each arm. All diets had equal calorie content.

The dietary portfolio provided 1.0 g of phytosterols (a soy bean derivative) per 1000 kcal; 9.8 g viscous fibers (as oat bran and oat products, barley, and psyllium seed) per 1000 kcal; 21.4 g soy protein per 1000 kcal; and 14 g (around 12 almonds) per 1000 kcal. A typical 2400 kcal diet would therefore provide 2.4 g phytosterols (2 tbsp Take Control or Benecol), 24 g viscous fiber, 51 g soy protein, and 34 g of almonds (around 34 almonds). Average fiber intake for participants was an impressive 78 g/day. (The average American takes in a meager 14 g/day.)

The control diet was also abundant in fiber at 57 g/day, but contained little of the viscous variety, as the primary fiber sources were whole wheat products which lack viscous fibers. The diet was otherwise very similar to the dietary portfolio in fat and cholesterol content, protein, and total calories.

The dietary portfolio achieved an impressive 28% reduction in LDL cholesterol. Unexpectedly, there was also a 30% reduction in C-reactive protein (CRP), a popular measure of inflammation. The results achieved with the dietary portfolio were virtually identical to the results obtained with lovastatin. The control diet achieved a paltry 8% reduction in LDL and a 10% reduction in CRP. Interestingly, a third of the participants in the dietary portfolio group reported that there was too much food (given the satiety-effect of fiber rich foods). This was the group that lost the most weight, though only a modest 1 lb.

Conclusion:

Dr. Jenkins’ portfolio of fiber-rich foods had the same effects on LDL cholesterol and CRP as a moderate dose of lovastatin. This is quite remarkable, given the relative failure of the diets usually prescribed to improve cholesterol values. Conventional diets, in fact, have been so ineffective that some physicians have abandoned the use of dietary recommendations in their practices.

The fiber-rich foods used in the

dietary portfolio are readily available and inexpensive. Though the specific components used in the study have each been shown to lower LDL cholesterol when used independently, the combination has not been examined. Many would likely have predicted that, in view of the similar mechanisms of LDL-reduction among the various components of the portfolio, the LDL lowering effect would not exceed 15%. (Soy protein is the only component with a significantly different mechanism of action—suppression of liver synthesis of cholesterol.)

Instead, this powerful combination achieved an impressive 28% reduction, as good as the prescription agent lovastatin. (In our experience with this approach, LDL cholesterol typically drops 30 to 50 points, sometimes more.)

The high-fiber approach of the dietary portfolio significantly exceeds the fiber intake of the average American. As a practical matter, people who elect to follow this program should introduce each component gradually and drink plentiful water, as constipation can result if hydration in inadequate.

To reproduce the LDL and CRP benefits of the dietary portfolio, a practical combination would be:

• Oat bran—1/4 cup (uncooked) + 3 tsp psyllium seed
• Soy protein powder—6 tbsp/day
• Almonds—34 or approximately 2 handfuls/day
• Take Control or Benecol 2 tbsp/day

Jenkins DJA, Kendall CWC, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs. lovastatin on serum lipids and c-reactive protein. JAMA. 2003 290:502-10.

William Davis, MD is a practicing cardiologist, author and lecturer. He is author of the book, Track Your Plaque: The only heart disease prevention program that shows you how to use the new CT heart scans to detect, track, and control coronary plaque. He is author of the soon-to-be released new book, What Does My Heart Scan Show?, available by May, 2005 at http://www.trackyourplaque.com