The Portfolio Diet: A New Way to Lower Cholesterol

It's been an incredible week at Exam Room Nutrition! Our Clinician-Dietitian Mixer was an incredible success and so much fun networking with other professionals! Don't worry if you missed it, we'll do another one in the Fall.

I also kicked off a new format to the podcast this week. I call it, Ask the Dietitian, where I feature 2 guests: one is a medical professional with nutrition questions and the other is a Registered Dietitian ready to provide answers. I released TWO episodes this week from my conversation with oncology PA Dane Thomas and oncology Dietitian Julie Lanford. 

If you'd like to be a guest on the podcast and have a chance to ask your burning nutrition questions to an expert Registered Dietitian, fill out this form to make it happen!

On The Podcast

In Episodes 56 & 57, we discuss the crucial role of nutrition in cancer treatment and survivorship. Including how to manage treatment side effects such as weight loss, taste changes, constipation, diarrhea, reflux, and nausea. Julie shares evidence-based recommendations and debunks common myths about sugar and cancer and which dietary patterns that can reduce the risk of cancer recurrence.

Listen to the podcast TODAY! 

Disease Spotlight | Dyslipidemia

As we all know, elevated LDL cholesterol is a major risk factor for cardiovascular disease. It's a battle we fight daily in our clinics, and while medication plays a crucial role, we also recognize the power of dietary intervention. But let's be honest, the generic "low-fat" advice often feels underwhelming, both for us and our patients. 

While there is no single diet that is the gold-standard for lowering lipids, many of the recommended dietary patterns do have a few things in common:  

• Mostly plant-based
• Strong focus on fruits and vegetables
• Limit processed, packaged foods
• Limit intake of saturated and trans fats

You’re probably well-aware of the Mediterranean diet and DASH diet, consistently ranked as the best overall by US News. However, I want to discuss a lesser-known, but equally promising dietary pattern called The Portfolio Diet. The Portfolio Diet is a plant-based diet designed to lower blood cholesterol. It gets its name because it emphasizes a "portfolio" of various cholesterol-lowering foods and food components. Suggest your patient introduce one component at a time to their diet and build from there.

• Plant protein: 50 grams per day. Sources: soy milk, tofu, tempeh, edamame, lentils, beans.
• Nuts: 1 handful (about 23) or 45g per day. Sources: almonds, walnuts, pistachios, cashews.
• Viscous (sticky) Fiber: This is a specific type of soluble fiber that is particularly thick and sticky. It forms a more viscous gel than other soluble fibers, especially good for lowering cholesterol. It is recommended to have 2 servings of oatmeal, barley, beans, lentils and chickpeas, 5 servings of fruit (notably apples, oranges and berries) and vegetables (okra and eggplant) and to replace white bread with whole grain.
• Plant sterols: 2 grams per day. Sources: fortified foods like spreads, yogurt, and milk, or supplements.

While the portfolio diet offers a powerful approach to lowering cholesterol, it's important to remember that individual factors like genetics and metabolism can influence how effectively it works. The key is to focus on gradual, sustainable changes that limit saturated fat and added sugars and focus on fiber and nutrients from whole grains, vegetables, fruits, beans, and nuts.

When talking about cholesterol-lowering diets, the question of butter always comes up.

As science has emerged, we now know that people differ in their sensitivity to saturated fats and dietary cholesterol. Limited amounts of butter for some individuals may not increase CVD risk, while people who have higher LDL cholesterol to start, butter may elicit a stronger LDL-raising effect. Even in moderate amounts, butter has a more harmful effect on cholesterol compared to other unsaturated oils. This is because it increases the number of atherogenic ApoB particles, which are associated with plaque buildup in arteries, and leads to significant increases in LDL-cholesterol levels.

While butter can be enjoyed in moderation as part of a healthy diet, it's important to be mindful of its impact on cholesterol and choose healthier alternatives like olive oil or avocado oil more often.

 References: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.065551

https://pubmed.ncbi.nlm.nih.gov/29807048/

https://pubmed.ncbi.nlm.nih.gov/28251937/

https://pubmed.ncbi.nlm.nih.gov/30006369/

Your Questions, Answered

“Should I count my macros?"

This has become a widely popular saying among the fitness world. “Counting your macros” is just a trendy way to say counting calories, because essentially, that’s all you’re doing. In the most basic sense, it involves breaking down your total daily calorie needs into individual macronutrients which your body needs in order to function properly. There are 3 macronutrients: carbohydrates, protein and fats. How much of each macronutrient a person needs will vary based on their activity level, gender, weight, age and medical conditions.  

The macronutrients have been nicely broken down for us by The 2020-2025 Dietary Guidelines for Americans, which recommends that 45% to 65% of calories in an adult's diet come from carbohydrates, 20% to 35% from fat and 10% to 35% from protein. 

When calculating macros, there’s a 3 step process: 

1. Calculate the patients estimated calorie needs.
2. Break down their total calorie needs into calories for each macronutrient (using the percentage ranges from the dietary guidelines)
3. Calculate how many grams of each macronutrient they can consume 

Following a diet based on macros is not ideal for every patient and it is absolutely contraindicated for those with a history of an eating disorder or any current disordered eating. Also, it can be very time-consuming for you to do the calculations in the clinic. The major purpose of counting macros should be for your patient to learn how much they are currently eating versus how much their body actually needs. You can encourage your patients to use an online tracker like Cronometer, MyFitnessPal or LoseIt to determine the daily breakdown of protein, carbs, and fats and to help keep them accountable and honest with their macro intake. To learn more about macronutrients and how to do the complete calculation, check out Episode 36 How to Calculate and Count Macros. 

Submit your question HERE

I'll leave you with a quote from George Lorimer: “You’ve got to get up every morning with determination if you’re going to go to bed with satisfaction.” 

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Have a great week!