Despite the rising number of COVID cases in the US, heart disease remains our number one threat with up to 650,000 deaths per year. COVID19 is a contagious, airborne virus that is preventable through social distancing, mask compliance, consistent hand-washing, and disinfectant. Scientists are also racing for a vaccine, but timing and accessibility are not in our control.

Heart disease is not contagious but lifestyle-driven and within our control. If you know your family history and/or lipid profile, it’s important to modify lifestyle choices including diet and exercise. Last week we discussed how a diet high in fiber helps in the prevention of diabetes. This week we’ll review why those high fiber foods also keep your arteries happy.

Sow those oats!Scientists have known for years about the risk of high cholesterol and heart disease. Individuals with elevated LDL in particular are at higher risk for developing coronary artery disease.¹ In 1997, whole oat food manufacturers were allowed to add the claim that soluble fiber from oats aids in cholesterol reduction, according to FDA law.²Oats provide beta-glucan, a type of water-soluble fiber that lowers LDL (“lousy) cholesterol). Soluble fiber moves through the digestive tract and combines with intestinal bile acids, then takes the acids from the body as waste. Since bile acids are made of cholesterol, less absorption of cholesterol occurs. A product must contain a minimum of .75 grams of soluble fiber to carry the claim and must also say, “Diets low in saturated fat and cholesterol”, rather than “Diets high in oats”, so consumers don’t think they can keep a daily habit of cheeseburgers and fries and expect their cholesterol levels to drop with a bowl of oatmeal. ²Other sources of soluble fiber include barley, dried beans, apples, citrus fruit, broccoli, Brussels sprouts, oat bran, brown rice, and spinach. If you’ve got elevated LDL, soluble fiber may help.Plant-based diets and heart diseaseIn addition to oats, a diet containing other high fiber foods such as whole grains, legumes, flaxseed, fruits, and vegetables may help reverse atherosclerosis and ischemic heart disease. ²A study was published in the Journal of the American College of Cardiology after research was conducted at the Harvard School of Public Health and Brigham and Women's Hospital, in Boston, MA. Subjects were recruited from three different health studies including Nurse’s Health Study, Nurse’s Health Study II, and Health Professional’s Follow Up Study.  Participants were tracked for over 20 years using questionnaires that evaluated lifestyle, medical history, and health behaviors. Out of the baseline healthy participants, 8631 subjects developed heart disease.An initial consideration from the investigators was that previous research did not differentiate between plant-based diets although they were all deemed vegetarian.  The researchers delved deeper and came up with three categories of plant-based diet patterns:

1. Diets that focused mostly on plant foods but didn’t completely exclude animal-derived nutrients.
2. Totally plant-based diets that maximized intake of healthful plant foods (including fruits, vegetables, and whole grains)
3. Plant-based diets consisting of mostly unhealthful plant-derived food (like sweetened beverages, processed potatoes, sweets, and refined grains)

Participants that followed a healthy, vegan diet including most fruits, vegetables, and whole grains had a much lower risk of developing heart disease. Consumption of not-so nutritious refined grains had a negative influence on the heart. Overall, healthy plant-based foods were associated with lower risk while unhealthy plant-based and animal-derived products were linked with higher risk^{. 3}Obviously, there are other components than fiber in a plant-based diet that aid in the prevention of heart disease. Plants provide vitamins, minerals, antioxidants, and other phytochemicals known to prevent disease. Studies on the consumption of foods containing insoluble fiber from nuts, seeds, whole grains, and bran have also shown reduced rates of heart disease. ⁴Heart-healthy tips

• Adopt an apple a day. Apples provide soluble fiber and have been found to reduce the risk of stroke. ⁵
• Include a veggie at every meal, including breakfast. Spinach, peppers, and onions are great in eggs and breakfast burritos.
• Add citrus fruit to a salad, yogurt, or enjoy as a solo snack.
• Try cooked barley, oats, mushrooms, or chopped zucchini to burgers to boost fiber and cut the amount of meat used.
• Eat beans or lentils three times a week. They’re inexpensive, versatile, and delicious!

Lisa Andrews, MEd, RD, LDReferences

1. Blesso CN, Fernandez ML. Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients. 2018 Mar 29;10(4):426.
2. https://www.fda.gov/food/food-labeling-nutrition
3. Ambika Satija, Shilpa N. Bhupathiraju, Donna Spiegelman, Stephanie E. Chiuve, JoAnn E. Manson, Walter Willett, Kathryn M. Rexrode, Eric B. Rimm, Frank B. Hu Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017 Jul, 70 (4) 411-422.
4. Soliman, G.A. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients, 2019, 11, 1155.
5. Heike Wersching, MD, MSc An Apple a Day Keeps Stroke Away? Consumption of White Fruits and Vegetables Is Associated With Lower Risk of Stroke. Stroke Volume 42, Issue 11, November 2011, Pages 3001-3002

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