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Supplement Article  |   April 2010
Managing your dyslipidemia with TLC: Therapeutic Lifestyle Changes
Article Information
Cardiovascular Disorders
Supplement Article   |   April 2010
Managing your dyslipidemia with TLC: Therapeutic Lifestyle Changes
The Journal of the American Osteopathic Association, April 2010, Vol. 110, eS17-eS18. doi:
The Journal of the American Osteopathic Association, April 2010, Vol. 110, eS17-eS18. doi:

The “DO Touch” column is designed to help osteopathic physicians communicate to patients the information they need to know about their medical conditions.

This column is written in a language that patients should easily understand. DOs can use this column to improve their verbal communication with patients. DOs can also use this column as patient education material to supplement their discussions with patients.

 
Dyslipidemia is a term used by health care professionals to describe a disruption in the amounts of fats—or lipids—in a patient's blood. In the United States, most cases of dyslipidemia are hyperlipidemias: elevated lipid levels in the blood often brought on by diet and lifestyle. This condition is frequently characterized by higher than ideal amounts of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C; ie, “bad” cholesterol), and triglycerides (TG) as determined through blood tests ordered by your physician. Furthermore, hyperlipidemia can be characterized by lower than ideal levels of high-density lipoprotein cholesterol (HDL-C; ie, “good” cholesterol). 
Since dyslipidemia puts you at significant risk for coronary heart disease (CHD) and other cardiovascular conditions, managing your lipid levels is critical to your overall health and wellness. Depending on your CHD risk category, your physician may suggest a combination of diet and exercise—collectively known as therapeutic lifestyle changes (TLC)—to bring your lipid levels within the acceptable range. If your lipid levels are well outside of the acceptable range for your risk category, your physician may also prescribe drug therapy in addition to TLC (Table 1). 
A first-line therapy against dyslipidemia, TLC is a key component of your treatment and one that is completely dependent on your participation. If you already have heart disease or are at high risk for developing it because of your dyslipidemia, you should take immediate action in initiating TLC, namely diet and exercise modifications. The diet component of TLC is based on lowering your intake of saturated fat, cholesterol and sodium to help reduce your blood cholesterol level and lower your cardiovascular risk. 
According to the National Heart, Lung, and Blood Institute's (NHLBI) TLC Diet Guidelines, you should consume the following: 
  • Less than 7% of the day's total calories from saturated fat
  • 25%-35% of the day's total calories from fat
  • Less than 200 mg of dietary cholesterol a day
  • Limit sodium intake to 2,400 mg a day
  • Just enough calories to achieve or maintain a healthy weight and reduce your blood cholesterol level (Ask your physician or registered dietitian [RD] what is a reasonable calorie level for you.)
The recommendations for cholesterol and sodium are the same for everyone on the TLC Diet, regardless of their recommended caloric intake; however, the recommendations for saturated fat and total fat are based on the percentage of calories an individual patient consumes. 
Since implementing this TLC Diet likely includes changes to your current eating plan, your physician may refer you to an RD who can assist in making diet modifications. An RD will teach you about the TLC Diet, help you choose foods and plan menus, monitor your progress, encourage you to stay on the diet, and help you to adjust your calorie levels accordingly. 
If your lipid levels are not lowered into the acceptable range for your risk category on the TLC Diet, your physician may first intensify the TLC Diet by increasing the amount of soluble fiber you consume and/or adding cholesterol-lowering food products to your diet. Soluble fiber consumption from foods such as whole grains, fruits and vegetables should be increased to 10 to 25 g per day. 
Cholesterol-lowering food products such as margarines, salad dressings, and other oil-based items that contain plant sterol esters or plant stanol esters, should be consumed in amounts equal to approximately 2 g per day. 
The exercise component of TLC has been proven to reduce levels of LDL-C and TG in the blood, as well as to increase levels of HDL-C. Your physician will recommend an exercise or activity program that is safe and effective for meeting your lipid goals. 
If you have been relatively inactive for a long period of time, it is suggested that you start with low-to-moderate level activities, such as walking, taking the stairs instead of the elevator, gardening, house work, dancing and moderate exercising at home. These activities should be performed for a few minutes on most days to start. 
If you have chest pain, feel faint or light-headed, or become extremely out of breath while performing these activities, you should stop immediately and tell your physician as soon as possible. For those patients currently recovering from a heart attack or heart surgery, your physician may suggest that you begin your new exercise program under the supervision of a physician or nurse in a facility such as a cardiac rehabilitation center. 
If you are able to tolerate these low-to-moderate physical activities, your physicians will likely increase your activity level depending on your risk category. This increased level of activity can include regular aerobic exercise, such as brisk walking, jogging, swimming, bicycling or playing tennis. For most people, the exercise goal is at least 30 minutes per day, three or four days per week. 
Considering that dyslipidemia is one of the most important modifiable risk factors for CHD, several measures must be taken to achieve lipid levels that fall within acceptable ranges. Although drug therapy has been proven effective in reaching these goals, TLC remains the core of treatment measures for dyslipidemia. Furthermore, by adhering to the diet and exercise components of TLC, patients can take a proactive role in managing their dyslipidemia. Although your physician will initially recommend and guide your individual TLC program, it is up to you to enact the lifestyle changes and take ownership in the process of improving your own health.