“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.