The 10% Solution For A Healthy Life, Appendix 3
Charts for the Kurzweil ChallengeThe Kurzweil Challenge is a ten-step program that enables you to try out the principles of the 10% solution on a trial basis, to determine for yourself the impact it can have on your immediate health, cholesterol levels. weight, and sense of well-being. It also allows you to test the assertion that your tastes and attitudes toward food can change. The Kurzweil Challenge is described in chapter 9.
These charts are intended to be used in this program. The Baseline Chart is to be used at the beginning of the program to establish your initial state. This is essentially the "before" picture of your health. After a one month period of gradual change and then a two-month period of full compliance with the guidelines of the 10% solution, you should fill out a copy of the Progress Chart to evaluate the impact that this three month period has had. Assuming that you subsequently make a long-term commitment to this life -style, I suggest that you fill out another Progress Chart after another nine months (which is twelve months from the beginning of the program). The Weekly Chart should be filled out each week for at least the first three months to track basic eating patterns and exercise. You should copy these charts onto separate pieces of paper rather than write in the book, so that multiple copies of these blank forms can be made.
It is strongly suggested that you read the full contents of this book, and in particular the chapter on the Kurzweil Challenge, before beginning this program. I also want to emphasize step 2 of the Kurzweil Challenge, which is to consult with your physician before attempting any program of dietary change or exercise to make sure that your individual health concerns and issues will be appropriately monitored if necessary. This is particularly important if you have such health conditions as heart disease, advanced atherosclerosis or angina pain, diabetes, hypertension, or any other serious disease or condition. BASELINE CHART (FOR STEP 3)I. GENERAL DATA1. Name: __________________________________________________________
2. Sex: ____________________
3. Age: ____________________
4. Date: ____________________
5. Physician: _______________________________________________________
6. Date on which physician was consulted on this dietary and exercise program:
__________________________________________________________________ II. LIPID (BLOOD) LEVELS7. Total cholesterol: ____________________
8. HDL cholesterol: ____________________
9. Ratio of total cholesterol divided by HDL cholesterol: ____________________
10. LDL cholesterol: ____________________
11. Triglycerides: ____________________
12. Fasting glucose: ____________________
13. Any abnormal levels from kidney, liver, and thyroid tests: ____________________
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______________________________________________________________________ III. OTHER HEALTH DATA14. Blood pressure: ____________________
15. Weight: ____________________
16. Percentage body fat: ____________________
17. Chest measurement: ____________________
18. Waist measurement: ____________________
19. Hips measurement: ____________________ IV. MAJOR HEALTH PROBLEMS20. Any indication or history of heart disease: _________________________________
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21. Family history of heart disease: ____________________
22. Angina pain: ____________________
23. Type I diabetes: ____________________
24. Type II diabetes: ____________________
25. Diabetes medication (if any): ____________________
26. Hypertension: ____________________
27. Hypertension medication (if any): ____________________
28. History of cancer: ____________________________________________________
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29. Other major health disease, condition, or issue: _____________________________
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______________________________________________________________________ V. OTHER HEALTH ISSUES30. Gastrointestinal discomforts or problems: _________________________________
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31. Regularity: _________________________________________________________
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32. Aches or pains: ______________________________________________________
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33. Complexion problems: ________________________________________________
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34. Other (minor) health issues: ____________________________________________
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______________________________________________________________________ VI. SUBJECTIVE EVALUATION35. How do you feel? ____________________________________________________
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36. How well do you sleep? _______________________________________________
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37. Characterize your mood: _______________________________________________
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38. Characterize your general outlook: _______________________________________
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______________________________________________________________________ PROGRESS CHART (FOR STEP 7, AFTER TWO MONTHS OF CAREFUL COMPLIANCE, AND FOR STEP 9, AFTER ONE YEAR)I. GENERAL DATA1. Name: _______________________________________________________________
2. Date: ____________________
3. Date of follow-up examination: ____________________ II. LIPID (BLOOD) LEVELS4. Total cholesterol: ____________________
5. HDL cholesterol: ____________________
6. Ratio of total cholesterol divided by HDL cholesterol: ____________________
7. LDL cholesterol: ____________________
8. Triglycerides: ____________________
9. Fasting glucose: ____________________
10. Any abnormal levels from kidney, liver, and thyroid tests: ____________________ III. OTHER HEALTH DATA11. Blood pressure: ____________________
12. Weight: ____________________
13. Percentage body fat: ____________________
14. Chest measurement: ____________________
15. Waist measurement: ____________________
16. Hips measurement: ____________________ IV. MAJOR HEALTH PROBLEMS17. Any improvement in angina pain? _______________________________________
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18. Any improvement in diabetic condition? __________________________________
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19. Any changes in diabetes medication (if any)? ______________________________
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20. Any improvement in hypertension? ______________________________________
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21. Any changes in hypertension medication (if any)? ___________________________
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22. Any changes or improvement in other major health disease, condition, issue?
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______________________________________________________________________ V. OTHER HEALTH ISSUES23. Any changes in gastrointestinal functioning? _______________________________
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24. Any changes in regularity? _____________________________________________
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25. Any changes in aches or pains? _________________________________________
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26. Any changes in complexion? ___________________________________________
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27. Other (minor) health issues: ____________________________________________
______________________________________________________________________ VI. SUBJECTIVE EVALUATION28. How do you feel? ____________________________________________________
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29. Changes in alertness and/or energy level: __________________________________
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30. How well do you sleep? _______________________________________________
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31. Characterize your mood: _______________________________________________
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32. Characterize your outlook: _____________________________________________
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33. Any other changes or improvements from the Baseline Chart or the last Progress Chart: _________________________________________________________________
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______________________________________________________________________ VII. ENJOYMENT OF DIET34. Describe how you like/dislike the diet: ___________________________________
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35. Do you miss foods you used to eat? ______________________________________
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36. How well have you adapted to the guidelines of the 10% solution? _____________
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37. Have you noted changes in your tastes? ___________________________________
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38. Do you find the diet satisfying? _________________________________________
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39. Are you ever hungry? _________________________________________________
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______________________________________________________________________ WEEKLY CHARTName: _________________________________________________
Date (for Monday): __________________________
DAY | CALORIES | FAT GRAMS | CALORIES EXPENDED IN EXERCISE |
Monday | | | |
Tuesday | | | |
Wednesday | | | |
Thursday | | | |
Friday | | | |
Saturday | | | |
Sunday | | | |
Total | | | |
Average | | | |
(divide total by 7) | | | |
Percentage of calories from fat (multiply fat grams by 9 and divide by calories):
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