Most coronary heart disease is due to blockages in the arteries that supply blood to the heart muscle. Cholesterol and fat, circulating in the blood, build up in the walls of these arteries. This buildup narrows the arteries and can slow or block the flow of blood. This process is known as "atherosclerosis." Atherosclerosis is a slow progressive disease that may start very early in life yet might not produce symptoms for many years. Most heart attacks are caused by a clot forming at a narrow part of an artery which supplies blood to the heart muscle.
Blood carries a constant supply of oxygen to the heart. If the flow of blood is slowed or blocked, the oxygen supply may be reduced or cut off. With not enough oxygen to the heart muscle, there may be chest pain ("angina" or "angina pectoris"), and if the oxygen is cut off, there is heart muscle injury and a heart attack.
WHY SHOULD I CARE ABOUT BLOOD CHOLESTEROL?
Elevated blood cholesterol is one of the three major controllable risk factors for coronary heart disease (cigarette smoking and high blood pressure are the other two). In other words, the higher your cholesterol level the greater your chance of getting heart disease, especially at levels of 200 mg/dL or more.
More than half the adults 20 years of age or older in the United States have total blood cholesterol levels of 200 mg/dL or more. About one out of every four adults has a blood cholesterol level considered "high," that is, 240 mg/dL or greater.
The risk of heart disease is not limited to those with "high" blood cholesterol. The number of people with heart disease who have blood cholesterol levels below 240 mg/dL is actually greater than the number with levels of 240 mg/dL or above. This is partly a result of the fact that even moderately elevated blood cholesterol levels increase the risk of heart disease, and a large proportion of the population is in this range. The average level in U.S. adults is 210-215 mg/dL. It also results from the influence of risk factors other than elevated blood cholesterol. Fortunately you can do something about elevated blood cholesterol, high blood pressure, and smoking.
WILL I BENEFIT FROM LOWERING MY BLOOD CHOLESTEROL LEVEL?
Lowering your elevated blood cholesterol slow the fatty buildup in the arteries and in some cases even reverse the process. It will also help reduce your risk of heart disease.
High intakes of saturated fat and dietary cholesterol, and excess calories leading to overweight, all contribute to elevated blood cholesterol. Your usual eating pattern may well be too high in saturated fat, total fat (which may also add too many calories), and cholesterol. Average Americans eat 13 percent of their calories from saturated fat and 36-37 percent of their calories from total fat. The average daily intake of dietary cholesterol is 304 milligrams (mg) for women and 435 mg for men. These intakes are higher than what is recommended for the health of your heart.
The National Cholesterol Education Program recommends that all healthy Americans change their eating patterns to lower their blood cholesterol levels and thus reduce their chances of getting heart disease.
The recommended eating pattern is to eat:
* less than 10 percent of calories from saturated fat,
* an average of 30 percent of calories or less from total fat, and
* less than 300 mg a day of dietary cholesterol.
The saturated fat and total fat recommendations are intended to be achieved as an average intake over several days. Healthy children should also eat this way as they begin to eat with their family, usually at 2 years of age or older. This eating pattern can be achieved by following the guidelines beginning on page 5 .
WHAT IS "BLOOD CHOLESTEROL?" FOR THAT MATTER, WHAT IS CHOLESTEROL?
Pure cholesterol is an odorless, white, waxy, powdery substance. You cannot taste it or see it in the foods you eat.
Cholesterol is found in all animal products. Your body needs cholesterol to function normally. It is present in every cell in all parts of the body, including the brain and nervous system, muscle, skin, liver, intestines, heart, and skeleton. Cholesterol is carried from one part of your body to another in blood--"blood cholesterol." Your liver makes enough cholesterol for your body's needs, even if you don't eat any cholesterol -- "dietary cholesterol."
HOW HIGH IS "HIGH" BLOOD CHOLESTEROL?
A blood cholesterol level of 240 mg/dL or greater is considered "high" blood cholesterol. If your blood cholesterol is 240 mg/dL or greater, you have more than twice the risk of heart disease of someone whose cholesterol is 200 mg/dL, and you need to seek advice from a doctor who should conduct more tests.
But any cholesterol level of 200 mg/dL, or more, even in the "borderline-high" category (200-239 mg/dL), increases your risk for heart disease. Levels less than 200 mg/dL put you at lower risk for heart disease. It does not mean "no" risk.
Table 1. Total Blood Cholesterol Categories Less than 200 mg/dL Desirable 200 to 2339 mg/dL Borderline-High 240 mg/dL or greater High Note: These categories apply to anyone 20 years of age or older.
While any single risk factor will increase the likelihood of developing heart-related problems, the more risk factors you have, the more concerned you should be about prevention and treatment. A person with any two risk factors has four times the risk of someone without any risk factors. The presence of all three major controllable risk factors -- high blood cholesterol, high blood pressure, and smoking -- can raise your risk to eight times that of people who have none of these risk factors. The factors that increase your risk for coronary heart disease are listed in table 2.
Table 2. Risk Factors for Coronary Heart Disease * High blood cholesterol * Cigarette smoking * High blood pressure * Obesity * Diabetes * Being a male * Family history of heart disease before the age of 55 * Low HDL-cholesterol (less than 35 mg/dL) * Circulation disorders of blood vessels to the legs, arms, and brain
SHOULD I HAVE MY TOTAL BLOOD CHOLESTEROL CHECKED?
Yes. The National Cholesterol Education Program recommends that all adults age 20 and over have their total blood cholesterol measured at least once every 5 years. If you do not know your level, ask your doctor to measure it at your next visit.
HOW IS MY TOTAL BLOOD CHOLESTEROL MEASURED?
Cholesterol measurement requires a blood sample which may be drawn from a vein in your arm or taken by a fingerprick. If your first measurement is 200 mg/dL, or greater, it should be rechecked with a second measurement on blood drawn from your arm. You do not have to fast for a total blood cholesterol measurement.
A second measurement is important. It helps your doctor decide what to do next. Your cholesterol level naturally changes over time. Also, lab errors can affect the number. A second measurement helps your doctor find your average number.
WHAT ARE LDL- AND HDL-CHOLESTEROL?
LDL and HDL refer to two types of "lipoproteins." These are packages of cholesterol, fat, and protein that are made by the body to carry fat and cholesterol through the blood. They are not in the foods you eat.
LDLs are low density lipoproteins. They carry most of the cholesterol in the blood. If the level of LDL-cholesterol is elevated, cholesterol and fat can build up in the arteries contributing to atherosclerosis. This is why LDL-cholesterol is often called "bad cholesterol."
HDLs are high density lipoproteins. They contain only a small amount of cholesterol. HDLs are thought to carry cholesterol back to the liver. Thus HDLs help remove cholesterol from the blood, preventing the buildup of cholesterol in the walls of arteries. HDL-cholesterol is often called "good cholesterol."
SHOULD I CHECK MY LDL- AND HDL-CHOLESTEROL TOO?
If the average of your total cholesterol measurements is either "borderline-high" or "high," your doctor should ask you to return for another test. This test will show values for your LDL-cholesterol, HDL-cholesterol, and triglycerides. Your doctor will ask you to fast (except for water or black coffee) for 12 hours before the test.
WHAT DO LDL- AND HDL-CHOLESTEROL LEVELS MEAN?
LDL- and HDL-cholesterol levels more accurately predict your risk of coronary heart disease than a total cholesterol level alone. A high LDL-cholesterol level or a low HDL-cholesterol level increases your risk.
If your doctor measured your LDL-cholesterol level, use the chart below to see how your LDL-cholesterol level measures up.
Table 3 LDL-Cholesterol Categories Less than 130 mg/dL Desirable 130 to 159 mg/dL Borderline-High Risk 160 mg/dL and above High Risk
After evaluating your LDL-cholesterol level and other risk factors for coronary heart disease, your doctor will determine your treatment program. The treatment your doctor will prescribe first is a diet that is low in saturated fat and cholesterol. You may start on a diet that is similar to the recommended eating pattern for all healthy Americans. In general, however, the higher your LDL-cholesterol level the more intensive will be the treatment and followup you receive compared to a person with a lower LDL-cholesterol level. This is because a higher LDL-cholesterol level increases your risk for heart disease.
The lower your HDL-cholesterol level, the greater your risk of coronary heart disease. Any HDL-cholesterol level lower than 35 mg/dL is considered low. Quitting smoking, losing weight if you are overweight, and becoming physically active may help raise your HDL-cholesterol level.
DO RATIOS PREDICT MY RISK FOR HEART DISEASE?
You may have heard of a cholesterol "ratio." This is actually your total cholesterol or LDL-cholesterol divided by your HDL-cholesterol. Because LDL- and HDL-cholesterol both predict your risk of heart disease, it is more important to know the value for each of these and not combine them into a single number.
WHAT ARE TRIGLYCERIDES?
Triglycerides are the form in which fat is carried through your blood to the tissues. The bulk of your body's fat tissue is in the form of triglycerides. Triglyceride levels less than 250 mg/dL are considered normal.
It is not clear whether high triglycerides alone increase your risk of heart disease. On the other hand, many people with elevated triglycerides also have high LDL-cholesterol or low HDL-cholesterol levels which do influence their doctor's decisions on how to treat high blood cholesterol.
HOW DOES MY CHOLESTEROL LEVEL BECOME ELEVATED?
Among the factors you can do something about, what you eat has the largest effect on your blood cholesterol level. Saturated fat raises your blood cholesterol level more than anything else you eat. Dietary cholesterol can also increase your blood cholesterol level, but less than saturated fat in most people. Eating in a way that is low in saturated fat and cholesterol will help lower your elevated blood cholesterol.
Being overweight may also increase your blood cholesterol level. Most overweight people with elevated blood cholesterol can help lower their levels by losing weight. Regular physical activity may help control your weight and is associated with a reduced risk of heart disease and lower blood pressure.
Genetic factors affect your blood cholesterol level and can determine how much you can lower your level by diet.
Age and sex also influence blood cholesterol levels. In the United States, blood cholesterol levels in men and women start to rise at about age 20. Women's blood cholesterol levels prior to menopause are lower than those of men of the same age. After menopause, however, the cholesterol level of women usually increases to a level higher than that of men. In men, blood cholesterol generally levels off or declines slightly around age 50. Since the risk of coronary heart disease is especially high in the later decades of life, reducing high blood cholesterol is important in the elderly.
Oral contraceptives and pregnancy can increase blood cholesterol levels in some women. For pregnant women, blood cholesterol levels should return to normal 20 weeks after childbirth.
WHAT CHANGES CAN I MAKE IN THE WAY I EAT?
Dietary changes that work together to reduce saturated fat, total fat, and cholesterol will work to lower blood cholesterol levels in most people. Whether your level is in the desirable, borderline-high, or high category, making the changes listed in table 4 will help lower your blood cholesterol. However, if your level is high, you are at greater risk for heart disease and you may need closer followup and nutrition counseling to help lower your blood cholesterol.
Table 4. Guidelines for Lowering Blood Cholesterol Levels * Eat fewer foods high in saturated fat. * Eat fewer high-fat foods. * Replace part of your saturated fat with unsaturated fat. * Eat fewer high-cholesterol foods. * Choose foods high in complex carbohydrates (starch and fiber). * Lose weight, if you are overweight. These guidelines are also consistent with the "Dietary Guidelines for Americans" developed by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services.
EAT FEWER HIGH-FAT FOODS
There are two major types of dietary fat -- saturated and unsaturated. Unsaturated fats are further classified as either polyunsaturated or monounsaturated fats. Together, saturated, polyunsaturated, and monounsaturated fats equal total fat. All foods containing fats have a mixture of these types.
One of the goals in lowering your blood cholesterol level is to eat less total fat, especially saturated fat. Because fat (all types) is the richest source of calories, eating less fat will help you cut calories to lose weight if you are overweight. If you are not overweight and want to maintain your weight, choose more often foods high in complex carbohydrates and eat less frequently foods high in fat. While your calorie level remains the same, the percent of calories from fat decreases and the percent of calories from carbohydrates increases.
EAT FEWER FOODS HIGH IN SATURATED FAT
Saturated fat raises your blood cholesterol level more than anything else in your eating plan. The best way to reduce your blood cholesterol level is to reduce the amount of saturated fat that you eat.
Animal products as a group are a major source of saturated fat in the typical American diet. The fat in whole-milk dairy products (like butter, cheese, whole milk, ice cream, and cream) contains high amounts of saturated fat. Skim-milk, low-fat, and nonfat dairy products can be substituted for the higher fat products.
Saturated fat is also concentrated in the fat that surrounds meat and in the white streaks of fat in the muscle of meat (marbling). Well-trimmed cuts from the "round" cuts of the animal are lower in saturated fat than well-marbled, untrimmed meat. In general, poultry, especially when the skin is removed, is lower in saturated fat than meat. Fish is generally lower in saturated fat than poultry and meat.
A few vegetable fats -- coconut oil, palm kernel oil, and palm oil -- are high in saturated fat. Although recently the food industry has largely discontinued the use of these fats in many foods, they may be used for commercial deep fat frying and in foods such as cookies and crackers, whipped toppings, coffee creamers, cake mixes, and even frozen dinners. Because you can not see these vegetable fats in foods it is important for you to read food labels. The label may tell you what type of fat or how much saturated fat a food contains. This information will help you choose foods lowest in saturated fats.
REPLACE PART OF YOUR SATURATED FAT WITH UNSATURATED FAT
Replacing unsaturated fat for saturated fat helps lower blood cholesterol levels. Use fats and oils that contain primarily unsaturated fats whenever possible.
Polyunsaturated fats are found in greatest amounts in safflower, corn, soybean, cottonseed, sesame, and sunflower oils, which are common cooking oils. Polyunsaturated fats are also found in most salad dressings.
Olive and canola oil are examples of oils that are high in monounsaturated fats. Like other vegetable oils, these oils are used in cooking as well as in salad dressings.
Not all salad dressings are made with oils that contain primarily unsaturated fats. Some could be high in saturated fats. Read the labels to find out.
EAT FEWER HIGH-CHOLESTEROL FOODS
Dietary cholesterol is the cholesterol found in some of the foods we eat. It can also raise your blood cholesterol level, but less than saturated fat in most people.
Although you can not see cholesterol, it is found in all foods that come from animals, including egg yolks, meat, fish, poultry, and dairy products. Egg yolks and organ meats (liver, kidney, sweetbread, brain) are particularly rich sources of cholesterol. Egg whites and foods that come from plants, like fruits, nuts, vegetables, grains, cereals and seeds, have no cholesterol.
Since cholesterol is not a fat, you can find it in both high-fat and low-fat animal foods. In other words, even if a food is low in fat, it may be high in cholesterol. For instance, organ meats, like liver, are low in fat but are high in cholesterol.
CHOOSE FOODS HIGH IN COMPLEX CARBOHYDRATES (STARCH AND FIBER)
Breads, pasta, rice, cereals, dry peas and beans, fruits, and vegetables are good sources of complex carbohydrates (starch and fiber) and contain little or no saturated fat and no cholesterol. They are excellent substitutes for foods that are high in saturated fat and cholesterol.
Contrary to popular belief, high-carbohydrate foods (like pasta, rice, potatoes) are lower in calories than foods high in fat. What adds calories to these foods is the addition of butter, rich sauces, whole milk, cheese, or cream, which are high in fat, especially saturated fat.
LOSE WEIGHT, IF YOU ARE OVERWEIGHT
People who are overweight tend to have higher blood cholesterol levels than people of desirable weight. You can reduce your weight by eating fewer calories and by increasing your physical activity on a regular basis. By reducing the amount of fat in your diet, you will be cutting down on the richest source of calories. Fat has more than twice the calories as the same amount of protein or carbohydrate. Substituting foods that are high in complex carbohydrates for high-fat foods is a good way to help you lose weight.
ARE THE RECOMMENDED CHANGES IN EATING SAFE?
Yes. Eating patterns designed to lower blood cholesterol can be as high in nutritional quality as, or higher than, other diets. The special needs of women for nutrients such as calcium, iron, and zinc can be met in these patterns. Eating a variety of foods helps to assure nutritional adequacy. This also applies to children and teenagers.
Calories are necessary to maintain growth, and it is important that children and adolescents get enough calories. An eating pattern low in saturated fat, total fat, and cholesterol is not necessarily a low-calorie way of eating. On the other hand, many young children pass through a phase when they are more selective and more independent about food; desire for food becomes erratic and the variety of foods selected may become limited. During this phase what the child does eat should be as nutritious as possible.
Pregnant or breastfeeding women and many patients with diabetes, kidney, heart or liver disease may need special counseling from an expert in nutrition such as a registered dietitian.
CAN I REALLY LOWER MY BLOOD CHOLESTEROL LEVEL?
Generally your blood cholesterol level should begin to drop 2 to 3 weeks after you start with a cholesterol-lowering eating pattern. Over time, the average reduction in blood cholesterol level will be about 10-15 percent. Also, the higher your blood cholesterol level is to begin with, the greater reduction you can expect.
How much you reduce your blood cholesterol levels depends on
* how well you follow your new way of eating;
* how much saturated fat and how much cholesterol you were eating before starting to eat the cholesterol-lowering way;
* how much weight you lose, if you are overweight;
* and how responsive your body is to your changed way of eating.
HOW DO I CHANGE?
Look at your overall eating pattern and begin to plan. You don't have to cut out all the high-saturated fat and high-cholesterol foods that you eat. Try to substitute one or two low-saturated fat or low-cholesterol foods each day, and soon you will reach your goal of a low-saturated fat, low-cholesterol way of eating.
If you are eating few foods high in saturated fat, an occasional high-saturated fat food won't raise your blood cholesterol level. If you expect a high-saturated fat, high-cholesterol day, have especially low-saturated fat, low-cholesterol days before and after.
You should eat a variety of foods each day to get the nutrients you need. One way to do this is to choose, using the tips below, heart healthy foods from different food groups -- meat, poultry, fish, and shellfish; dairy products; eggs; fats and oils; fruits and vegetables; breads, cereals, pasta, rice, and dry peas and beans; and sweets and snacks. Foods are grouped by the nutrients they provide. Sweets and snacks often are high in saturated fat, cholesterol, and calories. The number and size of the portions should be adjusted to reach and maintain your desirable weight.
The following tips will help you choose foods low in saturated fat and cholesterol within groups.
MEAT, POULTRY, FISH, AND SHELLFISH
* Choose fish, poultry, lean cuts of meat, and eat moderate portions (about 6 oz. a day). Choose fish and poultry without the skin more often. They are, in general, lower in saturated fat than meat.
Table 5. Lean Cuts of Meat Beef Veal Pork Lamb Round All trimmed Tenderloin Leg Sirloin cuts Leg (fresh) Arm Chuck Shoulder (arm Loin Loin or picnic)
* "Select" grades of meat are lower in fat than "choice." "Choice" grades are lower in fat than "prime" grades.
* Shellfish generally has less saturated fat than meat, poultry, and fish, but its cholesterol content varies -- some are relatively high and some are low.
* Cholesterol is found in high amounts in organ meats (liver, kidney, sweetbread, brain).
* Processed meats, like bacon, bologna, salami, hot dogs, and sausage, are high in fat; they should be eaten infrequently.
* "Lean," "lite," "leaner," and "lower fat" generally refer to foods containing less fat. They may not be "low" in fat. Read label information for grams of fat.
* Goose, duck, and many processed poultry products, like chicken or turkey bologna and hot dogs, are very high in saturated fat and should be limited.
* Trim fat from meat and remove skin from poultry before cooking and eating.
* Bake, broil, roast, poach or braise instead of frying to reduce the fat.
* Drink skim and 1% milk rather than 2% and whole milk.
* Substitute low-fat and imitation cheeses whenever possible for natural, processed, and hard cheeses which are higher in saturated fat.
* Instead of hard cheese choose low-fat cottage cheese, farmer cheese or pot cheese which are lower in saturated fat. Choose low-fat cheeses that have between 2 and 6 grams of fat per ounce.
* Substitute low-fat or nonfat yogurt for sour cream in recipes or as toppings.
* The egg yolks you eat include those hidden in processed foods and many baked goods.
* Egg whites contain no cholesterol; substitute two whites for each whole egg in recipes.
FATS AND OILS
* Choose liquid vegetable oils that are highest in unsaturated fat such as canola, safflower, sunflower, corn, olive, sesame, and soybean oils, in cooking and in salad dressings.
* The vegetable oils from palm kernel, coconut, and palm, as well as cocoa fat, which are used in some commercial products, contain large amounts of saturated fat.
* Read labels of commercially prepared foods to find out what type of fat or how much saturated fat they contain.
* In your cooking, limit your use of butter, lard, fatback, and solid shortenings.
* When using fats and oils, use only small amounts and replace those high in saturated fat with those that contain mostly unsaturated fat.
* Use margarine instead of butter as a spread.
FRUITS AND VEGETABLES
* Fruits and vegetables -- fresh, frozen or canned -- contain no cholesterol and are almost always very low in saturated fat.
* Use fruits as a snack or dessert.
* Prepare vegetables as snacks and side dishes. Limit use of cream, cream cheese, cheese, and butter or other animal fats in preparing and serving them.
BREADS, CEREALS, PASTA, RICE, AND DRY PEAS AND BEANS
* Cereals are usually low in saturated except for granola-type cereals.
* Breads and most rolls are low in saturated fat; however, many other types of commercially baked goods such as those listed are made with large amounts of fat, especially saturated fats.
* Croissants * Biscuits * Doughnuts * Butter rolls * Muffins
* Try pasta, rice, and dry peas and beans (like split peas, lentils, kidney beans, and navy beans) as main dishes, casseroles, soups, or other one-dish meals with low-fat sauces.
* Extend meat with pasta or vegetables for hearty dishes.
* Bake your own muffins and quick breads using unsaturated vegetable oils, and substitute two egg whites for each egg yolk.
SWEETS AND SNACKS (avoid too many sweets)
* Commercial cakes, pies, cookies, cheese crackers, and some types of chips are high in saturated fat, cholesterol, and calories. Read labels carefully
* Try angel food cake, fig bars, and ginger snaps as substitutes for commercial baked goods high in saturated fat.
* Try frozen desserts like ice milk, low-fat or nonfat yogurt, sorbets, and popsicles which are low in saturated fat, instead of ice cream which contains considerably more saturated fat and cholesterol.
* Try a piece of fruit, some vegetables, or a low-fat snack like unbuttered popcorn or breadsticks.
WHAT DO I LOOK FOR ON FOOD LABELS?
Look for the amount of saturated fat, total fat, and cholesterol given with the nutrition information provided per serving. Use this information to compare and choose products lower in total fat, saturated fat, and cholesterol.
In addition, food labels include a list of ingredients. The ingredient in the greatest amount is listed first. The ingredient in the least amount is listed last. To avoid too much fat, saturated fat, and cholesterol go easy on products that list first any ingredient higher in saturated fat or cholesterol. Some examples of these ingredients include animal fats like bacon, beef fat, butter, and lard; coconut, coconut oil, palm kernel or palm oil; and egg and egg yolk solids.
WILL I BE ABLE TO EAT OUT?
Yes. Whether you are eating on the run or sitting down to a full course meal, you can make choices that are low in saturated fat and cholesterol. Choose restaurants that have low-fat, low-cholesterol items on their menus; or call ahead to find out if special requests will be honored. Ask how menu items are prepared. Ask about the availability of foods not on the menu. Select meat, poultry or fish that is broiled, grilled, baked, steamed, or poached rather than fried. If the portion served is large, take home the extra. Choose lean deli meats such as fresh turkey instead of higher fat cut such as salami or bologna. Look for vegetables seasoned with herbs or spices rather than butter, sour cream, or cheese. Try sharing dessert with a friend or order a light dessert such as sherbet, fruit ice, or sorbet.
HOW MUCH SATURATED FAT AND CHOLESTEROL ARE THERE IN DIFFERENT FOODS?
There are higher and lower saturated-fat foods within each of the food groups. The tips in this fact sheet will help you select and prepare lower saturated-fat and cholesterol foods. Table 6 gives the saturated fat, total fat, and cholesterol values for a few basic foods. To see how other foods rank in saturated fat and cholesterol, more extensive lists should be consulted.
Prepared dishes which are made from a combination of foods will vary in saturated fat content. How much they vary depends on the type and amount of fat-containing ingredients. Addition of fat during frying or basting may add to the saturated fat content of the final meal. Prepared foods include recipes made at home, takeout food, restaurant food, and commercial prepackaged items.
[TABULAR DATA OMITTED]
HOW DO I FIND MORE INFORMATION?
If you would like more information about healthful eating, contact:
National Cholesterol Education Program
4733 Bethesda Avenue, Suite 530
Bethesda, MD 20814-4820
Materials are available to help you eat in a low-saturated fat, low-cholesterol way and lower your blood cholesterol level. If your doctor has diagnosed you as having high blood cholesterol, ask for two pamphlets: Eating to Lower Your High Blood Cholesterol and So You Have High Blood Cholesterol.
Public libraries and book stores carry nutrition/health magazines, low-fat, low-cholesterol cookbooks, and books on the fat and cholesterol content of foods. American Heart Association local affiliates, school systems, county education departments, hospitals, and public health departments may offer additional materials, supermarket tours, and courses in low-fat cooking and weight control.