The 10% Solution For A Healthy Life, Appendix 3

March 6, 2002

Charts for the Kurzweil Challenge

The 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 DATA

1. 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) LEVELS

7. 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 DATA

14. Blood pressure: ____________________

15. Weight: ____________________

16. Percentage body fat: ____________________

17. Chest measurement: ____________________

18. Waist measurement: ____________________

19. Hips measurement: ____________________

IV. MAJOR HEALTH PROBLEMS

20. 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 ISSUES

30. 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 EVALUATION

35. How do you feel? ____________________________________________________

______________________________________________________________________

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36. How well do you sleep? _______________________________________________

______________________________________________________________________

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37. Characterize your mood: _______________________________________________

______________________________________________________________________

______________________________________________________________________

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 DATA

1. Name: _______________________________________________________________

2. Date: ____________________

3. Date of follow-up examination: ____________________

II. LIPID (BLOOD) LEVELS

4. 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 DATA

11. Blood pressure: ____________________

12. Weight: ____________________

13. Percentage body fat: ____________________

14. Chest measurement: ____________________

15. Waist measurement: ____________________

16. Hips measurement: ____________________

IV. MAJOR HEALTH PROBLEMS

17. Any improvement in angina pain? _______________________________________

______________________________________________________________________

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? ______________________________________

______________________________________________________________________

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 ISSUES

23. 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: ____________________________________________

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VI. SUBJECTIVE EVALUATION

28. How do you feel? ____________________________________________________

______________________________________________________________________

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 DIET

34. 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 CHART

Name: _________________________________________________

Date (for Monday): __________________________

Percentage of calories from fat (multiply fat grams by 9 and divide by calories):

______________________________________________________________________