Doctor's Note

Did I say heart disease reversal? If you didn’t know there was a way to treat heart disease without getting your chest cracked open then my blog Heart Disease: There Is a Cure is a good place to start.

More on the radiation risks associated with diagnostic procedures in Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

Carotid artery wall thickness is what was measured in the study I profiled in Eggs vs. Cigarettes in Atherosclerosis.

Another comparison between athletes and plant-eaters can be found in Is It the Diet, the Exercise, or Both? It compares cancer-fighting abilities with a similar result. See the “prequel” video, though, so you know what test they’re talking about: Ex Vivo Cancer Proliferation Bioassay. For weight loss, diet also provides more control: Diet vs. Exercise for Weight Loss.

None of this is to disparage exercise, which is critical for a variety of important reasons, immunity (Preserving Immune Function in Athletes With Nutritional Yeast), breast health (Exercise & Breast Cancer), and brain protection (Reversing Cognitive Decline). So diet and exercise, not or exercise. My physical activity comes from walking while I work: Standing Up for Your Health.

Not all studies have shown vegans have superior arterial form and function, though. Find out why in my next video Vitamin B12 Necessary for Arterial Health.

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  • Veganrunner

    We need to do both. Ok maybe not 45 miles a week but exercise is so important for heart health. And maybe everyone isn’t going to set up a computer on a treadmill (ultimate multitasker) as Dr Greger has but Ornish, Essylstein, etc include exercise in their wellness programs.

    Your last sentence in this video makes it sound like we can do the easy think and skip exercise and we can’t.

    • Duke

      Also, the biggest thing missing from this study is a category of vegan runners and vegan couch potatoes. If the vegan runners beat out all other categories, it would be clean what the healthiest lifestyle is. My assumption is that vegan runners should be healthiest, but until they, “put it to the test”, we don’t know. My paleo friends will say to this video. Yes, but they didn’t compare grass fed meat eaters to vegans. Just SAD endurance runners. And Paleo (High exercising, fruit, veg, low grain, “quality” meat eaters) think (and probably are) much healthier than SAD eaters at any athletic level. We need some smoking gun studies that compare ALL variables.

      • Veganrunner

        All great points. Other things to point out. People who run 45 miles per week don’t eat the SAD. They are generally very aware of the role food plays in performance.

        Dr Barnard out of UCLA who is associated with the Pritikin center includes exercise in his studies.

      • DStack

        Good points. I have to laugh at the Paleo crowd. I don’t understand why people who eat the “grassfed organic” SAD think they’re so much better off. It’s still SAD.

        • Duke

          Many Paleo people (friends of mine) are very close to plant based. High fruit and veg. low junk food, low processed food. Low refined carbs and sugar. Even low organic meat (% of calories). Some even promote whole grains and legumes. The main issue is that some Paleo people are still going for Ketosis (no carbs) and saying that is healthy long term. They have the challenge of proving its healthy long term. Grassfed Organic meat and low processed foods is far from Standard American Diet of fast food processed meat and packaged foods and lots of sugar.

      • olhg1

        If vegans avoid all the unhealthy foods and exercise routinely, it stands to reason that they are living the “healthiest.” But if a longtime sick person-say morbidly obese for 50 years after eating omnivorously-begins to live a vegan life, he/she may still be sick and not very healthy for a great while.

        • poppy52

          no results start immediate

    • I think his point is that a lot of activity like distance running many days of the week for any years is not necessary to lose weight and clean arteries. The easier route would be to eat a plant based diet. I eat a mostly raw wholefood plant based diet and I am extremely active, so I support both. But a person can easily be healthy eating a wholefood plant based diet with minimal exercise. A wholefood plant based diet and walking can easily do it.

      • Veganrunner

        Absolutely. I recommend daily walking for my patients. Dr Onish says eat well, love, decrease stress and exercise. All play a role in CV health.

      • Mike Quinoa

        Good points. Dr. Greger has a treadmill desk, so we know he believes in exercise. It’s just that the positive effects of a plant-based diet are so powerful that the WFPB diet trumps exercise (but of course, not diet and exercise).

    • Jimbo

      Running may be good for the arteries and heart, but it’s “H-E-double toothpicks” on the knees and joints. I still get occasional knee pain more than 30 years after quitting my 16 years of a ten mile day run. Now days I use an elliptical trainer- not for distance, but for High Intensity Interval Training. three times a week. I also walk a few miles most days. I’ve also got a feeling that once the thickness in the arteries gets down to the healthy level that it is in vegans, getting it any lower won’t produce any additional health benefit.

      • Veganrunner

        Running (and yes walking) actually increases the strength of the joints. But that being said, anyone who is mechanically challenged with poor hip, knee, or feet alignment should find another way to get that heart a pumping. I am sure you have seen the person who is bull legged (genu varum) running down the street. Ouch!

        • Anon

          “mechanically challenged” or, in come cases, “fat.”

          I think some of us should stick with biking, swimming and walking until we no longer have extra weight causing misalignment.

      • Veganrunner

        10 miles per day! JImbo you are a stud!!!

  • Byron

    This is interesting.

    What about the high carb intake associated with a plant based diet? What does it do to people with insulin resistance?

    This question gets asked often but never answered. Why?

  • Arun Mukherjee

    Dr. Greger, what is your opinion of the full body scanners at airports? How much radiation do we get from them?

  • Mark

    I understand that it wasn’t -necessary- , but it would’ve been easy enough to include vegan runners, too. There must be plenty of them, & this article sure does make me curious re how well they’d do.

  • Plantstrongdoc M.D.

    I think the point is that exercise can not compensate a poor diet. Choose both and get the best from both worlds.

  • Darryl

    Clearly diet and exercise are additive in health, but moderate exercise may be healthier than more intense running. Slow jogging (1-2.5 hours/week) or running up to 5 miles/wk seems to capture the longevity benefits, and running more then 20 miles/wk appears to lose most.

    I never caught the running bug, but hopefully get into the longevity sweet spot with hours of dog walking and salsa dancing weekly.

    • Daniel Wagle

      I once ran from 1-20 miles a week and it did not help me that much to lose weight or even improve my health at all . It did not improve my cholesterol levels at all. Once i started (at my doctor’s suggestion) to bicycle everyday for at least an hour, my weight peeled off way below it had been for years, my LDL cholesterol went down and my HDL went from below 20 to now 77. The amount of exercise this article suggests doing was never helpful for me in the least. I continue to bicycle everyday for at least an hour (albeit at not too vigorous a pace) and I never get sick like I did before. All my blood word is better. My physicals are all fine. My BMI used to be 34.5 and now it is 21. I wonder if the deleterious effects these studies find are the result of persons doing a lot of exercise in order to “out train” a bad diet. That is why a whole foods Vegan diet is important. I have steadily improved my diet since losing the weight and as arteries are cleared, there is much less strain on the heart in response to exercise. Eating a lot of anti-oxidants can relieve the oxidative stress caused by exercise. I wish there was a study in which they compared Vegan ultra runners with ultra runners who ate a standard American diet- I bet the exercise would not harm the Vegans nearly as much.

      • Anon

        Not to mention, it’s easy to see how obsessive or extreme exercising might correlate to a high stress level or other heart-unhealthy factors.

        • Daniel Wagle

          I don’t find riding my bike everyday raises my stress level at all. I find it very enjoyable. It actually lowers my stress level. The Paleo groupie Mark Sisson claimed that it raises stress level. Maybe if a person was doing something they didn’t enjoy or they were pushing themselves way beyond their limits could it be stressful. Also, a low carb diet does not support exercise and doing a lot of exercise on a low carb diet, as Mark Sisson is on DOES raise the stress level. Exercise has to be properly fueled and a low carb animal based diet does not adequately fuel it at all. Another thing I do differently is that I exercise for weight control, but watch my diet (eat as plant based as possible) for health. In other words, I eat healthfully, but don’t terribly restrict calorie intake that much. Many persons do diet for weight control (restrict calorie intake more than me) and do only enough exercise for health- which might be only 150 minutes a week as opposed to at least 420 minutes a week that is necessary for weight control.

    • Daniel Wagle

      Here is an article which refutes the article you linked. Of course, many times the linked article you linked is used as an argument by many reputable persons, and you are reputable. Here is the argument against that article,

      But here, from the actual abstract, is the part they never mention:

      Cox regression was used to quantify the association between running and mortality after adjusting for baseline age, sex, examination year, body mass index, current smoking, heavy alcohol drinking, hypertension, hypercholesterolemia, parental CVD, and levels of other physical activities.

      What this means is that they used statistical methods to effectively “equalize” everyone’s weight, blood pressure, cholesterol, and so on. But this is absurd when you think about it. Why do we think running is good for health? In part because it plays a role in reducing weight, blood pressure, cholesterol, and so on (for more details on how this distorts the results, including evidence from other studies on how these statistical tricks hide real health benefits from much higher amounts of running, see my earlier blog entry). They’re effectively saying, “If we ignore the known health benefits of greater amounts of aerobic exercise, then greater amounts of aerobic exercise don’t have any health benefits.”

      So possibly as I theorized, when a person has high cholesterol, when they run, they put lot more strain on the heart as if they had lower amounts of plaque on the arteries.

      • Veganrunner

        Excellent quote from your above link.

        “To reiterate, I’m not flipping to the other extreme and arguing that there’s no point of the diminishing returns for exercise, or even that there’s no possibility of heart damage associated with extreme ultraendurance exercise. These are open and legitimate questions. But this scaremongering about relatively modest amounts of exercise in favor of “hunter-gatherer” exercise is silly. We can speculate all we want about “potential” risks and benefits, but the real-world epidemiology is crystal-clear: if you exercise for an hour a day, you’re likely to live longer than if you exercise less than an hour a day.”

        • Daniel Wagle

          The video suggests running more than 20 miles per week can result in weight loss. Surely if one loses a lot of weight by doing a high dose of exercise, one would not lose but rather gain a longevity benefit. Adding a plant based diet magnifies the benefit even more.

      • Darryl

        O’Keefe and Lavie, given their association with paleo, are to be taken with salt, but I’m not so quick to dismiss the results of the Aerobics Center Longitudinal Study and Copenhagen Heart Health Study.

        Nearly every cohort study that attempts to isolate the health effects of a behavior adjusts for confounders. I presume Mr. Hutchinson of Runner’s World mostly objects to the Cox adjustments for BMI, hypertension, and hypercholestrolemia, which jogging would effect (as would diet). I just don’t think the adjustments for those variables would effect the U-shaped results much. The Cox adjustments definitely reduce the observed benefit of running compared to non-running, which was large in both studies, but between running cohorts, the effect of any adjustments would be much smaller.

        This paper examined the relation of those cofounders to weekly running distance. Averaging regression slopes for male and female omnivore runners yields Total cholesterol/HDL: 0.009 / km, systolic BP: -0.048 mm Hg/km, and BMI: -0.035 kg/m^2/km. On average, omnivores running 40 km (25 mi) per week compared to those running 20 km/12.5 miles per week would be expected to have 0.17 lower Total cholesterol/HDL, 0.96 mm Hg lower SBP, and 0.7 kg/m^2 lower BMI.

        According to the regressions in this paper, 0.17 lower Total/HDL would reduce IHD mortality by 4.2% (hence total mortality by ~1.2%). Using least favorable assumptions I estimate from this paper, 0.96 mm Hg lower SBP would lower all-cause mortality by 4.1%. As TC/HDL and SBP aren’t remotely independent, just adding them would yield an overestimate of their aggregate effects, but this is a just back of the envelope guestimate for how much Cox risk adjustments would effect the outcomes. Average omnivore runner BMIs were 21.28 (F) and 23.78 (M), both of which are in the flat part of the BMI-mortality curve, so 0.7 BMI risk adjustment in that neighborhood would be expected to have negligible effect. It would appear that any risk adjustments based on jogging-affected cofounders would reduce any hazard ratio benefit between the 40 km and 20 km runners by at most 6%, and probably less.

        Give that Cox risk adjustment for those 3 confounders back to the 40 km runners in the ACLS study and their all-cause mortality hazard ratio would still be 0.84 or 0.89 (depending on which near-40 km cohort is chosen), vs the 0.73 for the 20 km runners. I expect we’ll see unadjusted mortality figures once the ACLS study is published – for now it appears to be a conference poster abstract.

    • Veganrunner

      The commentary you linked says, 30–50 min/day. That is anywhere from 3 to 6 miles a day. (depending on day) That is well above 20 miles per week on the higher end of time.

    • Veganrunner

      Darryl since you are about the smartest guy I know and you probably have this info tucked into that large brain of yours I have a question. So my endocrinologist said she is finding elevated estrogen levels in men that eat a lot of soy. But I thought that was pretty much an urban myth. However if she is actually finding that clinically there is some credence. My teenage son drinks soy lattes.

      What are your thoughts? I see her next week and want to have an informed conversation.

      One of my patients also sees her and that is how I found out she told him to stay clear of soy. (Tofu etc)

      • I have seen nothing in the scientific literature to support that fact. I have seen reports where the amount of steroid binding globulin is increased on a low fat plant based diet which means there would be less “free” estrogen and testosterone in the blood stream. Helps explain the benefits of a whole plant food non oil diet for patients with Polycystic Ovarian Syndrome. Of course everything is relative… is a soy latte better than a dairy latte… no contest there. Given the amount of estrogen in dairy products see I would be more concerned with getting my patients off dairy than worrying about soy. You might suggest that your endocrinologist review the videos and literature on and see what s/he thinks.

      • I recently started (again) eating more arugula, spinach and cabbage and noticed some libido enhancements – they say they remove some of the estrogens in the blood giving testosterone more effect. It also helps the endothelium by opening the arteries from the nitrates in the plants. Soy was bashed by the dairy industries so there is a lot of incorrect feelings towards soy although Dr. McDougall does mention IGF.

      • Anon

        Might as well go with almond milk over soy.

        Many sources say tofu or any fermented soy is OK or at least better than regular soy. But I don’t have a link.

        (Teenagers drinking coffee, oy vey!)

        • Veganrunner

          Oy vey is right! I pick my food battles. Gummy bears drive me nuts.

      • Darryl

        Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor β

        Soy isoflavone genistein has about 4% of 17β-estradiol’s affinity for estrogen receptor α, responsible for estrogen’s feminizing effects, and 87% of its affinity for ERβ, which acts as a tumor suppressor. The other major soy isoflavone, daidzein, has much lower affinities.

        So yes, genistein in soy can mimic the effect of estrogen on ERα at high doses. Normally men and post-menopausal women have 0.05-0.20 μM 17β-estradiol, so serum increases of 1.25-5.0 μM of genestein would be required to double their current ERα induction. This study found ingesting 90 mg of soy isoflavones daily for 12 weeks increased serum genestein by 0.18 μM, so perhaps around 625 mg of soy isoflavones would be required to match the lower end of 17β-estradiol ERα induction in males.

        For comparison, the total isoflavone content in mg in 100 g of some soy foods:
        tempeh 60.61
        edamame 48.95
        tofu 30.41
        soymilk 10.73

        It seem to equal the ERα induction of 0.05 μM 17β-estradiol, one would need to eat 1030 g (2.3 lbs) tempeh, 1275 g (2.7 lbs) edamane, 2055 g (4.5 lbs) tofu, or 5.8 kg (1.5 gallons) of soymilk.

        • Veganrunner

          Thank you Darryl. I knew you would clear this up for me. I will pass this on.

    • Daniel Wagle

      Even though your response was not posted, I did get to see it before. Here is something which basically says what I suspected. It is that intense, prolonged exercise is not that advisable for persons who have plaque build up in their arteries. In this case, I would just do enough to barely push oneself, but not too hard. Middle aged men are often more at risk from doing high intensity, high volume exercise, because in Middle age, many men have greater plaque buildup than they had when they were younger. Therefore, that is why they find more heart scarring in middle aged athletes than younger ones. With plaque build up, the heart would probably have to work much harder to pump the blood, and therefore scarring would much more likely occur with too much strain. There probably would be higher mortality rates for persons with plaque buildup in their arteries who do a lot of exercise over those who do more moderate. When they control for high cholesterol, that means that the vigorous exercisers would have just as much plaque build up as the more moderate exercisers. Therefore the moderate exercisers come out ahead. I bet there is little harm to persons who have little to no plaque buildup to doing a lot of exercise, or more than 20 miles a week if running. There even could be an extra benefit. The Vegan diet (along with B12 supplementation) can reduce plaque build up in one’s arteries and make a higher dose of exercise much safer to do.

    • HereHere

      I love salsa and other partners dancing! Sure it is good for the body, but it is great for the soul! You can get vegan dance shoes (ballroom, ballet, etc.), too. Just be sure to pack ear plugs when you go salsa dancing, they always play the music way too loudly. So tempting to by a sound meter (dosimeter).

  • Maggie

    As they say, you can’t outrun a poor diet!

    • Daniel Wagle

      I think this does show that a person can sometimes “outrun” a poor diet and lose weight. However, one doesn’t get the optimal health results from doing this- however the runners had better arteries than the controls. Jim Fixx is an example of someone who lost a lot of weight by running but died of a heart attack, presumably because he didn’t improve his diet as well.

  • Tan

    Plants and exercise = win.

  • DH

    We routinely and serially scan the arteries of all patients in our practice; unfortunately, I have only recently begun promoting a strictly plant-based diet, and thus can’t provide anything more than a couple of anecdotal data points, which are not really worth very much.

    In addition, virtually everyone who has come in for a first visit is consuming meat, eggs, dairy, fish, and thus it’s impossible in our practice to have a control group (at least at baseline). That is why the studies that Dr G. cites here are so valuable.

    As to exercise, I feel something is missing if I do not do a workout daily. Me? I like 45-60 minutes on an exercise bike, alternating moderate aerobic CV with high-intensity spikes to get my heart rate up (to 160 or so). I feel that exercise + plant diet + psychological approaches = the best of all worlds for CV prevention.

    From human evolution, we were probably once much more physically active in small tribal societies of our origins than we are now….

  • DH

    The one problem is “making” time for exercise when you are exhausted, tired, sick, busy or stressed out. It is a matter of priorities, but if things get really intense and busy, exercise is the first thing to be sacrificed. Following that, meditation goes. Further to that, reading is discarded. But that is a really crappy day, and only happens about once per week. Doug Lisle makes the great point that we should really be exercising for about an hour each and every day, not 3 days per week, not 5 days per week, but 7 days per week, just as we did when we were early hominids.

    One thing you have to overcome as a vegan — all the garbage food they serve you at work. The only way is to your bring your own. Does anyone else have any tips on transportable vegan foods with a vengeance?

    • b00mer

      I guess I’m lucky that no one serves me any food at work ;) so I always bring my own. I’ve never had any issues transporting whatever yesterday’s dinner leftovers were. Certainly an extensive pyrex collection is key to success. I like the quart size bowls, and I like to “layer” my foods: layer of pilaf, layer of hummus, layer of “meat”balls, etc all in the same bowl. I also like to take a whole quart of leafy greens (I like the uber cheap pre-washed pre-cut bagged kind) or frozen stir fry veggies and microwave steam them. I cut down on weight (I walk/bike) by bringing the veggies/greens in tupperware and then steaming them in a glass bowl with glass lid that I keep at work (I think the brand is “anchor bay”). Sometimes I mix the veggies/greens in with the rest of the food if it’s saucy enough, or I eat the veggies by themselves with some nutritional yeast or lemon and pepper. Plus I usually bring a couple fruits.I don’t know if that helps, hopefully there’s something useful in there. :)

      • DH

        That is very helpful indeed. I eat all of those things (except rice pilaf, but I eat other grains – eg whole wheat orzo pasta).

        I am curious as to why you avoid plastic tupperware … is there any evidence beyond bisphenol A that ingredients in the plastic lining or walls or lids have harmful health effects, or is it all overblown? (I bet Darryl knows the literature on this). I have heard that many plastics contain endocrine disrupters. I don’t exclusively own glass though. It’s more expensive and as you said, very heavy to carry.

        • One of the culprits in plastics that you allude to are the endocrine disrupters (e.g. phthalates). They have been banned in Europe along with other chemicals… see the book Exposed for much more on that story. I bike commuted for years and always used glass containers. True they weigh more but not that much more. The only food I tended to avoid were soups… never figured out a good way to transport liquids without some spillage. Aerobics are a key component of fitness as is strength, flexibility, stability and balance… some would add relaxation as well. I think the jury is still out on the effects of alot of intense activity. As far as promoting a plant based diet I found one resources especially valuable… The Vegetarian Starter Kit and Nutrition for Kids booklets… both are PCRM products and available for free down load off their website. I found as I practiced I was able to use my own experience and the success of my other patients as stories or therapeutic metaphors to encourage others. The interesting fact, for me at least, is that even though I had known many of my patients for over twenty years I was often surprised at who would adopt essentially a plant based diet. I also found it helpful to use each patients goals and beliefs as the basis for my recommendations. Good luck.

          • DH

            Thanks Don. This is very helpful. I was meaning to ask you what resources you used. Dr G. referred me to the PCRM website and I got a 100 copies of the VSK printed off (in black and white, as it saved me about $500 over colorized version) … don’t have pediatric patients, so I don’t need to worry about those (and my patients tend to be much older and their kids are grown up).

            I am curious as to your statements – “the success of my other patients as stories or therapeutic metaphors to encourage others” and “helpful to use each patients goals and beliefs as the basis for my recommendations”.

            I am sure these things are best modelled and can’t be conveyed easily over the web, even as concrete examples. So much fits with the domain and the situation you are dealing with and relates to basic “people skills” (rather than preaching). I believe a lot of this is called “motivational interviewing” and nurses and other allied health professionals typically are better equipped to do this sort of counseling than doctors. However, I practice alone and do not have the benefit of a nurse, SW, or nutritionist. Hence I am constantly haranguing people like yourself and Dr Greger for practice tips….

        • Eve

          I bought a box of glass tuberware at Costco for a great price.

      • Elias

        Sure, most fruits are highly transportable, bring a few pounds of them to work and it should carry you between breakfast and dinner.

    • Thea

      DH: I share the same problem! Where I work, people are always bringing in (accidentally) vegan donuts and chips etc. I find it very hard to resist and have been loosing the battle (of resisting) more every year.

      One thing that I do think helps me is to bring about 3 types of raw, easy fruits or veggies to work every day. The very first thing I do in the morning is put the fruits and veggies on the desk right between me and the monitor. All day long then, I can reach for the sugar snap peas or the apple or the cherry tomatoes or the banana or bell peppers (I eat them like an apple) or the green beans, etc. It’s RIGHT THERE.

      What I mean by “easy” is that these are foods that I like and will eat without any preparation. I’m far more likely to stick to something if I don’t have to chop or peel first. I’ve been doing this for about 7? years now. Prior to that, I probably ate one serving of fruits or veggies every couple of days – if that. I was terrible. So, now I’m eating several serving of fruits and veggies every work day–not counting the normal vegan dishes I prepare for meals. It is a big improvement.

      I find that having the fruits and veggies doesn’t stop me from craving the donuts when people bring them into the office, but my theory is that the good stuff keeps me from eating as much of the bad stuff as I would otherwise.

      This isn’t much different than what other people have already suggested. I just supplied some details to the idea. Good luck.

      • DH

        Thanks Thea, that is most helpful. My problem is not snacking, but rather the main meals that are served at work (particularly in committee meetings and in the cafeteria). They are virtually never vegan, and what vegan part there is, consists entirely of crudite. What sort of meals are you whipping up to bring with you to work for lunch?

        • Thea

          DH: I know what you mean about this too. I don’t often get fed meals, but when we have say a retirement party during lunch, the agency does provide a meal. And sometimes we have group potlucks. In both cases, the food is atrocious. I usually end up bringing my own meal. Judging by the envious way people eye my food, it is clear that my food is way better than what everyone else is eating. Plus, I end up being a role model. Here are my tips for you.

          My approach to lunch is to make a dish or two over the weekend when I have time to relax and make them. I then divide the food into lunch containers so that all I have to do each morning is grab a my lunch from the fridge. I found that the brand “Anchor”? makes the same bottomed Pyrex bowls, but their lids are spill proof. That lid gives you a lot of options for what to bring/make. I last saw this brand at Target.

          I make something different each week for variety. Sometimes I make up a dish, but usually I follow a recipe. Categories of lunch foods include: hearty stews, chilies, burritos, enchiladas, casseroles of a bazillion types, “burgers”, and the dishes that Jeff Novick has on his Fast Food DVD series. Sometimes I take my favorite “bowl” ingredients (a grain such as quinoa or barley or brown rice pasta, broccoli, mushrooms, beans and onion) and then add whatever sauce/dip/dressing sounds good (see examples below) or I want to experiment with. This is really fast since I can buy broccoli and mushrooms pre-prepped. All I have to do is zap them in the microwave. The onion can similarly be zapped in the microwave instead of sauteing. The grains are easy enough to cook one way or another (try quinoa in a rice cooker. Comes out perfect every time!), but if that’s too much, you can now get grains pre-cooked from packages in stores.

          I have over 70 vegan cookbooks now and have been able to find some really great options. A few of the books particularly stand out as having recipes that a) appeal to me, b) are pretty healthy, c) aren’t too hard to make. If you have a pressure cooker, I highly recommend Lorna Sass’s book, Great Vegetarian Cooking Under Pressure. It’s really a vegan book and the Chickpea and Onion stew (with or without putting over quinoa) is a must-try! It is one of the few dishes that I have made more than once.

          Regardless of where you get your recipes, most dishes tend to have a tablespoon or two of oil – especially for sauteing. I take lots of shortcuts when cooking – including liberally using the microwave. I find that I can completely skip the oil and the recipe does not suffer for it. The point is: You are not stuck only using oil-free recipes/cookbooks. (Another option for sauteing is to water-saute. But that takes a bit of skill/practice and still requires the work of standing over a stove. I don’t bother.)

          The other two books that I get a lot out of are: Vegan on the Cheap and Let Them Eat Vegan. I rate each recipe that I try with the following scale: yuck, ok, good and great. To get a “good” status, the food has to be truly enjoyable/something I look forward to eating. Here are some of the recipes that got a rating of either “good” or “great” (just to give you some recommendations to get you started or ideas to start you off making your own food):

          Vegan on the Cheap
          Cheezee Sauce (made with soy milk instead of nuts – so lower-calories)
          Easy Peanut Sauce (with the Peanut Noodle Salad or your own bowl)
          Handy Hummus
          Southwestern Black Bean and Corn Chowder (more like a corn-y thick chili)
          Bean and Barley Salad with Creamy Dijon Dressing
          Roasted Sweet Potato Salad with Cashews and Kidney Beans
          White Bean and Barley “Risotto” with Kale and Tempeh
          Barbeque Black Bean and Tofu Burritos
          Mu Shu Burritos
          Tortilla Strata
          Deconstructed Enchilada Bake
          Mexican Rice and Bean Bake
          Cacciatore Noodle Bake
          Savory Vegetable Cobbler (works great with whole wheat flour instead of white for the topping)
          Rice Island Casserole

          Let Them Eat Vegan
          Smoky Sweet Potato and Black Bean Salad
          No-Fu Loaf (best next day with the rosemary gravy)
          Chickpea and Artichoke “Bliss in a Dish” (I use sweet potatos instead of the plain. And Trader Joes sells the frozen artichoke hearts. One bag = perfect for the recipe)
          Creamy Barley Risotto with Thyme and Star Anise (I use powdered anise and just cook it all for a long time in my pressure cooker instead of the traditional method. I also add cooked mushroom. This is definitely one of my favorite dishes.)
          Festive Chickpea Tart (especially good for Thanksgiving)
          Mushroom Pecan Burgers, Take II
          Too-Good-to-be-Tofu Burgers
          KD Dip
          Artichoke and White Bean Dip
          Creamy Curried Almond Dressing (or dip or sauce)
          Rosemary Gravy
          Wonder Bean Puree (to go with a “bowl”)

          And that’s just some of what I’ve tried so far. I haven’t tried them all. (And not all recipes that I did try rated a “good” or better.)

          The sausage patties and pepperoni in Vegan On The Cheap are not exactly whole foods, but they are the best vegan “meats” I have had anywhere. And they are so easy to make. And they don’t have some of the ingredients I REALLY try to stay away from with the processed/purchased store varieties.. I once made my own vegan pizza using the pepperoni from Vegan On the Cheap and then other pizza ideas from Heart Healthy Pizza. I took my pizza to a potluck, and it was gobbled up. These “meats” can be great additions to some dishes as long as they are not eaten too frequently.

          That’s all I have for now. I sure hope this helps too.

          • DH

            That is very helpful. I follow the same approach as you. About every 6-7 days I make up a huge batch recipe for lunches then just parcel it out. But this is when I eat from home. If I eat at work, the food quality drops considerably, as the food served there is garbage…. obviously I need to start porting my food in.

            My mother says that 6-7 days is far too long to keep anything in the fridge, but I do not find this is so. Especially if you separate the cooked pasta or any grain you are using into its own separate container, and then add it to a serving each day. Otherwise, pasta will become mush. I find soup lasts the longest of all foods that I can cook. I made a winter minestrone which took forever to get the ingredients and make it, but it was worth it. It lasted 7 days although I skipped a day in the middle.

            I too have a number of vegetarian cookbooks. One of my favorites is Tosca Reno’s Eat Clean Vegetarian Cookbook. While not all the dishes are vegan, and her panels on health advice are worse than useless (she is anti-soy), her recipes are typically excellent. My prioritization for recipes is that they must contain sufficient quantities of protein (at least 10 g per serving), and minimize net carbs / processed carbs – typically 30-35 g of net carbs at most per serving, but I have been thinking of relaxing this latter requirement. I am also not afraid to use a little salt (1/2 tsp) or a little olive oil (up to 1 tsp) in a recipe, but bear in mind this is split 6 to 7 ways for 6 to 7 days. So it ends up being very little salt or oil. I would be happy to drop these ingredients to see if there is any difference in taste/palatability as an experiment.

            Thanks for sharing all that.

          • Thea

            DH: Thanks for the reply.

            Concerning your mother’s thoughts on the food and fridge: That just hasn’t been my experience. I find that almost all my dishes keep a good week – some even improve over at least a day’s wait.

            I’ll have to check out that book you recommend. (I’m addicted to cookbooks now.)

          • DH

            For what it’s worth, and everyone’s tastes are different, here is what I believe to be the best recipes in that book:

            Roasted Red Pepper Minestrone Soup
            Mexican Pepper and Black Chickpea “Stoup”
            Tofu, Broccoli and Mushroom Fajitas
            Taco Night
            Lemon Orzo with Edamame, Orange Peppers and Cherry Tomatoes
            The Soup-er Cleanse

            “The Eat-Clean Diet Vegetarian Cookbook” (by Tosca Reno). What I also like is that there seems to be a picture on every page, together with nutritional information. I find the pictures motivating and they help with screening which recipes are most appealing.

            Thank you for the tip and reassurance that a week in the refridgerator is worth a lifetime of less cooking hassles.

          • Thea

            DH: I’ve been meaning to follow up on this topic. I saw a newscast the other day about food safety. The reporter was saying that food should immediately refrigerated and then eaten within 3-4 days. But the report was specifically talking about “Christmas dinner” followed by words and pictures that included turkey and other meats.

            This news report led me to think that your mom may be on to something there! But only as applies to meat (and maybe dairy and egg?) dishes.

            This is one more reason to appreciate being a plant-based eater. And either way, it always feels better when we can say that mom was right, even if only partially. :-)

          • DH

            I would say 7 days is the outside limit in the refridgerator for anything that’s been cooked, depending of course on what it is and how cold you run your fridge. One thing that helps is draining all liquid out of dishes (unless it’s a soup, obviously), and repeatedly transferring cold leftovers over time to successively smaller tupperware so that the ratio of air to cooked food stays as low as possible (air oxidizes food).

            I once nearly ate some leftovers which I was consuming daily for 9 days that emitted a very strong garbage smell and gladly I spat out everything immediately. So at least for tofu/broccoli/bell pepper stir-fry, we know that 9 days is probably too long.

            It seems to me that soup keeps longer than other types of cooked food, and that anything with lemon on it tends to keep a fair while.

  • Merio

    Personally, as a martial art practitioner (2.5 years and keep going) i suggest to all readers to evaluate the possibility to study Tai Chi, Kung fu, or other martial arts… i think it is a really great way to train mind and soul…

  • Tobias Brown

    Combine this news with Michael Klaper’s report added to YouTube yesterday by Jeff Nelson titled “Are Failed Vegans Addicts?” where Klaper claims that “meat withdrawal” can cause depression… I’m a somewhat startled vegan. Now Dr Greger says that simply not having enough b12 can make our arteries as a bad as meat eaters. Hmm. Maybe there should be a more rigorous protocol for those of us switching to vegan diet. I certainly found Dr Greger’s list of supplements to take and I do take B12.. but how do I know if they are working or not. Maybe blood testing should be a part of this? Maybe working with a certified vegan nutritionist should be part of this? Anyway. I will keep my nose to the grindstone trying to perfect my diet.

  • The study also shows that the vegans were ‘raw’ (although they ate nuts/seeds which aren’t raw) ate 42.8% fat including olive oil! Even though it was lower in saturated fat. And Jeff Novick pointed out that most vegans don’t eat this healthy as far as unprocessed, saturated fat, raw, etc.

  • DH

    When I was on LCHF I saw dramatic remission of my markers of metabolic syndrome, including incredible reduction in A1c (down to 0.047). There is definitely something to the carb hypothesis of disease causation. I don’t recommend it, for obvious reasons, but I do not think we should dismiss the dysglycemic effects of high free carb intake even in thin people.

    I was going to ask you — if all other variables are equal — what is worse, saturated fat or dietary cholesterol? Eggs have little saturated fat but very high amounts of cholesterol. Coconut oil has no cholesterol but very high amounts of saturated fat. Which is worse?

    • Darryl

      I believe that for the population at large, the saturated fat is worse, as dietary saturated fat independent of dietary cholesterol will increase serum cholesterol and cause inflammation, while dietary cholesterol is inefficiently absorbed in those who already have high serum cholesterol. However,

      modest amounts of cholesterol added to a cholesterol-free diet would be expected to most efficiently elevate serum cholesterol

      So eggs, which are a mild risk in the context of a high-fat Western diet, would constituted a greater risk for those eating a Ornish / Esseltyn / McDougall-type cholesterol-free very low fat diet, likely preventing them from achieving the heart attack proof zone of under 150 mg/dL total cholesterol, achieved through dietary means, found in the Framingham study.

      • DH

        That is so helpful. But wouldn’t that suggest that lacto-ovo-vegetarians or pesco-vegetarians (since fish contains cholesterol) would have outcomes at least as bad as omnivores, if not worse? From Adventist Health Study-II and other studies, it appears that they actually have as good an outcome as vegans, even a little better. I guess it could be residual confounding, but I find it hard to square away.

        Not to belabor you in any way, but I was wondering if you had any comment on what I wrote about glycemia and carbs –

        “When I was on LCHF I saw dramatic remission of my markers of metabolic syndrome, including incredible reduction in A1c (down to 0.047). There is definitely something to the carb hypothesis of disease causation. I don’t recommend it, for obvious reasons, but I do not think we should dismiss the dysglycemic effects of high free carb intake even in thin people.”

  • Carnegan

    Dear doctor your video’s are very informative but what do you think about Dr. William Davis, according to him wheat is meat. We all even need to become carnivores instead of vegans if I understand him well.

  • Toxins

    Excellent post Darryl! You may find it funny to know that because your posts include so many links, I am constantly bailing you out of the “spam” folder on the Disqus Moderation so that your posts can be viewed by all!

    • Darryl

      I was pretty sure you, Thea and other mods were rescuing my “this guy needs a blog” posts. Thanks.

      I neglected to mention above that before Barnard, before McDougall, before Pritikin, the rather eccentric Dr. Walter Kempner had been treating diabetics with a diet of rice and fruit since 1939, with results on reversal of diabetic retinopathy reported in 1958. Thankfully, the use of whips has fallen out of favor in lifestyle medicine.

    • Thea

      Toxins: It never occurred to me to look in the spam area. I have all the posts sent to my e-mail box and rarely look at the admin screen. I’m glad you are on top of this!

      • Toxins

        Wow Thea, that’s a messy way of dealing with moderating. That’s a lot of emails! It seems to work for you though.

        • Thea

          Toxins, re: “messy”
          That’s such a surprising response to me. I could easily believe that I have missed features in the Discus site, but the last time I looked, it wasn’t very user-friendly and was completely lacking in what I consider basic features for efficiency.

          In the e-mail system, I quickly make decisions on the vast majority of e-mails to either delete or reply. In the rare cases where I want to give it some thought or a longer reply than I have time for I leave the e-mail in the in-box as “read”.

          The benefits of this system are:
          1) I touch the vast majority of posts exactly once.
          2) I never have to remember where I am in my reviews of the posts.
          3) (except for the 2 posters whom I no longer bother to read most of the time), I read every single post without missing any/no one falls through the cracks.

          4) I can quickly find the handful of random posts that I still need to respond to without any extra work/memory on my part.

          It would be nice to combine the features that I get from e-mail with some of the nice things in Discus’s site, but the features I get with e-mail outweigh anything offered on Discus (that I could see) in terms of basic management of all those posts.

          The drawback of my system is exactly what you said – a whole lot of emails! I can’t ever take a vacation from being on the team or the e-mails would get overwhelming. I’ve known this for a while. So, I may end up giving up my system and live with the inefficiencies of working through Discus/living with missing out on some posts and looking at others multiple times. But in terms of evaluating the pros and cons, I consider my system the very opposite of messy. :-)

        • Thea

          I meant to add: I’m glad we each do things different ways, because we seem to be better covered that way. If you hadn’t been carefully using the Discus site, we might have missed Darryl’s great posts!

  • 3yrvegan
  • Rivka Freeman

    Daryl: Can I put your entire comment on my website? In March 2003 I tried to join the obese teens vs McDonalds lawsuit. Dr Barnard, the expert witness, said it was the saturated fat in the meat that caused obesity in the plaintiffs. I told Judge Sweet it’s not the saturated fat causing obesity, it’s the overabundance of high glycemic carbs in the Big Mac and in “value meals.” Only Judge Sweet listened to me. I needed all these references to make Dr Barnard hear me.

    • Darryl

      Dr. Barnard’s take appears largely correct: it is primarily the saturated fats, and not the carbs, that initiate to process of insulin resistance and metabolic syndrome, though there’s also been a lot of attention placed on added fructose in recent years.

      Our bodies seems to tolerate 10-15% dietary fats (2-4% saturated) pretty well (the Paleocene diet). Its when we get to the typical 29-37% range with 10-15% saturated fats that metabolic syndrome becomes endemic. High glycemic carbs alone don’t initiate the process, and societies that eat high-glycemic starch diets with low fat (& fructose) have low diabetes incidence.

      That McDonald’s happy meal is by calories 39% fat, 14% saturated fat, and 6% fructose. The 36% starch is in my opinion the most innocuous thing about it.

      • Rivka Freeman

        Dr Barnard has it right, saturated fats cause insulin resistance. In his affidavit he said “the saturated fat in the burger meat caused obesity.” He was probably simplifying, who would think a pharmacist trying to land a nutrition job would tell the judge he was saying it wrong?
        We can handle more fat if it’s Vegan monounsaturated and omega 3.

      • Which of those 22 studies would you suggest reading in order for us layfolks to better understand how sat fats, not carbs, initiate the progression of IR? I’m still trying to get a handle on that one.

    • Yes

  • Darryl,

    Do all saturated fats trigger the same deleterious results you discuss above? How do sat fats from plants compare to those from animals?

    Could you talk a bit more about the process by which protein, especially animal protein, elicits an insulin response? Why does animal protein do so more than plant protein?

  • It would definitely be interesting to see a study comparing various health parameters–like carotid artery thickness–of vegans who exercise at various levels. We could see what impact exercise has, if any, whether significant differences are found among groups of plant-based eaters with different exercise levels, and what minimum amount is needed to make those differences. I would expect that some significant differences would be found (in weight, for instance) but I wonder about carotid artery thickness specifically? Dr. Greger, or anyone else who’s familiar with the literature, do you know of such a study?

  • mitch

    If I remember correctly back in the ’70 a runner wrote a book saying running is the be all end all for health.. He had a massive heart attack and died on the side of the road

  • Jim Coleman

    Hi, I would like to get your opinion on internasal light theraphy. Thank You.

  • Neil

    Too much long-term, high-endurance exercise seems to be detrimental to our arterial health, causing hardening and calcification of arteries. Watch this informative TED Talk on the subject:

    • dogulas

      What I’m curious about is if runners like this with clean, low-fat blood suffer from the same outcome. The mechanical heart failures? Probably. But the calcification and plaque? I doubt it. These weren’t necessarily low-fat athletes, so I can imagine why increased blood flow of fatty blood would increase plaque buildup, but the mechanical failures of the heart later in life bother me a bit. I’d be willing to bet that vegan marathoners don’t have the save plaque buildup, but the mechanical bit is interesting.

      Also, see this post (especially his points 5 & 6) by Jeff Novick

  • Liam White

    Very poor analysis. Endurance runners would be expected to have signs of atherosclerosis due to chronic cardio.

  • Michael

    An athlete banned for doping is in the main photo! Doh!