percent. For those who take cholesterol-lowering
medications, following the TLC program can ensure
that they take the lowest dose needed to achieve
results.
Precautions
Along with a qualified physician, making sure that
qualified professionals who can assist with safe dietary
and lifestyle changes should include registered dietitians,
doctors, nurses, psychologists, and exercise physiologists.
Risks
According to the NCEP Guidelines, all adults 20
years of age and older should have their total choles-
terol as well as HDL-cholesterol measured every five
years.
Risks
Positive Risk factors for heart disease:Male greater than 45 years of age
Female greater than 55 years of age
Female with premature menopause without estrogen
replacement
Family history of premature coronary heart disease
having definite myocardial infarction or sudden
death before age 55 in father or other first-degree
male relative, or mother before age 65 years of age
Currently smoking or history of cigarette smoking
Blood pressure greater than 140/90 mmHg or on
antihypertensive medications
HDL cholesterol less than 35 mg/dl
LDL cholesterol greater than 130 mg/dl
Diabetes Mellitus
Research and general acceptance
Scores of research articles support a direct rela-
tionship between LDL cholesterol levels and the rate
of coronary heart disease (CHD) in a person. Within-
population studies such as the Framingham and
MRFIT studies and between-population studies,
most notably the Seven Countries study support this
research as well. Studies on familial Hypercholestero-
lemia, a genetic disorder characterized by high levels
of LDL cholesterol, have an exceedingly high rate of
premature atherosclerosis. The majority of research
from experimental animals, laboratory investigations,
epidemiology, and genetic forms of hypercholestero-
lemia indicate that elevated low-density lipoprotein
(LDL) cholesterol is a major cause of CHD. In addi-
tion, clinical trials demonstrate a reduction of coro-
nary heart disease risk when low-density lipoprotein-
lowering therapy is instituted. For these reasons, the
NCEP Expert Panel on Detection, Evaluation, and
Treatment of High Blood cholesterol in Adults
(Adult Treatment Panel III) continues to identify ele-
vated low-density lipoprotein cholesterol as the pri-
mary target of cholesterol-lowering therapy.Resources
BOOKS
Hark, Lisa and Gail Morrison.Medical Nutrition & Disease:
A Case-based Approach,2003.
Marian, Mary J., Pamela Avonne Williams, and Jennifer
Muir Bowers.Integrating Therapeutic and Complemen-
tary Nutrition, 2006.
Meskin, Mark S. et al. eds.Phytochemicals: Mechanisms of
Action2003.
Stamford, Bryant A. and Robert J. Moffrat.Lipid Metabo-
lism and Health 2006
Stanfield, Peggy S. and Yiu H. Hui.Nutrition and Diet
Therapy, 2003.
ORGANIZATIONS
National Cholesterol Education Program NHLBI Infor-
mation Center. P.O. Box 30105 Bethesda, MD 20824-
0105 <http://www.nhlbi.nih.gov>.
National Diabetes Information Clearinghouse http://
diabetes.niddk.nih.gov/
Tobacco Information and Prevention Source TIPS.<http://
http://www.cdc.gov/tobacco/index.htm>.Megan C.M. Porter, RD, LDTotal Wellbeing dietseeCSIRO total well-
being dietQUESTIONS TO ASK YOUR
DOCTOR When should I start having my cholesterol level
checked?
What is my risk of developing heart disease?
When should cholesterol-lowering drugs be used?
When I begin making changes, when can I cut
my dosage of cholesterol lowering drugs?
When should I expect to see a difference in my
cholesterol profile?
How long should I try the TLC diet before
medication is prescribed?TLC diet