Evidence-Based Nutrition

Evidence-Based Medicine or Evidence-Biased?
facebook
tweet
google

Dr. Esselstyn’s landmark study, demonstrating that even advanced triple vessel coronary artery disease could be reversed with a plant-based diet, has been criticized for being such a small study. But the reason we’re used to seeing large studies is that they typically show such small effects. Drug manufacturers may need to study 7,000 people in order to show a barely statistically significant 15% drop in ischemic events in a subsample of patients. Esselstyn achieved a 100% drop in those who stuck to his diet, all the more compelling considering that those 18 participants had experienced 49 coronary events (like heart attacks) in the eight years before they went on the diet. These patients were the sickest of the sick, most of whom having already failed surgical intervention. When the effects are so dramatic, how many people do you need?

Before 1885, a symptomatic rabies infection was a death sentence, until little Joseph Meister became the first to receive Pasteur’s experimental rabies vaccine. The results of this and one other case were so dramatic compared with previous experience that the new treatment was accepted with a sample size of two. That is, the results were so compelling that no randomized controlled trial was necessary. Having been infected by a rabid dog, would you be willing to participate in a randomized controlled trial, when being in the control group had a certainty of a ‘‘most awful death’’? Sadly, such a question is not entirely rhetorical.

In the 1970’s, a revolutionary treatment for babies with immature lungs called “extracorporeal membranous oxygenation” (ECMO), transformed immature lung mortality from 80% dead to 80% alive nearly overnight. The standard therapy caused damage to infants’ lungs and was a major cause of morbidity and mortality in infants. ECMO is much gentler on babies’ lungs, “providing life support while allowing the lungs to ‘rest.’”

Despite their dramatic success, the researchers who developed ECMO felt forced to perform a randomized controlled trial. They didn’t want to; they knew they’d be condemning babies to death. They felt compelled to perform such a trial because their claim that ECMO worked would, they judged, carry little weight amongst their medical colleagues unless supported by a randomized controlled trial. Therefore, at Harvard’s Children’s Hospital, 39 infants were randomized to either get ECMO or conventional medical therapy. The researchers decided ahead of time to stop the trial after the 4th death so as not to kill too many babies. And that’s what they did. The study was halted after the fourth conventional medical therapy death, at which point nine out of nine ECMO babies had survived. Imagine being the parent to one of those four children.

Similarly, imagine being the child of a parent who died from conventional medical or surgical therapy for heart disease.

In her paper “How evidence-based medicine biases physicians against nutrition,” Laurie Endicott Thomas reminds us that medical students in the United States are taught very little about nutrition (See Evidence-Based Medicine or Evidence-Biased?). Worse yet, according to Thomas, their training actually biases them against the studies that show the power of dietary approaches to managing disease by encouraging them to ignore any information that does not come from a double-blind, randomized controlled trial. Yet, humans cannot be blinded to a dietary intervention—we tend to notice what we’re eating—and, as a result, physicians are biased in favor of drug treatments and against dietary interventions for the management of chronic disease.

Evidence-based medicine is a good thing. However, Thomas points out that the medical profession may be focusing too much on one type of evidence to the exclusion of all others. Unfortunately, this approach can easily degenerate into “ignoring-most-of-the-truly-important-evidence” based medicine.

Heart disease is a perfect example. On healthy enough plant based diets, our number one cause of death may simply cease to exist. The Cornell-Oxford-China Study showed that even small amounts of animal-based food were associated with a small, but measurable increase in the risk of some chronic diseases. In other words, “the causal relationship between dietary patterns and coronary artery disease was already well established before Dean Ornish and Caldwell Esselstyn undertook their clinical studies.” The value of their studies was not so much in providing evidence that such a dietary change would be effective, but in showing that “physicians can persuade their patients to make such changes,” and in “providing interesting data on the speed and magnitude of the change in severe atherosclerotic lesions as a result of dietary therapy.”

Therefore, any complaints that these studies were small or unblinded are simply irrelevant. Because the evidence of the role of diet in causing atherosclerosis is already so overwhelming, “assigning a patient to a control group eating the standard American diet could be considered a violation of research ethics.”

Evidence of the value of plant-based diets for managing chronic disease has been available in the medical literature for decades. Walter Kempner at Duke University, John McDougall, the Physician’s Committee for Responsible Medicine, Nathan Pritikin, and Denis Burkitt all warned us that the standard Western diet is the standard cause of death and disability in the Western world. Yet physicians, especially in the US, are still busily staffing the ambulances at the bottom of the cliff instead of building fences at the top.

If you’re not familiar with Dr. Esselstyn’s work, I touch on it in:

Sadly, medical students learn little about these powerful tools:

If you haven’t heard of Pritikin, I introduce him here: Engineering a Cure

An intro to Dr. Ornish: Convergence of Evidence

Dr. Burkitt: Dr. Burkitt’s F-Word Diet

The Cornell-Oxford-China Study: China Study on Sudden Cardiac Death

Dr. Walter Kempner: Kempner Rice Diet: Whipping Us Into Shape


-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of DeathMore Than an Apple a DayFrom Table to Able, and Food as Medicine.

Image Credit: clement127 / Flickr

  • mbglife

    Most period know the importance of diet but don’t want face it. Over my many years on a plant based diet, only one relative tried it after two heart attacks. He reads nf.org, but started again eating meat when his doctor told him he needed meat for “high quality lean protein”.

    A friend also converted to a wfpb diet and also follows NF.org (but he still eats meat, but infrequently). People don’t want to hear suggestions to drop animal products. So for my other friends I’ve encouraged them to add some raw nuts to their diets to reduce the risk of sudden cardiac death. No one’s done it.

    When people, including strangers, see how I eat (like at Whole Foods Market prepared foods bar) they comment on how healthy I eat. So most people seem to know the basics. But they’re not interested in change.

    Mark G.

    • rumicat

      I know the feeling. My husband and I have modified our eating habits, just eating meat and/or dairy once or twice a week. It would be easier to make the transition fully if there were more options outside of my kitchen (and if I had more time). Even this amount of change has made a huge difference for us in terms of weight maintenance, inflammation, and cholesterol level. My husband for one has more energy than he had when I met him twenty years ago. Can’t get anybody else on board though. It really would help if there was a more consistent message coming from the medical community. People are so slow to change:( But at least we can support each other here, for which I am grateful.

      • mbglife

        Congratulations in making the changes you have. What I can tell you helps make things more convenient for me are these few little things:
        – making extra for leftovers during the week
        – keeping a can opener in the car. While traveling I can always stop at a grocery store for some fruit/veggies and a can of beans. (Whole Foods Market always has a microwave for customer use, so I can even get packaged frozen veggies, even sweet potatoes or butternut squash. And the provide the paper plates).
        – I pack a lunch box if I know I’m not going to be close to a good food source for must if the day.

        These things make most days food options easy for me.

        • rumicat

          Carrying the can opener around us a great idea. Thanks.

        • Alan

          I carry a can opener with me also. And i make extra so i do not have to prepare so often. When i am going to be gone during my usual meal time i take food with me in a cooler. Usually a one container meal with some beans, veggies and grains or grains, nuts and fruit. I take it out of the cooler a few hrs before i need to eat and let it warm up some so it will not be so cold. Actually in the summer time down here in the South i do not mind it being on the cold side.

      • SeedyCharacter

        I agree that getting the support here is so helpful! With most people’s harried lives, food has become a top form of self comfort–it’s hard to pry yummy cookies out of peoples’ hands when that’s the one treat they may give themselves in a day. I just retired from a 60+ hour/week directorship. It was hard to have the bandwidth to shop and cook. And I was in a setting with so much junk food around (for free). In retrospect, I did really well under the circumstances. But now that time is more spacious, I am eating many more greens and much less sugar and bringing higher quality foods to potlucks, etc.

        • rumicat

          It’s tougher when you have more responsibilities for sure. You give me something to look forward to in retirement. Meanwhile I’ll keep looking for ways to keep it healthy but simple.

          • SeedyCharacter

            Best of luck! Retirement is glorious, though I actually have a small private counseling practice that keeps me out of mischief.

    • Dasaniyum

      How does a nf.org reader get influenced by a doctor to start eating meat again with the argument: high quality lean protein? Dr.Greger has addressed the issue of protein plenty of times. I think your relative needs to do a bit more digging.

      • mbglife

        Well, this was my point about people in general: I don’t think it’s a lack of knowledge; I think it’s hearing what they want to hear. And, also for people in general, I wonder how much of it is habit or even addiction. I had cheese cravings long after I stopped reading the stuff.

        • livewire

          I hear you! My husband had heart disease when we met 17 years ago. He had already had one carotid cleaned out, and shortly after we were married he had triple bypass surgery following a failed stent placement four months earlier. When his second carotid was 100% blocked we went wfpb in 2011, and it reversed enough so he doesn’t feel like a time bomb, but he’s back to eating many no-no foods. He mostly likes what I fix, but he makes his own extras – all things I don’t touch. He has watched the Esselstyn videos and a few other similar programs, but he thinks of his adding back animal foods as OK because it isn’t much. Yet I see it is more all the time.

          • Alan

            Livewire – the last sentence — Yet i see as it more all the time. Dr John McDougall, whom i think highly of, recommends a WFPD, but says a small amount of animal food taken occasionally probably would not hurt, but says usually a small amount ends up being a lot and occasionally ends up being frequent. So he sticks with recommending NO animal foods.

        • Betty

          Dr. Neal Bernard sites studies that show That casein is a form of mild opiate and reacts like any opioids do in the human brain. Scientists believe it was put there to keep the nursing calves from wandering off from the momma. Even though it is a very small amount, it does create addiction. I tell people this all the time but it seems not to phase them. Or else a lot of people just don’t believe me, in denial, get defensive, are skeptical or just don’t care. I understand why. It’s very hard to change. I’ve had a mild heart attack a stent etc and I find it very difficult to stick with 100% Plant based. I revert to vegetarian from total plant based constantly. ( I call it relapsing) I’m also addicted to sugar and I’m a diabetic. I’m all for WFPB and I’m extremely knowledgable about it yet, I can’t stick to it. So, it makes sense that People who are not into changing are going to have an even harder time.

          • mbglife

            Hi Betty
            Thanks for sharing your struggle with certain foods. I think it helps others, who also struggle, to not feel guilty about their diet urges. I’ve been very lucky because I’ve only ever struggled with cheese and chocolate. And both were hard, but I no longer have any urges for those (or any other foods) at all, even when right in front if me. Best wishes you for continuing to make good food choices. Your heart is thanking you. :-D

      • Karl Young

        Well, the situation with MD’s seems complicated. Until my latest doc I was constantly warned that a WFPB diet was dangerous and that I should get off it. While certainly individuals getting over their own resistance to changing habits is important, as Dr. Greger continually points out the medical profession also needs to overcome it’s inertia. Even my favorite radio doc, Dr. Dawn, who is a functional medicine practitioner that has a very sensible approach to most medical issues and frequently discusses the pernicious effects of big pharma and big ag, seems to suffer from the lean protein delusion. While never outwardly dissing a WFPB diet she often argues that different people have different nutritional needs including the fact that some people need animal based lean protein. I emailed her links to specific nf.org videos that dispelled that notion but never got a reply or any discussion of it on her radio show. I assume a lot of the resistance for any doc is related to being conflicted about their own habits.

        • Paul

          My HMO is Kaiser Permanente, and I have a plant based PCP! He told me it’s still rare for patients to be on a plant based diet but I’m one of his star patients because I’m walking the walk, as he puts it. Kaiser is vocal about pushing WFPB and they have FOK and other PB cookbooks available for sale at their book shops. I still can’t stand Kaiser, their rate/premium structure is now just as bad as BC/BS, Anthem, and HealthNet, so screw them all. I want single payer health care so EVERYBODY is covered.

      • Charzie

        A lot of things come into play here, but from experience I know that so many people rely on their doctors for all their advice as if they were gods. I have been trying to get my ex’s doctor to encourage him to eat better because he values her advice so much, but even she doesn’t have a clue what that actually means, so it’s a real uphill battle. Despite my success, he ignores anything I try to share with him, because his doctor “went to school to become a doctor!”. Go figure!

    • Craig

      After reading “How Not To Die”, I wanted to give a copy as a gift to at least one person but couldn’t think of any friend or family member would read it let alone follow its message.

      • Brian R Gard

        Hold a 357 Magnum to their head when ya hand them a copy!

      • mbglife

        I just ordered a copy sent to my nephew in hopes that he’ll read it if it’s around. If not, maybe it’ll make a good doorstop. ;-)

      • Thea

        Craig: I shared a similar belief about some friends. But I bought them copies of the book anyway. The one friend who I had the least faith in is the one who has surprised me the most–not just reading, but making actual changes in her diet. This is a person who is morbidly obese and eats meat, dairy and eggs and fast food as the main portion of most meals. She has a long way to go, but for all I know, this book is a turning point for her.

        I gave the books with the attitude of, “They will likely put this in the back of the closet unread. That’s on them, not me. I will have done all I can for the people I love. I will feel good about that.” I didn’t push them to read the book. I just handed it over with a giant smile. I think the cover design and title can pull people in. All of which is to say, I think it is worth a try. (But then again, I don’t know your peeps. Maybe I don’t know what I’m talking about.)

        • Karl Young

          Thea – Love your attitude; if there is any general trend towards greater health it will be because of people like you.

          • Thea

            That’s the best compliment possible. Thank you!!!

        • Alan

          Keep on Keepin on Thea !!!

        • peseta11

          Thea and Craig. I too have distributed copies with the admonition “Use as directed for a Merrier Christmas” or the like for later special days, with so far many times the response levels I expected.
          But then, my own response is greater than I anticipated, reminding me again that we know neither others nor ourselves as well as we suppose.

    • Brian R Gard

      Mark G. – almost exactly my experience, people can know, but do not change, they suffer but do not correct themselves, it is the unusual person that embraces and adopts a new healthy dietary pattern, and it is so frustrating for those of us that have and want our family and friends to benefit too.

      • mbglife

        Hi Brian
        Ironically, the only friend who has ever followed my lead, started eating a wfpb diet and following nf and never told me. I found out sometime later from his brother. So being an example can sometimes help when a person is ready.

      • Karl Young

        Yeah, I wish I could figure out what it actually was that got me to change and bottle that. It didn’t seem like any great strength of character or will; it’s a bit mysterious; maybe something like the Protestants are trying to get at with the idea of grace…

        • Paul

          I was scared into starting it. My dad had a CABG at age 63. He died ten years later from lung cancer. The poor guy’s prosperity got the best of him – he ate too much, drank too much, smoked too much (he quit three days before his heart surgery and never smoked again), and sat too much. My father’s surgery occurred right around the time Ornish’s first book came out in 1990, and I read it and never looked back. I owe my life to Dr. Ornish.

    • Alan

      I agree with you Mike. Almost everyone, if not everyone knows the benefits of giving up animal foods and know what a good diet looks like, but refuse to make the changes. It is sad knowing the condition of most peoples health and the cost it is to individuals and tax payers. And why would anyone choose to be sick when they do not have to be?? They have made their bellies their gods!!!

      • https://disqus.com/mbglife/ mbglife1

        I have a close family member that believes in a paleo diet. He has one meal a day that usually is a combination of a LOT of chicken, beef, ribs, a couple hardboiled eggs, yogurt (all together) and almonds. He thinks it’s ok because he eats a soup-bowl size of veggies with it. It’s hard to watch. He thinks my approach is wrong, although he’s recently added beans from time to time. He’s very smart. He’s a college prof, but I don’t understand how he can believe in his diet.

        • Alan

          It is hard for me to believe that he actually believes in his diet. As Dr John McDougall says “people like to hear good news about their bad habits”. As we and Dr McDougall know it is not really good news, it is apparent good news, false hope !!!

    • Alan

      Sorry – I called you Mike instead of Mark in my other post.

    • Richard

      One does not have to be a vegan to be eating healthful. There is no known healthy large culture or population that was vegan. It appears to me that if one were consuming about 80% or more of calories from whole plant-based foods from young that chances for far fewer diseases in later years are very good regardless of dna at birth.

      • https://disqus.com/mbglife/ mbglife1

        Well, what’s sustainable and what’s optimal are two different things. For me, I’ll pervert the odds with optimal. And in the case of my relative, it’s more like 80/20 meat to veg. So that’s pretty risky to my thinking.

      • Reluctant Vegan

        What about Buddhist monks and nuns? There are lots of them, right? They live in monasteries, so they are localized populations… I’ve heard that there are a lot of vegans among the Seventh Day Adventists in California – would that be considered a population? And there are whole populations in Africa and elsewhere who are (or were at the time of record) vegan. I think your assertion might be wrong.

        • Richard

          You heard, you think but I know…do some reading on the subject before making a fool of yourself. Nowhere in my comments do I say it is not healthy to be a vegan. It will likely be another 100 years before we really know the ins and outs of nutrition. I gave you the most current information, take it or leave it! Seventh Day Adventists are not vegans and they consume a considerable amount of nuts/seeds which could prove to be very good nutrition. As I said numerous times before, look at the five Blue Zones….none are vegans or big animal protein consumers but all are heavy on the whole plant-based products.

      • Paul

        The problem is that for many folks 80/20 just isn’t sustainable because they’re addicted to the “20.” And I truly believe the bad stuff has addictive properties – meat, fat, salt, sugar. If people could do 100/0 for say 3-4 weeks, they could perhaps break through their addiction, but most people just don’t give it enough time because their addictions literally call to them. I don’t see how it’s different from other forms of substance abuse. Some of the externalities might figure in people not doing the diet (social constraints, family constraints, propaganda, whatever), but from everything I’ve heard from the people in my life who have tried it, it’s too hard for them to stay away from the bad stuff, and they spiral away from the diet completely or nearly completely.

        I was already a vegetarian when I started it 25 years ago, so for me it wasn’t a huge transition like going from paleo 8 pounds of meat a day to 100% plants. I just had to drop oil and cheese. That’s a far cry from folks today who are addicted not only to meat and fat but salt and processed sugary foods and snacky stuff. :(

        If I were a nutritionist, I’d be pushing “one day at a time” on board with WFPB. I know that’s from the discredited addiction model or whatever, but you have to remind people that they’re addicted and it won’t be easy. At least they can eat all they want, unlike some other diet plan, but for many of them it’s still not easy.

  • charles grashow

    From Dr Esselstyn’s study
    http://www.dresselstyn.com/site/study01-methods/

    “Each participant also received an individualized prescription for a cholesterol-lowering drug. The most frequent regimen included cholestyramine, 4 g twice daily, and lovastarin, 40 mg to 60 mg daily. Time-release niacin was prescribed for a short while but was discontinued when many patients reported nausea, vomiting, and swollen ankles.”

    http://www.dresselstyn.com/site/study-01-discussions/

    ” Because this report is the first on the effects of long-term diets containing less than 10% fat coupled with the use of cholesterol-lowering drugs, other studies are necessary to confirm these results.”

    ” We made no attempt to determine the contribution of the cholesterol- lowering medications to the total reduction of serum cholesterol levels. All the participants continue to take these medications as well as to follow the diet.”

    http://www.dresselstyn.com/site/study02/
    “The only goal was to achieve and maintain a total serum cholesterol of 150 mg/dl.”

    “During the 7 years since the conclusion of the 5-year study, all but 1 patient have continued to adhere to the prescribed diet and medication.”

    “The study focused solely on lipid reduction through medication and diet, addressing, as Roberts has stated, “the only true risk factor for coronary artery disease–a cholesterol above 150 mg/dI.”

    “These significant lipid reductions were undoubtedly because of our unrelenting persistence in dietary compliance combined with a statin agent”

    SO – if the “The only goal was to achieve and maintain a total serum cholesterol of 150 mg/dl.” why does it matter how it’s achieved??

    • Russell

      It has always been curious to me that Esslystyn uses a total cholesterol target of 150, instead of using LDL as Dr. Greger has recently (Greger has set LDL 50-70 as the goal). After all, if one has LDL of 65, VLDL of 15, and HDL of 90, that’s an exceptional lipid profile but will exceed the Esslystyn target by twenty points. What then? Try to reduce HDL, too? That doesn’t make sense.

      • Wilma Laura Wiggins

        You touch on one of my questions too. If your LDL is “near optimal” at 129 and HDL is 60 which is minimum for some protection, you are already above 150 at 189 which doesn’t include any HDL. Even if LDL were 100 (optimal) it would be “too high” unless your also reduced HDL which is supposed to be the good stuff. I bring this up because these were my numbers, with total at 243 and HDL at 96. And I have been a very strict vegan with NO oil diet for 2 years. I reversed diabetes, lost 60 lbs and also reversed congestive heart failure with this diet and yet these are my cholesterol numbers.

        • Russell

          That’s great news about your diabetes and congestive heart issues! Congratulations! I may not be reading this correctly but I think you are saying your LDL is 129, and HDL is 96. If so, then you need to add your VLDL to get the total cholesterol. But you also mention 243, so subtracting, your VLDL must be 18. Anyway, yes, Esslystyn would say to get the total down to 150, which is impossible in your situation, and Greger would say to only worry about LDL, which should top out at 70. I face the same problem — low-carb, pre diabetic and it is tough to get below 100 given all the almond butter I need to add into my diet to keep weight on. I did an experiment using http://www.cronometer.com and dropped saturated fats to 5.0 grams/day for a week, and that brought LDL to 85, but I’m generally around 106. Also, be sure to add psyllium and other high fiber goods — studies show 2 tbsp of psyllium a day are good for a 12% drop in LDL. Also, use VAP for your lipid profile… low carbers like us can’t use the standard lipid tests as they will be highly inaccurate. So… you may actually be lower than you thought.

          • Wilma Laura Wiggins

            What is VAP?

        • Reluctant Vegan

          “I have been a very strict vegan with NO oil diet for 2 years. I reversed diabetes, lost 60 lbs and also reversed congestive heart failure”

          WOW!!! That is awesome! Congratulations.

    • AllVegan

      Because Statins have been shown to distroy muscle tone when used regularly. http://nutritionfacts.org/video/statin-muscle-toxicity/ Taking Statins put my mother in law who was always active and energic in a wheel chair. It has been several years since we got her off statins and she can now use a walker. This happened to a Woman who walked 5 miles a day and did aerobics most of her life. Yes you can use Statins to block your bodies production of cholesterol so you can eat the cholesterol from the bodies of other sentient beings, but why would you want to do that, given the horrendous side effects?

      • charles grashow

        While I’m truly sorry what happened to your mother-in-law that doesn’t happen to everyone.

        Since you use the term “eat the cholesterol from the bodies of other sentient beings” it’s obvious that you came to veganism due to moral reasons. Logic is useless in discussing this topic with you.

        • AllVegan

          If you had watched the video I referenced you would know that it happens to everyone who takes statins.

          How would you describe taking a drug with horrible side effects for no other reason than to be able to consume the cholesterol laden corpse of some other being.

          I have been plant based for the majority of the last 35 years. At 60 in perfect health I think I’ll keep eating this way.

          • charles grashow

            ” it happens to everyone who takes statins”

            That a load of crap and you know it

          • AllVegan

            Really! you should know that I do not consider ignorance to be a virtue. If you want to live in a fantasy world go on and do it but leave those of us who believe in reality alone

          • charles grashow

            If you say that EVERYONE who takes a statin gets horrible side effects then you are ignorant. Mo other way to put it

          • AllVegan

            Everyone who takes statins sustains some level of muscle damage, an increased falls risk and possibly other side effects. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/path.2018https://www.researchgate.net/profile/David_Scott25/publication/26696142_Statin_therapy_muscle_function_and_falls_risk_in_community-dwelling_older_adults/links/0046351d100447668a000000.pdf I did not say everyone who takes a Statin has horrible side effects, however there are horrible side effects associated with statin use. http://nutritionfacts.org/video/statin-muscle-toxicity/

          • charles grashow

            https://www.researchgate.net/profile/Katia_Monastyrskaya/publication/6984453_Statin_therapy_induces_ultrastructural_damage_in_skeletal_muscle_in_patients_without_myalgia/links/00b49517a429593e5c000000.pdf

            “We collected skeletal muscle samples from a total of 22 individuals, including 14 who were receiving treatment with HMG CoA reductase inhibitors for hypercholesterolaemia and eight individuals who had not received statin treatment and served as controls. None of the patients had a previous history of rhabdomyalgia or weakness.”

            SO – 22 = EVERYONE!!

          • AllVegan

            Whatever

          • charles grashow

            http://www.ncbi.nlm.nih.gov/pubmed/21872435
            Vegetarianism produces subclinical malnutrition, hyperhomocysteinemia and atherogenesis.
            A study of 24 rural male subjects 18 to 30 y old and 15 urban male controls was conducted in the Sahel region of Chad.

            WOW – my study had 24 people – your study only had 22

          • AllVegan

            Really?

          • Karl Young

            WOW – maybe my previous docs were right, i.e. I should go back to being overweight, having high cholesterol, high triglycerides,… rather than remaining vegan and risking subclinical malnutrition.

          • peseta11

            My notes on NAS (2006) amino acids show the sulfur-aminos methione+cysteine for 19+yr adults or those pregnant or lactating, EAR or RDS, of 15-26mg/kg wt.

            The rural group in the Chad study seems to average 10, below a norm of 13, itself below th NAS range.. No surprise, gross deficiency in those aminos yields poor results. If you equate that to a vegan diet, or for that matter a potato chips-corn chips-beer vegan diet, then of course vegan diets yield bad results, and I doubt anyone here advocates either diet.

            As to relative animal content in diets of long-lived Okinawans (pre-McD), I count ~1230 grams of plant foods and under 20g fish-meat-eggs-dairy, as well as 3g each sugars and oils and twice that as ‘flavors and alcohol’, some of which might not be favored here. 97-8% WFPB vegan, not 100%, but why quibble?

          • charles grashow

            Were the benefits of the traditional Okinawan diet due to the dietary components or to caloric restriction?

          • peseta11

            As I understand it, the benefits to humans of calorie restriction have not been demonstrated, and what effects have been seen may more likely result from better diet (which is an inherent part of CR).
            But my motive in mentioning that diet (now largely defunct thanks to McDo and KFC) was in reply to the assertion that humans haven’t eaten vegan diets. The term ‘vegan’ is not well defined. as I also mentioned. using two horrible examples which I doubt this site would approve of. But a diet well over 90% from plants is WFPB.
            [And my mention of flat-earthers, mostly in fun, was meant also to emphasize the ease with which plausible reasoning can generate errors, if the reasoning’s engine is a Cause, as well as the ease with which confident deniers commit similar errors.]

          • charles grashow

            http://okicent.org/docs/anyas_cr_diet_2007_1114_434s.pdf
            Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging
            The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span

            http://www.healtheiron.com/Websites/healtheiron/images/The_Okinawan_diet__health_implications_of_a_low-calorie__nutrient-dense__antioxidant-rich_dietary_pattern_low_in_glycemic_load.pdf
            The Okinawan Diet: Health Implications of a Low-Calorie, Nutrient-Dense, Antioxidant-Rich Dietary Pattern Low in Glycemic Load

            http://www.okicent.org/docs/dcw_biogerontology.pdf
            Caloric restriction and human longevity: what can we learn from the Okinawans?

          • peseta11

            Willcox et al 2007 gives very good results for Okinawa, and is a good example of a 97-8% plant-based diet; it is, as it says, hypothesis-generating– and the second reference suggests explanations in more detail, “low levels of saturated fat, high antioxidant intake, and low glycemic load”. The CR level of ~11% is close to the least ordinarily imposed on non-human animals, who in lab conditions or equivalent are normally fed ad lib. That’s roughly equivalent to an indulgent US population, which may be the underlying motive behind selection of Rancho Bernardo… though I would have been more interested in a vegan or near-vegan subset of 7th-Day Adventists in the Region.
            Also the “CR” time period is undefined, depending solely on the 1949 data point, with the next in 1961.
            And a BMI of 21.2..how does that compare to non-CR “vegans” in US studies?
            It suggests that “CR” sufficient to produce that BMI, but discontinued over ensuing decades, still results in unusual longevity– nice to know, if confirmed for other, preferably US, populations. Anyone want to join in?
            Meanwhile, we have a cultural basis for self-limiting food intake: the Okinawan preference for eating ‘hara hachi bu’, till 4/5ths full, far from the agonies I’ve known from US CR-advocates, who seem far from that full.

          • Wilma Laura Wiggins

            Are you serious?

          • charles grashow

            It’s not me – just posted the study for your consideration

          • Wilma Laura Wiggins

            You assume that eating animals is the only way to have high cholesterol. Not true. Your body makes cholesterol whether you eat any or not and it can be too high according to medical professionals. Dr. McDougall said I was a candidate for statins even though I am vegan and if I took them (which I won’t) it wouldn’t be so that I could eat meat. So why not stop with the typical obnoxious comments typical of “ethical” vegans and stop giving them a bad name.

          • AllVegan

            What?

          • Wilma Laura Wiggins

            I suggested no such thing. I suggested you not jump to conclusions about why someone might take a statin. It might NOT be for the sole reason they want to eat meat. I am not convinced that I make too much cholesterol, only that they think I do. I am inclined to believe there is a lot more to learn about it and I am inclined to trust my body..

          • http://twitter.com/MacSmiley MacSmiley

            Have you had your DNA tested for genetically-determined homozygous or heterozygous familial hypercholesterolemia?

          • Wilma Laura Wiggins

            No but heart problems run in my family. My father died of a heart attack at 53, my brother at 63. However, here is the really really weird part, when I eat SAD with meat, fat, etc. my cholesterol levels have been better than now (not that good, but better unless you go by ratio and then it is slightly better). I don’t know how to make sense of this.

          • Betty

            If you eat processed food, you can consume too many unhealthy plant fats as well. Like oils. Plus wholesome plant based foods will also increase lipid levels. Esselstyn doesn’t allow any healthy plant based fats on his diets either.

          • Wilma Laura Wiggins

            I eat no oil, few processed foods and those I use have no oil. I was losing too much weight so I increased the number of avocados I ate and nuts but I still don’t eat that much of them. What would Dr. Esselstyn suggest to maintain weight and stop losing?

          • http://twitter.com/MacSmiley MacSmiley

            More beans/lentils and whole grains, I believe.

          • Wegan

            Are you getting enough iodine? It is very easy to be deficient because of halogens like bromide and flouride in the environment take the place of iodine in the thyroid if you dont’t get enough iodine in your diet. Iodineresearch.com

          • Wilma Laura Wiggins

            I visited the site you linked but did not see anything that seemed to apply to either cholesterol or maintaining weight. Why do you ask if I am getting enough iodine? Where I live now thankfully does not have fluoride or chlorine in the water but I have no idea whether I get enough iodine. I use Himalayan pink salt if that helps and I avoid anything from the sea due to mercury and radiation (Japan) pollution. So its a definite possibility I am deficient, but what made you think of this?

          • Wegan

            I don’t know if it applies to you but high TSH and high LDL are linked. TSH can be high if iodine is insufficient. Vegans gets very little iodine unless they are eating enough sea vegetables. http://nutritionfacts.org/video/avoiding-iodine-deficiency-2/ Based on information from iodineresearch.com and the books that are mentioned on that site, people need even more iodine than was thought because of environmental halogens taking the place of iodine in the body. If you do supplement iodine it is very important to get enough selenium. One or two Brazil nuts a day should do it.

          • Wilma Laura Wiggins

            It doesn’t apply. My TSH is around 0.54. LDL is not really tested, it is calculated or estimated.

          • Wilma Laura Wiggins

            I don’t take iodine but have been considering it. I don’t eat white bread or white flour (bromide) and our water is not fluoridated so I don’t know if I really need it. Is there a way to know? I do have high blood pressure, and hypothyroid. I have COPD and I take inhalers for that. I wonder if any one knows if they cause high blood pressure? Well of course I can look them up.

          • Wilma Laura Wiggins

            I know that Dr. E doesn’t allow many things. and his program is very successful. I just wonder if he disallows more things than are really necessary, like Kempner did with only rice and fruit. It turns out apparently that Dr. McDougall’s diet works just as well (not sure about that) and includes many more foods than rice and fruit. It would be great if there could be research on Dr. E’s program examining each restricted food by itself.

        • BT

          Being kind trumps being logical any day!

          Would you advocate war because it benefits military-industrial complex and hence creates jobs?

          A way of life (which includes some eating of course) that follows basic ethical principles is more sustainable in many sense than a way of life that is singularly focused on improving longevity! Everyone dies (and dies sooner than they think).

        • Reluctant Vegan

          Charles Grashow, I feel that your comments in this thread (and below) are inappropriate for this site. Not because of the perspective that you share, but for the pejorative way in which you share it. Would you consider editing your posts to be more civil as befits this site?

  • susan

    I hope it does work, because my husband had a triple vessel heart attack last Oct. We have been vegan for at that time 6 months. But I hope it keeps him living for along time, being vegan

    • Betty

      Cut out the processed foods, and it should work. Not just vegan, but anything processed, including oils.

  • Liatris

    Presumably these patients were taking cholesterol lowering medicines prior to following a wfpb diet, but they still had many cardiovascular events. It seems they needed both to stabilize or reverse their disease.

    • charles grashow

      Thew study makes no mention of whether the patients were on any medications prior to starting. My point is that EVERY patient involved took the statins for the entire length of the study and the many years of followup.

      As Dr Esselstyn says – “The study focused solely on lipid reduction through medication and diet.”

      Dr. Esselstyn also says – “Combining a plant-based diet with medication achieves better long-term results than changing diet alone or combining modest diet changes and medication.”

      ” These significant lipid reductions were undoubtedly because of our unrelenting persistence in dietary compliance combined with a statin agent.”

      “Every patient with diagnosed coronary artery disease has the potential to make themselves heart attack proof and abolish any future disease progression by achieving and maintaining every 4-6 weeks a total serum cholesterol less than 150 mg/dL through ingesting a totally plant-based diet and cholesterol-lowering medication.”

      • AllVegan

        Charles, you seem to be inferring that without the statins there would have been no benefit to to plant based diet. Ornish, Pritikin, and Fuhrman as well as others have all done studies which show that a plant based diet reverses Heart Disease. There is no debate in the literature on this.

      • Charzie

        Don’t forget, these people were essentially at death’s door, so they weren’t taking ANY chances because they needed to quickly REVERSE the issues. I would have liked to see the results minus the medication too, but it could put this particular study into the same questionable ethical category as Dr Greger discussed above. There have been other studies that clearly show the benefits of a WFPB diet, so it’s pretty well documented anyway.

      • Jim Felder

        Patients were only on lipid lowering medications if that was necessary to keep cholesterol below 150. In his book Esselstyn says that many of the study participates were able to maintain a 150 mg/dL cholesterol level long term without any medications. And for those that were not, the number and dosage was much lower than comparable CAD sufferers who didn’t follow the study diet.

        Also statins were not available in 1985 at the start of the study and only were added as needed in 1987. So for two years all the gains in this very ill patient cohort were due purely to diet. However data points to 150 as being a critical level and so it would have been unethical to withhold medication from those with total cholesterol levels higher than this.

        • charles grashow

          To quote Dr Esselstyn

          “Combining a plant-based diet with medication achieves better long-term results than changing diet alone or combining modest diet changes and medication.”

          ” These significant lipid reductions were undoubtedly because of our unrelenting persistence in dietary compliance combined with a statin agent.”

          Those are DIRECT quotes from the study.

        • charles grashow

          The study commenced in 1985 and Lovastatin was approved by the FDA in July 1987.

          http://www.dresselstyn.com/site/study01/
          In 1985, we began to study how effective one physician could be in helping patients achieve this cholesterol level and what the associated effect of achieving and maintaining this cholesterol level has on coronary disease.

          Methods. The study included 22 patients with angiographically documented, severe coronary artery disease that was not immediately life threatening. These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat.

          Question – why give the patients statins at the start of the study?
          Question – if the diet is so good at lowering TC, LDL, TG why were the patients NEVER taken off of the stains for the entire length of the study?

          • 2tsaybow

            I believe it may have been for an over abundance of caution. The doctor wanted to be careful and wanted to ensure the health of the patients. It’s an ethics thing, you know. But you’d have to ask Dr. Esselstyn why to be sure. Remember, the doctors doing these studies were doing so in a pretty hostile environment. Animal products were considered “quality” protein and the idea of not consuming it was pretty heretical.

            But, the later study by Dr. Ornish, the Lifestyle Heart Trial, did not use any drugs, surgery or technology to treat the patients. They were allowed only egg white and one cup per day of non-fat milk or yogurt and the results were very similar. They also had some stress management, meditation, breathing and relaxation exercises they learned to do. The did weekly physical exercise as well which may have helped. On average, their total cholesterol dropped from 227 mg/dL to 172 mg/dL and their “bad” LDL cholesterol dropped from 152 mg/dL to 95 mg/dL.
            I got all that information from the China Study. Good book.

          • charles grashow

            They also quit smoking as well.

            http://ornishspectrum.com/wp-content/uploads/Intensive-lifestyle-changes-for-reversal-of-coronary-heart-disease1.pdf
            Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years

            “Although we did not use lipid lowering drugs in the experimental group, their value has been demonstrated in studies that have been published since the Lifestyle Heart Trial began. We do not know if experimental group patients may have demonstrated even more improvement by including lipid-lowering drugs.”

          • 2tsaybow

            Charles our bacterial biome is different for the two types of consumption, animal and plants; our body, when we receive optimal nutrition, does very well on a WFPB diet; and our planet benefits when we consume a WFPB diet. Let me also mention that we, as a species raise ourselves a little higher, when we aren’t slaughtering one billion animals a week. Even Ray Cronise, someone who you respect, moves his clients toward this way of eating.
            Please tell me, do you feel your skepticism is only intellectual or is there something like a “gut” feeling that makes you leery of what these scientists and doctors are saying?
            Do you think the “buggies” in your tummy could be stroking your objections? I’m talking about that “second” brain that makes up the bacteria living in our gut. This is crazy talk, I know; but there are times when interacting with people about this subject that their reaction is down right reptilian. There just seems to be such anger, they stiffen physically, and their nostrils kind of flair; it’s just strange. This happens if I just say I am not eating animal products anymore. I don’t even press the subject beyond that one statement. I wonder what part of the brain is working and what is motivating their reaction.

            Please, I am not trying to make you angry, I just wonder and you’re so consistent in your presence here.

          • http://twitter.com/MacSmiley MacSmiley

            Anecdotal, to be sure, but I know quite a number of Jehovah’s Witnesses who have suffered heart attacks from atherosclerosis and ischemic strokes. All of them either never smoked or stopped smoking upon conversion.

            Aside from abstaining from foods containing significant amounts of blood (blood pudding/blood sausage, etc. but kosher meat not required), JWs have no dietary restrictions.

            Comparing JWs vs Adventists as cohorts might prove interesting.

          • kylemeister

            From the paper: “Only 1 patient in the experimental group was actively smoking at baseline,and she quit at entry.”

          • Wilma Laura Wiggins

            Has there been anything studied about longevity in general with and without statins or even cholesterol?

  • MildlyEccentric

    There is a recent study Am J Clin Nutr 2016 103: 218-230 which discusses the “Mortality in vegetarians and comparable nonvegetarians in the United Kingdom” ( http://ajcn.nutrition.org/content/103/1/218.full.pdf#page=1&view=FitH). It would be interesting to try and reconcile the facts that the longest lived “blue zone” inhabitants follow a primarily vegetarian diet, but other studies such as the one in the ajcn show no mortality benefit to vegetarians. Also, why did meat eaters in the ajcn study have fewer deaths due to respiratory disease and “other causes” than non meat eaters? Perhaps Dr. Greger could do an update to the youtube video titled “40 Year Vegan Dies of a Heart Attack.”

  • charles grashow

    https://www.youtube.com/watch?v=AYTf0z_zVs0
    Make Yourself Heart Attack Proof – Caldwell Esselstyn MD

    Uploaded on Dec 2, 2009
    Caldwell Esselstyn, MD of the famed Cleveland Clinic gives a FULL 62 minute talk about reversing heart disease with a plantbased diet, from the 2003 VegSource Healthy Lifestyle Expo.

  • charles grashow

    https://www.youtube.com/watch?v=4XVf36nwraw
    The Starch Solution – John McDougall MD

    Uploaded on Nov 20, 2010

    This truth is simple and is, therefore, easy to explain. You must eat to live. But the choice of what you eat is yours. There is an individual, specific diet that best supports the health, function, and longevity of each and every animal. The proper diet for human beings is based on starches. The more rice, corn, potatoes, sweet potatoes, and beans you eat, the trimmer and healthier you will be — and with those same food choices you will help save the Planet Earth too.

    This talk is by John McDougall MD from the VegSource Healthy Lifestyle Expo 2010. You can purchase a copy of all 14 fascinating and life-saving talks from the Expo on DVD.

    • TheHulk

      Extreme of anything as far as diet is concerned is bad. Use that as a common sense. Our body is a careful balance, our diets should be the same. Don’t fall for FAD diets.

      • GEBrand

        WFPB diets are far from a fad. The science insures this.
        I, for one, reject the position that “all things in moderation” (which is implied by The Hulks comments) is worthy to live by in the face of scientific results.
        Moderation in cocain, heroin, Meth use? No thank you. Moderation in all things is not an adequate standard by which to live.

        • TheHulk

          Don’t bend the statements. Science will ensure this today, and 5 years down the line, it will desist it. I have lived long enough to see these fad diets come and go. I meant wholesome plant and foods in moderation. There is a huge variety that GOD has made us, why restrict ?

  • http://grokjs.com/ Alexander DiMauro

    “physicians…are still busily manning the ambulances at the bottom of the cliff instead of building fences at the top.”

    What a great quote! Sums it up perfectly.

    • BT

      Well, the pharma-physician complex is akin to military-industrial complex. You need a constant supply of crises to make money and be employed. So prevention from lifestyle choices, however evidence based, is as good as UN speeches demanding world peace.

  • Cindy K

    I was lucky enough to attend one of Dr. Esselstyn’s talks. He was very impressive. Both he and his wife walked up the stairs to the stage without holding onto the handrail. Dr. Esselstyn gave his talk without any notes. There was one woman there who was one the eighteen people first studied. She still to this day follows Dr. Esselstyn’s diet. I think she must be in her 80’s now. There was another man, much younger, there who needed another stent. He started to follow the diet and didn’t need that stent operation. Just seeing how healthy the Esselstyns and the two people, who are following the diet, are,everybody should follow “The Fork Over Knives Diet.”

  • Wilma Laura Wiggins

    I just got my cholesterol numbers after having been on Dr. McDougall’s Starch Solution for two years. Many good things happened to me (lost a lot of weight, reversed diabetes, heart failure) but my cholesterol was still high. In fact, I expected it as that was what happened the first time I followed Dr. McDougall in the 1980’s. I just finished the article on http://www.diagnosisdiet.com/food/cholesterol/ which proposes the cause of high cholesterol is high refined starches and sugar. I am wondering if that is true and if so, why did my diabetes reverse? Take note also that I had ultra sound done on my arteries and they showed clear, so no plaque build up. Is high cholesterol still bad if you don’t have any plaque?

    • AllVegan

      That is a good question, If you are following the dr McDougall diet then the only Cholesterol in your system is what your body is making. I am quite sure that there are variations in the amount of Cholesterol a body makes on its own and it would make sense that it would be within normal tolerances. If you don’t have plaque buildup there probably isn’t a problem. However someone with more expertise than I have could perhaps provide more insight. As for refined starches and sugar causing diabetes, I know of no study which as shown that in the absence of meat and dairy, diabetes is a problem. Diabetes only seems to be a problem in countries with large amounts of animal fat consumption.

    • jj

      “Is high cholesterol still bad if you don’t have any plaque?” I don’t think so but then again that is just my opinion.

  • Linda

    I’m wondering is there any study done on effect of plant base diet on adult onset grand mal cluster seizures?

  • maki

    6 years of eating plants (and mushrooms) only, middle-aged male, HDL 35, LDL 63! Life’s beautiful!

    • maki

      Sorry. Got the numbers wrong. HDL 35, LDL 53!

      • BT

        I hope you did not see the numbers from the test report and then concluded “Life is beautiful!”.
        : )

        • maki

          No. It was sharing with everyone that great health and optimal cholesterol is possible on a plant and mushroom based diet.

  • drgallenstein

    If building fences at the top of the cliff was as lucratively profitable as manning ambulances at the bottom, the problem would be solved. The root of all evil sadly prevails.

    • maki

      But then are we talking about a nanny state? Aren’t people responsible for themselves? Isn’t it each individual’s responsibility to find out for themselves what’s good and what’s bad?! The root of all evil? – Yeah!but it’s not money – it’s ignorance and laziness.

      • Johanna Martin

        People cannot be responsible for themselves when they are lied to by the creation of government recommendations including meat and dairy which were in turn influenced by HUGE monetary influences–so NO–people cannot be expected to be responsible. Teachers receive “health” booklets and materials and thinking they are helping, pass along bogus recommendations to innocent children in the schools–so NO–people cannot be expected to be responsible when they are lied to. Big moneyed interests advertise their products as healthful on television, but there are no adds for broccoli–so NO–people cannot be expected to be responsible when they hear these messages.

        Unfortunately, we already have a nanny state, but the nannies are lying to us.

        • maki

          Dependence on the nanny state is the problem. It’s because you expect guidance that this weakness is exploited to provide you with a manipulated one. No responsibility for oneself = death.

          • Johanna Martin

            I disagree.

          • Paul

            Survival of the fittest applied to human beings is an immoral position. Frankly, I would judge any society by how it treats the most vulnerable. Capitalism by definition does a piss-poor job at that.

        • GEBrand

          I SO like your comments and SO agree.
          The nanny state already exists.

          And to clarify – the nanny state is when people are externally forced to abide by a “rule”. Providing excellent nutritional information from which people may CHOOSE for themselves is not a nanny state. For example, Consumer Reports magazine provides information to individuals on all sorts of matters. This is not ‘nanny state’ coercement – it is providing information.
          Since our tax dollars directly pay for health care (disease care) via Medicare and Medicaid our medical establishment SHOULD be required to provide the information from which individuals may choose. This is far from nanny state coercement.

          • Johanna Martin

            The fact is that people are led like sheep. I was one of them so I see how it can happen. I was very angry when I saw the truth and how it is kept from everyone. It’s nice that Maki was taught to question, but not everyone is taught to do that–especially in our environment of big business. If someone is not taught to question, that is not their fault.

  • itsmikeholland

    I found the way to incorperate more cloves into your diet! Every morning i make ginger shots with about 1/8th of a cup of squeezed lemon juice, then i’ll add half a teaspoon each of cayenne powder, ginger powder, and now half a teaspoon of cloves! It’s quick and easy, plus its very energizing! i feel amazing every time! I wouldn’t call it tasty, but im very excited every morning to kick off the day with such a powerful antioxidant bang!

    • maki

      Don’t forget real food – beans, grains, greens… :)

    • jj

      Wow! I’ll bet that is energizing! I’d be jumping all over the place. lol

    • Trevor

      What I do is to make a mixture of organic Ceylon cinnamon powder, organic ginger powder, and organic clove powder at 3:3:1 ratio by volume and add a heaping 1/4 teaspoon to my green or black tea for a home-made chai. It’s strong but great on cold wintry days. Lemon will be a good addition, too. I’ll try it.

  • Rick W Cuyler

    Thank you for always providing great info Dr Greger. I’ve been following the nutritional guidelines of Dr Esselstyn for almost a year now. On June 1st I went completely off all medications for heart & diabetes. Since going WFPB Vegan NO OIL, no added salt or sugar, all of my blood chemistry is perfect including blood sugar. There were short periods where I was eating things I shouldn’t have and my blood pressure showed it. Eating this way is the medicine. Thanks to Dr Esselstyn for holding your ground and consulting with me by phone even though I’m a few thousand miles away!

  • Richard

    We are decades away from evidence-based nutrition. Dr Esselstyn does not allow nuts and seeds but many studies claim they are beneficial to the arteries. We do not know the full story on saturated fat or eggs or even coconut milk.

    • largelytrue

      Even if we grant that all as true, that doesn’t mean that we are far from evidence-based nutrition. Evidence-based nutrition is basing advice on the evidence that we have and only allowing judgment calls where the evidence allows. It’s a matter of willpower and having the appropriate culture to respect science and seek scientific evidence to know more, rather than having all the evidence one could ever want in hand.

      • Richard

        It takes only a small amount of research to learn that there is very little real evidence of anything concerning nutrition. Maybe sugar this or maybe olive oil that, maybe eggs whatever and maybe milk/dairy this….etc etc must I continue? how about saturated fat or fish oil????? What we really know about nutrition does not take much more than a paragraph but reasonable questions fills volumes.

        • largelytrue

          For you they do, but can’t that be because you have done only a small amount of research? Your very untextured way of referring to the research base (“but many studies claim”) suggests that you aren’t thinking about what you find very hard or looking much into the texts beyond the conclusion in the abstract or something like that.

          Also, at best you are replying to one phrase in my reply: “even if we grant that all as true”. Again, evidence based nutrition amounts to responding to the evidence that we have, and doesn’t mean that everyone is a legitimate expert in interpreting the evidence, either. It takes time and effort to read and understand the evidence base, as much as it takes time to produce it.

          Honestly to me you sound more like you are reviewing media hype, which loves to present controversy, the egosyntonic, and the counterintuitive, and hence gives the impression that the research is less solid and more prone to reversal than it actually is. The headlines reverse much more often than the opinion of scientists working in the field. Saturated fats are pretty well known to be bad within the consensus view of nutrition largely due to their effects on the lipid profile, for instance, but the popular sphere helps to exaggerate the importance of contrary studies and keep the controversy alive.

          This is the Internet, after all. There’s a thought bubble which confirms practically any position, including completely ridiculous positions such as belief in the flat earth. Confirmation bias can affect communities powerfully, and the Internet supplies the information and communication that can help make denialist communities self-contained and apparently evidenced within their own sphere of ignorance.

          • peseta11

            largelytrue, I couldn’t resist a quasi-serious reply to your dissing of flat-earthers. I find most arguments for a more-or-less spherical Earth specious; they are of the order of “Since as we gaze at railroad tracks they seem to meet near the horizon, that accounts for all those rail accidents”.
            Or to cite authority, Bernard Shaw once interpreted the results of a flat vs round-Earth debate as demonstrating that Earth is probably a cylinder.
            No, it’s not flat or conic, but oh so many hours are spent trying to create debate, seemingly for its own sake, where the results are long in, those who did the research have gone home or are working on other matters, and we need to get on with life.

          • largelytrue

            Identify the part that’s serious or even on topic with the existing conversation between myself and another person. You aren’t saying that the Earth is flat, so are you saying that this isn’t a ridiculous position that people still believe and whose communities the Internet hosts and facilitates?

            Are you saying that the Earth is not more or less spherical in shape? Why are you saying that here? Trying to stir an off-topic debate or what? I wasn’t trying to debate the issue here, but only using flat-earthers as an example.

  • Matt K

    I don’t mean to troll in my comment here. Does anyone have a link to a specific study suggesting an increase in the chance of a heart attack due to an increase in cholesterol levels? I’m having difficulty finding one.

    • Daniel Wagle

      Look up ‘familial hypercholesterolemia.” These persons who naturally have higher cholesterol also have higher heart attack rates.

    • Thea

      Matt K: It’s a perfectly reasonable question. I have two places for you to look. I haven’t reviewed the original studies myself, but you can click the “Sources Cited” button on the NutritionFacts video and look it up yourself to see what you think. The second resource I have for you is PlantPositive and while he does not have a fancy button the way NutritionFacts does, you can pause the video and see enough information about the study to look it up.
      .
      For the NutritionFacts video: http://nutritionfacts.org/video/how-the-egg-board-designs-misleading-studies/
      The first two sentences: “Blood cholesterol concentration is clearly increased by adding dietary cholesterol. In other words, putting cholesterol in our mouth means putting cholesterol in our blood, and it may also potentiate the harmful effects of saturated fats, meaning when we eat sausage and eggs, the eggs may make the effects of the sausage even worse”
      .
      Also, I would like to direct you to the last third of this video at PlantPositive. I would swear he as another video that also addresses the serum cholesterol question, but I couldn’t find it. But this one I think will be of interest to you:
      http://plantpositive.com/23-cholesterol-confusion-6-die/
      Look for: “This study of cholesterol absorption is valuable because the subjects in it were semi-vegetarian. They weren’t vegans. They did ordinarily consume eggs, fish, and dairy. For these people who had lower than average cholesterol, dietary cholesterol did raise their blood cholesterol.” and “You can see quite clearly that cholesterol feeding did raise LDL bad cholesterol markedly in these semi-vegetarians.” and “It was known in 1957 that vegetarians who did not eat eggs and dairy had lower cholesterol than those who did.”
      .
      Also very important is the part about how saturated fat and cholesterol work together to make everything worse. Since those two components are, I believe, always eaten together in whole animal products, the effect of eating animal products is worse than just eating cholesterol or saturated fat separately. Look for the part that starts with: “The effects of dietary cholesterol are variable. For one thing, saturated fat consumed with cholesterol causes it to be more effective at raising blood cholesterol.” The first part of Dr. Greger’s video also covers this point.
      .
      Does this help?

  • Psych MD

    I watched the live Harvard program today on Cancer and Diet. Dr. Willett, chairman of the dept. of nutrition, made some interesting comments: Their decades-long research shows no correlation between total dietary fat and cancer. Fruits and vegetables confer little protection against cancer. Twice he referred to “refined starch such as sugar and potatoes.” Red meat increases cancer risk and should be replaced by “white meat and fish.” Adequate, but not excessive calcium is important and can be obtained through dairy and/or supplements. It seems Harvard is not yet ready to jump on the vegan bandwagon.

    • Jim Felder

      That is because their big studies like the Nurses Health Study have a very narrow dietary range (ranging from carnivorous nurses and very carnivorous nurses) and so it can hardly be surprising that they don’t see much of a signal. Like Dr. Esselstyn says when you are studying the effect of speed on fatality rate in automobile crashes you won’t see much of a difference if all the crashes you study are between 80 and 100 mph. If that is all the data you have, then you would have to conclude that velocity of the crash has little effect. Fatality rates are nearly always 100% because you are past a threshold level. It is only when you look at a broad enough range, when you include crashes from parking lot speed and up, do you see the real relationship. The same is likely true for things like fruit and vegetable consumption. There may very well be a threshold level where any consumption less has little effect and only above the threshold do you start seeing the positive impact.

      The China Study had a good example of a dietary threshold in the graph of the rates of liver cancer foci development and percent of calories from casein. The rat who got 5% casein developed few if any foci and the increase in foci development with increasing casein was slow until about 10%, which is about as much protein that rats can fully utilize. After the 10% threshold there was a completely different and much steeper rate of foci development with increasing casein in the diet. So if Dr Campbell had only studied a narrow range of protein consumption. If he only looked at protein consumption between 18% and 20%, there would have been very little difference in foci development and what little variation there was would have been hard to pick out from the variation between individual rats. The overall message would have been that casein had little effect on the development of liver cancer initiated by aflatoxin.

      So Harvard will not find anything with their largely homogeneous cohorts. Usually you think that it would require a large international study to be able to find large enough populations that eat a sufficiently broad range of diets to be able to really see if difference. Such studies aren’t usually done because it would have to be huge and cover many different countries. But we may have the necessary populations right here in this country. We have a large and rapidly growing population who follows a WFPB diet to form one cohort which eats substantially different than the general population. There are folks like those who rigorously follow a Paleo diet as well as the terribly misguided (IMHO) folks who follow a Low-carb diet like Atkins or South Beach that could form other cohorts with vastly different dietary patterns. And we all passionately believe that we are eating the best diet diet and so likely to follow the diet for a number of years. We just need researchers brave enough to put such a study together and then we can let the data speak for itself.

  • jogi

    I don’t know where I should put my question. Alopecia has certainly several causes. Is there any study that shows that a plant based diet reduces the alopecia?

    • Wegan

      If you search for autoimmune on this site you might find some helpful info. Apparently eating proteins similar to our own can be a trigger. WFPB is low inflammation plus turmeric could help.