Portfolio Diet

The goal of the eating plan's creators was simple: to see if a "portfolio" of foods, each with some minor cholesterol-lowering benefits, can have a larger effect when eaten together as part of a regular diet.

The concept was developed by David Jenkins, professor of nutrition and metabolism at the University of Toronto and a strong proponent of using food to help reduce blood cholesterol, high levels of which increase the risk of heart disease. Funding for research came from 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.



But the Portfolio approach won't be for everyone. Strictly followed, it's a near-vegan regimen, meaning no meat, eggs, poultry, fish or dairy.

"It's a real challenge for people to stay on this kind of diet," notes Alice Lichtenstein, professor of nutrition at Tufts University and chair of the American Heart Association's Nutrition Committee.

In carefully controlled scientific settings, however, the Portfolio plan's cholesterol-lowering benefits rivaled those of statin drugs. That's important because millions of people take these prescription drugs long-term to control their blood cholesterol levels. Research suggests that about 25 percent of users stop taking their medicine within the first year of treatment because of complications. Without the drugs, cholesterol levels usually rise again to unhealthy levels.

When a low dose of statins isn't enough, doctors prescribe more. But there's a diminishing return: doubling the lowest dose only reduces cholesterol by about an additional 6 percent.

That's why the American Heart Association and the National Heart, Lung, and Blood Institute also recommend cutting saturated fat, trans fatty acids and cholesterol while boosting fiber as well as using drugs to help control cholesterol.

So can the Portfolio approach help even people who don't strictly follow this eating plan? To find out, Jenkins and his colleagues at the University of Toronto enrolled 66 adults with elevated blood cholesterol in a one-year study of the diet.

Participants were instructed to eat a mostly vegetarian diet rich in soy foods, almonds, fruit, vegetables, whole grains and beans, as well as some healthy oils and margarine made with plant sterols (substances proven to lower cholesterol). They were also advised to skip or limit fat-free and low-fat dairy products and were encouraged to forgo eggs as well as poultry, fish and lean meat. Those who continued to eat these foods were urged to limit them to three or fewer meals a week.

The study found a direct link between how closely participants followed the portfolio plan and how much their blood levels of low-density lipoprotein (LDL) improved. LDL is directly linked to heart disease risk.

Nearly a third of participants who stuck closest to the plan's goals lowered their LDL levels by 20 percent or more, an improvement that rivals use of low-dose statins.

"There's no question that you can have very good results with diet," notes Robert Eckel, president of the American Heart Association (AHA) and a faculty member at the University of Colorado Health Sciences Center in Denver. What the latest findings suggest, he notes, is that for some people, "diet can match that doubling of statins." And for others, altering their diets may mean a reduction in dose, "or help them avoid adding a second cholesterol-lowering drug."

Here's how you can apply some of the lessons from the study:

· Nuts and healthy margarine proved easiest to add. About 79 percent of participants ate almonds while two-thirds used Take Control spread. But there's no need to stick with these foods, which were used because of the study's sponsorship. Other healthy spreads, including Benecol and Smart Balance, also are proven to help cut cholesterol -- if they are eaten daily. Additional options fortified with plant stanols or sterols include some brands of orange juice and chocolate.

Branch out with different nuts, too. "Any that are low in saturated fat would be just fine," Lichtenstein notes. Participants ate about two ounces daily, or roughly two handfuls. Just remember that both nuts and margarine are high in calories. So if you add them, you'll need to subtract other items to avoid weight gain, which also raises blood cholesterol.

· Include okra and eggplant . Both are among the more potent cholesterol-lowering vegetables. Skip fried versions of either, because frying almost always adds saturated fat (and, when such dishes are commercially prepared, may add unhealthy trans fats). Pickled okra is one option. Another is baked eggplant. To prepare: Wash and prick an eggplant. Cover in foil. Bake in a 400-degree oven for about an hour. Cool. Scoop out the inside. Use as a meat substitute in spaghetti sauce or as a dip mixed with garbanzo beans (good source of protein and fiber) and a little tahini (sesame paste, a healthy type of fat).

· Add soy, beans and fiber. Recent research questions soy's ability to lower blood cholesterol. But as a food low in saturated fat and high in fiber and protein, "soy can be beneficial when it is used to displace animal foods from the diet, such as hamburger," Lichtenstein notes. Beans, oat bran and psyllium were some of the other high-fiber foods that helped to improve LDL blood levels. ·