BetterU – Week 7 Information & Action Steps

Welcome to week 7 of the BetterU Challenge! (New here or want to find out more about this program? Jump back to the week 1 information here!)

Week 7

Week 7 focus: Learn the truth about cholesterol

As you will see in the BetterU program book (which you are hopefully making time to sit down and explore and fill out weekly) this week we are learning more about cholesterol.

Dr Siecke

This past Tuesday was a really poignant presentation given by Dr. Neil Siecke, a cardiologist at the Swedish Medical Center in Edmonds.  Dr. Siecke not only talked to us about cholesterol, he also educated us about how our hearts function, what happens when a heart attack occurs, what he recommends as the best lifestyle to keep our hearts healthy, how living a less-than healthy lifestyle leads to much more than an increased waist line and how high cholesterol is not only an adult problem anymore.

Better U artery

Seeing the images of a heart damaged by years of poor lifestyle choices really puts things into perspective. When most of us set out to lose weight it is for vanity reasons, to shed excess pounds to “get skinny” or to look better in clothes. The REAL goal of living a healthy lifestyle, which has the added benefit of helping our bodies achieve a healthy weight naturally, should be to keep our hearts as healthy as they can be.

What is cholesterol?


The American Heart Association says 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. Low-density lipoprotein (LDL or ‘bad’) cholesterol 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. High-density lipoprotein (HDL or ‘good’) carries harmful cholesterol away from the arteries and helps protect you from heart attack and stroke.

It may surprise you to know that cholesterol itself isn’t bad. In fact, cholesterol is just one of the many substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is produced naturally (and can be affected by your family health history), while some of it comes from the food we eat.

There are two types of cholesterol: “good” and “bad.”  It’s important to understand the difference, and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type — or not enough of another — can put you at risk for coronary heart disease, heart attack or stroke.

Dr. Siecke informed us that it is not always a good thing to have very elevated HDL “good or helpful” cholesterol. He said a good way to judge if it is healthy is if there are also elevated triglycerides. If so, then having a very elevated HDL number is not necessarily healthy. The AHA says cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat. Cholesterol is only found in animal products.”

What can cholesterol do?


The American Heart Association says high cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors {such as high blood pressure or diabetes} as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk.

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. Your cholesterol level can be affected by your age, gender, family health history and diet.

What is a healthy cholesterol level and how can I manage my numbers?


Click here for a file showing how to read your cholesterol numbers and what is optimal or unhealthy.  Further, the AHA has this statement: “We recommend using the absolute numbers for total blood cholesterol and HDL cholesterol levels. They’re more useful to physicians than the cholesterol ratio in determining the appropriate treatment for patients. Some physicians and cholesterol technicians use the ratio of total cholesterol to HDL cholesterol in place of the total blood cholesterol. The ratio is obtained by dividing the HDL cholesterol level into the total cholesterol. For example, if a person has a total cholesterol of 200 mg/dL and an HDL cholesterol level of 50 mg/dL, the ratio would be 4:1. The goal is to keep the ratio below 5:1; the optimum ratio is 3.5:1.”

According to the AHA a cholesterol screening measures your level of HDL and LDL.  HDL is the “good” cholesterol which helps keep the LDL (bad) cholesterol from getting lodged into your artery walls.  A healthy level of HDL may also protect against heart attack and stroke, while low levels of HDL (less than 40 mg/dL for men and less than 50 mg/dL for women) have been shown to increase the risk of heart disease.

If you need to increase your HDL to your reach your goals, studies show that regular physical activity, such as at least 150 minutes of moderate-intensity aerobic physical activity (e.g. brisk walking) every week or 75 minutes of vigorous intensity aerobic physical activity (e.g., jogging, running) or a combination of both every week can help your body produce more HDLs.  Reducing trans fats and eating a balanced, nutritious diet is another way to increase HDL.  If you smoke – stop: cigarette smoking can decrease your HDL. If these measures are not enough to increase your HDL to goal, your healthcare practitioner may prescribe a medication specifically to increase your HDLs.

LDL cholesterol is the “bad” cholesterol. When too much of it circulates in the blood, it can clog arteries, increasing your risk of heart attack and stroke.

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much. Being overweight, eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different, so work with your doctor to find a treatment plan that’s best for you.

How can I get (or keep) my cholesterol under control?


Lifestyle Changes

Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level — and these factors may be controlled by:

  • eating a heart-healthy diet
  • enjoying at least 150 minutes a week moderate-intensity aerobic physical activity, and more than two days a week muscle strengthening activities
  • avoiding tobacco smoke (to be discussed in depth in week 11)
  • We’ve gone through all of the ways to help improve your lifestyle in these ways over the past 6 weeks. Go back through the weeks to continue to learn more or refresh yourself about how to plan weekly to set yourself up for a healthy lifestyle, how to shop for heart healthy foods, foods to avoid, exercise, tools to help ensure lasting positive change such as identifying goals, breaking through barriers, journaling, as well as having a healthy mindset to help you keep this lifestyle for…life!


Know Your Fats

According to the AHA knowing which fats raise LDL cholesterol and which ones don’t is the first step in lowering your risk of heart disease.  In addition to the LDL produced naturally by your body, saturated fat, trans-fatty acids and dietary cholesterol can also raise blood cholesterol. Replacement of saturated fat and trans fat with monounsaturated fat and polyunsaturated fat might help lower LDL cholesterol when eaten as part of a healthy diet.

The American Heart Association’s Nutrition Committee strongly advises these fat guidelines for healthy Americans over age 2:

  • Limit total fat intake to less than 25–35 percent of your total calories each day;
  • Limit saturated fat intake to less than 7 percent of total daily calories;
  • Limit trans fat intake to less than 1 percent of total daily calories;

The remaining fat should come from sources of monounsaturated and polyunsaturated fats such as unsalted nuts and seeds, fish (especially oily fish, such as salmon, trout and herring, at least twice per week) and vegetable oils; and

Limit cholesterol intake to less than 300 mg per day, for most people.  If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day.

For example, a sedentary female who is 31–50 years old needs about 2,000 calories each day. Therefore, she should consume less than 15 g saturated fat, less than 2 g trans fat and between 56 and 77 grams of total fat each day (with most fats coming from sources of polyunsaturated and monounsaturated fats, such as fish, nuts, seeds and vegetable oils).

Saturated Fat:

Saturated fat is found mostly in foods from animals and some plants. Foods from animals include beef, beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole and 2 percent milk. All of these foods also contain dietary cholesterol. Foods from plants that contain saturated fat include coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter.

Unsaturated Fat:

Polyunsaturated and monounsaturated fats are the two unsaturated fats. They’re found mainly in many fish, nuts, seeds and oils from plants. Some examples of foods that contain these fats include salmon, trout, herring, avocados, olives, walnuts and liquid vegetable oils such as soybean, corn, safflower, canola, olive and sunflower.

Both polyunsaturated and monounsaturated fats may help lower your blood cholesterol level when you use them in place of saturated and trans fats. Keep total fat intake between 25 and 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids such as fish, nuts and vegetable oils.

Trans-fats and hydrogenated fats:

During food processing, fats may undergo a chemical process called hydrogenation. This is common in margarine and shortening. These fats also raise blood cholesterol. The saturated fat content of margarines and spreads is printed on the package or Nutrition Facts label.

Unsaturated fatty acids can be in one of two shapes — “cis” and “trans.” These terms refer to the physical positioning of hydrogen atoms around the carbon chain. The cis form is more common than the trans form. Trans-fatty acids (TFA) are found in small amounts in various animal products such as beef, pork, lamb and the butterfat in butter and milk.

TFA are also formed during the process of hydrogenation, making margarine, shortening, cooking oils and the foods made from them a major source of TFA in the American diet. Partially hydrogenated vegetable oils provide about three-fourths of the TFA in the U.S. diet. The trans fat content of foods is printed on the package of the Nutrition Facts label. Keep trans fat intake to less than 1 percent of total calories. For example, if you need 2,000 calories a day, you should consume less than 2 grams of trans fat.

Trans-fatty acids are also formed during the process of hydrogenation. “Hydrogenate” means to add hydrogen. When unsaturated fatty acids are hydrogenated, some of the hydrogen atoms are added on opposite sides of the molecule to the already attached hydrogen. Cis double bonds convert to trans double bonds, and the fatty acids become saturated.

In clinical studies, TFA or hydrogenated fats tended to raise total blood cholesterol levels. Some scientists believe they raise cholesterol levels more than saturated fats. TFA also tend to raise LDL (bad) cholesterol and lower HDL (good) cholesterol when used instead of cis fatty acids or natural oils. These changes may increase the risk of heart disease.

Because there are no standard methods, it’s difficult to estimate the TFA content of food items. It’s also difficult to estimate intake, especially long-term intake. The four most important sources of TFA in one large group of women studied included margarine; beef, pork or lamb as the main dish; cookies (biscuits); and white bread.

As of January 2006, the FDA requires trans fat to be listed on the nutrition label. Although changes in labeling are important, they aren’t enough. Many fast foods contain high levels of TFA. There are no labeling regulations for fast food, and it can even be advertised as cholesterol-free and cooked in vegetable oil. Eating one doughnut at breakfast (3.2 g of TFA) and a large order of french fries at lunch (6.8 g of TFA) add 10 grams of TFA to one’s diet, so the lack of regulations for labeling restaurant foods can be harmful to your health.

Is butter better than margarine? Recent studies on the potential cholesterol-raising effects of TFA have raised public concern about the use of margarine and whether other options, including butter, might be a better choice. Some stick margarines contribute more TFA than unhydrogenated oils or other fats.

Because butter is rich in both saturated fat and cholesterol, it’s potentially a highly atherogenic food (a food that causes the arteries to be blocked). Most margarine is made from vegetable fat and provides no dietary cholesterol. The more liquid the margarine, i.e., tub or liquid forms, the less hydrogenated it is and the less TFA it contains.

The American Heart Association’s Nutrition Committee strongly advises that healthy Americans over age 2 limit their intake of trans fat to less than 1 percent of total calories.

Based on current data, the American Heart Association recommends that consumers follow these tips:

  • Choose a diet rich in fruits, vegetables, whole-grain, high-fiber foods, and fat-free and low-fat dairy most often.
  • Keep total fat intake between 25 and 35 percent of calories, with most fats coming from sources of monounsaturated and polyunsaturated fats such as fish, nuts, seeds and vegetable oils most often.
  • Use naturally occurring, unhydrogenated vegetable oils such as canola, safflower, sunflower or olive oil most often.
  • Look for processed foods made with unhydrogenated oil rather than partially hydrogenated or hydrogenated vegetable oils or saturated fat.
  • Use soft margarine as a substitute for butter, and choose soft margarines (liquid or tub varieties) over harder stick forms. Look for ”0 g trans fat” on the Nutrition Facts label. *Tip from Chef Kirsten – don’t just read the nutrition information, look at the ingredients. If you see trans-fat ingredients, even if it shows “0 g trans fat” on the label, choose a healthier product.
  • French fries, doughnuts, cookies, crackers, muffins, pies and cakes are examples of foods that are high in trans fat. Don’t eat them often.
  • Limit the saturated fat in your diet. If you don’t eat a lot of saturated fat, you won’t be consuming a lot of trans fat.
  • Limit commercially fried foods and baked goods made with shortening or partially hydrogenated vegetable oils. Not only are these foods very high in fat, but that fat is also likely to be very hydrogenated, meaning a lot of trans fat.
  • Limited fried fast food. Commercial shortening and deep-frying fats will continue to be made by hydrogenation and will contain saturated fat and trans fat.

According to the AHA It’s easier to gauge how much healthy and unhealthy food you are eating by using a food diary to keep track of what you eat for a period of time.”

There are many different ways to keep track of what you eat. We (the AHA) suggest that you write down the times you eat, the foods you eat, portion sizes (more or less), and make notes about what you were doing or feeling at the time.

At the end of the day, review your food list (Food Diary) and ask these questions: 

To control hunger:

• Did I eat three meals?

• Did I have filling foods (including water) with every meal or every snack?

• Did I eat at least  4-5 servings each of fruits and veggies?

To reduce calories:

• Did I keep portions smaller than my fist?

• Did I keep cooked meat, chicken, fish or shellfish to three ounces per portion (the size of a deck of cards)?

• What trade-offs can I make to cut calories?

• Did I eat when I was not hungry?

If yes, what was I feeling or doing that made me eat?


Here  is a link to a food diary you can print out from the AHA. I recommend using one for your menu planning, then another one to write down what you actually eat and your emotions to be able to look over it if you are not reaching your goals. Not reaching your goals? That is when you make changes if necessary as listed above, have your plan analyzed by a doctor, health or nutrition professional.

Understand Drug Therapy Options

According to the AHA for some people, lifestyle changes alone aren’t enough to reach healthy cholesterol levels. Your doctor may prescribe medication. It takes a team to develop and maintain a successful health program. You and your healthcare professionals each play an important role in maintaining and improving your heart health. Know how to talk with your doctor about your cholesterol levels and be sure you understand all instructions. Follow your plan carefully, especially when it comes to medication — it won’t work if you don’t take it as directed. And learn how to make diet and lifestyle changes easy and lasting.


Dr. Siecke emphasized how excess fat is a large factor in elevated cholesterol. Fat is not just a “dead” substance, or just aesthetically unappealing. Fat cells create inflammation and hormones that are very damaging. Achieving a healthy weight through a healthy lifestyle is crucial to keeping your heart healthy. That doesn’t mean you have to go on a strict diet. Living a healthy lifestyle while focusing on your health, not your weight, is the best way to shed excess pounds and keep them off for good. A diet is something you go on, then go off. Living a healthy lifestyle is forever, not just until you shed excess fat.


Cholesterol is not just a middle-age problem anymore.


Dr. Siecke talked to us about how 8, 9, 10 year old children are showing signs of high cholesterol due to poor lifestyle choices. He referenced research done on deceased 18 year olds from the Vietnam war that showed no signs of high cholesterol. Times sure have changed over the past couple of decades! We need to help our children live healthier lives NOW to help keep them healthy later. Once built up in the arteries, the plaque that causes Atherosclerosis and can lead to stroke and heart attack doesn’t disappear. The good news is just like adults, you can help keep your children’s cholesterol levels healthy (in addition to reducing the risk factors of developing Type 2 Diabetes and other  highly preventable health problems) by having our children lead the same healthy lifestyle listed above and hopefully modeling that lifestyle ourselves.

BetterU Greek

Dr. Seicke recommended the Mediterranean lifestyle as a great example of a heart-healthy lifestyle. (I sure agree!) The Mediterranean lifestyle entails:

  • Enjoying an abundance of vegetables and fruits
  • Enjoying  healthy fats such as olive oil
  • Enjoying healthy nuts such as almonds
  • Eating a limited amount of meat
  • Eating several servings of fish and seafood every week
  • Enjoying healthy carbohydrate choices such as legumes and whole grains (which happen to be gluten free)
  • Enjoying red wine in moderation
  • Enjoying meals slowly, surrounded by family and friends
  • Walking often

For more information head on over to the AHA website!

A very special thanks and much gratitude to Dr. Siecke for taking the time to come and meet with us and deliver such a wonderful, impactful message about our heart health.

Week 7 Action Items

Nutrition goals:

  • Analyze your food journals and reference the questions from above:To control hunger:Did I eat three meals?Did I have filling foods (including water) with every meal or every snack?

    Did I eat at least 4-5 servings each of fruits and veggies?

    To reduce calories: 

    Did I keep portions smaller than my fist?

    Did I keep cooked meat, chicken, fish or shellfish to three ounces per portion (the size of a deck of cards)?

    What trade-offs can I make to cut calories?

    Did I eat when I was not hungry?

    If yes, what was I feeling or doing that made me eat? Seek additional help if you need it.

  • Continue to celebrate every healthy choice you make, new healthy habits and identify a new healthy habit you want to go for next week.
  • Seek some new healthy recipes! Check out the AHA website for wonderful recipes!

Activity goals:

  • Keep planning your 150 minutes of movement every week then stick to your plan! Getting bored? Try something new!
  • Celebrate your successes so far!

Week 7 Highlights

  • Did you see the shout out on New Day NW featuring a few of our participants? Check out the segment….it’s short but sweet! Here is the link!
  • Kirsten’s recipe of the week: A Mediterranean lifestyle inspired Pan Seared Cod with Roasted Vegetables. I hope you enjoy this heart-healthy meal!  Click here for the recipe!

Have a wonderful week and congratulations on Week 7 towards a BetterU!

Chef Kirsten Signature

Special thanks to our sponsors:

Verdant Health Commission

Lynnwood Rec center


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