The Therapeutic Lifestyle Changes diet, or TLC, is a lifestyle and eating program that provides helpful tips and tools to lower high blood cholesterol. The three-part program was coordinated by the National Heart, Lung, and Blood Institute, an arm of the U.S. Department of Health and Human Services, in cooperation with the American Heart Association.
The focus of the program is lowering your blood cholesterol levels to reduce your risk for heart disease — the leading cause of death in the United States — through a combination of diet, exercise, and making other healthy lifestyle choices.
The TLC diet provides a step-by-step program to lower your low-density-lipoprotein (LDL) cholesterol and in so doing your risk for heart disease. You are encouraged to devise a plan with the help and support of your doctor or other health professionals such as a dietitian. You will work with your team to devise a diet and exercise plan to meet your unique needs and address other risk factors such as smoking and high blood pressure.
The program is explained in an 85-page booklet that’s available online. The booklet gives an overview of “good” and “bad” cholesterol, explains how they affect your disease risk, and offers suggestions for eating and exercise to get blood cholesterol levels into the desired range.
Although the hope is to avoid the need for cholesterol-lowering drugs, the program recognizes that for some people medication may be necessary, especially when the cause is one or a combination of factors out of your control, like heredity, age, or sex.
Cholesterol is a necessary part of every cell in your body. It’s a waxy, fat-like substance your body uses to make hormones and bile acids, which are critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine, as well as other functions.
Your body has the ability to make all of the cholesterol it needs. Cholesterol circulates in your blood in packets called lipoproteins, which consist of fat (lipid) on the inside and protein on the outside. There are two main kinds of lipoproteins: low-density lipoproteins (LDL), also known as bad cholesterol, and high-density lipoproteins (HDL), also called good cholesterol.
LDL is considered bad because it carries cholesterol to tissues and arteries. Most of the cholesterol in your blood is the LDL form, so the higher your LDL, the greater your risk for heart disease.
HDL is considered good because it takes cholesterol away from tissues, transporting it to your liver, which removes it from your body. The lower your HDL number, the higher your risk for heart disease.
When you have too much cholesterol circulating in your blood it can stick to the walls of your arteries. Over time, this buildup, or plaque, causes blood vessels to narrow making them less flexible, a condition known as atherosclerosis or “hardening of the arteries.” This can happen anywhere in your body, but when it happens in the arteries that go to your heart (coronary arteries) your blood can’t deliver needed oxygen and nutrients. This is why high cholesterol is considered a major risk factor for coronary heart disease.
Not all risk factors are created equal
There are a number of risk factors for high cholesterol. These can be broken down into those you can control and those you cannot. Risk factors you cannot control are:
• Age and sex. Blood cholesterol naturally rises in everyone after the age of about 20 and continues to rise until the age of 60 to 65. Before the age of 50, men tend to have higher cholesterol levels. After 50, women generally have higher cholesterol levels as a result of menopause.
• Heredity. How much cholesterol your body makes and how efficiently it is removed is partly determined by your genes. If high cholesterol runs in your family you may be more likely to have it, too. However, just because you “inherited” the condition doesn’t mean you can’t do anything to correct it. Likewise, not having a family history of high cholesterol doesn’t mean you can’t develop it.
The TLC program focuses on the risk factors you can control with the ultimate goal being to lower your LDL level. Controllable risk factors are:
• Diet. Specifically the three nutrients that can make LDL levels rise: saturated fat, which raises your LDL cholesterol more than anything else in your diet; trans fat, primarily found in processed foods; and dietary cholesterol, which comes only from animal products.
• Excess weight. Being overweight tends to raise your LDL and lower your HDL. Excess pounds also raise your triglycerides, another type of fatty substance found in your blood and food.
• Physical inactivity. Being a couch potato increases your risk of being overweight, which can have the negative effects noted above.
In order to know where to begin in addressing your cholesterol levels, you need to know where you are starting from. Many people have high cholesterol and don’t even know it because often there are no symptoms. All adults should have their cholesterol levels checked every 5 years.
The TLC program takes into account your current blood cholesterol levels in combination with your specific risk factors to place you in one of four categories for heart disease risk. The higher your risk category, the more important it is to lower your LDL and control other heart disease risk factors such as smoking and high blood pressure.
You’ll also need to determine how many calories per day you need to consume based on whether you need to lose or maintain your current weight.
The TLC program directs you to make common-sense changes that most of us already know are fundamentals for a healthy lifestyle. Specifically, you’re directed to have:
• Less than 7 percent of your daily calories from saturated fat
• Less than 200 mg a day of cholesterol
• 25 to 35 percent of daily calories from total fat
• Only enough calories to reach or maintain a healthy weight
• At least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week
Once you and your team have determined a course to attain your goals, the booklet provides you with information such as cooking techniques and food swaps to lower calories and fat, ways to spice up your food to keep it tasty and interesting, label-reading tips to avoid hidden ingredients that may sabotage your efforts, and an overview of different activities and how many calories they burn.
The guide also provides the number of daily servings for each food group, recommendations about getting more fiber and its role in lowering cholesterol, a guide to serving sizes, and how to stay on track when eating out.
You are encouraged to schedule follow-up visits with your doctor or other health professional every six weeks to monitor your progress and implement additional dietary and lifestyle changes if needed. As a last resort, drug therapy can be incorporated to help you achieve your goals.
The TLC diet is a plan that incorporates basic principles of healthy eating and activity into a program that can be tailored to your unique needs to achieve healthy cholesterol levels and lower your risk for heart disease.
Although there are no recipes, the program offers a variety of one-day sample menus to give you an idea of what you should be eating based on your caloric needs.
Online support is somewhat limited. There is no official website other than the booklet, but a few available books expand on the principles of the program, and a few independent websites are also available.
January 11, 2018
Janet O’Dell, RN