Low Cholesterol Diet

If your cholesterol (LDL) is too high, your doctor may suggest you follow a low cholesterol diet such as the National Cholesterol Education Program (NCEP)'s Therapeutic Lifestyle Changes diet or TLC. Such diets help the average American could reduce total cholesterol levels by 15 percent. Additional percentage points of cholesterol may be reduced while also raising "good" HDL by adding regular exercise.

The low cholesterol diet prescribed in the TLC program is a low saturated fat, low cholesterol diet that will help to reduce your blood cholesterol level to decrease your chance of developing heart disease, future heart attacks, and other heart disease complications.

The Therapeutic Lifestyle Diet (TLC)

The TLC diet is a low-saturated fat, low-cholesterol eating plan. The TLC diet is for anyone whose LDL is above his or her goal level.

You should eat according to the following TLC guidelines:

• Less than 7% of the day's total calories from saturated fat.
• 25-35% or less of the day's total calories from fat.
• Less than 200 milligrams of dietary cholesterol a day.
• Limit sodium intake to 2400 milligrams a day.
• Just enough calories to achieve or maintain a healthy weight and reduce blood cholesterol level. (Ask your doctor or a registered dietitian what is a reason able calorie level for you.)

Other Low Cholesterol or TLC diet factors:

• Soluble fiber may be increased in the diet if LDL is not lowered enough by reducing saturated fat and cholesterol.
• Certain food products that contain plant stanols or plant sterols (e.g., cholesterol-lowering margarines and salad dressings) can also be added to the diet to boost its LDL-lowering power.

What to eat

Eat foods low in saturated fat, such as:

• fat free or 1% dairy products
• lean meats
• fish and shellfish
• skinless poultry
• whole grain foods
• fruits
• vegetables

Note:
Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). For more on choosing fats and oils, see the National Heart, Lung, and Blood Institute Tipsheet Fats and Oils to Choose at: http://www.nhlbisupport.com/chd1/Tipsheets/tipsheet-satfat.htm.

Eat foods high in soluble fiber, such as:

• oats
• certain fruits (e.g., oranges and pears)
• certain vegetables (e.g., Brussels sprouts and carrots)
• dried peas and beans

What NOT to eat

Limit foods high in cholesterol, such as:

• liver and other organ meats
• egg yolks
• full-fat dairy products (National Heart, Lung, and Blood Institute 2001a; National Heart, Lung, and Blood Institute, 2002m).

For more details on making wise food choices for the TLC diet, see the National Heart, Lung, and Blood Institute Tipsheet TLC Diet Daily Food Guide Food Groups at: http://www.nhlbisupport.com/chd1/Tipsheets/foodgroup.htm.

Limit foods high in saturated fat, such as:

• High fat processed meats (e.g., sausage, hot dogs, bologna, salami) and fatty, untrimmed red meats
• Fried foods (American Heart Association, 2002c).

How to prepare food

When preparing foods, the following cooking methods tend to produce lower saturated fat levels:

• bake
• broil
• microwave
• poach
• grill
• roast (when roasting, place meats on a rack so fat can drip away)
• lightly stir-fry or sauté in cooking spray, small amounts of vegetable oil, or reduced sodium chicken broth ( National Heart, Lung, and Blood Institute, 2002k).

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

To keep your blood cholesterol level low, choose only the leanest meats, poultry, fish and shellfish.

• Choose chicken and turkey without skin or remove skin before eating.
• Some fish, like cod, have less saturated fat than either chicken or meat.
• Since even the leanest meat, chicken, fish, and shellfish have saturated fat and cholesterol, limit the total amount you eat to 6 ounces or less per day.

Poultry

In general, chicken and turkey are low in saturated fat, especially when the skin is removed. When shopping for poultry remember:

• You can buy chicken and turkey pieces with the skin already removed. Or buy pieces with the skin on and remove it yourself before eating. It is easy to do. Remember, the white meat itself always contains less saturated fat than the dark meat.
• Limit goose and duck. They are high in saturated fat, even with the skin removed.
• Try fresh ground turkey or chicken that is made from white meat like the breast.
• Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also "lean" beef hot dogs and vegetarian (made with tofu) franks that are low in fat and saturated fat.

Fish and Shellfish

When shopping for fish and shellfish remember that:

• Most fish is lower in saturated fat and cholesterol than meat or poultry.
• Shellfish varies in cholesterol content. Shellfish have little saturated fat and total fat. Even shrimp can be enjoyed occasionally on a Heart Healthy Diet provided you eat less than 300 milligrams of cholesterol a day. For example, 3 ounces of steamed shrimp has 167 milligrams of cholesterol.

Meat Substitute

Dry peas and beans and tofu (bean curd) are great meat substitutes that are low in saturated fat and cholesterol. Dry peas and beans also have a lot of fiber, which can help to lower blood cholesterol. Try adding a ½ cup beans to pasta, soups, casseroles, and vegetable dishes. Tofu takes on the flavor of marinades well. Try marinating tofu in a nonfat dressing or a tangy sauce and grilling or baking for a heart healthy dish.

Eggs

Egg yolks are high in dietary cholesterol--each contains about 213 milligrams. So, egg yolks are limited to no more than 4 yolks per week. This includes the egg yolks in baked goods and processed foods. Check the label to see how much cholesterol the food contains or ask the bakery if the recipe uses whole eggs. Limit these types of foods for occasional treats.

Egg whites have no cholesterol, and you can substitute them for whole eggs in recipes -- two egg whites are equal to one whole egg. You can also use cholesterol-free egg substitute in place of whole eggs - In many baked goods, you can't tell the difference.

Milk, Yogurt, and Cheese Group

Like high fat meats, regular dairy foods that have fat -- such as whole and 2% milk, cheese, and ice cream -- are also high in saturated fat and cholesterol. However, dairy products are an important source of nutrients. You should eat 2 to 3 servings per day of lowfat or nonfat dairy products. Here is a guide to buying low fat and nonfat dairy foods:

Milk

• Buy fat free and 1% milk rather than whole or 2% milk. Fat free and 1% milk have just as much or more calcium and other nutrients as whole milk - with much less saturated fat and cholesterol.

Cheese

• When looking for hard cheeses, go for the versions that are "fat free," "reduced fat," "low fat," or "part skim." Choose varieties that have 3 grams of fat or less per ounce.
• When looking for soft cheeses, choose low fat (1%) or nonfat cottage cheese, farmer cheese, or part-skim or light ricotta. Some of these cheeses have 3 grams of fat or less per ounce.
• If you are watching your sodium intake, choose lower sodium cheeses. Read the label to compare the sodium content.

Frozen Dairy Desserts

• Buy frozen desserts that are lower in saturated fat, like ice milk, low fat frozen yogurt, low fat frozen dairy desserts, fruit ices, sorbets, and popsicles.

Other Dairy Foods

• Buy low or nonfat yogurt; like many other dairy foods, it is an excellent source of protein and calcium. Eat lowfat or nonfat yogurt alone or as a topping or in recipes. Try topping with fruit.
• Try lowfat or nonfat sour cream or cream cheese blends. Many taste as rich as the real thing, but have less fat and calories.

Fats and Oils

You can help keep your blood cholesterol low when you replace saturated fats with unsaturated fat. Just be sure to limit the total amount of fats or oils to keep calories in check.

When buying fats and oils, remember to:

• Choose liquid vegetable oils that are high in unsaturated fats -- like canola, corn, olive, peanut, safflower, sesame, soybean, and sunflower oils.
• Buy margarine made with unsaturated liquid vegetable oils as the first ingredient. Choose soft tub or liquid margarine or vegetable oil spreads.
• Limit butter, lard, fatback, and solid shortenings. They are high in saturated fat and cholesterol.
• Buy light or nonfat mayonnaise and salad dressing instead of the regular kind that are high in fat. For example, two tablespoons of regular Italian dressing can add as many as 14 grams of fat.

Fruits and Vegetables

You should be eating at least 3 to 5 servings of fruits and vegetables each day. Fruits and vegetables are very low in saturated fat and total fat, and have no cholesterol. A diet high in fruit and vegetables may also help keep cholesterol levels low. So, fruits and vegetables are great substitutes for foods high in saturated fat and cholesterol.

When shopping, remember to:

• Buy fruits and vegetables to eat as snacks, desserts, salads, side dishes, and main dishes
• Add a variety of vegetables to meat stews or casseroles or make a vegetarian (meatless) main dish.
• Wash and cut up raw vegetables (carrot, broccoli, cauliflower, lettuce, etc.) and store in the refrigerator for quick and easy use in cooking or snacking.
• Serve fresh fruit for dessert or freeze (banana, berries, melon, grapes) for a delicious frozen treat.
• Display fresh fruit in a bowl in the kitchen to make fruit easier to grab as a snack.

To keep naturally lowfat vegetables low in fat and saturated fat, season with herbs, spices, lemon juice, vinegar, fat free or lowfat mayonnaise or salad dressing.

Breads, Cereals, Rice, Pasta, and Other Grains

Breads, cereals, rice, pasta, and other grains, and dry beans and peas are generally high in starch and fiber and low in saturated fat and calories. They also have no dietary cholesterol, except for some bakery breads and sweet bread products made with high fat, high cholesterol milk, butter and eggs.

Like fruits and vegetables, naturally low fat, low cholesterol breads and other foods in this group are also good choices. You should be eating 6 to 11 servings of foods from this group each day. If you have high triglycerides and/or low HDL, you should keep your carbohydrate intake below the maximum of 60% of total calories. You can choose a diet up to 35% fat, substituting unsaturated fat for saturated fat.

When buying foods from this group, remember to:

• Choose whole grain breads and rolls often. They have more fiber than white breads.
• Buy dry cereals, most are low in fat. Limit the high fat granola, muesli, and oat bran types that are made with coconut or coconut oil and nuts, which increases the saturated fat content. Add fat free milk or 1% milk instead of whole or low fat (2% milk) to save saturated fat and cholesterol.
• Buy pasta and rice to use as entrees. Hold the high fat sauces (butter, cheese, cream, white).
• Limit sweet baked goods that are made with lots of saturated fat, mostly from butter, eggs, and whole milk such as croissants, pastries, muffins, biscuits, butter rolls, and doughnuts. These are also high in cholesterol.

Sweets and Snacks

Some sweets and snacks -- like baked goods (cakes and cookies) cheese crackers, and some chips -- often are high in saturated fat and cholesterol.

Here are some low fat sweets and snacks to buy and use only now-and-then:

• Angel food cake topped with fruit puree or fresh fruit slices
• Fat free or low fat brownies, cakes, cheesecake, cupcakes, and pastries
• Fat free or lowfat cookies like animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, and vanilla or lemon wafers
• Frozen lowfat or nonfat yogurt, fruit ices, ice milk, sherbet, and sorbet
• Gelatin desserts - watch the whipped cream!
• Graham crackers
• Puddings made with 1% or fat free milk

Just remember that, while these treats are may be low in fat, most are not low in calories. So choose them only every now-and-then, especially if you are trying to control your weight to improve your blood cholesterol levels.

Not all snack foods are high in saturated fat and cholesterol. Buy some of these low fat ones and keep them on hand for snack attacks:

• Bagels
• Bread sticks*
• Ready-to-eat cereals without added sugar*
• Frozen grapes or banana slices; or other fresh fruit
• Fruit leather or other dried fruit
• Low fat or fat free crackers* like melba toast, rice cakes, rye crisp, and soda crackers
• No-oil baked tortilla chips*
• Popcorn (air popped or "light")*
• Pretzels*
• Raw vegetables with nonfat or low fat dip

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*If you are watching your sodium intake, be sure to look for low sodium or unsalted varieties.

References:

• NIH
• NHBLI
• National Cholesterol Education Program (NCEP)