So You Have High Blood Cholesterol...
From the National Institutes of Health

Three Steps to Reducing High Blood Cholesterol Levels

1. Follow the Step I or Step II diet.Your doctor will first recommend one or the other. The diets contain all the daily nutrients you need and emphasize eating foods that are low in saturated fat, total fat , and cholesterol, and high in starch and fiber. You will probably be asked to follow the Step I diet first to see if it brings your blood cholesterol levels down sufficiently. If not, you may have to move to the Step II diet. If you already have coronary heart disease or a very high LDL level, your doctor may recommend starting with the Step II diet.

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2. Be more physically active.

3. Lose weight if you are overweight.

Fortunately, these three steps work together. For example:

• Eating less fat, especially saturated fat, also may help you decrease the amount of cholesterol and calories you eat. Why? Foods high in fat and saturated fat are high in calories and often high in cholesterol. In fact, all fats both saturated and unsaturated fat have more than twice as many calories as either carbohydrate or protein. They provide 9 calories per gram and the other two provide 4 calories per gram.
• Being more physically active helps burn more calories which helps in weight loss. It may also help you lower your LDL- cholesterol and raise your HDL-cholesterol, as well as improve the health of your heart and lungs.
• Losing excess weight if you are overweight can help lower your LDL-cholesterol and increase your HDL-cholesterol.

How Low Will You Go?

By closely following your diet , being more physically active, and watching your progress with regular checkups,you can lower your blood cholesterol level. How much your cholesterol levels change depends on:

• How much fat, especially saturated fat, and how much cholesterol you ate before you changed your diet;
• How closely you follow the changes; and
• How your body responds to these changes. Usually the higher your blood cholesterol is to begin with, the more the levels go down. However, sometimes due to heredity, levels will not change enough no matter how well you change your habits.

For example: Your total blood cholesterol level is 240 mg/dL, and you are eating a diet high in saturated fat and cholesterol. By going on the Step I diet, you could reduce your cholesterol level by 5-35 mg/dL; and 5-15 mg/dL more, if you then go on Step II. Over time, you may reduce your cholesterol level by 10-50 mg/dL or even more. This drop will slow the fatty buildup in your arteries and reduce your risk of illness and death from heart attack. In fact, studies have shown that, in adults with high blood cholesterol levels, for each 1 percent reduction in total cholesterol levels, there is a 2 percent reduction in the risk of heart attack. So if you reduce your cholesterol level by 10 percent (for example, from 240 mg/dL to 216 mg/dL), your risk of heart disease could drop by 20 percent. And many people will get even more of a drop in their cholesterol level.

1. Learn About the Step I and Step II Diets

STEP I DIET

On the Step I diet, you should eat:

8-10 percent of the day's total calories from saturated fat. 30 percent or less of the day's total calories from fat. Less than 300 milligrams of dietary cholesterol a day. Just enough calories to achieve and maintain a healthy weight. (You may want to ask your doctor or registered dietitian what is a reasonable calorie level for you.)

STEP II DIET

On the Step II diet, you should eat:

Less than 7 percent of the day's total calories from saturated fat. 30 percent or less of the day's total calories from fat. Less than 200 milligrams of dietary cholesterol a day. Just enough calories to achieve and maintain a healthy weight. (You may want to ask your doctor or registered dietitian what is a reasonable calorie level for you.)

Practical Ways to Change Your Diet

Here are some tips on how to choose foods for the Step I and Step II diets. For more help, write. for Step by Step: Eating To Lower Your High Blood Cholesterol (see Get More Information page).

To cut back on saturated fats, choose:

• Poultry, fish, and lean cuts of meat more often. Remove the skin from chicken and trim the fat from meat.
• Skim or 1 percent milk, instead of 2 percent or whole milk.
• Cheeses with no more than 3 grams of fat per ounce (these include low-fat cottage cheese or other low-fat cheeses). Cut down on full-fat processed, natural, and hard cheeses(like American, brie, and cheddar).
• Liquid vegetable oils that are high in unsaturated fat (these include canola, corn, olive, and safflower oil). Use tub or liquid margarines that list liquid vegetable oil as the first ingredient (instead of lard and hydrogenated vegetable shortening which are high in saturated fat). Choose products that are lowest in saturated fat on the label.
• Fewer commercially prepared and processed foods made with saturated or hydrogenated fats or oils (like cakes, cookies, and crackers). Read food labels to choose products low in saturated fats.
• Foods high in starch and fiber, instead of foods high in saturated fats.

Cutting back on saturated fat helps you to control dietary cholesterol as well. Two additional points to remember when cutting back on dietary cholesterol are:

• Eating less organ meat (such as liver, brain, and kidney).
• Eat fewer egg yolks as whole eggs or in prepared foods (try substituting two eggs whites for each whole egg in recipes, or using an egg substitute).

To included more foods high in starch and fiber, choose:

• More whole grain breads and cereals, pasta, rice, and dry peas and beans.
• More vegetables and fruits.
• Foods high in starch and fiber, instead of foods high in saturated fats.

2. Make Physical Activity Work for You

Regular physical activity by itself may help reduce deaths from heart disease by:

• lowering LDL levels
• raising HDL levels
• lowering high blood pressure
• lowering triglyceride levels
• reducing excess weight
• improving the fitness of your heart and lungs

If you have been inactive for a long time, start with low-to- moderate level activities such as walking, taking the stairs instead of the elevator, gardening, housework, dancing, or exercising at home. Begin by doing the activity for a few minutes most days, then work up to a longer programat least 30 minutes per day, 3 or 4 days a week This can include regular aerobic activities such as brisk walking, jogging, swimming, bicycling, or playing tennis.

If you have heart disease or have had a heart attack, talk with your doctor before starting an activity to be sure you are following a safe program that works for you. Otherwise you may experience chest pain or further heart damage. If you have chest pain, feel faint or light-headed, or become extremely out of breath while exercising, stop the activity at once and tell your doctor as soon as possible.

3. Lose Weight If You Are Overweight

Two action steps are key.

• Eat fewer calories (cutting back on the fat you eat will really help).
• Burn more calories by becoming more physically active.

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