The Preventive Approach: Therapeutic Lifestyle Changes

There are many genetic screenings available in the market today which allow individual to screen for genetic predisposition towards certain diseases such as breast cancer and colorectal cancer. Have you ever wonder what would you do if the genetic test result turns out to be positive?

Many will freak out or go into depression mode. However, having a genetic predisposition is not the end of the story. Except for some rare genetic disease, genetic alone does not condemn you to disease nor determines your fate. 

Lifestyle disease such as heart disease is multifactorial in its nature. Apart from genetic predisposition, factors such as not smoking, eating a healthy diet or regular exercise may delay or offset the expression of the disease.  Many studies had showed that although the genotype (which bearing the risk allele) cannot be changed, the expression of the gene can be influenced by the external factors such as diet and environment. Recently, a researcher named Ornish D. has conducted a study to analyze the effects of Therapeutic Life Style Changes (TLC) at genetic level [1] (PMID: 18559852). It was revealed that through adoption of good diet plan and exercise regime, the genes which involves in Cancer causation were “switched off” whereas the genes which offer protection towards cancer were “switched on”. 

What is TLC?

Therapeutic Lifestyle Changes (TLC) was first introduced in the Third Report of the National Cholesterol Education Program (NCEP)’s Adult Treatment Panel (ATP) III guidelines, 2002 [2]. It was highly recommended by various health organizations such as American Diabetes Association, American Heart Association, and The Obesity Society. This therapeutic strategy includes specific dietary regime (TLC diet), weight management, and increased physical activity, targeting at obese person at risk for type 2 diabetes and/or coronary heart disease. TLC is not something new. Previously it was referred as lifestyle intervention, lifestyle therapy, or lifestyle medicine. In short, it is a patient-centered or personalized approach for disease management, reduction, and prevention, which incorporates diet and nutritional recommendations, regular exercise, adequate rest, and stress management for lifestyle-related conditions.

A major component of TLC is diet. The cumulative effect of the TLC diet components can reduce low density lipoprotein by 25-30% which is similar to the effect of drug therapy [2]. The following table describes the TLC diet. 

Table 3. Dietary Recommendations for TLC Diet [3]
Component	TLC Diet	Food Sources
Total fat	25-35% of total calories*
Saturated fat	<7% total calories	Animal-based foods, including whole-fat dairy products (milk, cream, butter, cheese), fatty meats such as beef and pork. Some vegetable-based foods such as coconut, palm, and palm kernel oils also contain relatively high levels of saturated fats.
Polyunsaturated fat	Up to 10% of total calories	The two primary types of polyunsaturated fats are omega-6 and omega-3 fats. Omega-6 fats are found in nuts, seeds, and vegetables oils such as sunflower, canola, safflower, corn, and soybean oils. Plant sources of omega-3 fats (-linolenic) include canola oil, soybean oil flaxseed, and English walnuts.
Monounsaturated fat	Up to 20% of total calories	Oils including olive, canola, and peanut oil.
Trans fat	Lower intake	Foods containing or prepared with partially hydrogenated vegetable oils, including stick margarine, pastries, fried foods, french fries, and pastries. Naturally occurring trans fats are also found in milk, butter, and meats.
Carbohydrate**	50-60% of total calories
Dietary fiber	20-30 grams per day
Protein	15-25% of total calories
Cholesterol	<200 mg/day	Foods of animal origin. Highest amounts are found in liver and egg yolks. Moderate amounts are found in full-fat dairy products, some seafood (shrimp and lobster), and fish (salmon and sardines)
Sodium	<2,300 mg/day
Dietary options
Plant sterols/stanols	Add up to 2 grams per day
Soluble fiber	Increase 5-10 grams per day
Fish (fatty fish)	Include in weekly eating plan

In conclusion, TLC is not a rocket science; it is simply a pro-active way of managing one’s health in an informed and scientific manner. With some discipline, you will be well on the way to adopting a healthy lifestyle and reducing your risk for chronic disease.

In the subsequent articles, there will be highlights of 2 famous gurus of TLC. Please stay tuned!

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[1] http://www.ncbi.nlm.nih.gov/pubmed/18559852

[2] http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

[3] Can Lifestyle Modifications Using Therapeutic Lifestyle Changes (TLC) Reduce Weight and the Risk for Chronic Disease? Research to Practice Series, No. 7, National Centre for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity

by Susan Ong, Manager, Product Portfolio