The document discusses two diets for treating cardiovascular disease: the DASH diet and the TLC diet. The DASH diet focuses on limiting sodium while increasing fruits, vegetables and whole grains. It aims to control hypertension and cholesterol. The TLC diet focuses on lowering LDL cholesterol and blood triglycerides to reduce heart disease risk. The document analyzes these diets based on cost, health outcomes, and compliance to recommend the best option for a medical care group to advise patients.

1. LOUISIANA PROFESSIONAL MEDICAL CARE GROUP
Diets for Cardiovascular
Diseases
An Evaluation of Two Diets for Treatment
Ashish Pokharel
11/4/2013
PreparedforLouisianaProfessionalMedical Care Group(LPMCG) and inpartial fulfillmentof Mrs.Susan
Eller’sEnglish303 Technical WritingClass

2. 602 S. Trenton St.
Ruston, LA71270
November 4, 2013
Dr. David Sheringham, Chief of Medical Diagnostic Team
Louisiana Professional Medical Care Group
1687 Lake road
Ruston, LA, 71272
Dear Dr. Sheringham:
Attached with this letter is my analytical research recommendation report on analyzing and
evaluating two of the best diets for treating cardiovascular disease (CVD) patients. For this
report, I compared two highly recommended diets for CVD patients: Dietary Approaches to Stop
Hypertension (DASH) diet and Therapeutic Lifestyle Changes (TLC) diet.
To evaluate these two diets, I used criteria of cost, health outcomes, and long-term compliance.
After my primary and secondary research, I determined the best diet for Louisiana Professional
Medical Care Group to recommend would be the DASH diet. This diet provides better health
outcomes and is more feasible than the TLC diet. Although the DASH diet costs seem to higher,
the difference is negligible.
I appreciate the opportunity to research the diet options for treating CVD patients and to present
my recommendations to Louisiana Professional Medical Care Group. I look forward to more
research opportunities in the future. If you have any queries, please contact me at
ashish_pokharel@hotmail.com or 201-716-9100.
Sincerely,
Ashish Pokharel

3. Introduction
Cardiovascular Diseases1 (CVD) and related complications are the leading causes of death in
USA. Various interrelated diseases like hypercholesterolemia, hypertension, heart failure,
cerebrovascular accident (stroke), coronary artery diseases etc. classify as CVD. The incidence
of CVD is on the rise. According to a report by Division of Vital Statistics (2012), the leading
cause of death among Americans is heart disease. The same report states that cerebrovascular
accident or Stroke, which is similar complication of blood vessels, is the fourth leading causes of
death in USA. According to a CVD future forecast report by American Heart Association
(AHA), about 40.5% of Americans will have some form of CVD by 2030 (Heidenreich et al.,
2011). The following projection table from the same report shows the estimated increase in CVD and
related complications prevalence from 2010-2030.
Projections of Crude CVD Prevalence (%), 2010-2030 in the United States
Year All CVD Hypertension Coronary
heart
disease
Heart
failure
Stroke
2010 36.9 33.9 8 2.8 3.2
2015 37.8 34.8 8.3 3 3.4
2020 38.7 35.7 8.6 3.1 3.6
2025 39.7 36.5 8.9 3.3 3.8
2030 40.5 37.3 9.3 3.5 4
% change 9.9 9.9 16.6 25 24.9
Source: Adapted from Heidenreich et al. (2011). Forecasting the future of cardiovascular disease in the United
States: a policy statement from the American Heart Association.Circulation, 123.
As the table predicts, the incidence of all forms of CVD among US population will increase by
10%.
Currently, heart diseases make up one sixth of the entire healthcare expenditure. R. Morgan
Griffin of webmd.com (2013) writes that about four hundred and forty four billion dollars were
spent on heart disease in America in 2010. Various projections predict increase in the prevalence
of CVD. Along with the rising prevalence of CVD, the medical costs, both direct and indirect,
will increase. In the future, direct expenses like medicines, hospital checkups, treatment follow-
up, surgery etc. will make up a significant portion of the healthcare expenses for both
government and individuals. Direct costs related to hypertension, the most prevalent CVD
disease, are projected to increase by 130.4 billion dollars by 2030 (Heidenreich et al., 2011).
Similarly, indirect costs related to CVD disease like loss of productivity, sick leaves, and
mortality will also increase. The following table from future forecast report by AHA shows the
projected increase in direct medical costs from 2010-2030.
1 All the italicized text in this report are defined in the glossary

4. Projected Direct (Medical) Costs of CVD , 2010-2030 (in billions 2008$) in the United States
All
CVD
Hypertension Coronary
Heart
Disease
Heart
Failure
Stroke Hypertension
as risk factor
2010 272.5 69.9 35.7 24.7 28.3 130.7
2015 358 91.4 46.8 32.4 38 170.4
2020 470.3 119.1 61.4 42.9 51.3 222.5
2025 621.6 155 81.1 57.5 70 293.6
2030 818.1 200.3 106.4 77.7 95.6 389
%
change
200 186 198 215 238 198
Source: Adapted from Heidenreich et al. (2011). Forecasting the future of cardiovascular disease in the United
States: a policy statement from the American Heart Association.Circulation, 123.
The table above predicts that Americans will spend about 818 billion dollars on CVD by 2030
and this is 200 % increase from 2010. Thus, medical expenses will be a major issue for both
government and individuals.
Problem
With increasing health risks and increasing costs issue of CVD diseases, the development of
effective measures to treat CVD is a priority for healthcare organizations. Healthcare
Organizations need to design and implement effective preventive and treatment strategies in
order to attain the best health and cost outcome. Most prevention and treatment plan for CVD
diseases underline proper diet and exercise as their principle area of focus. Considering
prevalence and expenses related to heart disease, the Center for Disease Control and Prevention
(CDC) recommends eating a healthy diet as one of the key strategy to stop CVD.
With awareness about diet plans increasing in the general public, various popular media like
television, internet, and magazines target people with advertisements about diet plans. Common
people debate about which diet works for them and how to approach diets. Many people deprive
themselves of essential nutrients while striving to lose weight through popular diets. This
dilemma holds true for people trying to decide on a diet for medical purposes like treating CVD.
Proper advice and recommendation about diet is essential as many people have CVD or they are
genetically prone to develop CVD in later years of life.
Louisiana Professional Medical Care Group (LPMCG) serves many patients with CVD and
related complications. According to LPMCG’s annual report, about 35 percent of its patients
have CVD and related issues. In future, there will be more patients with CVD because of its
increasing prevalence. As Louisiana Professional Medical Care Group (LPMCG) specializes in
nutrition therapy and care, recommending the best diet for improving patients’ health outcomes
is of primary importance. Giving the best treatment based on scientific data, research is one of

5. our organizational goals, and we need to implement the best treatment plan for every patient
based on evidence-based practice.
Improving health outcomes through the most effective diet plan will improve customer
satisfaction as well as our organization’s image in medical community. Thus, there is a need to
implement and recommend the best diet plan for CVD patients.
Purpose
The major purpose of this analytical research report is to analyze two of the best diet plans for
CVD patients and to recommend LPMCG the best diet plan for treating its CVD patients. In this
report I will discuss about two highly recommended diets to treat CVD, and compare and
contrast between them. Providing the best treatment for CVD patients requires evaluation of
these two scientifically proven diets based on cost, health outcomes, and long-term compliance.
Sufficient data and knowledge about these two diets will provide nutrition and healthcare
professionals of Louisiana Professional Medical Care Group (LPMCG) a strong basis for diet
recommendation and treatment.

6. Solutions
Various healthcare institutions have researched and formulated a wide range of diet plans for
CVD. National Heart, Lung, and Blood Institute (NHLBI), a leading government organization in
heart disease research, have developed many diets based on scientific research and results.
Dietary Approaches to Stop Hypertension (DASH) plan and Therapeutic Lifestyle Changes Diet
(TLC) are two prominent diet plans designed by NHLBI to tackle CVD causative factors like
hypertension and cholesterol.
A. Dietary Approaches to Stop Hypertension(DASH)
Dietary Approaches to Stop Hypertension (DASH) is a diet plan that focuses on limiting sodium
or salt from regular diet of individuals along with increasing heart healthy food. The diet
emphasizes consumption of food which meets basic nutritional criteria along with increasing
intake of protein, fiber, and minerals like potassium, calcium, and magnesium. The DASH diet
aims to control hypertension and hypercholesterolemia among patients and ordinary individuals.
Medical professionals recommend the DASH diet along with regular physical activity to lower
bad cholesterol (LDL cholesterol), blood pressure, and thus lower the risk of heart diseases.
The DASH diet gives various recommendations regarding various food groups and their daily
servings. The DASH diet recommendations for major food groups are shown in the table below.
Food Group Daily Servings
Grains 6-8
Vegetables 4-5
Fruits 4-5
Fat-free or Low-fat milk and milk products 2-3
Lean meat, poultry, and fish 6 or less
Nuts, Seeds, Legumes 4-5 times/week
Fats and Oils 2-3
Sweets and Sugars 5 or less/week
Source: Your guide to lowering your blood pressure with DASH, 2011. US department of health and human
services.
As the table shows, the DASH diet primarily focuses on increasing grain, fruits and vegetable
intake while reducing saturated fat intake through consumption of low fat dairy and lean meats.

7. B. Therapeutic Lifestyle Changes (TLC)
Therapeutic Lifestyle Changes (TLC) diet plan focuses on lowering LDL cholesterol and thus,
reducing the risk of CVD. The TLC also reduces blood triglycerides (TG) among patients.
Furthermore, the diet also improves other risk factors like obesity and diabetes which is closely
associated with CVD. The diet plan along with weight management and physical activity is
recommended for improving CVD patients’ outcome. Firstly, the TLC diet plan categorizes the
patients into four risk group: high risk, next high risk, moderate risk, and low to moderate risk.
The TLC classifies patients based on risk factors like age, family history, smoking habits, LDL
and HDL cholesterol. Next, TLC recommends healthy cholesterol intake levels to individuals
based on the risk category.
The TLC plan differs from the DASH plan as it recommends plant sterols/ stanols in diet
plans. The major recommendation for food groups according to the TLC plan is shown in the
table below.
Food Group Daily Servings
Grains 6 or more
Vegetables 3-5
Fruits 2-4
Fat-free or Low-fat milk and milk
products
2-3
Lean meat, poultry, and fish 5 or less ounces per day
Eggs 2 or fewer yolks per
weekPlant sterols/stanols About 2 gms per day
Source: Your guide to lowering your cholesterol with TLC, 2005. US department of health and human services.
As the table shows, the primary focus of the diet is to provide the adequate macronutrient and
calories while reducing the cholesterol intake of patients through lean meat, yolk free eggs, and
low fat milk. The TLC diet also focuses on promoting plant sterols intake of 2 gms a day which
reduces LDL cholesterol up to 15 % within a few weeks (Your Guide to lowering cholesterol
with TLC, 2005).

8. Criteria
A. Cost
The average cost of a diet plan is always important for health professionals and patients.
Reasonable costs provide better implementation on the part of patients and better health
outcomes. As the cost influences the diet plan and health results, it is an important factor to
consider for health professionals before they recommend a diet plan. The higher costs of
healthy foods especially fruits and vegetables make recommending the proper diet more
challenging than before. Thus, in order to get a fair estimate of the costs, I will calculate
total price of sample diets of the DASH diet and the TLC diet. For consistency, I will use
prices set by Wal-Mart in order to determine the cost of ingredients. The prices information
will be obtained online through Wal-mart website www.walmart.com. Nevertheless, if
prices are not found online, I will personally visit Wal-mart located in Ruston, Louisiana to
determine the price. The costs of sample diets will be then evaluated.
B. Health Outcome
The health outcome result is perhaps the most criteria for health professionals while
recommending a diet plan. Adherence to the diet plan must give positive outcomes in terms
of blood lipid profile, blood pressure, and anthropometric measurements for CVD patients.
Health recommendations are based on scientific evidence showing the effectiveness of a
diet plan for a specific disease condition. If a diet does not have sufficient evidence to
prove efficiency, then there is no point in recommending it. Hence, I will examine
scientific evidence and results of both the TLC and the DASH diet in order to determine
which diet will provide the best outcome for treating CVD patients.
C. Long-term Compliance
The patient’s compliance to a diet plan usually determines the health outcomes over a
course of time. Although compliance is primarily of a patient’s concern, medical
professionals must be aware about which diet is followed by their patients consistently. If
patients find it hard to comply with a diet, recommending the diet will be futile. As
compliance may be the difference between a successful nutritional intervention and a non-
successful one, determining which diet provides better compliance is very important.
Therefore, I will examine the present literature to find information regarding long-term
compliance of each diet.

9. Methods
A. Primary Research
I calculated the total costs of the sample TLC diet and the sample DASH diet through the
prices of ingredients at Wal-Mart. I used Walmart.com to get the prices of the food items.
When the prices were not available on the website, I went to the Wal-Mart in Ruston,
Louisiana to get the prices of the ingredients.
I interviewed Mrs. Susan Hughes, a Dietetics and Nutrition professor at Louisiana Tech
University, for her views on the TLC and the DASH diet. She is also a consulting
dietitian at Turin Lakes Rehabilitation and Care Center in Texas. Mrs. Hughes has
knowledge about medical nutrition therapy and has worked with patients with CVD in
her professional career. In our email interview, she shared her ideas and views about the
TLC and the DASH diet.
B. Secondary Research
I studied recent peer reviewed journals about the TLC and the DASH diet. Many journals
have published articles about the TLC and the DASH diets and their outcomes. Many
journals contained results from experiments, health study, and research designs about the
DASH and the TLC.
I also looked for information on US government website and publications as US
government does a lot of research on CVD. DASH and TLC handouts by National
Institute of Health were two very useful resources while writing this report. Along with
the government websites, I also looked into literature published by reputed organizations
like American Heart Association, Academy of Nutrition and Dietetics.

10. Results
A. Cost Analysis
The DASH Diet
One sample daily menu of the DASH diet was evaluated in terms of cost. Wal-Mart prices of
the food items were used either through the Wal-Mart website or the store price on 10/25/13.
The following table shows a sample DASH menu with its prices.
Breakfast
Food Items COST
(approx.)
¾ cup of bran flakes cereal with 1medium banana and 1 cup of milk 2.15
1 slice of whole wheat bread with 1 tsp of soft margarine
1 cup of orange juice
Lunch
¾ cups of chicken salad with 1 tbsp of Dijon mustard 3.5
2 slices of whole wheat bread
1 cup of salad(cucumber, tomato, sunflower seeds)
½ cup of fruit cocktail, juice pack
Dinner
3 oz beef with 2 Tbsp of beef gravy 4.15
1 cup green beans sauteed with 1 tsp of canola oil
1 small baked potato with 1 tbsp sour cream, cheddar cheese, chopped
scallions
1 small wheat roll with 1 tsp soft tub margarine
1 small apple
1 cup low fat milk
Snack
1/3 cup of almonds 1.75
¼ cup of raisins
½ fruit yogurt
Total 11.55
Source: Adapted from Your guide to lowering your blood pressure with DASH, 2011. US department of
health and human services.
As the table shows, the estimate of total cost of a sample DASH diet is about 11.55 dollars
per day. This averages up to about 350 dollars per month. However, this table does not
include other expenses like the cost of preparation including water, utensils, electricity and

11. gas expenses. The prices of the food items may also vary on a day-to-day basis at
Walmart.com and Wal-Mart store.
The TLC Diet
Similarly, the cost of food items of a sample TLC diet was evaluated. For consistency
Wal-Mart website and store prices were attained on 10/25/13 for sample TLC diet. The
following table shows sample TLC diet and its prices.
Food Items COST
(approx.)
Breakfast
1 cup oatmeal with fat free milk and raisins 2.10
1 cup Honeydew melon
1 cup calcium fortified Orange juice
1 cup coffee with fat-free milk
Lunch
Roast beef sandwich( whole wheat bun, lean beef, swiss cheese, lettuce,
tomato, mustard
3.85
¼ cup Pasta salad with ¼ cup of mixed vegetables and 1 tsp olive oil
1 medium Apple
1 cup unsweetened ice tea
Dinner
1 cup of Rice with 1 tsp soft margarine 3.15
½ cup of broccoli with 1 tsp soft margarine
1 cup of Strawberries with ½ cup of low fat yogurt
1 orange cooked with 2 tsp olive oil
Snack
2 cups of popcorn cooked with 1 Tbsp canola oil 1.50
1 cup peaches canned in water
Total 10.60
Source: Adapted from Your guide to lowering your cholesterol with TLC, 2005. US department of health and
human services.
As the table shows, the estimate of a TLC diet plan is about 10.60 dollars per day. This
averages up to about 320 dollars in a month. As with the DASH diet cost, this table does not
include other expenses like the cost of preparation including water, utensils, electricity, and
gas expenses. Like mentioned previously, the prices of the food items may also vary on a
day-to-day basis at Walmart.com and Wal-Mart store.
.

12. B. Health Outcomes
The DASH diet
There have been numerous studies regarding the efficiency of the DASH diets. A study
linking DASH diet adherence to risks of CVD shows that the DASH diet reduces the
incidences of CVD accidents among adult population. The study observed that the risks
of venous thromboembolism significantly decreased by 25% in adults with higher fruit
consumption and 23% in adults with higher nut consumption (Fitzgerald et al., 2012).
Another DASH diet study in India notes that there were changes in the systolic and
diastolic blood pressure of several participants who followed DASH diet for 2 months.
The Systolic blood pressure decreased in 23 participants (76.6% of the total) and the
diastolic blood pressure decreased in 20 participants (66.6% of the total). The mean blood
pressure decreased among 21 participants (70% of the total). Although, the results were
not statistically significant, DASH diet still proved effective in reducing blood pressure
among most of the participants (Koley et al., 2013).
The DASH diet is often modified to suit the preferences of individuals from different
regions of the world. A study that used modified version of the DASH diet in UK
population found that there were significant reductions in the blood pressure of the
individuals who participated in the DASH study for duration of a month. The systolic
blood pressure and the diastolic blood pressure decreased significantly by 4.6 and 3.9 mm
of Hg (Harnden, Frayn,& Hodson, 2010).
The TLC diet
Various scientific studies have published the results of the TLC diet. In one study where
TLC diet with high fish contents , Ooi et al. (2012) reported that TLC diets with higher
fish content showed 24% decrease in blood triglycerides (TG) than low fish diet. Since
higher total TG level correlates with increased risk for CVD, a significant decrease of TG
shows that the TLC diet has positive health outcomes. However, the same study showed
that high-density lipoprotein (HDL) decreases along with the decrease in TG and low-
density lipoprotein (LDL). As HDL helps in preventing CVD, medical professionals do
not favor this outcome.
Similarly, Han et al. (2003) argues that older adults can benefit from enhanced cell
immune response along with decrease in LDL cholesterol levels. This study shows 10%
decrease in LDL cholesterol with about 6% decrease in HDL cholesterol. Again, the
decrease in HDL cholesterol is not a positive outcome as HDL cholesterol is beneficial to
stop plague formation in blood vessels and reduce the risks of CVD.
Health professionals frequently prescribe the TLC diet and other TLC recommendations
like lifestyle changes in order to improve health outcomes. A six-month intervention
study aimed at understanding clinical and behavioral effects of TLC diet shows that the

13. participants had reductions in systolic and diastolic blood pressure. The systolic and
diastolic blood pressure decreased from 129 and 78.3 mm of Hg to 124 and 72.8 mm of
Hg (Aldana et al., 2006). The role of the TLC diet in reducing hypertension is a favorable
outcome.

14. C. Long-term Compliance
The DASH Diet
Measuring the recommended nutrition intake of any diet is the best way to assess the diet
compliance. A Polish study measuring the compliance of DASH diet to 159 hypertensive
patients found that the total fat intake percentage of the male participants was 126.3±
24.5 (mean±SD) to the percentage recommended by DASH. This intake was classified as
high intake that is 111 to 130 % of the recommended intake of fats. By using similar
reasoning, the intakes of cholesterol among male participants were classified into very
high intake. Nevertheless, the DASH diet was successful in limiting the sodium intake in
the recommended level for male participants and the DASH resulted in low intake of
sodium in female participants. (Gajewska, Niegowska, & Kucharska, 2010).
Harnden, Frayn, & Hodson (2010) state that subjective communication with the patients
highlighted that modified DASH diet is acceptable to the study population. The
researchers also found that there were no complications in going to a low salt intake once
the participants were accustomed to the low salt taste. The researchers point out that this
finding is very important as the main goal of the DASH diet is to lower blood pressure
among hypertensive people through lower intake of sodium. The compliance and the ease
of switching to low salt dietary pattern make the DASH diet an effective diet in treating
hypertension.
The TLC Diet
The TLC diet primarily focuses on decreasing cholesterol and saturated fat intake along
with increasing plants sterol and stanols intake. In an article published in the Journal of
American Heart Association, Fletcher et al. (2005) state that about one fourth of the
patients with CVD problems discontinue drug therapy and diet adherence. The main
problems with following a low saturated fat and cholesterol diet are the availability and
use of fats in daily foods. Unlike the DASH diet, which lowers high salt intake by
omitting it, the TLC diet cannot reduce fats easily as fats are required in many cooking
recipes. As most protein sources are also fat sources, it is difficult to limit fats in the diet
with protein. In the book “Fat Detection: Taste, Texture, and Post Ingestive Effects” the
author states that fats do have an effect on satiety and appetite hormones (National Center
for Biotechnology Information, 2010) Thus, reducing fats as recommended in the TLC
diet might cause quicker hunger response and thus more food consumption. This cause
and effect is important as more consumption leads to poor adherence to the TLC diet.

15. Conclusions and Analysis
Cost: In terms of cost, both DASH diet and TLC diet have reasonable prices. A sample DASH
diet for a day was 11.55 dollars and a sample TLC diet for a day was 10.60 dollars. The results
of the sample diet cost analysis of these two diets show that there is a minor difference in price
of the sample diets. This minor difference cannot be significant as the ingredients and cost for
other TLC and DASH diets may change daily. With different food options available for making
TLC and DASH menus, there will be fluctuations in price of the daily menus. In addition, as
Wal-Mart pricing was used for consistency purposes, one must be aware that other food vendors
can also be used. This influences the cost of food item largely. The DASH diet may have been
slightly higher in costs as the DASH diet places an emphasis on fruits and vegetables in a diet.
As both of these food groups have higher prices compared to other food groups, the DASH diet
has higher food costs. Similarly, the DASH diet also recommends nuts and seeds in diets, which
has higher prices than other foods.
Nonetheless, cost is an important criterion to consider even if there are many limitations to cost
estimation. Many people who suffer from CVD in Louisiana are from low-income group. Thus,
cost of the food products will concern this affected group of people. According to World Health
Organization (WHO)’s official website, low socio-economic status plays a role in incidents of
deaths due to CVD. Hence, in order to address issues of CVD among low-income group, cost
must be considered while giving the prevention and treatment recommendation.
Although, the TLC diet edges the DASH diet on the criteria of cost, LPMCG needs to weigh
them equally. Due to the limitations in the primary research and fluctuations in market price,
LPMCG can estimate both of these diets to be of the same cost for the patients.
Health Outcomes: Each of the diets was scientifically designed and there have been various
studies conducted to examine the health outcomes of each diet. Through literature research, one
can find that various short-term and long-term studies have been done with the DASH and the
TLC diet.
According to the results, the DASH diet was very successful in reducing venous
thromboembolism, which is a type of CVD. Furthermore, the DASH was effective in reducing
sodium intake and increasing potassium intake, and the DASH diet was successful in reducing
hypertension among patients. Likewise, the results of the studies show that patients following a
DASH plan have significant decrease in their systolic and diastolic blood pressure. This result
means that the DASH diet is successful in meeting its goals.
The diet can be modified to suit the taste preference and there are menus that help patients to
adopt a southern style of diet. Availability of modified diet is important as LPMCG mostly
serves southern people. Thus, medical professionals can easily recommend the modified DASH
diet to suit the patient’s preferences.
Similarly, there have been numerous study about the health outcomes of the TLC diet which
shows that TLC diet is useful in reducing blood triglycerides and cholesterol levels. The TLC
diet high in fish intake was effective at reducing triglycerides by 25%. The studies have also

16. shown that the TLC diet has effectively reduced cholesterol and LDL levels. As the main aim of
the TLC diet is to reduce LDL cholesterol and triglycerides, the TLC works very well to meet the
goals. However, the literature studies also show that TLC resulted in lowering of HDL
cholesterol as well. As HDL cholesterol is beneficial in preventing various forms of CVD, this
effect of TLC diet is not favored. The decrease in HDL will undermine the efficiency of the TLC
diet.
In addition, there is no scientific literature that clearly states that the TLC diet has modified
menus for various people. Medical professionals at LPMCG must consider this lack of
flexibility in the TLC diet while giving recommendations to the patients.
Long-term Compliance: Very few studies studied the long-term compliance to a diet. Most of
the scientific literature focuses on health outcomes during a scientific study period. The DASH
diet and the TLC diet have few studies regarding adherence to the diet.
The long-term compliance results of the DASH diet shows that patients generally overestimate
their consumption in food group while underestimating other food groups. The statistics of the
study show that the compliance with the DASH diet controlled sodium intake, but increased the
calorie intake. The subjective communication with patient highlights that the DASH diets
modified to suit the patient’s preferences is well tolerated and adhered. Considering these facts
about reduced sodium intake, medical professionals at LPMCG can recommend the DASH diet.
The long-term compliance results of the TLC diet are more complicated. There are no clear
studies aimed directly at adherence to the TLC diet. From literature studies, one can deduce that
reducing fat in a diet may create satiety and appetite hormones issue. Diets lowering fats can be
counterproductive as people might overindulge in food in the long-term. Similarly, fats are used
in most cooking procedures and fats play an important role in promoting the taste of the food.
Thus, reducing or eliminating fats in a diet is difficult . This reasoning works against the
compliance of the TLC diet as the diet aims at reducing fats from the diet.
In terms of practice, dietitians favor a balanced diet with appropriate macronutrient distribution.
Mrs. Susan Hughes who works as a consulting dietitian at Twin Lakes Rehabilitation and Care
Center says that in long- term care of geriatric patients the diets used for patient care are more
liberalized than restricted. She adds that diets are more balanced and general to make them more
feasible and more valuable to the patients (Personal Communication, 10/27/2013). Considering
the TLC diet’s poor feasibility in long-term care, LPMCG can recommend TLC diet to patients
with very specific CVD symptoms, but not to general patients.

17. Recommendation
Based on the analysis of the DASH and the TLC diet by the criteria of cost, health outcomes, and
long-term compliance, I am able to mention Louisiana Professional Nutrition Care Group
(LPNCG) to recommend the DASH diet while treating their CVD patients. Clearly, the DASH
diet is more feasible in terms of modification and compliance. The DASH diet has sufficient
scientific studies proving its efficiency with health outcomes in patients. The DASH diet clearly
improves hypertension along with blood lipid profiles; whereas, the TLC diet only improves the
blood lipid profile.
While the TLC diet proves to be cost effective, the difference in costs of the two diets is
negligible. LPNCG needs to be aware that the costs are subjective to the market costs of food
that fluctuates every day. I am confident that the higher costs of the DASH diet will not be a flaw
of the DASH diet.
The DASH diet is scientifically studied and proven by many reputed healthcare organizations. It
is endorsed the US government as well. Overall, the DASH diet is the best recommendation to
prevent and treat CVD patients.

18. References
Aldana, S. G., Greenlaw, R. L., Diehl, H. A., Salberg, A. A., Merrill, R. M., Ohmine, S. S., &
Thomas, C. C. (2006). The behavioral and clinical effects of therapeutic lifestyle change
on middle-aged adults. Preventing Chronic Disease, 3, A05.
Fitzgerald, K. C., Chiuve, S. E., Buring, J. E., Ridker, P. M., & Glynn, R. J. (2012). Comparison
of associations of adherence to a dietary approaches to stop hypertension (DASH)-style
diet with risks of cardiovascular disease and venous thromboembolism. Journal of
Thrombosis & Haemostasis, 10, 189-198.
Fletcher, B., Berra, K., Ades, P., Braun, L., Burke, L., Durstine, J., & ... Winston, M. (2005).
Managing abnormal blood lipids: a collaborative approach. Circulation, 112, 3184-3209
Gajewska, D., Niegowska, J., & Kucharska, A. (2010). Compliance to DASH diet by patients
with essential hypertension. Polish Journal Of Food And Nutrition Sciences, 60(1), 71-76
Griffin, R. M. (2011). Heart diseases: What are the medical costs? www.webmd.com Retrieved
from http://www.webmd.com/healthy-aging/features/heart-disease-medical-costs.
Han, S., Leka, L. S., Lichtenstein, A. H., Ausman, L. M., & Meydani, S. N. (2003). Effect of a
therapeutic lifestyle change diet on immune functions of moderately
hypercholesterolemic humans. Journal of Lipid Research, 44, 2304-2310.
Harnden, K., Frayn, K., & Hodson, L. (2010). Dietary approaches to stop hypertension (DASH)
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20. Glossary
Blood triglycerides (TG): any of a group of lipids that are esters formed from one molecule of
glycerol and three molecules of one or more fatty acids, are widespread in adipose tissue,
and commonly circulate in the blood in the form of lipoproteins—called also neutral fat.
Cardio vascular diseases: diseases affecting heart and blood vessels.
Cerebrovascular accident (stroke): sudden diminution or loss of consciousness, sensation, and
voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the
brain.
Coronary artery diseases: a condition and especially one caused by atherosclerosis that reduces
the blood flow through the coronary arteries to the heart muscle and typically results in
chest pain or heart damage
Diastolic blood pressure: the lowest arterial blood pressure of a cardiac cycle occurring during
diastole of the heart
HDL cholesterol: a lipoprotein of blood plasma that is composed of a high proportion of protein
with little triglyceride and cholesterol and that is associated with decreased probability of
developing atherosclerosis
Heart failure: a condition in which the heart is unable to pump blood at an adequate rate or in
adequate volume.
Hypercholesterolemia: the presence of excess cholesterol in the blood.

21. Hypertension: abnormally high arterial blood pressure that is usually indicated by an adult
systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm
Hg or greater, is chiefly of unknown cause but may be attributable to a preexisting
condition (as a renal or endocrine disorder), that typically results in a thickening and
inelasticity of arterial walls and hypertrophy of the left heart ventricle, and that is a risk
factor for various pathological conditions or events (as heart attack, heart failure, stroke,
end-stage renal disease, or retinal hemorrhage).
LDL cholesterol: a lipoprotein of blood plasma that is composed of a moderate proportion of
protein with little triglyceride and a high proportion of cholesterol and that is associated
with increased probability of developing atherosclerosis.
Sterols/ stanols: any of various sterols derived from plants.
Systolic blood pressure: the highest arterial blood pressure of a cardiac cycle occurring
immediately after systole of the left ventricle of the heart.
Venous thromboembolism: the blocking of a vein by a particle that has broken away from a
blood clot at its site of formation.
Source : National Institute of Health .Medline Plus. Merriam WebsterOnline Medical Dictionary