"The Portfolio Diet nicely illustrates that dietary change alone can dramatically lower cholesterol levels (as much as 30 percent) -- although it may be a diet that only the very motivated can follow for the long term," Messina says. "On the other hand, even partially following this type of diet will still result in a reduction in cholesterol and presumably, a reduced risk of coronary heart disease.
"Phytosterols, which markedly lower cholesterol, are part of the Portfolio Diet. Although the standard dose of phytosterols for the treatment of high cholesterol is 2g per day, an amount possible to consume only through supplements or enriched foods such as margarine, recent data indicate that phytosterol intake within the dietary range (150-350mg) is associated with lower cholesterol levels and lower risk of heart attack in men. Foods high in phytosterols include soybeans, soy oil, nuts."
And, believe it or not, margarine, corn chips and orange juice – at least some brands.
Cargill manufactures CoroWise plant sterols, which have found their way into several products as a cholesterol-lowering agent. "They have an FDA reduction of heart disease health claim and the method of doing that is by reducing LDL cholesterol," says Stauffer. "You can position it as a cholesterol-reducing product or as a heart-healthy kind of product. This broadens the scope of people who might be interested in buying the product, including boomers. The opportunity is to identify the applications that are going to best meet their lifestyle and taste preferences."
While many consumers do understand ingredients such as plant sterols, the food industry needs to do more education. "We do some targeted campaigns to reach consumers on the benefits. [We want] people to look for that CoroWise logo and trust that brand of plant sterols so they will go out and seek products that contain that ingredient specifically.
"We also do health care professional outreach, so that when they are counseling patients on opportunities to manage heart health and specifically to reduce cholesterol they also think of CoroWise and say, 'Oh it's in Minute Maid Heart Wise orange juice' or 'Its in Corazona's oatmeal squares.' We hope they would get down to recommending very specific products to meet the needs of their patients."
Getting back to the Portfolio Diet, one of its key ingredients is a reliance on soy foods as the major source of protein. Soy foods come in a wide variety of forms from traditional to modern so there are lots of options for even those consuming a fairly traditional Western diet.
"Soy foods not only provide high quality protein but were awarded a health claim for coronary heart disease in 1999 by the FDA based on the cholesterol-lowering effects of soy protein," Messina continues. "However, elevated cholesterol is just one risk factor for coronary heart disease and it is by no means the most important. Elevated blood pressure is major risk factor, and recent evidence indicates soy foods have a modest hypotensive effect.
"Interestingly, coronary heart disease mortality among women in Japan is one of the lowest in developed countries, much lower than in the U.S. And yet, traditional coronary heart disease risk factors – lipids (cholesterol), blood pressure, diabetes, smoking and early menopause – don't explain the difference between these two countries.
"It could be that soy foods, which are widely consumed in Japan, are a contributing factor since a recent study found that isoflavone-rich soy protein markedly reduced carotid intima media thickness (CIMT) in young postmenopausal women. CIMT refers to the thickness of the carotid artery (the arteries that supply the neck and brain with blood); the thicker the artery the more likely is a stroke or coronary event. This reduction in thickness is almost certainly due to the isoflavones in soybeans since isoflavones have been shown to improve endothelial function. The endothelial cells are the thin layer of cells that line the blood vessels. When the health of these cells is impaired coronary heart disease risk is increased."
Just as the baby boomers age and look for help in their diets, there appears to be innovation coming from food processors and their ingredient suppliers.
"That's the key," Mehta said, "you can have indulgent foods by controlling some ingredients and by sourcing the right grains and right ingredients, so you can have your cake and eat it, too."