A portfolio diet is linked to decreased risk of heart attack and stroke, a new study finds.
If you are looking to follow a heart-healthy diet, a specific eating pattern may help.
Whether you are looking to lower your cholesterol, decrease your stroke risk, or just eat more plant-based, new research, published last month by the American Heart Association, shows a connection between the lesser-known portfolio diet and a decreased risk of heart disease and stroke.
The objective behind the portfolio diet is to lower LDL, or “bad” cholesterol—a risk factor for heart disease and stroke.
To do this, the eating pattern focuses on four main groups that are seen to lower cholesterol: soluble fiber, soy protein, plant sterols, and nuts.
Because of these focal points, the diet encourages certain swaps, like soy milk as a dairy replacement, and avocados and plant oils as a butter alternative.
In addition to swapping out certain foods with choices more likely to lower cholesterol, the portfolio diet emphasizes the importance of soluble fiber. Foods such as oats, barley, lentils, beans, broccoli, eggplant, and psyllium are encouraged, as they can bind cholesterol in the blood so it can be excreted.
Many of these foods are found in other existing heart-healthy diets, but according to Andrea Glenn, PhD, RD, one of the new study’s authors and postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, “for this specific study, we were interested in exploring if the combination of these foods part of the portfolio diet also translated into lower heart disease risk.”
Here’s what you need to know about the practical implications of the portfolio diet, as well as tips for following the eating pattern.
To understand how the portfolio diet impacts heart health, the research team followed three different large-scale studies and assessed participants’ food frequency questionnaires at baseline and every four years.
The authors established a Portfolio Diet Score (PDS) that ranked plant protein, nuts and seeds, viscous fiber sources, plant sterols, and monounsaturated fat sources. After looking at the diet data over 30 years of follow-up in more than 200,000 individuals, they found that those with a higher PDS score had a 14% lower risk of cardiovascular disease, coronary heart disease, and stroke.
Glenn explained that the original trials showed that LDL cholesterol can be lowered by almost 30%.
“We also saw that the individuals in the current study were not eating as much of the portfolio diet as they did in the trials,” she said, “which highlights that even partial adoption of the dietary pattern can confer cardiovascular benefits.”
The earlier research also compared the portfolio diet to statin (cholesterol-lowering medication) use.
While the diet can result in clinically meaningful reductions in LDL cholesterol, the 28.6% reduction of LDL cholesterol was close to the 30.9% to 20 mg reduction with lovastatin.
So ultimately, the reductions seen through diet are at the low end of what could be achieved through medication alone.
“The research doesn’t compare to statin use at all,” Gregory Katz, MD, a cardiologist at NYU Langone, told Health.
He explained that the study didn’t assess the effectiveness of the portfolio diet on reduction in heart attack or stroke. Making dietary changes in line with the portfolio diet may help lower disease risk, but Katz doesn’t recommend it in place of a statin.
The study also isn’t clear on how many participants were also taking statins, Jay Chudow, MD, a cardiologist at Montefiore Medical Center, told Health.
“It is important to note that statins are not recommended for everyone for primary prevention,” Chudow said, “but those who are at a higher risk related to high cholesterol, diabetes, or other conditions.”
It’s no surprise that moving toward a plant-based way of eating contributes to lower cholesterol levels, but more research is needed before the portfolio diet is recommended more widely for heart health.
The portfolio diet is less known than the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet, but there are significant overlaps.
All of the diets focus on eating whole grains, fruits, vegetables, plant protein, nuts, seeds, and plant oils. They also emphasize a decrease in saturated fat from red meat and dairy.
“The main difference between the dietary patterns and the portfolio diet is that the portfolio diet emphasizes plant protein, particularly soy, as well as the viscous fiber sources and phytosterols,” Glenn said.
Since all of these diets have been shown to have a positive effect on heart disease risk, individuals can choose what elements to include that work with their preferences, lifestyles, and values.
The best way to implement the portfolio diet in your life is by starting with small, achievable swaps.
Try breaking it down by choosing one of the four parts of the portfolio diet to focus on at a time.
For example, start by swapping out meat for a soy-based protein for one meal a week. Or, add one source of viscous fiber to your diet a day, such as oatmeal for breakfast or roasted broccoli for dinner.
Since the portfolio diet is not the only heart-healthy eating pattern out there, your diet may look like some combination of the portfolio diet, Mediterranean, and DASH diets based on what is suitable for your lifestyle and individual nutrition needs.
The good news is, any step toward heart-healthy choices is a good one.
Chudow recommends patients just choose whatever healthful diet that is easy for them to stick with and make part of their routine, whether that be portfolio, Mediterranean, or DASH diet.
“I discuss with my patients ways to increase their healthy food choices by adding in fruits, vegetables, and whole grains,” he said.
For individualized guidance and advice for your nutrition needs, it’s best to consult a registered dietitian.