THE PORTFOLIO DIET: HOW IT AFFECTS CHOLESTEROL AND HEART HEALTH

Medically Reviewed and Updated by Dr. Rosmy Barrios - October 08, 2024

The negative impacts of elevated LDL, otherwise known as bad cholesterol, on overall health and well-being have been widely covered. There have been numerous health drives all over the world aiming to tackle high cholesterol by spreading awareness about the quantity and quality of dietary fats. Some of these efforts include world-famous heart-healthy diet plans such as the DASH diet, the Mediterranean diet, and an all-around push for plant-based eating.

 In recent years, a lesser-known cholesterol-lowering diet plan has emerged that can improve upon and perhaps even replace some of the most popular recommendations available. The Portfolio diet is a simplistic plant-based approach that emphasizes the consumption of four cholesterol-lowering foods daily. The results of following this diet have been likened to those seen while on cholesterol-lowering medications, without any of the potential side effects.

In this article, we will explain what the Portfolio diet is and how it can be easily implemented to reduce bad cholesterol naturally.

The Problem with Cholesterol

Cholesterol is a sterol, a type of lipid that the body produces. In reality, it is part of a package used to store and transport fats (triglycerides) around the body.^[1]

We also need our cholesterol for several other reasons, such as:

• Construction and repair of cell membranes
• Bile salt production for digestion and dietary fat absorption
• Hormone and Vitamin D3 production

There are two prominent types of cholesterol: High-Density Lipoprotein cholesterol (HDL) and Low-Density Lipoprotein cholesterol (LDL).

Low-Density Lipoprotein cholesterol comprises larger molecules of fat that supply all tissues with their cholesterol requirements.^[2] LDL is often called “bad” cholesterol because if levels are excessive, it can accumulate in the arteries and form plaque. This can, in turn, lead to the narrowing of blood vessels, thereby elevating the risk of heart disease and stroke.

High-Density Lipoprotein cholesterol comprises small molecules of fat that remove and recycle excess cholesterol and triglycerides in the bloodstream. HDL is often called “good” cholesterol.

Therefore, it is desirable to have a low level of LDL and a high level of HDL in the blood. Yet, a high level of HDL does not necessarily indicate having more HDL than LDL. Roughly two-thirds of cholesterol ought to be LDL, with the remaining third HDL. If LDL levels exceed this amount, they are considered too high. If HDL levels significantly exceed this amount, they may contribute towards heart disease and amyloidosis risk by depositing into blood vessel walls.

Hence, when thinking in terms of low LDL and high HDL, it is best to acknowledge that a balance is best for overall health. Many unhealthy dietary and lifestyle habits push LDL levels above the healthy threshold and promote either low or dysfunctional HDL, all of which can increase the risk for disease.

Introducing the Portfolio Diet for Lowering Cholesterol

The Portfolio diet is an adaptive vegan diet for lowering cholesterol that was created by Dr. David J.A. Jenkins, a British physician and professor at the University of Toronto. 

Results regarding the diet’s efficacy were published recently this year. In a large-scale trial that spanned 30 years and included 166,270 women and 43,970 men, it was shown that those with the highest adherence to the Portfolio diet had a 14% decreased risk of coronary artery disease and stroke than those with the lowest adherence.^[3]

Other studies over the last few decades show that the Portfolio diet has effects on cholesterol levels similar to first-generation statin medication, without side effects, and may also have other benefits for cardiovascular health that do not interfere with medication. In a smaller trial, 6 months of following the Portfolio diet resulted in 13% lower LDL cholesterol levels in 351 participants with hyperlipidemia.^[4]

The Portfolio diet lowers cholesterol by emphasizing the daily consumption of four types of foods that have been scientifically proven to have substantial cholesterol-lowering effects^[5]:

1. 50g Soy protein
2. 2g Plant sterols
3. 50g Nuts
4. 10-25g Soluble fiber

The daily quantities are required to receive the full benefit. Aside from the specified amounts, the diet does not have strict rules or restrictions. It encourages participants to replace certain foods with healthier alternatives, for instance: 

• Meat and dairy products are substituted with soy-based foods.
• Butter or cooking oils rich in saturated fats are replaced with plant sterol-enriched margarine.
• Highly processed fatty foods are replaced with nuts and healthy plant-based fats high in monounsaturated fats.
• Fruits, vegetables, oats, legumes, and flaxseed are consumed for their soluble fiber content. 

Other Portfolio Diet Benefits

In general, plant-based dietary patterns are associated with a lower risk of heart disease, dyslipidemia, obesity, metabolic syndrome, diabetes, and more. While the Portfolio diet has been shown to lower cholesterol levels and heart disease risk, further investigation has proven that it has other benefits as well, such as:

• Lowers Blood Pressure More than DASH: In a smaller study of 241 individuals, the Portfolio diet was shown to lower blood pressure by an average of 1.9 mm Hg more than those on the DASH diet.^[6]
• Doubles the Cholesterol Benefits of the Mediterranean Diet: In just 2-4 weeks, a combination of the Portfolio and Mediterranean diets lowered LDL cholesterol by twice as much compared to a regular Mediterranean diet.^[7]
• Reducing CVD Risk in Post-Menopausal Women: In a 15-year study conducted among post-menopausal women aged 50-79, higher intake of the four main cholesterol-lowering foods resulted in a lower risk of cardiovascular disease by 11%, coronary heart disease by 14%, and heart failure by 17%.^[8]

One of the most compelling aspects of the Portfolio diet plan is that it is simple, easy-to-understand, and highly adaptive. Those who wish to follow it can make a few basic tweaks to their eating habits that will automatically translate into improved heart health in the long run. The more closely the diet is followed, the better the results.

Cholesterol-Lowering Foods to Include in a Portfolio Diet Meal Plan

Foods that can be included to decrease bad cholesterol while on the Portfolio diet are suggested below alongside alternatives.

Soy Protein 50g

Early studies surrounding soy suggest that it serves to lower LDL and boost HDL, particularly due to its isoflavone and sterol content. This is reflected in the Portfolio diet results.

To give an idea, here are the average levels of soy protein per serving of the following soy products:

Thus, to reach 50g, one would need to consume 3-4 servings of soy-based foods.

In recent years, studies have been conflicting about whether soy can lower cholesterol or not. Some people cannot consume soy due to hormonal reasons and glutamate sensitivity. For those who cannot eat soy, substituting with legumes may pose similar cholesterol-lowering benefits. Like soy, legumes are also rich in sterols and phytoestrogens.

Viscous Fiber 10-25g

Viscous fiber refers to water-soluble fiber, which is known for its prebiotic benefits. Most fruits and vegetables contain between 1-2g of viscous fiber per half cup serving, as do servings of oats, nuts, and seeds.

Some foods exceptionally high in viscous fiber include^[9]:

To reach 10-25g per day, one would need to opt for roughly 10-25 portions of fiber-containing foods. From the rest of the diet, the contribution of nuts and soy would account for roughly 2-5g of viscous fiber intake.

Sterols 2g

Sterols or phytosterols are plant-based fats that have a similar structure to cholesterol. They have been shown to inhibit cholesterol absorption in the gut through bile and promote its excretion. Sterols may also prevent excess fat absorption and promote cholesterol clearance from cells and tissues once absorbed.^[10]

Sterols are not available in abundant quantities throughout the diet, which is why the Portfolio diet plan tends to recommend consuming sterol-fortified products, such as sterol-enriched margarine or yogurt. Fat spreads, cereal bars, and other products are also fortified with sterols.

Foods highest in sterols include vegetable oils, nuts, seeds, legumes, and whole grains.

Examples of foods high in plant sterols include^[11]:

Variations of the Portfolio diet recommend including oats or barley, which are rich sources of beta-glucan and also contain reasonable sterol levels. Half a cup of cooked oats contains 1.6g of beta-glucan. Up to 3g per day can greatly lower cholesterol and improve heart health.^[12]

Nuts 50g

Nuts have always been recommended in cholesterol-lowering diet plans. They contain higher amounts of sterols and viscous fiber than other foods, yet they also comprise a wealth of micronutrients, including trace minerals and vitamin E. All these factors serve to lower cholesterol levels.

It is best to consume a variety of nuts and avoid those known to cause allergies. For example, cashews contain a decent level of lactose (enough to trigger a reaction in some), almonds are high in oxalates, peanuts have been associated with molds, and Brazil nuts contain appreciable quantities of selenium, which ought to be moderated.

Tips for Putting the Portfolio Diet into Action

To integrate the Portfolio diet into your diet plan, you can follow these steps:

• Start by replacing foods that are high in saturated fat and cholesterol, such as meat, cheese, butter, and eggs, with plant-based alternatives, such as soy products, plant sterol-enriched kinds of margarine, and oatmeal. You can also add more fruits, vegetables, legumes, and whole grains to your meals and snacks, as they are rich in soluble fiber and antioxidants. That way, you can gradually transition to a plant-based diet before implementing the Portfolio diet.
• Gradually increase the amount of Portfolio foods that you consume until you reach the recommended daily intakes of 2 grams of plant sterols, 50 grams of soy protein, 50 grams of nuts, and 10-25 grams of soluble fiber. You can use fortified foods, such as spreads, yogurts, and juices, that have added plant sterols or supplements, such as capsules or powders, that contain plant sterols or soy protein, to help you meet your goals.
• When working out how much of each food you should be eating, focus on your nut and soy or legume intake first. These contain both sterols and fiber. Once you have worked out how much of these nutrients they each contribute, you can then work out how much sterols and fiber you will need. It is advisable not to go overboard on vegetable oils to reach your sterol intake, as even high levels may not contribute 2g. The average diet contains 150-450mg of sterol per day; therefore, you would be better off supplementing with fortified foods to reach 2g.
• When followed properly, the Portfolio diet offers radical LDL cholesterol-lowering benefits that ought to be balanced with appropriate healthy lifestyle changes. The studies show that extremely high HDLc is rare, and when it occurs, it is due to genetic conditions or HDL dysfunction, which in turn can be just as much of a risk factor as excessive LDL cholesterol.^[13] Practice healthy eating habits while on the Portfolio diet, such as consuming a balanced and varied diet, limiting your salt and sugar intake, drinking plenty of water, and avoiding processed and fried foods. Regular exercise, getting adequate sleep, and stress management can also improve the outcome.

By following these tips, you can put the Portfolio diet in action and enjoy its benefits for your cholesterol levels and your heart health. 

Other Ways to Lower LDL Naturally

To support a heart-healthy diet, the following tips can help you lower bad cholesterol and support overall well-being:

• Get fit: Regular physical activity can improve blood circulation, lower blood pressure, and increase “good” HDL cholesterol levels. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.
• Minimize inflammation: Chronic inflammation can damage the arteries and contribute to plaque buildup. To reduce inflammation, avoid smoking, limit alcohol intake, cut refined foods high in sugar, trans-fat, or additives out of the diet, and consume foods rich in antioxidants, such as berries, green tea, and dark chocolate.
• Manage stress: Stress can raise cholesterol levels by stimulating the production of cortisol, a hormone that increases blood sugar and fat storage. To cope with stress, practice relaxation techniques, such as meditation, yoga, or deep breathing, exercise regularly, and seek social support from friends and family.

Conclusion

The Portfolio diet was devised several decades ago by Dr. David Jenkins to lower cholesterol levels and improve risk factors for heart disease. Results from long-term studies have recently shown positive results, likening the diet to first-generation statin medications, which are capable of lowering cholesterol by up to 14% without side effects. The diet is simple, easy to implement, and can double the benefits associated with other heart-healthy diets like the DASH and Mediterranean diets. To transition to Portfolio, all one has to do is focus on consuming four foods daily: soy, nuts, sterol-enriched foods, and soluble fiber foods. However, it is recommended to consult a healthcare professional before commencing a new dietary program.

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