by Sung Han, M.D.

When people ask for “a little TLC,” it usually means they want “tender loving care.” But doctors fighting to reduce heart disease are giving new meaning to “TLC,” re-defining it as “Therapeutic Lifestyle Changes.”

TLC, a concept developed by the National Cholesterol Education Program, is a three-part strategy using diet, physical activity, and weight management to lower cholesterol levels. By implementing these Therapeutic Lifestyle Changes, the 65 million Americans with high blood cholesterol levels can lower their risks for heart attacks, diabetes, and strokes.

To begin those changes, patients must first know their baseline cholesterol level. Doctors have long recommended cholesterol testing starting at age 35; but everyone should know their cholesterol numbers by getting a routine blood test.

Cholesterol, a fat-like substance manufactured in the liver, helps create cell membranes, vitamin D, hormones, and bile; but it cannot travel through the bloodstream on its own. To circulate, cholesterol is wrapped in “packages” called lipoproteins with fat (lipid) inside and protein outside. The density of these lipoproteins determines the effect of cholesterol on health:

*Low-density lipoprotein – LDL – delivers cholesterol to tissues and arteries instead of to the liver. Excess blood cholesterol causes LDL “packages” to pile up and cling to artery walls, creating plaque. That plaque can narrow blood vessels and restrict oxygen flow, which potentially leads to chest pain, angina, blood clots, and heart attacks.

*High-density lipoprotein – HDL – by contrast, takes cholesterol from tissues and sends it to the liver for elimination from the body.

Understandably, then, HDL is called the “good” cholesterol, while LDL is labeled “bad.”

For the general population, LDL (bad) cholesterol should be lower than 130(mg/dL), and HDL (good) cholesterol needs to be higher than 45 (mg/dL). The total cholesterol number includes both LDL and HDL, plus other blood fats, and should generally be lower than 200 (mg/dL).

Several of those factors can be impacted by individual behavior and that is where the Therapeutic Lifestyle Changes come into play. To reduce risk, the first change to make is to cut consumption of saturated fats (including animal fats and high-fat dairy products like cheese, butter or whole milk).

Other TLC strategies include increasing fiber intake to 25 grams per day; upping HDL levels by getting more omega-3 fatty acids (through salmon, walnuts or almonds); and avoiding foods high in fat that raise triglyceride levels. Getting regular exercise – at least 20 to 30 minutes on most or all days of the week – is another important change to implement.

Taking drugs to reduce cholesterol can help but are more effective when patients make healthy lifestyle changes too. In other words, everyone can use “a little TLC.”

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Dr. Han practices family medicine at Castro Valley Primary Care, 20130 Lake Chabot Road, Ste. 201, Castro Valley, CA. To make an appointment call (510) 728-6370.