The scientific literature provides a basis for understanding the impact of food and food constituents on cholesterol levels and heart disease risk. Based on this science, the National Heart Lung and Blood Institute Adult Treatment Panel III guidelines describe a heart-healthy diet as one that is moderate in total fat (25-35% of calories), low in saturated fat (7% or less of calories), low in cholesterol (200 mg or less), and emphasizes foods such as whole grains, fruit and vegetables. Since the inception of the health claims process in the United States, the Food and Drug Administration (FDA) has approved health claims for the reduced risk of cardiovascular disease and certain foods or food components such as soy, beta-glucan and psyllium, nuts and stanols/sterols. For example, the FDA approved the following qualified health claim on the heart-healthy impact of nuts:
Scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, such as almonds, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.1
On their own, each of these components is often described as heart healthy. So the University of Toronto team asked themselves, “What would happen if you added these components together in a diet low in saturated fat and cholesterol?” Their hypothesis, based on the body of literature, was that there would be a synergistic and additive effect on cholesterol levels. Armed with this hypothesis, the team entered Phase 1 of the Portfolio Eating Plan. The Portfolio Eating Plan is a dietary approach to managing cholesterol levels. The test diet is a National Cholesterol Education Program Step 2 diet (saturated fat less than 7% of calories; less than 200mg cholesterol) plus:
- Viscous Fiber: ~20g/d
- oats, barley, psyllium, legumes, eggplant, okra
- Vegetable Protein: ~80g/d (half from soy)
- soy, beans, chick peas, lentils
- Plant Sterols: ~2g/d
- plant sterol margarine (1g/1000kcal)
- Almonds: ~30g/d
1. One serving of almonds (28g) has 13g of unsaturated fat and only 1g of saturated fat.
