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High Cholesterol: Using the TLC Diet

Introduction

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.

How To

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.

You can also get help from a dietitian.

TLC (Therapeutic Lifestyle Changes) diet recommendations
Food group Number of servings Serving size

Lean meat, poultry, fish, dry beans, and dry peas

No more than 5 ounces total a day

  • 5 ounces maximum a day of lean meat, poultry, or fish
  • Substitute ¼ cup dry beans or peas for 1 ounce of meat.

Eggs

No more than 2 yolks a week

  • 1 whole egg. Egg whites or substitutes are not limited.

Low-fat milk and milk products

2–3 a day

  • 1 cup fat-free or 1% milk
  • 1 cup nonfat or low-fat yogurt
  • 1 ounce nonfat or low-fat cheese (3 grams of fat or less per ounce)

Fruits

2–4 a day

  • 1 piece fruit, such as apple, orange, or half a banana
  • ½ cup canned fruit
  • 1 cup berries or melon
  • ¾ cup fruit juice

Vegetables

3–5 a day

  • 1 cup raw leafy greens
  • ½ cup cooked or raw vegetables
  • ¾ cup vegetable juice

Bread, cereals, pasta, rice, and other grains

At least 6 servings a day

  • 1 slice of bread
  • ½ hot dog or hamburger bun, bagel, or English muffin
  • 1 ounce cold cereal
  • ½ cup cooked pasta, rice, noodles, or other grains

Sweets and snacks

Within calorie limit (check labels for number of calories per portion)

Choose snacks that are low in fat or are made with unsaturated fat.

For an example, see the topic TLC Diet Sample Menu.

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.
  • Get help from a registered dietitian if you have questions about the TLC diet.
  • 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.

For more suggestions on foods to eat and foods to avoid, see Healthy Food Choices to Lower Cholesterol.

References

Other Works Consulted

  • 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.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
Last Revised August 13, 2013

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