1. Limit sugar and alcohol. They provide few nutrients but many calories. Therefore, they contribute to high cholesterol by increasing body weight. An overweight body contains excess fat that is saturated.
2. Certain habits, such as cigarette smoking and a sedentary life, can increase the risk of heart disease. Cigarette smokers should quit. Regular aerobic exercise (at least 20 to 30 minutes, 3 times a week) can lower cholesterol levels and help to prevent the build-up of cholesterol plaque. It can also reduce stress that may cause high blood pressure, another heart disease risk.
3. Fish should be eaten often, 3 or more times per week. Research indicates that certain deep-sea fish -- mackerel, salmon, herring, albacore tuna, lake trou -- contain an oil called Omega-3 fatty acid. This oil may help to lower blood cholesterol. Fish oil supplements, however, are not recommended because they add too many calories.
4. Avoid high sodium content in foods. Some patients with high cholesterol also have high blood pressure. Reducing sodium can help to keep blood pressure within normal limits. Table salt is about 1/2 sodium. Sodium is also an ingredient in many commercially processed foods. Common medications such as antacids, laxatives, and cough remedies can contain large amounts of sodium. Read product labels and use products with no more than 300 mg of sodium per serving. Herbs and spices can be used in place of salt to add flavor and variety to meals. Do not use a salt substitute unless the physician has approved it.
5. Increase complex carbohydrates, (pasta, whole grains, and potatoes) in the diet. Like fats, they are an excellent source of energy without the harmful effects fats can have on the body. But, read labels of commercially prepared baked goods, cookies, and crackers. These products are notorious for using highly saturated fats such as coconut or palm oils and hydrogenated fats.
6. Eat 20 to 30 grams of dietary fiber every day. Foods such as legumes, oats, barley, brown rice, apples, strawberries, and carrots are good to eat because they contain soluble fiber. Research indicates that soluble fiber helps to lower blood cholesterol levels. Supplements such as psyllium mucilloid (trade names: Konsyl, Metamucil) can lower cholesterol up to 15% when used daily. Oat bran is another soluble fiber that has the same benefit.
7. Choose meats carefully. Grading of meats (Prime, Choice, or Good) refers to fat content, with Prime grades having the most fat. Marbling refers to the threads of white fat running through a cut of meat -- the greater the marbling, the more fat. Read labels and avoid any meat product with more than 3 grams of fat per ounce.
8. Eating out can be a challenge. Avoid fast food restaurants; their foods are usually high in fats and sodium. However, many restaurants now understand the need to provide items for clients on fat or cholesterol-restricted diets. Their menus often contain words like "heart healthy" or have items marked with the symbol™. Ask about ingredients and how foods are prepared. Choose foods wisely and ask for smaller portions.

The new nutrition labels on food products give consumers information on fat, saturated fat, cholesterol, sodium, and fiber content. If help is needed interpreting the labels, the physician or registered dietitian should be consulted.

Fat is measured in grams. Determine the number of calories needed each day. Then use the following chart for an easy way to find how many grams of fat are permitted each day for the Step-1 and Step-2 diets.

• grapefruit 1/2 cup
• cereal 3/4 cup
• banana 1/2
• egg substitute 1/4 cup
• whole wheat toast
  2 slices
• margarine 2 tsp
• jelly or jam 1 Tbsp
• 1% milk 1 cup
• coffee/tea*

*Use polyunsaturated creamer.

• vegetable beef soup 1 cup
• lean hamburger 2 oz
• low-fat cheese 1 oz
• hamburger bun
• sliced tomato and lettuce with
  2 tsp olive oil,
  2 tsp vinegar
• fresh fruit salad
  1/2 cup
• oatmeal cookie 1
• 1% milk 1 cup

• tomato juice 1/2 cup
• broiled chicken breast 3 oz
• herbed brown rice 1/2 cup
• broccoli spears 2
• hard dinner roll 1
• margarine 1 tsp
• carrot/raisin salad 1/2 cup
• frozen strawberry yogurt 1/2 cup
• 1% milk 1 cup

Calories

Fat

Protein

Sodium

Carbohydrates

Potassium

Saturated fat

Cholesterol

• grapefruit 1/2
• cereal 3/4 cup
• banana 1/2
• egg substitute 1/4 cup
• whole wheat toast 2 slices
• margarine 2 tsp
• jelly or jam 1 Tbsp
• skim milk 1 cup
• coffee/tea*

*Use polyunsaturated creamer.
**Use allowed polyunsaturated fat in preparation.

• vegetable beef soup 1 cup
• lean hamburger 2 oz
• low-fat cheese 1 oz
• hamburger bun
• sliced tomato and lettuce
• dill pickle 1/4
• fresh fruit salad
  1/2 cup
• oatmeal cookie 1**
• skim milk 1 cup

• tomato juice 1/2 cup
• broiled chicken breast 3 oz
• herbed brown rice
  1/2 cup
• broccoli spears 2
• hard dinner roll 1
• margarine 1 tsp
• carrot/raisin salad
  1/2 cup
• frozen strawberry yogurt 1/2 cup
• skim milk 1 cup

Calories

Fat

Protein

Sodium

Carbohydrates

Potassium

Saturated fat

Cholesterol

Total Fat

no more than 30% of total calories

no more than 30% of total calories

Saturated Fat

no more than 1/3 of the total fat calories may be saturated fat

less than 1/4 of the total fat calories may be saturated fat

Cholesterol

no more than 300 mg

no more than 200 mg

Baked goods: whole grain or enriched breads and rolls; low-fat or homemade muffins, pancakes, waffles, and biscuits using polyunsaturated margarine or oil and non-fat milk

butter or cheese rolls and breads; croutons; commercial biscuits, muffins, pancakes, pastries, sweet rolls, donuts, croissants, popovers

Home recipes use weekly egg allowance or use egg whites and egg substitutes

store bought mixes with saturated fats including coconut, palm oils, and hydrogenated fats

Tortillas: corn, soft flour made with unsaturated oils

soft flour made with lard, shortening, hydrogenated fats, coconut, and palm oils

Pasta & Rice: noodles, spaghetti, macaroni, brown rice (preferred), white rice, wild rice

prepared with whole eggs, cream, and cheese sauces; canned or boxed noodle and macaroni dishes; canned spaghetti dishes

Cereals: cooked or dry (unsweetened preferred), oats and bran, barley

any with coconut, instant hot cereals, granola

Crackers/Snacks: unsalted crackers, pretzels, popcorn prepared with air popper or mono/polyunsaturated oil

salted crackers or snacks; fried snack foods; any snacks or crackers containing saturated fats, coconut or palm oils, hydrogenated or partially hydrogenated fats; cheese crackers or snacks; potato chips; corn chips; tortilla chips; chow mein noodles; commercial buttered popcorn

Raw meat, fish, and poultry lose weight in cooking. Three ounces cooked is about the size of a deck of cards and equals:

Serving guide for substitutes - 1 ounce of meat equals the following:

• 4 oz raw meat or fish without bone
• 3/4 cup cooked, flaked, or chopped meat, fish, crab, lobster
• 9 to 12 clams, oysters, scallops
• a ground beef patty, 3" diameter x 1" thick'1/2 large chicken breast
• 1/2 large chicken breast
• 1 chicken thigh and drumstick

• 1/4 cup tuna or cottage cheese
• 2 oz lobster
• 4-6 oz tofu
• 1 Tbsp peanut butter
• 1 oz cheese
• 1 egg
• 2 egg white
• 1/3 cup cooked legumes

Lean meats: trim visible fat, limit to one 3 oz serving per meat, five meals per week, beef (round, sirloin, chuck, loin, super lean hamburg/ground beef); lamb (leg, arm, loin); pork (tenderloin, fresh leg, shoulder-arm, picnic); veal (all trimmed cuts except commercially ground)

Fatty meats: corned beef, regular pastrami, mutton, ham, Canadian bacon, luncheon meats, short ribs, spareribs, bacon, sausage, frankfurters, canned meats, scrapple, sandwich spreads

Poultry: chicken and turkey with skin removed

self-basted poultry; processed poultry products such as turkey franks, chicken franks, turkey bologna

Eggs: egg whites and low cholesterol egg substitutes; Step-1 limit, 4 egg yolks per week; Step-2 limit, one egg yolk per week

Step-1: egg yolks over 4 per week Step-2: egg yolks over one per week; Includes yolks in cooked or prepared foods

Organ meats: liver for Step-1, limit to one 3 to 4 oz serving per week in place of one whole egg

liver for Step-2, brain, kidney, heart, tripe, sweetbreads, chitlins (pig intestines), gizzards, pork maw (stomach), all other organ meats

Seafood: swordfish, mackerel, albacore tuna, salmon, walleye, pollack, blue; Step-1: shrimp, eel, oysters, squid limited to one serving per week

caviar, roe, anchovy for Step-1 and Step-2; No shrimp, eel, oysters, squid for Step-2

Cheese: Step-1: skim or part-skim milk cheese such as mozzarella, ricotta, bakers, farmers, hoop, low-fat (1%) cottage cheese, and pot cheese; special low-fat/low cholesterol cheeses Step-2: low-fat (1%) cottage cheese, pot cheese, part-skim ricotta, Weight Watchers, Swiss

cream cheese; processed cheese and cheese spreads; all other cheeses

Wild game: elk, deer (venison), pheasant, rabbit, wild duck, squirrel

domestic duck and goose

Beans: dried beans, peas, lentils; tofu; peanut butter - limit to 2 Tbsp a day

regular canned peas, beans, lentils

Milk: skim, non-fat (fluid, powered, evaporated, condensed), buttermilk, lactose-reduced, and sweet acidophilus made from skim milk

any milk product made with whole or 2% milk, chocolate milk, milkshakes, eggnog, coconut milk

Yogurt: made from skim or non-fat milk

made from whole milk or custard style

Creamers: only those containing polyunsaturated oils

any containing coconut or palm oils; whipped, sour, light, heavy, half& half creams

Vegetables: fresh, frozen, or low-sodium canned; low-sodium tomato and vegetable juices

regular tomato sauce and puree; spaghetti sauce; creamed, breaded, or deep-fat fried vegetables; vegetables in sauces; regular tomato and vegetable juices

Fruit: fresh, unsweetened dried fruits; canned or frozen packed in water, own juice or light syrup preferred; all fruit juices (unsweetened preferred)

canned or frozen packed in heavy syrup, sweetened dried fruits, coconut, fried fruit snack chips

Although fats in nuts, seeds, and avocado are mostly unsaturated, they are very high in calories and should be limited.

Polyunsaturated fats: sunflower, safflower, corn, soybean, cottonseed, sesame oils; monounsaturated fats canola, olive, peanut oils

butter, lard, beef tallow, salt pork, bacon, bacon drippings, him hock, animal fat, shortening, suet, chocolate, cocoa butter, coconut, coconut oil, palm and palm kernel oil, hydrogenated fats

Margarine: made with unsaturated fats, with liquid oil the first ingredient; tub margarine preferred over stick

made with saturated fat or hardened (hydrogenated) vegetable oil

Salad dressings: made with unsaturated oils

made with saturated oil and/or egg yolk

Seeds and nuts: unsalted pumpkin seeds, sesame seeds, sunflower seeds, any nuts not on the avoid list

cashews, macadamia, pistachio, Brazil, salted seeds & nuts, coconut

Desserts: homemade baked goods made with unsaturated oils or margarine, skim or 1% milk, and egg substitute or egg whites; gelatin; angel food cake; ginger snaps; fruit ice, fruit whips, sorbet, sherbet - lime two 1/2 cup servings per week; low-fat frozen desserts; puddings, custards, or junkets made with non-fat milk and egg allowances

made with whole milk, cream, butter, chocolate, and egg yolk; commercially prepared cakes, pies, cookies, pastries; ice cream; chocolate desserts; frozen cream pies; commercial dessert mixes such as cake and brownie mixes; chocolate; candies made with cream fillings

Beverages: sparkling or mineral water, seltzer, club soda - unsweetened preferred; coffee; tea; Postum

tonic, commercially or home softened water, instant cocoa mixes, Dutch processed cocoa

Soups & sauces: fat-free, low-salt broth, consomme, and bouillon; homemade soup skimmed of fat; cream soup and sauces made with non-fat milk and fat allowance

soup made with whole milk or cream; broth containing fat; canned soups; dehydrated soup mixes; bouillon not labeled low-sodium; gravy and sauces made with butter, other animal fat, and whole milk

Other: spices, herbs, pepper, lemon juice, garlic & onion powder, Tabasco, catsup, mustard, vinegar, relishes, jam, jelly, marmalade (unsweetened preferred)

commercially fried foods, pickles, any foods containing items not allowed

The new nutrition labels on food products give consumers information on fat, saturated fat, cholesterol, sodium, and fiber content. If help is needed interpreting the labels, the physician or registered dietitian should be consulted.