Doctor's Note

Dr. Ornish talks about how diet can be more sustainable than drugs, since compliance is more based on love-of-life rather than fear-of-death. See his editorial in Convergence of Evidence.

More on how lifestyle medicine is not only safer, and cheaper, but more effective:

Many physicians just weren’t taught the power of diet:

But there have been cases of the medical profession actively seeking to limit further nutrition training. See my series about a bill in California:

Why not take drugs every day for the rest of our lives instead of using dietary change? That’s the question I ask in my video Fast Food: Do You Want Fries With That Lipitor? Not only is that not treating the root cause, but there are potentially serious drug side-effects. See, for example, Statin Muscle Toxicity and Statin Cholesterol Drugs and Invasive Breast Cancer

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  • Veganrunner

    Another great review! What a way to start my day.

  • Matt K

    Can someone help me find some studies that correlate cholesterol to risk of heart attacks?

    • Darryl

      The correlation is stronger for plasma cholesterol than dietary cholesterol: Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. You may want a cholesterol converter to convert the international units to the American mg/dl convention. In most diets, the LDL raising trans- and saturated fats (myristate, palmitate, laurate) have a greater effect on plasma cholesterol that than cholesterol from the diet, however for those achieving plasma cholesterol in the “heart attack proof” range (< 150 mg/dl, < 3.9 mmol/l) with low-fat plant-based diets, "modest amounts of dietary cholesterol added to a cholesterol-free diet would be expected to most efficiently elevate serum cholesterol“.

      • Coacervate

        Outstanding work Darryl, thank you. I need this info for skeptical friends/family who have “locked on” to the misinformation about dietary cholesterol.

        One question… in Paul Hopkin’s review figure 1 shows a model that predicts the increase in serum concentration as a function of dietary cholesterol. For example at the 500 mg/d ingestion level there is a predicted concentration of about 0.5 mmolar. But even if all 500 mg went into a volume of say 5 l of blood that would correspond to about 0.25 mM. Am I misinterpreting their model?

        • Darryl

          Fig 1 illustrates the mathematical model Hopkins used. Actual estimates from experimental data are in Fig 2. My calculations are the same as yours. The 27 experiments Hopkins is estimating parameters from were generally multi-day controlled feeding trials in metabolic wards. Ie, “if 500 mg/d cholesterol (in pills) was added to a baseline 300 mg/d cholesterol diet over a week (or longer), how much would blood cholesterol change compared to baseline diet only”. We’d have to track down the individual studies to determine the actual durations.

          • Coacervate

            Begs the question, “Where does the extra cholesterol come from?” Does it seem likely that ingestion stimulates greater production too? Wouldn’t that be an obvious and glaring problem to them and their model?

      • Toxins

        As always Darryl, everyone here on NF.org values your contributions. Thank you!

      • Tsandi Crew

        Triglycerides, however, are from diet, are they not? From too much refined carbohydrates.. and even just from grain?

        • Darryl

          The covariance of triglycerides with other CVD risk factors make them [not particularly useful](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284229/) as clinical predictors.

          The hazard ratio for coronary heart disease with triglyceride was 1.37 (95% CI, 1.31-1.42) after adjustment for nonlipid risk factors, but it was reduced to 0.99 (95% CI, 0.94-1.05) after further adjustment for HDL-C and non-HDL-C.

          . However, more recent Mendelian randomization studies confirm a causal role, particularly for non-fasting/post-prandial triglycerides, though weaker than that for LDL (1, 2, 3).

          Sugars, high-glycemic index starches, alcohol, and health conditions like obesity, diabetes, liver or kidney disease can all contribute to elevated triglycerides. So, yes, refined carbs contribute. On the other hand, insoluble fiber, like that in beans and whole grains reduce both glycemic index and triglycerides in human trials, and are both consistently associated with lower risk from a variety of diseases. On balance I think starches remain the safest source for the bulk of calories, but I try to eat the whole grain/bean/tuber with the fiber, rather than refined products. My weakness is white rice, but my trigs are well within the normal range (< 150 mg/dL).

  • HemoDynamic, M.D.

    The physicians I work (except one) don’t care about patients enough to encourage them to eat healthier. Sad but true. I have been at my current practice for over one year and we even created a professionally edited video of our patients that have reversed there diabetes, obesity, erectile dysfunction, hypertension etc. They (the docs) have read the evidence, and seen the incredible results but still the docs look at me and the dietitian like Deer in the Headlights.
    One of the physicians still explains, “Remember, those sick patients pay our bills.”
    Absolutely ludicrous, I say!

    This goes out to everyone that keeps this website functioning: Keep up the great work!

    • Karl Young

      Thanks for the insiders perspective (though now I have to be even a wee bit more cynical ! :-)). It seems to me that big ag and big pharma happily profit from a generally unhealthy population but I naively assumed that most docs were victims stuck in the middle, trying to help their patients but overwhelmed by corporate influence. I guess it’s a little more nuanced than that…

    • Psych MD

      In nearly thirty years of practice I have never heard a colleague make a comment like that. If I wanted to work twice the hours I could easily have twice the number of patients. The insinuation that physicians intentionally keep patients sick to increase business is “absolutely ludicrous.”

      • RappFan

        You are a statistic of one, as is the one doc that Hemo referenced. She did not insinuate that ALL physicians intentionally keep patients sick to increase business. And you may not think like that and are well within your right to believe that most don’t, but don’t you insinuate that none do because that would be a ludicrous assertion.

      • Coacervate

        /What RappFan said. For over 30 years I have heard my dr’s say: “Diabetics are babies” (referring to my complaint about fatigue), another said that it was “all in your imagination” in reference to other complaints. NOT ONE even hinted that I could TRY changing to a whole foods, plant-based diet as pioneered by real physicians like Kempner, Ornish, Pritikin, Esselstyn, Campbell et al. Rather, they all got in line to dope me up, slice me up and collect the cash. Wake up and smell the…erm… absolutely watercress.

      • HemoDynamic, M.D.

        “The insinuation that physicians intentionally keep patients sick to increase business is ‘absolutely ludicrous.'”

        Interestingly, that is what I used to think as well.

    • Veganrunner

      Dr Hemo you work with a bunch of slugs!

      I think it is more complicated then they just don’t care. They don’t know any better is probably more accurate. They don’t believe patients will change or they themselves eat like that and don’t exercise. It is practically impossible for a doctor to sell a patient on a WFPB diet and exercise with a fat tire around their waist and a hamburger in one hand!

      I have great luck with my patients. It takes time and I can’t put any pressure on them but little by little they drop the animal and start to exercise more.

      I feel for you….you must be so frustrated!

      • HemoDynamic, M.D.

        It really is that bad! And it’s not even about the WFPB lifestyle thing. I don’t know if some of the physicians I work with have lost compassion for human beings, have ever had compassion or really just don’t care. It’s a trip to experience.

        I’m not frustrated (OK maybe a little) but getting burnt out quickly. I’m one of only two physicians that sees anyone who comes through the door. Heroin addict, drug abusers/malingerers, suicidal patients, acute psychosis, morbid obesity, non-compliant diabetics (I call them Limb losers), chronic pain with no desire to change. I even have a patient that tried to cut off his leg with a chain saw. It’s like I work in an ER/Psych Hospital but in an outpatient setting and even though I leave work at work it is mentally draining.

        We have two physicians who refuse to see those kinds of patients–they cherry pick! And they probably do that because it is so draining. I have asked them why they cherry pick but they deny it.
        I even had a Medical Assistant trainee recently, who has worked with all the doctors there, that asked why I see all the difficult, complex and psychiatric case patients? They asked if those are the patients I liked to see. Spontaneously I told them, “Have you ever seen a toilet?” they stared at me somewhat perplexed, I said, “That’s me.” My Nurse just busted up laughing with tears running down their face. Why? Because they saw the truth in that statement–I get dumped on. But hey, the patients need to be seen and if I don’t see them who else is going to.

        Regardless, when I get a patient who is interested in getting off their medication I seize the moment and when I see them change and their diseases stop or even reverse that is what motivates me to keep going; it’s hard, however, to keep making water when you are in the middle of a fire!

        My previous private practice was the same way with doctors. One of them would always be late to office management meeting by over 20 minutes and he would do the same to patients. And if the patient complained about having to wait so long he would go to his office and make them wait longer or go see his next patient first just to make them wait even longer! Happened nearly everyday for the two years I worked there. We had another doc at that practice that if the patient questioned the doctor at all he would kick them out of the practice! Really!!!! If the patient came to see me and wanted to switch providers, he would kick them out of the practice. His practice was mostly very compliant chronic pain patients. The reality is quite a few of the physicians I have been around have taught me there are a lot of unhappy doctors out there.

        I’m sharing this with you not for any empathy or sympathy but just to give you a glimpse into the crazy world of medicine.

        • Thea

          Hemodynamic: Every time I see your posts, I cheer. You are one of the good guys.

          But also sometimes when I see your posts, I not only get quite an interesting education about medical care, but I feel bad for you, because I know you are in such a difficult situation. I wanted to share with you the following article about a plant-based doctor who got burnt out and decided to tackle the situation in a unique way. I think there are a couple of articles about this doctor on the web and she has her own website.
          http://www.thedailybeast.com/articles/2014/04/29/the-health-care-system-is-so-broken-it-s-time-for-doctors-to-strike.html
          http://www.idealmedicalcare.org/dr-wible.php

          She even has physician retreats:
          http://www.petgoatsandpapsmears.com/teleclass.php

          Maybe this will help/inspire you in some way. You are such a valuable poster on this site! Thanks for your participation.

          • HemoDynamic, M.D.

            Hey Thea I just saw your post ;(. Guess I should check my inbox on Discus more often.
            Your words are very kind and appreciated!

            After rereading my post I feel like I came across as probably a “down and out” burned out. But I’m not!
            I live my doctor life at work like the docs in M.A.S.H. (the old TV show) BJ Honneycut and Hawkeye Pierce– with a lot of humor. Oh, OK, and a Martini every once in awhile. :-)

            I’ll give you an example. When I was on one of my surgical rotations in residency I rounded with a very skilled 40 year surgeon who had an interesting side of humor. We performed a hemorrhoidectomy on another 70 year old Family Medicine doc (his friend). When he was done we glued a rhinestone butterfly to his left butt cheek.

            Medicine is kinda like a secret society and I like to let people look inside and see the real doings in medicine–The funny and the sad.

            I hope that made you smile. ;0

            Thanks for the links!

          • Thea

            Oh yes, I’m smiling big right now. :-) !!

            I loved M.A.S.H, so I know exactly what you are talking about. Wow, that brings back some good memories.

            I’m so glad/relieved to hear that things are not as bad with you as they sounded. Whew. Keep up the good work! I always love your posts. They make me smile.

        • Tsandi Crew

          When you deal with people on illegal drugs and alcohol often, it’s a quick burnout. Perhaps a change of venue would be good… the rest of us need doctors like you, too.

        • HereHere

          Hemodynamic, I’d love to give you a big hug! You give the kind of medical care that I admire in a doctor. I do hope that you can find a way for your practice to be more sustainable for you. You studied so long and so hard, and invested so much in becoming and continuing to be a doctor. You deserve to enjoy the work that you do without feeling like you are burning out. Yes, your workload is unfair and you are a better doctor for seeing the challenging patients that you do, but your work-life must be full of joy too. I don’t know if your workload is too heavy, but that could be adding to your sense of burnout.
          I think the references from Thea are an option to consider, as well as taking a course in caretaker burnout (prevention, etc.), which many healthcare workers from many different disciplines suffer from. You are not alone. I think everyone here wishes you the best in dealing with your stressful role at work.

          • HemoDynamic, M.D.

            Thank you! I appreciate your kind words. See my post above to Thea.

    • HereHere

      What I find particularly shocking is that bariatric surgeons are willing to put their patients on a lifelong diet that provides them with virtually no choice. That is to say, they are only allowed to eat 1/2 to one cup of food per meal. I suspect most patients would prefer to eat until they feel full. Why don’t MD’s (GP’s in particular) prescribe a whole foods, plant-based diet? Why wouldn’t this be the first line of recommendation for patients seeking bypass operations? In Canada, where the system pays, it would save a lot of taxpayer money to go the dietary route, and the patient’s quality of life would be so much better afterwards. In theory, health professionals are required to discuss risks, benefits and alternatives of their proposed treatments. Something isn’t getting through to this population. Perhaps the WFPBD researchers/MDs should be presenting their results at Bariatric surgery conventions. Maybe it is starting to happen, but I’d sure like to hear about it if these specialists are being educated on the safety and cost-effectiveness of appropriate and effective dietary treatments. FYI, Mayo clinic suggestions for post-bypass diet is here:
      http://www.mayoclinic.org/tests-procedures/bariatric-surgery/in-depth/gastric-bypass-diet/art-20048472

  • Joel Kahn

    Cardiologist approved and applauded. Thanks Dr Greger, send to every medical student and hospital administrator

  • I eat only whole-food plant-based food at age 72 and feel good all the time, ride my bike, and walk, instead of driving.

  • Sidney

    I’m a 3rd year medical student and I’d have to agree that medical nutrition training is abysmal. I had one nutrition lecture in biochemistry which consisted of a rundown on the essential vitamins. As for diet the professor said “make sure you eat a healthy diet”.

    • Coacervate

      What do your peers say about the lack of attention to medical nutrition? Is the word spreading among the “new guard” at all?

    • Merio

      Believe me dear Sidney that if you’re going to have a “Do It Yourself” Nutrition degree (of course with sites like NF, or others like http://thescienceofnutrition.wordpress.com/ ) you’re going to help a LOT of people and by the way maybe after you’re a licensed doctor, you can decide to specialize in Human Nutrition (a master degree i think)… or join the Ornish Spectrum: http://ornishspectrum.com/site-certification/#section_training-certification :-)

    • HereHere

      I’m an RMT in Canada (2200 hour program), graduated in 2008. Even back in my day, we had a 24 hour course in which we had to keep and analyse a 1 week food diary, studied micronutrients, macronutrients, fibre types, essential fatty acids, anti-oxidants and phyto-nutrients. It is outside our scope of practise to prescribe anything to eat – we can’t even tell people to drink water (we can tell them to keep hydrated though). I am really shocked that your med school doesn’t have more training in nutrition, given how important it is to a person’s health and given the obesity epidemic.
      If you are brave, I would encourage you to address this issue with the Dean of your program. It’s a huge gap in the curriculum. Perhaps you have other colleagues who can also realize the importance of nutritional education and together you can petition the Dean.

  • dougdigi

    i would like to know if fat free cottage cheese is ok to eat inasmuch as one serving contains 0 Fat, 0 trans fat, 10mg cholest., 15g protein and 5g carb?? thank you

    • Julot Julott

      it would be better without it of course but it wont hurt you much especially in moderate amount and if you have a plant based diet~

    • mbglife

      I think this question is best answered by looking up videos on this site about milk products, allergies they produce, impacts on disease, like arthritis, dementia, asthma, ear infections, sinus problems and especially increased risks for prostate cancer (most recent video on this was posted not long ago). Someone else’s belief that it isn’t that bad is no substitute for you looking at the risks and deciding for yourself if you want to consume it. For example, in contrast, I will never again knowingly put dairy in my body. I encourage to do a few minutes of research and decide for yourself the level of risk you want to assume.

    • Tsandi Crew

      Go to Trader Joes and get organic cottage cheese… I believe it’s live culture.

  • Esther Salomon

    My my husband has been on a WFPBD for more than a year, yet his total cholesterol is around 230 with a very bad ratio LDL and HDL. Do you have any suggestion. Is he doomed to take pills

    • James Rivet

      I think this is an excellent article. It gets to the problem so many people are curious about when going to a plant-based diet. Why doesn’t my doctor recommend a plant-based diet when my cholesterol is high? I will have to stop eating all the junk foods that I like so much! How will I be satisfied when I can’t eat these foods any longer? These are the reasons so many people don’t move to a plant-based diet. I personally have found that I feel better eating a whole foods plant based diet. There is no question. My LDL cholesterol has gone from around 200 to just over 160. I feel better. I don’t have cravings for junk food. Though I still have some ‘food coma’ after lunch, I feel my energy level does not have the same high and low swings that it used to have. I also used to deal with chronic fatigue and dysthemia, both of which have vastly improved since I’ve gone on this healthier diet. People sometimes make fun of the food I eat, sometimes calling it bird food (and I can laugh about it too). The fact is, I feel better now; I have no reason to go back to how I used to eat (SAD- standard american diet). In my humble opinion, not eating a plant-based diet is foolish. The other thing is that it’s not hard to make vegetarian food taste good. In fact I don’t really like tofu–my body finds it difficult to digest– so I don’t eat that much of it. There are plenty of other things to choose from and ways to season them. Fruits, vegetables, whole grains, leafy greens–these all taste good naturally and with very little seasoning required. It may take some time for your taste to adjust to the new diet. But you won’t look back once you’ve made the decision to go plant based. It’s a win-win in so many ways.

      • Guest

        Sorry Esther, I meant for this to be a general post–not as a reply to your post.
        I do have some questions for you. Do you know how much oil/fat your husband is consuming? I know you said he’s eating whole foods and plant based. So the question is, “is he getting saturated fats from the preparation of these foods?” If the diet is solid- no excess of fats or oils in the preparation- and it is truly plant based, then there appears to be another process at work undermining his efforts. I wish I knew more to tell you. From what I’ve seen and read, very few cardiac (heart-unhealthy) patients don’t improve on a plant based diet.
        Don’t give up looking for the answer.
        J

        • Esther Salomon

          Thank you. I am positive. No saturated fíats, no industrialized food, just a few drops once in a while of olive oil, around 12 to 15 pecans a week, and yes 1/2 avocado almost every day. The rest of our daily intake is : around three pieces of fruit with granola and flaxseed on almond milk, lunch is made up of veggies, chickpeas, lentils, etc, quinoa and maybe a salad. Dinner could be a fresh greens wrap, a vegetable sándwich a bowl of beans. Or some hummus. Lots of hibbiscus, green tea, no sugar fresh lemmons lemmonade. Any suggestions????

          • Thea

            Dang, that sounds incredibly healthy to me! I know that’s not terribly helpful in regards to your problem. I just wanted to take a moment to celebrate what you have accomplished. I aspire to do as well you two have. I sure hope you can figure out the cholesterol issue . Good luck!

          • Penny

            Has your husband ever had his thyroid evaluated? Has he lost any weight since going plant-based? Does he exercise? Being hypothyroid can cause high cholesterol levels until proper hormone levels are established. Exercise can help increase HDL leading to a better ratio. I would consider having the thyroid evaluated and maybe the liver. I definitely wouldn’t give up on being plant-based, though. What a fantastic accomplishment. I hope you get to the bottom of the issue.

          • Jay M

            The rate and extent of recovery varies. If you want to be even more aggressive, possibly ditch the granola, almond milk and lower the fats.

          • Tsandi Crew

            Exercise?

    • James Rivet

      I do have some questions for you. Do you know how much oil/fat your husband is consuming? I know you said he’s eating whole foods and plant based. So the question is, “is he getting saturated fats from the preparation of these foods?” If the diet is solid- no excess of fats or oils in the preparation- and it is truly plant based, then there appears to be another process at work undermining his efforts. I wish I knew more to tell you. From what I’ve seen and read, very few cardiac (heart-unhealthy) patients don’t improve on a plant based diet.
      Don’t give up looking for the answer.
      J

      • Esther Salomon

        And yes. We feel much better. Some issues have improved, not high cholesterol. We would never go back to SAD

        • You might try reading Dr. John McDougall’s newsletters, september 2002 on treating cholesterol, and January 2003 on lowering triglycerides to give you some ideas in working with you and your husband’s physician. Sometimes patients have to do an experiment such as cutting out the avocado’s, nuts and fruits with a repeat panel in 2-3 weeks. Exercise helps stabilize the arterial system along with other many positive aspects. You can peruse the video’s on nutritonfacts.org for those of interest and keep tuned in as the science keeps coming. Congrats on you and your husband’s progress so far.

    • Dominic Marro

      Esther, Go to Dr. Esselstyn’s site and contact him via email. Inform him about your husband’s predicament. Leave your phone #. He often returns calls and provides his insight.

      • Esther Salomon

        Can you help me with an e-Mail address. I coul not find it in his site. Thanks a lot.

        • James Rivet

          In lieu of contacting Dr Esselstyn, you can post a question on Dr McDougall’s forum. https://www.drmcdougall.com/forums/

          • Esther Salomon

            Thanks again. Very nice community

  • James Rivet

    I think this is an excellent article. It gets to the problem so many people are curious about when going to a plant-based diet. Why doesn’t my doctor recommend a plant-based diet when my cholesterol is high? I will have to stop eating all the junk foods that I like so much! How will I be satisfied when I can’t eat these foods any longer? These are the reasons so many people don’t move to a plant-based diet. I personally have found that I feel better eating a whole foods plant based diet. There is no question. My LDL cholesterol has gone from around 200 to just over 160. I feel better. I don’t have cravings for junk food. Though I still have some ‘food coma’ after lunch, I feel my energy level does not have the same high and low swings that it used to have. I also used to deal with chronic fatigue and dysthemia, both of which have vastly improved since I’ve gone on this healthier diet. People sometimes make fun of the food I eat, sometimes calling it bird food (and I can laugh about it too). The fact is, I feel better now; I have no reason to go back to how I used to eat (SAD- standard american diet). In my humble opinion, not eating a plant-based diet is foolish. The other thing is that it’s not hard to make vegetarian food taste good. In fact I don’t really like tofu–my body finds it difficult to digest– so I don’t eat that much of it. There are plenty of other things to choose from and ways to season them. Fruits, vegetables, whole grains, leafy greens–these all taste good naturally and with very little seasoning required. It may take some time for your taste to adjust to the new diet. But you won’t look back once you’ve made the decision to go plant based. It’s a win-win in so many ways.

  • Health

    “Why then, don’t more doctors advise their patients to change their diets?”

    Because $$$$$$$$$$$$$$….. money. If people are sick, they go to doctors, then doctors give them drugs and similarly say,
    “If you feel ill again, please come back and I will give you more “medicine”.”

    “medicine” is bad drug.
    More sick people = more drugs = more $$$$$$$$$$$$ to docs.
    Evil cycle of money.

    • HemoDynamic, M.D.

      you have the cycle half correct.

      More sick people = more drugs = $$$$$$$$$$$$$$ to Pharmaceutical companies.

      Doc’s only get about $60-80 for a 20 minute office visit and with that money they have to pay about a 50-60% overhead. These monies that they get are controlled by the insurance companies and every year they trend downward. Why? Because Insurance companies are for profit and have share holders that want to make a profit. So for insurance companies to make increasing amounts of money every year they have to increase insurance rates and decrease reimbursements which they do by paying less to providers and approving less procedures.

      • Bris Vegas

        I suggest you come over to Australia:

        The benefits:

        You won’t have to deal with HMOs or insurance companies.

        You won’t get sued unless you are mind numbingly incompetent.
        You will probably earn FAR more ($150-200/hr net).

        The downsides:
        You’ll see far more patients (40-60 day)
        No nurses or physicians assistants to help out
        Longer working hours (50-60 hours) and fewer holidays (due to a severe doctor shortage).

        The neutrals:
        No white coat
        The patients will use your first name

      • Ray Tajoma

        All 3 (Doctors, Insurance Companies & Pharma) profit from sick people exploitation (not just the pharma). The whole health care system is based on exploitation of patients. I twice was almost conned into doing unneeded surgery (once for my back ache and a second time inside my eye – for a harmless “Birth Mark”. And don’t forget the hospitals. They charged my insurance company and sued me for more than 15K for a heat stroke I had in the park (in 100F I fainted). All they had to do was cool me down. Instead they did BRAIN SCAN & other Einsteinian unrelated crap. The vast majority are after your MONEY and it’s FRAUD.

  • Would you think that another barrier is sometimes the physician’s or nutritionist’s own psychological denial or unwillingness to adopt a WFPB diet? Might it sometimes be that the professional is projecting his or her own unwillingness to change or “to give up” favorite foods onto the patient?

    • HemoDynamic, M.D.

      Absolutely!

  • I have 60 years and
    I need to try to have a reasonable life.

    My question is about supplements that I take,
    everyday:

    – Astaxanthin 5mg,

    – Pine Bark Extract (Pycnogenol) 100mg

    – Gingko Biloba – standardized extract (24mg
    Gingkoflavona glycosides and terpenes lactones 6mg), and

    – Coenzyme Q10 100mg.

    Is correct consuming these supplements? Or am I just
    spoiling the money and health?

    I also use other substances which are foods, not
    supplements, like Tumeric Curcumin, currently in capsule, 50mg (95%
    curcuminoids), but I will go to consume it in biological powder.

    I am thinking consume Peruvian Maca powder, bio,
    because, also, I suffer from erectile dysfunction after I get widowed, in
    August 2013.

    I appreciate with all my heart your possible help.

    I have published your work on social networks and will
    continue to do so, with all my enthusiasm.

    My thanks for the good you do to all people who have a
    little common sense in his head.

    Thank
    you so much.

  • Susan

    its so true, we are eating a plant based diet and we feel great and my husband heart disease is no longer a problem. Blood test show he is doing great. We feel so healthy

  • ferdinand reinke

    So the question that comes to mind is if one can only partially shift to a plant based diet is it worth doing at all?

  • ksb935 .

    I’m a 66-year-old vegan female. I walk two miles a day and keep my weight under control. Yet, I can’t seem to get my LDL below 130-150. My ratio is always good, and my HDL is good. My husband’s cholesterol was normal when he died of a major heart attack. I’m starting to wonder how important cholesterol levels really are.

  • Han

    How long would you have to be on a vegan diet to get rid of all the plaque in the veins?

    • Toxins

      I think it has been demonstrated that changes can be seen within the first 3 weeks, although I do not remember the citation. Remember to go as low fat as possible, no oils, and only whole plant foods. That is key

      • Han

        I already notice a big difference since for examply my eyesight improved quite a bit in the last half year and the etternal backpain went away. Also my cold fingers are gone and I have much more air while sporting. And something else is just as functional as it used to be.

      • Han

        I’m doing mostly that. Except for the eating spoon of pumpkin seed oil I enjoy with a volumous salad, the local speciality of Austria.

    • Darryl

      The pilot trial evidence is that plaque reductions are visible during angiography after 1 year (in the 1990 Ornish study) or 32-60 months (in Esselstyn’s first study) of a very low fat plant based diet.

      More importantly, case reports from these and other lifestyle doctors report that symptoms of angina (chest pain, esp. during moderate exercise) are dramatically reduced within weeks. I’ve also read similar early signs of improved blood flow in erectile dysfunction, a sentinel of systemic vascular disease. This seems due to better endothelial function (vessel dilation to flow), and reduced inflammation.

      In reduction of coronary risk, reduced endothelial inflammation is all important. Most heart attacks occur not because a plaque progressively occludes the artery, but because the fibrous cap over a plaque ruptures, flopping into the stream or sending clots downstream. Perhaps by largely eliminating the postprandial floods of inflammatory compounds (long chain saturated fats, endotoxins, etc), these fibrous caps are offered a respite to heal and strengthen. Its this that may offer coronary protection within weeks, while actual plaque reduction may take longer.

      I highly recommend this energetic presentation by Dr. Esselstyn. It strongly influenced my decision to go low-fat plant based.

  • Geraldine

    My Phosphrous is high what can I take to lower it.

  • HereHere

    Doctors are lobbied hard by the pharmaceutical industry. Why isn’t it that the WFBP community hasn’t at least produced a brochure that could be delivered to all MDs in their community? I think this would be an excellent, life-saving strategy. Inexpensive. Maybe something that PCRM, VegFund or NutritionFacts could do (or combine efforts on).

  • CJ

    Thank you!!

  • Steve Ryd

    Wide differences in response to WFPB diet

    Both my wife and I started eating a whole foods, plan based diet on May 1st. In my case, the results were very much as I expected. My total cholesterol dropped from 246 to 169 and my LDL dropped from 176 to 106.

    My wife, who ate what I ate, saw very different results. Her total cholesterol increased from 233 to 289 and her LDL increased from 148 to 198. She has historically had problems with high cholesterol and was taking a statin for several years until the muscle problems became an issue. Prior to our starting to eat a WFPB diet, she had been taking 1 gram of niacin twice a day. When we started on May 1st she reduced the niacin to 500 milligrams twice a day, so maybe that decrease in niacin resulted in her increase in LDL.

    However, that still leaves the real question – what can she do to get her cholesterol numbers under control if 6 months eating a WFPB diet did not do it?

    Thanks in advance for any suggestions.

    • Thea

      Steve: Congratulations on both of you for making this effort.

      I’m not a doctor, but I would suggest that you search this site for specific foods that have been shown to lower cholesterol. I would think that you are both on the right path, but your wife’s diet (and couldn’t hurt for you too) may need some tweaking to focus on certain foods for her particular problem. Just an idea.

      Something also to think about: I’m not always sure when I see “WFPB” written that someone else understands that term the same way I do. Are you careful to stay away from oils? All oils? And what about other high, fat processed foods such as chocolate? (a personal weakness of mine) For most people, it may not matter to have some of these things in their diet. But maybe for your wife’s situation, it would be worth being particularly strict for a while.

      Good luck to both of you!

    • Steve Ryd

      Thea, thanks for your suggestions. As far as our diet goes, I would say we are 95-98% compliant with our understanding of a WFPB diet (no animal products, no added fat, no processed food). In her case, maybe strict compliance is necessary, but at this level (95-98%) there is no sense of “dieting” in the negative sense. I was just shocked to see her lipid numbers actually go UP when we are eating this way.

      • Thea

        Steve: re: being surprised. I would be to. That’s very perplexing. And it sure sounds like you are doing pretty good diet-wise. Hopefully focusing on some of the foods listed on this site that have been shown to lower cholesterol would help. I sure hope so.

  • rscoggin

    Spoiler, question coming… lately I have been reviewing Paleo (and its many perturbations) versus Vegan (Whole Food Plant Based) diets. I recently watched the John Durant versus John Mackey debate (https://www.youtube.com/watch?v=ery6ez2M7aw) which made me find several answers to why I “Just say NO to Paleo”. But, one item has come up that has stumped me. Low cholesterol seems to correlate with depression, suicide and all sorts of mess. A simple google search and tons of scholarly articles seem to address the topic recently. Common sense says, if this were true, then all the populations Campbell studied would have been like lemmings running off a cliff before they ever had heart disease – but then they lived in blue zones so that doesn’t seem to happen. Any meta studies, any hints of truth here? My cholesterol is down from 233 to 162 after 1 year animal free and I am “Happy as a Lark”… should I start eating Lark eggs to stay that way :P

    • Thea

      rscoggin: I would go with common sense. I don’t personally know anyone who eats a whole plant food based diet and who later developed depression. (Not that I personally know all *that* many people…) It seems like a pretty far fetched idea to me–especially when you take into account this information from NutritionFacts:
      http://nutritionfacts.org/?s=mood

      And here is a copy and paste from Healthy Longetivity, a wonderful science-based blogger:
      “In regards to depressive symptoms, a recent review of clinical trials found that cholesterol lowering statins are associated with improvements in mood scores. Furthermore, several clinical trials have found that vegetarian diets, also known to lower serum cholesterol have favorable effects on measures of mood and stress.
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568015/
      http://www.nutritionj.com/content/11/1/9
      http://www.ncbi.nlm.nih.gov/pubmed?term=8205407
      http://www.ncbi.nlm.nih.gov/pubmed/3783150

      I say, don’t worry, be happy! (And good on you for your last year’s worth of work! Awesome.)

      • rscoggin

        Thanks, Thea. I agree, common sense should prevail. That said, I cannot find studies on these cultures that Campbell uses to prescribe a magic number of “no higher than 150 mg/dl ttl cholesterol” to prevent heart disease. Also, sites like Mayo Clinic and articles like the one from Psychiatric Times warns about low cholesterol not just from statin use but also diet. The PT article warns about ttl cholesterol below 160 mg/dl. This kind of well-recognized brand name advise is not only giving fuel to the Paleos and others and I expect this topic to get more and more abuse and turn folks away from lowering their cholesterol even below near-200s.

        http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-level/faq-20057952

        http://www.psychiatrictimes.com/depression/cholesterol-and-mood-what%E2%80%99s-link

        Going to keep looking for meta-studies of populations but I an avionics engineer and not a doctor, so a bit challenged in the medical research dept. :)

  • ZeffR

    Dr. Greger: Because of a genetic defect my Lp(a) is 96.1 mg/dL. 30 mg/dL puts me at high risk for heart disease and I am three times over that. My LDL is 87, HDL is 40, Triglycerides are 108, and Total Cholesterol is 149. I cannot find any research or articles on how to lower my Lp(a) through either nutrition or drugs. Do you have any recommendations? Thanks, Jeff Rulifson

  • confused

    Im on a no cholesterol, ow fat diet, which leaves a very plant based diet. My concern is my carbs are high, 60+% of my calorie intake. But its all fruit, veggies, whole grains. How do you balance a plant based diet without carbs being an issue?

    • Joseph Gonzales R.D.

      High intake of carbohydrates don’t seem to be a problem. If you’d like to cut back on them cut back maybe this low-carb plant-based diet can help? I do not necessarily recommend it because I have seen excellent clinical results from a strict plant based diet: A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study.

      Good luck whatever you choose! Let me know if you want more information. Dr. Greger explains in his book, “Carbophobia”, the importance and healthfulness of carbohydrates (unrefined whole grains). I am sure others can attest to carbohydrates not being an issue, however, do what works for you!

      Best regards,
      Joseph

    • Thea

      confused: Why are you concerned about the 60%+ carbs when they are all from fruit, veggies, and whole grains? (no beans? Oh my! ;-) ) Your diet sounds so healthy to me. If only everyone ate as well as you… If only *I* ate as well as you!!

      I mean that as a sincere question. It only makes sense to be concerned about a carb percentage if we have some good evidence on the topic saying it is a problem. To give you something to compare against: traditional Okinawans are some of the longest lived, healthiest people on the planet. Here is their macro-nutrient breakdown by percent of calories:
      >>> carbs: 85 (mostly from sweet potatoes)
      >>> protein: 9
      >>> fat: 6
      from Table 1 of: The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span. Ann. N.Y. Acad. Sci. 1114: 434–455 (2007)
      (Thank you Rami for this info several years ago. It is priceless.)

      By that measure, your carbs are on the low side. *NOT* that I’m saying your carbs are really too low. I’m just giving you something to compare against.

      Does that help with your concern?

  • henry

    But 10 healthy volunteers dont build up much evidence, no?

  • andre porcelli

    Hello Dr Greger! would you please take a look at this article that talks about “High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men1,2,3” and let us know what you think about it. Thank you so much. Andre Porcelli. http://ajcn.nutrition.org/content/76/2/351.full#ref-list-1