Cholesterol-Lowering Diet Plans

The American Heart Association recommends a step-wise approach to lowering cholesterol levels.

The Step I Diet

If you have high blood cholesterol and have not tried other dietary approaches, the Step I diet is the place to start:

• Total fat intake should be no more than 30% of calories.

• Saturated fat (the kind that is solid at room temperature) intake should be less than 10% of calories.

• Polyunsaturated fat (liquid at room and refrigerator temperatures) intake should be 8% to 10% of calories.

• Monounsaturated fat (olive and canola oil) intake should make up the rest of total fat intake (about 10% to 15% of total calories).

• Cholesterol intake should be less than 300 milligrams daily.

• Sodium intake should be no more than 2,400 milligrams daily.

The Step II Diet

If you have already been on a diet similar to the Step I diet without enough improvement in your blood cholesterol levels, or if you have existing heart disease, you should follow the more aggressive Step II dietary recommendations. The Step II dietary recommendations as the same as Step I, but further restrict saturated fat and cholesterol intake:

• Saturated fat intake should be less than 7% of calories.

• Cholesterol intake should be less than 200 milligrams daily.

• Calorie intake should be just enough to maintain a healthy body weight.

Very-Low-Fat Diets

Some experts advocate diets that are extremely low in fat for people with severe heart disease or those who do not respond to the Step II diet and do not wish to take cholesterol-lowering drugs. Such diets can contain as little as 18% to 26% of calories from fat, which in practical terms means eliminating almost all meats, dairy products, and added fats.

One of the problems with such extreme diets, however, is that they may be difficult to follow over the long-term. Some experts question whether such drastic reductions in fat intake are necessary, and suggest that very-low-fat diets could raise blood triglyceride levels because of their high carbohydrate content.

The Ornish Program is an example of a very-low-fat diet program that combines dietary approaches with stress reduction and exercise. Research suggests that the intensive Ornish Program can reverse the artery-clogging build up of cholesterol and other substances in people who already have existing heart disease.

Mediterranean Diet

People in Mediterranean regions such as Greece and Southern Italy have a very low incidence of heart disease. Experts think one reason for this low incidence might be the traditional Mediterranean diet, which includes generous amounts of whole grains, fruits, vegetables, legumes (dried beans and peas), red wine, and fish, with only occasional and small servings of red meats.

The Mediterranean diet includes a more liberal 25% to 35% of calories as fat, provided mainly in the form of olive oil, which is rich in monounsaturated fat.

The Mediterranean diet has been shown to lower total cholesterol levels and raise levels of the helpful HDL cholesterol. For some people, the Mediterranean diet may be more palatable and easier to stay on long-term compared with very low fat diets. However, since it allows a more liberal fat intake, some people may get more calories than they need, and gaining weight would erase any healthful effects of the diet.