Easy diet shift helps reduce cholesterol
DOCTORS’ NOTES
If you’re struggling to lower your cholesterol with or without drugs, it’s possible to use food to achieve your target.
It’s called the Dietary Portfolio, an evidence-based dietary approach to reducing your cholesterol recommended by the current clinical practice guidelines of the Canadian Cardiovascular Society. We’ve had good results testing it on patients with high cholesterol in clinical trials and in the clinic here in Toronto for about 15 years. On average, people who stick to all components of this eating plan can decrease their LDL or “bad” cholesterol by as much as 30 per cent, with most reducing their LDL cholesterol by about 13 per cent to 14 per cent. Those who previously had very unhealthy diets tend to experience even greater reductions.
Using this approach, you aim to consume the following each day:
— 45 grams of nuts, which is about a handful
— 20 grams of sticky viscous fibre — 50 grams of plant protein — two grams of plant sterols As an example, for breakfast, you might have oatmeal with soy milk and blueberries or other fruit on top.
Lunch might include a lentil soup with 100-per-cent oat bran bread and a plant sterol-enriched margarine followed by peanuts and an apple. Maybe try a tofu stirfry for dinner.
In our clinic at St. Michael’s Hospital, we see patients who would like to try an alternative to medications.
Sometimes people feel strongly that they don’t want to start taking drugs, but they also fear the heart attacks and strokes that can come with high LDL cholesterol. That’s another reason to consider the Dietary Portfolio, which was developed with funding from the Canadian Institutes for Health Research, Natural Sciences and the Engineering Research Council of Canada, as well as Loblaw, Unilever, Almond Board of California, various soy manufacturers and the Saskatchewan Pulse Growers.
Over the years, we found that the cholesterol-lowering foods had a modest ability to reduce LDL cholesterol when tested alone. But it wasn’t until we put them together in a portfolio of cholesterol-lowering foods that we were able to get a druglike effect.
Each of the foods in the diet does something different to combat high cholesterol.
The plant sterols stop cholesterol from being absorbed. The sticky fibres block absorption of bile acid, which is made from cholesterol. Soy, beans and pulses stop the liver from producing cholesterol and increase the number of receptors on cells that clear LDL cholesterol from the blood. Nuts perform all four functions.
These are all the ways that LDL cholesterol can be kept low in our blood — and the four food components of the Dietary Portfolio work together and as a complement to lower blood cholesterol.
Some patients find the Dietary Portfolio easy to follow. Some don’t — but it’s very common to slip up when it comes to diets, because temptations are everywhere and everyone has to eat. That’s why it’s best to start with any change you can make. We don’t need 100 per cent adherence to have some success — we want you to make changes that are sustainable and this plan allows you choices.
Think of it as a set of targets to be layered into one’s background diet. Choose foods from each category that you enjoy and try to meet the target. If you can take one out of four components to start, then that’s better than none. Maybe next week you can try two and so on. We don’t want perfection to be the enemy of the good.
It’s amazing how much diet can influence your cholesterol. One of our patients, a man in his 50s, was very motivated to avoid drugs. His LDL cholesterol was high, but he got this level down by about 50 per cent using the Dietary Portfolio alone.
Others use the diet as an adjunct to their statin and/or other cholesterol-lowering medications to help achieve their LDL cholesterol targets. One such patient, a man in his 70s, used a combination of two medications including a statin plus the Dietary Portfolio to reduce his LDL cholesterol by 78 per cent — 56 per cent beyond what he was achieving with the two medications alone. We’ve had success with patients who have all kinds of other health problems, and who are at all stages of life. It can be done.
David Jenkins pioneered the Glycemic Index and Dietary Portfolio. He is the Canada Research Chair in Nutrition and Metabolism in the departments of Nutritional Sciences and Medicine at the University of Toronto. He serves as director of the Clinical Nutrition and Risk Factor Modification Centre, a scientist in the Li Ka Shing Knowledge Institute and a staff physician in the Division of Endocrinology and Metabolism at St. Michael’s Hospital. John Sievenpiper is an associate professor in the University of Toronto’s Department of Nutritional Sciences, a scientist at the Li Ka Shing Knowledge Institute and a staff physician in the Division of Endocrinology and Metabolism at St. Michael’s Hospital. He is a member of the Canadian Cardiovascular Society Clinical Practice Guidelines Committee for Dyslipidemia.