Doctor's Note

Yes, an ounce of prevention is worth a pound of cure, but a pound isn’t that heavy—why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my next video: Why Prevention is Worth a Ton of Cure.

Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I’ve previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment. What should we be saying? See: What Diet Should Physician’s Recommend?

So why don’t more doctors do it? See Barriers to Heart Disease Prevention.

More on Dr. Esselstyn’s heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course then there’s just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

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  • veganchrisuk

    I showed this video to my neighbour (he’s 71, he has prostate cancer and also takes statins – he’s 5,7″ tall and 17 stone) – he thinks it’s a load of rubbish – now matter how good the information, you can lead a horse to water etc etc……

    • justme

      My dad’s the same way. He actually says he’s known that diet can cure his health problems for a long time. Then he adds, “Change my diet? Never!” Well, I’m going to do everything in my power to live out my days as painless and healthy as possible eating wholesome plants. Nothing tastes as good as being fit feels.

      • veganchrisuk

        I feel your pain – it’s like trying to herd cats….

        At least you can take some comfort from knowing that your father has made his own choice, whereas my neighbour takes his Dr’s word as gospel and refuses to accept any other opinion, as do so many others of his generation…….

        All we can do is keep trying……

    • Julie

      Yeah, trying to help others with this info can be so frustrating! My mom wants to believe that the meds she and my dad take are helping them. It upsets her world too much to even consider that her doctor is doing a disservice by not informing them that diet can be way more helpful and medication more toxic than they’ve been led to believe. She told me that she’d respect Dr. Greger more if he offered a broader picture, stating both the pros and the cons. Aargh!

      • Misterimpatient

        Wow. You cannot get more PRO/CON than this video.

      • veganchrisuk

        Yes, some people will accept the conclusions, others will not – and there are people like your parents that require additional proof in many different formats – c’est la vie….

    • Zuppkko

      Thinking takes energy. And thinking against your beliefs takes tones of energy. Associating the food with love makes it even harder.

      • veganchrisuk

        Coincidentally, love does have something to do with it – he’s a comfort eater, he loves his wife but she hates him (long story).

        He is the definitive example of a person displaying akrasiac behaviour – smoking, drinking, comfort eating (all the wrong processed foods – are there any right ones?), refuses to exercise, just sits on the sofa watching TV all day – and his cancer has metastasized to the bones…..

        I hope that I never find myself in a similar situation.

        • Zuppkko

          I’d say loving wrong things and the lack of love (from others) are two great reasons why someone will never change. My dad knew about healing power of vegan, raw vegan food and fasting long before his gallbladder was taken out and long before he got colon cancer.

          No love = no motivation = no change. I too hope i will not end like this. Suffering and felling sorry for myself. In fact i will do more than just hope. I will do anything in my power to make myself and the world better.

          • veganchrisuk

            I share your enthusiasm for the future – I have told my neighbour that I will do my utmost to avoid finding myself in his position. To his credit he agrees, and says that if he had his time over again he wouldn’t make the same mistakes (we all must say this at some point in our lives), but now he feels he is too old for a lifestyle change. I don’t agree with this choice, you hear this type of comment all the time, and I interpret it as “I’m too lazy to change”, as there are a number of videos on NF that tell you it’s never too late, but then again I’m a few decades away from my 70’s, who knows whether I’ll live that long, and if I do, whether I become his clone……..

          • Zuppkko

            You are your own creator ;) And you can’t change others. Maybe you can pinch someone … but still they have to become aware themselves.

    • PontiacJones

      My grandfather was the same way. He refused to try anything new, even though he eventually came to admit that the statins weren’t actually helping. There isn’t much to do if the person in question isn’t willing to help themselves. It certainly reinforced my thoughts on the whole foods I eat everyday, however!

    • tbatts666

      It’s tough.

      It is pretty clear to me that a whole food plant based diet is great.

      But go back to when you weren’t vegan. You probably would be pretty uncomfortable with someone else trying to shit on your lifestyle. Maybe you would have a defensive reaction.

      It is important to remember that we as human beings don’t know reality, we just make “mental models’ for what reality can be. Your neighbor had probably lived his whole life having risky habits reinforced. You can expect a defensive reaction if you state something that challenges someone’s mental models.

      I am studying medicine and I am struggling with motivational interviewing… And when to wear the doctor hat and when to just listen.

      • KWD

        Encouraging change without eliciting defensive reactions is an art I hope to learn. Thanks for posting about motivational interviewing (just looked it up) as I’ve not yet studied these techniques. Good luck in your studies.

      • veganchrisuk

        Well I don’t have to go back far, and when I think about it, if I hadn’t stumbled across a comment on a bodybuilding forum re protein intake and “The China Study”, I would still be eating about 150-200gms of animal protein per day – maybe you can provide me with some motivational techniques for my neighbour – any involving chocolate, dairy, meat and lack of exercise should work……

        I hope you are spreading the NF word among your fellow students – reading what some of the other medical practitioners have written, I believe I’ve had more Health and Safety training on how to lift a box correctly, than you medical students have re nutrution – good luck with your studies.

        • tbatts666

          I would still consider myself mediocre at motivational interviewing.

          There are some videos on YouTube about it.

          But you could check out “the fifth discipline” by Peter Senge. I think it provides a philosophical framework for leveraging positive change.

          • veganchrisuk

            Thanks, I will take a look…..

        • Jacksaid

          I was diagnosed with Prostate Cancer two and half years ago. In that time. I’ve had two shots to lower my testosterone. My number was at five yesterday and today I had bone scan that revealed that my bone’s are cancer free.. I refused the radiation and have had good success with managing the cancer thus far.

          In regards to some of you lamenting that you are unable to convince love one’s to change their life style? You may have to wait until you become that age to get your answer? Sometime , life is just life and one day is like the next and there is no real reason to just be , to just be. I think I understand that one more day or year is not all that important…

    • Matthew Smith

      For prostate cancer, this site recommends fenugreek, amla. strawberry. black raspberry, mushrooms. seaweed. flaxseed. matcha. walnuts. pecans, cranberry, lemonade, apples. rosemary, tumeric with pepper. ginger, garlic, cloves, beets. spinach. collards. broccoli, kale. chamolle. dandelion. hibiscus. Nuts, beans, matcha, cocoa, Whole grains, berries, fresh fruit, fresh veggies, and spices are recommended. I think when presented with data on how effective fenugreek, amla, and other advice from this site are on a long term battle with prostate cancer, you could be a real game changer.

      • Psych MD

        Although your list sounds daunting, it is amazing how many of those things are incorporated in Ayurvedic medicine. eg. a single product called Hingvastak contains:cumin, ajamoda, black cumin seed, black pepper, ginger, pippali (another type of pepper), asafoetida, and fenugreek. I dump it on my food and it is absolutely delicious. I also turn my green tea into super tea by adding Tulsi powder, another Ayervedic herb with extensive scientific evidence supporting it.

    • Andrea Mercier

      I know…I am trying to get my GP to NOT prescribe drugs to my hubby. He has gone 90% vegetarian…he struggles some days, but his blood sugar is coming down and his weight is coming down…but they still want him to take statins and bloodpressure meds. Le sigh. If I tell him not to take them, my doctor thinks I am nuts.

      • veganchrisuk

        Try expanding your Dr’s nutrution knowledge by pointing him in the direction of NF – you could always consider changing your Dr (extreme – but if you feel so strongly about it, this it may be your only option).

        Good Luck…

      • Matthew Smith

        For hypertension, this site recommends beets, hibiscus tea, seaweed, grapefruit, beans, brazil nuts, whole grains, and flax seed meal. For high cholesterol, this site recommends nuts (particularly almonds), whole grains (like Cheerios), flax seed meal, kiwi, grapefruit, red yeast rice, dried apples, amla, and beans like chickpeas. For high blood sugar this site recommends hibiscus tea, cinnamon, flax seed meal, amla, and beans. Thule has produced another list of recommendations from this site for high blood sugar: Indian gooseberries (amla), coffee, soy, flaxseeds, green tea, pulses (dried beans), chamomile tea, purple potatoes, sprouts, whole grains, vinegar, and beans. Congratulations on your decision to be a vegetarian couple. One of the biggest sources of high blood pressure and rapid pulse is caffeine in the diet. You should be really prepared for heart disease. Dr. Greger in this site shows and states that lifestyle intervention should be front line or a main treatment and intervention for diseases that involve accumulated wear and tear on the bodies cellular machinery like heart disease. Intervention should be in one to two months, one year for full effect, based on Dr. Ornish’s results. Good luck to you and your family. In another video, Dr. Greger said that these medications have a low chance of working, below placebo effect, and have risk of side effects that could further hurt health. Lifestyle intervention is safe whether or not it works for you and you have already taken positive steps with it for health!

      • Amy Johnson

        Andrea…I had a similar thing happen to me as a Type 2 diabetic. However, there was a point where it became dangerous to KEEP taking meds because my blood sugar got too low. My doctor was amazed and took me off. Since then, I found a doctor here in Dallas that PROMOTES whole foods plant-based eating instead of meds. The Happy Herbivore has a list of doctors who support this way of eating. You might want to check it out!
        http://happyherbivore.com/2014/09/plant-based-vegan-doctors-list/

      • Karl Holtzer, M.D.

        Hi Andrea. Your concern is so valid. When you see the facts as they are outlined above by Dr. Greger it is very hard to not want to throw the pills in the garbage can. It has been said that young doctors entering medical school want to take care of the “whole” patient but by the time they graduate medical school they want to only focus on the “hole” that’s in the patient, meaning that the practice of medicine is so narrowly focused and “super subspecialized” that we’ve lost the forrest for the trees. And as we can see – we’re not doing a very good job at focusing on the “hole”. It’s going to take a movement (that we are in the midst of) and patients like yourselves asking questions over and over again combined with doctors who really want to treat the patient and not the symptom. I certainly have hope. What about vitamins to replace plants? ……you might ask. Take a look at these studies reviewed by Dr. Greger a few years ago Produce Not Pills to Increase Physical Attractiveness There are certainly exceptions to every rule……..Vitamin Supplements Worth Taking

    • Barbara Wagner

      I see this reaction often! I think much of it stems from fear: fear of change, regret that we may have been doing it wrong all this time, fear of the unknown diet we are afraid we could not comply with. Having our lifetime personal beliefs challenged can be difficult to handle for some individuals. The truth sometimes hurts but we need to push thru all that.

    • The Max22

      almost everybody I know thinks like that. However I see many young people have switched to a plant based no oil diet. I think the old generation must die off before something new will start. Question is: will the biosphere survive long enough?

      • Jacksaid

        I spent the night in the Biosphere in Arizona. The man that showed us around the place asked a qwuestion…What did they learn fromliving in the Biosphere? ” Nothing”, he said

    • Rob Williams

      Actually he might be right in this way: Humpty can’t just start eating salads and have his million pieces go back together again.

      In 2012 the US spent $250B on diabetes care. 100% of it was palliative as there is no cure. Go lookup a list of colleges in the US who have an endowment of $1B. Not even 250 long.

    • Monique

      Old people are so dumb and stupid, very stubborn as well. You can’t change them. It pisses me off.

  • Herb

    Why is it that that Dr Greger neglects to mention that in the trial he refers to 5 patients on the vegan diet died of non cardiac events while none of the standard diet patients died of non cardiac events – an important caveat even if many more patients were in the vegan group. Why is death ignored????

    • Floren

      Hi Herb,

      I believe you are misreading the publication. There were two groups, 177 that followed the vegan diet and 21 who did not. Of the ones following the vegan diet, 81% improved, 8% remained the same and 10% got worse. 5 of them (3%) died indeed, but not due to cardiac events (3 cancer-related deaths, 1 fatal pulmonary embolism, and 1 case of pneumonia). Of those who didn’t follow the diet and only took medication, 0% improved, 38% remained stable and 62% got worse. 2 of them (9.5%) died due to cardiac events.

      It’s all detailed in Table 2 of the manuscript: http://dresselstyn.com/JFP_06307_Article1.pdf

      You can play with the numbers all you want, but the picture is very clear. Much more so than with any other study involving medications. The only thing missing here is a study with much larger numbers to make the statistics more convincing (with the authors themselves suggest).

      Regards,

      Floren

      • Arjan den Hollander.

        Battle of the critics, and…….. truth wins!!!

        Welcome aboard Floren

        • Herb

          It may or may be statistically significant, as you yourself point out by your use of the word ‘probably’.

          My point which seems to be studiously avoided by all commenters it that the 5 deaths vs zero should have been disclosed in the video. Particularly since there are a number of trials that show a high all cause mortality associated with a significant reduction in cholesterol, which a vegan diet certainly results in.

          • You’re not being honest about the stats here. All cause mortality was 5 to 2, not 5 to zero. It’ll take a larger randomized controlled study to determine if your cholesterol “deficiency” hypothesis is has any validity.

          • Herb

            You’re correct -non cardiac mortality is 5 to 0. All cause is 5 to 2. I meant to say non cardiac instead of all cause as I correctly stated in other comments.

          • largelytrue

            Which trials?

            What I tend to note is that the major meta-analyses to date indicate no serious risk of excess non-CVD mortality from statins:

            http://www.ncbi.nlm.nih.gov/pubmed/23440795
            http://www.ncbi.nlm.nih.gov/pubmed/25579834

            Given that Greger was principally comparing different treatments in terms of benefits to CVD and did not take care to specifically mention any non-CVD mortality in any of the drug studies he cites, I don’t really see what has you in knots about this one omission versus all the others.

          • largelytrue

            “It may or may be statistically significant, as you yourself point out by your use of the word ‘probably’.”

            ‘Approximately’ is perhaps a better adverb for what Arjan is doing, because that comparison is grounded in a relatively standard statistical test. 5/8.4 is the expected number of non-CVD deaths for the non-adherent group if as a null hypothesis, you assume they have the same non-CVD mortality estimated for the adherent group. However, 5/8.4 is substantially less than 1, meaning that there must be a substantial probability of getting 0, meaning we fail to reject the null.

            More formally, if the expected number of deaths under the null hypothesis is 1-x and the probability of zero deaths is p, then 1-x >= 1-p. So in this case x is 0.40476 and p > 40%, and is thus clearly not significant at the 95% confidence level.

      • Herb

        I’m not playing with numbers. 5 people on the vegan diet died of non cardiac causes and none of the others. That’s a fact which you acknowledge. I am not questioning that the vegan diet was much better at preventing cardiac events. What most people also want to know is whether their overall chance of death is better or worse on a particular diet. By omitting the fact that 5 vs 0 people died of non cardiac causes on the vegan diet, he is omitting a very material fact. One can have a reasonable debate about whether a vegan diet leads to more cancer, embolisms, pneumonia etc, but one can’t have have that discussion if the facts are not revealed can we?

        • KWD

          “What most people also want to know is whether their overall chance of death is better or worse on a particular diet.” With all due respect Herb, every last one one of us, regardless of diet, has an infallible 100% chance of death.

          • Herb

            Your comment takes the grand prize for a non sequitur. I appears that you can provide no substantive rebuttal to my comment. The logical result of your comment would be – Why bother doing any trial if we all have a 100% chance of death? Thus this – and every health – site might as well shut down. Is that what you’re suggesting?

          • KWD

            It seems what you meant to say is “What most people also want to know is whether their overall chance of death in a specific manner is increased or decreased on a particular diet”. My reply was fair based on what you wrote.

            Today’s video addresses the conflict doctors face prescribing medications with efficacy rates that could be significantly bested if our treatment paradigm was to encourage and support lifestyle change when a patient is a candidate for Rx treatment. The study of 198 people that you’re referencing focuses on already very sick people with CVD who’ve agreed to change their diets from omnivorous to plant-based with the support of intensive nutritional counseling – and for which there were significant positive results for those adhering to the new diet.

            Yes, there were people in both groups who died (5 in the adhering group from three different manners of death and 2 in non-adhering from similar manner of death). And yes, of course, the question can be asked, did adherence to the new diet contribute to the three other manners of death in that group? Or did non-adherence contribute to that cause of death? We can also ask, would these patients have died from those same non-CVD events, or even CVD events regardless? Would it have been sooner? But, that’s all we can do is ask questions so it’s not that as you said, “death is ignored”….but in the context of this video, highlighting the outliers of the study doesn’t add one way or the other to the point of the video.

          • Floren

            There are studies showing that at least 70% of us will die at some point in our lifetimes.

          • Jacksaid

            Thanks for the update. I had always wondered about that?

        • Floren

          It was a royal use of the pronoun “you”, I was not accusing you personally of playing with the numbers. My apologies for the lack of clarity.

          I will insist that the really important numbers are how many people improve/don’t get worse with the vegan diet+drugs vs the drugs-only group. Those numbers are incredibly clear. But if you want to focus on deaths this is what I see:

          – 5 people died out of 177 with a vegan diet+drugs –> 2.8%. NONE of them for cardiac events.

          – 2 people died out of 21 with only drugs –> 9.5%. All of them for cardiac events.

          As a percentage, more people die when they take only the drugs. To be honest, with a population of only 21 individuals the 9.5% percentage is pretty meaningless to me. But it is significant to me that out of 177 patients with a vegan diet, in several years, NONE died of a cardiac event.

          As I see it, people dying for causes other than cardiac events is not relevant to this study. If there had been 20 people dying of say, liver cancer, I would be worried about the effects of the vegan diet. But they didn’t, so I won’t

          We can discuss to the end of days about what is relevant/material and what is not, but I guess it is a subjective matter. For me it is pretty clear that those deaths were unrelated to the study and therefore I would also leave it out of a 4 minutes video that discusses many other things. If someone is really interested in the details, he/she can look at the paper, which is cited in the video.

          If you wanted to have a discussion about the effects of diet on some other disease, then you should look at a study looking at that particular disease.

          Regards,

          Floren

          • Herb

            Floren,

            You’re concluding that the other deaths were not related to a vegan diet. I’m saying you can’t a priori assume that and thus the numbers should have been disclosed, particularly given the many studies that show cholesterol lowering drugs (which I know is not the same as a vegan diet) often lead to higher non cardiac deaths. I would feel much better if the Dr had disclosed the excess deaths and attempted to explain why they should be disregarded. I guess at this point we’ll have to agree to disagree but I certainly respect your viewpoint.

          • Floren

            Herb,

            You are right, no one can positively conclude those deaths are unrelated to the diet. But you do not have not enough data pointing in that direction in this study either. If you take 177 people with cardio vascular disease (CVD) with a mean age of 63+/-10 years, after 3.7+/-2 years (these are the numbers from the study)it is perfectly within expectations that 5 of them will die of a number causes.

            So, I cannot say with absolute certainty that those deaths are unrelated to diet, but I can say with great confidence that statistically speaking there is nothing suspicious in those 5 deaths and that the only observation with any statistical significance (and a great one for that matter) is the fact that nobody died of a cardiac event in a group of 177 people that were already sick at the beginning of the study.

            I still think that since the video was about the low efficiency of drugs, looking at the nitty-gritty details of 5 deaths with no statistical significance in a study that is mentioned as an counter-example, is really going to far.

            As you say, I will agree to disagree :)

            Have a great afternoon Herb.

            Floren

          • joeboosauce

            Herb,
            Do you honestly expect no deaths from people who are this seriously ill? I don’t think anyone who reads studies (testing vegan diet or not) with this population would even assume there were no deaths. I don’t imagine a layperson would either.

          • Herb

            The issue isn’t that people died. The issue is deaths in each group. I don’t think most people would expect 5 vegan deaths vs 0 non vegan deaths (non cardiac). As I’ve written above I believe it should have been disclosed and discussed. That’s the only point I’ve been making.

          • joeboosauce

            Surely, you’ve met people in your life who have had 5 more people die in their lives than yours. Is this statistically significant to draw some conclusion that that person may be the cause of death? Or how about that thing called chance? Now, if it was 50 in 2000, 500 in 20000, etc then it would warrant consideration. Much ado about nothing. Run a larger study (or fund it) and then we can move the conversation in a serious direction.

          • Marlon Welter

            Hey Herb,

            I think it is good that you pointed out a possible neglection of information here. Always need to question what people tell you.
            Anyway – on the matter I do agree with Floren and others. You can’t really compare the total numbers of 5 vs 0 for two reasons.
            First -> there were a lot more vegans in this study – so if the mortality rate would be the same it would need ~0.5 deaths in the non-vegan group (which is not far off from 0 actually.
            Second -> You can’t really discard the two cardiac deaths either, since they couldn’t die of any other cause since heart attack had them first, eventhough they might have been stage 4 cancer patients or something else.

            In my opinion stating the fact of 5 deaths vs 0 deaths in non cardiac deaths for vegan vs non-vegan seems to be more misleading than saying nothing at all, considering the above. No offense.

          • ale

            Great answer Floren!

        • ale

          Herb… 177 were those that followed the vegan diet and 21 who did not. More people equals more possibility of deaths…what’s not to understand? If those following the non vegan died would have been 177, the deaths (in proportion) would have been 16!!!

  • Julie

    You know, I had no idea that drugs were that ineffective! My husband and I haven’t taken any medications for 30 years, and we know that healthy lifestyle come first. It’s obvious that medications have some nasty side effects, however I never imagined the effectiveness rate could be as low as 3%! And you know those effectiveness rates are usually from the drug company’s own research, which means that’s a generous 3% (aka possibly 0%).

    • Herb

      That 3% can be misleading. Let’s say 6% of people in the trial who take the placebo get the disease without treatment. If 3% of the trial participants get the disease there is an absolute risk reduction of 3% (6-3%). Yet the relative risk reduction is 50% (half of the 6% who were expected to get the disease did not get it). Drug companies almost always publicize the 50% number rather than the 3% number for obvious reasons. Both numbers are important however to inform one as to what to expect from taking a drug.

      • Colin Wright

        Good point. Worth keeping in mind, though, that in this video Dr Greger is comparing high risk patients (who have a 5 % reduction in absolute risk taking pills) but a 60% chance of major cardiac event (using Esselstyn’s group of high risk patients). So the relative risk reduction of the pills would still only be about 10%. Correct me if I’m wrong.

        • charles grashow

          All of Esselstyn’s patients in his 15 year study took statins!

          • Colin Wright

            Yes, but so did the control group. Diet made all the difference:

            “Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%, significantly less than reported by other studies of plant-based nutrition therapy. Thirteen of 21 (62%) nonadherent participants experienced adverse events.”

    • Floren

      “There are lies, damned lies, and statistics”, but any doctor should be capable of clearly explaining to you what your expectations should be when taking a drug prescribed by her/him. It’s their job to give us the pertinent information and ours to make a decision.

      • Arjan den Hollander.

        Then Tom ran into Huck. Huck was carrying a dead cat. (Not at good sign) What are you gonna do with the cat? Gonna cure ma warts.
        – Yr a hoot :)

  • Kitsy Hahn

    Dr. G., I was hoping you’d stress (more) the dangerous side effects from those horrible drugs you mentioned in the article (Fosamax, etc.). When I was a kid, I used to hallucinate from swallowing even a spoonful of cough medicine, Some people are highly sensitive to medications, and I think I’m one of them. Therefore, I try to live in such a way that I’ll never have to be prescribed any. Avoiding doctors is one of the ways. :-)

    “With record numbers of patients suffering or dying as a result of
    prescription drug side effects, many wonder why medications that are
    considered dangerous are allowed on the market. The truth is that nearly
    all medications, both over-the-counter and prescription, have some kind
    of undesirable and sometimes dangerous aftereffects, from muscle aches
    to death.”

    http://www.drugwatch.com/side-effects/

    • Dr. Greger has addressed this issue in other videos, including his year in review videos.

  • mammaleone

    I’m a 72 year old female with a blood pressure that runs in the 130-145 systolic with a diastolic usually in the 80s and have been on 2 blood pressure medications for probably 15 years. My cholesterol is around 200 but I do not take statins. I’ve been a vegetarian for 47 years, a vegan for about 8 years and the last 3 1/2 years have not been using added fats or oils . I do eat nuts, avocados and olives in moderation. I limit my salt intake as well. Do you have any suggestions to bring both my cholesterol and B/P down?

    • Kent Nauman

      May I suggest at least walking around the block once a day but as much exercise as you can reasonable tolerate. Another physician wrote a book called How to grow younger as you grow older as I remember. Also do not smoke.

    • You need to work with your physician(s) to decide what is best for you. You need to balance the risks of the drugs with the benefits. If you have been on two BP medications and have changed your diet it is reasonable to revisit the need for your medication. First step is to understand what your goal for BP should be. At your age your BP results would be considered acceptable by all current guidelines. You might be a good candidate for a trial off going off done of your medications. A home BP monitoring kit will help you and your physician test this out. I would suggest that you read Dr. John McDougall’s article, “How I treat patients with elevated blood pressure” in his November 2009 newsletter… go to his website. He has the most experience and understanding of the clinical literature that I am aware of. He is very good at avoiding over diagnosing and treating patients as well as the most appropriate medications. Good luck.

    • Julot Julott

      Already tried high carb low fat raw vegan? which mean based on fruits if you want calories and easy digestion~

    • Psych MD

      Have you watched Dr. Greger’s videos on amla?

    • Matthew Smith

      For blood pressure, this site recommends beets, hibiscus tea, seaweed, grapefruit, beans, brazil nuts, whole grains, vegan diet, and flax seed meal. For high LDL, this site would recommend: nuts (particularly almonds), whole grains (like Cheerioes or oatmeal), flax seed meal, kiwi, grapefruit, red yeast rice, dried apples, amla, and beans like chickpeas.

    • Take a closer look at your vegan diet – if you are eating any foods made from flour (bread, pasta, crackers, etc.), then eliminate them completely and only eat whole grains (brown rice, quinoa, buckwheat, millet). Also, you may not be getting enough greens. Blend yourself a greens smoothie daily. My recipe: 2 handfuls of fresh greens (kale, arugula, or spinach), 1-2 fresh fruits (usually 1 banana or 1 apple with core removed or 1 cup berries), 1-2 medjool dates with pits removed, juice of 1/2 lemon, about 1.5 – 2 cups water. Blend well and enjoy – it’s really very tasty and easy to digest. Exercise, usually a 15-30 minute daily walk will work in addition to your regular activities.
      I also suggest that you look at taking a probiotic supplement at least 3x/week. There has been research showing that gut flora may be an important factor in hypertension:
      http://www.medicalnewstoday.com/articles/279909.php

  • Ilana

    Unrelated, anything on puerh tea? Curious to know which of its many claims are substantiated.

  • Psych MD

    As I sit here in my office enjoying my lunch of carrots, celery, apples, hummus and nuts I am reading the chart of a patient admitted yesterday for depression. 52 y/o woman, BMI 34. Here is her list of home medications: colace, Reglan, Ditropan, Inderal, Protonix, Neurontin, Compazine, Zoloft, Seroquel XR, lorazepam, Lipitor, Dilaudid, Antivert, aspirin, Evista, and, finally, Zofran. Oh, and she said she was having a migraine during our interview and requested a shot of Imitrex. Lest one might think she is an outlier, I can assure you that this is not an atypical patient. I’ve discussed lifestyle changes with her in the past. She prefers pills, especially when someone else, ie. the taxpayer, is footing the bill.

    • Enthusiast

      She most certainly could benefit from a lifestyle change, but I don’t know that it’s realistic for a person in the grips of depression to take on the taxing task of changing their diet. I have suffered from chronic depression since I was a child, and before the last time it got bad, I was doing really well losing weight and eating healthy. But it’s a lot of effort to avoid the things I want to eat, and when I really don’t care whether or not I wake up in the morning, I’m certainly not going to choose the long-term benefit of a salad over the immediate benefit of a box of cookies.

      But you do have her admitted…. so… she eats what you give her or she doesn’t eat? :)

      • Psych MD

        I learned long ago that there is little to be gained by forcing a diet for a few days in the hospital on someone with a lifelong history of unhealthy eating. I do draw the line when 300 pounders demand double portions. Our hospital actually does offer healthy alternatives, at least for snacks. That is where I get my supply of veggies and hummus.

        • Arjan den Hollander.

          2 years the clip is on youtube and within 18 hours after my attack its gone for copy right reasons. Hit a nerve hard huh?
          You must have a very low opinion of everybody here indeed if you think them incapable of seeing right through that move.
          I’m done here, what a joke.

          • Psych MD

            Sorry. I confused your name with Ariel.

        • jj

          Some people are unwilling to give up the unhealthy lifestyle because this is who they are. This is the life that they are uncomfortably comfortable in. “Who would I be if I weren’t this sick person seeking medical attention?” “This is the way I was brought up.” And they won’t break out.

          Adrian, In my opinion you are way out of line.

          • jj

            Arjan, In my opinion you are way out of line. Sorry for getting your name wrong.

          • Arjan den Hollander.

            I am out of line, and I’m sorry if I caused you upset.
            But this person Psych MD is a charlatan, who asserts himself as a person of importance and station, while he is not.
            Talks the talk of caregiver but has repeatedly shown disdain to lesser beings, this is not a good person.

          • jj

            Arjan, Thank you. We all have regrettable ” moments”.

    • Arjan den Hollander.

      She prefers pills, especially when someone else, ie. the taxpayer, is footing the bill.

      NOT the first time I noticed something weird about you, maybe you should put some effort into finding a different occupation.
      This one is clearly not one that comes natural to you, the role of care giver I mean.

      • John S

        Arjan,
        That is an extremely aggressive reaction!

        • Arjan den Hollander.

          Yes it is, but I suspect this person doesn’t just study nutrition facts here, I think decent people mannerisms have his interest too, to better mimic.

          • Psych MD

            In light of your previous tirade, “exposing” Dr. Greger for what he really is, I consider myself in good company.

          • Arjan den Hollander.

            That was not exposing for what he really is, I pointed out inconsistencies that could cause harm to either people or his reputation.
            And as person of good character he pointed out that any help toward maintaining quality control was most welcome, and offered his email to all to do just that. You are quite delusional if you think yourself of anywhere near similar caliber.

      • Matthew Smith

        Dear Arjan, in the recent study about antidepressants, they found people who take them are more likely to attempt to kill themselves with an antidepressant overdose than people who are not on antidepressants. They dressed this up to say people who do not take antidepressants are not likely to kill themselves and that antidepressants save lives. We are pretty sure antidepressants cause anxiety and depression and cause suicide attempts. These are very powerful and very dangerous pills. Almost all of them cause a loss of libido, weight gain, and impair some type of brain function. Many people who come to this site believe that the vegan diet can, at least biochemically cause happiness in the mentally ill. These are people who are told they will not be in control of their minds for the rest of their lives and will have to always be on these medicines for ever. The people who take them know there are terrible debilitating humiliating side effects and that the pills don’t work very well. I was happy to run into this report, vitamin B3 and Vitamin C for the treatment of mental illness, as a counter point. http://www.altmedrev.com/publications/13/4/287.pdf by Dr. Hoffra.

  • Barbi

    There are two schools of thought. the old school who are products of their parents and social environment and the New school, willing to break free learn why we are sick and do something to change their life. The best advise is don’t waste your time and choose to not own the outcome from people who are not interested in getting well. Let them experience their life the way they chose to learn from it to grow their spirit and soul whether its healthy or not. To own their misery is just an negative energy drain on you. Concentrate your efforts on your own health, wealth and wisdom and share only when others ask for it. Tell them….”don’t ever eat anything green, you might get well.”

  • Great video. I wrote a blog post on Supplements a couple weeks back. http://cleanfooddirtygirl.com/why-you-dont-need-vitamin-supplements/

  • Jimie Gibbon

    I was tod by drs maybe 6 yrs ago i had to start taking pharmaceuticals for extremely high bood pressure n cholesterol, or i would die.changed my diet instead to whole foods,now they say i have blood pressure of a teenager. I feel 20 yrs younger,actually went 100%vegan about a yr ago.i am 58.friends n family tell me how awesome it is n I’m the healthiest person they know but they continue their lifestyle of destruction. Never will understand the logic.

    • Congratulations Jimmie on how you’ve taken control and turned your health around over the past six years. It is a huge accomplishment, and a path that few are willing to take even if gravely ill. I think that the lifestyle of destruction you’ve mentioned is because most people are addicted to their high fat, high sugar, and high processed foods diet. There is research showing how processed junk foods light up the same areas of the brain as heroin:
      http://www.scripps.edu/news/press/2010/20100329.html

      The age of convenience we live in, at least in the West, is a blessing and a curse.

  • Antinutrient

    There is an interesting website on evidence-based medicine based on a concept of “Number-Needed-to-Treat” for one person to benefit from a treatment and with reviews of quite a few different treatments:
    http://www.thennt.com/thennt-explained/

  • Agi Goold

    When I was diagnosed with heart disease ,I was already organic vegan that did not stop my heart attack and being stented in one artery and found out the other three artery’s were at 90 , that was two years ago ,unfortunate for me my dad died from high cholestrol at 49 yrs when I was 13 ,I had my heart attack at 51 yrs I did not want to take statins I had no choice because my body produces high cholestrol ,and since that drama I now have other health issues ,so I never eat meat I am vegan and still in for more stenting .

  • Mie

    Comparing trials is possible (=meaningful) only if they are comparable. A single trial w/ no control group nor other interventions, based on an already very selected & motivated individuals vs a large amount of large, comparative trials (comparing the efficacy of statins against best known treatment) … There is no meaningful comparison here.

    Esselstyn’s diet may be more effective than current treatment options. Or it may not be. This cannot, however, be shown without a PROPER trial. Greger’s video is – simply put – useless.

  • lili

    What happened to the video? All Black!

  • lili

    Never mind, I needed to update on my computer..oops!

  • Commoner

    Can anyone please tell me exactly just how is plant-based diet is better? Every time I want to be a vegan, people around me always say that ‘plants’ (vegetables and fruits) are GM foods, are using lots of pesticides, chemical fertilizers, etc. Now I don’t really know what to eat. Thanks in advance!

    • Thea

      Commoner: Your confusion is understandable. First, please note that there are only 9 legally authorized/commercially available GMO plant foods in America. So, your friends’ idea that vegetables and fruits are GMO foods in general is simply not true. Some people even question whether GMO foods are a health threat at all, but if GMO foods bother you, those foods are quite easy to avoid.

      One way you can avoid GMO foods AND limit exposure to harmful chemicals is to eat organic when you can. But even if you can’t eat organic all that often, check out this information, which puts the question of “pesticides, chemical fertilizers, etc” into perspective:

      “A new study calculated that if half the U.S. population ate just one more serving of conventional fruits and vegetables, 20,000 cases of cancer could be prevented. At the same time the added pesticide consumption could cause up to 10 extra cancer cases. So by eating conventional produce we may get a tiny bump in cancer risk, but that’s more than compensated by the dramatic drop in risk that accompanies whole food plant consumption. Even if all we had to eat was the most contaminated produce the benefits would far outweigh any risks.”
      from: http://nutritionfacts.org/2013/06/25/apple-peels-turn-on-anticancer-genes/

      So, this idea that eating plants = eating chemicals = extremely harmful is a false equation. It is even more false when you understand the concept of bio-accumulation. If your friends think that those chemicals are bad for health, then they definitely shouldn’t be eating animal products since those chemicals get concentrated the higher you move up the food chain.
      http://nutritionfacts.org/?s=bioaccumulation

      The above quote from Dr. Greger is also helpful because it starts to get at your first question: ” just how is plant-based diet is better?” A whole food plant based, such as the one that Dr Greger recommends (see link below), minimizes your risk of getting the major diseases of our time. Including: cancer, heart disease, diabetes, etc, etc, etc. You can see proof of this claim by watching the many videos on this site. I would summarize by saying that in general, whole, intact, minimally processed plant foods promote health and protect against diseases. Animal foods are strongly linked to increasing our risk of getting debilitating diseases and early death. The good thing is that you can get all this benefit while still eating great food!
      http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      I hope this helps. Let me know if you would like some advice on how to get started.

  • Yikes!

    Today I spoke with an oncologist with 30 years of experience. It was a casual conversation, I was not his patient. He said some positive things about the progress made on cancers and how rewarding his career has been, etc. I have SUCH skepticism now but I was polite and did not tell him I thought he full of bologna.
    My work in healthcare is becoming more and more uncomfortable for me. I am not sure what to do or what my next step could be. Doctor’s and hospitals scare me!

    • FP

      totally. I’m a Feldenkrais Practitioner, which means I’m very far down the tree of treatment plans. I get back-pain patients who had surgery and 60-100 sessions of PT already, still all covered in sweat and taking strong pain medication because of high pain. It’s shocking how they have been treated. Doctors are very quick to take out the knife and to cut through flesh and bones. It’s their fav. They are butchers. Not all of them, of course, but too many of them.

  • erika

    Dr. Greger, I want to educate people about nutrition, specifically about vegan nutrition. I know nutrition is nutrition, whether or not it’s vegan, but I personally want to teach people how to eat vegan in a healthy long term way. My conflict with this is what is best? Doctor, dietitian, nutritionist? I know you’re an amazing doctor when it comes to nutrition, but most doctors don’t learn about treating people through nutrition. What do you think is the best path? I’m sort of at a cross roads, because currently I’m majoring in mechanical engineering, and my engineering interests seem to have been high jacked by vegan education interests. It seems I can help more people, the planet, and animals, through health education…especially my close family. Thank you for taking the time to read and reply to this.

    • Joseph Gonzales R.D.

      Hi Erika. I think it really depends on where you see yourself working in the future. I think any position in healthcare would be important if you were to focus on nutrition. We sure are in need of health educators so I would recommend seeking out where you see yourself in a job setting (hospital, school, non-profit) and what that position may look like. Of course, medical school is 7+ yrs, and dietetic school perhaps on 4 depending on programs. Whatever you choose best of luck and keep us posted! If it’s helpful my journey started off cooking food for breast cancer survivors and lead to becoming a dietitian. Family will be difficult to help regardless of your profession ;-) They’re family.

      Thanks for your nice post and good luck with schooling moving forward!
      Joseph

  • viennagirl

    I’m confused. Before statins my cholesterol was 219, then after I started, it dropped to 109 – prompting a switch to a milder statin, but that drop is not a 5% drop.

    • Joseph Gonzales R.D.

      I think everyone will have a different reaction to statins and the video is just talking about the benefits on average. I hope that helps clear the confusion. The good news is that your levels plummeted and now you are prompted to go on a lower dose! That is the direction you want to see…

      Best to you,
      Jospeph

  • Filipe Coimbra

    Hello everyone! Can anyone help me with the math here:
    “The best cholesterol-lowering statin drugs can do here is an absolute risk reduction of 3.1% over 6 years. A whole foods plant-based diet has been shown to work twenty times better, an absolute risk reduction of 60% after less than 4 years.”.

    How did Dr. Michael Greger arrived to this number when speaking about the results of Dr. Esselstyn study?

  • Imu2day

    I have an electrical problem with my heart. I also have hypothyroid and high cholesterol. I have been meat-free for three years but only gave up dairy about a year ago. I just gave up all oils as well. Are there any studies that you know of that would indicate whether diet can reverse an electrical problem. My doctor thinks I will need to see a cardiologist and have a pacemaker. She does not believe in nutritional intervention. She has prescribed a statin.

    • Thea

      Imu2day: I’m not a doctor, but it seems like you are describing two problems, one “electrical” and the other high cholesterol. I know that diet can address the cholesterol problem. I don’t know about the other problem. I may be that you need a pacemaker for your electrical problem, but a diet tweak for your cholesterol problem?

      It sounds like you are on the right track when it comes to addressing the cholesterol problem. But the devil is often in the details. I would recommend reading Prevent and Reverse Heart Disease by Caldwell Esselstyn. That book not only includes excellent information about addressing high cholesterol, it also includes some recipes in the back of the book that will give you practical guidance on how to put the diet into practice.
      http://www.amazon.com/Prevent-Reverse-Heart-Disease-Nutrition-Based/dp/1583333002/ref=sr_1_1_twi_pap_1?ie=UTF8&qid=1446578042&sr=8-1&keywords=prevent+and+reverse+heart+disease

      Sometimes people have to tweak their diet even more. Here is a copy of a post from Joseph who is sharing some information from Dr. Greger:

      “My go-to Dr. Greger answer (paraphrased) for those who have tried everything and still have high LDL, try focusing on the saturated fat sources (coconut oil; cocoa butter, and yes even nuts and seeds). I would also make sure you’re doing the Jenkins portfolio diet, including foods like (beans, okra, flax, etc.) and get thyroid function tested. Dr. Jenkins developed a portfolio diet for lowering cholesterol, and it actually includes some nuts. Weight loss is important if there is too much abdominal fat (abdominal circumference exceeds half height). So check with your doctor about these measurements. And if your diet is top-notch and LDL is still too high then try Dr. Esselstyn’s 6 servings of greens a day to keep nitric oxide flowing. More on Dr. Esselstyn can be found here and here. If you still find it’s not coming down consider a statin.

      Links:
      http://ncfamilydoctor.com/wp-content/uploads/2013/07/Portfolio-Diet.pdf
      http://www.jeffnovick.com/RD/Q_%26_As/Entries/2013/8/29_Clarifying_the_Confusion__Dr_Esselstyn_Responds.html
      http://www.pcrm.org/kickstartHome/celebrity/esselstyn
      http://www.chicagotribune.com/lifestyles/health/sc-hlth-0128-diet-for-heart-20150123-story.html

      I don’t know your situation, but I would be highly concerned about seeing a doctor who doesn’t understand that the best way to address high cholesterol is through diet. It speaks to a lack of very basic education, and a lack of concern for your health given that statins can have a terrible impact on some people’s health. You may not have a choice. I’m just suggesting that if you do have a choice, another doctor might be something to look into?

  • Filipe Coimbra

    Hello everyone!

    Joseph Gonzales R.D
    Can you help me with the math here:

    Dr. Michael Greger says that “the best cholesterol-lowering statin drugs can do here is an absolute risk reduction of 3.1% over 6 years. A whole foods plant-based diet has been shown to work twenty times better, an absolute risk reduction of 60% after less than 4 years.”.

    How did Dr. Michael Greger arrived to this number when speaking about the results of Dr. Esselstyn study?

    Thank you for all your help here in the forum

  • Darryl

    Another way to look at statins:

    Kristensen ML et al. 2015. The effect of statins on average survival in randomised trials, an analysis of end point postponement. BMJ open, 5(9), p.e007118.

    Death was postponed between −5 and 19 days in primary prevention trials and between −10 and 27 days in secondary prevention trials. The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively. Statin treatment results in a surprisingly small average gain in overall survival within the trials’ running time.

    • Thea

      Wow. That’s pretty shocking.

  • Kate

    Wow. So many of your study reviews are incredibly upbeat and hopeful. I am a 74 year old woman who has been struggling with “prediabetes” for a long while. I have eaten “low glycemic” blah blah for several years and finally found your book in January. I immediately jumped on your plant based diet and as a foodie have been enjoying it the whole way. As a “normal weight” obese person due to my hip to waist ratio, I have lost 14 pounds (a lot since I began trying last September but easier since I began plant based) and 1 1/2 inches around my waist. BUT sadly my blood sugar is still as high as it was running between 100 and 115. Might it come down over time or should I ever give in to the MDs suggestions of (gasp) insulin? Should I avoid higher carbohydrates like grains? I admit I do enjoy wine several times a week. Suggestions or patience welcome.

    • A Newton PhD RD

      Hi Kate, I am excited to hear that you have been implementing the WFPB diet and seen positive changes in your weight. I wonder if you have been doing any physical activity as well? Walking, among other things, does wonders for your insulin levels. It may help to further decrease your insulin. I would definitely encourage you to stick with the dietary changes you have made as it does take some time for the body to adapt to changes. I wish you all the best!

      • Kate

        Thank you for responding. For exercise the past year I do wonderful Suffi yoga 3 to 4 times a week, I am walking a mile a day 1/2 mile up a San Gabriel mountain and a half mile down — slow about 25 minutes. In addition I work out with weights 2,times a week. I’d say it is moderate in intensity. I haven’t yet lost 10% of my body weight and I am not naturally losing as I did. I am still obese in terms of hip to waist ratio anything over .85 and I am .86. Should I cut oils or carbs? Or just relax and give it time.? Course,I would love to do the latter. I am enrolled in Kaiser which has a plant based belief but have not come across one Kaiser MD who practices that way. Again thanks.