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Q: I went recently to my physician, who did a blood test and told me that my cholesterol level was elevated. He told me that I should modify my diet and follow a step 1 diet to lower my cholesterol. Can you tell me something in general about what this actually means and about the various step diets?
A: Modifying the diet is the initial therapy for an increase in cholesterol, provided that the cholesterol is not markedly elevated. The typical American diet contains about 35 to 40% of calories as fat, with approximately 15% of the calories being provided by saturated fat. (A saturated fat is one in which all the carbon atoms in the fat molecules contain as many hydrogen atoms as possible). In addition, the average daily intake of cholesterol in the American diet is about 400 mg per day. A step 1 diet for the dietary treatment of a cholesterol elevation consists in reducing the dietary fat to less than 30% of the total dietary calories, with 10% or less of the total dietary calories being provided by saturated fat, and in reducing the amount of ingested cholesterol to less than 300 mg per day. If the desired decrease in cholesterol elevation is not reached after 6 to 12 weeks of dietary therapy with a step 1 diet, a step 2 diet may be tried .The step 2 diet for the treatment of cholesterol elevation consists in further reducing the total amount dietary calories being provided by saturated fat to 7% or less, and in further reducing the amount of ingested cholesterol to 200 mg per day or less. An alternative diet, which is also effective in reducing cholesterol is the Mediterranean diet, in which the total fat ingested is kept at approximately 35 to 40% of total calories, but saturated fat is replaced with monounsaturated fat, as found in olives, peanuts, avocados, etc. (A monounsaturated fat is one in which one of the carbon atoms in each fat molecule, due to the type of binding with another carbon atom within the fat molecule, does not contain as many hydrogen atoms as it could, in principle contain.
Updated: 02/28/99
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