When Tofu Isn’t a Statin

People love to say “food is medicine.” Some even claim Hippocrates himself said it. But here’s the thing: he didn’t. The phrase does not appear in any of his surviving writings. In fact, historians believe the line was created centuries later and then falsely attached to Hippocrates to give it weight.

Still, the idea persists. Even the current head of HHS, Robert F. Kennedy Jr., has repeated the myth. And when RFK Jr. is your fact-checker, you know you’re in trouble.

Now, as someone certified in Culinary Medicine, I believe food is incredibly powerful. Eating the right foods can prevent disease, improve health, and help you live longer. However, food alone rarely works as well as actual medicine. That is especially true when it comes to cholesterol.

The Portfolio Diet

In the early 2000s, Dr. David Jenkins and his team introduced what they called the Portfolio Diet. Instead of focusing on one “superfood,” the diet combines several cholesterol-lowering foods:

• Soy protein
• Nuts, like almonds
• Viscous fibers from oats, barley, or psyllium
• Plant sterols from fortified foods

Each one has a small effect. But when you put them together, the benefits add up.

Why does it work? Cholesterol gets secreted by your liver into bile, then travels into your gut. Normally, most of that cholesterol is reabsorbed into your bloodstream. But fiber and plant sterols bind to cholesterol and drag it out of your body. That’s why bowel movements are brown—bile is brown, and fiber helps carry it out. More fiber means you feed your gut bacteria and flush away cholesterol. It really is a win-win.

What the Studies Show

The Portfolio Diet has been tested in multiple clinical trials. In one JAMA study, people who followed the diet lowered their LDL cholesterol by about 13 to 14 percent over six months. That translated to a drop of about 24–26 mg/dL.

Other studies show that people who stick with it can lower their LDL by 17 percent on average. Some who were especially diligent saw drops of more than 20 percent at one year. The Portfolio Diet also improves non-HDL cholesterol, apolipoprotein B, and long-term risk for heart disease.

So yes—it works. In fact, the effect is similar to what you get from early statins like lovastatin.

What It Looks Like in Real Life

The science sounds great. But how do you actually eat this way? Here’s one example day:

• Breakfast: Oatmeal made with soy milk
• Snack: A handful of almonds (about 25–30 grams)
• Lunch: Lentil soup with whole-grain bread
• Dinner: Tofu stir-fry with vegetables and barley
• Extra: Two grams of plant sterols, often from fortified margarine spreads

That daily pattern gives you soy protein, fiber, nuts, and plant sterols. But here’s the challenge: it takes careful planning to hit the right doses every day. It’s not impossible—but it is hard to sustain.

How It Differs from the Mediterranean Diet

Many people confuse the Portfolio Diet with the Mediterranean Diet. Both are plant-forward, emphasize nuts, legumes, whole grains, and lower cardiovascular risk. However, the Mediterranean Diet is broader and easier to follow. It includes olive oil, fish, fruits, vegetables, and even moderate wine.

The Portfolio Diet, on the other hand, is very prescriptive. You must hit specific amounts of soy protein, fiber, and sterols daily. Think of the Mediterranean Diet as the entire restaurant, while the Portfolio Diet is just one corner of the menu—focused squarely on cholesterol.

What About Statins?

Statins are still the gold standard. Modern statins like atorvastatin or rosuvastatin lower LDL cholesterol by 30 to 50 percent, far more than diet alone. More importantly, they reduce heart attacks and strokes by 25 to 40 percent.

And there’s more. When you combine a statin with Zetia (ezetimibe), which blocks cholesterol absorption in the gut, you can see another 20 percent reduction in LDL. That’s essentially the pharmaceutical version of the Portfolio Diet. Together, statins plus Zetia can lower LDL cholesterol by 65 to 70 percent.

The Bottom Line

The Portfolio Diet lowers cholesterol. The Mediterranean Diet improves heart health. Both are excellent for prevention and long-term wellness. But when your cholesterol is high or your risk is significant, medicine is usually necessary.

The best approach is not “food or medicine.” It’s food and medicine. Eat Mediterranean, fold in Portfolio Diet elements, and—if your doctor recommends it—add a statin or Zetia.

Because food lays the foundation. Medicine builds the house. And together, they keep the roof from caving in.

REFS

1. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-Analysis of Controlled Trials.

Chiavaroli L, Nishi SK, Khan TA, et al.

Progress in Cardiovascular Diseases. 2018 May - Jun;61(1):43-53. doi:10.1016/j.pcad.2018.05.004.

2. Effect of a Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia: A Randomized Controlled Trial.

Jenkins DJ, Jones PJ, Lamarche B, et al.

JAMA. 2011;306(8):831-9. doi:10.1001/jama.2011.1202.

3. Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study.

Glenn AJ, Lo K, Jenkins DJA, et al.Journal of the American Heart Association. 2021;10(16):e021515. doi:10.1161/JAHA.121.021515.

4. Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies.

Glenn AJ, Guasch-Ferré M, Malik VS, et al.Circulation. 2023;148(22):1750-1763. doi:10.1161/CIRCULATIONAHA.123.065551.

5. The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: A Prospective Cohort Study.

Kavanagh ME, Zurbau A, Glenn AJ, et al.

BMC Medicine. 2025;23(1):287. doi:10.1186/s12916-025-04067-1.