Heart Disease Death Rate Drops with Each Added Fruit and Veggie Serving

According to new research from the University of Oxford, UK, increasing your diet with fruits and vegetables from 5 a day to 8, isn’t just good for your waistline — it could save your life….

While “5 a day” has traditionally been the mantra for fruit and veggie consumption, researchers found that those who consumed eight or more servings were 22 percent less likely to die from heart disease than those who consumed three or fewer servings a day.

Even among those who couldn’t manage the eight servings, more fruits and veggies consistently meant a lower risk; for every additional serving above two per day, researchers observed a four percent decrease in the rate of heart disease deaths.

Though past studies have linked the consumption of fruit and vegetables to heart health, many remain skeptical as to whether these foods have a direct protective effect on the heart. Given the size of the study (over 300,000 participants from eight different European countries) and the strength of its findings, some doctors feel that it may erase any remaining doubts concerning fruits and veggies, and cardiovascular health.

Dr. Randall Zusman, director of the division of hypertension at Massachusetts General Hospital noted that, “This is probably the largest study of its type and should convince even the greatest skeptic of the value of fruits and veggies.”

“This compares ‘enough’ fruit and vegetable intake to ‘more than enough’ and suggests that ‘more than enough’ is better,” said Dr. David Katz, director of Yale University’s Prevention Research Center. This could have big implications considering that the U.S. population “doesn’t even approximate the ‘enough’ target” as it is. The long-term study was published and set up to track the effect of vegetable and fruit intake on cancer.

In the U.S., the recommended consumption of fruits and vegetables has often been promoted as “five a day.” The Centers for Disease Control and Prevention moved away from that recommendation in 2007, to a more flexible approach, dubbed “Fruits & Veggies – More Matters.”

Instead of a flat recommendation of five servings a day, the new program changes recommendations based on age, sex and activity level. For a 40-year-old sedentary man, recommendations are now two cups of fruits and three cups of vegetables a day; for a sedentary woman of that age, the recommendation is 1.5 cups of fruit and 2.5 cups of veggies.

So what exactly would the eight portions a day observed in the study look like?  A day of eight servings amounts to about 23 ounces. Eating nearly a pound and a half of produce may sound daunting, but put it into real terms and it becomes more manageable:

“A large navel orange can easily weight close to 8 ounces and so does a large apple,” says Carla Wolper with the Obesity Research Center at St. Lukes-Roosevelt Hospital in New York. “That leaves a measly six ounces for salad, string beans, or other vegetables on the dinner plate, so yes people can easily eat this much,” she said.

Considering that the majority of the general population in the U.K. and the U.S. consume fewer than five recommended servings of fruits and vegetables per day, asking for eight may be a bit of a stretch, concedes Dr. Francesca Crowe, lead author on the study.

We all know that fruits and veggies are good for us, but why would eating them prevent death from heart disease?   The evidence points to a number of ways that these foods could work to boost heart health.  It could be that vegetables and fruits contain vitamins, minerals, and antioxidants that are having a specific effect on cardiovascular health, says Dr. Keith Ayoob, associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.

Another possible mechanism “is the impact of fruit and vegetables to lower inflammation, a known mechanism contributing to cardiovascular disease,” adds Dr. Stephen Devries, a preventive cardiologist at Northwestern Hospital. It also may not be what fruits and veggies add to the diet, but what they replace. There’s less room in the diet for the high-fat, high-cholesterol, high-salt foods often associated with increased risk of heart disease when someone is consuming so many fruits and vegetables each day, doctors noted.

This makes for “lower blood pressure (because these foods are salt free), lower cholesterol (because they are fat free), lower weight (because they are likely to be associated with weight loss), [and] lower blood sugar (lower carbohydrate and sugar content),” says Zusman.

“Just by taking up a lot of room” in the stomach, [those] ounces of fruits and vegetables inherent in eight servings “will have a salutary effect vis-a-vis [cardiovascular disease],” Wolper says.   More importantly, there are few if any drawbacks to consuming a good amount of fruits and veggies.

This latest announcement about fruit and vegetable intake comes from an analysis of 313,074 people who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) Heart study. The study started in 1992 and followed individuals for an average of about 8.5 years. A total of 1,636 deaths from ischemic heart disease (IHD), the most common form of heart disease, occurred in this group.

According to Dr. Francesca Crowe of the Cancer Epidemiology Unit at the University of Oxford, she and her colleagues evaluated the data and found “a 4% reduced risk of dying from IHD for each additional portion of fruit and vegetables consumed above the lowest intake of two portions.” That is, people who ate at least eight portions of fruits and vegetables daily had a 22 percent lower risk of dying from IHD than individuals who ate two or fewer portions.

Ischemic heart disease is a general term for heart problems caused by narrowed heart arteries. When these arteries become compromised, they deliver less oxygen and blood to the heart muscle, resulting in coronary artery disease and coronary heart disease, both of which can lead to heart attack.

Although ischemia often causes chest discomfort or pain known as angina pectoris, as many as 3 to 4 million Americans may have painless ischemia (silent ischemia), and thus no warning of an impending heart attack. People with a history of heart attack or who have diabetes are especially at risk for developing silent ischemia.

In the United States, the Healthy People 2010 objectives for fruits and vegetables included targets of increasing to 75 percent the proportion of people older than 2 years who would consume two or more servings of fruit and to 50 percent those who would eat three or more vegetable portions.

Yet according to a recent (September 2010) report from the Centers for Disease Control and Prevention, only an estimated 32.5 percent of adults ate fruit two or more times daily and 26.3 percent consumed vegetables three or more times daily in 2009.

Clearly eating eight or more servings of fruits and vegetables daily is a challenge in the United States. Researchers with the new European study reported that while Europeans averaged five portions of fruit and vegetables daily, people in Greece, Italy, and Spain consumed more and individuals in Sweden ate less.

Although results of this study indicate that eating eight or more portions of fruit and vegetables daily can help prevent dying of ischemic heart disease, Dr. Crowe cautioned that “we are unsure whether the association between fruit and vegetable intake and risk of IHD is due to some other component of diet or lifestyle.”

American Heart Association, Centers for Disease Control and Prevention, Crowe F et al. European Heart Journal doi: 10.1093/eurheartj/ehq465