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How does the top-rated TLC eating plan help lower your cholesterol?

The diet was ranked fifth best overall in U.S. News & World Report’s 2023 diet report.
Woman putting together oatmeal with banana, strawberries and nuts.
Healthy whole grains, like oatmeal, and fruit are a go-to breakfast on the TLC eating plan. Arx0nt / Getty Images/iStockphoto

Ranked as fifth best overall in the U.S. News & World Report’s annual ratings of popular eating plans, the TLC, which was devised by the National Institutes of Health to help people lower their LDL cholesterol levels, is more of a program than a diet plan.

TLC, or Therapeutic Lifestyle Changes, not only offers an eating plan, but also recommends other lifestyle modifications including 30 minutes of activity each day and weight management in an 80-page booklet available online.

What is the TLC diet?

The program focuses on how changing eating habits might help lower “bad” cholesterol. The dietary part of the program emphasizes fruits, vegetables, whole grains, lean meats and fish, while advising the avoidance of saturated and trans-fats.  

Overall, TLC diet leans heavily on carbohydrates. Among the strategies to lower cholesterol, the diet encourages increasing the amount of plant sterols and stanols, which are abundant in foods such as wheat germ and nuts.

TLC suggests eating as little saturated and trans-fats as possible and cutting back on the consumption of red meat and cutting back on foods that contain cholesterol. For example, it suggests that no more than two eggs a week should be consumed. 

The TLC plan booklet offers possible meal and snack menus in various types of cuisines, including traditional American, Southern, Asian American and Mexican American.

“It’s family friendly,” says Charlotte Pratt, a nutritionist and deputy branch chief in the division of cardiovascular sciences at the NIH. “It helps with dietary management for the whole family,” she adds. “Making dietary changes for yourself can be easier if it’s a family affair.”

What can I eat on the TLC diet?

Like many heart-healthy diet plans, the TLC limits sodium and recommends replacing foods high in saturated fat with lower-fat options. Some of the foods you’ll eat on the plan include:

  • Fruits and vegetables
  • Beans and lentils
  • Whole grains
  • Nuts
  • Nonfat or lower-fat dairy products
  • Fish, poultry and some lean meats

One thing people don’t understand is that the more you eat something, such as sugar, the more you will crave it, Van Horn says. “So the more frequently the average consumer goes for fruits and vegetables or whole grain products the more they will crave them,” says Linda Van Horn, a professor of epidemiology and chief of nutrition in preventive medicine at Northwestern University’s Feinberg School of Medicine.

What foods do you avoid on the TLC diet?

The eating plan suggests avoiding foods high in sodium, sugar, trans fats and saturated fats.

One good thing about the TLC is that it doesn’t suggest completely avoiding any foods, says Van Horn. “What people fail to recognize is that by ignoring certain foods in the diet, they are doing themselves a disservice nutritionally as well as metabolically,” Van Horn says.

Does the TLC plan help you lose weight?

TLC provides suggestions on what to eat and also provides help for those looking to lose weight by offering menus with food choices that total 1,200 or 1,600 calories a day. 

But if you're primarily interested in losing weight, the TLC diet may not be for you. Studies comparing TLC to other eating plans found people shed fewer pounds on it. For example, a 2004 JAMA Internal Medicine study that compared weight loss in people on the TLC diet (called NCEP in the study) to what was lost on a low-carb diet over a period of 12 weeks, found nearly twice as many pounds were shed with the low-carb diet.  

The diet does, however, do the thing it was advertised to do, help lower cholesterol.

How does it compare to other healthy eating plans?

Compared to some other eating plans, the TLC is a higher in carbohydrates and lower in protein. Suggested menus, which can contain nearly 60% carbs and 30% fats, leave few calories for proteins.  That’s on the low side of the suggested daily requirement of 10% to 35%.

The diet is also low in vegetables compared to other eating plans. The USDA’s “My Plate” divvies up major food groups such that half the plate is taken up by fruits and vegetables, while protein and fruit portions are similar to the amount of grains.

The diet has some other flaws, Zhaoping says.  

For example, TLC unnecessarily limits eggs because they contain cholesterol, she says. Scientists have learned that the vast majority of cholesterol in our blood — 80% — does not come from high cholesterol foods, but rather, what is made by our livers, she adds.

Moreover, Zhaoping says, the diet isn’t great for those with diabetes. For example, she says, the TLC’s suggested breakfast menu containing ready to eat cereal, milk and orange juice would be a “disaster for glucose control.”

What health experts think about the TLC

Experts tell that overall the TLC is good because it doesn’t banish any food groups. But it’s heavier in carbohydrates and lower in protein and veggies than they would recommend. And because the diet is nearly two decades old (the front cover of the booklet has a December 2005 date), it doesn’t reflect changes since 2005 in how scientists view some aspects of nutrition.

However, because the TLC offers food choices that would be familiar to people who are currently consuming a typical American diet, it might be more sustainable over the long term compared to other options, says Dr. Zhaoping Li, a professor of medicine, Lynda and Stewart Resnick Endowed Chair in Human Nutrition and director of the Center for Human Nutrition at the David Geffen School of Medicine at the University of California, Los Angeles.

The TLC “from the 30,000 foot view has a lot of good things,” says Dr. Deepak Bhatt, a professor of cardiovascular medicine at the Icahn School of Medicine at Mount Sinai and director of Mount Sinai Heart in New York. “One good thing is that it makes the point that what you eat can affect blood cholesterol levels. Even healthy people trying to stay healthy need to realize that.”

Still, Bhatt says, the thinking has changed on just how much impact diet has on cholesterol levels. “Several years ago it was thought that diet had an enormous impact,” he adds. “But for those with really high cholesterol, the effect of diet is pretty modest and a medication will be needed.”

It’s good that the TLC suggests people “try to cut down or eliminate red meat,” Bhatt says. “That’s a good idea not just for cardiovascular risk, but also cancer risk. I endorse a diet that is completely plant based. But if your own personal preferences you can’t live with a vegetarian diet, then fish is probably the healthiest.”

Another strong point is that the TLC emphasizes activity, Bhatt says. “It doesn’t have to be 30 minutes on a treadmill,” he says. “It could be walking brisk enough to break a sweat.”

Among TLC’s negatives is the amount of carbs as compared to vegetables and protein, Bhatt says. Back when the diet was devised, there was a war on fat and many thought fat calories could be replaced by carbohydrates, he explains. Non-fat, high carb food choices often left people hungry and consuming more calories, he adds.

Unfortunately, “nothing is really new in this booklet” and some of the information is outdated, says Dr. Dr. Howard Weintraub, a clinical professor of medicine at the NYU Grossman School of Medicine and clinical director of the NYU Center for the Prevention of Cardiovascular Disease in New York.

The TLC is definitely a product of its time, Weintraub says. “It’s when protein was vastly underrated, fat was somewhat vilified and carbs got a free ride,” he adds. “What we know about nutrition and the role of certain carbs and fat has evolved since that time.”

Weintraub faults the diet for its abundant carbs and small amounts of protein. “How many people are going to be satisfied with 3 ounces of steak?” he says, adding that the high amounts of carbohydrates, such as rice, potatoes, and pasta, are also likely to leave people unsatisfied. Weintraub is especially put off by the suggestion of a bagel, which generally would not be whole grain and can run upwards of 400 calories, as a snack.

The six or more servings a day of carbohydrates, including rice, potatoes and those made from grains, such as bread, cereal or pasta, are suggested “only because these foods are low in fat,” he says.  

One of the things Weintraub does like is the booklet’s detailed visual descriptions of what a serving of various foods would look like: a cup of cereal flakes is equal in size to a fist, a pancake, the size of a compact disc, a half a cup of cooked rice, pasta or potato, half a baseball.

Weintraub says he would rather see people choose the Mediterranean diet than the TLC. “It’s the only diet that has been shown to save lives in randomized, controlled trials,” he adds. “It’s been shown to reduce cardiovascular events, most notably strokes.”

The bottom line

Van Horn says although she has concerns about some of food choices in the TLC menus, “the message itself is good,” she says. “There are certainly more benefits to this booklet than disadvantages.”

Overall, “this is a nicely written, consumer targeted booklet,” Van Horn says. “In plain language it addresses each of the elements involved, including diet, weight control, physical activity and medical/pharmaceutical contributions that can help lower the risk factors associated with cardiovascular disease.”