The Therapeutic Lifestyle Changes, or TLC, Program is a three-part program created by the National Heart, Lung, and Blood Institute to improve cholesterol numbers. The TLC Program is well known for its diet plan, which has led many people to adopt a heart-healthy eating regimen.

The TLC Program combines diet, physical activity, and weight management to help lower high blood cholesterol and improve heart health. The Program’s step-by-step plan can lower LDL cholesterol (the “bad” cholesterol) and risks for metabolic disease, heart disease, and other serious conditions.

The program starts with a heart-healthy diet and physical activity, while controlling other risk factors for heart disease such as smoking and high blood pressure. As the program continues, LDL goals are created and monitored by you and your healthcare provider.

Cholesterol is a waxy, fat-like substance that your body needs for good health, but in the right amounts. Unhealthy levels of cholesterol can lead to a condition called high blood cholesterol.

Cholesterol in your blood is carried on lipoproteins:

• Low-density lipoprotein (LDL), sometimes called “bad” cholesterol
• High-density lipoprotein (HDL), sometimes called “good” cholesterol.

High levels of “bad” LDL cholesterol cause plaque (fatty deposits) to build up in your blood vessels. This may lead to heart attack, stroke, or other health problems High levels of “good” HDL cholesterol may actually lower your risk for health problems. HDL cholesterol carries cholesterol and plaque buildup from your arteries to the liver, so it can be flushed out of the body.

Unhealthy cholesterol levels are often caused by lifestyle habits, such as unhealthy eating patterns, in combination with the genes that you inherit from your parents.

Routine blood tests can show whether your cholesterol levels are healthy. To help get your cholesterol levels into the healthy range, you may need heart-healthy lifestyle changes or medicines.

Metabolic syndrome is a group of conditions that together raise your risk of coronary heart disease, diabetes, stroke, and other serious health problems. Metabolic syndrome is also called insulin resistance syndrome.

You may have metabolic syndrome if you have three or more of the following conditions.

• A large waistline: This is also called abdominal obesity or "having an apple shape." Extra fat in your stomach area is a bigger risk factor for heart disease than extra fat in other parts of your body.
• High blood pressure: If your blood pressure rises and stays high for a long time, it can damage your heart and blood vessels. High blood pressure can also cause plaque, a waxy substance, to build up in your arteries. Plaque can cause heart and blood vessel diseases such as heart attack or stroke.
• High blood sugar levels: This can damage your blood vessels and raise your risk of getting blood clots. Blood clots can cause heart and blood vessel diseases.
• High blood triglycerides: Triglycerides are a type of fat found in your blood. High levels of triglycerides can raise your levels of LDL cholesterol, sometimes called bad cholesterol. This raises your risk of heart disease.
• Low HDL cholesterol, sometimes called good cholesterol: Blood cholesterol levels are important for heart health. “Good” HDL cholesterol can help remove “bad” LDL cholesterol from your blood vessels. “Bad” LDL cholesterol can cause plaque buildup in your blood vessels.

Metabolic syndrome is common in the United States. About 1 in 3 adults have metabolic syndrome. The good news is that it is largely preventable. Knowing the risk factors and making healthy lifestyle changes can help you lower your chances of developing metabolic syndrome or the health problems it can cause.

The first step toward heart health is understanding your risk of heart disease. Your risk depends on many factors, some of which are changeable and others that are not. Risk factors are conditions or habits that make a person more likely to develop a disease. These risk factors may be different for each person.

Preventing heart disease starts with knowing what your risks factors are and what you can do to lower them.

Risk factors for heart disease

• Have high blood pressure
• Have high blood cholesterol
• Have overweight or obesity
• Have prediabetes or diabetes
• Smoke
• Do not get regular physical activity
• Have a family history of early heart disease, for example if your father or brother was diagnosed before age 55, or your mother or sister was diagnosed before age 65
• Have a history of preeclampsia, which is a sudden rise in blood pressure and too much protein in the urine during pregnancy
• Have unhealthy eating behaviors
• Are age 55 or older for women or age 45 or older for men

Each risk factor increases your chance of developing heart disease. The more risks you have, the higher your overall risk.

Some risk factors cannot be changed. These include your age, sex, and a family history of early heart disease. Many others can be modified. For example, being more physically active and eating healthy are important steps for your heart health. You can make the changes gradually, one at a time. But making them is very important.

Women and heart disease

Women generally get heart disease about 10 years later than men do, but it’s still women’s #1 killer. After menopause, women are more likely to get heart disease, in part because estrogen hormone levels drop. Women who have gone through early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age who have not gone through menopause. Middle age is also a time when women tend to develop other risk factors for heart disease, such as high blood pressure.

Preeclampsia, which is high blood pressure during pregnancy, raises your risk of developing coronary heart disease later in life. It is a risk factor that you can’t control. However, if you’ve had the condition, you should take extra care to monitor your blood pressure and try to lower other heart disease risk factors.

You and your healthcare provider: A heart-healthy partnership

Risk factors such as high blood pressure or cholesterol generally don’t have obvious signs or symptoms. A crucial step in determining your risk is to see your provider for a thorough checkup and risk assessment. Your provider may use a risk calculator to estimate your risk of having a heart attack, having a stroke, or dying from a heart or blood vessel disease in the next 10 years or throughout your life.

For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Estimatore considers your cholesterol levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol.

Your provider can be an important partner in helping you set and reach goals for heart health. Ask about your risk for heart disease at your annual checkup. Since your risk can change over time, keep asking each year.

Questions to ask your provider at your annual checkup

• What is my risk of developing heart disease?
• What is my blood pressure? What does it mean for me, and what do I need to do about it?
• What are my cholesterol numbers? What do they mean for me, and what do I need to do about them?
• What is my body mass index (BMI) and waist measurement? Do I need to lose weight for my health?
• What is my blood sugar level, and does it mean I’m at risk for diabetes?
• What other screening tests for heart disease do I need? How often should I return for checkups for my heart health?
• How can we work together to help me quit smoking?
• How much physical activity do I need to help protect my heart?
• What is a heart-healthy eating plan for me? Should I see a registered dietitian or qualified nutritionist to learn more about healthy eating?
• How can I tell when I’m having a heart attack?

If you already are being treated for heart disease or heart disease risk factors, discuss your treatment plan with your provider. Ask questions if you do not understand something or need more information. You may want to write down questions before your appointment as well.

Questions to discuss about your heart disease prevention and treatment plan

• How does my treatment compare with what is recommended in the latest guidelines?
• How well is my treatment plan working for me?
• Are my risk factors for heart disease in a good range or getting better?
• If your provider recommends medicine or a medical procedure, ask about the benefits and risks.

Cholesterol is a waxy, fat-like substance that's found in all the cells in the body. The liver makes cholesterol, and it is also in some foods, such as meat and dairy products.

Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol travels through the blood on proteins called lipoproteins. One type, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

The treatments for high cholesterol are heart-healthy lifestyle changes and medicines. The lifestyle changes include healthy eating, weight management, and regular physical activity.

Heart-healthy lifestyle changes include a diet to lower your cholesterol. The DASH eating plan is one example. Another is the Therapeutic Lifestyle Changes diet, which recommends that you

Choose healthier fats.You should limit both total fat and saturated fat. No more than 25 to 35% of your daily calories should come from dietary fats, and less than 7% of your daily calories should come from saturated fat. Depending upon how many calories you eat per day, here are the maximum amounts of fats that you should eat:

Saturated fat is a bad fat because it raises your LDL (bad cholesterol) level more than anything else in your diet. It is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Trans fat is another bad fat; it can raise your LDL and lower you HDL (good cholesterol). Trans fat is mostly in foods made with hydrogenated oils and fats, such as stick margarine, crackers, and french fries.

Instead of these bad fats, try healthier fats, such as lean meat, nuts, and unsaturated oils like canola, olive, and safflower oils.

Limit foods with cholesterol. If you are trying to lower your cholesterol, you should have less than 200 mg a day of cholesterol. Cholesterol is in foods of animal origin, such as liver and other organ meats, egg yolks, shrimp, and whole milk dairy products.

Eat plenty of soluble fiber. Foods high in soluble fiber help prevent your digestive tract from absorbing cholesterol. These foods include:

• Whole-grain cereals such as oatmeal and oat bran
• Fruits such as apples, bananas, oranges, pears, and prunes
• Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

Eat lots of fruits and vegetables. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

Eat fish that are high in omega-3 fatty acids. These acids won't lower your LDL level, but they may help raise your HDL level. They may also protect your heart from blood clots and inflammation and reduce your risk of heart attack. Fish that are a good source of omega-3 fatty acids include salmon, tuna (canned or fresh), and mackerel. Try to eat these fish two times a week.

Limit salt. You should try to limit the amount of sodium (salt) that you eat to no more than 2,300 milligrams (about 1 teaspoon of salt) a day. That includes all the sodium you eat, whether it was added in cooking or at the table, or already present in food products. Limiting salt won't lower your cholesterol, but it can lower your risk of heart diseases by helping to lower your blood pressure. You can reduce your sodium by instead choosing low-salt and "no added salt" foods and seasonings at the table or while cooking.

Limit alcohol. Alcohol adds extra calories, which can lead to weight gain. Being overweight can raise your LDL level and lower your HDL level. Too much alcohol can also increase your risk of heart diseases because it can raise your blood pressure and triglyceride level. One drink is a glass of wine, beer, or a small amount of hard liquor, and the recommendation is that:

• Men should have no more than two drinks containing alcohol a day
• Women should have no more than one drink containing alcohol a day

Nutrition labels can help you figure out how much fat, saturated fat, cholesterol, fiber, and sodium is in the foods that you buy.

If you are concerned about your cholesterol, talk to your health care team about steps you can take to manage your cholesterol.

Take Your Medicine as Directed

If you take medicine to treat high low-density lipoprotein (LDL) cholesterol, heart disease, stroke, or diabetes, follow your health care team’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.

Make Healthy Lifestyle Changes

You can take steps to lower your high LDL cholesterol levels by making healthy changes to your lifestyle, such as choosing foods lower in saturated and trans fats and maintaining a healthy weight.

Talk with Your Health Care Team

You and your health care team can work together to prevent or treat diabetes and ensure that it doesn’t lead to high LDL cholesterol. Discuss your treatment plan regularly, and bring a list of questions to your appointments.

Check Your Cholesterol Regularly

You may need to have your cholesterol levels checked at least once every 4 to 6 years if you do not have heart disease. Some people need to get their cholesterol checked more often or less often. Talk with your health care team about the timeline that is best for you.

You probably know that fiber is great for keeping you regular, but you might not know that it's good for you in other important ways. Just 10 grams or more of soluble fiber a day decreases your total LDL-cholesterol levels by slowing absorption of cholesterol. And fiber may even fight cancer. Fiber discourages the growth of unhealthy bacteria in intestines, which secrete cancer-causing enzymes. And it encourages the growth of health-promoting bacteria that crowd out the dangerous kind.

Foods with Fiber

Animal products contain no fiber, only plant products do. For people with high cholesterol, a switch to a low-fat, high-fiber diet often causes cholesterol levels to drop dramatically. Your best choices for fiber are

• Whole grains (like oats, barley, brown rice, whole wheat)
• Nuts and seeds
• Beans, dried peas, lentils
• Many vegetables (like broccoli, avocados, carrots, peppers, dark leafy greens)
• Many fruits (like apples, bananas, berries, guava, dried fruits)

Soluble and Insoluble Fiber

There are two types of fiber, soluble and insoluble. Both are good for you. Insoluble doesn't dissolve in water but absorbs it, increasing bulk in your stool and shortening transit time through the intestine. Soluble fiber ferments in the large intestine and the end products of this fermentation are very beneficial for your health. What's more, soluble fiber acts like a sponge and soaks up LDL-cholesterol. It lowers your total cholesterol and LDL-cholesterol levels and your triglyceride levels as well. It even suppresses cholesterol synthesis by the liver.

Food sources of soluble fiber include oats, dried peas and beans, nuts, fruits and vegetables, barley, rye, flax, and psyllium husks. Food sources of insoluble fiber include fruits and vegetables, whole grains, brown rice, popcorn, wheat bran, and corn bran.

Diet affects blood levels of low-density lipoprotein (LDL) by influencing both the activity of LDL receptors and the synthesis of cholesterol in the liver. LDL receptors bind to LDL, which is the primary carrier of cholesterol in the blood. The receptors sit on the outer surface of many types of cells, where they pick up LDL circulating in the bloodstream and transport them into the cell. Once inside the cell, the LDL is broken down to release cholesterol. The cholesterol is then used by the cell, stored, or removed from the body. After the receptors drop off their "cargo," they are recycled back to the cell surface to pick up more LDL. LDL receptors therefore play a critical role in regulating the amount of cholesterol in the blood. They are particularly abundant in the liver, which is the organ responsible for removing most excess cholesterol from the body. The number of LDL receptors on the surface of liver cells determines how quickly cholesterol (in the form of LDL) is removed from the bloodstream.

The goal of dietary therapy in individuals with familial hypercholesterolemia (FH) is to increase the activity of LDL receptors while decreasing the synthesis of cholesterol in the liver. Two dietary factors have a major effect on LDL receptors: the amount of cholesterol in the diet and the amount of saturated fat in the diet. Both cholesterol and fat inhibit the activity of LDL receptors, and thus inhibit the removal of LDL from the blood by the liver. Dietary cholesterol and fat can also enhance or diminish the therapeutic effects of cholesterol-lowing drugs in individuals with FH.

Vegetarians miss out on lots of foods. No grilled burgers or franks at picnics. No holiday turkey or fries cooked in animal fat. Strict vegetarians may even forego honey made by bees. But vegetarians also tend to miss out on major health problems that plague many Americans. They generally live longer than the rest of us, and they’re more likely to bypass heart-related and other ailments.

The fact is, eating a more plant-based diet can boost your health, whether you’re a vegetarian or not.

What is it about the vegetarian lifestyle that can protect your health? And are there risks to being vegetarian? NIH-funded researchers are looking for answers. They’re exploring the many ways that diet and other factors affect our health.

Vegetarian meals focus on fruits and vegetables, dried beans, whole grains, seeds and nuts. By some estimates, about 2% of the U.S. adult population follows this type of diet.

People have many reasons for becoming vegetarians. Some want to eat more healthy foods. Others have religious or economic reasons or are concerned about animal welfare. “Vegetarian diets are also more sustainable and environmentally sound than diets that rely heavily on meat, poultry and fish,” says NIH nutritionist Dr. Susan Krebs-Smith, who monitors trends in cancer risk factors.

Most people think of vegetarian diets as simply eating plant foods and not eating meat, poultry and fish. “But in fact, there are many different types of vegetarian diets,” Krebs-Smith explains. “Some are more restrictive than others.”

Strict vegetarians, or vegans, eat plant foods and reject all animal products—meat, poultry, fish, eggs, dairy and sometimes honey. Those who also eat dairy products are called lacto vegetarians. Vegetarians who eat both dairy and eggs are called lacto-ovo vegetarians.

Some vegetarians eat fish but not meat or poultry. They’re called pescatarians (pesce is Italian for fish).

“Then there are the so-called flexitarians, or semi-vegetarians. These are people who eat a mostly vegetarian diet, but they occasionally eat meat,” says Jody Engel, a nutritionist and registered dietitian at NIH. “They might say ‘I’m a vegetarian, but I need to eat my burgers every Sunday.’ People tend to follow their own rules, which is one reason why it’s hard for researchers to study vegetarians. There’s so much variance.”

Despite the different definitions, “there’s tremendous agreement among nutrition experts and health organizations that a more plant-based diet is beneficial, whether you’re a true vegetarian or not,” says Krebs-Smith. “Most Americans don’t eat enough fruit, vegetables, legumes or whole grains. There’s a huge consensus that eating more of these foods would be a good idea for everyone.”

Vegetarian diets tend to have fewer calories, lower levels of saturated fat and cholesterol, and more fiber, potassium and vitamin C than other eating patterns. Vegetarians tend to weigh less than meat-eaters, and to have lower cancer rates. “Evidence also suggests that a vegetarian diet is associated with a lower risk of death from certain heart diseases, and that those who follow a vegetarian diet tend to have lower LDL [“bad”] cholesterol levels,” says Engel.

In some cases, though, it’s unclear if certain health benefits come from plant-based eating or from the healthy lifestyle of most vegetarians. “Vegetarians are generally more physically active and have healthier habits than non-vegetarians. They also typically have a higher socioeconomic status, at least in the United States,” says Krebs-Smith.

To tease out the effects of diet, scientists have to conduct large, carefully controlled studies that account for other factors. One of the world’s largest studies of plant-based diets is now underway at Loma Linda University in California. Cardiologist Dr. Gary Fraser is leading an NIH-funded team of scientists to analyze data on 96,000 Seventh-day Adventists in all 50 states and in Canada. Members of this religious group have unique dietary habits and a generally healthy lifestyle.

Adventists are encouraged to follow a vegetarian diet, but about half the population sometimes eats meat. These variable eating patterns allow scientists to compare a wide range of dietary habits and look for links between diet and disease.

To date, the researchers have found that the closer people are to being vegetarian, the lower their risk of diabetes, high blood pressure and metabolic syndrome (a condition that raises your risk for heart disease and stroke). “The trend is almost like a stepladder, with the lowest risks for the strict vegetarians, then moving up for the lacto vegetarians and then the pescatarians and then the non-vegetarians,” Fraser explains. Earlier studies found that vegetarian Adventists also tend to live longer than both meat-eating Adventists and non-Adventists. The vegetarians also have less coronary heart disease and lower rates of some cancers.

Because vegetarians by definition don’t eat meat, some people jump to the conclusion that simply cutting meat from your diet will lead to health benefits. “But it’s actually more complicated than that,” says Fraser. “Differences in life expectancy and other health matters might be related to the extra fruits, vegetables, nuts and legumes—including soy—that vegetarians tend to eat. You can’t necessarily conclude it’s based on the absence of meat,” he says.

Experts generally agree that vegetarians who eat a wide variety of foods can readily meet all their body’s needs for nutrients. “At any stage of life, you should be able to eat a healthy diet by consuming vegetarian foods. But it does take a little planning,” says Rachel Fisher, a registered dietitian involved in nutrition research at NIH.

Vegetarians need to be sure they take in enough iron, calcium, zinc and vitamin B12. Studies show that most vegetarians do get enough, in part because so many cereals, breads and other foods are fortified with these nutrients. “Vegans in particular need to be certain to get enough vitamin B12 and omega-3 fatty acids,” says Fisher. Omega-3—found in fish, flax seed, walnuts and canola oil—is important for heart health and vision.

Some vegetarians take dietary supplements to make sure they’re getting everything they need. It’s a good idea to talk to a registered dietitian or other health professional if you’re a vegetarian or thinking of becoming one.

Whether you’re a vegetarian or not, Fisher says, you can benefit from the high fiber, low fat and rich nutrients of a vegetarian diet. “Vegetarian foods can be so delicious, and they’re so good for you,” she says.

Try using a variety of spices and herbs to make things interesting. And make sure not to overcook your vegetables, or they might lose some of their valuable nutrients.

Tips for a Vegetarian Diet

• Meet protein needs by eating a variety of plant foods, nuts, eggs or dairy foods.
• Snack on unsalted nuts and use them in salads or main dishes.
• Vitamin B12 is naturally found only in animal products. Choose fortified foods such as cereals or soy products, or take a vitamin B12 supplement if you don’t eat animal products.
• Get calcium from dairy products and calcium-fortified soy milk, breakfast cereals or orange juice.
• Beans and peas have many nutrients and are recommended for everyone, vegetarians and non-vegetarians alike.

Food provides the energy and nutrients you need to be healthy. Nutrients include proteins, carbohydrates, fats, vitamins, minerals, and water.

Healthy eating is not hard. The key is to

• Eat a variety of foods, including vegetables, fruits, and whole-grain products
• Eat lean meats, poultry, fish, beans, and low-fat dairy products
• Drink lots of water
• Limit salt, sugar, alcohol, saturated fat, and trans fat in your diet

Saturated fats are usually fats that come from animals. Look for trans fat on the labels of processed foods, margarines, and shortenings.

The TLC diet is a heart-healthy eating plan that helps make choosing, preparing, and cooking foods easier and healthier.

At the core of the TLC diet, it's important to:

• Decrease saturated fat and cholesterol
• Add plant stanols and sterols found in whole grains, nuts, legumes, and oils, like olive and avocado oil
• Increase soluble fiber like in fruits, beans, and oats

The TLC Diet pinpoints lowering daily intake of saturated fat because too much of this type of fat increases cholesterol in the blood, LDL cholesterol in particular. Limiting intake of foods rich in saturated fat also helps reduce intake of cholesterol from food. To help lower cholesterol levels more, the TLC Diet recommends adding soluble fiber and plant stanols and sterols to daily meals. Soluble fiber blocks cholesterol and fats from being absorbed through intestinal walls into the bloodstream. As with soluble fiber, plant stanols and sterols help block the absorption of cholesterol from the digestive tract, which helps to lower LDL cholesterol. Making these three important dietary changes daily are important for successfully following the TLC Diet to treat and lower LDL cholesterol.

Heart-healthy eating involves choosing certain foods, such as fruits and vegetables, while limiting others, such as saturated fats and added sugars.

Your doctor may recommend the heart-healthy Dietary Approaches to Stop Hypertension (DASH) eating plan because it has been proven to lower high blood pressure and “bad” LDL cholesterol in the blood. 

Foods to eat

These foods are the foundation of a heart-healthy eating plan.

• Vegetables such as leafy greens (spinach, collard greens, kale, cabbage), broccoli, and carrots
• Fruits such as apples, bananas, oranges, pears, grapes, and prunes
• Whole grains such as plain oatmeal, brown rice, and whole-grain bread or tortillas
• Fat-free or low-fat dairy foods such as milk, cheese, or yogurt
• Protein-rich foods:
  • Fish high in omega-3 fatty acids (salmon, tuna, and trout)
  • Lean meats such as 95% lean ground beef or pork tenderloin or skinless chicken or turkey
  • Eggs
  • Nuts, seeds, and soy products (tofu)
  • Legumes such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
• Oils and foods high in monounsaturated and polyunsaturated fats:
  • Canola, corn, olive, safflower, sesame, sunflower, and soybean oils (not coconut or palm oil)
  • Nuts such as walnuts, almonds, and pine nuts
  • Nut and seed butters
  • Salmon and trout
  • Seeds (sesame, sunflower, pumpkin, or flax)
  • Avocados
  • Tofu

Foods to limit

A heart-healthy eating plan limits sodium (salt), saturated fat, added sugars, and alcohol. Understanding nutrition labels can help you choose healthier foods.

Limit sodium

Adults and children over age 14 should eat less than 2,300 milligrams of sodium a day. Children younger than age 14 may need to eat even less sodium each day based on their sex and age. If you have high blood pressure, you may need to limit sodium even more. Talk to your healthcare provider about the amount of sodium that is right for you or your child.

Try these shopping and cooking tips to help you choose and prepare foods that are lower in sodium:

• Read food labels and choose products that have less sodium for the same serving size.
• Choose low-sodium, reduced-sodium, or no-salt-added products.
• Choose fresh, frozen, or no-salt-added foods instead of pre-seasoned, sauce-marinated, brined, or processed meats, poultry, and vegetables.
• Eat at home more often so you can cook food from scratch, which will allow you to control the amount of sodium in your meals.
• Flavor foods with herbs and spices instead of salt.
• When cooking, limit your use of premade sauces, mixes, and instant products such as rice, noodles, and ready-made pasta.

Limit saturated fats

Saturated or “bad” fats come from animal sources such as butter, cheese, and fatty meats. They should make up less than 10% of your daily calories. Unsaturated fats are also known as “good” fats and are found in vegetable oils and nuts.

Read food labels and choose foods that are lower in saturated fats and higher in unsaturated fats.

• Eat leaner, lower-fat, and skinless meats instead of fatty cuts of meat and chicken with skin.
• Consume lower-fat dairy products instead of whole-milk.
• Use certain vegetable oils (such as olive and canola oil) instead of butter, lard, and coconut and palm oils.

Limit added sugars

You should limit the amount of calories you get each day from added sugars. This will help you choose nutrient-rich foods and stay within your daily calorie limit.

Some foods, such as fruit, contain natural sugars. Added sugars do not occur naturally in foods but instead are used to sweeten foods and drinks. They include brown sugar, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, raw sugar, and sucrose.

In the United States, sweetened drinks, snacks, and sweets are the major sources of added sugars.

• Sweetened drinks include soft drinks or sodas, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic drinks, and favored waters. Sweetened drinks account for about half of all added sugars consumed.
• Snacks and sweets include grain-based desserts such as cakes, pies, cookies, brownies, doughnuts; dairy desserts such as ice cream, frozen desserts, and pudding; candies; sugars; jams; syrups; and sweet toppings.

Lower how much sugar you eat or drink.

• Choose drinks without added sugar such as water, low-fat or fat-free milk, or 100% vegetable juice.
• Choose unsweetened foods for snacks or dessert.
• Eat sweetened drinks, snacks, and desserts less often and in smaller amounts.

Limit alcohol

Talk to your healthcare provider about how much alcohol you drink. They may recommend that you reduce the amount of alcohol you drink or that you stop drinking alcohol. Alcohol can:

• Add calories to your daily diet and possibly cause you to gain weight
• Raise your blood pressure and levels of triglyceride fats in your blood
• Contribute to or worsen heart failure in some people, such as some people who have cardiomyopathy
• Raise your risk of other diseases such as cancer

If you do not drink, you should not start. You should not drink if you are pregnant, are under the age of 21, taking certain medicines, or if you have certain medical conditions, including heart failure.

How much should you eat?

You should eat the right amount of calories for your body, which will vary based on your sex, age, and physical activity level. Remember that some healthy foods, including oils and dairy, can still have a lot of calories. Some fruits can have a lot of natural sugar, especially when they are dried.

You can visit the U.S. Department of Health and Human Services’ and U.S. Department of Agriculture’s 2020–2025 Dietary Guidelines for Americans has information about healthy eating and recommendations for healthy eating patterns.

While the TLC Diet means eating well for good heart health, it also means learning how to eat well – in other words, how to best prepare or cook foods so that they are heart-healthy.

Eating heart-healthy meals doesn’t mean giving up on taste. The TLC diet recommends limiting serving sizes or replacing foods high in saturated fat and cholesterol with healthier options.  Fruits, vegetables, legumes (beans and lentils), nuts, whole grains, low- or non-fat dairy products, fish, poultry without the skin, and in moderate amounts, lean meats are good options.

It’s also important to limit sodium intake to 2,300 milligrams each day. Salt-free spices and herbs can make your heart-healthy meals tasty.

Lifestyle changes

If you are diagnosed with high blood triglycerides, your healthcare provider may recommend that you make heart-healthy lifestyle changes.

• Choose heart-healthy foods. 
• Get regular physical activity. Before starting any exercise program, ask your provider what level of physical activity is right for you.
• Aim for a healthy weight. 
• Manage stress.
• Quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
• Get enough good quality sleep. 
• Limit alcohol. If your blood triglyceride levels are considered very high, your provider may recommend stopping alcohol use. Visit the National Institute on Alcohol Abuse and Alcoholism for resources on support and treatment to stop drinking.

Medicines

Your healthcare provider may prescribe a few different types of medicines to control or lower your triglyceride levels.

• Fibrateslower the number of triglycerides in the blood. These medicines may also be used to lower cholesterol.
• Concentrated omega-3 fatty acidsare available by prescriptionfor treating triglyceride levels of 150 mg/dL or above. These medicines are made differently than omega-3 dietary supplements, which are not FDA-approved to treat people with high triglyceride levels.
• Statins are the most common medicine used to treat high blood cholesterol but can also be used to lower the levels of triglycerides in the blood. Learn more about how you can stay safe while taking statins.
• Ezetimibe, another cholesterol-lowering medicine, can also be used to remove triglycerides from the blood when paired with a healthy diet.

More than one medicinemay be necessary to treat very high levels of triglycerides.

Increasing physically activity is another key part of the TLC Program — it’s a step that has many benefits. Lack of physical activity is a major risk factor for heart disease. Regular physical activity and reducing sedentary behavior can help with managing weight and, in that way, help lower LDL cholesterol. It also can help raise HDL cholesterol and lower triglycerides, improve the fitness of the heart and lungs, and lower high blood pressure. Additionally, it can reduce risks for developing diabetes or, if already present, lessen the need for insulin.

Physical activity is any body movement that works your muscles and requires more energy than resting. Walking, running, dancing, swimming, yoga, and gardening are a few examples of physical activity.

According to the Department of Health and Human Services' 2018 Physical Activity Guidelines for Americans physical activity generally refers to movement that enhances health. Physical activity is recommended for everyone from 3 years of age and older.

Types of physical activities include aerobic, muscle-strengthening, bone-strengthening, balance, and flexibility activities. Exercise is physical activity that is planned and structured, such as lifting weights, taking an aerobics class, or playing on a sports team.

Physical activity is good for many parts of your body. This topic focuses on the benefits for your heart and lungs and provides tips for getting started and staying active. Physical activity is one part of a heart-healthy lifestyle. A heart-healthy lifestyle also involves following a heart-healthy eating, aiming for a healthy weight, managing stress, and quitting smoking.

Being physically active is one of the best ways to keep your heart and lungs healthy. Many Americans are not active enough. The good news, though, is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit.