Doctor's Note

If cholesterol increases breast cancer risk, what about the use of cholesterol-lowering drugs? That’s the subject of my next video, Statin Cholesterol Drugs and Invasive Breast Cancer.

Other foods I mentioned protective against breast cancer include: Some I didn’t mention include: More on phytosterols and where they’re found in:

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  • Cassie

    This video is a little confusing. It seems to indicate that along with cholesterol, fat also plays a role in breast cancer. If this is so, how are sunflower and pumpkin seeds preventative when they’re both high in fat? Is it all fats that are increasing risk for breast cancer, fats only when combined with cholesterol, or are fats from plant sources an exception?

    • basskills

      This is a good question as I am often wondering the same thing about protein (apologies for piggy backing on your question).

      The China Study suggests a low fat, low protein whole food plant based diet is optimum, but then I see plant based doctors promoting the benefits of beans and nuts and seeds.

      I understand there is a difference between protein and fats from animal and plants but from a macro-nutrient point of view, is there really a difference if optimum is say 80/10/10 (80% carbs, 10% protein, 10% fat)?

      *NB: I am not referring to the raw 80/10/10 diet, what I mean is cooked food 80/10/10 ratio plant based whole food diet.

      • brec

        Animal foods are high in (animal) protein and/or fat.

        Plant foods are not high in protein. Canned kidney beans are 5% protein by weight; Atlantic salmon is 22% protein by weight.

        Many WFPB docs recommend limiting high-fat plant foods such as nuts, for weight maintenance if nothing else.

        • DStack

          …even though the science from this site supports the idea that they won’t make you fat.

        • MacSmiley

          Canned beans, 5% protein by weight: Does that include the water they’re packed in?

          • brec

            I’m not sure. I used a nutrition info app I’ve got on my iPhone, and made my calculation on an entry for “Kidney Beans, 1 cup (9 oz.)”

          • MacSmiley

            Cool. I’d be interested in a protein to calorie ratio.

          • brec

            For the Kidney Beans entry I mentioned: 210 calories; 13.4g protein. And for the Atlantic salmon in my original comment here: 233 calories; 25g protein (“Atlantic salmon, cooked with dry heat; 1 serving (4 oz.)”)

          • MacSmiley

            Interesting. By calorie, the beans are 6.4% protein versus the salmon at 10.7%. Depending on one’s goals, that kind of closes the gap a little.

          • basskills

            I think the maths here is wrong. If beans are 210 calories; 13.4g protein. Its 4 calories per gram of protein. Therefore 13.4g protein means:

            13.4 x 4=53.6 calories of protein

            therefore ~26% protein, not 6.4%.

            With this mind, I am still confused about my original question :s

          • MacSmiley

            Was your original question about 80/10/10 macronutrient diet? Nutritional adequacy is more important than macronutrient ratios.

            PS. Sorry for my poor math skills. It was never my best subject. :-/

    • MacSmiley

      It’s not fat per se, but the type and source. Most animal fat tends to raise serum cholesterol. Non-tropical plant fats, especially unsaturated fats encased in their natural fibrous containers, tend to lower blood cholesterol.

      According to today’s video, that would be a considerable net advantage.

      • DGH

        I eat nuts and seeds every day but I blend them into a smoothie – I guess I am breaking down the fibrous shell by doing that and liberating fats. Also I eat tahini (crushed sesame seeds which are pre-roasted) – but a small amount – about 1-2 tbsp every day. Finally, I just bought a jar of pumpkin seed butter. BTW: Jack Norris RD had a question for you at:

        • MacSmiley

          Thanks for the heads up about Jack. I just answered him “privately”.

    • yardplanter

      There have been several videos here on nut consumption resulting in no weight increase ( as long as the amount is moderate – 50-100 gms a day). This implies it is not the amount of fat consumed , it is the amount of fat absorbed. The fiber in nuts keeps absorption down. However, many nutrients in nuts still make it through to the circulation. So at low ‘dosage’ you get the benefits but not the hazards. If you eat a sufficient number of nuts, fat will accumulate, and many many studies show fat accumulation is inflammatory – the leading edge of many pathologies. Hence all the emphasis on anti-oxidants/inflammatory in these videos. So, the difference lies largely in the amount You would have to eat a pound of nuts at one sitting to match what you can do with one egg. And yes there is a difference in the amino acid profile of plants vs animal protein, not to mention the hormone issue.

      • DGH

        Agreed. The amount of nuts makes a huge difference. Limit to 1-2 oz per day MAX.

        • val

          YES…I like to say “a PALMFUL” …not a “Fistfull” of the nuts each day…for me, pistachios are the most difficult to eat according to that rule! I don’t keep them in the house but do enjoy them around the holidays!

      • Allan

        I’ll try again, on the consumption comment, the last one disappeared. “It’s not the nutrients you consume but rather the nutrients a body can and will absorb and utilize that matters.”

    • Rivka Freeman

      Pumpkin seeds are high in zinc, estrogen excess results from not enough zinc and too much copper. The fat in pumpkin seeds and plant sources is not the kind that stimulates cancer.

    • Evan

      Animal-based fats and animal based proteins are different structually and functionally that plant-based fats and plant-based proteins.
      Plant-based fats and plant-based proteins don’t help cancer cells grow as well as animal-based fats and proteins. If you really want to learn about this, check out the online course that Cornell has about this and/or just do some more research.

    • Christo Okulian

      i just wanna highlight a bit, from the transcript:

      ” Evidence for reduced breast cancer risk associated with consumption of sunflower and pumpkin seeds. Sunflower and pumpkin seeds were associated with reduced breast cancer risk….. Maybe it’s the phytosterols found concentrated in seeds.”

      both seeds contain a high phytosterols, i just have this link

      which told us the sunflower seed although having a high fat but full of phytosterol and become top contributor lowering cholesterol.

      and we need to understand between fats from animal that contains cholesterol and also contain bad pollutant vs fat from plant that contain phytosterol and contain other good stuff. so the source of the fats clearly defines the impact to our health. and of course it doesnt mean we need to drink the plant oil but to eat whole plant food that contain phytosterol.

  • Stefan

    Hey doc.

    Standing desk/treadmill desk question, i see you use one.
    I see a couple of internet pages saying standing up is as bad as sitting down, any truth here ? Can you do a video on this ? If not a reply would be great.


  • charles grashow

    Does it matter how one lowers TC and LDL-C? For example – I eat geass fed raw ground beef, raw goat milk, goat milk kefir, hard boiled eggs, nuts, seeds, fruits, veggies, etc. I take 10mgs Atorvastatin/day plus other supplements. Last blood test – TC was 100, LDL-C was 47, Trigs were 43, HDL was 44 and LDL-P was 401.

    • Veganrunner

      Nice numbers Charles. TC 100. Have you ever had high cholesterol?

      • charles grashow

        When I followed a full blown paleo diet my TC was as high as 274 and calculated LDL was 199

        • Veganrunner

          Yikes! I guess what you eat does affect your cholesterol . (sarcasm)

          • charles grashow

            My question still stands – If my TC is now 100 and my LDL-C is now 47 does it matter how those numbers are attained?

    • MacSmiley

      As you know from my postings at CarbSanity, lipid lowering/atheroma regression can be accomplished with high dose statins, diet + statins, or a whole foods plant-based diet. The choice is yours.

      Scientifically speaking, the superiority of one method over another will take an intensive intravenous ultrasound (IVUS) comparative study. In the meantime…

      Danger of food poisoning and parasite infection aside from consuming raw animal products, Dr. Greger endorses a whole foods, plant-based diet to lower TC/LDL to regress atherosclerotic plaques AND reduce adverse coronary event a. Better not to make the mess in the first place than try to clean it up later.

      • charles grashow

        10mgs/day Atorvastatin is NOT a high dose statin.

        Since the mess – as you call it – was made in the first place why should it matter how it is cleaned up?

        After all – Dr. Esselstyn used statins.

        • MacSmiley

          Sorry to upset you, Charles. I did not say 10 mg was a high dose of statins. (Esselstyn used 5 mg, I believe.)

          I was referring to the whopping 80 mg of Atorvatstatin Cleveland Clinic’s Dr. Nissen talked about in this 3-part presentation:

          Intravascular Ultrasound Insight into the Pathophysiology of Coronary Disease

          Factors Driving Progression and Regression of Coronary Plaques

          New Targets for Anti-Atherosclerotic Therapy

          (Caveat: The HDL-raising drug mentioned in the 3rd part was pulled by the manufacturer due to increased mortality.)

          Plaque regression happened when LDL was lowered to 60 ml/dl or below.

          Of course, the mess has already been made in existing coronary artery disease. The point is, it helps if we don’t work at cross-purposes and keep adding to the underlying disease process with the foods we eat.

          If we’ve got an overflowing sink, it’s a good idea to turn off the faucet, not just to get more towels. :-)

          • charles grashow

            Esselstyn used lovastarin, 40 mg to 60 mg daily.

            Dr William Clifford Roberts says it doesn’t make any difference how one lowers TC and LDL – just get TC<150 and LDL<80, same as McDougall

          • MacSmiley

            Interesting. I knew Esselstyn used what he calls a belt-and-suspenders method with that first group of patients, but I didn’t know the dosages were that substantial. It will be interesting to see the published study waiting in the wings of his 200 most recent patients. He has more faith in the diet now than he had when he first started.

            It is possible, however, for some, and perhaps most, to reverse coronary plaques with diet alone, as Dr. Esselstyn’s colleague, Dr. Joseph Crowe, did. Following the protocol, I believe he got his TC down to 89 and his LDL down to 38 from a respectable 98. This slide from Dr. Esselstyn’s presentation demonstrates the result.

          • MacSmiley

            I hate when I double post stuff. Thanks, Sprint.

          • MacSmiley

            There are a number of ways to get TC down to <150 and LDL-C <80. A few examples:

            Infectious disease
            Nutritionally adequate plant-based diet

            Take your druthers. ;-)

            Due to food intolerances, I have to consume some animal protein, but I eat mostly plants. My lipids are very close to your admirable numbers but without cholesterol-lowering drugs…even though CVD runs in my family.

          • charles grashow

            What/how much animal protein do you eat?

          • MacSmiley

            As little as possible, 3x a week. Smart Chicken. Strips poached with balsamic vinegar and dill weed.

          • Darryl

            Here, William Castelli of the Framingam study notes that in the STARS and Ornish clinic reversibility studies, “for the same fall in cholesterol, if you get there with diet you did get twice the shrinkage of the deposits than trying to do it with drugs alone.”

            So the means of achieving these lipid thresholds may matter.

          • charles grashow


            “another multifactorial trial, so you can’t tell whether the benefit came from replacing SFA with PUFA, weight loss, increasing pectin, less trans fats, more LCO3, restricting commercial baked goods or potentially more whole plant foods.

          • MacSmiley

            I have no problem with the multifactorial nature of the study since cardiovascular disease is a multifactorial disease.

          • VegAtHeart

            Fascinating presentation, thanks. A quote from Nissen’s talk that gave me pause:

            “Even if we put statins in the water supply, cardiovascular disease would still be the leading cause of death!”

        • Veganrunner

          What were your levels before going on the statin? You have really low numbers. Have you tried not taking it and making dietary changes. I know many people are not willing to give up the animal and would rather take a medication. Obviously you don’t have muscle pain or weakness. Not everyone is able to lower their cholesterol through diet alone.

          • charles grashow

            I made a few changes to my diet before going on statins – eliminated coconut milk/oil and reduced the number of eggs eaten from 6/day to 1 day – unfortunately I didn’t get blood tested immediately before starting statins. After 3 months on statins the test results were TC 126, LDL 71, ApoB 64, HDL 48 and Trigs 36. I maintained the diet and added some additional supplements and the TC went to its present 100 and LDLwent to 47

          • Veganrunner

            Charles if you look above under videos and then statins you will find the relevant videos/research. And also look under eggs. You can make a decision that works best for you. I prefer WFPB.

          • charles grashow

            I prefer what I’m eating

          • MacSmiley

            À chacun son goût! :-)

          • Veganrunner

            Better yet. Watch

            All you questions are answered in this great video.

        • Joe

          It is worth noting other problems that statins may cause – for example, Cholesterol cannot cross the blood brain barrier – the brain makes it locally and it is essential. But, I’m betting statins do cross over, and deplete this important cholesterol from one area that really needs it.

          There is also the underlying issue of inflammation and damage to the blood vessels, which I believe dietary changes will repair, but statins won’t.

          Potentially, it could be very important to retrace ones steps down the same road that got them lost in the first place to properly reverse all negative effects, not just the cholesterol.

          But – I guess the issue is that if the cholesterol occlusions are the biggest threat, then doctors will want to deal with that as quickly as possible – probably by using statins. When most people come in to see doctors like Esselstyn, they haven’t got a lot of wiggle room, so I can understand the statin choice as an initial treatment.

          • brec

            Some statins are water-soluble and can’t cross the barrier; others are fat-soluble and can. Regardless, statins inhibit an enzyme involved in production of cholesterol in the liver; I’m guessing that they don’t deplete specifically brain cholesterol. One study found that fat-soluble statins provide a protective effect on the brain. (Indirect source: )

          • Joe

            Interesting. Thanks for the reply!

    • Thea

      charles: re: “Does it matter how one lowers TC and LDL-C?”

      I would say it does matter if the method is one you use long term, and if that method can create other serious problems for you. For example, the animal protein in the beef, dairy and egg products you talk about is linked to cancer promotion. You can see the video series on IGF-1 on this website to learn more about that.

      Also, while the drugs have clearly helped you, it just doesn’t make sense to me to continue to eat the cholesterol-laden foods (beef, dairy, eggs) that caused the problem in the first place.

      Plus, who wants to be on drugs long term? Those things usually have some pretty bad side effects. Esselstyn had people on drugs at first as *part* of a treatment for desperate people at the end of their line. But if memory serves, by the end of the study, everyone was either completely off the drugs or had them greatly reduced. They were able to do that because they were eating a low fat whole plant food based diet that did not include any animal products.

      Here’s a quote I found from his book on reversing heart disease, page 75:

      “…the drugs alone are not enough. In Chapter 5, I cited a study, recently reported int eh New England Journal of Medicine, in which huge doses of statins successfully reduced patients’ cholesterol levels well below 150 mg/dL. But even so, as their diet never changed, one our of four of the subjects experienced a new cardiovascular event or diet within thirty months.”

      That’s my final reason for the question, “Does it matter how…?” It matters because your ultimate goal (probably) has nothing to do with lowering cholesterol. Your real goal is likely to be about having a long healthy life free of heart attacks and stroke. The evidence I have seen says that the best way to reach that goal is to eat a diet like the one that Esselstyn recommends.

      Good luck to you. I hope your diet and drug combo works for you as long as you choose to go that route.

      • brec

        “Those things usually have some pretty bad side effects.” I’m not sure if “Those things” refer to drugs generally or statins specifically. In either case, however, I’d say that “usually” is hyperbole. “As a class, adverse events associated with statin therapy are not common.” —

        I’ve been taking statins for a couple of decades, and am unaware of any side effects.

        (Relax, guys — for about 1.5 years I’ve also been eating per Esselstyn, et al :)

  • Eileen
  • Eileen

    Hi, I just want to ask whether it could just be the cholesterol in the eggs stimulating breast cancer rather than the choline? I ask because there have been some studies suggesting choline is protective, and one of the previous videos on this site suggest choline is cancer stimulating.

    • MacSmiley

      Perhaps choline may play a role one way or another. Cancer cells use the same things normal cells use. All cells need cholesterol. Since uncontrolled cancer cells proliferate faster than normal cells, and since serum cholesterol levels drop so precipitously when cancer takes hold, they are apparently especially thirsty for serum lipids.

  • Nick Kokoshis

    this is the second video you’ve done that has a humm in the soundtrack. What’s up?

    • Jay M

      don’t look a gift horse in the mouth

  • Buyay

    1) What is your opinion on food combining rules? For example those that Herbert Shelton was promoting (eat fruit alone or with greens, don’t mix starch with protein, etc) Any science regarding this topic?
    2) Should calories on 100% whole food plant based diet be counted the same as on normal diet? Regarding studies in which adding healthy calories didn’t cause people to gain weight. (I’m too skinny and want to gain weight)

    • Thea

      Buyay: I’ll try to answer your questions as best I can.

      1) On food combining: I do not remember any videos specifically addressing the type of food combining that you listed as examples. Here is Dr. Greger’s overall nutrition recommendations, and you can see for yourself what I mean:

      On the other hand, Dr. Greger has covered some specific “food synergy” topics that may interest you. In these cases, one food is clinically found to improve absorbption of one or more mineral in another food. For example, if you eat a food high in vitamin C with foods high in iron, you can increase your absorption of iron. So, you may want to take those foods together. For more information:

      2) My understanding is that the best way to gain weight on a whole plant food based diet is to eat more calorie dense foods. This would include foods like nuts, dried fruits, and avocados. I know that Dr. Greger has a video on nuts not causing weight gain, but in my opinion, that can only hold true for so so many nuts. At some point, you will gain weight. Also note, even according to Dr. Greger’s videos, if you eat pre-ground ground nuts (nut butters, nut sauces, etc), then you increase your calorie absorption over eating unprocessed nuts.

      While you may not be a teen and/or an athlete, the following page may interest you. Not all of the recommendations on the page are whole foods, but there are some good ideas that may help and it is a site (Vegetarian Resource Group) that I trust.

      Hope that helps!

      • Buyay

        Thanks! Until they make some studies on this I’ll just have to experiment on myself I guess. :) I feel like I am consuming enough calories for my body weight (over 3000 kcal/day with 62 kg or 136 pounds) but the amount of food to consume is very unappealing as I go 100% healthy (not even olive oil). My biggest meal is 200g of legumes with 100g of brown rice or other whole grain + veggies. I wonder if it may be weakened gut flora which doesn’t allow me to build my body, because from what I’ve read the majority of healthy people eat less and weight more than me.

  • Sam

    what correlation does this have with cholesterol. Wont your body manufacture cholesterol when needed even when adhering to a low fat cholesterol free diet?

  • Woodsmith

    To Toast or not to Toast: I love pumpkin and sunflower seeds on my porridge (oatmeal). Dry-toasting pumpkin seeds in a pan makes them puff (a little like pop-corn) resulting in lovely texture and flavour. In some places I have read roasting nuts improves absorbability of nutrients but also in others that high temperatures may result in carcinogens or damaged fats – so which is better for pumpkins seeds (and other seeds and nuts) – to toast or not to toast?? Thanks for all your great work – the constant flow of new interesting, convincing and evidenced material (and also the sense of community) helps keep me and my family on the healthy path. You have changed my life thank you.