High blood cholesterol is a major risk factor for heart disease. Lowering cholesterol, specifically LDL cholesterol (the "bad" cholesterol), can help prevent heart attacks. The National Cholesterol Education Program (NCEP) provides guidelines, called therapeutic lifestyle change (TLC), on how to prevent and treat high cholesterol in adults. For lowering high cholesterol, the NCEP TLC diet recommends consuming less than 7 percent of calories from saturated fat, less than 200 mg/day of cholesterol, 10 to 25 g/day of soluble fiber and 2g/day of plan sterols/stanols.
Step 1
Avoid or limit saturated fat and trans fat intake. Saturated fat intake is the main dietary cause of high blood cholesterol. To limit saturated fat intake to less than 7 percent of total calories, for a reference 2,000-kcal diet, saturated fat intake should be less than 15.5 g/day (7 percent of 2,000 kcal is 140 kcal, and 1g of fat provides 9 kcal). The most common sources of saturated fat are from meat, poultry, dairy and some tropical oils like palm oil and coconut oil.
Animal protein is the major source of saturated fat in our diets; substituting it with soy or other meatless protein (like legumes) at least once or twice a week will help lower blood cholesterol.
Although the exact mechanism of how omega-3 fatty acids reduce the risk of heart attack is not fully understood, the American Heart Association also recommends consuming omega-3 fatty acids from fatty fish (salmon, tuna, mackerel), vegetable oils (canola and soybean oil, and nuts (walnuts, pistachios and almonds) in place of saturated fats.
Baked goods like donuts, muffins, cakes and processed foods made with partially hydrogenated oil should be avoided.
Step 2
Decrease dietary cholesterol. Although saturated fat intake affects blood cholesterol more than dietary cholesterol, some people are more susceptible to high cholesterol intake as they have trouble clearing cholesterol. The most common sources of dietary cholesterol are eggs, shellfish, organ meats, cream, butter and whole milk Again, substituting animal protein with legumes or fish at least twice a week will help reduce your cholesterol level.
Step 3
Maintain a healthy weight. If you are overweight, losing as little as 10 pounds will reduce you cholesterol by 5 to 8 percent. Consider consuming small, frequent meals, as people who consume six meals per day have a 5 percent lower cholesterol compared to those who eat one or two big meals per day.
Step 4
Increase soluble fiber. Meta-analysis by Brown and colleagues showed that an increase of 5 to 10 g of soluble fiber significantly lowers LDL cholesterol by 3 to 5 percent. An intake of 10 to 25 g of soluble fiber as recommended by the TLC diet will lower LDL cholesterol even more. The best sources of soluble fiber are oatmeal, oatbran, psyllium seeds, beans and legumes, fruits like apples, pears and citrus, and vegetables like broccoli, okra, brussel sprouts and eggplants. If it is difficult for you to meet the requirement, consider taking a soluble fiber supplement like Metamucil or Benefiber.
Step 5
Incorporate sterols/stanols in your diet. If you have done all of the above, and your LDL cholesterol is still elevated, consider adding foods containing plant sterols/stanols to your diet. While some plant foods contain a small amount of naturally-occurring sterols, more foods are being fortified with plant sterol/stanols to help lower cholesterol. This includes certain brands of orange juice, milk, cheese and grain products. Look for the Corowise label on the food packaging which indicates that the product has been fortified with plant sterols. It is also available in the form of supplements. An intake of 2 g of plant sterols/stanols per day has been shown to reduce LDL cholesterol by 5 to 15 percent.
Tips and Warnings
- The above recommendations for lowering cholesterol are cumulative. Therefore if you implement all of the above dietary changes, you may lower your cholesterol by 20 to 30 percent. Even if you are on cholesterol-lowering medication, following the TLC diet will help you keep your dosage down. Changing dietary habits is a life-long journey; try implementing steps one at a time and you'll have a higher chance of adhering to the diet.
References
- Brown L, Roser B, Willett WW, Sachs, F. Cholesterol-lowering effects of dietary fiber meta-analysis. Am J of Clin Nutr. 1999, 69:30-42
- Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies Press; 2002
