Very good article on Grauniad on high fibre diet for a healthy heart: theguardian.com/lifeandstyl...
Diet for a healthy heart: Very good... - British Heart Fou...
Diet for a healthy heart
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HB-HB
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I was just reading that exact same article. Incidentally, different newspapers are quoting different parts from the original press release, so the more newspapers you read the fuller the account that you'll get, as well as The Guardian I'd also suggest these two,
independent.co.uk/news/heal...
telegraph.co.uk/news/2019/0...
One of the things that really struck me was how difficult it is to eat the recommended 30g of fibre a day. A regular portion of All Bran only gives 11g of fibre. So you'd need a serving of All Bran, five portions of fruit and veg, two slices of wholemeal bread, and a jacket potato to hit that daily target! In fact one of the newspapers points out that it would be virtually impossible to reach 30g of fibre on a low carb diet without taking supplements.
It all just adds to the dilemma that many of us on this forum face. Heart disease (atherosclerosis) is a progressive disease, so unless we do something it'll just keep on coming after us until it proves fatal. Medication is part of the answer, but for most of us we'll also need significant lifestyle changes, of which diet is a (some would say "the") key constituent.
But which diet do we choose?
The default Mediterranean diet option endorsed by the BHF and the NHS? Or do we go low carb/Keto (and if we do is that with or without intermittent fasting?), or should we choose plant based/Vegan? Or now there's this new option of high fibre, is that our best choice?
And then hovering above all these options is the view (supported by some really solid science) that before you can confidently pick a diet you actually need to know which variant of the Apo E gene you carry, which is a really interesting idea, except gene testing isn't widely offered on the NHS, so it would take a £600 private DNA test to fully untangle your genetic dietary predispositions.
It's certainly not easy!
I'm currently on about 90% whole foods, plant based. I cheat with some full fat milk for my porridge, a little cheese here and there mainly as a seasoning and once a week or less some oily fish or some chicken. I only use minimal amounts of good quality oil. Seeds and nuts are also regular ingredients. I also fast most days till at least noon or sometimes later. And this works for me so far, it feels right.
I'll have blood test done in couple of months and hopefully they'll show some good results which may get me off some medication (there's hope). If not improved, I was going to try low carb but wasn't looking forward to that. This diet, with lots of veg and wholegrain and occasional treats, suits me really well.
Thanks for your post. This is an interesting study as I have heart disease and my wife is on the low carb diet albeit she supplements her fibre intake by eating a green banana every day which she has read contains significant soluble fibre. For me I eat porridge oats, flaxseed and chia seed for breakfast every morning so probably get 30g fibre from this.
That's the thing, a lot of people *think* they eat enough but they don't. One green banana only contains 3g of fibre and a 40g portion of porridge oats contains about 4g of fibre. You'd need to eat 10 portions to make 30 grams. As Chappychap said - not easy. Check this article if interested: theguardian.com/society/201...
Hi HB HB. Yes I agree and had mentioned this to my wife that she wasn’t getting enough fibre from 1 banana; however 80% of a green banana is resistant (insoluble) starch which has the same effect on gut bacteria as fibre.
Hi hb hb, I’ve just looked at the fibre in the breakfast I’ve been having and it is indeed 30g.
I eat approx 50g chia seed (16.5) 30g ground flaxseed (7) and 70g of oats (6.5) fibre total in brackets. The chia seed and organic ground flaxseed are £5/kg and £8/kg respectively in Costco.
Hi Stu888, I must say that sound like a huuuuge breakfast. I can't imagine eating 50g of chia and 30g of flax. Even that abount of oats (70g) is a double what I'll have. I'm not religious of trying to get those 30g of fibre, I just eat what seems right. I also fast most days and when I eat it's mostly veg, bread, potatoes, whole grain, beans and pulses. Very low fat.
Like every study on diet, I'm taking this one with a pinch of salt, they've been wrong before. We are all different and not everyone requires the whole 30g. What I eat now is a lot different to what I used to eat (too much meat, eggs, dairy and fat), I largely quit alcohol, stopped smoking (18 months ago) and took on exercise (3 months ago, after stenting). I've lost about 15 kilos since last summer and I run 5K most days, sometimes 10K. This is working for me so far. In couple of months I should have some tests done and will find out the figures on cholesterol and if all is good, I'll just carry on because I like it.
Yes to be honest I have been eating this huge breakfast for the past 2 years for the omega 3 content and had not even thought about the fibre aspect.
I can’t say it’s done me any good as I have developed ischaemia due to a possible increase in blockage in my OM2 artery which now may require stenting.
To be honest my thoughts are that you can do as much positive steps as possible for your health but there’s always something that will take you by surprise.
My way of thinking is to consume what I think is right food in smallest possible quantities. That is not always little but I'm trying not to over eat. I also don't want to starve so there's balance. I don't want to count grams of fibre and I know by not using so much fat (already not eating meat, eggs, etc), my calorie intake is lower than before and I can see that on the scales as I'm still losing weight at about a kilo per week. I still need to shave off about 5 kilos to be in the green BMI but the most important thing is I feel great. You are right, something else can take me by surprise but I don't want to dwell on that.
In heart mag says bens pulses eat white fish 1 a week beans 3x a week eggs 3x a week. I was told eggs keep yr cholesterol down mine is 2.6 which dr says is excellent that's got to be due to having eggs as I wouldn't eat eggs since days of edwina curry saying they're bad for you.
My cholesterol was down to 2.8 and I had a good ldl/hdl ratio but my artery blockage may now be worse just under 2 years later. Nutrition once you’ve had a heart problem is a minefield as there is so much advice out there that’s often contradictory. Probably like hb hb says eating the right foods in small quantities may be the best way forwards.
Goodness me. I do try and eat healthy. why does nobody (Drs etc) warn you of this.
Can you explain apo E ? Did it influence your decision ? I am following hybrid of vegan no oil and mediterranian
I haven't actually made any decision, I'm only 12 weeks post bypass surgery and I'm currently treading water with the NHS and BHF recommended Mediterranean diet while I evaluate all the main diet options.
But the more I dig into the question of which diet is best, the more I keep concluding the question is really "which diet is best FOR ME". Because what works for you may very well not work for me.
That critical fact, that we're all different when it comes to how we metabolise food, seems to get constantly overlooked in almost all diet discussions. Which seems a bit daft given that we all know that the vast majority of Europeans and Middle Easterners can happily digest dairy products, where as the vast majority of the rest of the world's population are lactose intolerant and can not. So we go into this debate already knowing that we're all profoundly different, but then we immediately seem to forget that fundamental fact!
In the context of heart disease diet one particularly important gene is Apolipoprotein E, often shortened to "Apo E". The Apo E gene comes in three variants, and you'll inherit one of these three from each of your parents, so there are six possible combinations. For research purposes these six combinations are often simplified down to three groups, known as Apo E2, Apo E3, and Apo E4.
Each of these three groups will react differently to the carb/fat balance in their diet. The Apo E3 group, which represents about 65% of the population, is fairly neutral and thrives on a Mediterranean type diet but can tolerate a fairly wide range in dietary fat levels. The Apo E2 group is about 10% of the population, they will actually do best with a higher level of fat in their diet and surprisingly this group will even have a better lipid profile on a slightly higher fat diet. The third group, Apo E4, is about 25% of the population and they are the opposite. They do best on a very low fat, plant based diet, and can tolerate plant based carbs much better.
Sounds good, but there's an obvious problem. How do you find out which ApoE variant you have?
Apart from certain very specialised cases, the NHS will not fund your genetic testing. So you're left with private alternatives. These vary from the cheap and cheerful (for example "23and me" occasionally do special offers on their health gene testing package, this is pretty basic but for about £40 it will at least tell you if you're an Apo E4 carrier or not), up to the very comprehensive (for example for £600 Nuffield Health offer a cardiac related DNA testing service that analyses over 30 genes critical to cardiac health and gives you a personalised diagnostic report).
When I talk to previous work colleagues of mine in the US (or at least the ones who enjoy particularly generous health insurance packages!), they're astonished that genetic testing isn't a standard component of my cardiac care. As far as they're concerned it's critical in shaping all sorts of decisions, including fairly basic things such as what type of statin will work best for each individual. I also understand that the medical director of the British Heart Foundation (the sponsors of this forum) is a strong advocate of gene testing, saying that if it was more widely performed then the costs would tumble to just a few pounds per patient and the results would massively improve care effectiveness.
I'm sure that things will change, and our children will benefit from a much more tailored approach to heart care. But for us the reality is either put your hand in your pocket and pay for private gene testing, or get the care regime based on Mr and Mrs Average rather than one designed for you as a unique individual.
great information and insight for me . I wonder why bhf or aha does not bring in this apo E factor while recommending best diet .. still recommendation is for low fat diet which is convenient to 25% population
That is very interesting. So, a £40 could get you to know at least if you are carrier Apo E4 and if yes, you are done? If not, you are 50% to be either Apo E2 and Apo E3 and if with heart disease, most likely to be Apo E3 (65% of population) before any particular dietary change.
One could than go on a higher fat diet for a while and if lipids improve, they can be pretty sure they are Apo E2 type. That's how is done on the cheap. 
The Predimed trial was retracted only because of flaws in the randomisation process. Most diet trials are observational - one of the reasons Predimed was so important was that it was a randomised trial - the 'gold standard' of evidence. However it was later discovered that one clinic did not randomise patients, and that where patients were in the same family only the first patient was randomised. Because of this the trial was retracted, and re-analysed without the flawed data. The trial was then re-published with the new analysis. Importantly, the conclusions were the same and it is still the best evidence we have.
The other point to be made was that none of the Predimed diets were high in saturated fat. The fat was monounsaturated from extra virgin olive oil and nuts.
The Apo E diets are the usual diet book / youtube guru jumping on the bandwagon based on mangled science and the sort of 20 people and 10 mice 'evidence' that is useless.
Reading University has done extensive research on the Apo E gene and diet and heart disease. The point they make is that the variants in the gene affect risk of heart disease by affecting the body's response to saturated fat and the associated rise in LDL cholesterol.
Apo E2 is associated with a lower risk of heart disease as the rise in LDL is smaller.
Apo E3 (the most common) is average response and risk
Apo E4 increases the body's rise in LDL in response to saturated fat, and therefore the risk of heart disease is raised by 30-40% compared to E3. It certainly doesn't mean that those without this variant would be advised to eat more fat - lower LDL reduces cardiovascular risk for everyone.
The gene helps to explain why a family history of heart disease is a strong risk factor, and how two people can have the same diet but different LDL levels.
But it is really irrelevant on this forum as anyone with heart disease is high risk already - hence the Bhf advice on lowering LDL as much as possible with high-dose statins and avoiding saturated fat.
You don't need to know your Apo E gene but you do need to know your LDL .
Reading University also found that ApoE4 patients also had low antioxidants and therefore need to pay particular attention to fruit and vegetable intake.
The Apo E4 gene is thus a risk factor that makes it particularly important to follow the usual consensus of a healthy diet, which as the NHS, BHF, AHA, ACC all agree is low in saturated fat, sugar and salt and high in fruit, vegetables and wholegrains - whatever Apo E gene you have.
I strongly suggest following the bhf guidance rather than random individual doctors/ nutritionists / people with something to sell / on the web.
Science works best by consensus and a team approach - and by real evidence-based science, not the diet merchants spinning it to sell their merchandise.
Thanks for insight.Do you have the article link of apo E theory you have explained?
reading.ac.uk/web/files/rea...
As you see, Apo E4 is a risk factor associated with higher heart disease through LDL
Apo E2 is lower risk , but this does not mean eating a high fat diet is good for them - merely that it is less dangerous! It is extremely unlikely that anyone with established coronary heart disease is E2.
While the research is interesting it is really irrelevant here. It is just depressing to see how the science is twisted by people who want to make money. Stick to the BHF advice!
Absolutely brilliant. Didn't know about the above but when I've read it it's great. Thank you.
You write linking the articles which is very interesting. As a woman having had a heart attack gene testing would benefit hugely especially as we are generally treated as “little men” our drug regime is identical despite often being half the size! I’ve just finished reading the linked articles and will keep an eye open for specials on the gene testing. My cardiologist when discussing this had said he called upon his registrars (both women) and that things were changing. In 2021 this is a welcome sign.
I was really concerned about the BBC coverage on this. They kept referring to 'carbs'. I don't believe they were making it clear enough that the research was on the fibre element of carbs. Stop the 'useless' carbs and just eat the wholegrain type. Even the supposed dietitian didn't state clearly the difference between these. However, I agree it's difficult to eat 30g fibre in a day even with quite healthy eating.
Yeh, carbs make a comeback! I agree that it's difficult to hit the recommended 30g benchmark. I've been following a diet primarily to lose weight which I'm hoping will make an improvement to my overall health. It could be called the everything in moderation approach (apart from sugary carbs). I don't reckon I get near 30g of high fibre carb. If I ate what Chappychap is suggesting you need to get to 30g plus protein and fats I would never lose weight. The article doesn't seem to factor in protein etc. Is the recommendation for high fibre, low protein?
I take tbs of mixed seed (incl flax, sunflower, pumpkin, linseed, etc) with my porridge and I eat whole meal bread which I make myself with mixture of good flours, beans, pulses and all sort of other vegetables, starchy and otherwise. I also exercise quite a bit and I'm losing weight, feeling great in general. I'm on low fat, mainly plant diet - about 90%. I cheat a little.
I've got mixed views about the PREDIMED study. What you may not be aware of is the entire study was recently retracted because of faulty statistical procedures!
However, even though PREDIMED's reputation was badly damaged, I don't want to throw the baby out with the bathwater. I've read the re-issued report, following the procedural corrections, and the bottom line is it still delivers solid evidence endorsing a Mediterranean diet.
But there's a critical point here, one that you'll find over and over again in medical studies. Let's say you're testing a new drug, you have two groups of patients both with disease X. One group of 100 people has this new drug and the other group of 100 people has a placebo. At the end of the test five people in the group who took the drug have died, but in the group who took the placebo ten people have died.
So that means the new drug is a winner, right? Well, maybe. It might be that the new drug actually saved not five lives, but ten lives. However, it also effectively killed a separate five people, yet overall it still came out ahead. An even better result would have been possible if we could have identified in advance those five people for whom the new drug was toxic, and kept them out of the trial.
Medical diet research is a lot like that, and if you read my previous post regarding the Apo E gene it's very easy to understand why. About 65% of the population will do really well on a Mediterranean diet, but about 25% of the population would do better on a plant based diet, and about 10% of the population would do better on a slightly higher fat diet.
So let's say you take 100 random people who currently have a higher fat diet and you put them on a Mediterranean diet. Overall those 100 people will become healthier with a reduced mortality rate. That's great, except for the fact that 10 of those people will become less healthy.
The GOOD solution to this problem is for everyone to eat a Mediterranean diet, the BEST solution is for everyone to eat the diet optimised for them as individuals.
The NHS doesn't currently have the resources to always pursue the BEST solution, so it does the next best thing and recommends a GOOD solution. The more you dig into medical research and medical practise the more you find the same thing happening over and over again. For example, if we stay with the impact of genes on cardiac care, there are two variants of the KIF6 gene. If you have one variant then the statin Lipitor will have only a minimal effect on your lipid levels. However, the majority of the population have the other variant, so Lipitor works just fine. Taken across the general population Lipitor is a good thing. But I'm not the general population, I'm me, and therefore I'd prefer a drug that I know is working for me!
See my earlier reply!
The Predimed trial has been reanalysed and republished with the same conclusions.
The ApoE4 is a risk factor.
ApoE2 gene is lower risk for heart disease, but that certainly does not mean that they should eat a high fat diet - it's just that if they do, they are less likely to get heart disease.
There is no Apo gene diet - it's just people at high risk for heart disease must be particularly careful to keep their LDL low.
This study cannot conclude: "Eating more fibre will cut people’s chances of heart disease and early death."
It can infer that healthy people eat more fibre.
Picture the person who eats 0g vs 30g fibre daily.
The @guardian should be wiser to deprivation.
Dr. Zoe Harcombe, PhD
I have not seen the article but I have seen one on BBC.
Could this be the latest desperate attempt to cut the NHS spending on obesity-related care? I do wonder.
"The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year."
gov.uk/government/publicati...
The second link is somewhat older.
england.nhs.uk/2014/09/seri...
This "pro-fibre" diet does take back to the Okinawan model in Blue Zone where complex carbs are eaten with a small amount of protein/fats. But they live in an unpolluted paradise.
I will try to spend time and look through the file by the PHC which Concerned kindly posted on another thread.
Nutrition is so complicated i.e. age groups, portion control, the optimum time to consume which key nutrients (both macro and micro), am I getting enough antioxidants or am I doing it a wrong way? Is medium chain triglycerides worth "investing" to promote cardiac health etc?
Also, it's been debated on another hub that these "fibre-promoting" "eat this, eat this a lot and not that" news can be funded by the certain food industry.
I have had nutritionists in the past. I am no obese and non-smoker (and CVD runs in my family). The fact is that as we grow into middle/older age, our gut may get also weaken. An age-related adjustment would be definitely necessary.
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