Does consuming a high fiber diet decrease the risk of Cardiovascular Disease?

Alessandra Neal
3 December 2014

Introduction
Cardiovascular disease is the number one cause for mortality and morbidity in the United
States today.1 Cardiovascular disease (CVD) occurs when there is an excess buildup of plaque in
the walls of the blood vessels.2 Plaque is primarily composed of lipids and also has a fibrous
cap.2 It forms when blood vessel walls and the components in the blood interact with each other
(also inflammation at those interactions plays a large role). Too much plaque in the vessels
interferes with the blood flow to and from the heart. When passing through the plaque buildup,
blood flow slows because it is running into speed bumps that line the walls of the vessel
preventing the bloods normal fast fluid motion. In certain situations the plaque can break off of
the vessel wall and cause a blockage of blood flow, this is referred to as atherosclerosis.
Peripheral vascular disease, Congenital heart disease, Cerebrovascular disease,
Rheumatic heart disease, Coronary heart disease, and hypertension are all components of
Cardiovascular disease and together they can influence or affect one another. These diseases
typically depend on which type of vessel is being affected by the plaques or other abnormal
activities. For example Cerebrovascular disease is what occurs when the brain does not receive
its normal blood supply due to blood vessel malfunction and cause parts of the brain to become
dysfunctional.
Smoking, high blood pressure, high cholesterol, obesity, lack of physical activity,
improper diet, family history, and/or age are many of the risks that can lead to Cardiovascular
Disease.1 In turn these risk factors are influential with one another as well. If an individual is
obese and a smoker, the likelihood of developing heart problems increases due to an increase in
blood pressure, glucose intolerance, lipid concentration, blood vessel damage, and low oxygen

delivery to the heart because of the nicotine.2 This example illustrates that an individual may be
increasing their risk of developing Cardiovascular Disease through their daily actions. Some may
be totally unaware that they may be heading down a path towards the development of
cardiovascular disease. Individuals need to be aware of the severity of this condition and
implement lifestyle changes to decrease this risks associated with this disease.
Fiber, a possible solution to decreasing the risk of Cardiovascular Disease, is suggested
by many health professionals to consume in ones diet because of the many benefits it has on
health. Fiber is classified into two groups: soluble and insoluble.1 Soluble fibers (water soluble)
function by insulating and coating the inside walls of the intestines by acting like a gel so they
are able to hook onto bile that contains cholesterol and also trap toxins that flow through the
intestines.1 Examples of soluble fibers include oatmeal, nuts, seeds, legumes, apples, pears, and
berries. Insoluble fibers (insoluble in water) function to maintain the pH of the intestine and
mainly act as bulking agents meaning that they are not absorbed in the intestine like soluble
fibers are so they act as an escort out of the body, also relieving constipation.1 Whole grains,
barley, couscous, brown rice, wheat bran, carrots, zucchini, celery, or any skinned vegetable are
examples of insoluble fibers. The intake of fiber is dependent on age, gender, and energy intake.3
The recommended daily intake of fiber for women is 25 grams and for men it is 38 grams, and
over the age of 50 the recommended amount decreases slightly.1
Research Comparison
At one point Coronary Heart Disease was a leading killer in the 2000s and it was
discovered that in reducing the risk of CHD mainly reflected on diet changes. In a Cohort Study
example, high fiber diets demonstrated a comparison between a high consumption of dietary

fiber and a lower consumption of dietary fiber, that individuals that followed the higher fiber diet
were at a lower prevalence of Coronary Heart Disease (CHD).3 In this study, whole grain
consumption and dietary fiber were the main components observed in over 150,000 participants.3
The conclusion section of this reviewed article, stated that this cohort study was not strong. The
reasoning for this is because there is no known evidence about cause and effect. A randomized
control trial is needed to give this information strength and add value to what was stated.
In a 14 year prospective cohort study, 58,730 Japanese individuals of both races were
enrolled in a study that involved health check-ups and questionnaires before research was
performed for accurate results that were not biased.4 The participants were administered a
questionnaire for the consumption frequency of 40 food items.4 This analyzed total dietary fiber,
soluble fiber, insoluble fiber, cereal, fruit, and vegetable fibers consumption. Men and women
that had a high total dietary fiber showed a lower mortality from CVD and overall total CVD.4 A
decreased risk of Coronary Heart Disease in Japanese individuals was noted due to consumption
of both types of fiber, including the fiber from fruits and cereals.4
Pereira MA, O'Reilly E, Augustsson K, analyzed cohort studies to determine their results
and effects on Coronary Heart Disease. This study had a large sample size and 6-10 years of
following participants. This demonstrated an association between fiber and the risks of CHD
with whole grains, fruit and cereal being the strongest influencers on the decrease in risk. This
study was important to review because it determined the necessity of consuming both soluble
and insoluble fibers to provide the most beneficial impact.5
In another study that supported dietary fiber positively impacting heart health, 19,750
participants took part in a cross-sectional cohort by filling out a questionnaire to measure the

total dietary fiber consumption.6 Three dietary patterns were examined: fried vegetables and
salad, rich in red meats and low in dairy and fruits, and fried foods, sugared beverages, and white
breads. The diet rich in vegetables and salad demonstrated the most significance to health by
having low blood pressure levels and high HDL-cholesterol concentrations.6
A cross sectional study similar to the study by Van Dam also studied food patterns of
individuals through lifestyle questionnaires. A healthy cluster was formed out of five clusters
(healthy, sweet, coffee, traditional, fast energy) that contained individuals who consumed more
fiber, low fat foods, and a lower consumption of sugars and alcohols. The findings stated the
consumption of dietary fiber resulted in lower rates of triglycerides and higher amount of HDLcholesterol in the body.7
In a meta-analysis individuals were grouped into how many servings per day they
consumed of fruits and vegetables based off of several studies: less than three servings, range of
three to five servings or more than five servings.8 Fruits and vegetables have a high nutritional
value of fiber along with many vital nutrients. This fiber study was also compared to the
Coronary Heart Disease prevalence risks. Within this study, 13 cohort studies were thoroughly
examined utilizing large sample size and long periods of participant involvement or follow up
providing better accuracy.8 The meta-analysis resulted in support of high consumption of
vegetables and fruits positively affecting heart health. The increased consumption or servings of
fruits and vegetables concluded a lower risk of Coronary Heart Disease. The group of 5 or more
servings per day resulted in the most significant results for ones heart health.8

Analysis and Conclusion

In comparison of the study examples listed above dietary fiber demonstrated it assisted in
reducing the risks of Cardiovascular disease and its components. The Majority of the research
findings supported the statement that increasing the consumption of fiber in the diet helps reduce
inflammation, oxidative stress that occurs from free radicals, decreasing the bad LDLcholesterol and increasing the good HDL-cholesterol, and triglycerides in the body.8 Some of
the strengths in these studies were the large sample sizes and extended participant follow up.
Cohort studies are very prevalent in research methodology of this topic. These types of
studies are more observational, utilizing questionnaires, and therefore less experimental. They do
provide a generous amount of information on the study as a whole; however this type of study
can be questioned. Limitations of cohort studies: not knowing fully if the participants completely
followed what was asked, sometimes lacking evidence because of loss of follow-ups, or presence
of confounding factors. Implementation of randomized control trials or meta-analyses would
provide more randomization, controls, and causes for why those results occurred and the
mechanisms involved.3
Concluded from King DE and Player M, this topic should be left ongoing because of the
need of confidence and validity.9 The subject of nutrition is controversial and so many studies are
performed on various topics that all vary in conclusions. Because of this, further research is
needed to secure a definitive answer for how fiber affects the heart. Stronger studies are
suggested to be administered that provide better control on the confounding factors to determine
more accurate results.

This research comparison has concluded that fiber beneficially affects the risks of
Cardiovascular disease by decreasing the prevalence for this disease. Fiber is understood to
affect the body by increasing the secretion of bile acids, lowering energy intake, decreasing some
fatty acid production; increasing the amount of antioxidants, as well as providing the body
vitamins and minerals.10 These beneficial actions in turn will impact the risks of cardiovascular
disease and hopefully along with other healthy actions like exercising, improving overall healthy
eating, receiving enough rest, and remaining in a positive state should lower some risks for
disease. Register dietitians currently advocate that fiber should be present and increased in ones
diet to promote overall health.

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