History of the TLC diet
In November 1985, in order to standardize the medical approach to treating high blood cholesterol levels, the National Heart, Lung, and Blood Institute (NHLBI) launched the National Cholesterol Education Program (NCEP). . The overall goal of the NCEP is “to reduce disease and death from coronary heart disease (CHD) in the United States by reducing the percentage of Americans with high cholesterol.”

In its first approach, the NCEP designed the Step 1 and Step 2 diet to lower cholesterol. Designed as a starter diet for people with high cholesterol, the Step I diet limited total fat to no more than 30% of total calories, saturated fat to no more than 10% of total calories, and cholesterol to less than 300 mg / day.

If this approach did not result in a lowering of cholesterol, or if people have had a heart attack or are at high risk for one, the Step II diet goals were instituted. In this case, they recommended less than 7% of total calories for saturated fat and less than 200 mg / day for cholesterol.

For the general population, the NCEP still recommends a diet following the recommendations in Step 1. However, in May 2001, the NCEP issued the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) that recommended the new TLC diet therapy for subgroups of people with specific medical conditions and risk factors detailed below:

• High level of LDL cholesterol or other lipid disorders
• Coronary heart disease or other cardiovascular diseases
• Diabetes mellitus, insulin resistance, or metabolic syndrome.

How the TLC diet works
The goal is to lower your high LDL or “bad” cholesterol and your risk of heart disease. The TLC diet also aims to reduce the risk of stroke and high blood pressure associated with a high-fat diet.

The initial steps of the program are divided into two six-week periods. After that, it is recommended that you see your doctor every four to six months. The program uses four different categories to classify your LDL goals.

Level one is the highest risk category. It means that you already have heart disease or diabetes and are at risk for a heart attack. All other groups are based on a health questionnaire that your doctor may ask you to complete to determine your goals.

The TLC diet is based on:

– Reduce your intake of foods high in cholesterol, saturated and trans fats, and sodium by avoiding butter, egg yolks, fatty cuts of meat, lard, and whole milk-based dairy products.
– Moderately increase physical exercise
– Increase the amount of foods rich in fiber (whole grains, whole grains, vegetables, fruits and legumes)
– Cut calories if you are overweight
– Eat more plant stanols / sterols (fortified foods)
– Increase the intake of healthy fats such as avocado, olive oil, olives, seeds, nuts, nut butters, fat from oily fish (salmon, tuna, mackerel, etc.)
– The creators of the TLC diet estimate that the longer you stay on the diet, the more your cholesterol levels will drop.

According to the U.S. Department of Health and Human Services, making the following dietary changes can result in a decrease in total LDL cholesterol by up to 30 percent:

• Decrease saturated fat to less than 7 percent of calories
• Limit dietary cholesterol to less than 200 mg per day
• Lose ten pounds if you are overweight
• Add five to ten grams of soluble fiber to your diet every day
• Eat two grams of plant stanols / sterols each dayGet 30 minutes of
• exercise every day, such as brisk walking
  What you can and cannot eat on this diet

The recommended foods are:

• Lean meat, chicken, fish, dried beans, and dried peas: No more than 5 ounces total per day.
• Eggs: No more than 2 yolks a week.
• Low-fat milk and dairy products: 2-3 servings per day.
• Fruits: 2 to 4 pieces per day.
• Vegetables: 3-5 servings per day.
• Bread, cereals and derivatives: at least 6 servings per day.
• Sweets and snacks: within 10% of total calories.
• Your doctor or nutritionist may recommend that you add soluble fiber or a cholesterol-lowering margarine to your diet. This could help you lower your LDL cholesterol. Soluble fiber is found in foods like oatmeal, beans, and fruits. Cholesterol-lowering margarines contain plant stanols and sterols.

The foods to avoid are those that stimulate the formation of cholesterol by the liver:

• Vegetable shortening
• Cookies
• Packaged snacks

and pastry products in general
– Whole dairy

• Viscera

Who should follow this diet
– Overweight people
– People who suffer from diabetes in order to reduce their cardiovascular risk
– People with kidney disease
– People with high blood pressure
– People with high cholesterol and / or triglycerides
– People with a personal or family history of cardiovascular disease

Who should not follow this diet

Although this is not a diet that excludes food groups with essential nutrients, it is recommended that those under 18 years of age, as well as pregnant women, avoid restricting cholesterol and following this type of diet

TLC diet: adverse effects
This diet does not have adverse effects, since it does not reduce fats, but rather, it restricts those that are dangerous and gives preference to those that contribute to normalize cholesterol and / or triglyceride levels.

Pro and cons of this diet
The benefits of this diet are as follows:

• The diet is simple and easy to follow.
• It can help lower cholesterol.
• The diet is suitable for most people.
• Contributes to weight loss
• It is complete and balanced so it helps to change habits
  

Cons of this diet include:

• It does not replace the use of cholesterol-lowering medications
• Foods fortified with phytosterols / phytostanols are often expensive
• You need to learn to read nutrition labels to identify foods high in cholesterol / trans fat / saturated fat.
• Not all people respond well to lowering cholesterol in the diet
  

TLC diet: how to get started
If you are interested in the TLC diet but are not sure where to start, it may be helpful to consult a sample menu of the foods you will be eating, as well as some of the ones you will need to avoid. You should also keep in mind that calorie control is an integral part of the diet if you need to lose weight.

Your doctor or nutritionist can help you come up with an exact number, but most men require around 2,500 calories per day, while women need 1,800. If you are looking to lose weight, the TLC diet recommends considering reducing these numbers to 1,600 for men and 1,200 for women. Some research shows that losing weight can significantly help lower LDL cholesterol, which is the main goal of the TLC diet.

Consider these tips when choosing what foods to eat:

• Six or more servings a day of whole wheat bread and cereals, pasta, rice, potatoes, crackers, and low-fat crackers
• Three to five servings a day of vegetables, dried beans, and peas
• Two to four servings a day of fruits
• Two to three servings per day of low-fat or skim milk, ricotta, yogurt, low-fat spread, and cheese (no more than three grams of fat per ounce)
• Two or fewer egg yolks per week (substitute egg whites in recipes)
• Five or fewer ounces a day of meats and seafood (limit organ meats,
• focus on skinless poultry and low-fat cuts of meat)
• Eat nuts and oils in moderation
• Focus on foods high in plant sterols / stanols, such as margarine and orange juices
• Eat lots of foods rich in soluble fiber: barley, oats, psyllium, apples, bananas, berries, citrus fruits, nectarines, peaches, pears, plums, prunes, broccoli, Brussels sprouts, carrots, dried beans, peas and soy products ( tofu, miso).