Therapeutic Lifestyle Changes (TLC) for High Cholesterol

Therapeutic Lifestyle Changes (TLC) is a program that can help you lower cholesterol. The lifestyle changes include diet, exercise, weight loss, and not smoking. Your doctor will want you to follow TLC even if you are taking cholesterol-lowering medicine. And medicine will work better if you have healthy habits.

This program is recommended by the National Cholesterol Education Program of the U.S. National Institutes of Health.^{footnote 1}

TLC diet

People have varying degrees of success in lowering their cholesterol by changing their diets. Those who are most successful using diet changes to lower their cholesterol are those who lose excess weight. Diet changes are usually the first step in lowering cholesterol before medicines are added.

The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat elevates your cholesterol. You can reduce the saturated fat in your diet by limiting the amount of meat and whole milk products you eat. Choose low-fat products from those food groups instead. Replace most of the animal fat in your diet with unsaturated fat, especially monounsaturated oils, such as olive, canola, or peanut oil. If monounsaturated fat is substituted for saturated fat, it lowers LDL ("bad") cholesterol and keeps HDL ("good") cholesterol up.

What can you eat?

The TLC diet recommends that you eat specific amounts of different types of foods. These amounts are sometimes a percentage of your total calorie intake for each day.

• Saturated fat: Less than 7% of total calories
• Polyunsaturated fat: Up to 10% of total calories
• Monounsaturated fat: Up to 20% of total calories
• Carbohydrate: 50% to 60% of total calories
• Soluble fiber: At least 5 to 10 grams a day
• Protein: Approximately 15% of total calories
• Cholesterol: Less than 200 mg a day
• Total calories: Balance calories taken in and calories burned to reach and stay at a healthy weight.

Avoid trans fat. Foods with trans fats include some vegetable shortening, crackers, cookies, and packaged snack foods.

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.

Sample menu

Here is a sample one-day menu. The menu contains approximately 2,200 calories, with 25% of calories from total fat (5% from saturated fat, 13% from monounsaturated fat, and 7% from polyunsaturated fat).

Breakfast

• ½ cup oatmeal with 1 cup fat-free milk, 1 teaspoon of brown sugar, and 1 sliced banana
• Caffe latte made with 1 cup fat-free milk

Lunch

• Sandwich made from 2 slices whole wheat bread, 2 ounces lean turkey, 1 tablespoon mayonnaise, lettuce, and tomato
• 1 cup carrot sticks
• 1 apple

Snack

• 1 cup low-fat or nonfat vanilla yogurt
• ½ cup mixed raisins and peanuts

Dinner

• 3 ounces baked or broiled salmon
• 1 cup cooked brown rice
• 1 cup cooked broccoli
• 1 tablespoon olive oil (used in cooking)
• Salad made with 1½ cups romaine lettuce, ½ cup tomatoes, ¼ cucumber, 1 tablespoon vinegar and oil dressing
• 1 slice Italian bread with 1 teaspoon soft margarine

Snack

• 1 sliced peach with 1 cup fat-free milk

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 information, see:

• High Cholesterol: How a Dietitian Can Help
• High Cholesterol: Healthy Food Choices