avoid nuts. Limit peanuts and walnuts to one tablespoonful per day. Any baked goods with shortening and/or sugar. Commercial mixes with dried eggs and whole milk. Avoid sweet rolls, doughnuts, breakfast pastries (Danish) , and sweetened packaged cereals (the added sugar converts readily to triglycerides).

FOODS TO USE

FOODS TO AVOID

MILK PRODUCTS

Always use 99% fat-free or skim milk, dairy products such as low-fat cheeses (farmer's, uncreamed diet cottage), low-fat yogurt and powdered skim milk.

FATS, OILS

Use soft (not stick) margarine; vegetable oils that are high in polyunsaturated fats (such as safflower, sunflower, soybean, corn and cottonseed). Always refrigerate meat drippings to harden the fat and remove it before preparing gravies.

Butter, lard, animal fats, bacon drippings, gravies, cream sauces, as well as palm and coconut oils. All these are high in saturated fats. Examine labels on "cholesterol-free" products for "hydrogenated fats." (These are oils that have been hardened into solids and in the process have become saturated.

DESSERTS, SNACKS

Limit to two servings per day, substitute each serving for a bread/cereal serving; ice milk, water sherbet (1/4 cup); unflavored gelatin or gelatin flavored with sugar substitute (1/3 cup); pudding prepared with skim milk (1/2 cup); egg white souffles; unbuttered popcorn (1 1/2 cups). Substitute carob for chocolate.

Fried snack foods like potato chips; chocolate; candies in general; jams, jellies, syrups; whole-milk puddings; ice cream and milk sherbets; hydrogenated peanut butter.

BEVERAGES

Fresh fruit juices (limit 4 oz per day); black coffee, plain or herbal teas; soft drinks with sugar substitutes; club soda, preferably salt-free; cocoa made with skim milk or nonfat dried milk and water (sugar substitute added if desired); clear broth. Alcohol: limit two servings per day.

Sugared fruit juices and soft drinks; cocoa made with whole milk and/or sugar. When using alcohol (1 oz liquor, 5 oz beer, 2 1/2 oz dry table wine per serving), one serving must be substituted for one bread or cereal serving (limit two servings of alcohol per day).

MISCELLANEOUS You may use the following freely: vinegar, spices, herbs, nonfat bullion, mustard, Worcestershire sauce, soy sauce, flavoring essence.

ANSWERS

by heart

Lifestyle + Risk Reduction Cholesterol

What Are High Blood Cholesterol and Triglycerides?

Cholesterol travels to the body’s cells through the bloodstream by way of lipoproteins (LDL and HDL). LDL deposits cholesterol in the artery wall, forming plaque. HDL removes cholesterol from plaque and from the bloodstream.

Cholesterol is a soft, fat-like substance found in the bloodstream and in all your body’s cells. Your body makes all the cholesterol it needs. The saturated fats, trans fats and cholesterol you eat may raise your blood cholesterol level. Having too much cholesterol in your blood may lead to increased risk for heart disease and stroke.

What’s so bad about high blood cholesterol? Low-density lipoprotein (LDL) cholesterol is often called “the bad kind.” When you have too much LDL cholesterol in your blood, it can join with fats and other substances to build up in the inner walls of your arteries. The arteries can become clogged and narrow, and blood flow is reduced. If this buildup of plaque ruptures, a blood clot may form at this location or a piece may break off and travel in the bloodstream. If a blood clot blocks the blood flow to your heart, it causes a heart attack. If a blood clot blocks an artery leading to or in the brain, a stroke results. High-density lipoprotein (HDL) cholesterol is called the “good kind.” It carries harmful cholesterol away from the arteries and helps protect you from heart attack and stroke. It’s better to have a lot of HDL cholesterol in your blood. How can I lower the bad cholesterol in my blood? • Cut down on foods high in saturated fat and cholesterol. These include fatty meats, organ meats such as liver, shellfish, cheese, whole-milk dairy products, egg yolks, and solid fats such as butter.

• Do moderate intensity physical activities, such as brisk walking, at least 30 minutes on most or all days for a total of at least 150 minutes each week. • Eat more foods low in saturated fat and cholesterol, and high in fiber. Aim for about 25 grams of fiber each day. Be sure to include a variety of fruits and vegetables, whole grains and grain products, beans, peas and legumes, fat-free and low-fat milk products, lean meats and poultry without skin, fatty fish, and nuts and seeds in limited amounts. • Lose weight if you need to and maintain a healthy weight. • If you can’t control your cholesterol through lifestyle changes, ask your doctor about medicines that can reduce cholesterol. What are triglycerides? Triglycerides are the most common type of fat in your body. They come from food, and your body also makes them. High levels of blood triglycerides are often found in people who have high cholesterol levels, heart problems, are overweight or have diabetes. (continued)

ANSWERS

by heart

What Are High Blood Cholesterol and Triglycerides?

Lifestyle + Risk Reduction Cholesterol

What about fats? There are different kinds of fats in the foods we eat. Saturated fat raises blood cholesterol, so it’s not good for you. Avoid animal fats like lard and meat fat, and some plant fats like coconut oil, palm oil and palm kernel oil. • Trans fat comes from adding hydrogen to vegetable

oils and tends to raise blood cholesterol. It’s used in commercial baked goods and for cooking in many restaurants and fast-food chains. It’s also found naturally in milk and beef. • Polyunsaturated fats are found in vegetable oils

and fish oils. These tend to lower blood cholesterol when eaten in moderation and used to replace saturated or trans fats. • Monounsaturated fats are found in olive, canola,

peanut, sunflower and safflower oils. In a lowsaturated-fat diet, they may lower blood cholesterol. You can help lower your LDL cholesterol by eating foods that are lower in saturated fat and cholesterol, and high in fiber. Aim for about 25 grams of fiber each day.

HOW CAN I LEARN MORE? Talk to your doctor, nurse or other healthcare professionals. If you have heart disease or have had a stroke, members of your family also may be at higher risk. It’s very important for them to make changes now to lower their risk. Call 1-800-AHA-USA1 (1-800-242-8721), or visit heart.org to learn more about heart disease. For information on stroke, call 1-888-4-STROKE (1-888-478-7653) or visit us at StrokeAssociation.org.

Do you have questions for the doctor or nurse?

My Questions:

Take a few minutes to write your questions for the next time you see your healthcare provider. For example:

Will I need cholesterollowering medicine? How does exercise affect my levels?

We have many other fact sheets to help you make healthier choices to reduce your risk, manage disease or care for a loved one. Visit heart.org/answersbyheart to learn more. Knowledge is power, so Learn and Live! ©2012, American Heart Association