The Portfolio Diet for Cardiovascular Disease Risk Reduction

An Evidence Based Approach to Lower Cholesterol through Plant Food Consumption

Wendy Jenkins, Amy Jenkins, Alexandra Jenkins, Caroline Brydson

• Publisher: Academic Press
• Year: 2019
• ISBN:
  9780128105115
• Topic: Medicine
• Subtopic: Cardiology

The Portfolio Diet for Cardiovascular Disease Risk Reduction: An Evidence Based Approach to Lower Cholesterol through Plant Food Consumption examines the science of this recommended dietary approach to reduce cholesterol in addition to other risk factors for cardiovascular disease. With a thorough examination into the scientific rationale for the use of this diet, discussions are included on the experimental findings both for the diet as a whole, and its four principle food components: nuts and seeds, plant based protein, viscous fibers, and plant-sterol-enriched foods. Environmental and ethical considerations of the diet are also discussed, showing the ramifications of food choice on health and beyond. Referenced with data from the latest relevant publications and enhanced with practical details (including tips, dishes, and menus), the reader is enabled to meet the goals of cholesterol lowering and cardiovascular disease risk reduction while also taking the health of the planet into consideration.

• Provides the scientific basis for the selection of the foods included in the Dietary Portfolio and the experimental evidence demonstrating cholesterol lowering and cardiovascular risk factor reduction
• Provides an understanding of the current guidelines for lowering cholesterol and other risk factors of cardiovascular disease, explaining how the Dietary Portfolio effects these components and compares to other diet based approaches
• Provides a holistic view of the Dietary Portfolio by investigating issues of sustainability and ethics in the food system
• Allows readers to acquire the skills to successfully construct a potent cholesterol-lowering diet
• Includes tips, recipes and meal planning aids

Chapter 1

The Power of Diet in CVD Risk Factor Reduction

Abstract

This chapter investigates how factors like body-weight, blood pressure, and blood lipid levels can contribute to the developof cardiovascular disease (CVD) and what qualifies an individual to be at risk. These factors were chosen as the focus of this chapter due to their extensive association with CVD. The effectiveness of the Portfolio diet in reducing these risk factors, is compared to other diets, including The Mediterranean diet, the Okinawan diet, the Nordic diet, a low glycemic index (GI) diet the Dietary Approaches to Stop Hypertension (DASH) diet. Many of these diets were developed to mimic the traditional diets of populations known to have low levels of these risk factors and the incidence of CVD. In contrast, the Portfolio diet was developed by combining components known to individually reduce the risk of CVD and situating them in the context of a healthy eating pattern. These compoinclude nuts, viscous fiber, plant sterols, and soy protein. When combined the effect on risk factor reduction is much greater than any component individually. As some of these components are also found in the other diets which we discussed, this chapter reviews the overlap in risk reduction with other evidence-based diets.

Keywords

Dietary patterns; DASH diet; Mediterranean diet; Low glycemic index; Atkins; Eco-Atkins; Nordic diet; Okinawan diet; Ornish diet; Portfolio diet; Pritikin; Vegetarian diet; Vegan diet; Plant-based diet; The zone; Blood pressure; LDL cholesterol; HDL cholesterol; C-reactive protein; Apolipoprotein; BMI; Weight loss; Statins; Coronary heart disease; Cardiovascular disease

Introduction

Cardiovascular disease (CVD) is the number one cause of death globally. The term CVD covers a range of conditions affecting the heart, but is primarily used to describe conditions that result in narrowed or blocked blood vessels, which can lead to heart attack, stroke, and angina (chronic chest pain). Many forms of heart disease are largely preventable and improved with diet and lifestyle changes. As a result, a number of evidence-based diets have been designed to target CVD. One such diet is The Dietary Portfolio, others include: The Mediterranean diet, the Okinawan diet, the Nordic diet, a low glycemic index (GI) diet, the Dietary Approach to Stop Hypertension (DASH) diet, Atkins, and Eco-Atkins. Most of these diets were developed to mimic the traditional diets of populations known to have low levels of CVD risk factors and incidence of CVD. In contrast, the Portfolio diet deconstructed this approach, combining food components known to individually reduce the risk of CVD and situating them in the context of a healthy eating pattern. By combining foods known to lower CVD risk factors, their effect, on lowering blood lipids, was maximized. As the Portfolio diet includes key components from other diets, there are similarities in terms of its effects on CVD risk factors with other evidence-based diets. This chapter will discuss the similarities and differences between evidence-based diets and how these relate to their effects on three CVD risk factors: body weight, blood pressure, and blood lipids. A summary of the following discussion on risk factors addressed by evidence based diets can be found in Table 1.1. This chapter will also give an overview of each these risk factors for those wishing to gain a more thorough understanding of their importance and relevance.

Table 1.1

Comparison of Dietary Patterns and Main Components

Diet	CVD-Related Target	Key Components of Dietary Pattern
Low Carb diet	WL	Atkins [1] – Carbohydrate < 20% of total energy intake, high in animal products, high in fat. Eco-Atkins [2] – Increased protein and fat from gluten and soy products, nuts, and vegetable oils.
DASH[3]	BP	– High in low fat fermented dairy products, vegetables, whole grains, poultry, fish, and nuts. – Low consumption of red meat recommended. Omni heart variations [4]: – 10% of carbohydrate derived energy replaced with mostly plant-based sources of protein. – 10% of carbohydrate derived energy replaced with unsaturated fats (mainly monounsaturated).
Low Glycemic Index Diet[5]	BL, WL	– No specified portion sizes or optimal calories specified. Relies on consumer constructed plan based on GI/GL values of foods. – Typically high in plant-based foods and whole grains. – The Zone, Sugar Buster and the Slow Carb Diet are all based off this diet and contain more specific parameters.
Mediterranean [6,7]	Overall CVD	– High in fresh fruits, vegetables, whole grains, fatty fish, nuts, plant-based oils, and margarine. – Low in red meat.
Nordic[8]	Overall CVD	– Including oily fish (salmon and mackerel), vegetables, roots, legumes, fruits, berries, and wholegrain cereals (oat, rye, and barley).
Okinawan[9]	BP	– Traditional diet rich in fish, seaweed, soybean products, vegetables, and green tea.
Ornish[10]	Overall CVD	– Vegetarian, high fiber and low fat diet.
Portfolio Diet[11]	BL	– High in whole grains, legumes, plant sterols (plant based oils), nuts, viscous fiber foods (barley, okra, psyllium), berries and soy.
Pritikin[12]	Overall CVD	– Low fat, emphasis on complex carbohydrates: less than 10% of calories from fat, 10%–15% from protein and 75%–80% complex carbohydrates. – Added exercise component.
Vegetarian[13]	BP, BL	– High in fruits and vegetables, legumes, nuts, whole grains, moderate amounts of dairy and eggs.
Zone[14]	GH	– Based on macronutrient distribution, with heavy emphasis on protein. Each daily meal consists of: 30% protein, 40% carbohydrates, 30% fats.

WL, weight loss; BP, blood pressure; CVD, cardio vascular disease; BL, blood lipids; GH, general health; NA, not applicable; GI, glycemic index; GL, glycemic load.

Key points:

Weight

• ● Low-carbohydrate diets like Atkins may negatively affect CVD risk in the long run once the benefits of weight-loss have plateaued as low-density lipoprotein cholesterol (LDL-C) levels remain high.
  • ● Eco-Atkins, a high protein, plant-based variation of the Atkins diet, resulted in reductions in both waistlines and LDL-C.
• ● Both a low GI diet and the Portfolio diet have been observed to reduce body weight over the long term.

Blood pressure

• ● Significant reductions in blood pressure (BP) were observed for the DASH diet, the Vegetarian diet, the Portfolio diet, and the Mediterranean diet, likely due to the high consumption of fruits and vegetables common to these diets.

Blood lipids

• ● LDL-C reductions are seen in the Portfolio, Nordic, Mediterranean, DASH, and Low GI diet.
• ● There is strong evidence for the benefits of reducing LDL-C irrespective of baseline LDL-C levels.
• ● LDL-C: HDL-C (low-density lipoprotein: ...