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CHAPTER 6 Popular Dietary Patterns Around the World
The Therapeutic Lifestyle Changes (TLC) Diet
The dietary management of dyslipidemia (defined as elevated total or LDL cholesterol or triglycerides levels, or low levels of HDL cholesterol) is a major goal in the management of CHD. According to the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for the management of dyslipidemias, the dietary strategy for lowering LDL cholesterol is to replace saturated and trans fatty acids with unsaturated and monosaturated fatty acids, as well as simple carbohydrates (e.g., sugars) with complex carbohydrates (e.g., whole grains, fruits, and vegetables).
In 2001, the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, ATP III) published the dietary guidelines for lowering LDL cholesterol called the “Therapeutic Lifestyle Changes” (TLC) diet. These guidelines replaced what had been the most widely accepted dietary approaches for lowering LDL, the Step I and Step II diets. The basic principles of the TLC diet are shown in Table 6.1.
The first step of the TLC dietary approach is to reduce the intake of saturated fats, trans fatty acids, and cholesterol in order to lower LDL cholesterol. At this step, emphasis is also given to physical activity (at least 200 kcal/d of daily energy expenditure). After 6 weeks, if the LDL goal has not been achieved, other dietary choices for lowering LDL, such as plant stanols/sterols and soluble fiber, can be added. Sterols and stanols prevent the absorption of cholesterol in the human gastrointestinal tract, thereby decreasing cholesterol concentration in the bloodstream. When maximum LDL reduction is achieved with dietary therapy, emphasis is shifted to other metabolic abnormalities. Given that dyslipidemias are mostly prevalent among obese individuals who live a sedentary life, body weight loss plays an important role in further ameliorating not only LDL levels but also other risk factors associated with obesity. Physicians and other health professionals should advise their patients to visit a registered dietitian or other qualified nutritionist for expert advice and the development of appropriate/individualized nutritional plans.
TABLE 6.1 The basic principles of the TLC diet. a
| Saturated fat | Less than 7% of total calories |
| Polyunsaturated fat | Up to 10% of total calories |
| Monounsaturated fat | Up to 20% of total calories |
| Total fat | 25–35% of total calories |
| Carbohydratesb | 50–60% of total calories |
| Total fiber Soluble fiber | 20–30 g/d 10–25 g/d |
| Proteinsc | Approximately 15% of total calories |
| Cholesterol | Less than 200 mg/d |
| Plant stanols/sterols |
2 g per day
|
