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Heart of the matter

Out of all the things likely to shorten our lives in the UK, coronary heart disease is the most likely. It is believed that almost 80 per cent of adults have total cholesterol levels above the ideal and that raised cholesterol and fats in the blood are responsible for well over half the deaths caused by the disease.

Lowering cholesterol levels has become a big focus of the NHS, and the mass prescription of a group of cholesterol-lowering drugs known as statins is underway to those whose cholesterol levels register as “high” in routine GP tests. Statins work by blocking enzymes that play a key role in the production of cholesterol in your liver.

About three million of us are knocking back statins daily, millions more are being offered them and there is a proposal that these drugs should ultimately be offered to all men over 50 and women from the age of 60. Fat-busting drugs are the most costly class of drugs to the NHS and there has been a 17-fold increase in their prescription since 1997.

Which poses the question, is there an alternative? For some people the answer is “no”. If, for instance, you have an inherited form of raised cholesterol, have had a heart attack or stroke, have diabetes or raised blood pressure, you should do as your doctor tells you and take your medicine.

Some doctors argue that patients are more willing to pop a pill once a day than to change their diet. But for those who prefer not to take the pharmaceutical route, the outlook is brighter because recent studies have suggested that including a “portfolio” of certain foods — a portfolio diet — can help to lower cholesterol by up to 30 per cent, a result which reflects the achievement of statins.

FOLLOW THE PORTFOLIO DIET
Armed with this information, I worked on Heart of the Matter, a piece for the Tonight With Trevor McDonald programme, on ITV1, to test the portfolio eating plan on three people from Huddersfield, one of the country’s worst hot-spots for raised cholesterol levels.


One of the most recent and relevant studies into the portfolio diet was published in the American Journal of Clinical Nutrition and builds on evidence gleaned from previous tightly controlled clinical studies. In it, researchers from the University of Toronto revealed how people following what has become known as the portfolio eating plan for a full year in the real world, achieved some remarkable results.


Over a 12-month period, 55 middle-aged men and women were asked to follow a diet containing daily quotas of almonds; substances known as plant sterols, most of which came from fortified margarines (such as Benecol or Flora Pro-Activ); soy protein from foods such as tofu and soy milk; and soluble fibre in porridge, fruits and veg.


The guinea-pigs, armed with their list, selected and prepared foods to fit in with their normal routines. After one year, a third of them had achieved a statin-like effect from the portfolio eating plan, lowering their cholesterol levels by 20 per cent or more. Most of them included fish and lean meats in their diet. Another third that tended to follow the eating plan less strictly achieved an average 15 per cent LDL cholesterol — so-called “bad” cholesterol — reduction. Those that had the least compliance lowered their cholesterol an average of 10 per cent.


And so I set off to Huddersfield to perform a UK test of the portfolio diet. Given a similar set of instructions, and told to avoid foods that contained saturated fats, such as burgers, Allan Butters, 38, a campus support officer at the University of Huddersfield; Kerena McEvoy-Ives, 31, a hairdresser, and Russ Hayden, 51, an engineer, took on the challenge. All tried to increase their exercise as well by attempting to walk 10,000 steps daily.


After only four weeks, Allan and Kerena’s cholesterol levels fell by more than 30 per cent. Allan’s total cholesterol fell from 6.34 to 4.6 milli-moles per litre (mmol/l), bringing him under the 5mmol/l threshold, with his risk of a heart attack in the next 10 years falling from 18 per cent to 8 per cent. Kerena brought her cholesterol down from 6.38mmol/l to 4.3, while Russ lowered his chances of a heart attack or stroke from one in three in the next 10 years to one in five.


No one is claiming that the portfolio diet is the answer to all cholesterol problems. However, if your GP diagnoses high cholesterol and gives you the all-clear to try this diet, you may well find yourself leaving the surgery with a shopping list of groceries rather than a prescription. You might also soon discover the added benefits of following a regimen — weight loss and a huge improvement in general intake of vitamins, minerals and supernutrients, improving your quality of life still further.

STOCK A NUTRITIOUS LARDER
Here is a list of foods, each with their own cholesterol-lowering capabilities, to eat every day

Almonds 30g (a handful or about 23 whole almonds): Great for antioxidants, fibre and monounsaturated fat.
Soluble fibre: You need to get 20g of soluble fibre a day. You can get this amount by eating all the following food: a grapefruit, a big bowl of porridge with prunes, an apple and a pear, some baked beans, a baked sweet potato and a serving of broccoli. Soluble fibre appears to carry some excess cholesterol out of the body in stools.
Plant stanols and sterols: 2g, found in about two servings of Benecol or Flora Pro-Activ products each day. Stanols and sterols work in a similar way to soluble fibre.
Soya protein: 25g-plus of this is equivalent to three to four servings of soy-based foods, such as soy milk and yoghurt, tofu, soya beans or soya burgers. The protein appears to help reduce cholesterol being made in your liver.
In addition to these foods it is really good to eat oily fish such as salmon, mackerel, sardines, pilchards, anchovies, eel and fresh tuna at least twice a week. They are rich in omega 3 oils, which appear to help raise levels of “good” cholesterol, improve artery health and help to keep blood flowing smoothly.

What to avoid

As in any healthy eating plan, avoid food rich in saturated fats, such as fatty cuts of meat, meat pies, burgers and sausages, full-fat dairy foods, most cakes.

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