 The
Portfolio Plan: Diet for a Healthy Heart?
We’ve asked three advisors to Today’s Diet
& Nutrition to weigh in on the value of the Portfolio
Eating Plan, a diet that aims to reduce the risk of heart disease.
It revolves around four cholesterol-fighting foods: soy-based foods
in place of meat, fiber, plant sterols, and nuts.
By Robert Kushner, professor of medicine, Northwestern University
Feinberg School of Medicine, author of Dr. Kushner’s Personality
diet and medical director of diet.com, an online version of the
personality type diet.
As a physician nutritionist, I think of diet as a continuum of
choices, ranging from a very unhealthy pattern (foods high in saturated
and trans fats, calories, simple sugars, and salt) to an extremely
healthy pattern (foods higher in monounsaturated fats, fruits, and
vegetables, fiber and whole grains). The Portfolio Plan clearly
resides at the far end of the healthy continuum and requires a major
commitment to be true to the diet. It’s not for the casual
dieter.
In addition to choosing low fat foods (just to warm up), the principle
foods of the diet consist of oats, okra, eggplant, psyllium (as
a supplement), soy milk and soy meat substitute, dried legumes,
fruits and vegetables, whole almonds, and plant sterol ester-enriched
margarine. It was designed from a ‘portfolio of foods’
that have been shown to lower blood cholesterol levels. Carefully
conducted studies have indeed demonstrated its beneficial effect
in lowering the bad cholesterol in the blood by 13% to 20%. I view
the Portfolio Plan as a testament to the power of foods in improving
health and well being. If you’re interested in a complete
makeover of your diet, the Portfolio Plan may be right for you.
By Brenda Ponichtera, RD, author of Quick & Healthy Recipes
and Ideas, Quick & Healthy Volume II, and Quick & Healthy
Low-fat Carb Conscious Cooking (www.quickandhealthy.net)
The Portfolio diet, for some, offers a possible alternative to
medication. A positive change in diet is always preferable to medication
since all medications have side effects. However, as with many diets,
the real question is, can you stick with it long term? A couple
of weeks won’t cut it. A few visits to a registered dietitian
can help you decide if this or any diet will work for you or to
have a plan designed that’s more likely to help you succeed.
It’s also important to note that some individual components
of the Portfolio diet may also be effective even if you don’t
follow the whole program, and a dietitian can help you individualize
the plan for your needs.
I have no problems recommending parts of the Portfolio diet, but
I do have great difficulty prohibiting dairy and meat, fish, or
poultry because I’m not convinced that those restrictions
are necessary. And I know that my clients would not accept all parts
of the Portfolio diet over the long term. Again, individualization
may be the key to success.
By Marlene Lesson, MS, RD, LDN, CDE, is nutrition director of Structure
House, a residential weight loss facility in Durham, N.C. (www.structurehouse.com)
Pro #1
The beauty of the Portfolio Plan is that it is very much about what
you can eat: including enjoyable whole plant foods like vegetables,
beans, whole grains and healthy fats (i.e. almonds and designer
margarines). The Portfolio studies demonstrate that lowering LDL
(bad cholesterol) levels is not accomplished merely by reducing
saturated fat and cholesterol but by adding healthful whole foods.
A recent study by an independent group found that a low-fat diet
with extra vegetables, beans, and whole grains lowers LDL levels
more than an equally low-fat diet with refined grains, half as many
vegetables, and lots of prepared foods (Annals of Internal
Medicine, 2005; 142: 725-733). The Portfolio Plan
encourages us to think of heart-healthy eating in a more positive
way.
Pro #2
Some individuals have genetically high LDL cholesterol. Even when
they follow the American Heart Association’s 2006 Therapeutic
Lifestyle Change (TLC) program their LDL levels may continue to
be elevated. The Portfolio Plan may be an option for highly motivated
individuals whose lipid levels do not reach the ideal range on the
TLC program.
A 2006 study found that people who attempted to follow the Portfolio
Plan for a year under real-world conditions gradually became less
strict. Even so, they experienced a significant drop in LDL cholesterol.
However, the more closely a participant followed the Portfolio Plan,
the greater the reduction in LDL levels.
Pro #3
The Portfolio Plan may be a nonpharmacological treatment option
for people who discontinue their statin medication due to complications.
The Portfolio Plan has been found to lower cholesterol levels nearly
as well as low-dose statins in some people.
Con #1
One drawback of the Portfolio Plan is that it is challenging. The
Portfolio Plan is vegan, which means it has no animal products—not
even heart-healthy animal foods like fat-free dairy, egg whites,
and fish. Many individuals who have not been successful controlling
their weight have a history of alternating between overly challenging
diets and overeating. For these people, being able to sustain a
more realistic diet is quite an accomplishment and one that will
yield long-term results.
The American Heart Association’s TLC program, which has the
potential to reduce LDL cholesterol by 20% to 30%, is more realistic
for the average person. These changes, which are intended for those
at higher risk of heart disease, include:
o Reducing saturated fat to less than 7% of calories,
o Reducing trans fatty acids to less than 1% of calories,
o Reducing dietary cholesterol to 200mg per day,
o Losing ten pounds, if overweight,
o Increasing soluble fiber by 5 to 10 grams per day, and
o Including 2 grams of plant sterols per day.
How do you eat to limit saturated fat and cholesterol to recommended
amounts? Rather than eliminating all animal products, limit yourself
to 5 ounces of lean meat, poultry, fish, and cheese per day and
2 egg yolks per week. Choose healthy added fats from plant sources
like mono- and poly-unsaturated oils. Making these changes is less
daunting for the average person than the Portfolio Plan.
Con #2
Another questionable element of the Portfolio Plan is the inclusion
of 6 servings of soy foods per day. Based on a review of 22 randomized
trials, the American Heart Association concluded that soy protein
with isoflavones has little or no benefit on blood lipid levels.
The American Heart Association also cautions that the safety of
large amounts of soy in women has not been established. However,
replacing high-fat animal protein with soy as well as other plant
protein foods can be beneficial for heart health.
A Personal Perspective
I am a perfect example of a good candidate for the Portfolio Plan
because of naturally high LDL levels. My Body Mass Index has been
well within the ideal range my entire life. I have exercised regularly
for decades. My diet has been well under 7% of the calories from
saturated fat, and 200mg of cholesterol during all of my adult years.
Because of my genes, my LDL cholesterol was still higher than optimal.
So I followed the Portfolio Plan for more than 6 months. The only
change I made was reducing the number of soy servings from six to
one per day. My LDL cholesterol dropped by 35%. Like most people
I found the Portfolio diet to be hard to sustain for an extended
period of time. So I added fish, fat-free yogurt, and egg whites
back into my diet. I continued including hot oat bran cereal every
morning, bean soup at every lunch, as well as other sources of water-soluble
fiber, and plant sterol margarine. My LDL cholesterol levels have
remained in the optimal range.
For more information about the Portfolio Plan, visit www.portfolioeatingplan.com.
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