Howard LeWine, M.D.

“Portfolio” beats low-fat diet for lowering cholesterol

Low-fat diets, move over. When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods such as oatmeal, nuts, and soy products is better.

Several years ago, researchers at St. Michael’s Hospital and the University of Toronto created what they called a “dietary portfolio of cholesterol-lowering foods.” It went after cholesterol by adding to a heart-healthy diet specific foods known to lower cholesterol: margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.

In a head-to-head test against the low-fat diet traditionally recommended by the American Heart Association, the portfolio approach was the clear winner. (You can see the makeup of the test diet here.) After 24 weeks, it lowered harmful LDL cholesterol by 13%, while the low-fat diet lowered LDL by only 3%. As an added benefit, the portfolio approach also lowered triglycerides and blood pressure, and did not depress the level of beneficial HDL cholesterol. The results were published in the Journal of the American Medical Association.

What I appreciate about this study is that it gives me evidence to support a positive message—”in with the good”—rather than always having to tell my patients what they need to give up to lower their cholesterol.

For someone with mildly elevated cholesterol, a heart-healthy diet that includes the elements of the portfolio may be all that is needed to get cholesterol under control—no prescription necessary. All of the ingredients are available in most grocery stores, and lend themselves to dozens, if not hundreds, of different recipes.

None of these foods is a magic bullet against high LDL. In fact, the combination is probably important, since they lower cholesterol in different ways.

Here are some suggestions for adding these foods to your diet:

Plant sterols. The best sources of these are margarines enriched with plant sterols and stanols, such as Benecol and Take Control, and other foods to which they have been added, including orange juice, granola bars, and cooking oil. You don’t need more than 2 grams a day.

Soluble fiber. Two servings per day should be sufficient. Good sources of soluble fiber include oats and oat bran, barley, almost any kind of bean, eggplant, and okra. Aim for 10 grams of soluble fiber per day.

Nuts. For a great midday snack, eat a handful of nuts. Any kind will do—almonds, walnuts, pecans, peanuts… Keep in mind that nuts pack a lot of calories.

Soy products. Not long ago, the only ways to get soy protein was by eating soybeans or tofu (also called bean curd). Today you can buy soy milk, soy bars, soy burgers, dried soy protein, and more. Soy protein and fish are two of the healthiest ways to get your daily protein. Twenty-five grams of soy protein a day is a good target.

What’s in the “portfolio”?

All participants in the study followed a heart-healthy diet that was low in saturated fat (minimal butter and other dairy fats, beef fat) and rich in fruits and vegetables, beans and whole grains. Those in the portfolio group added cholesterol-lowering foods. For someone eating 2,000 calories a day, these included:

  • A handful of nuts each day.
  • Two teaspoons of sterol-enriched margarine, such as Benecol or Take Control.
  • Two servings a day of soy-based foods, such as a glass of soy milk or a soy burger.
  • Two servings a day of foods rich in soluble (viscous) fiber, such as oatmeal, psyllium-enriched cereals, barley, and vegetables such as okra and eggplant.

Related Information: Healthy Eating for a Healthy Heart

Comments:

  1. kelly

    Strangely, the article did not mention the role of omega-3, garlic or even red yeast rice extract in supporting healthy cholesterol levels

  2. Om Jae

    low-fat diet is very good for heart health, I think this is a portfolio that is necessary for me someday.

  3. Maria D

    It’s in reality a nice and helpful piece of info. I am happy that you simply shared this helpful info with us. Please keep us informed like this. Thanks for sharing.

  4. richart2012

    hI
    I used Pure Vegan B12 spray.There is also a cheaper version that does not advertise vegan but says so on the label called Pure Advantage B12. The ingredients are identical.

  5. Heather Smith

    It’s really hard to loose weight if you have the love for food. All we need to learn is discipline if we wanna have a healthy and happy life. I suggest proper to those who neglect eating nutritious food that are essential to the body. Thanks for posting this topic.

    • Anonymous

      Hi Heather Smith,

      I am agree with you.those who want happy and healthy.its need to take proper diet.Thanks for this article…

      Beef recipes

  6. Anonymous

    The nurses study has shown fiber to be of zero benefit beyond constipation. Diets high in fat do a better job of changing the particle size of LDLs, and diets that avoid carbohydrates do a better job of lowering triglycerides.

    Thanks to everyone for your great articles & Merry Christmas xxx

  7. Anonymous

    Low carb is the path to being forever young :)
    Thanks to everyone for your great articles & Merry Christmas xxx

  8. Emily Fong

    Well one thing that I found recently that has helped me get on track diet wise is some of the more healthy vegan recipes

    I’m not much of a soy lover and trying to find something that my boyfriend will also eat and that I’m not ugh about is a challenge but a friend gave me this recently and after making it I was amazed how good tofu could be when prepared this way and I’ve had a whole new outlook on soy based foods.

  9. Harman

    Would surely suggest this diet to my Dad…:]

  10. kayus

    I have been careful of recent about eating fatty foods.Now,i understand that no all fatty food have harmful cholesterol.thanks for the information as i know which diet take according to the portfolio.

  11. BigFatGuy

    I tried a very slightly modified version of this diet that was published in the UK years ago. My total cholesterol went from 280 down to 175 in less than 1 month. My Doc asked me what I had done, and when I told him about this diet, he told me to stay with it. I hope it actually does me some good.

  12. alice22

    nice article

  13. stevenreynolds20

    NICE WORK

  14. Özel Ders

    Thank you very much, because I’ve read on the subject of many articles and news. But none of the period was not useful for my duty, I wish you success in life …

  15. kayus

    I am excited i’m on the path of the portfolio.This is because i like eating oats in the morning but don’t take much of nuts.Recently,i have included soyamilk into my diet and reading this 24weeks portfolio method,i believe i would shed some weeks in some weeks time.

  16. Ian

    12 months ago I was informed that I have high cholesterol and a fatty liver.I cut down my food intake to 2 large meals a day and EVERY day I ate raw brocolli with Horseradish sauce. 3 months later after my medical check revealed I had lost 11 pounds in weight and liver was in a vastly improved condition and my cholsterol was greatly reduced.
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  17. I learned more new stuff on this fat loss issue. One particular issue is a good nutrition is vital when dieting. A massive reduction in junk food, sugary meals, fried foods, sweet foods, red meat, and white-colored flour products may be necessary. Retaining wastes organisms, and contaminants may prevent targets for fat loss. While selected drugs briefly solve the situation, the horrible side effects aren’t worth it, and so they never give more than a momentary solution. It is a known undeniable fact that 95% of fad diets fail. Many thanks sharing your ideas on this blog.

  18. amy

    Are you familiar with the Okinawa diet? THe consumption of soy has been argued back and forth as to it’s health benefits and I can’t seem to get a clear picture. It appears that being a major player in Okinawans diets may be helping them become some of the longest lived people on the planet. Then others say that soy is harmful to health. Where do you stand on this dr?

  19. Anonymous

    Notices should be allowed to be posted at local county fairs and amusement parks as to the high cholesterol some of the food that’s being eaten at these fun parks. Some carnival machines today actually produce a lower cholesterol level then just a few years ago.

  20. Henry

    Great article. Another potentially harful thing about low fat diets–at least for those who dont know anybetter and is easily swayed by marketing strategies, is purchasing ‘low fat’ alternatives which, if you don’t read the fine print may contain lots of sodium or other flavor enhancers.

    Henry
    [URL removed by moderator]

    • brent

      you are not going to change anyone’s life by simply adding some nuts or soy if they continue to eat the garbage that our government is peddling. our body isn’t meant to eat whole grain. garbage articles/”research” does not help anyone. promote healthy eating…as in, eat as close to nature as possible. juicing is a good way to start, eat grass fed, pasture raised animals, and cut out process foods. it shouldn’t be rocket science…we’ve been doing it for hundreds of thousands of years.

  21. Vince

    “So yes, statins save lives.” Actually a recent review questioned that “Do statins have a role in primary prevention?” An update.
    Therapeutics Letter Issue 77 / Mar – Apr 2010 ” The claimed mortality benefit of statins for primary prevention is more likely a measure of bias than a real effect.
    ……. The reduction in major CHD serious adverse events with statins as compared to placebo is not reflected in a reduction in total serious adverse events. …..

    Whether the LDL lowering by diet will lower events is very questionable.

  22. Anonymous

    Interesting article, though there is some controversy as to the benefits of soy products when it comes to women. Personally, I try to stay away from them, what might be a better alternative to these with this diet?

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  23. Trim

    I once read a blog post which promote the same thing. I did not get the exact name of the regime but the same approach. Consuming foods which combat bad fats. It is the best way to trim.
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  24. George MacDonald

    It is unfortunate that we still do not know enough about the actual causes of the vascular problems that cause heart attacks and strokes. While it is clear that statins are beneficial, the idea that they do so simply by lowering LDL-C is an assumption. For example, the Enhance trial showed that adding an additional cholesterol lowering agent to people already taking a statin did not help save lives and, in fact actually hurt their chances slightly. That agent is physiologically identical to oatmeal.

    So yes, statins save lives. But, while Oatmeal lowers cholesterol it is questionable whether it actually saves lives (particularly if you are already taking a statin). But, as with a religious agnostic who goes to church just in case he is wrong, a daily bowl of oatmeal is a good insurance policy: it won’t hurt and it just might help.

    Again, we need more research in this area that is not driven by the profit motive so we know what actually saves lives and what doesn’t.

  25. MP Sidhu

    I think liver function is also important in determinig cholesterol content in your blood.Genes play a significant role too.Portfolio diet alone can’t help.My diet includes all vegetables(also eggplant& okra),fruits, wheat porridge and also nuts.But my cholesterol count remains high especially after menopause.As a precaution I take a prescribed drug to lower it.My HDL is always sufficiently good.What do you think?

  26. Richard Serlin

    3% is nothing, and 13% is not much better. How strict were these diets? Only a little less fat and a little more whole plant foods, or really strong whole plant food diets? I’ve heard of much more than these tiny results for a truly strong move to whole plant foods.

    You want to really test something, try something like the Fuhrman diet and see if the results are still so paltry. I know you may say most people say won’t do that diet, but if they knew how effective it was, and that it’s a lot less hard than they think once they get used to it, a lot might try, or at least go 50-60%.

  27. Bob bramel

    Is there any science at all behind this stuff??! So a 24 week test got some marginal reduction in LDL? Exotic “foods” like” margarine enriched with plant sterols … psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.” presumably because of their fiber content?!

    The nurses study has shown fiber to be of zero benefit beyond constipation. Diets high in fat do a better job of changing the particle size of LDLs, and diets that avoid carbohydrates do a better job of lowering triglycerides.

    Awful.

  28. CuriousRD

    I appreciate your summary of this study and especially the suggestions you give of good sources of food items and components discussed in the study, however I am surprised you did not mention that the study participants were encouraged to “follow weight maintaining vegetarian diets” during the course of the study (see the Methods section of the JAMA article).

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