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.

 What is the TLC diet?
 Why is the TLC diet a good idea?
 How do you follow the TLC diet?
 Where to go from here

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What is the TLC diet?

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 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.

Test Your Knowledge

1. The TLC diet focuses on cutting back on sugar.

1. True

The TLC diet focuses on cutting back on sugar.

You chose true, which is incorrect.

The TLC diet focuses on limiting fats in your diet.

2. False

The TLC diet focuses on cutting back on sugar.

You chose false, which is correct.

The TLC diet focuses on limiting fats in your diet.

Continue to Why is the TLC diet a good idea?
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Why is the TLC diet a good idea?

Limiting the amount of fat in your diet can lower cholesterol. The TLC diet helps you limit how much fat you eat.

Diet changes are usually the first step in lowering cholesterol before medicines are added. If you use the TLC diet, you may be able to avoid taking medicine.

Test Your Knowledge

1. Following the TLC diet may lower my cholesterol.

1. True

Following the TLC diet may lower my cholesterol.

You chose true, which is correct.

You may be able to lower your cholesterol by following the TLC diet, especially if you are overweight.

2. False

Following the TLC diet may lower my cholesterol.

You chose false, which is incorrect.

You may be able to lower your cholesterol by following the TLC diet, especially if you are overweight.

Continue to How do you follow the TLC diet?
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How do you follow the TLC diet?

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.

Sample menu

Here is a sample one-day menu for the TLC diet. 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 nonfat milk, 1 teaspoon brown sugar, and 1 sliced banana
• Caffe latte made with 1 cup nonfat 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 nonfat milk

Foods to avoid

Check food labels for fat and cholesterol content. Try to:

• Avoid 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.
• Limit trans fatty acids or partially hydrogenated vegetable oils. These oils go through a process that makes them solid. They're found in 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 nonfat 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.

Test Your Knowledge

1. If I follow the TLC diet, I can't have any sweets.

1. True

If I follow the TLC diet, I can't have any sweets.

You chose true, which is incorrect.

You can eat sweets on the TLC diet as long as you don't overdo it. Stay within your calorie limit, and choose sweets that are low in fat or are made with unsaturated fat.

2. False

If I follow the TLC diet, I can't have any sweets.

You chose false, which is correct.

You can eat sweets on the TLC diet as long as you don't overdo it. Stay within your calorie limit, and choose sweets that are low in fat or are made with unsaturated fat.

Continue to Where to go from here
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Where to go from here

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.

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone:	1-800-AHA-USA1 (1-800-242-8721)
Web Address:	www.heart.org
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
Phone:	(301) 592-8573
Fax:	(240) 629-3246
Email:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov/about/ncep
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
Phone:	(301) 592-8573
Fax:	(240) 629-3246
TDD:	(240) 629-3255
Email:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov
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.

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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
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Carl Orringer, MD - Cardiology, Clinical Lipidology
Last Revised	May 26, 2011

By:	Healthwise Staff	Last Revised: May 26, 2011
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Carl Orringer, MD - Cardiology, Clinical Lipidology
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