Cholesterol-TLC-NIH by yantingting


The National Cholesterol Education Program (NCEP) recommends the following
Therapeutic Lifestyle Changes (TLC) to promote desirable lipid levels and decrease
your risk of heart disease. A summary of the guidelines is provided on the last page.

Meat, Poultry, Fish and Shellfish
Limit to 5-6 ounces per day to limit your saturated fat intake.

•   Choose poultry and fish most of the time.
•   Remove skin and trim off visible fat from chicken and turkey.
•   Eating fish at least twice a week will provide healthy fish oils,
    known to be beneficial for your heart.
•   Strictly limit organ meats, such as brain, liver, and kidneys.
•   Choose only lean cuts of red meats, and trim off any visible fat. Meat cuts lowest in fat
       Beef: round steaks and roasts (round eye, top round, bottom round, round tip), top loin,
       top sirloin, and chuck shoulder and arm roasts. Choose extra lean ground beef (at least
       90% lean).
       Pork: round steaks and roasts (round eye, top round, bottom round, round tip), top loin,
       top sirloin, and chuck shoulder and arm roasts.

Use low-fat cooking methods when preparing these foods, like grilling, baking, or roasting.

Eat no more than 2 egg yolks per week, including yolks in baked goods and in cooked
or processed foods.

          •   Egg whites and egg substitutes are fat-free and cholesterol-free. They may be
              eaten as desired.

Dairy Products
3 servings a day will help most people meet their recommended intake for calcium and

•   Choose only non-fat or low-fat dairy products. These include:
            Non-fat (or skim) milk
            Low-fat (or 1%) milk
            Non-fat or low-fat yogurt
            Non-fat or low-fat sour cream or cream cheese
                                                                                        TLC DIET
              Cheeses containing no more than 3 grams of fat per ounce
Fats and Oils

Limit your intake of saturated fat. This fat is found in greatest amounts in foods from
animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, butter, and

Avoid trans fat, which is made from partially hydrogenated fats and oils.
• These fats are sometimes found in hard margarines, shortenings, baked goods, snack
  foods, and fried fast foods.
• Choose products marked “no trans fats.” Check labels and select those that don’t list
  “partially hydrogenated fats” as an ingredient.

Instead, choose healthy unsaturated fats.
• Monounsaturated fats are found in greatest amounts in olive, canola,
   sunflower, and peanut oils.
• Polyunsaturated fats are found in safflower, sunflower, corn, soybean, and
   cottonseed oils, and many kinds of nuts.
• Omega-3 fat sources include fatty fish, nuts, avocado, and flax seed oil.
• Use oils or light tub margarine spreads in place of hard stick margarine or butter.

Limit your total fat intake to a maximum of 5 to 6 teaspoons (or 2 tablespoons) of fat per
If you need to reduce your fat and calorie intake, choose low fat, fat free, and reduced fat
products (such lowfat mayonnaise). In general, low-fat products have only half the fat and
calories of regular products. Non-fat or fat-free items have less than 1 gram of fat per serving,
so intake of these products usually does not need to be limited.

Aim for at least 2 cups of fruit each day.

•  Fruits are good sources of vitamins, fiber, and other nutrients. Best of all, they are naturally
   very low in fat and calories.
• Choose a variety each day.
• Look for fresh, frozen, or canned or dried -- prepared without added fat or sugar.

Vegetables, Dry Beans/Peas
Aim for at least 2 cups each day. That’s 3 to 5 servings.

•   These are important sources of vitamins, minerals, fiber and other
    nutrients. Dry beans/peas are fiber-rich and good sources of plant protein.
•   Choose fresh, frozen, or canned, without added fat, sauce, or salt.
•   Avoid vegetables prepared in cream, with butter, and with high fat cheese sauces

                                                                                    TLC DIET

Breads, Cereals, and Grains
Eat 6 or more servings per day; adjust to meet your calorie needs.

 If you are overweight or need to reduce your triglyceride level, you should limit your
intake of these foods to no more than 6 servings per day.

•   At least half of your servings should be whole grains.
•   Most breads and cereals are low in fat, but read the label to make sure. These products
    should contain no more than 2 grams of fat per serving.
•   High-fat bread products such as croissants, Danish pastry, and doughnuts should be eaten
    only occasionally.
•   Control the amount of fat added to breads and pastas in cooking and at mealtime according
    to recommended levels, and avoid products made with cream, butter, and cheese sauces
    unless the sauce recipe has been modified to make it low in fat.


Sweets and Snacks
Limit amounts eaten, especially if you are trying to control your weight.

•   Choose sweets and snack foods that are lower in fat. Look for low-fat snack
    foods with 2 grams of fat or less per serving, such as pretzels and low-fat
•   Fat-free sweets / desserts include popsicles, fudge pops, flavored gelatin, hard candies
    and jelly beans, Italian ices, Angel Food cake, and other fat-free commercial desserts.
•   Many recipes can be modified to decrease their fat and saturated fat content. Make
    pudding or custard with skim milk and egg whites, bake with one of the cholesterol-free egg
    substitutes, and replace about half of the fat in cookie recipes with applesauce or non-fat

                                                                                      TLC DIET

Other Diet Options

Dietary Fiber
Try to consume 20 to 30 grams of dietary fiber per day, with special
emphasis on increasing soluble fiber intake.

Fiber refers to natural substances in food that are not digested and contribute to bulk and stool
output. They serve many functions, and are generally considered a healthful addition to a diet.
Soluble fiber dissolves into a gel-like substance in the intestines which helps to block
cholesterol and fats from being absorbed. Soluble fiber can help lower your cholesterol level
by about 5%. Most Americans consume only around 10 grams of dietary fiber daily.
 To increase your fiber intake:
   • Eat whole grain breads and cereals. Oatmeal is particularly high in soluble fiber.
   • Eat at least 5 servings of whole fruits and vegetables (especially beans) per day. Most
       juices do not contain fiber or contain limited amounts of fiber.
   • Eat skins on foods such as baked potatoes.

Plant Sterols
Consider adding foods containing plant stanols and sterols to your diet.

Plant sterols or stanols are natural substances found in many plants, especially tall pine-tree
oils. They help block the absorption of cholesterol from the digestive tract. Research suggests
that consuming 2 grams of plant sterols per day may lower LDL cholesterol levels by 5-15%.

Some food manufacturers are now marketing spreads containing these substances that can be
used in place of traditional margarines. They may also be added to other foods, like orange
juice. Both the National Heart Lung and Blood Institute and the American Heart Association
recommend the use of plant stanols/sterols for lowering LDL-cholesterol.
Read labels to find out if a food provides plant sterols or stanols.


Physical Activity
Aim for at least 30 minutes of moderate physical activity every day.
Walking is a great way to get started!

                                                                                                 TLC DIET
SATURATED FAT [and trans fats]                        < 7% of calories
TOTAL FAT                                             25 to 35% of calories*
SOLUBLE FIBER                                         20 to 30 grams per day
PLANT STEROLS                                         2 grams per day
CHOLESTEROL                                           < 200 mg per day
SODIUM                                                2400 milligrams a day or less
TOTAL CALORIES (ENERGY)                               Balance energy intake and energy expenditure
                                                      to maintain a desirable body weight and
                                                      prevent weight gain

* A higher total fat intake (up to 35% of calories from fat) may help to reduce triglycerides and raise
HDL cholesterol levels in some people. If fat is increased to 35% of calories, it is very important to limit
both saturated and trans fats.

Use the Nutrition Facts Labels on Foods

 Nutrition labels list total fat, saturated fat, and trans fat in grams. The following chart tells you
how many grams will meet the recommendations for various calorie levels.

       CALORIE                  Total Daily Fat (grams)            Daily Saturated + trans Fats
       LEVEL                        providing                        (grams) providing ≤ 7%
                                25 - 35% of calories                     of calories

          1200                            35-45                                   9
          1500                            40-55                                  12
          1800                            50-70                                  14
          2000                            55-75                                  15
          2200                            60-85                                  17
          2400                            65-90                                  19

                                              Prepared by the Nutrition Department, NIH Clinical Center 12/06


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