The Portfolio diet: a statin you can spread on toast. Almost.
A Canadian researcher put four cholesterol-lowering foods together, like stocks in a portfolio, and compared the result with a cholesterol pill. In a small trial, the food came surprisingly close. The real world is less tidy, but the idea holds.
The short version
- What it is
- A plant-heavy diet built around four daily foods: nuts, soy and other plant protein, sticky fibre from oats and barley, and plant sterols.
- Good for
- Lowering LDL ("bad") cholesterol. That's its job, and it does it.
- Bad at
- Being easy. Eating all four every day takes effort, and real-life results are about half the lab results.
- Evidence
- Strong for LDL cholesterol. Observational for heart attacks.
- Our take
- When your cholesterol is high, these foods move up your plan. Pills are your doctor's call, not ours.
What the Portfolio diet actually is
LDL cholesterol is the kind that builds up in your artery walls. Lower LDL means lower risk of heart attacks and strokes. Some foods each nudge LDL down a little. Professor David Jenkins and his team at the University of Toronto had a simple idea: what if you eat all of them, every day, at once?
That's the "portfolio": several small investments that add up. On top of a diet already low in saturated fat, you add four things daily:13
- Nuts, a good handful, around 40 g a day
- Plant protein from soy (tofu, soy drink, edamame) and beans, lentils and peas
- Viscous fibre, the sticky kind, from oats, barley, psyllium, okra and aubergine
- Plant sterols, natural compounds in plants that block cholesterol uptake, added to special spreads, yoghurts or drinks
It's mostly plants, but it isn't vegan by definition. It's an eating pattern with a single, measurable target.
How it works in your body
Each of the four foods attacks cholesterol from a different side. Plant sterols look so much like cholesterol that they compete with it in your gut, so less gets absorbed. Sticky fibre from oats and barley forms a gel in your gut that traps bile, which your liver makes from cholesterol, so it pulls more cholesterol out of your blood to make new bile. Soy and other plant protein replace meat, and with it saturated fat. Nuts bring unsaturated fat in place of saturated fat.
None of them is dramatic alone. Together, they add up to something your blood test will show.
What you eat, what you don't
Eat
- Oats and barley: porridge, overnight oats, barley in soups
- Tofu, tempeh, soy drink, edamame
- Beans, lentils, chickpeas, peas, most days
- Almonds, walnuts, pistachios, a handful a day
- Aubergine, okra, plenty of other vegetables
- Spreads or yoghurts with added plant sterols, if your doctor agrees
- Olive or rapeseed oil, avocado
Forget it
- Butter, lard, ghee as your daily fat
- Fatty and processed meat
- Full-fat cheese and cream at every meal
- Coconut and palm oil in large amounts
- Pastries, biscuits, cakes
- Sugar and soft drinks
Alcohol on the Portfolio diet
OK, now and then
- One glass of dry wine with a meal
- A clear spirit with soda water
- A small beer
Works against you
- Several drinks in one sitting (raises triglycerides, another blood fat)
- Creamy liqueurs and cocktails
- Drinking with salty, fatty bar food
- Wine "for your cholesterol"
50 Club: one glass of wine with dinner, weekends only.
Alcohol is not part of the Portfolio diet, and the World Health Organization says no safe level of drinking has been shown.5 All the details are in our alcohol guide.
What it's good for, with proof
LDL down by almost as much as a starter statin, in the lab
In the first trial in 2003, 46 adults with high cholesterol were given one of three diets for a month: a low-fat control diet, the same diet plus a statin, or the Portfolio diet. LDL fell 8% on control, 31% with the statin and 29% on the Portfolio diet. The statin and the diet weren't significantly different.1 Small trial, short trial, all food supplied. But that's still remarkable.
Real life: about half that
Then the honest test. In 2011, 351 Canadians with high cholesterol got advice, not meals, for six months. The Portfolio groups lowered LDL by about 13–14%, versus 3% on a standard low-saturated-fat diet.2 Half the lab result, because people don't eat every portfolio food every day. Still more than three times the effect of the usual advice.
The pooled evidence
A meta-analysis of the controlled trials found the Portfolio diet lowered LDL by about 17% on top of a heart-healthy diet, and also lowered triglycerides, blood pressure and a marker of inflammation (CRP). The authors rated the evidence for LDL as high quality.3
Fewer heart attacks and strokes, probably
Harvard researchers scored over 200,000 people in three large US studies on how closely they ate like the Portfolio diet, and followed them for up to 30 years. The top fifth had about 14% less heart disease and stroke than the bottom fifth.4 Observational, so it shows a link, not proof. But it points the same way as the trials.
The uncomfortable truth
"The Portfolio diet works as well as statins." In one month-long trial of 46 people with all food provided, yes, nearly.1 In real life, the effect is closer to half.2 If your doctor has prescribed a statin, this diet works with it, not instead of it. Never stop a statin because you've bought oats.
"Plant sterol spreads are a health food for everyone." No. EU labelling rules require sterol products to say they're meant for people who want to lower their cholesterol, and that they may not be suitable for pregnant or breastfeeding women or children under five.6 If your cholesterol is fine, you don't need them.
The risks
- Gas and bloating. Beans, oats, barley and psyllium all at once is a lot of fibre. Increase slowly, drink plenty of water.
- Calories. Nuts are healthy and calorie-dense. A handful, not a bag.
- Medication timing. If you take regular medicines and want to add a fibre supplement like psyllium, ask your pharmacist when to take which.
- Sterol products. Not for pregnancy, breastfeeding or small children, and not needed if your cholesterol is normal.6
- False security. Some high cholesterol is genetic (familial hypercholesterolaemia). Diet helps, but it rarely does the job alone. Get checked.
Allergies: watch the staples
The Portfolio diet relies on several major allergens. Allergic to one? The other three still work.
| Staple | Allergen (EU list of 14)6 | Swap |
|---|---|---|
| Tofu, soy drink, edamame, tempeh | Soy | Beans, lentils, chickpeas, peas |
| Almonds, walnuts, pistachios | Tree nuts | Sunflower and pumpkin seeds |
| Peanuts, peanut butter | Peanuts | Sunflower seed butter |
| Oats, barley | Cereals containing gluten | Certified gluten-free oats (if tolerated), psyllium, okra, beans |
| Sterol yoghurts and some spreads | Milk | Dairy-free sterol products, or skip sterols |
| Lupin flour in some high-protein products | Lupin | Pea or bean flour |
Don't do the Portfolio diet if you…
- are pregnant or breastfeeding and plan to use plant sterol products
- are planning it for a child under five with sterol products
- want to use it instead of a statin your doctor has prescribed
- have kidney disease with potassium or protein limits (beans, nuts and soy are rich in both)
Healthen me asks about all of these and gives you a different plan if any apply.
How we use the Portfolio diet in your plan
The Portfolio diet is a building block. When you tell us in Healthen me that your cholesterol is high, the engine moves its four foods up: oats or barley in one meal, nuts as the after-dinner snack, tofu or beans as the protein several days a week, more aubergine and okra in your vegetable picks.
It fits neatly into our Mediterranean backbone, which already has nuts, beans and olive oil. Porridge goes into your later meals, not the one that breaks your fast, which stays low-carb. We don't add sterol products ourselves. If you want them, ask your doctor first.
Want to go fully plant-based for your heart? That's the whole-food plant-based approach, and it belongs with your doctor.
This article is general information, not medical advice. If you have a medical condition or take medication, talk to your doctor before changing how you eat.
Sources
- Jenkins DJA et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;290(4):502–510. doi.org/10.1001/jama.290.4.502
- Jenkins DJA 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(8):831–839. doi.org/10.1001/jama.2011.1202
- Chiavaroli L et al. Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Progress in Cardiovascular Diseases 2018;61(1):43–53. pubmed.ncbi.nlm.nih.gov/29807048
- Glenn AJ et al. Portfolio diet score and risk of cardiovascular disease: findings from 3 prospective cohort studies. Circulation 2023;148(22):1750–1763. doi.org/10.1161/CIRCULATIONAHA.123.065551
- WHO Regional Office for Europe. No level of alcohol consumption is safe for our health. News release, 4 January 2023. who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
- Regulation (EU) No 1169/2011 on food information to consumers, Annex II (the 14 allergens) and Annex III (labelling of foods with added plant sterols). eur-lex.europa.eu/eli/reg/2011/1169/oj