Low Cholesterol Diet


TLC Diet – Therapeutic Lifestyle Changes Diet

High blood cholesterol can affect anyone. It’s a serious condition that increases the risk for heart disease, the number one killer of Americans-women and men. The higher your blood cholesterol level, the greater your risk.

What Affects Cholesterol Levels?

Various factors can cause unhealthy cholesterol levels. Some of the factors cannot be changed but most can be modified. The factors are:

Those you cannot change-

■ Heredity. The amount of LDL cholesterol your body makes and how fast it is removed from your body is determined partly by genes. High blood cholesterol can run in families. However, very few people are stuck with a high cholesterol just by heredity -and everyone can take action to lower their cholesterol.

Furthermore, even if high cholesterol does not run in your family, you can still develop it. High cholesterol is a common condition among Americans, even young persons, and even those with no family history of it.

■ Age and sex. Blood cholesterol begins to rise around age 20 and continues to go up until about age 60 or 65. Before age 50, men’s total cholesterol levels tend to be higher than those of women of the same age-after age 50, the opposite happens. That’s because with menopause, women’s LDL levels often rise.

Those under your control-

■ Diet. Three nutrients in your diet make LDL levels rise:

  • Saturated fat, a type of fat found mostly in foods that come from animals;
  • Trans fat, found mostly in foods made with hydrogenated oils and fats such as stick margarine, crackers, and french fries; and
  • Cholesterol, which comes only from animal products.

But it’s important to know that saturated fat raises your LDL cholesterol level more than anything else in your diet. Diets with too much saturated fat, trans fat, and cholesterol are the main cause for high levels of blood cholesterol-a leading contributor to the high rate of heart attacks among Americans.

■ Overweight. Excess weight tends to increase your LDL level.

Also, it typically raises triglycerides, a fatty substance in the blood and in food, and lowers HDL. Losing the extra pounds may help lower your LDL and triglycerides, while raising your HDL.

■ Physical Inactivity. Being physically inactive contributes to overweight and can raise LDL and lower HDL. Regular physical activity can raise HDL and lower triglycerides, and can help you lose weight and, in that way, help lower your LDL.

Knowing Your Cholesterol Level

You can have high cholesterol and not realize it. Most of the 65 million Americans with high cholesterol have no symptoms. So it’s important to have your blood cholesterol levels checked. All adults age 20 and older should have their cholesterol levels checked at least once every 5 years. If you have elevated cholesterol levels, you’ll need to have it tested more often. Talk with your doctor to find out how often is best for you.

The recommended cholesterol test is called a “lipoprotein profile.”

It measures the levels of total cholesterol (which includes the cholesterol in all lipoproteins), LDL, HDL, and triglycerides. The lipoprotein profile is done after a 9- to 12-hour fast. A small sample of blood is taken from your finger or arm. If you don’t fast, you can still have your total cholesterol and HDL levels measured.

The levels are measured as milligrams of cholesterol per deciliter of blood, or mg/dL.

Setting Your Goal

The main goal in treating high cholesterol is to lower your LDL level. Studies have proven that lowering LDL can prevent heart attacks and reduce deaths from heart disease in both men and women. It can slow, stop, or even reverse the buildup of plaque.

It also can lower the cholesterol content in unstable plaques, making them more stable and less likely to burst and cause a heart attack.

Lowering LDL is especially important for those who already have heart disease or have had a heart attack-it will reduce the risk of another heart attack and can actually prolong life.

The level to which your LDL must be lowered depends on the risk for developing heart disease or having a heart attack that you are found to have at the start of treatment. The higher your risk, the lower your goal LDL level.

The TLC Program uses four categories of heart disease risk to set LDL goals and treatment steps.

The higher your risk category, the more important it is to lower your LDL and control any other heart disease risk factors (including smoking and high blood pressure) you have. Further, the higher your risk category, the more you’ll benefit from taking action. But whatever your risk category, you will use the TLC approach as a basic part of your treatment.

The TLC Path to Success

The TLC Program is a step-by-step way to lower your LDL cholesterol-and your heart disease risk. You’ll start the program by following a heart healthy diet and becoming physically active, in addition to controlling other risk factors for heart disease such as smoking and high blood pressure. As you continue with the program, you and your doctor will review your progress toward reaching your LDL goal and, if needed, add other treatment options. Throughout the program, you may seek the advice of a dietitian or other health professional.

A typical TLC path to success would be:

First Doctor Visit-Start Lifestyle Changes

Reduce saturated fat, trans fat, and cholesterol.

Increase physical activity moderately.

If overweight, reduce calories-increase fiber-rich foods to

help reduce calorie intake.

-Allow 6 weeks-

Second Doctor Visit-Check LDL and, If Needed, Add More

Dietary Approaches

Reinforce reduction of saturated fat, trans fat, and cholesterol.

Add plant stanols/sterols.

Increase soluble fiber.

-Allow 6 weeks-

Third Doctor Visit-Check LDL and, If Needed, Add Drug

Therapy

Start drug therapy for LDL lowering, if needed.

Focus on treatment of metabolic syndrome – reinforce weight management and physical activity.

-Every 4 to 6 months-

[Keep Checking Progress]

Working With Your Doctor- A Healthy Partnership

Your doctor is your partner in treating your high cholesterol. The better you communicate with your doctor, the better you’ll understand and carry out your treatment. This rule also applies to other health professionals who may join your treatment team, such as a dietitian or a physical activity specialist.

Here are some pointers on how to make your partnership work well:

Speak up. If you don’t understand something, ask questions.

Even if you think you know the answer, ask and be sure you

do. Ask for explanations in simple language.

Write it down. Be sure you write down any treatment instructions. If you have trouble hearing, take a friend with you to the visit.

Keep records. Record your test results at each visit.

Review your treatment. Use your visit as a chance to go over your treatment plan. Check your goals. Be sure you’re all in agreement over the next steps.

Be open. If your doctor or another health professional asks you questions, give full and honest answers.

Tell if you’re having trouble following the TLC Program.

Changes probably can be made so the program is easier for you to follow.

Tell any symptoms or side effects. If something causes a side effect, briefly say what the symptom is, when it started, how often it happens, and if it’s been getting worse.

The TLC Diet: A Heart Healthy Eating Plan

As noted earlier, what you eat greatly affects your blood cholesterol levels. That’s why a key step in your treatment is to adopt a heart healthy eating plan-one that’s low in saturated fat, trans fat, and cholesterol.

When you start on the TLC Program, you’ll be asked to make dietary changes and to become physically active. The TLC diet calls for you to have:

Less than 7 percent of your daily calories from saturated fat

Less than 200 mg a day of cholesterol

25-35 percent of daily calories from total fat (includes saturated fat calories)

Diet options you can use for more LDL lowering

2 grams per day of plant stanols or sterols

10-25 grams per day of soluble fiber

Only enough calories to reach or maintain a healthy weight

In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week.

This is not a temporary diet, but rather a new way of eating that is both heart healthy and tasty. The aim of the TLC diet is to help you eat healthier foods, cooked in healthier ways.

Saturated Fat

As noted earlier, saturated fat raises your blood cholesterol more than anything else in your diet. That can’t be stressed enough. You may read that trans fat raises cholesterol similarly to saturated fat, but it makes up far less of the American diet.

The average person eats much more saturated fat than trans fat-about 4 to 5 times more. In fact, it’s estimated that Americans eat an average of 11 percent of their total calories from saturated fat, compared with about 2.5 percent from trans fat.

It’s important to keep your saturated fat intake to less than 7 percent of your calories for the day.

Trans Fat

Trans fat-or trans fatty acids-is found mostly in foods that have been hydrogenated. Hydrogenation is a process in which hydrogen is added to unsaturated fat to make it more stable and solid at room temperature-and more saturated. Some trans fat also occurs naturally in animal fats, such as dairy

products and some meats.

When you consume more unsaturated fat, you still must be careful to reduce your intake of trans fat. Main sources are stick margarine, baked products such as crackers, cookies, doughnuts, and breads, and foods fried in hydrogenated shortening, such as french fries and chicken. Trans fat also may be in some unsuspected places, such as dietary supplements.

Soft margarines (tub and liquid) and vegetable oil spreads have lower amounts of trans fat than hard margarines. Some margarines are now free of trans fat.

A new Federal regulation requires the amount of trans fat in a product to be noted on the Nutrition Facts label of the food package by January 2006. Use the label to choose margarines and other food products that have the least amount of saturated fat and trans fat. If trans fat is not listed on a product’s Nutrition Facts label, check the ingredients list. Look for shortening or hydrogenated or partially hydrogenated vegetable oil-that often indicates the presence of trans fat. Keep your intake of trans fat low. Be aware that trans fat is not included in the less than 7 percent of calories you can have from saturated fat

There are types of unsaturated fat-monounsaturated and polyunsaturated. When used instead of saturated fat, monounsaturated and polyunsaturated fats help lower blood cholesterol levels. Monounsaturated fat is found in greatest amounts in foods from plants, including olive, canola, sunflower, and peanut oils. Polyunsaturated fat is found in greatest amounts in foods from plants, including safflower, sunflower, corn, soybean, and cottonseed oils, and many kinds of nuts.

Total Fat

Not all fats raise cholesterol-that’s why total fat is not itself a key target of your cholesterol-lowering treatment. But it’s important to watch your total fat intake for a couple of reasons: Fat is calorie-dense and, if you need to lose weight, limiting your intake of it can help. Many foods high in total fat also are high in saturated fat. So eating foods low in total fat will help you eat less saturated fat. When you do eat fat, make it unsaturated fat-either monounsatured (such as olive and canola oils) or polyunsaturated (such as safflower, sunflower, corn, and soybean oils).

Total fat intake on the TLC Program can be from 25-35 percent of daily calories to allow flexibility in putting together a diet that works for you.

[The Skinny on Fats]

Fat is a nutrient that helps the body function in various ways: For example, it supplies the body with energy. It also helps other nutrients work. But the body needs only small amounts of fat, and too much of the saturated type will increase cholesterol in the blood.

There are different types of fat, and they have different effects on cholesterol and heart disease risk. Here’s a quick rundown:

Saturated fat. This fat is usually solid at room and refrigerator temperatures. It is found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, and lard, as well as in some vegetable oils, including coconut and palm oils.

Studies show that too much saturated fat in the diet leads to higher LDL levels. Populations that tend to eat more saturated fat have higher cholesterol levels and more heart disease than those with lower intakes. Reducing the amount of saturated fat in your diet is a very effective way to lower LDL.

Unsaturated fat. This fat is usually liquid at room and refrigerator temperatures. Unsaturated fat occurs in vegetable oils, most nuts, olives, avocados, and fatty fish, such as salmon. A type of polyunsaturated fat is called omega-3 fatty acids, which are being studied to see if they help guard against heart disease. Good sources of omega-3 fatty acids are some fatty fish, such as salmon, tuna, and mackerel.

Trans fat. Also called trans fatty acids, it tends to raise blood cholesterol similarly to saturated fat. Trans fat is found mainly in foods made with hydrogenated vegetable oils, such as many hard margarines and shortenings. The harder the margarine or shortening, the more likely it is to contain more trans fat.

Total fat. This is the sum of saturated, trans, monounsaturated, and polyunsaturated fats in food. Foods have a varying mix of these types. The types of fat you eat have more to do with your LDL level than the total fat you take in.

[Sample Saturated Fat Intakes]

In the war against elevated blood cholesterol, your foremost foe is saturated fat. So the TLC Diet calls for you to have less than 7 percent of your daily calories from saturated fat. To help you follow that golden rule, here are some intakes for different daily calorie totals:

If you consume: Eat no more than:

Calories a day Saturated Fat*

1,200 – 8 grams

1,500 – 10 grams

1,800 – 12 grams

2,000 – 13 grams

2,500 – 17 grams

*Amounts shown are equal to about 6 percent of total calories.

Cholesterol

The cholesterol in your diet raises the cholesterol level in your blood-but not as much as saturated fat. However, the two often are found in the same foods. So by limiting your intake of foods rich in saturated fat, you’ll also help reduce your intake of cholesterol.

Dietary cholesterol comes only from foods of animal origin, such as liver and other organ meats; egg yolks (but not the whites, which have no cholesterol); shrimp; and whole milk dairy products, including butter, cream, and cheese.

Keep your dietary cholesterol to less than 200 milligrams a day.

Use the Nutrition Facts label on food products to help you choose items low in cholesterol.

Soluble Fiber

Fiber comes from plants. Your body can’t really digest it or absorb it into your bloodstream-your body isn’t nourished by it. But it is vital for your good health.

Foods high in fiber can help reduce your risk of heart disease. It’s also good for your digestive tract and for overall health. Further, eating foods rich in fiber can help you feel full on fewer calories, which makes it a good food choice if you need to lose weight.

There are two main types of fiber-insoluble and soluble (also called “viscous”). Both have health benefits but only soluble fiber reduces the risk of heart disease. It does that by helping to lower LDL cholesterol.

The difference between the two types is how they go through the digestive tract. Insoluble fiber goes through it largely undissolved. It’s also called “roughage” and helps the colon function properly. It’s found in many whole-grain foods, fruits (with the skins), vegetables, and legumes (such as dry beans and peas).

Soluble fiber dissolves into a gel-like substance in the intestines.

The substance helps to block cholesterol and fats from being absorbed through the wall of the intestines into the blood stream. Research shows that people who increased their soluble fiber intake by 5-10 grams each day had about a 5 percent drop in their LDL cholesterol. TLC recommends that you get at least 5-10 grams of soluble fiber a day-and, preferably,

10-25 grams a day, which will lower your LDL even more.

One caution: Increase the amount of fiber in your diet gradually, rather than all at once. A sudden increase in fiber can cause abdominal cramps or bloating.

Plant Stanols and Sterols

Plant stanols and sterols occur naturally in small amounts in many plants. Those used in food products are taken from soybean and tall pine-tree oils. When combined with a small amount of canola oil, the product is used in various foods.

As with soluble fiber, plant stanols and sterols help block the absorption of cholesterol from the digestive tract, which helps to lower LDL-without affecting HDL or triglycerides. Studies show that a daily intake of about 2 grams of either stanols or sterols reduces LDL cholesterol by about 5-15 percent-often within weeks.

Stanols and sterols are added to certain margarines and some other foods, such as a special type of orange juice. But remember that foods with stanols/sterols are not calorie-free. If you use these products, you may need to offset the calories by cutting back elsewhere.

Other Dietary Factors

The following dietary factors may not affect LDL levels but you should be aware of their relationship to heart health:

Omega-3 Fatty Acids-Omega-3 fats are found in some fatty fish and in some plant sources, such as walnuts, canola and soybean oils, and flaxseed. They do not affect LDL levels but may help protect the heart in other ways. In some studies, people who ate fish had a reduced death rate from heart disease. It is possible that this is related to the effects of omega-3 fats, which may help prevent blood clots from forming and inflammation from affecting artery walls. Omega-3 fats also may reduce the risk for heart rhythm problems and, at high doses, reduce triglyceride levels. Studies have suggested that omega-3 fats reduce the risk for heart attack and death from heart disease for those who already have heart disease.

Based on what is now known, try to have about two fish meals every week. Fish high in omega-3 fats are salmon, tuna (even canned), and mackerel. Pregnant women and nursing mothers should avoid some types of fish and eat types lower in mercury.

See the Web site www.cfsan.fda.gov/~dms/admehg3.html for more information.

Sodium-Studies have found that reducing the amount of sodium in your diet lowers blood pressure. High blood pressure is a major risk factor for heart disease.

Sodium is one component of table salt (sodium chloride). But it’s found in other forms too. So read food labels. Some low fat foods are high in sodium-use the label to choose the lower sodium options. Vegetables and fruits are naturally low in sodium-and low in saturated fat and calories.

Instead of using salt or added fat to make foods tastier, use spices and herbs

Alcohol-You may have heard that moderate drinking reduces the risk for heart disease. Small amounts of alcohol may help protect some persons.

However, drinking too much alcohol can have serious health consequences. It can damage the heart and liver, and contribute to both high blood pressure and high triglycerides.

If you don’t drink now, don’t start. If you do drink, have no more than one drink a day for women and two a day for men.

And don’t forget that alcohol has calories. If you need to lose weight, you will need to be especially careful about how many alcoholic beverages you drink.

Foods To Choose for TLC

The TLC diet encourages you to choose a variety of nutritious and tasty foods. Choose fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, poultry without the skin, and, in moderate amounts, lean meats.

A Word About Fruits and Vegetables

Eating more fruits and other low-fat foods is a good way to cut down on saturated fat. Fresh fruits offer great taste and variety- and, as a bonus, they require little or no preparation. Dried fruits can be carried with you, even in the car, and make a handy snack- try mixing raisins with nuts. One caution: If you’re watching your calories, you may need to limit your intake of dried fruits and nuts.

A serving of dried fruits is only 1/4 cup.

Eating more fruits and vegetables has another benefit too: It will make your diet richer in fiber, vitamins (such as the antioxidants C, E, and beta-carotene), and minerals. As a further plus, fresh fruits and vegetables are low in sodium.

What About Dessert?

The TLC diet lets you have moderate amounts of sweets and low saturated fat desserts.

Cooking With TLC

It’s not just what you eat but how you prepare food that matters. Click here for cooking tips.

Eating Out With TLC

You can eat out in restaurants and go to parties while on the TLC diet. Click here for tips for staying on TLC at restaurants and social events.

Becoming Physically Active

Becoming physically active is another key part of the TLC Program -it’s a step that has many benefits.

Lack of physical activity is a major risk factor for heart disease. It affects your risk of heart disease both on its own and by its effects on other major risk factors. Regular physical activity can help you manage your weight and, in that way, help lower your LDL. It also can help raise HDL and lower triglycerides, improve the fitness of your heart and lungs, and lower blood pressure. And it can reduce your risk for developing diabetes or, if you already have the condition, lessen your need for insulin.

You don’t have to run marathons to become physically active. In fact, if you haven’t been active, the key to success is starting slowly and gradually increasing your effort. For instance, start by taking a walk during breaks at work and gradually lengthen your walks or increase your pace.

If you have heart disease or high blood pressure, or if you are a man over 40 or a woman over 50 who is planning to be very active, youshould check with your doctor before starting your physical activity program.

Unless your doctor tells you otherwise, try to get at least 30 minutes of a moderate-intensity activity such as brisk walking on most, and preferably all, days of the week. You can do the activity all at once or break it up into shorter periods of at least 10 minutes each.

Moderate-intensity activities include playing golf (walking the course, instead of riding in a cart), dancing, bowling, bicycling (5 miles in 30 minutes), as well as gardening and house cleaning.

More intense activities include jogging, swimming, doing aerobics,or playing basketball, football, soccer, racquetball, or tennis.

Maintaining a Healthy Weight.

Being overweight or obese increases your chances for having high triglycerides, a low HDL, and a high LDL. You’re also more likely to develop high blood pressure, diabetes, heart disease, some cancers, and other serious health problems. If you have excess weight around your waist, you’re more likely to develop the metabolic syndrome – click here.

Losing your extra weight reduces these risks and improves your cholesterol and triglyceride levels.

If you are overweight and have a high cholesterol, you’ll need to get your LDL and your weight under control by changing your diet and increasing your physical activity. At the start of the TLC program, your main focus will be on lowering LDL toward the goal level by making changes such as reducing saturated fat and calories and increasing fiber, which could also help you lose weight.

After about 2-3 months of TLC, if you are still overweight, you may need to focus additional attention on losing weight as you approach your LDL goal, especially if you have the metabolic syndrome. Click here for more on metabolic syndrome.

Finding out if you need to lose weight involves a two-step process:

First, your doctor may already have checked your body mass index, or BMI, which relates your weight to your height.  A BMI of 18.5-24.9 indicates a normal weight; a BMI of 25-29.9 is overweight; while a BMI of 30 or higher is obese. You can easily check your BMI on this page!

Second, your doctor may have taken your waist measurement.

A waist measurement of 35 inches or more for women or 40 inches or more for men is one of the factors involved in the metabolic syndrome. Click here for more. It also indicates an increased risk of obesity-related conditions, such as heart disease.

Check with your doctor and find out what a healthy weight is for you. If you need to lose pounds, do so gradually-a reasonable and safe weight loss is 1 to 2 pounds a week. You don’t have to reach your ideal weight to reap health benefits. If you are overweight, losing even 10 percent of your current weight lowers your risk for heart disease and other health problems.

Follow the TLC diet, watch your calorie intake, and increase your physical activity. The TLC diet is low in saturated fat and cholesterol- which fights heart disease-and calls for only enough calories for you to reach or maintain a healthy weight. If you need to lose weight, you’ll have to take in fewer calories than you burn-this includes calories used by the body in normal functions and in physical activities. To lose 1 pound a week, you need to eat 500 fewer calories a day than you use up. In general, eating plans containing 1,000-1,200 calories will help most women lose weight safely, while eating plans with 1,200-1,600 calories a day are suitable for men. Click here for tips on how to reduce your calorie intake. If you need to lose weight, be aware that low fat and low calorie are not the same. This confusion may lead you to overeat when you eat low-fat because you may think you’re getting a calorie-free ride.

Unfortunately, there are no such rides. To be sure you avoid this error, use the food label to compare products’ calorie totals. Another thing to keep an eye on is portion size. Studies show that portion sizes at restaurants and at home have gotten bigger in the past couple of decades. And most people eat what’s on their plate.

But portion size is not the same as serving size. A portion is the amount of a food you choose to eat at one sitting. A serving is a measure used to describe the amount of food recommended from each food group, and the size of a serving is shown on the Nutrition

Facts label on the food package. Be sure to read the food label to learn how many servings are in a product-some items may appear to be sold as single portions but actually have more than one serving. Click here for a guide to serving sizes. One trick to shrink your portion size at home is to use smaller plates. In a restaurant, try sharing the meal or taking part of it home.

You may want to talk with your doctor about getting help to lose weight. Various resources are available, including dietitians, who can help you better plan meals, and organized weight loss programs. Click here for tips on how to choose a weight loss program.

The Metabolic Syndrome – A Special Concern

If you have the metabolic syndrome, you have an increased risk for heart disease. The syndrome isn’t a disease itself but a cluster of risk factors for heart disease and other disorders, such as diabetes. One risk factor alone increases your chance of developing heart disease-having a group of them boosts your risk more. This is true even though some of the factors in the metabolic syndrome may be at levels below those for full-fledged heart disease risk factors. In fact, research indicates that having the metabolic syndrome can raise your chance of developing heart disease and diabetes even if your LDL cholesterol isn’t elevated.

Heredity can play a role in whether a person develops the metabolic syndrome, but its underlying causes are abdominal obesity-too large a waist-and physical inactivity. The metabolic syndrome also is related to a condition called “insulin resistance”- which can lead to diabetes.

Insulin is a hormone that helps your body convert glucose (sugar) in the blood into energy. With insulin resistance, the body cannot properly use the insulin it produces. As more and more Americans have become obese in recent years, the problem of metabolic syndrome has become more widespread. Today about one-quarter of all adults in the United States have the metabolic syndrome. If you have three or more of the following factors, you have the metabolic syndrome:

  • Large waist measurement-35 inches or more for women,

40 inches or more for men (this is also one of the measurements that determine if you need to lose weight)

  • Triglyceride level of 150 mg/dL or higher
  • HDL cholesterol of less than 50 mg/dL in women, less than 40 mg/dL in men
  • Blood pressure of 130/85 mmHg or higher (either number counts as a raised blood pressure)
  • Fasting blood sugar of 100 mg/dL or higher

If you have the metabolic syndrome, it is especially important for you to follow the TLC Program. Lifestyle changes are the main treatment for metabolic syndrome. TLC can help you reverse or reduce all of the metabolic syndrome’s risk factors, which will reduce your risk of developing heart disease and diabetes.

Your first goal is to move toward getting your LDL under control.

Then you’ll focus on the risk factors of the metabolic syndrome.

The key parts of the TLC Program for treating the metabolic syndrome are:

  • Achieve a healthy weight
  • Become physically active
  • Follow the TLC diet

As was said earlier, the TLC diet calls for total fat to be 25-35 percent of the day’s calories. Some experts recommend that people with the metabolic syndrome should aim for the higher end of this range- about 35 percent of calories from total fat. This is meant to keep carbohydrate consumption from being too high, which could further raise triglycerides and lower HDL. Other experts hold that, since weight loss is so important for treating the metabolic syndrome risk factors, a diet with less fat could be right for you if it helps you lose weight. Whichever diet you follow, remember to choose complex carbohydrates rather than simple sugars.

There are a couple of added points. First, if you have the metabolic syndrome and drink alcoholic beverages, it’s doubly important to do so only in moderation. Drinking too many alcoholic beverages increases the risk for elevated triglycerides and high blood pressure. Further, alcoholic beverages add extra calories. So drinking too much also can add pounds. Click here for what “moderate drinking” means.

Second, the “don’t smoke” advice that goes for everyone applies especially to you if you have the metabolic syndrome. Smoking tends to raise triglycerides and lower HDL. If you smoke, quitting can help reduce your triglyceride level and raise your HDL.

If lifestyle changes do not sufficiently control the metabolic syndrome risk factors, then drug therapy may be needed to manage one or more of them. For instance, you may need medication to treat high blood pressure, or elevated triglycerides and low HDL. Aspirin also may be prescribed to help prevent blood clots.

All of these actions will help reduce your risk for heart disease.

Learning to Live the TLC Way

Making lifestyle changes is never easy. But as you adopt the TLC Program, keep your key goal in mind: Living healthier and longer by lowering your cholesterol and other risk factors and reducing your risk for heart disease.

This section offers guidance on how to make the needed lifestyle changes. It also will describe how you can follow the TLC Program with your family and friends. In fact, your family and friends also can benefit from the program-it’s never too early or too late to learn a heart healthy lifestyle. The key difference between your efforts and theirs is that yours must be more intense because you need to reverse high cholesterol and/or other risk factors, not merely prevent them.

Also, remember to work closely with your doctor, dietitian, or other health care providers. Make them valuable members of your heart health improvement team. They can help you learn how to eat healthy, satisfying meals, find a weight loss program, or do physical activities safely and effectively.

Keeping Track of Your Changes

A good way to begin making changes is to start a TLC diary. This can be a diary of what you eat each day and other information, such as your physical activity and, if you need to lose pounds, your weight. You can copy it to record what you eat and what physical activity you do. But all it takes is a small notebook. Use the diary before you start on TLC to see what you need to change, and while on TLC to see how you are doing. Diaries help you keep on course and give you a boost by tracking your progress. A diary also can help your doctor, dietitian, or other health professional assess your progress. If you are walking for physical activity, a pedometer is a good way to keep track of your progress. It tells you how many steps you’ve taken, so you can set a goal to increase your activity. Record your progress in your TLC diary.

Be SMART When You Start

When you start making changes, try using the “SMART” approach.

Whether it’s reducing saturated fat, adding more fruits and vegetables to your meals, losing excess weight, or becoming more physically active-it’s hard to change behaviors. But knowing how to approach a change helps make the change possible. And that’s what the “SMART” approach does. It sets you up for success. Using this method, you set goals that are Specific, Measured, Appropriate,

Realistic, and Time-bound.

Start by setting specific goals. For instance, if you need to increase your physical activity, saying you’ll “do more now and then” is vague. It’s hard to achieve a vague goal. But be sure the goal is also appropriate and realistic. For example, if you’re not physically active, saying you’ll walk 3 miles a day may be too much just yet.

Instead, saying you’ll walk an extra 2,000 steps a day gives you a specific aim-one that can be measured (using a pedometer), so you know when you succeed-and one that is also realistic. Nothing succeeds like success-so program yourself to be a winner.

Another key aspect of the SMART approach is to use those realistic, smaller steps to lead you toward your larger goal. For instance, if you’re trying to switch from whole milk to fat-free milk, start by drinking 2-percent milk. Then, when you’ve achieved that change, move to 1-percent milk, and finally to fat-free milk. With this approach, you should stay motivated to make the entire journey.

Reward Yourself

Be sure to reward yourself for the progress you’ve made on TLC- but not with food. As you start a new goal, offer yourself a promise such as, “If I reach my goal this (day, week, month), I will treat myself to a well deserved (fill in a nonfood reward).” Think of something you want, such as a CD, a movie, or a massage. Or put down a deposit on a larger reward.

Making TLC a Family Affair

It’s a good idea to talk about your plans for TLC with your spouse, family, or friends-whoever can provide support or needs to understand why you’re changing your habits. They may even be able to help in concrete ways. For example, your spouse can help you plan heart healthier meals. In fact, you can follow the TLC program with your family.

You can follow the TLC diet without making separate meals for you and the rest of your family. The main difference between your diet and your family’s is that yours has a lower intake of saturated fat and cholesterol than theirs. So you’ll just eat less saturated fat and cholesterol than they do, or smaller portions.

How does this work at mealtimes? One approach is to use “add on’s”-heart healthy sauces or foods that can be added to dishes so others can meet their nutrition goals while you keep to yours.

Make salads and let everyone choose how much to add of nuts, seeds, raisins, or fruit. Put low-fat salad dressing and sauces on the side so others can have them.

Portion size is another way to share meals but remain on your TLC diet. Take less of the main course, such as meat, and more of the side dishes, such as vegetables.

At breakfast, top a whole grain English muffin with sugar-free preserves or jams, while others have a regular topping.

Family time should not mean only food. Physical activities also can be done with family or friends. Walking with your family or a friend can be fun-buddying-up can keep the activity from becoming dull. You’ll also be sharing the heart health benefits.

Get your spouse to join a dance class with you. Invite your spouse or child or friend to play tennis with you regularly. Join a hiking or biking club. Start a softball team with family, neighbors, friends, or coworkers. Your family and friends may have other ideas too.

Ask them and then get moving.

A Final Note

The TLC Program is a new way of living, not just a quick fix. So don’t worry if you slip now and then. Don’t let a slip keep you from reaching your health goals. Click here for advice about how to get back on track if you slip.

The biggest step is getting started. After that, take encouragement from your progress, and you’ll reach your goal-a lifetime of heart health.

Content Created/Medically Reviewed by our Expert Doctors

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