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The Heart Health Benefits of Dietary Fiber

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The Heart Health Benefits of Dietary Fiber Conclusions. Heart disease continues to be one of the most factors for cardiovascular disease, including blood pressure, weight, widespread health problems in the United States. Fortunately, it is and glucose levels. Not all fibers provide the same cardiovascular ™ also among the most preventable health problems. To that end, benefits; however, and differences among the various types of fibers Expert Views Americans are encouraged to adopt heart-healthy habits, which should be appreciated when choosing a fiber supplement. Psyllium include a healthy diet and regular exercise.7 In addition to being an and oat fibers are the only fibers that have been recognized by the GI HealtH & Wellness | Issue four | february 2011 important part of a healthy diet, dietary fibers provide a number of FDA for their cholesterol-lowering and cardiovascular benefits, while cardiovascular benefits. The cholesterol-lowering benefits of certain other fibers such as calcium polycarbophil are indicated for their fibers (psyllium and oat fibers) as adjunct to a low-fat diet are well- laxation effects. An understanding of these differences should allow features: the heart health benefits of recognized and have been demonstrated in numerous well-controlled physicians and patients to tailor their choice of dietary fiber and fiber trials. Further, dietary fibers have beneficial effects on other key risk supplements to better meet their individual health goals. One dietary fiber CHD Prevalence february Is amerIcan Heart HealtH montH Cholesterol Lowering Benefits Heart disease remains the leading cause of death in the United States, with someone dying from a Two heart-related event every 34 seconds.1 Cardiovascular disease accounts for over 20% of reported cases of Postprandial Glucose chronic diseases in America, surpassing other major chronic diseases such as pulmonary conditions (17.4%), Weight Control diabetes (4.9%), mental disorders (10.7%), and cancer (3.7%).2 Nine out of ten patients with heart disease Daily Fiber Requirements have at least one risk factor for heart disease, with about 1 in 6 Americans reported to have high cholesterol (ie, hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. total cholesterol >240 mg/dL)3 and 1 in 3 having high blood pressure.4 In addition, obesity—a major risk factor 2000;71:472-479. Three references for heart disease—has increased dramatically during the past 20 years in the United States, with only two states 1. Centers for Disease Control and Prevention. Heart disease fact sheet. 13. Moreyra AE, Wilson AC, Koraym A. Effect of combining psyllium fiber with Not All Fibers Are Created Equal currently having a prevalence less than 20%.5 Available at: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_ simvastatin in lowering cholesterol. Arch Intern Med. 2005;165:1161-1166. Health Benefits Vary By Fiber disease.htm. Accessed November 7, 2010. 14. Moreyra AE. Personal communication. Practical Considerations In an effort to raise awareness about heart disease and encourage Americans to adopt healthier lifestyles, 2. Milken Institute. The economic burden of chronic disease on the United 15. Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol- For Fiber Supplementation February has been proclaimed American Heart Month.6,7 In keeping with these goals, dietary fibers are lowering effects of psyllium as an adjunct to diet therapy in the treatment of States. Available at: http://www.chronicdiseaseimpact.com. Accessed Four increasingly recognized for their heart-healthy benefits, which include proven cholesterol-lowering effects as well November 30, 2010. hypercholesterolemia. Am J Clin Nutr. 2000;71:1433–1438. as beneficial effects on key risk factors such as weight and glucose levels.8,9 3. Centers for Disease Control and Prevention. Cholesterol fact sheet. Available 16. Ziai SA, Larijani B, Akhoondzadeh S, et al. Psyllium decreased serum Conclusions The insights of Abel Moreyra, MD, Professor of Medicine, Division of Cardiology at UMDNJ-Robert Wood at: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm. glucose and glycosylated hemoglobin significantly in diabetic outpatients. Johnson Medical School of New Brunswick, New Jersey are featured in this publication. Accessed November 7, 2010. J Ethnopharmacol. 2005;102:202–207. 4. Centers for Disease Control and Prevention. Blood pressure fact sheet. 17. Landin K, Holm G, Tengborn L, Smith U. Guar gum improves insulin Dr. Moreyra is a Fellow of the American College of Physicians and the American College of Cardiology and he Available at: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_ sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. is a member of the American Heart Association. He has authored over 70 peer-reviewed publications, and has bloodpressure.htm Accessed November 7, 2010. Am J Clin Nutr. 1992;56:1061-1065. conducted research using fiber supplementation in the management of hyperlipidemia. 5. Centers for Disease Control and Prevention. US obesity trends. Available 18. Position of the American Dietetic Association: Health implications of at: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm. dietary fiber. J Am Diet Assoc. 2002;102:993-1000. Accessed November 7, 2010. 19. Institute of Medicine of the National Academies. Dietary reference intakes: dietary fiber and cardiovascular health 6. American Heart Association. American Heart Month. Available at: macronutrients. Available at: http://iom.edu/Reports/2002/Dietary-Reference- http://www.americanheart.org/presenter.jhtml?identifier=4441. Accessed Intakes-for-Energy-Carbohydrate-Fiber-Fat-Fatty-Acids-Cholesterol-Protein- CHD Prevalence. Epidemiologic studies over the past several decades have associated high levels of dietary November 23, 2010. and-Amino-Acids.aspx. Accessed November 24, 2010. fiber intake with a lower prevalence of coronary heart disease (CHD).9 A review of seven prospective cohort 7. The White House. Office of the Press Secretary. Presidential 20. United States Department of Agriculture. Dietary Guidelines Advisory studies demonstrated that the prevalence of CHD was 29% lower among persons with the highest dietary fiber proclamation-American Heart Month. Available at: http://www.whitehouse.gov/ Committee. Report of the Dietary Guidelines Advisory Committee on the intake compared with those with the lowest intake.9 the-press-office/presidential-proclamation-american-heart-month. Accessed Dietary Guidelines for Americans, 2010. Appendix E-1: Major conclusions: November 24, 2010. Section 1: Energy balance and weight management. Available at: Faculty Cholesterol Lowering Benefits. Recognizing low-density lipoprotein (LDL)-cholesterol, and serum 8. Anderson JW, Allgood LD, Turner C, Oelgten PR, Daggy BP. Effects of http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/ Abel Moreyra, MD the scientific evidence supporting the cholesterol- ratios of apolipoprotein (apo) B to apo A-I beyond psyllium on glucose and serum lipid responses in men with type 2 diabetes E-Appendix-E-1-Conclusions.pdf. Accessed November 30, 2010. lowering benefit of viscous soluble fibers, the U.S. reductions seen with low-fat diet only.12 Psyllium and hypercholesterolemia. Am J Clin Nutr. 1999;70:466–473. 21. Park Y, Hunter DJ, Spiegelman D, et al. Dietary fiber intake and risk of Professor of Medicine 9. Anderson JW, Baird P, Davis RH, et al. Health benefits of dietary fiber. colorectal cancer: a pooled analysis of prospective cohort studies. JAMA. Division of Cardiology Food and Drug Administration (FDA) has authorized did not significantly lower high-density lipoprotein Nutr Rev. 2009;67:188-205. 2005;294:2849-2857. UMDNJ-Robert Wood Johnson the use of a health claim in the labeling of foods and (HDL)-cholesterol or triglycerides. Similar reductions 10. Food and Drug Administration, US Department of Health and Human 22. Anderson JW. All fibers are not created equal. J Med. 2009;2:87-91. Medical School dietary supplements containing psyllium (and oat) in cholesterol have been found in high-quality Services. Code of Federal Regulations, Title 21, Volume 2, Section 101.81. 23. National Fiber Council. Fiber and your heart. Available at: New Brunswick, New Jersey fibers regarding the potential for these fibers to controlled studies with oat fibers.8,9 In one 12-week, Health claims: Soluble fiber from certain foods and risk of coronary heart http://www.nationalfibercouncil.org. Accessed November 23, 2010. reduce the risk of heart disease.10 Indeed, many controlled study, the addition of psyllium to a low disease (CHD). Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ 24. Pastors JG, Blaisdell PW, Balm TK, Asplin CM, Pohl SL. Psyllium fiber dose of simvastatin (10 mg) achieved the same LDL- reduces rise in postprandial glucose and insulin concentrations in 13 patients short-term (4-8 week) controlled trials have shown that cfcfr/CFRSearch.cfm?fr=101.81. Accessed November 23, 2010. Supported by 11. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol lowering effects with non-insulin-dependent diabetes. Am J Clin Nutr. 1991;53:1431-1435. dietary fiber intake, in conjunction with low-fat diets, cholesterol and apo B-lowering effects as doubling the 25. Sierra M, Garcia JJ, Fernandez N, et al. Therapeutic effects of psyllium 11,12 simvastatin dose in 68 patients who met the National of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69:30–42. Personal Health Care reduces
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