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The Portfolio diet: An investment in your heart health?

The Bottom Line

  • The Portfolio diet is a plant-based diet that consists of four cholesterol-lowering foods: nuts, plant-based proteins, soluble fibre, and plant sterols.
  • In combination with a National Cholesterol Education Program Step II diet, the Portfolio diet can reduce “bad cholesterol” and other types of fat found in the blood, inflammation, blood pressure, and the ten-year risk of coronary heart disease.
  • More research is needed to determine if these positive effects translate into real changes in heart health. 

Think of the Portfolio diet as a dietary portfolio of cholesterol-lowering foods. Invest in the right ones and you may see gains in your heart health.


Heart disease is an umbrella term for diseases that affect the heart and blood vessels (1;2). These diseases most often result from the narrowing and blockage of arteries by plaque deposits, and this is often caused by high cholesterol (1;3). Luckily, healthy lifestyle choices—like diet modifications—are a good way to combat heart disease (4;5).


Enter the Portfolio diet—a plant-based diet that is made up of four core foods: ≥ 45 grams of nuts, ≥ 50 grams of plant protein from soy or beans, ≥ 22 grams of viscous fibre from things like oats, eggplant, apples, or barley, and 2 grams of plant-sterols from items like plant-sterol-enriched margarine (6). The premise of this diet is simple: grouping foods that have their own cholesterol-lowering ability when eaten alone will have a larger effect when there are combined into a “portfolio” as part of a regular diet. Preliminary research supports this idea (6-12), with the diet’s benefits being recognized by the Canadian Cardiovascular Society, Diabetes Canada, and other world renowned experts in heart disease and diabetes (6;13-14).


While the Portfolio diet is backed by emerging evidence, a recent systematic review took a closer look to find out if this diet provides a good return on investment for one particular group of people: those who are overweight and have high cholesterol, but have not yet developed heart disease or diabetes. In this review, people started out on a low-fat National Cholesterol Education Program (NCEP Step II) diet, where ≤30% of their energy came from total fat, <7% of their energy came from saturated fat, and they consumed <200 milligrams of cholesterol per day. They then switched from an NCEP Step II diet to a version of the Portfolio diet or to receiving nutritional advice encouraging the consumption of foods within the Portfolio diet (6).


What the research tells us

The current evidence is encouraging! The review found that, compared with people who followed the NCEP Step II diet alone, people who followed the combination of a Portfolio diet and NCEP Step II diet lowered multiple risk factors for heart disease and diabetes. “Bad” LDL cholesterol and other fats found in the blood such as non-HDL cholesterol, total cholesterol, and triglycerides were all reduced, as were inflammation and blood pressure. Even better, this was accompanied by a reduction in the ten-year risk of coronary heart disease. In contrast, the Portfolio diet did not have any effect on weight or “Good” HDL cholesterol. Although promising, larger, high-quality studies are needed to confirm that these beneficial findings translate into real improvements in heart health (6).


Struggling to keep your cholesterol levels under control? The Portfolio diet may be a good way to manage your cardiovascular risk.


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References

  1. Hartley L, May MD, Loveman E, et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2016; (1):CD011472. doi: 10.1002/14651858.CD011472.pub2.
  2. World Health Organization. Cardiovascular diseases (CVDs). Fact sheet number 317. [Internet] 2017. [cited May 2019]. Available from http://www.who.int/mediacentre/factsheets/fs317/en/index.html
  3. National Health Service. Atherosclerosis. [Internet] 2016. [cited May 2019]. Available from https://www.nhs.uk/conditions/atherosclerosis/#commentCountLink 
  4. Abdelhamid AS, Martin N, Bridges C, et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018; (11):CD012345. doi: 10.1002/14651858.CD012345.pub3. 
  5. Schwingshackl L, Dias S, Hoffmann G. Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: A systematic review and network meta-analysis. Syst Rev. 2014; 3:130. doi: 10.1186/2046-4053-3-130. 
  6. Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio dietary pattern and cardiovascular disease: A systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018; 61(1):43-53. doi: 10.1016/j.pcad.2018.05.004.
  7. Jenkins DJ, Chiavaroli L, Wong JM, et al. Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering good in hypercholesterolemia. CMAJ. 2010; 182(18): 1961-1967. doi: 10.1503/cmaj.092128. 
  8. Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003; 29(4): 502-510. doi: 10.1001/jama.290.4.502. 
  9. Jenkins DJ, Kendall CW, Faulkner D, et al. A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metab Clin Exp. 2002; 51:1596-1604. doi: 10.1053/meta.2002.35578. 
  10. Jenkins DJ, Kendall CW, Marchie A, et al. The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metab Clin
    Exp 2003;52:1478-1483. doi: 10.1016/s0026-0495(03)00260-9. 
  11. Jenkins DJ, Kendall CW, Faulkner DA, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 2006; 83:582-591. doi: 10.1093/ajcn.83.3.582. 
  12. Jenkins DJ, Jones PJ, Lamarche B, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: A randomized controlled trial. JAMA. 2011; 306:
    831-839. doi: 10.1001/jama.2011.1202. 
  13. Anderson TJ, Gregoire J, Pearson GJ, et al. 2016 Canadian cardiovascular society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2016; 32:1263-1282. doi: 10.1016/j.cjca.2016.07.510.
  14. Sievenpiper JL, Chan CB, Dworatzek PD, et al. Nutrition therapy. Can J Diabetes. 2018; 42(Suppl 1):S64-s79.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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