 Fiber-containing foods may not only help prevent heart disease, but 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 really don't want to have a heart attack in the first place? If 7 grams of fiber gets us a 9% reduced risk, would 77 grams a day drop our risk 99%? Well, that's what they used to eat in Uganda, a country in which coronary heart disease, our number one killer, was almost non-existent. Heart disease was so rare among those eating these traditional plant-based diets. There were papers published like this. A case of coronary heart disease in an African? After 26 years of medical practice, they finally recorded their first case of coronary heart disease in a judge consuming a partially westernized diet, having fiber-free foods like meat, dairy, and eggs displace some of the plant foods in his diet. Were there so few cases because Africans didn't live very long? No. The overall life expectancy was low because of diseases of childhood, like infections. But when they reached middle age, they had the best survival, thanks in part to our number one killer being virtually absent. Of course, now diets have westernized across the country, and it gets to now be their number one killer as well, from virtually non-existent to an epidemic. Some blame this change on too much animal fat. Others blame it on too little fiber, but they both point to the same solution, a diet centered around unrefined plant foods. In fact, sometimes it's easier to convince patients to improve their diet by eating more of the good foods to kind of crowd out some of the less healthy options. The dietary fiber hypothesis first proposed in the 70s zeroed in on fiber as the dietary component that was so protective against chronic disease. And since then, evidence has certainly accumulated those who eat lots of fiber appear protected from several chronic conditions. But maybe fiber is just a marker for the consumption of foods as grown, in whole, unprocessed plant foods, the only major source of fiber. So maybe all these studies showing fiber is good are really just showing that eating lots of unrefined plant foods are good. Fiber is just one component of plant food, and to neglect all the other components, like all the phytonutrients, may be to seriously limit our understanding. Why did Drs. Birkitt, Troll, Painter, Walker, the fathers of the fiber theory place all their bets on fiber? Well, one possible explanation for this is that they were doctors, and we doctors like to think in terms of magic bullets. And that's how we're trained, you know, like one pill, one operation. There 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. Birkitt saw a disease rate 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, his top recommendations was eat whole grain bread, but they never used to eat any kind of bread in Uganda, and sprinkle some spoonfuls of wheat bran onto your food. But 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's not at all clear whether fiber consumed as a supplement is beneficial. In retrospect, maybe it was a mistake to isolate fiber from the overall field of plant food nutrition. The evidence supporting the value of fruits, vegetables, whole grains, as opposed to only fiber, has proved to be much more consistent. Plant whole foods are what's of fundamental importance in our diet. Fiber is just one of the many 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 Birket and others had instead emphasized 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 leads people to shop in this aisle for their fiber, instead of this aisle.