Heart disease remains the leading cause of death in the United States in 2024. One of its risk factors is having high low-density lipoprotein (LDL) cholesterol, commonly referred to as “bad” cholesterol.
Hence, the National Heart, Lung, and Blood Institute (NHLBI), together with National Institutes of Health (NIH), created the therapeutic lifestyle changes (TLC) program. It’s recommended by medical professionals to help lower heart disease risks.
What’s the TLC Program?
The TLC Program is a Cholesterol Reduction Plan that combines diet, 30-min daily physical activity, and weight management. These step-by-step plans are available for everyone in an 85-page booklet online.
While it’s a three-part program, it’s more well-known for its diet plan. In fact, in the US, it ranked 4th in Best Heart-Healthy Diets, 5th in News & World Report’s Best Diets, and 5th in Best Diets for Healthy Eating.
How Does It Work?
The TLC diet focuses on lowering daily consumption of saturated fats, which are usually found in animal-based food sources and dairy products. They increase cholesterol in the blood, particularly the bad cholesterol, which increases the risk of heart disease.
According to the American Health Association (AHA), the following are the main sources of saturated fats:
- Beef
- Beef fat (tallow)
- Butter
- Cheese
- Coconut
- Ice cream
- Lamb
- Lard and cream
- Palm kernel oil
- Palm oil
- Pork
- Poultry, especially with skin
- Some baked and fried foods
Instead of saturated fats, the TLC diet recommends adding more soluble fiber and phytosterols, also known as plant stanols and sterols, to daily meals. Note that phytosterols are cholesterol-like compounds found naturally in many plant-based sources, including fruits, vegetables, vegetable oils, legumes, nuts, seeds, and grain products such as cereals.
According to NHLBI, soluble fiber prevents any fat absorption, including cholesterol, through the intestinal walls into the bloodstream. Similarly, phytosterols help prevent cholesterol absorption from the digestive tract, which helps to lower bad cholesterol.
Listed below are fiber and phytosterols sources you can add to a TLC diet:
- Beef (lean cuts only, e.g., round steak, sirloin tip, and extra-lean ground meat)
- Brown rice
- Cheese (low-fat)
- Cottage cheese (low-fat)
- Egg substitutes
- Egg whites
- Egg yolks (two or fewer only per week)
- Fatty fish (e.g., salmon or tuna twice per week and choose tuna that has low mercury as per FDA recommendations, like canned light tuna)
- Fruits (can be fresh, frozen, or canned as long as without added sugar)
- Legumes (e.g., dried or canned black beans, chickpeas, and peas)
- Low-fat cookies (e.g., ginger snaps or fig bars)
- Low-fat, whole-grain crackers
- Milk (fat-free or low-fat)
- Nuts
- Potatoes
- Seeds
- Shrimp (occasionally)
- Skinless chicken and turkey
- Sour cream (fat-free or low-fat)
- Vegetable oils (e.g., canola, corn, olive, safflower, or soybean)
- Vegetables (can be fresh, frozen, or canned as long as without added salt or sauce)
- Whole grains (e.g., bread, cereal, or pasta)
- Yogurt (fat-free or low-fat)
As noticed, the TLC diet is still fairly inclusive of most food groups despite limiting foods high in saturated fat and cholesterol. The key is consistent portion control and regular physical activities.
Lastly, note that this diet plan is prescriptive. Doctors will recommend consumption guidelines, including a specific amount of servings of a specific food group, for every individual, depending on current health status and other factors. In other words, the TCL diet may vary from person to person.
Is the Keto Diet Great with the TLC Program?
The NHLBI doesn’t specifically mention the ketogenic or simply keto diet as part of the TLC program, but both diet plans have similar goals. First, both encourage eating whole, nutrient-dense foods instead of processed foods, including refined carbohydrates and sugars.
Second, both promote weight loss. The TLC program achieves this through a balanced intake of nutrient-rich foods and portion control, while the keto diet does so through ketosis. As explained in the previous post, the metabolic state happens when our body processes its fat reserves to produce energy, which can eventually get rid of unwanted fats.
Lastly, both have cardiovascular benefits. As stated, the TLC program aims to lower bad cholesterol, while the keto diet is found to increase good cholesterol levels and lower triglycerides in some studies. All of these benefits from keto and TCL diet plans can reduce the risk of cardiovascular diseases.
However, it’s important to consult your doctor and undergo it first before following both diet plans at the same time. Studies and clinical observations have shown that a keto diet can lead to a sudden surge in triglycerides and bad cholesterol that could last for weeks and months.
One of the main reasons is because it’s often made of 75% fats, which are typically taken from saturated fats like butter, cheese, and fatty meats. As mentioned, these food sources can increase bad cholesterol.
A medical professional explained that a cholesterol spike after a keto diet doesn’t do much in increasing an individual’s risk of cardiovascular disease, only if it’s short-term. However, if it persists over months to years, it’s very concerning, even life-threatening.
Final Thoughts
The TLC program is one of the government initiatives to improve cholesterol numbers in the US. Its diet program mainly focuses on decreasing saturated fat intake and increasing soluble fiber and plant stanols and sterols consumption. However, its plan and effectiveness vary among people, so seeking medical advice is deemed necessary.
