These days, we know that our cholesterol numbers aren't totally determined by what we eat. In fact, the relationship between cholesterol and food is a bit more complicated.
But our diet does play a role, and certain foods can help bump our cholesterol into a healthier range. That's where the Therapeutic Lifestyle Changes (TLC) diet comes in.
Here, we'll break down how the diet works and which foods are included, and offer a sample day's menu to get you started.
So, What Is the TLC Diet?
The TLC diet was created by the National Institutes of Health with the goal of helping followers lower their cholesterol through heart-healthy foods and lifestyle modifications. The plan consists of mainly whole foods that are low in saturated fat and — you guessed it — cholesterol, and high in soluble fiber, but it otherwise allows a good deal of freedom in food choices. The TLC diet is safe for just about everyone and has been proven to help lower cholesterol as well as the risk of heart disease and stroke.
Unlike other diets focused on weight loss, the TLC diet is meant to be a sustainable lifestyle shift that people can stick to in the long term.
- 25 to 30 percent of your daily calories should come from fat, and specifically unsaturated fat in the form of vegetable oils like canola, avocado, olive, corn, sunflower and safflower.
- Less than 7 percent of your daily calories should come from saturated fat (think: butter, cheese, dairy products and fatty meats).
- Daily cholesterol intake is limited to 200 milligrams or less per day. Cholesterol is found in all animal products. For reference, one whole egg contains about 186 milligrams of cholesterol, per the USDA.
- Trans fat is to be completely avoided. This is a manufactured fat found in processed foods. Check food labels, and avoid any foods with a partially hydrogenated oil in the ingredients list.
- Whole grains, fruits and vegetables are encouraged rather than refined carbohydrates such as sugar.
- Aim for 10 to 25 grams of soluble fiber daily.
- Get at least 30 minutes of moderate-intensity physical activity every day.
Benefits of the TLC Diet
Over the years, research has shown that the TLC diet is effective when it comes to both lowering cholesterol and reducing the associated risks of heart disease and stroke.
In one of the earliest studies on the diet, 36 people followed the TLC guidelines for about a month and decreased their levels of LDL or "bad" cholesterol by an average of 11 percent. The findings were published February 2002 in the Journal of Lipid Research.
Today, the rules laid out by the TLC diet are in line with the Dietary Guidelines for Americans, which are compiled by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. The guidelines are meant to help promote health and prevent chronic disease.
As an added benefit, the diet may help reduce blood pressure as well. A meta-analysis published January 2018 in Nutrition, Metabolism, and Cardiovascular Diseases found that consuming more soluble fiber, as encouraged by the TLC guidelines, can help lower levels of both systolic and diastolic blood pressure.
Fiber has also been shown to reduce cholesterol levels in the body by binding to cholesterol molecules in the intestine, which then allows them to pass through the body, per the Mayo Clinic. Keep in mind that the Academy of Nutrition and Dietetics recommends 25 grams of fiber per day for women and 38 grams per day for men. (Unfortunately, most Americans do not meet their daily fiber needs.)
The physical activity component of the diet is important, too. Indeed, a study of overweight and obese people published January 2015 in Progress in Cardiovascular Diseases concluded that exercise training, regardless of weight loss, provides numerous health benefits for those at risk for heart disease or with current cardiovascular conditions.
Who Should Follow the TLC Diet?
The TLC diet is a good choice for just about anyone looking to improve their cholesterol and lower their heart disease risk. The diet consists of lean meats, fish, poultry, low-fat or non-fat dairy, veggies, fruits, whole grains and plant-based sources of fat, which amounts to a healthful diet for most people. Plus, the diet doesn't restrict any food groups, and it includes a lot of flexibility with food choices, both of which make it a sustainable plan.
Those with type 2 diabetes may see particular benefits when following the TLC diet, especially with a slight tweak. A small study of 31 people with the condition, published October 2014 in the European Journal of Clinical Nutrition, found that when they followed the TLC diet and replaced red meat with legumes, they both lowered their cholesterol levels and improved their blood sugar control.
If you have a medical condition, take medications or are pregnant or breastfeeding, it's always best to check with your physician and/or a registered dietitian to make sure the TLC diet is right for you.
Foods to Eat on the TLC Diet
At its core, the TLC diet focuses on eating food that is low in saturated fat and cholesterol. Here, we'll break down smart choices by food group.
- Olive oil, canola oil, avocado oil and safflower oil
- Nut butter
- Seeds and nuts
- Fatty fish like salmon, trout, herring and mackerel
- Soy products
- Skinless chicken breast
- Egg whites
- Low or non-fat dairy
- Lean cuts of pork and red meat on occasion
Complex carbohydrates are recommended on the TLC diet, meaning carbs that come from whole grains and are naturally high in fiber.
- Whole grain and whole wheat foods (think pastas and bread)
- Brown rice
A One-Day Menu to Kickstart the TLC Diet
If you want to follow the TLC diet, the American College of Cardiology provides the following sample menu to get you started.
- 1/2 cup oatmeal with 1 cup fat-free milk, 1 teaspoon brown sugar and 1 banana
- Fat-free latte
- Sandwich made from 2 slices whole-wheat bread, 2 ounces lean turkey, 1 tablespoon mayonnaise, lettuce and tomato
- 1 cup carrot sticks
- 1 apple
- 1 cup low-fat or nonfat vanilla yogurt
- ½ cup mixed raisins and peanuts
- 3 ounces baked or broiled salmon
- 1 cup cooked brown rice
- 1 cup cooked broccoli
- 1 tablespoon olive oil (used in cooking)
- Salad made with 1½ cups romaine lettuce, ½ cup tomatoes, ¼ cucumber, 1 tablespoon vinegar and oil dressing
- 1 slice Italian bread with 1 teaspoon soft margarine
- 1 sliced peach with 1 cup fat-free milk
- American College of Cardiology: "High cholesterol: the TLC diet"
- European Journal of Clinical Nutrition: "Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial"
- Journal of Lipid Research: "Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects."
- Mayo Clinic: "Cholesterol: Top foods to improve your numbers"
- Academy of Nutrition and Dietetics: "Easy Ways to Boost Fiber in Your Daily Diet"
- American College of Cardiology: "TLC Diet Sample Menu"
- National Institutes of Health: "Your Guide to Lowering Your Cholesterol with TLC"
- My Food Data: "Nutrition Facts for Eggs (Raw)"
- Dietary Guidelines for Americans: "Key Elements of Healthy Eating Patterns"
- Nutrition, Metabolism, and Cardiovascular Diseases: "The effect of viscous soluble fiber on blood pressure: A systematic review and meta-analysis of randomized controlled trials."
- Progress in Cardiovascular Diseases: "The Role of Exercise and Physical Activity in Weight Loss and Maintenance"