High Cholesterol

Eating a sensible diet low in saturated fat, trans fat, and cholesterol, getting moderate exercise, and losing excess weight are important ways you can lower your high cholesterol level. For many people, these lifestyle changes may be all that is needed to decrease LDL cholesterol and raise HDL cholesterol.

If high cholesterol runs in your family, you may not be able to reduce your cholesterol level by following a strict diet and exercise routine only. In this case, you may need to take medicine.

As part of the treatment for high cholesterol, your doctor may recommend using the Therapeutic Lifestyle Changes (TLC) recommended by the National Cholesterol Education Program of the U.S. National Institutes of Health.

These lifestyle changes recommend:

• Following the TLC cholesterol-lowering diet.
• Getting plenty of exercise.
• Losing weight, if needed.

The TLC diet is low in saturated fat and cholesterol. Less than 7% of your daily calories should come from saturated fat, and you should limit your cholesterol to no more than 200 milligrams a day.

Saturated fat and cholesterol are in foods that come from animals, such as meats, poultry, fish, whole milk, egg yolks, butter, and cheese. Trans fat is found in fried foods and packaged foods, such as cookies, crackers, and chips.

The TLC plan also recommends increasing the amount of fiber you eat and adding plant stanols and sterols to your diet.

Plant sterols are found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, and other plant sources. Plant stanols come from some of the same sources. Vegetable oils, for example, contain both plant sterols and plant stanols. You can also find them in some salad dressings and margarines, such as Benecol and Take Control. They are safe for children who have genetic high cholesterol, but pregnant women need to avoid them.

For more information about the TLC diet, see:

• Nutrient composition of the TLC diet.
• Tips for success with the TLC diet.
• Sample menu for the TLC diet.

You might also consider following the Mediterranean diet, which is similar to the TLC diet. On the Mediterranean diet, an average of 35% of calories can come from fat, mainly from unsaturated oils, such as fish oils, olive oil, and certain nut or seed oils (such as canola, soybean, or flaxseed oil).

See the following for more information about food and high cholesterol:

• Meat and the low-fat diet
• Soy protein
• Fiber
• Fish and fish oil
• Antioxidants, flavonoids, and red wine
• Cholesterol-lowering margarines
• How fats affect cholesterol levels
• Foods to avoid

Not recommended for reducing cholesterol

• Garlic. Studies have shown that eating lots of garlic or taking garlic supplements does not effectively lower cholesterol levels. Eating too much garlic can have side effects, including allergic reaction, gas (flatulence), heartburn, garlic odor from the skin, interference with some drugs, and longer blood-clotting time.
• Very low-fat diets. Although very low-fat diets may indeed lower cholesterol levels, they are not recommended. Very low-fat diets usually allow less than 15% of total calories from fat. In comparison, a cholesterol-reducing diet allows 25% to 35% of calories to come from total fat, with 7% from saturated fat. A diet with less than 25% of its calories from fat can increase triglycerides and decrease HDL (good) cholesterol. Such a diet may deplete your body of other important nutrients and vitamins.
• Policosanol. Policosanol, which is made from sugar cane, has not been shown to lower cholesterol.⁶