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The Portfolio Diet: Lower Cholesterol Without Statin Drugs?

Find out whether the Portfolio Diet can help you lower cholesterol naturally through diet  … without Statin drugs.

Could dramatically lowering your cholesterol simply be a matter of eating the right combination of foods?healthy_foods

Dr. David J.A. Jenkins thinks so.  And if his research is right, it might actually be possible to cut cholesterol significantly just by eating the right foods, in the right combinations.

Jenkins, a nutrition and metabolism expert at the University of Toronto and the “Father” of the gylycemic index, calls it the “The Portfolio Diet” and the concept is actually quite straightforward: By combining a variety of foods that have been shown to lower cholesterol on their own, it may be possible to lower serum cholesterol naturally without resorting to prescription statin drugs.

Besides having profound public health consequences, this approach to eating and cholesterol control also promises to lower the cost of treating high cholesterol, potentially saving millions in prescription drug costs and health issues that arise from the side-effects of prescription statin drugs.

The Portfolio Diet: The Sum Is Greater Than The Parts?

For more than a decade, researchers have known that certain foods like oatmeal and soy can help lower blood cholesterol levels. However, until recently these foods have been viewed more or less independently of each other.

Dr. Jenkins decided to take a look at how combining a variety of foods that have been shown to reduce cholesterol might collectively work together, providing more bang for your buck.

Jenkins’ study took a look at forty-six healthy, middle-aged adults who had high cholesterol. The subjects were divided into three groups:

  1.  One group was placed on a whole-grain and low-fat dairy diet that was low in saturated fats;
  2.  The second group followed the same diet, but also took a lovastatin, a cholesterol-reducing statin drug;
  3.  The third group ate a diet high in plant sterols, ”sticky” fiber, soy and almonds.

All groups experienced a reduction in low-density lipoprotein cholesterol (LDL), and not surprisingly, the statin group experienced the most dramatic drop — a 30.9 percent reduction.

However, what did surprise researchers was the reductions seen in the porfolio diet group, which experienced a 28.9 percent reduction in fasting blood cholesterol levels, making it nearly as effective at cutting cholesterol as prescription statin drugs.

Statin Drugs: Lower Cholesterol in a Pill?

The American Heart Association estimates that more than 140 million Americans have cholesterol levels that are either borderline-high or high based on fasting lipid tests. And of these, about 37.2 million American adults have levels of 240 or above.

High blood cholesterol, especially the “bad” LDL cholesterol, is one of the major risk factors for developing heart disease, liver failure and high blood pressure.  Each 1 percent drop in serum cholesterol translates to a 2 percent drop in the risk of developing heart disease or stroke.

Until recently, most doctors treated high cholesterol with a combination of modifications to the diet and exercise. However, the past decade has seen a influx of cholesterol-lowering prescription drugs (the majority of which belong to a class of drugs known as “statins”) enter the market, and increasingly doctors have turned to medication as a way to treat borderline-high and high-cholesterol.

Last year alone, almost $30 billion in prescription cholesterol-lowering drugs written were written in the US, and Americans spent $10 billion in 2007 on the statin drug Lipitor, alone.

But cholesterol-lowering statin drugs — like most prescription drugs — come with their own set of risks. In 2001, the cholesterol-lowering statin drug Baycol (cerivastatin) was voluntarily pulled off the market by Bayer after reports of severe (and sometimes fatal) reactions to the medication.

The side effects of statin drugs like Lipitor and Zocor can range from the mild to the severe, including numbness and tingling in extremities, memory loss and problems with attention, headaches, fatigue and muscle weakness.

In severe cases, people may serious reactions to the drug, resulting in permanent muscle damage. A Danish study found that long-term statin drug users had a 4-14 times higher risk of peripheral neuropathy, nerve damage that can cause weakness, pain, and trouble walking.

More troubling is recent research from the University of California San Diego that suggests doctors may frequently ignore or dismiss patient concerns around side-effects of statin drugs, despite receiving remarkably consistent reports of these side effects across their patients currently taking statin drugs.

This may have broader safety implications, since the US Food and Drug Administration (FDA) relies heavily on adverse reaction reports from doctors in the field to identify serious health issues associated with prescription drugs. This can result in the under-reporting of side effects from statin drugs or create a false-sense of safety among doctors and patients.

Food: A Safer Alternative to Cholesterol-Lowering Drugs?

Yet a growing body of research, including Dr. Jenkins’ work around The Portfolio Diet, suggest that many cases of high cholesterol can be treated successfully with diet modifications alone.

The problem, doctors say, is that historically, many people are reluctant to make the necessary changes to their diet, or struggle to maintain cholesterol-lowering diets over the long-haul.

However, as more people turn to statin drugs to get their cholesterol under control and experience some of the unpleasant or harmful side effects of prescription cholesterol-lowering medication, there is renewed interest among some statin-users in more natural, non-prescription methods for lowering cholesterol, including things like The Portfolio Diet.

The Portfolio Diet: How Do You Do It?

The portfolio of foods that the subjects in Jenkins’ study ate may already individually be part of your diet, especially if you watch what you eat and try to include a wide variety of foods like nuts, fresh vegetables and complex carbohydrates into you meals. All of these foods alone can have a modest impact on lowering or maintaining low cholesterol levels.

Jenkin’s porfolio diet approach targets four specific foods:

  • Almonds: A long-time staple in many healthy diets, consumption of almonds has been linked with a number of health benefits, including lower blood pressure, descreased risk of some cancers and lower cholesterol. While Jenkins’ study looked specifically at the impact of including almonds in the diet portfolio, he admits that other nuts including walnuts and pecans may produce similar effects. Jenkins’ subjects ate a handful of almonds each day.
  • Soy:  Jenkins’ diet substituted soy-based foods for things like meat and dairy. This included soy meat substitutes, soy milk, and tofu.
  • Plant Sterols: Plant sterols  (also known as “phytosterols”) are a class of phytochemicals that are naturally present in plants. These compounds have been shown to reduce cholesterol, as well as potentially protect against certain classes of cancer. Plant sterols are present in small quantities in things like corn oil and soybean oil, however most whole foods do not contain enough of the phytochemicals to produce dramatic reductions in cholesterol. So scientists have isolated and concentrated plant sterols into a form that can be included as an additive to other foods like margarine and cereals.  Phytosterols are also available in a capsule form. In Jenkins’ study, subjects consumed plant sterols by including a plant-sterol-enriched margarine spreads into their diet. Brands of phytosterol-enriched spreads include Benecol and Take Control.
  • Soluble Fiber: The fourth class of foods that make up The Portfolio Diet are sources of soluble or “sticky fiber.” These foods include grains like oatmeal, oats, oat bran, and barley. Vegetables that are high in soluble fiber included okra and eggplant. Beans and legumes also can be good sources of sticky fiber. In Jenkins Portfolio Diet study, subjects also supplemented their diet with three daily servings of natural psyllium fiber, such as Metamucil.

The key to The Portfolio Diet is making sure you are incorporating these four foods into each meal of the day.  A typically meal plan on The Portfolio Diet might look like this:

  • Breakfast: Low-fat granola with soy milk and some slivered almonds and chopped apples; a slice of whole-grain oatmeal bread with a plant-sterol enriched spread.
  • Lunch: A hambuger made with a soy-based meat substitute like Boca Burger on toasted oatmeal bread, bean soup or a three bean salad and fruit such as apples.
  • Dinner: Stir fry with tofu and vegetables and fruit.
  • Snacks: Almonds, nuts, yogurt, soy yogurt and soy milk thickened with psyllium fiber
Is the Diet Sustainable?

If the diet seems regimented, it is.

While nearly all of these foods should already be a part of a healthy person’s diet (with the exception, perhaps of plant-sterol-enriched spreads), it may be difficult for people who aren’t used to eating this way to stick close enough to the diet to achieve cholesterol-reductions on par with prescription statin drugs.

The subjects in Jenkins’ first study cut out all meat and eggs and substituted soy products instead, which can be a challenge for most omnivores.  The diet would, however, be a cinch for vegans or vegetarians, but those groups probably already have low-cholesterol.

Jenkins and his team were aware of this issue and have since conducted a follow-up study in 2006 to look at how The Portfolio Diet might work in the “real-world” versus a carefully monitored and controlled lab environment.

In that study, they expanded their group to sixty six adult men and women with high cholesterol. For 12 months, the group was put on a prescribed diet high in plant sterols, soy protein, viscous fibers and almonds.

While the results weren’t quite as impressive as with the carefully-controlled diet, the reductions in cholesterol were still significant — more than one-third of the subjects who attempted the portfolio approach to eating saw at least a 20 percent reduction in serum cholesterol levels, which is not statistically different from what the same people would have experienced from first-generation statin drugs.

“One-third of the patients achieved and sustained a clinically meaningful reduction in LDL cholesterol of more than 20 percent,” explains Dr. Cyril Kendall from the University of Toronto and co-author of the study along with Jenkins. ”The extent to which they lowered their LDL cholesterol level depended on how closely they followed the diet by eating certain heart-healthy foods.”

In otherwords, just changing your eating habits to include a generous daily dose of these four cholesterol-lowering foods may be enough to produce significant, natural reductions in blood cholesterol.

Getting Started with the Porfolio Diet

As Kendall and Jenkins point out, the effectiveness of The Portfolio Diet really depends on how committed you are to including heart-friendly foods into your diet. Incorporating even small amounts of all of these foods in your diet daily is a good start, especially if you also reduce your consumption of foods and cuts of meat that are high in saturated fat.

Adding in sticky fiber is really not particularly difficult and can be easily accomplished by eating a bowl or two of oatmeal daily, along with other sources of soluble fiber like granola or even psyllium fiber from things like Metamucil. While Jenkins’ studies looked specifically at almonds, other nuts like walnuts and pecans also have been shown to reduce cholesterol. Adding in sources of soy like tofu or meat substitutes (which are actually quite tasty these days) will also help. Substituting plant-sterol enriched spreads for normal margarine on your morning toast or baked potato can help you include plant sterols in your diet.

Again, even adding a few of these foods into your diet each day can help reduce cholesterol or prevent you from developing high cholesterol. So something is better than nothing.

What If I’m On Statin Drugs and Want to Try The Portfolio Diet?

If you are already on statin drugs to treat high cholesterol, make sure you check with your doctor before trying food-based treatment of high cholesterol, especially if you already have a history of heart disease or other complications. Do not abruptly stop taking your medication. Instead, work with your doctor to try to migrate slowly aways from statins as you add in more cholesterol-lowering foods.

Criticisms of The Portfolio Diet

The research conducted by Jenkins is not without it’s critics.

The initial research on The Portfolio Diet approach to cholesterol-reduction was funded by four organizations: the Canadian government; Unilever, the maker of Take Control, a margarine-like spread that helps to lower blood cholesterol; Loblaw, Canada’s largest food distributor; and the Almond Board of California. So the source of the money for the study was provided by companies and organizations that had a vested interest in the showing that these foods can lower cholesterol.

Does that mean the studies are somehow invalid?

Probably not.

Regardless of what your personal feelings are about scientific studies being underwritten by private commercial entities, there is no evidence that any of the researchers’ results were biased by their funding sources. While the foods they chose to include in the research were associated with these organizations, there is a broad-range of research (not all of it funded by food companies) that has demonstrated that these foods may lower cholesterol. Nothing sinister or mysterious there.

One other thing to keep in mind: These are studies published in peer-reviewed journals. All of the data and methodology is available for other researchers to study. If they are flawed or biased, there are plenty of qualified eyeballs looking carefully at the data to find weaknesses. And other researchers can always — and often do — attempt to duplicate the results themselves. That’s just how good science works, regardless of where the funding comes from.

Can The Portfolio Diet Help You Lose Weight?

While The Porfolio Diet is not intended to be a weight-loss diet — it’s rather a pattern of healthy eating that encourages management of cholesterol — you may lose weight on the plan, especially if you substitute these foods for less healthy versions that you may be eating now. While nuts and almonds are high in heart-healthy fats, they are also high in calories gram-for-gram. However, research has shown that eating nuts may actually help control weight.

If your primary goal is to lose weight, this won’t be your plan. However, if you want to eat healthier, improve your cholesterol and possibly lower your risk of heart disease and stroke, The Porfolio Diet may be worth a shot.


Comments (4)

  1. bartolomo (2 comments) says:

    Thanks for posting this study. I hadn’t seen it. I read the study with an admitted bias. I retired from Merck last year and one product that I promoted was Zocor. Hard not to be biased, you see! Anyway, I love the emphasis on diet and excercise instead of drug therapy. With the proper lifestyle changes, many if not most could discontinue drug therapy for cholestorol. Most are not that disciplined, however. Also, I would take care in drawing too much from a study with such a small number of patients. Always look at the n, we used to say. The n=46 here is extremely small, especially when split into 3 arms. (Sort of like looking at player’s batting average after only a few games in April.) It’s hard to move ldl much more than 20% with diet. So a baseline of, say 160 can’t be taken much lower than 125, and that’s not good enough. That said, there just isn’t enough emphasis on diet and exercise. Sure, the doctor always instructs the patient to “watch” their diet and try to get “more” exercise. Then they hand them their rx. Bad habits are hard to change. Take care.

  2. Matt (194 comments) says:

    Bartolomo, thanks for stopping by. Really appreciate the perspective, as well as the fact that you’ll admit your biases up front. All of us have them — and it’s never an issue as long as we are aware of them and disclose it.

    I also agree with you on the issues around small studies. This is a problem with a lot of the research that comes out around diet and exercise. The devil, as the say, is in the details. Statistical significance and data scarcity is always a challenge — as are outlyers that you can’t necessarily control for or even anticipate.

    For perspective, I really try to stress statistic that for every 1 percent drop in serum cholesterol your reduce your risk of developing heart disease or stroke by 2 percent. So if you can even cut your total cholesterol by 15 percent, that’s a 30 percent reduced risk. Of course, your LDL could still stay too high, as you point out, so even this way of looking at it can be deceiving or give people a false-sense of progress. Also, I’ve seen people with very high total cholesterol with extremely low LDL and high HDL, which can create the opposite impression.

    So many health issues are related to diet and activity, or poor habits around these things. The issue, obviously, is larger and more complicated than just what people choose to eat, since there are broader trends that create an environment that discourages certain healthy behaviors, while encouraging those that aren’t so good for us. At the end of the day, it’s possible through personal action to overcome them, but you have to be aware of what they are in the first place to do this. I find that many people are simply lacking the most basic information about nutrition, how modern foods are processed and how what we eat and do impacts both our physical and mental state-of-mind.

    I actually have met people who didn’t know that steaks came from cows, that bread was made out of wheat and that Kraft Macaroni and Cheese wasn’t a “health food.” They look at the label, see zero fat, and think it’s healthy. People like to focus in on single solutions (like “no fat”), because understanding the complex interplay of nutrients (as in the Portfolio Diet) requires a deeper knowledge of where our food comes from and how it’s handled. Most people are already innundated with information (much of it conflicting … again, the details), so they get paralyzed and gravitate toward one-point solutions, like cutting carbs or fat.

    I think the most intriguing aspect of Jenkins’ ongoing research around things like the Portfolio Diet is that it reinforces the idea that we can’t look at single foods in a vacuum. There is a growing body of research around how portfolio approaches to eating also may reduce the risk of cancers, since there may be a similar synergistic effect among antioxidents and phytonutrients. We try to simplify this by advising people to “eat from the rainbow” — but at the end of the day, this advice is kind of meaningless unless you at least understand some of the basic reasons why this advice is good.

    In terms of cholesterol and cholesterol-lowering drugs, it’s a real challenge for physicians. My father is a great example. I’m pretty sure that if he took my advice around eating, he wouldn’t be on statins right now. He loves to eat — which I can appreciate — but he views his Zocor as a magic pill that makes the “bad stuff” in his coney dog go away. The irony is that he actually likes a lot of the foods in the Portfolio Diet (well, maybe not the soy), so if he would just eat more of them in place of the chili dogs and sweets, he’d probably be able to move his cholesterol without the pill. Exercise is also key here, which is something that the Jenkins studies don’t really look at. The most successful portfolio will also include exercise alongside the dietary changes, which when combined might actually be able to move that LDL down into a safe range.

    Again, thanks for stopping by and sharing. Hope you’ll drop in again.

  3. James Wangsness (1 comments) says:

    The diet worked for me. In 2 months I lowered my total cholesterol 54 points and dropped my triglycerides over 100 points. What isn’t shown on this web page is the most crucial part of this diet–and a part that Dr. Jenkins prescribes–is the exercise component, which recommends an hour of vigorous exercise every day. I am so happy with my results, especially since I threw my doc’s prescription for Lipitor in the trash and followed my instincts. Statins are extremely dangerous and can do irreparable damage.

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