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.

>> Dr. Terry Simpson: You've probably heard the phrase, food is

medicine. It sounds good, right? Ancient

wisdom, supposedly from Hippocrates, the father of

medicine. Except here's the problem.

Hippocrates never said it. Not once.

It is not in any of the surviving writings. Zero

evidence. Chances are someone a couple hundred years

ago just slapped his name on it to give their

idea more weight. And even Robert F.

Kennedy, Jr. The chief grifter currently running

Health and Human Services, quoted it as

well. If RFK Jr. Is your historical reference,

you're already in trouble. But the phrase stuck,

and people cling to it like it is carved in marble. And

as someone who's certified in culinary medicine, you

might think I'd be all in on that idea. And sometimes

I am. But food isn't the cure for everything.

And let me be clear. Food is one of the

most empowering tools we have. And

I absolutely prescribe food for

patients. The right food can prevent, slow, and sometimes

even reverse some, but not all, chronic diseases.

But here's the catch. While tofu, tempeh,

almonds, and oats are fantastic, they're not going to

replace your pharmacy.

Which brings us to today's episode,

the Portfolio Diet and why Tofu

isn't a Statin.

I am your Chief Medical Explanationist, Dr. Terry

Simpson, and this is Fork U Fork

University, where we make sense of the madness,

bust a few myths, and teach you a little bit about food

and medicine.

The Portfolio Diet was designed by Dr.

David Jenkins, the same scientist who gave us

the glycemic H index. The idea

is simple. Combine a portfolio of foods that each

lower cholesterol just a little, like

nuts. Plant proteins like soy.

Viscous fiber like oats, barley, psyllium.

Plant sterols from fortified foods. Together,

they act on cholesterol recycling through what's called the

enterohepatic circulation. Okay, here's

how that works. Your liver makes cholesterol,

it packages it into bile and and sends it

down into your gut through your common bile duct.

Normally, most of that bile and the cholesterol in it gets

reabsorbed back into your bloodstream. But when

you eat viscous fiber and plant sterols,

those foods bind to the cholesterol and carry it out

of your body. That's one of the reasons your bowel movements are

brown. Bile is brown. And when fiber

catches it and drags it out, you flush away

some of the cholesterol with it. It's a win win. You feed

your gut microbes and you keep cholesterol from sneaking

back into circulation. The issue is

can you stick to eating that much fiber every

single day? That's the rub. It's a

lot easier just to take Crestor like I do.

There's some clinical data and here's where it gets

impressive. The portfolio diet

isn't just theory. It's been tested.

A randomized control trial published in the Journal of the American

Medical association compared the portfolio diet against

standard low saturated fat diets in patients with high

cholesterol. And here's what they found. If your starting

LDL was about 171 with the

portfolio diet, LDL dropped by

about 13 or 14%, or about 24 to

26 milligrams per deciliter over six months.

In the most adherent patients,

the reductions exceeded 20%

at one year. Now this wasn't a one off.

Multiple meta analysis and systematic reviews

confirm these results showing that mean LDL, which

is the bad cholesterol reduction of about

17%. The portfolio diet also

improved other cardiometabolic risk Factors including

non HDL cholesterol, apolipoprotein

D and the estimated 10 year coronary

heart disease risk. So yes, the

portfolio diet works. It is

especially true in the most motivated adherent patients.

The LDL reduction is actually comparable to first

generation statins like lovastatin.

But let's make this real. What does it take to

get those results? So here's a day in the life of the

portfolio diet. Breakfast bowl of

oatmeal made with soy milk that gives you viscous fiber and

soy protein. One Shot Snack handful of

almonds, about 25 or 30 grams. Not Trail

mix, which I love. The candy coated

stuff. Nope, this is just plain almonds. Lunch A cup of

lentil soup, maybe with a slice of whole grain bread.

More fiber, more plant protein. Dinner

Tofu stir fry with vegetables and barley on the side.

That's more soy, more viscous fiber. Somewhere in

the day you'll need plant sterols, usually in the form of a margarine

spread, about 2 grams worth. That's how you

hit the therapeutic doses. Soy protein,

viscous fiber, nuts and sterols every day

consistently. And that's the challenge. It

takes planning and honestly, it takes

motivation. It's not impossible, but it's

harder than taking medicine.

Now you might be thinking, wait a minute, isn't this basically the

Mediterranean diet? And the answer is kind of

both diets are plant forward, emphasize nuts, legumes,

whole grains and fiber. Both lower LDL cholesterol, both

reduce cardiovascular risk, but they are not

identical. The Mediterranean diet is a broader

lifestyle pattern. It has olive oil, fish, vegetables,

legumes, limited red meat. It's flexible, delicious,

and a lot more embedded in most of our cultures. The

portfolio diet is more prescriptive.

You need specific amounts of soy protein,

viscous fiber, almonds, and plant

siderols every single day. It's less about

lifestyle and more about hitting cholesterol with targeted

foods. If the Mediterranean diet is the whole restaurant,

olive oil, fish, vegetables, joy, the

portfolio diet is just the cholesterol lowering section

of the menu. You can actually fit the portfolio diet

in the Mediterranean framework. And when you do, you'll probably get the

best of both worlds and maybe a lot of

sadness. But now let's

continue. Let's, let's do some comparison. Let's go to the

world of pharmacy. Let's take statins like atorvastatin

or rosuvastatin, which is Crestor, the medicine. I take

those two typically lower LDL by

double that amount, 30 to 50%. That's

double or sometimes triple what you get on the portfolio diet.

And they don't just change cholesterol numbers.

They reduce heart attacks and strokes by 25 to

40%. And here's the kicker.

When you add zdia, also known as

ezetimide, it also, it's another drug. It

blocks cholesterol absorption in the gut. So

that's basically the portfolio diet on high

octane. On its own, ZD can lower

LDL by about 15 or 20%, similar to the diet.

But when you combine zdia with a statin, LDL

drops another 20% on top of what the statin does.

So a statin alone might give you a 50% reduction in

LDL. At Zetia, you're at 65 or 70%. That's

massive and far more consistent than anyone can

manage with oatmeal and tofu alone. Let me give you a real life

example. Me, I have familial

hypercholesterolemia. My father had a heart

attack when he was 55. My brother had a heart attack

at age 50. I have high cholesterol.

My LDL, the bad cholesterol, runs at about

190 if I do nothing with it. But I

take both Crestor, Rosuvastatin

and Ezetimibe. And my LDL

is in the 40s, which is remarkable

because that is lower than the number we think that is

needed to have me continue to form

atherosclerotic plaque. It's great.

So what about red yeast rice? There's a story here. And

here's the before we had prescription statins,

we had red yeast rice.

It's a traditional Chinese food that produces something

called Monacolin K, chemically

identical to lovastatin, the very first

statin drug. Sounds great, right? A, uh, natural

statin, except the dose is

unpredictable.

One batch might have none, another might have near drug levels.

Many samples are contaminated with a, uh, kidney

toxin. And the FDA said if there's enough monoclin

K to work, it's not a supplement, it's an unapproved drug.

So even when it works, Red rice yeast

is basically a first generation statin. And here's what that

means. It's less effective than fourth generation

and it has far more side effects than modern fourth

generation statins. So meanwhile, Crestor

and atorvastatin or Lipitor are more potent,

safer and consistent. So if you want a

statin, go to your doctor, not the supplement

side. So here's the takeaways. The

evidence is clear. The portfolio diets lower LDL

by 17% at best, more if you stick with

it. And that's real meaningful. And that's why

diet always matters. The Mediterranean diet

is broader, easier, proven to reduce events

when followed long term. But statins, they're

stronger, safer, have the best evidence for

preventing heart attacks and strokes. And when you combine them with

zdia, the pharmacologic version of the portfolio

diet, you can lower LDL by nearly

70%. The best outcomes happen

when you do all three, though. Eat Mediterranean,

weave in portfolio elements. Take a statin

if your doctor prescribes it. Take Xetia if you can,

or some of the newer Drugs like the PCSK9 inhibitors

or bempeditic acid. Diet is

always a foundation. It is the empowering thing that

you can do. Medicine builds the house, and, uh,

together they keep the roof from caving

in.

This has been episode one of a new series where we're

calling Food isn't a Prescription Pad. And up

next, we're going to revisit the dash diet and blood pressure.

How beans, bananas and leafy greens can lower your numbers.

But maybe not enough to toss out the pill bottle just yet.

I'm Dr. Terry Simpson, your chief medical explanationist.

Remember, tofu and almonds are great, but they're not

Crestor. I have researched and

written, obviously this episode, but

remember, while I am a board certified

physician, I am not your physician.

This podcast is for education, not personal medical

advice. If you need to talk about lowering your

cholesterol, or if you have a history, family history, please

see your own doctor. And if you need dietary advice,

a registered dietitian before making any

changes to your healthcare. Please don't see a chiropractor. They

can't prescribe anything and they're oftentimes anti

statin and anti whatever. Please don't see an eastern trained

shaman, a real doctor. This is in

their wheelhouse. Also,

for more deeper dives into this, please see the

blog associated with this podcast

either@yourdoctorsorders.com or

or4q.com and for more

Mediterranean style types of foods go

to my website terrysimpson.com

thank you everybody. Have a good week.

You know Ivo, some people think if they eat oatmeal,

soy milk and almonds, they can ditch a statin. But

that's like saying you can patch a leaky roof with duct tape.

It'll hold until the microburst monsoon or

whatever big storm hits you. And in this case, it. It's worse than

a storm. It's like a heart attack or a stroke.

So I'm going to keep my statin and let's keep both

of our cholesterols down. Because you know what? We're coming up on

100 episodes of 4Q and we've got

about 900 more episodes to go before

we can retire.

Wait, hold on. I get retirement benefits with

this gig. Sweet

SA.