What is the TLC diet and can it improve your heart health?

What is the TLC diet?

The TLC diet is a programme that uses diet, physical activity and weight management to lower cholesterol levels. It was developed by the National Institutes of Health in the US to help reduce the risk of heart disease and stroke. Unlike quick-fix weight loss diets - or fad diets - the TLC diet is more of a lifestyle change and is designed to be followed long-term.

What is cholesterol?

Cholesterol is a natural fatty substance in your blood. It’s produced in the liver and it is also in some of the foods we eat. Cholesterol is important to keep the cells in our bodies healthy, but having high cholesterol means you have too much in your blood. This increases your risk of heart disease, heart attack and stroke.

Proteins in the blood carry cholesterol around the body to the cells that need it. When cholesterol and proteins combine, they're called lipoproteins - and there are two main types.

High-density lipoproteins (HDL) -  ‘good’ cholesterol - gets rid of the ‘bad’ cholesterol from your blood by taking it to the liver where it is removed.

Non-high-density lipoproteins (non-HDL) - bad cholesterol - lead to a build-up of fatty deposits inside the walls of the blood vessels. This narrows the blood vessels, increasing the risk of a heart attack or stroke. 

How to follow the TLC diet

The TLC diet is pretty simple - you need to eat fewer foods containing saturated fats and bad cholesterol, eat more wholegrains, nuts, beans, oats, fruits and vegetables.

Eat fewer foods containing saturated fats and trans fats

Saturated fat can raise your cholesterol and lead to heart disease.

UK health guidelines recommend that men should eat no more than 30g of saturated fat a day and women should eat no more than 20g. A two-finger KitKat chocolate bar contains around 14% of your saturated fat allowance, as well as 11% of your sugar allowance.

Trans fats - or trans fatty acids - are chemically altered vegetable oils used in processed foods. They are produced artificially by a process called hydrogenation, which turns liquid oil into solid fat. You should try to avoid trans fats as much as possible.

Eat more whole foods

Adding more vegetables, fruits, beans, lentils, chickpeas and wholegrains to your meals is also a good idea, as it will boost your fibre intake. Switch white bread for a wholemeal version.

Reduce dietary cholesterol

The TLC diet advises cutting down the amount of dietary cholesterol you eat. Dietary cholesterol is found in eggs and shellfish such as prawns. However, the recommendation to avoid dietary cholesterol may be outdated. According to the British Dietetics Association, updated research suggests dietary cholesterol doesn't make a big difference to the amount of cholesterol in the blood².

Choose low-fat alternatives

The TLC diet also advises eating lower-fat dairy products or dairy alternatives. However, lower fat products like yoghurts often contain added sugar or sweeteners.

Switch up the way you cook

The TLC diet recommends using an oil spray to eat less oil, trimming the fat off your meat before cooking it, or choosing leaner meats like turkey breast. Grilling, poaching or steaming food is healthier than frying it.

Check food packaging

It’s also important to check your food packages - which tell you whether your food contains a lot of saturated fat. Avoiding processed foods will help you cut down your intake of salt and saturated fat.

Eat good fats

Replacing foods containing saturated fats with 'good' fats is also advised to help lower your cholesterol. These healthier foods - like avocado, fish, nuts and seeds - contain fats, but also important minerals, vitamins, fibre and protein. However, some foods that contain good fats may still contain lots of calories - so although they are healthy, they still need to be eaten in moderation.

Exercise

Increasing the amount of exercise you do is also an important part of the TLC diet. Regular physical activity helps you manage your weight and lowers your cholesterol levels³. It also improves your heart health and helps to lower your blood pressure. The programme recommends 30 minutes of moderate intensity exercise - like brisk walking, hiking, dancing or water aerobics - every day or most days.

Weight management

Sticking to a healthy diet and keeping active will help you maintain a healthy weight.

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Does the TLC diet work?

Some key components of the TLC diet are known to benefit our health. Fruits, vegetables, wholegrains, nuts, seeds and legumes - and avoiding foods containing saturated fats - have been shown to lower levels of bad cholesterol⁴.

The programme also advises staying physically active and maintaining a healthy weight, which fits with UK guidelines. The current advice in the UK states to do at least 150 minutes of moderate exercise - brisk walking, hiking or mowing the lawn - or 75 minutes of vigorous exercise a week - for example, running or aerobics - spread evenly over 4 to 5 days a week or everyday.

Small studies have found the eating programme can have a positive effect on health. One study, which monitored 36 patients over 32 days, was found to lower levels of bad cholesterol by 11%⁵. However, this was a very small study.

Criticism of the TLC diet

However, some aspects of the TLC diet have come under criticism for being outdated. Firstly, the premise that dietary cholesterol increases your risk of heart disease no longer holds. Research suggests that saturated fats and sugary foods affect your cholesterol level more than the cholesterol you eat from food such as eggs⁶.

Although the diet suggests eating low-fat alternatives, they often contain a lot of sugar or sweeteners which are bad for our health⁷.

This said, some key components of the diet have been shown to lower bad cholesterol, like eating less saturated fat and eating more fruit, veg and fibre. You can find aspects of the TLC diet in other eating plans like the Mediterranean diet.

TLC diet recipes

Breakfast: Porridge with blueberries and banana

Oats are filling, tasty and research suggests they can help to lower your cholesterol levels⁸. Make the porridge with skimmed or semi-skimmed milk and top with fruit of your choice. You can add a sprinkling of nuts or seeds for some crunch and texture.

Lunch: Vegetable and bean chilli

There's nothing better than a warm bowl of comforting chilli, especially when the weather turns cold. Make a big batch of chilli with peppers, cubes of butternut squash, sweetcorn, lentils, kidney beans and other vegetables of your choice. Top with Greek yoghurt instead of sour cream.

Dinner: Wholemeal noodles with turkey and vegetables

Instead of a takeaway, whip up a quick noodle dish using fresh, healthy ingredients. Fry strips of turkey breast, broccoli and peppers with soy sauce, chilli flakes, a teaspoon of honey, chopped garlic and minced ginger. Add to cooked, wholemeal noodles for a satisfying dinner.

Further reading

1. British Heart Foundation: Heart statistics.

2. British Dietetics Association: Cholesterol.

3. Mann et al: Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: Review, synthesis and recommendations.

4. AbuMWeis et al: Plant sterols/stanols as cholesterol lowering agents: A meta-analysis of randomised controlled trials.

5. Lichtenstein et al: Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects.

6. Kratz: Dietary cholesterol, atherosclerosis and coronary heart disease.

7. Nguyen et al: A systematic comparison of sugar content in low-fat vs regular versions of food.

8. Grundy et al: Processing of oat - The impact on oat's cholesterol lowering effect.