What about the “cholesterol myth”?

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I would love to see more debate with regard to…cholesterol/saturated fat proponents (Gary Taubes, for example). I don’t know how many times people have recommended I read Taubes books….Just look at the reviews on Amazon for Johnny Bowden’s The Great Cholesterol Myth!

Synergy / Originally Posted in Does Coconut Oil Clog Arteries?

Answer:

I wrote about the cholesterol “skeptics” in my book Carbophobia (now available free, full text online).

I think the issue was best summarized in a medical journal editorial entitled Cholesterol Myth Club on Par with Flat Earth Society that read: “as mixed up as Flat Earth Society members obviously are, at least you can laugh their dumb idea off, and if you want to believe the Earth is flat, this view is not going to cause serious problems like… coronary artery disease.”

image credit: Grahams Child via Wikimedia Commons

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  • Maria Jose

    Thank you for all your amazing contributions to humanity. You are truly admirable Dr. Greger!!

  • http://www.facebook.com/petarc Petar Ceklic

    Would love to see a video tackling this.. I have so many people ask ‘what about paleo’??

    • Darryl Roy

      I recommend the “Plant Positive” YouTube channel for more evidence-based video rebuttal of Taubes et. al. than most may have patience for.

      • Toxins

        Plant positive is excellent

    • BPCveg

      Taubes vs Ornish video was interesting:

      http://www.youtube.com/watch?v=HCgTlC8PE0Q

      • Evie

        That was amazing. thank you for sharing. I was not aware that there is not a single peer reviewed, published study for the atkins diet. That explains quite a bit.

      • DStack

        Taubes is so difficult to listen to!

      • http://www.dachia.com Dachia

        Taubes is just too condescending and uneducated to listen to. They are wasting their time with him. It would be more interesting if they had a real conversation with someone who had solid education and held a different vuew… and there is the rub. The people (95%) who are educated and do real research don’t disagree with the Ornish, McDougall, Novick, Gregers of the world.

        • VegAtHeart

          So true. I do find that those who aren’t that much into veganism give half-hearted praise to Dr. Greger and company. You may find this short essay by Dr. Joe Schwarcz to be an interesting example of a Greger critique.

  • http://www.facebook.com/veganblue Alistair Ⓥ Cornell

    For Petar Ceklic – the issue and video links are discussed here:
    http://nutritionfacts.org/2013/02/21/the-real-paleo-diet/

  • sanne

    i would like to know how to gain weight on a vegan diet.Since 3 months i skipped dairy/meat products,but lost 7 kilo’s,wich i cant afford to lose.My hight is 1.63 cm and my weight went from 52 kilos to 48,wich makes my BMI 18(too little for my seize)

    • Amanda

      Eat more:)

      Its that easy. Track your calories on http://cronometer.com/ .
      A good way is to incorporate healthy fats, like for example in a morning green smoothie, add flax seeds.
      Eat a handful of nuts as a snack etc..;

      • BPCveg

        Also try healthful but calorie-dense snacks like Lara bars and date-rolls.

    • Phill

      Hey, check out vegan bodybuilding sites. veganbodybuilding . com and veganmusleandfitness . com are good places to start. From what I understand when you switch to a nutrient dense whole foods diet, initially everyone will lose weight. The more toxic you are the more weight you will lose, as fat is used by the body to remove and store toxins. So your weight should stabilise to a healthy weight.

  • Amanda

    I have a question for Dr greger:

    Can you tell more about dark circles under eyes.
    I have had them since a very long time, from the beginning of my teens actually. Its not like dark dark, but more like a blue , and you can also see a little bit of blue veins.

    • b00mer

      Hi Ann,

      I see that this is an old comment but I would like to respond anyway. I have always had hereditary dark circles (as opposed to fatigue or illness-induced ones), as it sounds like you do too. I know how incredibly frustrating they are!

      Over the years I tried all the topical products and nothing worked. I do not believe there are any products in existence that genuinely remedy hereditary dark circles.

      However, since switching to a nutrient dense WFPB diet, and consequently consuming massive amounts of well, most vitamins, but particularly vitamin K (lots of kale and berries), I do think there has been a very gradual but significant improvement. I still wear undereye concealer every day, but not as much. I used to wear three separate layers, now I wear two (concealer plus setting powder). Might not sound like a huge improvement but I remember in years past when I would try to skip one of the three layers and everyone would be so concerned! “Oh, are you okay?” “Are you sick?” Lol! Now when I don’t have concealer on, there are still circles there, but not to a degree in which I could frighten small children. ;)

      p.s. the best concealer I’ve found (and I’ve tried them allll) is also the cheapest, is widely available, and is not tested on animals: glamoflauge by hard candy. Six bucks, can get it at walmart. It’s not perfect, but again, it’s the best I’ve tried. Dark circle sufferers unite!

  • Frances

    What are your thoughts regarding green coffee bean extract for fat metabolism?

  • http://www.mycompletelackofboundaries.blogspot.ca/ Ellen Reid

    Yes, Dr. G., would love to have some things to point to when people bring up The Cholesterol Myth. Some of my friends have gently suggested that maybe I’m just seeing the data that confirms my bias. Where do you weigh in on how some are saying that cholesterol is not the problem we once thought it was?

    • http://www.DonForresterMD.com/ Don Forrester MD

      The evidence linking cholesterol intake to arterial disease is pretty solid at this point. We all tend to be guilty of confirmatory bias. It is true that as our understanding has progressed that the focus of the research has shifted to other areas such as the nitrous oxide system. This just shows how the old information about cholesterol fits into our new improved model. This is not controversial… people are entitled to their opinions but not their own facts. Unfortunately to understand the studies requires a degree of understanding of statistics which most folks lack. As the saying goes many folks use statistics like a drunk uses a lamp post…more for support than illumination. Keep tuned to NutritionFacts.org as the science keeps changing.

      • http://www.mycompletelackofboundaries.blogspot.ca/ Ellen Reid

        Thanks Dr. F. I don’t understand all the science stuff most of the time, so I have to base my opinions on the research/writings of people whom I respect and who don’t seem to have ulterior motives. This gets me in to trouble sometimes. :-)
        Cheers

        • http://www.DonForresterMD.com/ Don Forrester MD

          Stick with reliable sources as there is no way to keep up. You are correct alot of ulterior motives… pushing supplements and pseudoscience. The most reliable sources free of ulterior motives are Michael Greger MD, John McDougall MD, PCRM(Physicians Committee for Responsible Medicine), and Jeff Novick RD. Be well and try and stay out of trouble!

      • Naturehike

        I have been vegan for three years and started to see my cholesterol and triglyceride levels start to fall. Still being about 40 pounds overweight, about four months ago I also reduced my fat intake and have lost just over 15 pounds. My blood work just came in and my cholesterol has shot up to its highest level ever. What’s that about?

        • Toxins

          What constitutes your vegan diet? Are you consuming processed white flours? Do you consume free oils? These are important points as one needs to eat minimally processed plant foods to reach optimal health goals.

          • Naturehike

            Right now I am using the Happy Herbivore food plans. I will need to look through the site to determine what makes up a free oil. My consumption of oils like olive oil etc. are almost non-existent. I make my own vegetable stock and use that for all sauté and stir fry.
            She does depend some on canned items, but for the most part I make foods from scratch. Her plans are higher in carbs than I ate previously, but not what I think is a lot of processed flours. There is some use of corn tortillas, or whole wheat tortillas.

          • Toxins

            Happy Herbivore is a good stepping stone, but still tends to be higher in salt and added sugars compared with forks over knives recipes.
            http://www.forksoverknives.com/category/recipes/

            If you exercise regularly, eat minimally processed plant foods, get plenty of leefy greens and fruits in your diet and limit your consumption of added sugars, added fat and added salt, you should find that your cholesterol numbers will drop. Do you exercise regularly?

          • Naturehike

            I probably do OK on the salt as I don’t add any, and cook some items from scratch. Sugar maybe not so much.
            Have stuff going at work right now that has meant working very long hours – I’ve actually dropped nearly all exercise since September. I was actually online yesterday trying to find a couple of classes that could be outside of all of the hours I am working. Will stress drive up total cholesterol?

        • SisQ

          Mostly vegan for a year, mostly vegetarian for about 9 years. For the past year no flours at all, no foods with added sugar, fats mostly consist of nuts, chia seeds, flax meal, avocado, and a little avocado oil or olive oil. My triglycerides have gone up and so has my total cholesterol, although HDLs went up and LDLs went down, VLDLs went up. My total cholesterol is the highest it has ever been, although the ratios are very good. I Lost 20 pounds in the past year and am at BMI 18 and trying to hold steady. When I googled triglycerides going up I found reference to active weight loss causing temporary increases in cholesterol and triglycerides as fat is burned away. Could weight loss be causing elevations in cholesterol or triglycerides? I hope it isn’t the fruit . . . :(

        • Cyndi Phillips

          It proves my point. It’s not about cholesterol, it’s the carbs and grains and sugars.

        • http://earthasset.com Melissa

          Naturehike, when you burn your own fat, your cholesterol readings can indicate as such. Your body is ‘eating’ the fat stored on it, so naturally it is as if you are eating animal fat, especially if you got fat on animal fat to begin with. This is what can account for cholesterol readings during initial weight loss. The fat you’re burning is the fat you ate initially…Makes sense, eh? After your initial weight loss, the numbers will drop.

      • Gross Bro

        “The evidence linking cholesterol intake to arterial disease is pretty solid at this point.”

        Which study/studies shows that dietary cholesterol contributes to CVD?

  • dale

    wtf man u go on here looking for advise from these educated doctors and they cant agree on anything?????? so my question is an answer if one says vagan and another says meat maybe the truth is somewhere in the middle? but if all meat is bad cuz of the studys then all fruit is bad too.. what clots your arteries?? meat or sugar? or both? if i ate meat and sat around on my fat ass i am sure i would get clot same with fruits.. what do u think doc?

    • http://www.DonForresterMD.com/ Don Forrester MD

      Most of the physicians who are knowledgable about the role of nutrition in avoiding disease and disability agree 95% of the time. The science does keep changing however it keeps building to support the following paradigm or belief. Anatomically and physiologically we are “hind gut fermenting herbivores”. Eating meat, dairy and eggs even if they do not contain persistent organic pollutants (e.g. dioxin, pesticides) and chemicals such as mercury and arsenic is not healthy unless to avoid starvation. Fruit is fine in limited quantities. We burn glucose as our primary fuel so starches (e.g. potatoes, rice, whole grains) should be our main food. Fructose in fruits or added to sodas is only metabolized in the liver to triglycerides, uric acid, inflammatory aldehydes and cholesterol. Some does get converted to glucose but that the amount and thresholds for these are still being worked out. I would stay tuned to nutritionfacts.org as the science is changing. Other reputable commercial free information can be found on the John McDougall MD website and the PCRM website. You mentioned exercise which is certainly important but nutrition is probably 80%, exercise 15% and 5% other. At any rate.. my opinion based on the current science. I am open to change as the science changes.

      • pat

        So, should we cut back on fruit consumption to avoid fructose and all if it’s evils?

        • http://www.DonForresterMD.com/ Don Forrester MD

          I think moderate fruit consumption is fine. I would avoid the concentrated processed sugars although used in limited amounts you are most likely okay. There may be certain patients with fructose malabsorption syndrome or elevated cholesterol that would need to decrease consumption of fruits. The current pharmacokinetics of how the body handles fructose suggests that up to four servings a day should be fine but more research would be useful.

  • badcellist

    Dr. Greger,
    Six months ago I was facing yet another stenting ‘procedure’, after a heart attack, Quad-bypass, two stenting procedures (5 stents total). I was suffering, intensely, from every side effect that comes with statin drugs including dementia and muscle wasting and cramping, popping Nitro like candy just to get through the day, 30 pounds overweight, and, in candor, mentally getting my final business in order.

    At the same time, I chose to stop statin drugs and become an Uber-Vegan. This decision was after extensive research and information gathering about statin drugs and ways to live without them. Operative word here is LIVE – not exist. The information that you have offered, along with several others, was instrumental for an educated decision to take my sojourn into a new life.

    My status today, at 64; I am off all medications except for nutraceuticals, my cholesterol is 155, results of my latest Nuclear stress test shows no indications of blockages, 34 pounds lighter – from 192lbs to 158lbs (from a snug 38″ waist to a comfortable 30″), briskly walking 3+ miles a day, mentally sharp, and looking forward to a longer and healthier life.

    Wishing to share this option to others in my predicament, I am working on a project in which your information would be important to reference.

    If you would, Doctor, please PM me at ronzet@hotmail.com to let me know if it is possible and if you would be willing to discuss this project with me.
    At your service,
    Ron Z

    • b00mer

      What an incredible story! Congratulations! p.s. I love your username! I’ve often thought about taking up the cello and as an old dog learning new tricks would no doubt be a “bad cellist”. I think it’s such a beautiful instrument. Cheers.

  • Dave

    Dear Doctor, is Quaker quick cooking oats good for diabetic patient.?

  • P

    Hi Doctor… I eat 4 egg whites every morning (no yolk at all). Is this still bad for me ? I believe there is no cholesterol at least in egg whites. Is there anything else I should be aware of ? It would be great if you did a video of this, many people have stopped eating yolks and feel safe with the whites, hope we aren’t wrong.

    Thanks

    • Toxins

      The issue with animal protein is also the IGF-1 raising effects which promotes tumor growth. The more protein, the greater effect we will see.
      http://nutritionfacts.org/index.php?s=igf-1

    • Ken

      I don’t know if it’s bad for your health but I know it’s not good for the chicken’s health.

      • rsbmg

        Chickens are on earth to be eaten.

    • mbglife

      There are lots of problems with eggs in addition to the IGF-1, like the choline. Just go to the top of any page on this site and type, “egg” in the search box. Then watch a few videos for a sense of the problems and risks.

  • Pete Greider

    Dr. Gregor. Would you be able to comment on the recent article about Saturated Fats that was published in the British Medical Journal on Oct. 22, 2013. I would love to know your perspective on what he says. Thanks. Pete Greider. Here’s the link: “Saturated fat is not the major issue.” BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6340 (Published 22 October 2013)Cite this as: BMJ 2013;347:f6340

    • Toxins

      I will share with you what I have shared elsewhere on this site regarding this myth.

      “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease”

      http://ajcn.nutrition.org/content/91/3/535.full.pdf+html

      This Meta-analysis looked at 21 different studies, and came to the conclusion that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD [heart disease].”

      Shared by Jeff Novick:

      One major problem with this study is they did not look at any studies where the saturated fat intake was less than 7%, which is the level recommended by the American Heart Association. Most of the diets had saturated fat intakes in the range of 10-15% (or more).

      So, just like the studies that criticize “low fat” diets, but never analyze any diet that is truly low fat and based on the principles of low fat, high fiber, whole plant foods, this study criticizes the impact of lowering saturated fat, but never looked at any diet that truly lowered saturated fat to the level recommended.

      Another problem with the study is what the subjects replaced the saturated fat with when comparing the 2. For many, if not most, it was with either (or products containing) hydrogenated/trans fat, while flour, white sugar and/or mono fats.

      People who replaced saturated fat in their diet with polyunsaturated fat (omega 3/6) reduce their risk of coronary heart disease by 19 percent, compared with control groups of people who do not.

      http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000252

      Lastly, studies on all-cause mortality trumps findings for subsets such as CHD and CVD. Most all-cause studies demonstrate a direct relation between saturated fat intake and all-cause mortality and the lower the better. Here is a list of studies showing just this.

      “the results of this study support earlier observations that dietary intakes low in SF or high in FV [fruits and vegetables] each offer protection against CHD mortality. In addition, however, our data suggest that the combination of both high FV with relatively low SF intake offers greater protection against both total and CHD mortality than either practice alone.”

      http://jn.nutrition.org/content/135/3/556.long

      “The major finding of the present study is that the average population intake of saturated fat and vitamin C and the prevalence of smokers are major determinants of all-cause mortality rates. Saturated fat and smoking are detrimental, but vitamin C seems to be protective in relation to the health of populations…The potential effect of changes in saturated fat, vitamin C and the prevalence of smokers can be illustrated as follows. A change in saturated fat of 5% of energy is associated with a 4.7% change in age-adjusted all-cause mortality rate (Table 3).”

      http://ije.oxfordjournals.org/content/29/2/260.long

      “A high RRR pattern score, which was associated with high intake of fat and protein and low intake of carbohydrates, increased the risk of death. Subjects with a pattern score belonging to the highest quintile obtained on average 37·2 % of their energy from fat and 37·6 % from carbohydrates and thus did not meet current dietary recommendations (Institute of Medicine of the National Academies, 2002). Food groups that contributed to this unfavourable pattern of energy sources were red meat, poultry, processed meat, butter, sauces and eggs, whereas a high intake of bread and fruits decreased the pattern score.”

      http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN93_05%2FS000711450500111Xa.pdf&code=6fbdbd311fb43ee23a840b894cced959

      From the National Academy of Science:

      “Saturated fatty acids are synthesized by the body to provide an adequate level needed for their physiological and structural functions; they have no known role in preventing chronic diseases. Therefore, neither an AI nor RDA is set for saturated fatty acids. There is a positive linear trend between total saturated fatty acid intake and total and low density lipoprotein (LDL) cholesterol concentration and increased risk of coronary heart disease (CHD). A UL is not set for saturated fatty acids because any incremental increase in saturated fatty acid intake increases CHD risk”

      http://www.nap.edu/openbook.php?record_id=10490&page=422

      “The saturated fatty acids, in contrast to cis mono or polyunsaturated fatty acids, have a unique property in that they suppress the expression of LDL receptors (Spady et al., 1993). Through this action, dietary saturated fatty acids raise serum LDL cholesterol concentrations (Mustad et al., 1997).”

      http://www.nap.edu/openbook.php?record_id=10490&page=432

      From the editor in chief of the American Journal of Cardiology.

      “As shown in Figure 1, most of the risk factors do not in themselves cause atherosclerosis [heart disease]…The atherosclerotic risk factors showing that the only factor required to cause atherosclerosis is cholesterol.”

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603726/

      • Pete Greider

        Dr. Greger. Thanks for taking the time to post such a thorough reply. I will read all of this carefully this weekend.

        • Toxins

          I am not Dr. Greger, I am a nutritionfacts team member. But I am glad I could share with you helpful information.

  • Fabio

    ABC Catalyst recent documentary “Hearth of the matter” http://www.abc.net.au/catalyst/heartofthematter/ made a strong statement interviewing many doctors who think that the association between high colesterol and hearth disease is uncertain, to say the least. I think you should address this claims with scientific rigor and not just dismiss them as the matter is really important. Thank you

  • ross

    My wife works out 2 hours per day and has been doing wonderfully on the 100% Vegan for about a year and her health has improved along with her blood numbers. With my energy levels low would there be foods you might suggest I get back into to repair what you outlined as missing (heme iron, taurine, CoQ10, not to mention cholesterol, saturated fat, and protein generally) in your email? I would appreciate it. I’m thinking fish(oil) fresh from the sea or sardines? FYI, just for interest sake this is what I eat each day: Anyone else out there having energy issues with Vegan? Remember guys, a damaged ego is better than death!)

    Everyday starts
    1 Quart of Lemon Water (this has appeared to be very helpful to me)

    Breakfast
    6 various fruits per day
    Oatmeal(real oats) with Chia/Millett/Flax/raisins/drop of MS or Agave/ goji berries, hemp hearts(have this about 3-4X’s per week(weekends flax bread with PB&J)

    Lunch
    3 pounds of salad made up of broccoli, cauliflower, red cabbage, red pepper, snow peas, carrots, tomatoes, quinoa, red onion and a drop of homemade dressing(olive oil/lemon)
    or large homemade mushroom or other vege soup

    Supper
    Cooked various vegan cookbook fair with lots of veges

    Desserts
    Homemade ginger cookies or banana bread or fruit

    I figure if you saw what I eat maybe you would have some quick suggestions about ‘what foods’ I’m missing. I sincerely appreciate your thoughts as this is becoming quite frustrating when I have ALWAYS been perfectly healthy and although I only workout 30 minutes per day, have always had stamina!

    PS: For the past 8 years our meals have been similar except we ate ‘fresh from the sea’ no processed varieties of NS fish 4 nites per week.

    Happy New Year. Ross

  • Stacey Vas

    Dear Dr,
    I am still confused about the cholesterol myth. After reading the book I am convinced that cholesterol does not cause heart disease and it’s more of an inflammatory response which drives the disease. I have read your posts on the Atkins diet as well. If we all ate a low sugar diet (which causes lots of inflammation) ate predominantly vegetables and a little bit of meat and animal products, would that be the best option for optimal health? It’s difficult to get my head around with so much conflicting evidence! Clients always ask me about this and I just wanted to clarify. Thanks so much, I love your website! (you saved me a lot of research whilst I was in uni!)
    Kind Regards,
    Stacey

  • Gross Bro

    Dr. Greger, I appreciate your work on this site. It has helped me eat more plant-based.

    But this post is seriously lacking, especially for anyone who is trying make informed decisions.

    The premise behind “The Great Cholesterol Myth” is that dietary cholesterol has little to no influence on blood cholesterol, and therefore dietary cholesterol cannot be blamed for CVD.

    The sources in your “Carbophobia” book, and the medical journal editorial entitled “Cholesterol Myth Club on Par with Flat Earth Society” do not show that dietary cholesterol causes CVD, or raises blood cholesterol to significantly increase CVD.

    What are your real thoughts on this?

  • Melissa

    Hi Dr. Greger, I’m sure many of us are awaiting your response to the latest study, described here “Study Questions Fat and Heart Disease Link” : http://well.blogs.nytimes.com/2014/03/17/study-questions-fat-and-heart-disease-link/?alg=44K8Y. Would love to hear your always cogent thoughts.
    Many thanks, Melissa

  • Austin Rogers

    I’ve been searching for a study that demonstrates eggs raise LDL cholesterol levels but have not yet found one. Most of what I read indicates eggs only raise cholesterol in “hyper responders,” who make up 30-40% of the population. Can anybody provide insight into this?

    • Skeptic

      There are many, many studies showing that consuming dietary cholesterol raises LDL levels. There’s certainly nothing special about eggs to make them an exception to the rule. Try searching “eggs” in the search field, then open the citations under various videos. I’m sure you’ll find plenty of studies that show eggs raise cholesterol.

  • websww

    Maybe you should check out “The Questionable Link Between Saturated Fat and Heart Disease – “Saturated fat does not cause heart disease”— concluded a big study published in March in the journal Annals of Internal Medicine.The dubious science behind the anti-fat crusade”http://online.wsj.com/news/articles/SB10001424052702303678404579533760760481486?mod=WSJ_hp_RightTopStories&mg=reno64-wsj

  • Lawrence

    When I click on the link above “Cholesterol Myth Club on Par with Flat Earth Society” it takes me to the publication but it only shows the title. There is nothing there to read. Any suggestions?

    • Thea

      Lawrence: Dr. Greger does his best to provide full references and *when possible,* links to the actual studies or editorials. However, many times it is just not possible to link to the full text of the study because those studies/papers are available only to paying subscribers of the related journal.

      Some ideas: Sometimes local libraries, especially university libraries have subscriptions to those journals. You might try there. If you were really gung-ho to read an article, *I think* some publications have some short-term or single-study access rates. Other than that, I’m not sure what else you could do other than paying for a full subscription to the journal. Other people may have better ideas than me.

      Personally, I would like to see journal’s supported in some way that makes their content fully available for free to the public. But no one asked me.

  • Michael Frank

    I am sorry to read about flat earth. Seems like you are not taking science into serious consideration. As a Dane I am aware of the Danish researcher and professor Uffe Ravnskov, ph.D.. He worked on cholesterol myth in more than 20 years. Please See his results on: http://www.ravnskov.nu/cholesterol
    Also the distinguised double Nobel Prize Winner: Linus Pauling has stated that the cholesterol plays a minor roll. It is the Lp(a) which parcitipates in giving CVD. Refer to his studies also with Dr. Rath and Pauling. But apart from that I honour your very serious and Scientific based results here on this website. Best Regards Michael Frank , Denmark.

  • Avalon P

    Can Familial hypercholesterolemia be managed by diet alone or is medication needed?