Fiber-containing foods may not only help prevent heart disease, but also help treat it as well. Heart patients who increase their intake of fiber after their first heart attack reduce their risk of a second and live longer than those who don’t. But what if we don’t want to have a heart attack in the first place? If 7 grams of fiber gets us a 9 percent reduced risk, would 77 grams a day drop our risk by 99 percent? That’s about how much fiber they used to eat in Uganda, a country in which coronary heart disease, our number-one killer, was almost nonexistent.
Heart disease was so rare among those eating traditional plant-based diets in Uganda that papers were published with such titles as “A Case of Coronary Heart Disease in an African.” After 26 years of medical practice in East Africa, doctors finally recorded their first case of coronary heart disease in a judge who consumed a “partially Westernized diet,” in which fiber-free foods, such as meat, dairy, and eggs, displaced some of the plant foods in the traditional diet.
Were there so few cases because Africans just didn’t live very long? No, the overall life expectancy was low because of diseases of childhood, such as infections, but, when Africans reached middle age, they had the best survival rates, thanks in part to our number-one killer being virtually absent. Of course, since diets have been Westernized across the continent, coronary heart disease is now their number-one killer as well, going from virtually nonexistent to an epidemic.
Some blame this change on too much animal fat, while others blame it on too little fiber, but they both point to the same solution: a diet centered on unrefined plant foods. In fact, sometimes, it’s easier to convince patients to improve their diets by eating more of the good foods to crowd out some of the less healthful options.
The “dietary fiber hypothesis,” first proposed in the 1970s, zeroed in on fiber as the dietary component that was so protective against chronic disease. Since then, evidence has certainly accumulated that those who eat lots of fiber appear to be protected from several chronic conditions. But maybe fiber is just a marker for the consumption of foods as grown, whole, unprocessed plant foods, the only major source of fiber. Maybe all these studies showing fiber is good are just showing that eating lots of unrefined plant foods is good. “Fiber is but one component of plant food, and to neglect the other components [such as all the phytonutrients] is to seriously limit our understanding.”
Why did Drs. Burkitt, Trowell, Painter, and Walker—the fathers of the fiber theory—place all their bets on fiber? One possible explanation is that they were doctors, and we doctors like to think in terms of magic bullets. That’s how we’re trained: There’s one pill, one operation. They were clinicians, not nutritionists, and so they developed a reductionist approach. The problem with that approach is that if we reach the wrong conclusion, we may come up with the wrong solution. Burkitt saw disease rates skyrocket after populations went from eating whole plant foods to refined plant and animal foods. But instead of telling people we should go back to eating whole plant foods, he was so convinced fiber was the magic component that his top recommendation was to eat whole grain bread—though they never used to eat any kind of bread in Uganda—and sprinkle some spoonfuls of wheat bran on your food.
However, studies to this day associating high fiber intake with lower risk of disease and death relate only to fiber from food intake rather than from fiber isolates or extracts. It is not at all clear whether fiber consumed as a supplement is beneficial. In retrospect, it might have been a mistake “to isolate fiber from the overall field of plant food nutrition.” The evidence supporting the value of fruits, vegetables, and whole grains, as opposed to only fiber, has proved to be much more consistent. Whole plant foods are of fundamental importance in our diet. Fiber is just one of the beneficial components of fruits, vegetables, nuts, grains, and beans. “Much of the effort on defining fiber and studying the fiber isolate would have been better applied to a whole-plant-food approach.”
What would have happened if Burkitt and others had emphasized instead the value of plant foods? The value of eating unrefined plant food, which incorporates fiber and phytonutrients, might have been the focus of attention rather than just isolated fiber, which led to people shopping for their fiber in the supplement aisle instead of the produce aisle.