Introduction
What is the Portfolio Diet?
Supporting Evidence
How Does it Work?
Real-World Applications
Who Should Consider It?
Limitations and Considerations
Conclusions
References
Discover how the Portfolio Diet leverages plant-based foods to deliver clinically proven reductions in LDL cholesterol and cardiovascular risk, offering a potent alternative to medication for heart health.
Image Credit: Chiociolla / Shutterstock.com
Introduction
Cardiovascular disease (CVD) is the leading cause of death globally, as it is responsible for nearly 18 million lives each year. Statins have historically been the primary pharmacologic treatment for reducing LDL cholesterol, which is a major contributing factor in CVD risk. However, growing evidence suggests that certain diets can achieve similar effects without the need for medication.
One powerful and evidence-based approach that consistently reduces the risk of CVD is the Portfolio Diet. This plant-based eating pattern significantly reduces LDL cholesterol, while also improving other markers of cardiometabolic health.1 The Portfolio Diet combines four specific food components, each proven to lower cholesterol, into a "portfolio" of heart-healthy eating.
What is the Portfolio Diet?
The Portfolio Diet was originally developed by Dr. David Jenkins and colleagues at the University of Toronto in the early 2000s as a dietary strategy to lower LDL cholesterol by combining several cholesterol-lowering foods. Unlike general healthy eating guidelines, the Portfolio Diet is therapeutic and targets LDL cholesterol reduction through a multi-factorial approach.1
The Portfolio Diet builds upon a foundation of low-saturated-fat and low-cholesterol diets, similar to the National Cholesterol Education Program Step II diet, and augments it with four key components: soluble fiber, plant sterols, soy protein, and nuts. Each of these elements is associated with specific lipid-lowering properties, and their combination yields synergistic effects.1
Soluble fiber binds to bile acids and cholesterol in the gut, thereby promoting their excretion and lowering circulating LDL cholesterol levels. Good sources of soluble fiber include oats, barley, legumes, psyllium, eggplant, okra, apples, and citrus fruits.1
Plant sterols, which are naturally present in fruits, vegetables, nuts, and seeds, reduce the intestinal absorption of cholesterol. Fortified foods, such as spreads or juices, typically provide the recommended daily dose of two grams for clinical impact.1
Soy protein derived from tofu, soy milk, tempeh, and legumes has been shown to modestly lower LDL cholesterol levels, particularly when used as a replacement for animal-based proteins.1,2
Nuts, especially tree nuts like almonds and walnuts, are rich in healthy fats, fiber, and phytochemicals. Regular consumption of nuts can improve lipid profiles by reducing LDL cholesterol and enhancing endothelial function.1
Image Credit: Shutterstock AI Generator / Shutterstock.com
Plant-based monounsaturated fats (MUFAs), such as those found in olive oil and avocados, have also been incorporated into updated versions of the Portfolio Diet due to their benefits on lipid profiles.4 However, the foundational concept of this diet remains the integration of targeted food-based interventions into a cohesive and evidence-based dietary plan.
Supporting Evidence
The effectiveness of the Portfolio Diet has been consistently demonstrated in randomized controlled trials and meta-analyses. In one key systematic review, adherence to the Portfolio Diet resulted in an average LDL cholesterol reduction of 17%. In fact, some studies have reported LDL reductions of up to 30% associated with this diet, with these levels comparable to those achieved with first-line statin treatment in individuals with mild to moderate hyperlipidemia.2
A recent analysis reported that high adherence to the Portfolio Diet Score (PDS) was associated with a significantly lower risk of cardiovascular disease, coronary heart disease, and stroke across three large U.S. cohorts. This association remained consistent, even after adjusting for lifestyle and dietary confounding factors.4
In young adults, adherence to the Portfolio Diet has correlated with low LDL cholesterol levels, as well as improved blood pressure, body weight, and triglyceride levels. Modeling suggests that partial or full adherence to the diet could delay the onset of cardiovascular risk by up to 13 years.3
These findings highlight the robust effectiveness of the Portfolio Diet and support current clinical guidelines from the American Heart Association and Diabetes Canada, which recommend this diet as a viable first-line dietary approach for lipid management.4
Lower Your Cholesterol With THESE Foods | Dr. David Jenkins | The Proof Podcast EP 216
How Does it Work?
The strength of the Portfolio Diet is attributed to its synergistic mechanism of action, as each dietary component targets cholesterol metabolism distinctly. Soluble fiber, for example, binds cholesterol in the gut, thereby reducing its reabsorption. Compared to plant sterols, dietary and biliary cholesterol compete for absorption in the intestine, thereby lowering serum levels.1,5
Soy protein appears to influence hepatic cholesterol metabolism to reduce its synthesis, whereas nuts provide bioactive compounds and unsaturated fats that modulate lipid metabolism and inflammation.1,2
Real-World Applications
Although clinical trials are tightly controlled, the Portfolio Diet can be implemented in the real world through simple steps, such as replacing cow’s milk with soy milk or fortified plant-based alternatives, adding legumes to salads, soups, and entrees, and snacking on almonds or walnuts.
The Portfolio Diet is primarily plant-based; however, it can be adapted to various eating styles, including vegetarian and semi-vegetarian diets. Furthermore, the Portfolio Diet does not entirely exclude fish, dairy, or poultry, thus making it accessible to a broad audience.
Digital tools, such as the PortfolioDiet app, have also been developed to help users self-monitor their adherence using simplified scoring systems, thereby aiding behavioral changes in both clinical and community settings.6
Who Should Consider It?
The Portfolio Diet is particularly beneficial for individuals with high LDL or total cholesterol levels, as well as those with a family history of heart disease. Individuals who prefer diet-based interventions before initiating statin therapy can also consider the Portfolio Diet.
The risks of conditions like metabolic syndrome or type 2 diabetes can also be addressed through the Portfolio Diet. This diet may also be ideal for individuals seeking a structured yet flexible eating pattern supported by scientific evidence.
Notably, several studies have reported that even partial adherence to the Portfolio Diet can yield meaningful health benefits.4
Limitations and Considerations
Finding products with adequate plant sterol content requires attentiveness, as these are often fortified. Furthermore, some components, such as enriched margarine or soy-based foods, may not be readily available in all regions.
Although the Portfolio Diet significantly lowers LDL cholesterol, it should not be considered as a comprehensive solution. Optimal cardiovascular health is best achieved when combined with regular physical activity, smoking cessation, and the management of other risk factors, such as blood pressure and glucose levels.
Conclusions
The Portfolio Diet is a scientifically validated dietary approach that lowers LDL cholesterol levels and improves cardiovascular risk profiles. Although it requires thoughtful planning, the potential of this diet to delay or prevent cardiovascular disease is significant.
As dietary interventions continue to gain traction in clinical practice, the Portfolio Diet underscores the pivotal role that food-based strategies can play in promoting heart health.
References
- Jenkins, D. J., Josse, A. R., Wong, J. M., Nguyen, T. H., & Kendall, C. W. (2007). The portfolio diet for cardiovascular risk reduction. Current Atherosclerosis Reports, 9(6), 501–507. DOI:10.1007/s11883-007-0067-7, https://link.springer.com/article/10.1007/s11883-007-0067-7
- Chiavaroli, L., Nishi, S. K., Khan, T. A., Braunstein, C. R., Glenn, A. J., Mejia, S. B., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Jenkins, D. J. A., Kendall, C. W. C., & Sievenpiper, J. L. (2018). Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Progress in Cardiovascular Diseases, 61(1), 43–53. DOI:10.1016/j.pcad.2018.05.004, https://www.sciencedirect.com/science/article/pii/S003306201830094X?via%3Dihub
- Chen, V., Chiavaroli, L., Glenn, A. J., Kavanagh, M. E., Zeitoun, T., Mahdavi, S., Kendall, C. W. C., Jenkins, D. J. A., El-Sohemy, A., & Sievenpiper, J. L. (2025). Portfolio diet and LDL-C in a young, multiethnic cohort: cross-sectional analyses with cumulative exposure modeling. BMC Public Health, 25(1), 1761. DOI:10.1186/s12889-025-22479-9, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-22479-9
- Glenn, A. J., Li, J., Lo, K., Jenkins, D. J. A., Boucher, B. A., Hanley, A. J., Kendall, C. W. C., Shadyab, A. H., Tinker, L. F., Chessler, S. D., Howard, B. V., Liu, S., & Sievenpiper, J. L. (2023). The Portfolio Diet and Incident Type 2 Diabetes: Findings From the Women's Health Initiative Prospective Cohort Study. Diabetes Care, 46(1), 28–37. DOI:10.2337/dc22-1029, https://diabetesjournals.org/care/article/46/1/28/147679/The-Portfolio-Diet-and-Incident-Type-2-Diabetes
- Glenn, A. J., Boucher, B. A., Kavcic, C. C., Khan, T. A., Paquette, M., Kendall, C. W. C., Hanley, A. J., Jenkins, D. J. A., & Sievenpiper, J. L. (2021). Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire. Nutrients, 13(8), 2850. DOI:10.3390/nu13082850, https://www.mdpi.com/2072-6643/13/8/2850
- Kavanagh, M. E., Glenn, A. J., Chiavaroli, L., Morgan, G. A., Josse, R. G., Malik, V. S., Marinangeli, C. P. F., Kendall, C. W. C., Jenkins, D. J. A., & Sievenpiper, J. L. (2024). Simulation model to assess the validity of the clinical portfolio diet score used in the PortfolioDiet.app for dietary self-tracking: a secondary analysis of a randomized controlled trial in hyperlipidemic adults. Frontiers in Nutrition, 11, 1398450. DOI:10.3389/fnut.2024.1398450, https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1398450/full