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Health Behavior Change Project Analysis – High Cholesterol-

Lauren Feuerman Leahy

American University Master of Nutrition Education

Dr. Panzera

August 5, 2020

The program I created provided a natural way to lower one’s cholesterol. High cholesterol can lead to heart disease and stroke and can easily go undetected (Mayoclinic, 2019). I have spent my life fighting genetic high cholesterol. Both of my parents and siblings have high cholesterol. My grandfather on my father’s side died young of a stroke. The US reported that LDL cholesterol with “familial high cholesterol” was five times the risk of coronary artery disease (Nordestgaard & Benn, 2017). Cholesterol is a waxy substance found in the blood (Mayoclinic.org, 2019). There are two forms of lipoproteins, LDL or low-density lipoprotein “bad cholesterol” and HDL or high-density lipoproteins “good cholesterol” (Mayoclinic.org, 2019). Without high cholesterol management, one can be at risk of clogging arteries, heart attacks, and strokes (Mayoclinic.org, 2019).

My target age would be 15-20 year old’s because that is a critical time in one’s life to learn good eating habits. According to the Mayoclinic, young adults should be tested between the ages of 9-11 and again between 17-19 years of age (Mayoclinic, 2019). The program I would develop would have an educational program to start. I would use information from the American Heart Association (see below) to show the best way to prevent high cholesterol.

Here are the steps of teen program:

1- Find teens that are open to improving their health

2- Set up a school-based presentation (high school and college campus) on heart health and cholesterol

3- Schedule one on ones with teens

4- Use Motivational Interviewing to help teens figure out what they would like to change about their eating and exercise

5- Provide charts for tracking and infographic for discussion

6- Meet weekly to review goals

Here is the infographic I would use:

Studies have shown that eating a strict diet of less than 10% calories from saturated fat and exercising 30 minutes a day for five days a week lower one’s cholesterol, lowering your risk of heart attack or stroke (Journal of American College of Cardiology, 2003). One particular way to reduce cholesterol was found in an article that stated eating 1/3 cup of oats, 30 grams of almonds, and ½ of an avocado daily reduced patients’ high cholesterol by 40.25% (Rensburg, 2018). I would advise my patients to have a goal of tracking of daily intake of avocado, oatmeal, and almond intake, along with saturated fat reduction and tracking. I would encourage them by providing a tracking sheet and having my patient fill it out daily. I would also recommend a program like lose it or my fitness pal to track daily saturated fat.

The behavior changes biologically from the biopsychosocial model, that are necessary to increase protection and reduce risk are: eating a low-fat diet and avoiding saturated fat, exercising 30 minutes a day and adding more cardio exercise to the routine. Also, including almonds, oatmeal, and avocado in one’s daily diet while cutting down on eating red meat are important changes they should make. One study that influenced me to design this program around one’s diet was a randomized, 2 -period (6 week/period) controlled feeding study of 48 individuals with elevated LDL. After eating 1.5 oz of almonds a day, the study proved that the almonds reduced non-HDL-C, LDL-C, and central adiposity (Berryman et.al., 2015). The research shows that substitution of almonds instead of another snack can help lower cholesterol (Berryman et al., 2015). Another resource I found showed that in normal, healthy subjects, effects of saturated, polyunsaturated fat and monounsaturated fats were described in 60 clinical trials and 1% of energy from saturated fat, elevated LDL by .03 mmol/L and polyunsaturated fat lowered LDL by .02 mmol/L (Clifton, 2019). Also, plant sterols, fish oil, were shown to lower LDL (Clifton, 2019). Another key contributor to lowering cholesterol was Oat fiber (Clifton, 2019).

We also would educate people on the importance of physical activity. Physical activity has been proven to prevent thirty-five diseases (Pedersen & Saltin, 2015). Physical training of patients with Coronary Heart Disease was found to reduce total cholesterol, triglycerides, and blood pressure (Pederson & Saltin, 2015, p. 29). The American Heart Association guidelines are 20-60 minutes for three-five days a week of 50% to 80% intensity training (Pederson & Saltin, 2015). Examples of this were walking, running, step machine, cycling, rowing, or stair master (Pederson & Saltin, 2015, p. 29).

The program strategy from a psychological aspect will use is Motivational Interviewing and the Transtheoretical model. I will conduct one on ones with the teens to discuss their understanding and concern about cholesterol and go through a series of open-ended questions to have an awareness of their health behaviors. The prevention I am using is biological, psychological intervention and social support which are the components of the biopsychosocial model.

For social support or the social aspect of the biopsychosocial model, I will pair two people to work together to help each other attain their goals. If they are not comfortable with this, I will see if they have a friend or family member who can help them. The biopsychosocial model shows that there are many layers to our health issues. The layers range from our biology and extend to our community, family, government, and psychology (Leffingwell, 2020). I will show them this infographic which describes behavior change and make sure they understand that I realize they don’t need to be perfect and may go backwards before getting to a goal.

Behaviors and decision made at a young age can help influence this disease. It would be essential to change a younger generation with proper nutrition education and disease prevention through the use of schools and the development of good habits at a young age. Also, it would be beneficial to have more social media campaigns to spread the word about healthy ways to start young and combat the silent killers.

I conducted this experiment and behavior change on myself for the past six weeks. I am happy to say I had positive results on my bloodwork I took last week. My cholesterol dropped 10% and my triglycerides went down 100 points. I am confident I can help other people before they may need to use medication. I believe my work met the standards of the assignment since it helped me lower my cholesterol and taught me about my own personal challenges in making changes. I will need to improve on my ability to stick with the program after this class is over, but I do feel it’s been so valuable and has changed my life.

My peer feedback was very helpful to my progress in this paper. Maribeth explained that I needed to include two multimedia elements which I added after reading her comments. Both Maribeth and Nitchell mentioned I should talk about the target group early in the paper and I improved that from my original paper. In addition, Nichell mentioned I should use a step by step explanation of the implementation plan, so I did add that too. They were both very positive and made me feel successful in my work.

References

Berryman, C. E., West, S. G., Fleming, J. A., Bordi, P. L., & Kris‐Etherton, P. M. (2015). Effects

of Daily Almond Consumption on Cardiometabolic Risk and Abdominal Adiposity in Healthy Adults with Elevated LDL‐Cholesterol: A Randomized Controlled Trial. Journal of the American Heart Association,4(1). doi:10.1161/jaha.114.000993

The authors use a randomized, 2 -period (6 week/period) controlled feeding study of 48 individuals with elevated LDL and have them eat 1.5 oz of almonds a day as compared to a diet with isocaloric muffin substitute to determine if almonds can reduce cholesterol. The study proved that non-HDL-C, LDL-C and central adiposity were reduced by the almonds. The study shows that substitution of almonds instead of another snack can help lower cholesterol.

Berryman, C. E., Fleming, J. A., & Kris-Etherton, P. M. (2017). Inclusion of Almonds in a

Cholesterol-Lowering Diet Improves Plasma HDL Subspecies and Cholesterol Efflux to Serum in Normal-Weight Individuals with Elevated LDL Cholesterol. The Journal of Nutrition,147(8), 1517-1523. doi:10.3945/jn.116.245126

In this study, the authors examine whether or not almonds can increase HDL or good cholesterol. The study incorporated 43 grams of almonds into a cholesterol lowering diet in a randomized, 2-period, crossover, controlled feeding study. The breakdown of the diet was 43 grams of almonds, compared to a control diet, increased HDL.

Clifton, P. M. (2019). Diet, exercise and weight loss and dyslipidemia. Pathology,51(2),

222-226. doi:10.1016/j.pathol.2018.10.013

Some key points in the Clifton article is that a 1% reduction in trans-fat intake of saturated fat intake would lead to a reduction in LDL. Replacing saturated fat with fish oil lowers LDL. Phytosterol intakes of .6-3.3 g a day lowers cholesterol by 6-12%. Higher sugar intakes raise triglycerides. Ho et. al. looked at 58 trials with Oat B-glucan and found that 3.5 g a day of oat significantly reduced LDL. Finally, exercise lowered triglycerides, but a combination of diet and exercise can lower LDL the most. Another point that was made was that nibbling on food all day vs three meals can reduce LDL by 13%.

High cholesterol. (2019, July 13). Retrieved from https://www.mayoclinic.org/diseases

conditions/high-blood-cholesterol/symptoms-causes/syc-20350800

This website has a description of high cholesterol and overview of causes, diagnosis, risk factors and ways to treat the disease.

Leffingwell (Director). (2020). Introduction to the Biopsychosocial Model[Video file]. Retrieved

August 5, 2020, from https://www.youtube.com/watch?v=FKtWr2xvRpQ&list=PLTilxYYZdj_Klfn8z4THJJnRC-6jAXfXJ&index=2&t=543s

This is a YouTube video from a PHD at the University of Oklahoma which describes the Biopsychosocial Model in detail and helps the listener understand how it works.

Nordestgaard, B. G., & Benn, M. (2017). Genetic testing for familial hypercholesterolemia is

essential in individuals with high LDL cholesterol: Who does it in the world? European Heart Journal,38(20), 1580-1583. doi:10.1093/eurheartj/ehx136

Some countries routinely test for this condition. Unfortunately, the United States is not one which is doing any testing. Japan, Norway and the Netherlands are two countries that have higher diagnoses of this condition.

Rensburg, W. J. (2018). Lifestyle Change Alone Sufficient to Lower Cholesterol in Male Patient

With Moderately Elevated Cholesterol: A Case Report. American Journal of Lifestyle Medicine,13(2), 148-155. doi:10.1177/1559827618806841

American Heart Association recommends change in lifestyle to lower cholesterol. A 33-year-old man with high cholesterol and a family history of high cholesterol followed a healthy fat diet and exercise program. He was able to lower cholesterol by 40.25% in six weeks. Rensburg also mentioned that adding 1/3 cup of oats, 30 grams of almonds and ½ of an avocado daily, helped a patient reduce his total cholesterol by 40.25% and his LDL cholesterol by 52.8% over six weeks, without the use of cholesterol-lowering drugs.

Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine - evidence for prescribing exercise as

Therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports,25, 1-72. doi:10.1111/sms.12581

This article shows how exercise is effective to treat 26 chronic diseases ranging from Anxiety to Dementia.

Trichopoulou, A., & Vasilopoulou, E. (2016). Mediterranean Diet. Encyclopedia of Food and

Health,711-714. doi:10.1016/b978-0-12-384947-2.00454-2

Examples of how the Mediterranean Diet helps your longevity and heart health.


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My Journey

My journey began in graduate school for Nutrition Education a few years ago. I was studying for my MBA and had a realization that health and wellness was my passion and helping others was something I needed to do…

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