What is the TLC diet plan? Can it lower cholesterol, lead to weight loss and control diabetes?

The TLC (Therapeutic Lifestyle Changes) Programme was introduced by the National Lung, Heart and Brain Institute in 1985 to tackle the rising problem of obesity and improve the heart health of Americans.

In actuality, the TLC is a programme, not just a diet and includes exercise and weight management for better heart health. The obesity pandemic has engulfed India too – the last NFHS data states that 24 per cent of Indian women and 23 per cent of Indian men are obese. Diabetes has grown exponentially in India in the last three decades. Besides, Indians have a greater risk of heart disease at a younger age. Therefore, the question arises – Is the TLC diet relevant in the Indian context?

COMPONENTS OF THE TLC PROGRAMME

Diet

The dietary recommendations of TLCP are:

1. Calorie restriction such that only enough calories to maintain a healthy weight must be taken. If weight loss is the goal, a reduction in calorie intake is required. This should be based on your overall health and comorbidities should ideally be planned in consultation with a trained nutritionist.

2. Fats: Fats should provide 25 to 35 per cent of calories and saturated fat should account for less than seven per cent of calories. Saturated fats and trans-fats are known to increase LDL levels, which are the main culprits for coronary artery disease. Therefore, foods containing saturated fats, like red meats, and those containing trans-fats, like deep fried snacks, cookies and desserts, should be limited in the diet.

The TLCP also recommends limiting dietary cholesterol to 200 grams per day. Cholesterol dense foods are of animal origin – egg yolks, liver and full fat dairy products. However, the American Heart Association now states that dietary cholesterol intake does not significantly increase LDL levels, therefore the TLC recommendation on dietary cholesterol may need revision. It also states that intake of one egg daily does not significantly increase the risk of heart disease or stroke.

Monounsaturated and polyunsaturated fats are good for you. TLC recommends that 20 per cent of calories should come from MUFAs (olive oil, canola oil) and 10 per cent from
PUFAs. Omega-3 PUFA rich foods are olive oil, canola oil and nuts, and Omega-6 rich PUFAs are contained in oily fish like salmon, mackerel and cod.

3. Carbohydrates and fibre: According to TLCP, carbohydrates should provide 50-60 per cent of all calories. Refined carbohydrates should be avoided. The diet should contain soluble fibre – 10 grams to 25 grams per day. Fibres may be soluble in water – they form a gel-like substance in the intestines that helps block the absorption of fats, or insoluble in water – they help keep the digestive system healthy. Apples, guavas, sweet potatoes, oats, legumes are all rich in soluble fibres. Insoluble fibre-rich foods include cauliflowers,
broccoli, peas, green beans and whole wheat. Indians often say that our diet is naturally fibre rich. Originally yes, but sadly, with the umpteen refined and processed options available now, our diet is not what it used to be anymore!

4. The TLC diet also advocates that two grams of plant sterols or stanols should be consumed each day. Plant sterols and stanols are known to decrease cholesterol absorption. Sterol-rich foods include wheat germ, corn oil and canola oil. Almonds, brussels sprouts and wheat bran also contain good amounts of phytosterols (plant sterols).

5. Dietary salt: Reduction in salt intake leads to decreased blood pressure and reduced risk of heart disease. Based on this, the TLC recommends no more than 2.3 grams of salt every day. One way to do this is by not adding salt to your salads, avoiding salted snacks and choosing low sodium versions of processed foods.

Exercise and Weight Management

The TLC programme recommends at least 30 minutes of moderate intensity physical activity every day. It further recommends 60-90 minutes of moderate intensity activity to achieve and sustain weight loss.

CAN THE DIET PLAN WORK FOR INDIANS?

With diets, there is truly no one-size-fits-all. However, there are some good takeaways from the TLCP. It is holistic, in the sense that it focusses not just on diet, but also encourages daily exercise and weight loss as equal contributors to better heart health.

The TLCP was designed to lower blood cholesterol levels. However, the lowering of blood LDL (bad cholesterol) is only 10-11 per cent after three to six months of the TLC diet. Increasing evidence indicates that lowering LDL cholesterol to a substantial extent is only possible by using medications. Hence, while the TLC diet continues to be a healthy one, it does not exert its health benefits by lowering cholesterol.

However, the TLCP caters to Americans and needs to be modified to fit Indian eating habits. The principles of a metabolically healthy diet for Indians are:

· Reduction in refined and processed carbohydrates, like ‘maida.’

· Increase in fibre content, for example whole wheat millets, vegetables, and fruits.

· Increase in protein intake like dairy products, nuts, eggs, poultry and fish.

· Omitting trans-fats and reducing saturated fats.

· Adding good fats to the diet, for example olive oil, canola oil, almonds and walnuts.

To keep your heart healthy, stay away from fad diets, follow sustainable diets, exercise daily, and sleep well. And of course, reducing stress helps!