If you're one of the nearly 65 million Americans with high blood cholesterol, National Cholesterol Education Month (September) is a perfect time to read a new publication designed to help you make the lifestyle changes needed to reduce cholesterol and, with it, your risk for heart disease.

Your Guide to Lowering Your Cholesterol with TLC (Therapeutic Lifestyle Changes) from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health details a three-part program of diet, physical activity, and weight management designed to bring cholesterol levels down.

“Lifestyle is crucial for lowering cholesterol but it’s not enough to tell people it’s important – you have to help them do it. This guide offers a set of tools to help people get started and to embrace a heart-healthier way of living,” said the NHLBI’s James Cleeman, M.D., coordinator of the National Cholesterol Education Program (NCEP).

The 80-page easy-to-read booklet is based on the NCEP’s guidelines on cholesterol management. These guidelines emphasize the importance of therapeutic lifestyle changes (TLC) — intensive use of heart-healthy eating, physical activity, and weight control — for cholesterol management. TLC is the cornerstone of treatment, according to Cleeman, even if someone also has to take a cholesterol-lowering medication.

As the booklet explains, following a TLC diet means reducing saturated fat, trans fat, and cholesterol in order to lower LDL, the “bad” cholesterol. How do you know how low your LDL cholesterol should be? Your goal LDL level is determined by your risk for developing heart disease or having a heart attack. To help you determine your risk, the new guide includes the NCEP 10-year coronary heart disease risk calculator. Once your LDL goal is determined, you and your doctor can use the new booklet to implement TLC and reach your goal.

To help reduce saturated fat, trans fat, and dietary cholesterol, the guide offers tips on choosing and preparing low fat meals, selecting healthy snacks, reading nutrition labels, and dining out while staying on the TLC diet. The booklet includes sample menus for different types of cuisine (traditional American, Southern, Mexican-American, and Asian).

The LDL-lowering power of the TLC diet can be boosted by adding soluble fiber and plant stanols and sterols, substances derived from plants that help block cholesterol absorption. The guide suggests ways to add fiber to the diet and discusses the value of plant stanols and sterols and which food products have them.

In addition to what you eat, how much you move is also important for heart health. Lack of physical activity is an important risk factor for heart disease. Inactivity contributes to weight gain and raises LDL as well as lowering HDL, the “good” cholesterol. The booklet offers a step-by-step program to get people moving and includes a chart of calories burned in common activities.

Overweight and obesity increase a person’s LDL level and can also raise triglycerides and lower HDL. To help people lose those extra pounds, the guide includes calorie-cutting strategies, ideas for substituting lower calorie foods for high calorie favorites, and a handy chart of portion sizes based on NHLBI’s Portion Distortion Interactive Quiz: http://hin.nhlbi.nih.gov/portion/. There are also sample menus for TLC at different calorie levels.

A special section of the booklet is devoted to the metabolic syndrome, a cluster of risk factors for heart disease and diabetes that is associated with obesity and overweight. Having one risk factor increases a person’s risk of heart disease, but having several as in metabolic syndrome increases risk even more. The lifestyle changes recommended in the TLC program — especially weight control and physical activity – are the main treatment for metabolic syndrome.

The last chapter of the guide, Learning to Live the TLC Way, offers suggestions for how to make the needed lifestyle changes — and get back on track if you fall off the program. A key strategy is to follow TLC with family and friends. Those closest to you can provide support – and help you plan heart healthy meals and physical activities. They can also benefit as the program can help them prevent high cholesterol and/or other risk factors.

“TLC is more than a diet. It’s really a change in your way of living to help you stay heart healthy,” said Dr. Cleeman.

The new guide is the latest in the NHLBI Your Guide to Better Health series. The series provides easy-to-read science-based health information and features compelling testimonials from people about their real-life health issues. Other Guides include Your Guide to Lowering Your Blood Pressure With DASH; Your Guide to a Healthy Heart; Your Guide to Physical Activity and Your Heart; Your Guide to Living Well With Heart Disease; and Your Guide to Healthy Sleep

To interview Dr. Cleeman about cholesterol, heart disease prevention, and the TLC diet, contact the NHLBI Communications Office at 301-496-4236. For an online version of the new booklet, go to: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.htm. Printed copies are available for $4.00 through the NHLBI website or from the NHLBI Information Center at P.O. Box 30105, Bethesda, MD 20824-0105, or at 301-592-8573 or 240-629-3255 (TTY).

For more information on cholesterol and heart disease, check out the following NHLBI resources:

What is High Blood Cholesterol? http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC_WhatIs.html.

High Blood Cholesterol, What you Need to Know http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm.

Live Healthier/Live Longer http://www.nhlbi.nih.gov/chd/index.htm.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at: www.nhlbi.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.