Episode 92
Tofu Isn't a Statin: Food as Medicine
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
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.
Jenkins DJ, Jones PJ, Lamarche B, et al.
JAMA. 2011;306(8):831-9. doi:10.1001/jama.2011.1202.
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.
Kavanagh ME, Zurbau A, Glenn AJ, et al.
BMC Medicine. 2025;23(1):287. doi:10.1186/s12916-025-04067-1.
Transcript
>> Dr. Terry Simpson: You've probably heard the phrase, food is
Speaker:medicine. It sounds good, right? Ancient
Speaker:wisdom, supposedly from Hippocrates, the father of
Speaker:medicine. Except here's the problem.
Speaker:Hippocrates never said it. Not once.
Speaker:It is not in any of the surviving writings. Zero
Speaker:evidence. Chances are someone a couple hundred years
Speaker:ago just slapped his name on it to give their
Speaker:idea more weight. And even Robert F.
Speaker:Kennedy, Jr. The chief grifter currently running
Speaker:Health and Human Services, quoted it as
Speaker:well. If RFK Jr. Is your historical reference,
Speaker:you're already in trouble. But the phrase stuck,
Speaker:and people cling to it like it is carved in marble. And
Speaker:as someone who's certified in culinary medicine, you
Speaker:might think I'd be all in on that idea. And sometimes
Speaker:I am. But food isn't the cure for everything.
Speaker:And let me be clear. Food is one of the
Speaker:most empowering tools we have. And
Speaker:I absolutely prescribe food for
Speaker:patients. The right food can prevent, slow, and sometimes
Speaker:even reverse some, but not all, chronic diseases.
Speaker:But here's the catch. While tofu, tempeh,
Speaker:almonds, and oats are fantastic, they're not going to
Speaker:replace your pharmacy.
Speaker:Which brings us to today's episode,
Speaker:the Portfolio Diet and why Tofu
Speaker:isn't a Statin.
Speaker:I am your Chief Medical Explanationist, Dr. Terry
Speaker:Simpson, and this is Fork U Fork
Speaker:University, where we make sense of the madness,
Speaker:bust a few myths, and teach you a little bit about food
Speaker:and medicine.
Speaker:The Portfolio Diet was designed by Dr.
Speaker:David Jenkins, the same scientist who gave us
Speaker:the glycemic H index. The idea
Speaker:is simple. Combine a portfolio of foods that each
Speaker:lower cholesterol just a little, like
Speaker:nuts. Plant proteins like soy.
Speaker:Viscous fiber like oats, barley, psyllium.
Speaker:Plant sterols from fortified foods. Together,
Speaker:they act on cholesterol recycling through what's called the
Speaker:enterohepatic circulation. Okay, here's
Speaker:how that works. Your liver makes cholesterol,
Speaker:it packages it into bile and and sends it
Speaker:down into your gut through your common bile duct.
Speaker:Normally, most of that bile and the cholesterol in it gets
Speaker:reabsorbed back into your bloodstream. But when
Speaker:you eat viscous fiber and plant sterols,
Speaker:those foods bind to the cholesterol and carry it out
Speaker:of your body. That's one of the reasons your bowel movements are
Speaker:brown. Bile is brown. And when fiber
Speaker:catches it and drags it out, you flush away
Speaker:some of the cholesterol with it. It's a win win. You feed
Speaker:your gut microbes and you keep cholesterol from sneaking
Speaker:back into circulation. The issue is
Speaker:can you stick to eating that much fiber every
Speaker:single day? That's the rub. It's a
Speaker:lot easier just to take Crestor like I do.
Speaker:There's some clinical data and here's where it gets
Speaker:impressive. The portfolio diet
Speaker:isn't just theory. It's been tested.
Speaker:A randomized control trial published in the Journal of the American
Speaker:Medical association compared the portfolio diet against
Speaker:standard low saturated fat diets in patients with high
Speaker:cholesterol. And here's what they found. If your starting
Speaker:LDL was about 171 with the
Speaker:portfolio diet, LDL dropped by
Speaker:about 13 or 14%, or about 24 to
Speaker:26 milligrams per deciliter over six months.
Speaker:In the most adherent patients,
Speaker:the reductions exceeded 20%
Speaker:at one year. Now this wasn't a one off.
Speaker:Multiple meta analysis and systematic reviews
Speaker:confirm these results showing that mean LDL, which
Speaker:is the bad cholesterol reduction of about
Speaker:17%. The portfolio diet also
Speaker:improved other cardiometabolic risk Factors including
Speaker:non HDL cholesterol, apolipoprotein
Speaker:D and the estimated 10 year coronary
Speaker:heart disease risk. So yes, the
Speaker:portfolio diet works. It is
Speaker:especially true in the most motivated adherent patients.
Speaker:The LDL reduction is actually comparable to first
Speaker:generation statins like lovastatin.
Speaker:But let's make this real. What does it take to
Speaker:get those results? So here's a day in the life of the
Speaker:portfolio diet. Breakfast bowl of
Speaker:oatmeal made with soy milk that gives you viscous fiber and
Speaker:soy protein. One Shot Snack handful of
Speaker:almonds, about 25 or 30 grams. Not Trail
Speaker:mix, which I love. The candy coated
Speaker:stuff. Nope, this is just plain almonds. Lunch A cup of
Speaker:lentil soup, maybe with a slice of whole grain bread.
Speaker:More fiber, more plant protein. Dinner
Speaker:Tofu stir fry with vegetables and barley on the side.
Speaker:That's more soy, more viscous fiber. Somewhere in
Speaker:the day you'll need plant sterols, usually in the form of a margarine
Speaker:spread, about 2 grams worth. That's how you
Speaker:hit the therapeutic doses. Soy protein,
Speaker:viscous fiber, nuts and sterols every day
Speaker:consistently. And that's the challenge. It
Speaker:takes planning and honestly, it takes
Speaker:motivation. It's not impossible, but it's
Speaker:harder than taking medicine.
Speaker:Now you might be thinking, wait a minute, isn't this basically the
Speaker:Mediterranean diet? And the answer is kind of
Speaker:both diets are plant forward, emphasize nuts, legumes,
Speaker:whole grains and fiber. Both lower LDL cholesterol, both
Speaker:reduce cardiovascular risk, but they are not
Speaker:identical. The Mediterranean diet is a broader
Speaker:lifestyle pattern. It has olive oil, fish, vegetables,
Speaker:legumes, limited red meat. It's flexible, delicious,
Speaker:and a lot more embedded in most of our cultures. The
Speaker:portfolio diet is more prescriptive.
Speaker:You need specific amounts of soy protein,
Speaker:viscous fiber, almonds, and plant
Speaker:siderols every single day. It's less about
Speaker:lifestyle and more about hitting cholesterol with targeted
Speaker:foods. If the Mediterranean diet is the whole restaurant,
Speaker:olive oil, fish, vegetables, joy, the
Speaker:portfolio diet is just the cholesterol lowering section
Speaker:of the menu. You can actually fit the portfolio diet
Speaker:in the Mediterranean framework. And when you do, you'll probably get the
Speaker:best of both worlds and maybe a lot of
Speaker:sadness. But now let's
Speaker:continue. Let's, let's do some comparison. Let's go to the
Speaker:world of pharmacy. Let's take statins like atorvastatin
Speaker:or rosuvastatin, which is Crestor, the medicine. I take
Speaker:those two typically lower LDL by
Speaker:double that amount, 30 to 50%. That's
Speaker:double or sometimes triple what you get on the portfolio diet.
Speaker:And they don't just change cholesterol numbers.
Speaker:They reduce heart attacks and strokes by 25 to
Speaker:40%. And here's the kicker.
Speaker:When you add zdia, also known as
Speaker:ezetimide, it also, it's another drug. It
Speaker:blocks cholesterol absorption in the gut. So
Speaker:that's basically the portfolio diet on high
Speaker:octane. On its own, ZD can lower
Speaker:LDL by about 15 or 20%, similar to the diet.
Speaker:But when you combine zdia with a statin, LDL
Speaker:drops another 20% on top of what the statin does.
Speaker:So a statin alone might give you a 50% reduction in
Speaker:LDL. At Zetia, you're at 65 or 70%. That's
Speaker:massive and far more consistent than anyone can
Speaker:manage with oatmeal and tofu alone. Let me give you a real life
Speaker:example. Me, I have familial
Speaker:hypercholesterolemia. My father had a heart
Speaker:attack when he was 55. My brother had a heart attack
Speaker:at age 50. I have high cholesterol.
Speaker:My LDL, the bad cholesterol, runs at about
Speaker:190 if I do nothing with it. But I
Speaker:take both Crestor, Rosuvastatin
Speaker:and Ezetimibe. And my LDL
Speaker:is in the 40s, which is remarkable
Speaker:because that is lower than the number we think that is
Speaker:needed to have me continue to form
Speaker:atherosclerotic plaque. It's great.
Speaker:So what about red yeast rice? There's a story here. And
Speaker:here's the before we had prescription statins,
Speaker:we had red yeast rice.
Speaker:It's a traditional Chinese food that produces something
Speaker:called Monacolin K, chemically
Speaker:identical to lovastatin, the very first
Speaker:statin drug. Sounds great, right? A, uh, natural
Speaker:statin, except the dose is
Speaker:unpredictable.
Speaker:One batch might have none, another might have near drug levels.
Speaker:Many samples are contaminated with a, uh, kidney
Speaker:toxin. And the FDA said if there's enough monoclin
Speaker:K to work, it's not a supplement, it's an unapproved drug.
Speaker:So even when it works, Red rice yeast
Speaker:is basically a first generation statin. And here's what that
Speaker:means. It's less effective than fourth generation
Speaker:and it has far more side effects than modern fourth
Speaker:generation statins. So meanwhile, Crestor
Speaker:and atorvastatin or Lipitor are more potent,
Speaker:safer and consistent. So if you want a
Speaker:statin, go to your doctor, not the supplement
Speaker:side. So here's the takeaways. The
Speaker:evidence is clear. The portfolio diets lower LDL
Speaker:by 17% at best, more if you stick with
Speaker:it. And that's real meaningful. And that's why
Speaker:diet always matters. The Mediterranean diet
Speaker:is broader, easier, proven to reduce events
Speaker:when followed long term. But statins, they're
Speaker:stronger, safer, have the best evidence for
Speaker:preventing heart attacks and strokes. And when you combine them with
Speaker:zdia, the pharmacologic version of the portfolio
Speaker:diet, you can lower LDL by nearly
Speaker:70%. The best outcomes happen
Speaker:when you do all three, though. Eat Mediterranean,
Speaker:weave in portfolio elements. Take a statin
Speaker:if your doctor prescribes it. Take Xetia if you can,
Speaker:or some of the newer Drugs like the PCSK9 inhibitors
Speaker:or bempeditic acid. Diet is
Speaker:always a foundation. It is the empowering thing that
Speaker:you can do. Medicine builds the house, and, uh,
Speaker:together they keep the roof from caving
Speaker:in.
Speaker:This has been episode one of a new series where we're
Speaker:calling Food isn't a Prescription Pad. And up
Speaker:next, we're going to revisit the dash diet and blood pressure.
Speaker:How beans, bananas and leafy greens can lower your numbers.
Speaker:But maybe not enough to toss out the pill bottle just yet.
Speaker:I'm Dr. Terry Simpson, your chief medical explanationist.
Speaker:Remember, tofu and almonds are great, but they're not
Speaker:Crestor. I have researched and
Speaker:written, obviously this episode, but
Speaker:remember, while I am a board certified
Speaker:physician, I am not your physician.
Speaker:This podcast is for education, not personal medical
Speaker:advice. If you need to talk about lowering your
Speaker:cholesterol, or if you have a history, family history, please
Speaker:see your own doctor. And if you need dietary advice,
Speaker:a registered dietitian before making any
Speaker:changes to your healthcare. Please don't see a chiropractor. They
Speaker:can't prescribe anything and they're oftentimes anti
Speaker:statin and anti whatever. Please don't see an eastern trained
Speaker:shaman, a real doctor. This is in
Speaker:their wheelhouse. Also,
Speaker:for more deeper dives into this, please see the
Speaker:blog associated with this podcast
Speaker:either@yourdoctorsorders.com or
Speaker:or4q.com and for more
Speaker:Mediterranean style types of foods go
Speaker:to my website terrysimpson.com
Speaker:thank you everybody. Have a good week.
Speaker:You know Ivo, some people think if they eat oatmeal,
Speaker:soy milk and almonds, they can ditch a statin. But
Speaker:that's like saying you can patch a leaky roof with duct tape.
Speaker:It'll hold until the microburst monsoon or
Speaker:whatever big storm hits you. And in this case, it. It's worse than
Speaker:a storm. It's like a heart attack or a stroke.
Speaker:So I'm going to keep my statin and let's keep both
Speaker:of our cholesterols down. Because you know what? We're coming up on
Speaker:100 episodes of 4Q and we've got
Speaker:about 900 more episodes to go before
Speaker:we can retire.
Speaker:Wait, hold on. I get retirement benefits with
Speaker:this gig. Sweet
Speaker:SA.
