phc

🛒 Portfolio Diet Guide & Shopping List

For Severe Familial Hypercholesterolemia + Prediabetes

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🎯 Core Principles (Based on Latest Evidence 2019-2025)

Evidence-Based Priority Hierarchy:

1. ⭐⭐⭐ HIGHEST PRIORITY: Saturated Fat < 7% of Total Calories
   • Evidence: AHA 2019 - Replacing saturated fat with PUFA reduces CVD by ~30%, similar to statin effect
   • Saturated fat increases LDL-C by reducing hepatic LDL receptors
   • More impactful than dietary cholesterol restriction
2. ⭐⭐ HIGH PRIORITY: Portfolio Diet Core Components
   • Plant sterols: 2g/day
   • Soluble fiber: 10-20g/day
   • Soy protein: 25-30g/day
   • Nuts: 30-45g/day
3. ⭐ MODERATE PRIORITY: Dietary Cholesterol
   • Evidence: AHA 2019 - “Observational studies generally do not support a significant association between dietary cholesterol and CVD risk”
   • Keep as low as reasonably possible, BUT not an absolute prohibition
   • Exception: “High-cholesterol + Low-saturated-fat” foods (eggs, shellfish, fish roe) can be consumed in moderation

Key Distinction: Cholesterol vs Saturated Fat

Food Category	Cholesterol	Saturated Fat	Status	Rationale
Eggs	High (186mg/egg)	Low (1.6g/100g)	⚡ Moderate	Low sat-fat exception (AHA 2019)
Shellfish/Fish Roe	High (200-500mg/100g)	Low (1-2g/100g)	⚡ Moderate	Low sat-fat, high omega-3
Fatty Red Meat	Medium (70mg/100g)	Very High (8-15g/100g)	🚫 Forbidden	Sat-fat is primary concern
Butter	High (215mg/100g)	Extremely High (51g/100g)	🚫 Forbidden	Sat-fat is primary concern

Bottom Line: Prioritize limiting saturated fat over obsessing about every milligram of dietary cholesterol.

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1. 🥬 Vegetables (Including Blood Sugar Control Stars: Bitter Melon, Winter Melon)

✅ Recommended: Required, unlimited quantity

• Leafy greens: bok choy, spinach, lettuce, water spinach, romaine lettuce, amaranth, watercress, Chinese broccoli (gai lan), pea shoots
• Cruciferous vegetables: broccoli, cauliflower, cabbage, napa cabbage, kohlrabi
• Blood sugar control vegetables (highly recommended): bitter melon (contains charantin, lowers blood glucose), winter melon (traditional blood sugar control), cucumber, luffa, chayote
• Nightshades: eggplant (high soluble fiber), tomato, bell peppers
• Other recommended vegetables: celery, daikon radish, carrot, bean sprouts (mung bean, soybean), lotus root (raw or lightly stir-fried)

⚡ As Needed: Necessary but portion-controlled

• Starchy vegetables (count toward carb quota, replace equivalent rice/noodles): Chinese yam (½ cup/serving), taro (½ cup/serving), potato (½ cup/serving), sweet potato (½ cup/serving, low GI preferred), pumpkin (½ cup/serving), corn (½ ear/serving)

⚪ Neutral: Occasional use only

• Pickled vegetables (high sodium): preserved mustard greens (small amount, rinse thoroughly), sauerkraut (small amount, rinse thoroughly), pickled vegetables (small amount)

🚫 Forbidden: Even trace amounts harmful

• Fried vegetable products: fried eggplant boxes, fried lotus root boxes, fried spring rolls, fried vegetable tempura

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2. 🍄 Mushrooms (Shiitake Can Reduce Cholesterol 55%)

✅ Recommended: Required, unlimited quantity

• Fresh mushrooms: shiitake (contains eritadenine, reduces cholesterol up to 55%), oyster mushroom, enoki, white button mushroom, king oyster mushroom
• Dried mushrooms: dried shiitake (rehydrate before use), wood ear mushroom (black/white fungus), bamboo fungus, tea tree mushroom

⚡ As Needed: Necessary but portion-controlled

• None

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Even trace amounts harmful

• None

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3. 🍎 Fruits (Classified by GI Value)

✅ Recommended: Low GI, required 2-3 servings daily

• Berries (GI <40): blueberries (1 cup), strawberries (1 cup), blackberries (1 cup), raspberries (1 cup), cherries (15-20 pieces, GI 22)
• Citrus (GI <50): grapefruit (½-1 whole, GI 25), orange (1 whole, GI 40-43), mandarin (1-2 pieces, GI 47), lemon (for flavoring)
• Other low GI fruits: dragon fruit (1 whole, GI 48-52), guava (1 whole, GI 30-50)

⚡ As Needed: Medium GI, 1-2 servings daily, pair with nuts/protein

• Medium fruits (GI 40-60): apple (1 medium, GI 36-44), pear (1 medium, GI 38), peach (1 medium, GI 42), plum (2-3 pieces, GI 39), apricot (2-3 pieces, GI 34), kiwi (1 piece, GI 47-58), grapes (small bunch, GI 46-59), papaya (1 cup, GI 60)

⚪ Neutral: High GI, occasional use, pair with protein/nuts to reduce glycemic response

• High GI fruits (GI >60): watermelon (small piece, GI 72), pineapple (small piece, GI 66), lychee (3-5 pieces, GI 57), longan (small amount), mango (½ piece, GI 51-60)

🚫 Forbidden: Even trace amounts harmful

• Juice, canned fruit: all fruit juices (even fresh-squeezed), canned fruit in syrup, candied fruit, dried fruit (except small amounts unsweetened)

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4. 🥜 Protein Sources

4A. Plant-Based Protein (Priority Recommendation)

✅ Recommended: Required 25-30g soy protein daily

• Soy products: tofu (½-¾ block/day, ~150-200g), soy milk (unsweetened, 2 cups/day), dried tofu (50-75g), edamame (1 cup in shell), tempeh (fermented soy, 100g), silken tofu (for soup, steaming)
• Legumes (3-4 times weekly): mung beans (congee, soup), adzuki bean, black beans, chickpeas, lentils

⚡ As Needed: Necessary but portion-controlled

• None

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Even trace amounts harmful

• Processed soy products (high sodium, high oil): fried tofu puffs, fried tofu skin, processed vegetarian meat (high sodium), fermented bean curd (high sodium)

4B. Seafood

Evidence Update (AHA 2023, Harvard Health): Shellfish and fish roe, despite high cholesterol, are low in saturated fat and rich in omega-3. Current research suggests saturated fat is a greater concern than dietary cholesterol for CVD risk. The AHA removed the 300mg/day cholesterol limit in 2015.

✅ Recommended: Rich in Omega-3, 2-3 times weekly, 120-150g per serving

• Fatty fish (steam or bake primarily): salmon, mackerel, sardines
• Rationale: High omega-3 (EPA+DHA) reduces triglycerides and inflammation, low saturated fat (<1g/100g)

⚡ As Needed: High-cholesterol but low-saturated-fat seafood

• White fish (2-3 times weekly): sea bass, grouper, cod, halibut, sole
• Shrimp (1-2 times weekly): 8-12 pieces/100-120g per serving
  • Cholesterol: 152mg/100g (moderate-high)
  • Saturated fat: 0.4g/100g (very low)
  • Evidence: Despite high cholesterol, shrimp doesn’t negatively impact blood cholesterol due to low saturated fat (Medical News Today, AHA)
  • Remove heads and shells (higher cholesterol concentration)
• Shellfish (1-2 times weekly): clams, mussels, oysters, scallops
  • Cholesterol: 40-60mg/100g (moderate)
  • Saturated fat: <1g/100g (low)
  • Rich in omega-3, zinc, iron
• Fish roe/caviar (small portions, 1-2 times monthly):
  • Examples: salmon roe (ikura), flying fish roe (tobiko), mentaiko (marinated pollock roe), caviar
  • Portion size: 15-30g (1-2 tablespoons) per serving
  • Nutritional profile:
    • Cholesterol: 300-500mg/100g (very high)
    • Saturated fat: 1.5-2g/100g (low, only ~20% of total fat)
    • Omega-3: Very high (EPA+DHA)
    • Protein: ~25g/100g
  • Evidence: Harvard Health notes “shellfish and fish roe have cholesterol but not a lot of saturated fat, therefore okay to have some”
  • Conditions for FH patients:
    • ✅ Only on days with <100mg other dietary cholesterol
    • ✅ Total daily saturated fat remains <7%
    • ✅ Avoid fried/high-sodium preparations (e.g., heavily salted mentaiko)
    • ✅ Treatment phase: max 1x/month; stable LDL phase: 2x/month acceptable
  • Specific examples:
    • Mentaiko (明太子): 20-25g serving = ~100-125mg cholesterol, 0.4g sat-fat ✅
    • Salmon roe: 30g serving = ~150mg cholesterol, 0.5g sat-fat ✅
    • Caviar: 15g serving = ~88mg cholesterol, 0.3g sat-fat ✅

⚪ Neutral: Higher cholesterol shellfish, occasional use

• Squid/Cuttlefish (1-2 times monthly): 80-100g serving
  • Cholesterol: 233mg/100g (high)
  • Saturated fat: 0.4g/100g (very low)
  • Acceptable occasionally due to low saturated fat, but higher cholesterol than other shellfish

🚫 Forbidden: Truly harmful preparations

• Fried seafood (adds saturated fat): fried fish fillets, fried shrimp, fried calamari, tempura
• Very high cholesterol parts: shrimp heads (eat in moderation), crab roe/tomalley (limit to special occasions, small amounts)
• High-sodium preparations: salted fish, heavily preserved seafood
• Note: The cholesterol content itself is not the primary concern—it’s the preparation method (frying adds saturated fat) and portion size that matter most

4C. Poultry

✅ Recommended: Required, unlimited quantity

• None (poultry not primary protein, prioritize soy products and fish)

⚡ As Needed: Necessary but portion-controlled

• Skinless poultry (2-3 times weekly, 100-120g per serving): skinless chicken breast, skinless chicken thigh (lean parts)

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Even trace amounts harmful

• Poultry skin and organs: chicken/duck skin (extremely high saturated fat), chicken heart, chicken liver (high cholesterol), duck liver (extremely high cholesterol), braised organ meats
• Processed poultry: sausages, ham, bacon, lunch meat

4D. Red Meat

✅ Recommended: Required, unlimited quantity

• None (red meat incompatible with Portfolio Diet, severe FH patients should minimize consumption)

⚡ As Needed: Necessary but portion-controlled

• Extremely lean cuts (1-2 times monthly, 40-60g per serving): pork tenderloin (leanest part), pork loin (remove all visible fat)
• Note: Only for special social occasions, choose leanest parts, remove all visible fat

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Even trace amounts harmful

• All fatty meat and most red meat: pork belly/bacon, ribs, beef brisket, beef ribs, lamb (most cuts), pork trotters, animal fats (lard, tallow, suet)
• Processed meat products (Group 1 carcinogen): cured bacon/sausage, ham, sausages, hot dogs, lunch meat

4E. Eggs

Evidence Update (AHA 2019, BMJ 2020): Eggs are “high-cholesterol + low-saturated-fat” foods. For healthy older adults, up to 2 eggs/day is acceptable. For FH patients, moderate intake (3-4/week) is reasonable when overall saturated fat is controlled.

✅ Recommended: Egg whites unlimited

• Egg whites (unlimited): egg whites only
• Uses: steamed egg white custard, boiled egg whites, scrambled egg whites

⚡ As Needed: Moderate intake acceptable

• Whole eggs (3-4 per week, up to 1 per day if other diet is strict):
  • Boiled eggs (1 egg = 186mg cholesterol, 1.6g sat-fat)
  • Steamed eggs (use 1 whole egg + 2 egg whites)
  • Rationale: Eggs have low saturated fat (1.6g/100g) despite high cholesterol. AHA 2019 notes dietary cholesterol from eggs has minimal impact on blood cholesterol when saturated fat intake is controlled.
  • Condition: Only if daily saturated fat < 7% and no other high-cholesterol foods that day

⚪ Neutral: Occasional use only

• Whole eggs (more than 1/day): Acceptable on days with no other animal products, but monitor blood lipids

🚫 Forbidden: Even trace amounts harmful

• High cholesterol + high sodium egg products: salted egg yolk (extremely high cholesterol + sodium), marinated eggs (high sodium + cholesterol)
• Fried egg products: fried eggs with excessive oil, deep-fried eggs (adds saturated fat)
• Century eggs: Acceptable occasionally due to moderate cholesterol, but avoid if high sodium

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5. 🌾 Grains and Staples

✅ Recommended: Whole grains, low GI, ½-⅔ cup cooked per meal

• Whole grains: brown rice (GI 55, first choice), black rice (rich in anthocyanins), pearl barley (β-glucan), steel-cut oats (β-glucan), quinoa (complete protein), buckwheat (GI 54), millet
• Mixed grains (recommended): brown rice + pearl barley (2:1), brown rice + black rice (1:1), oats + pearl barley
• Whole wheat products: whole wheat bread (100% whole wheat), whole wheat steamed buns, whole wheat bun wrappers, whole wheat dumpling wrappers, whole wheat noodles (pasta, GI 45-50)
• Grain flours (for congee): oat flakes, brown rice flour

⚡ As Needed: Partially refined grains, limited

• Partially refined grains: white rice (GI 73, small portion ½ cup), white noodles (small amount, with plenty of vegetables), udon noodles (moderate)

⚪ Neutral: Refined staples, occasional use

• Refined staples: white steamed buns (small, GI 88), white bread (1 slice)

🚫 Forbidden: High GI/fried staples

• Glutinous rice products (GI 87-98): glutinous rice and glutinous rice products
• Fried staples: fried dough sticks (youtiao), fried dough twists, fried flatbread, fried rice (with excessive oil), fried noodles (with excessive oil)
• High GI products: white congee (GI 90+), rice cakes, sweet rice balls (tangyuan), sticky rice dumplings (zongzi)
• Refined baked goods: white bread, cakes, cookies, pastries, mooncakes

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6. 🥜 Nuts and Seeds (Key to Cholesterol Reduction)

✅ Recommended: 30-45g daily (~¼ cup), required intake

• Core nuts: almonds (12-15 pieces/day), walnuts (6-7 halves, highest Omega-3), pistachios (unsalted, 20-25 pieces), hazelnuts (15-20 pieces)
• Seeds: flaxseed (ground, 1-2 tablespoons/day, Omega-3), chia seeds (1 tablespoon/day, Omega-3 + fiber), pumpkin seeds (1 tablespoon), sunflower seeds (unsalted, 1 tablespoon), sesame seeds (black/white, 1-2 tablespoons)
• Note: Choose unsalted/low-salt plain varieties, can lightly roast for flavor (not deep-fry), consume in 2-3 portions daily, can add to oatmeal/salad/yogurt

⚡ As Needed: Other nuts, moderate

• Other nuts: cashews (10-12 pieces, slightly higher carbs), Brazil nuts (2-3 pieces, high selenium), macadamia nuts (5-6 pieces, high fat), pecans (10-12 halves)

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Processed/high-salt nuts

• Processed nuts: salt-roasted nuts, honey-roasted nuts, sugar-coated nuts, fried peanuts, salt and pepper nuts

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7. 🛢️ Oils and Fats

✅ Recommended: Healthy oils, 2-3 tablespoons (30-45ml) total daily

• Primary cooking oils: extra virgin olive oil (cold dishes, low heat), avocado oil (high-heat cooking, smoke point 270°C), camellia oil (high heat, Chinese cooking)
• Flavoring oils (small amounts): toasted sesame oil (1-2 drops/dish), flaxseed oil (cold dishes, 1 teaspoon/day)
• Principles: primarily monounsaturated fatty acids (MUFA), limit saturated fat <7% total calories, avoid all animal fats

⚡ As Needed: Other vegetable oils, moderate

• Other vegetable oils: peanut oil (high-heat cooking, small amount), corn oil (moderate), soybean oil (moderate), sunflower oil (moderate)

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: High saturated fat/trans fat

• Animal fats: lard, butter, tallow, chicken/duck fat, bacon fat, ghee
• Tropical oils (high saturated fat): coconut oil, palm oil
• Hydrogenated vegetable oils (trans fat): margarine (some), shortening, baking oils containing trans fats
• Reused oils: repeatedly fried oils, restaurant deep-frying oils

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8. 🧂 Seasonings and Spices

✅ Recommended: Unlimited/generous use

• Fresh herbs (unlimited): garlic, ginger, scallion, cilantro, basil, mint
• Dried spices (unlimited): star anise, Sichuan peppercorn, five-spice powder, cinnamon bark, cumin, white pepper, black pepper, chili powder, turmeric, cinnamon powder (lowers blood sugar), curry powder
• Natural umami (unlimited): dried shiitake powder, kombu/kelp (natural MSG), tomato (for umami)

⚡ As Needed: Fermented seasonings, portion-controlled

• Fermented seasonings: low-sodium soy sauce (1-2 teaspoons/dish), miso (low-sodium version, small amount), doubanjiang/chili bean paste (small amount, rinse), fermented black beans (small amount, rinse), yellow bean paste (small amount)
• Acidic seasonings: rice vinegar (unlimited), black vinegar, aged vinegar, lemon juice
• Cooking wine: Shaoxing wine (1-2 tablespoons/dish)

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: High sodium/high sugar/trans fat

• High sodium seasonings: regular soy sauce (1000mg sodium per tablespoon), dark/light soy sauce (high sodium), oyster sauce (600mg sodium per tablespoon), fish sauce (extremely high sodium), salt (strictly limit), chicken bouillon/MSG (high sodium), fermented tofu (extremely high sodium)
• High sugar seasonings: white sugar, rock sugar, honey (excessive), sweet bean paste, hoisin sauce (high sugar + sodium), ketchup (high sugar), BBQ sauce (high sugar + sodium), teriyaki sauce (high sugar + sodium)
• Trans fat seasonings: salad dressing (some contain hydrogenated oils), coffee creamer (contains hydrogenated oils)

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9. 🥤 Beverages

✅ Recommended: Unlimited

• Sugar-free beverages: plain water (primary), green tea, oolong tea, pu-erh tea, chrysanthemum tea, lemon water (unsweetened), bitter melon tea (lowers blood glucose), cassia seed tea
• Herbal teas: rose tea, osmanthus tea, jasmine tea

⚡ As Needed: Beverages with minimal sugar/fat, moderate

• Beverages with minimal sugar/fat: unsweetened soy milk (2 cups/day), unsweetened milk alternatives (almond milk, oat milk)
• Coffee (moderate): black coffee (2-3 cups/day), Americano
• Note: No sugar, no creamer, can add unsweetened soy milk

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: High sugar/high fat/alcohol

• Sugary beverages: all sugary sodas, fruit juice (even fresh-squeezed), sports drinks (with sugar), flavored tea drinks, bubble tea, canned/bottled tea (with sugar), energy drinks
• High-fat beverages: whole milk, milk tea (with creamer), latte (whole milk), cappuccino (whole milk), cocoa/chocolate drinks, coconut milk
• Alcohol (strictly limited): liquor, beer, sweet wines, cocktails (Note: small amounts of cooking wine in dishes acceptable, direct consumption forbidden)

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10. 💊 Special Functional Foods (Portfolio Diet Core)

✅ Recommended: Required daily intake

• Plant sterol-fortified foods (2g/day): plant sterol-fortified soy milk, plant sterol-fortified oat milk, plant sterol gummies (as prescribed)
• Soluble fiber supplements (under medical guidance): psyllium husk powder (1-2 teaspoons/day), β-glucan supplements
• Omega-3 supplements (if dietary intake insufficient): fish oil (EPA+DHA 500mg/day), algal oil (for vegetarians)

⚡ As Needed: Necessary but portion-controlled

• None

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: Fake “health” foods

• Fake “health” foods: “sugar-free” but high-fat cookies, “low-fat” but high-sugar yogurt, energy bars (high sugar high fat), protein powder (sweetened versions), meal replacement shakes (high sugar)

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11. 🍚 Common Cooking Ingredients

✅ Recommended: Required, unlimited quantity

• Wrapping materials: bamboo leaves (for zongzi, use whole grain fillings), lotus leaves (for steaming rice)

⚡ As Needed: Necessary but portion-controlled

• Thickeners: cornstarch (small amount for thickening), kudzu root powder (traditional cooling agent)
• Flours: whole wheat flour (baking), starch (potato starch, small amount)

⚪ Neutral: Occasional use only

• None

🚫 Forbidden: High sodium/high fat processed products

• High sodium/high fat processed products: instant noodles, instant rice noodles, frozen dumplings (high sodium high fat), frozen steamed buns (high sodium), frozen tangyuan (high sugar), frozen fried dough sticks
• High trans fat products: vegetable cream, puff pastry, pre-made pie crusts

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📊 Quick Reference: Required Daily Intake

Nutrient/Food	Daily Target	Primary Sources	Evidence Level
⭐⭐⭐ Saturated Fat	< 7% of total calories	AVOID: red meat, butter, coconut oil, processed meat	AHA 2019 (Highest priority)
	(~15g for 2000 cal/day)	CHOOSE: fish, poultry without skin, plant proteins	Reduces CVD ~30%
Soluble Fiber	10-20g	Oats, pearl barley, legumes, eggplant, apples, shiitake	Portfolio Diet core
Plant Sterols	2g	Fortified soy milk, nuts, whole grains	Portfolio Diet core
Soy Protein	25-30g	Tofu, soy milk, edamame, dried tofu	Portfolio Diet core
Nuts	30-45g	Almonds, walnuts (in 2-3 portions)	Portfolio Diet core
Omega-3 (EPA+DHA)	250-500mg	Fatty fish (2-3x/week), walnuts, flaxseed	Anti-inflammatory
Total Fiber	30-50g	Vegetables, whole grains, legumes, fruits	Metabolic health
Vegetables	≥5 servings	Various leafy greens, cruciferous, mushrooms	Blood sugar control
Fruits	2-3 servings (low-med GI)	Prioritize berries, citrus	Prediabetes management
Dietary Cholesterol	As low as practical	Limit eggs to 3-4/week, avoid organ meats	AHA 2019: Secondary priority
	(Strict: <200mg; Moderate: <300mg)	Fish roe/shellfish: small portions 1-2x/month acceptable	Not an absolute limit

Key Insight: Saturated fat restriction > dietary cholesterol restriction for LDL-C reduction (AHA 2019)

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🛒 Shopping Principles Summary

✅ Priority Shopping List (Buy Weekly):

1. Vegetables: 3-4 types of leafy greens, bitter melon/winter melon, eggplant, mushrooms
2. Fruits: 1-2 types of berries, 1 type of citrus
3. Protein: 1-2 blocks of tofu, soy milk, 2 types of fish
4. Grains: brown rice, oats, pearl barley
5. Nuts: almonds, walnuts (weekly replenishment)
6. Oils: olive oil or camellia oil
7. Aromatics: garlic, ginger, scallions

⚡ Limited Purchase (1-2 times monthly):

• Skinless chicken breast (if needed)
• Whole eggs (2-3 per week)
• Shrimp (small amount)
• Low-sodium seasonings replenishment

🚫 Never Purchase:

• Any animal fats, fatty meats
• All processed meat products
• Fried foods
• Sugary beverages, fruit juices
• High-sodium seasonings
• Refined pastries, cookies
• Convenience foods

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💡 Practical Shopping Tips

Weekly Shopping Schedule:

1. Sunday: Plan next week’s menu, create shopping list
2. Monday/Tuesday: Purchase fresh vegetables, tofu (can store 3-4 days)
3. Thursday/Friday: Replenish fresh vegetables
4. Monthly (1x): Purchase dried goods (dried shiitake, wood ear, nuts, whole grains)

Storage Guidelines:

• Leafy greens: Refrigerate 3-4 days
• Mushrooms: Paper bag in refrigerator 5-7 days
• Tofu: Use same day after opening, or change water and refrigerate 2 days
• Fish: Consume day of purchase or next day, do not freeze and thaw
• Whole grains: Sealed container, cool dry place, 1-2 months
• Nuts: Sealed container, refrigerate, 1-2 months
• Oils: Store away from light, use within 3-6 months

Cost Optimization:

• Seasonal produce costs less and has better nutrition
• Dried goods (shiitake, wood ear) more economical in bulk
• Nuts in large packages for portioning save money
• Homemade soy milk cheaper than store-bought and additive-free