Cholesterol & Nutrition: TLC


Bringing the Science to your Dinner Table

The National Heart, Lung and Blood Institute's National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) guidelines for cholesterol reduction include the latest information known to date on how to optimally reduce your risk for coronary heart disease.

It is estimated that millions of people are at much greater risk for heart disease than previously realized. This means more and more people will be walking away from their doctor’s office with a cholesterol-lowering drug prescription in hand (it is estimated prescription drug needs will increase from 13 to 36 million). Medications aside, what these new guidelines also so vividly illustrate is the growing epidemic of poor dietary habits, obesity, hypertension, hyperlipidemia and sedentary lifestyles that lead to the number one killer in America today.

Because of this the ATP intensified the use of nutrition, physical activity and weight control in the treatment of elevated cholesterol and titled it the "Therapeutic Lifestyle Changes" (TLC) treatment plan. Even if you come out with a gold star on your cholesterol level and overall risk for coronary heart disease, most of us would surely benefit from implementing these guidelines.

The following table can help you implement the guidelines into practical terms you and your family can enjoy and reap heart-healthy benefits:

Feeding your heart well is a powerful way to reduce your risk for heart and vascular disease.

Your doctor may have prescribed that you start eating a healthy diet, however, knowing what foods fit into a healthy diet can often be difficult and overwhelming.

To get you started, we have listed The National Heart, Lung and Blood Institute's National Cholesterol Education Program (NCEP) guidelines for cholesterol reduction, called Therapeutic Lifestyle Changes (TLC).

These new guidelines introduce the latest information known to date on how to optimally reduce your risk for coronary heart disease.

New TLC Guidelines

Saturated Fat – Less Than 7% of Total Calories

  • Why? What does this mean? Diets high in saturated fats are linked to increased risk of coronary heart disease. Saturated fats are thought to have the most potent cholesterol raising potential.
  • Examples: Fatty cuts of meat, skin on poultry, egg yolks, lard, butter, whole milk dairy products, palm kernel oil, palm oil, coconut oil, desserts and sweets, fried foods and most snack foods and fast foods made with hydrogenated or partially hydrogenated fats. These fats are generally solid at room temperature.

Trans Fat - As Little As Possible

  • Why? What does this mean? Trans fatty acids are formed when a liquid fat is turned into a solid one; a process called hydrogenation. Research indicates that trans fat have the same cholesterol-raising effect that saturated fats do. Therefore we recommend keeping your trans fat intake as low as possible.
  • Examples: To keep your trans fat intake down, limit foods with the following ingredients: partially hydrogenated oil, hydrogenated oil, stick margarine and shortening. Limit your intake of fried foods, cakes, pies and other foods containing the above. Foods containing trans fat are also solid at room temperature.

Polyunsaturated Fat – Up to 10% of Total Calories

  • Why? What does this mean? Diets moderate in polyunsaturated fats are generally recommended. Substituting polyunsaturated fats for saturated fats will reduce both total and LDL (bad cholesterol) but do have the potential to also lower HDL (good cholesterol) levels when consumed in large amounts. That is why they should be consumed to no more than 10% of total calories each day.
  • Examples: Margarine, soybean, safflower, sunflower, cottonseed and corn oils, pumpkin and sunflower seeds, most salad dressings and mayonnaise. These fats stay liquid at room and refrigerator temperatures.

Monounsaturated Fat – Up to 20% of Total Calories

  • Examples: Olive and canola oils, nuts, nut butters and oils (e.g. peanut butter, almond oil), avocados and olives. These fats stay liquid at room temperature but solidify slightly when placed in the refrigerator.

Dietary Cholesterol – less than 200 milligrams each day

  • Why? What does this mean? Excesses in dietary cholesterol have been linked to increases in coronary heart disease. Consuming less than 200 milligrams per day is a prudent attempt at lowering your risk.
  • Examples: Cholesterol comes from two sources – that which your body creates and that which is found in animal products (meat, poultry, fish, egg yolks and dairy contain dietary cholesterol). Choose reduced fat or lean sources of animal products to help reduce your dietary cholesterol intake.

Carbohydrates – 50% - 60% of Total Calories

  • Why? What does this mean? Carbohydrates are the building blocks of a heart-healthy diet. Choose complex carbohydrates (instead of refined ones with white flour) to get the maximum nutritional benefit from these foods.
  • Examples: Whole grain or oat based breads, crackers, pastas and cereals, other whole wheat/grain based flour products; brown or wild rice; couscous, quinoa, barley, buckwheat; lentils, split peas and beans; fruits and vegetables.

Fiber – 20-30 Grams Per Day

  • Why? What does this mean? Dietary fiber, specifically the viscous (soluble) form, is associated with a decrease in cholesterol and contributes to a host of other health benefits.
  • Examples: All of the above complex carbohydrate food sources. Aim for a minimum of 10 or more grams of viscous (soluble) fiber each day by increasing oats, barley, lentils, split peas, beans, fruits and vegetables. Aim for 8 or more servings from fruits and vegetables daily, eat legumes like beans or lentils at least 3 times a week and choose only unrefined flour based products.

Protein – Approximately 20% of Total Calories

  • Why? What does this mean? Dietary protein can come from both plant and animal sources and is an essential nutrient to good health. The problem is, many protein sources (especially animal sources) contain a lot of saturated fat and cholesterol so choose your protein sources wisely.
  • Examples: Major sources of protein in the diet: beef, veal, pork, fish, chicken, legumes like lentils and beans, dairy products, nuts, seeds and soy foods.

Total Calories – Balance Energy Intake with Output to Achieve or Maintain a Desirable Body Weight

  • Why? What does this mean? Excessive calories, regardless of the source, results in weight gain. Excessive weight gain over time can result in obesity, diabetes, hyperlipidemia, hypertension, joint problems and a host of other debilitating diseases including heart disease.
  • Examples: Aim to consume 4-6 small meals and snacks daily. Avoid skipping meals and eating late at night for optimal weight maintenance.

Margarine Enriched Plant Sterol/Stanol Esters

  • Why? What does this mean? Plant sterols are substances naturally occurring in plants. They are similar in structure to the cholesterol molecule and when ingested, inhibit the cholesterol molecule from being absorbed in the small intestine, resulting in a net decrease in overall cholesterol.
  • Examples: The NCEP recommend incorporating margarine enriched with stanols as an enhancement to therapy prescribed by your physician, NOT as a replacement for diet, lifestyle change or prescribed lipid-lowering medications. Currently, two stanols are available on the market- Benecol® and Take Control©.

Incorporating the Guidelines into Your Family's Hectic Lifestyle

You may wonder how you can incorporate these guidelines into your and your family's hectic lifestyle. Take the following steps one day at a time. Focus first on the foods in your diet that are high in saturated fat and cholesterol. Start making simple substitutions for saturated fats with mono and polyunsaturated fats. Couple these with a focus on fruits, vegetables and whole grains, some physical activity and you are well on your way towards reaching your nutritional goals.

Below is an example of how the TLC guidelines would be implemented for someone on a 1,800-calorie diet. You may require more or fewer calories for weight loss or maintenance. See your registered dietitian or physician for more information on your caloric needs.

Sample 1800 calorie diet


½ cup cooked oatmeal
½ cup fresh blueberries
½ cup skim milk
1 slice whole wheat toast
1 Tbsp. natural peanut butter


8 oz. nonfat yogurt
1 medium apple


2 oz grilled chicken breast, sliced
2 cups mixed greens with ¼ cup diced red and yellow peppers, ¼ cup diced red onion, 6 cherry tomatoes, 5 slices of cucumber, 1 Tbsp. grated Parmesan cheese, 2 tsp. extra virgin olive oil, 1 Tbsp. balsamic vinegar
1 cup vegetable soup
1 medium pear


Nature Valley® Heart Wise granola bar


3 oz. Atlantic salmon fillet, broiled
1 cup brown rice
1 cup steamed broccoli
1 Tbsp light trans-free Take Control spread
4 oz. nonfat chocolate pudding

Nutritional Analysis:

Calories 1,750
Total fat 54g, 27% of calories
Saturated fat 9g, 5% of calories
Cholesterol 110mg
Sodium 2,480mg
Total carbohydrate 246g, 55% of calories
Dietary fiber 32g
Protein 85g, 19% of calories


More Information

A new browser window will open with this link.

The inclusion of links to other websites does not imply any endorsement of the material on those websites nor any association with their operators.

Reviewed by a Cleveland Clinic medical professional.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy