Diet changes are usually the first step in lowering high cholesterol before medicines are added.Many people whose cholesterol is high because they eat too many fatty foods are able to lower their cholesterol with diet changes alone.
The TLC (Therapeutic Lifestyle Changes) diet is recommended by the National Cholesterol Education Program of the U.S. National Institutes of Health. It calls for limiting saturated fats and avoiding trans fats in your diet.
You may get 25% to 35% of your daily calories from fat, mainly from unsaturated fat.
Most of the fat should be monounsaturated, and only 10% of the fat should be polyunsaturated fat.
Less than 7% of your daily calories should come from saturated fat.
Eat no more than 200 mg of dietary cholesterol a day.
The TLC diet may seem complicated at first, but it's really not. Follow the guidelines in the table below, but take one step at a time. For example, start with the meat and beans group. When you feel confident that you're eating the right amount and type of meat and beans every day, move on to the next category.
Your doctor or dietitian might recommend that you add soluble fiber or a cholesterol-lowering margarine to your diet. These might help you lower LDL cholesterol. Soluble fiber is found in foods like oats, beans, and fruit. Cholesterol-lowering margarines contain plant stanols and sterols.
Foods to avoid
Check food labels for fat and cholesterol content. Try to:
Limit saturated fat and oils, such as butter, bacon drippings, lard, palm oil, and coconut oil. Instead, use soft tub margarine or vegetable oils, such as olive or canola oil.
Avoid trans fatty acids or partially hydrogenated vegetable oils. These oils go through a process that makes them solid. They're found in some hard margarines, snack crackers, cookies, chips, and shortenings.
Limit fatty meats such as corned beef, pastrami, ribs, steak, ground meat, hot dogs, sausage, bacon, and processed meats like bologna. Also limit egg yolks and organ meats like liver and kidney. Replace with skinless chicken or turkey, lean beef, veal, pork, lamb, and fish. Try some meatless main dishes, like beans, peas, pasta, or rice.
Limit meat, poultry, and fish to no more than two servings, or 5 oz (140 g), a day. Remember that a serving is about the size of a deck of playing cards.
Limit milk products that contain more than 1% milk fat. This includes cream, most cheeses, and nondairy coffee creamers or whipped toppings (which often contain coconut or palm oils). Instead try fat-free or low-fat milk (0% to 1% fat) and low-fat cheeses.
Limit snack crackers, muffins, quick breads, croissants, and cakes made with saturated or hydrogenated fat, whole eggs, or whole milk. Try low-fat baked goods, and use any spreads or toppings lightly.
Dip bread in olive oil instead of spreading butter or margarine on your bread.
Avoid fast foods like hamburgers, fries, fried chicken, and tacos. They are high in both total fat and saturated fat. When you eat out, choose broiled sandwiches or chicken without skin, salads with low-fat dressing, and foods that aren't fried. Ask the server to leave off the cheese and high-fat dressings like mayonnaise.
Tips for success
Work with your doctor on a plan to lower your cholesterol through diet.
Collect information about menus, cooking classes, support groups, books, and videos.
Get support from your family in making changes in your diet.
Think ahead, and make realistic and customized meal plans.
Learn how to understand food labels. Look for the amount of saturated fat per serving, and figure out its percentage of your total saturated fat intake for the day. "Low-fat" does not always mean what it seems. Some labels measure fat content by weight rather than as a percentage of the calories in a serving.
Exercise. Always talk to your doctor before you start an exercise program.
Now that you have read this information, you are ready to start following the TLC diet.
Talk with your doctor
If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to mark areas or make notes where you have questions.
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.
National Cholesterol Education Program (NCEP)
P.O. Box 30105
Bethesda, MD 20824-0105
The National Cholesterol Education Program (NCEP) provides education and tips for patients about how to lower high cholesterol. The NCEP provides clinical practice guidelines for health professionals to treat high cholesterol. The goal of the NCEP is to help people lower high cholesterol because this can lower their risk of coronary artery disease. The NCEP is part of the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
National Heart, Lung, and Blood Institute (2005). Your Guide to Lowering Your Cholesterol With TLC (NIH Publication No. 06-5235). Available online: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.
The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.