Each patient is unique and as such, has varying needs based on the individual's genetics and current state of health. Some patients prefer to accomplish their health goals through diet and lifestyle alone, while others may opt to rely heavily on supplementation or pharmaceutical interventions.
In terms of nutrition, Hippocrates said it best; "Let food be thy medicine and medicine by thy food." Sleep, hydration and environmental exposures also play a considerable role in wellness, but for the purposes of this discussion, we will explore nutrition and diets that target specific elevated cholesterol and diabetes.
Pop media has shone the spotlight on many fad diets like the Atkins diet and the South Beach diet, but there additional options that can help you target specific health conditions that go beyond the goal of losing weight. For instance, the Mediterranean diet supports cardiovascular health using Mediterranean-style cooking that focuses on primarily plant-based foods, as well as fish, poultry and olive oil.
There is also the Anti-Candida diet, which eliminates intake of foods that contain yeast and high-glycemic foods to help rebalance intestinal flora. The Elimination diet is the gold standard when your objective is to identify and remove food sensitivities. The D.A.S.H. diet has a list of recommendations to help control elevated blood pressure that focuses on limiting sodium intake while emphasizing vegetables, fruits and low-fat dairy products.
Elevated cholesterol and diabetes are prevalent conditions for which a targeted diet plan can offer tremendous benefit. Nearly 71 million Americans have elevated cholesterol and less than half of them seek treatment.1 The Centers for Disease Control and Prevention (CDC) reported that more than 16 million people are diagnosed with diabetes in our country. In addition, it is estimated that there are 7 million undiagnosed cases and an astounding 79 million people are considered prediabetic. The Portfolio diet and the Low-Glycemic-Index diet are two great examples of how a targeted diet can help individuals "let food be thy medicine."
The Portfolio diet is a twofold plan designed to help reduce elevations in cholesterol. In a review of clinical studies, the Portfolio diet was found to reduce LDL cholesterol by 22-30 percent after one month when all food was provided. A community-based study found a 15 percent reduction in cholesterol after six months.2
The first part of recommendations involves following the Formal Step II dietary guidelines devised from the National Cholesterol Education Project, which permits total fat calories to account for less than 30 percent of total dietary intake; with less than 7 percent from saturated fat and less than 200 mg per day of cholesterol.
As the name suggests, the second part of the diet relies on a business strategy of utilizing a diverse array of nutritional "investments" to increase returns. Four specific types of foods encompass the second set of recommendations:
- Plant sterols (1 gram per 1,000 calories)
- Soy proteins (21.4 grams per 1,000 calories)
- Almonds (14 grams per 1,000 calories)
- Soluble fiber (10 grams per 1,000 calories)
Sterols are the cholesterol made by plants that block the absorption of cholesterol in the digestive track. Sterols are found in small amounts in legumes, vegetables, grains, nuts and seeds. To achieve the target recommendation of sterols, it will likely be necessary for your patients to use supplements or consume sterol-fortified foods.
Eating a handful of unsalted almonds (as well as cashews or walnuts) is an easy way to incorporate the nut recommendation. Reading labels and enjoying regular intake of soy and colorful vegetables will help you reach the fiber and soy protein goals.
It does not have the catchiest name, but the results are fantastic when lowering blood sugar is your goal. Glycemic index refers to the amount of glucose released into your blood within two hours of a meal. As diabetes mellitus is one the largest and most costly chronic diseases facing Americans, learning to identify and incorporate low-glycemic foods into your diet is a healthy step on the road to preventing or managing diabetes.
Foods with a high glycemic index release glucose faster into the bloodstream than low-glycemic-index foods. A quick rush of sugar into the bloodstream puts a strain on the pancreatic cells that secrete insulin. Chronic strain on these cells will lead to decreased production and insulin resistance – precursors to diabetes.
Balancing meals and snacks with a combination of low-glycemic-index carbohydrates, fats and proteins will help slow the release of glucose into the bloodstream and support healthy blood-sugar control.
As you might expect, maple syrup, honey and high-fructose corn syrup are at the high end, while lentils, beans and nuts are at the low end of the glycemic index.
White rice, breads and pasta are also at the high end of the spectrum, along with popcorn and corn flakes. Whole vegetables and legumes nearly all have a low glycemic load, with exceptions including white potatoes, corn, carrots and parsnips that are higher glycemic index veggies. Melons, pineapples and grapes are high-glycemic-index fruits and should be minimized.
At the onset, it can be challenging for individuals to remain compliant on a targeted diet plan. This is especially true when foods seem completely foreign. Help your patients gain expertise in learning new foods and recipes, or recommend the support of a licensed nutritionist. There are also low-glycemic-index applications available for smartphones, as well as numerous sites online to help patients make sure they are purchasing specific low-glycemic and low-cholesterol foods. Be sure they enjoy the process by offering ongoing support and urging them to keep an open mind.
- Vital signs: prevalence, treatment and control of high levels of low-density lipoprotein cholesterol. United States, 1999-2002 and 2005-2008. Centers for Disease Control and Prevention, MMWR, 2011;60(4):109-14.
- Harland JI. Food combinations for cholesterol lowering. Nutr Res Rev, 2012 Dec;25(2):249-66.
Dr. Beaudoin is a medical educator for Emerson Ecologics, a distributor of professional nutritional supplements to healthcare practitioners. She also enjoys maintaining a naturopathic family practice and is the president of the New Hampshire Association of Naturopathic Doctors. She can be reached at