Doctor's Note

It’s worth rewatching and pausing on the Framingham data, the graph with the bell curves. That’s a very important concept to understand. At first glance, it looks like those that get heart disease and those that don’t have very similar cholesterol levels, but that’s only at “normal” levels. To get an Optimal Cholesterol Level, one has to eat an exceedingly healthy diet. It’s worth it, though, since we’re not just talking life and death with heart disease, but life and the #1 cause of death.

For more on this concept of being at normal risk and dying from all the normal diseases, watch When Low Risk Means High Risk.

And I continue this streak of questioning the patronizing paternalism of authorities in the next video, Optimal Diet: Just Give it To Me Straight, Doc. Stay tuned!

What’s so bad about having high cholesterol? It’s not just involved in the formation of atherosclerotic plaque. Cholesterol Crystals May Tear Through Our Artery Lining.

But wait a second, what about fluffy versus dense cholesterol? See Does Cholesterol Size Matter?

Can’t you just take cholesterol lowering statin drugs? Check out The Actual Benefit of Diet vs. Drugs.

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  • Tobias Brown

    Excellent report. Thanks.

    It would be interesting to know what proportion of strict plant diet eaters who follow your suggested eating pattern don’t reach the low 150 cholesterol level after 3 years. Will the level continue to drop over the years until it finally reaches 150 or below? Should statins be used while one is on that path but not quite at 150 yet?

    • http://www.vegannursepractitioner.com Vegan Nurse Practitioner

      Your cholesterol level drops pretty quickly, I would suggest if you turned your eating lifestyle around to a plant based one that you will not ever need a statin, unless you return back to your old style of eating, then it will quickly return.

      • Tobias Brown

        So above 150 would be okay? I found that my level based another 10 points after an additional year. First level after 4 months had dropped 245 to 180, then 170 a year later, so 16 months out from the start. I hesitate to get a test after 3 years now for fear that it won’t be below 150. But, as you suggest, I figure that if I’m eating strict plant, no oils, etc, that about as much as I can do. (Though actually I think I could get hyper-focused on doing every last thing that might possibly help and get it down even lower naturally.) Would love to have some insight on this area.

        • David Johnson

          I’ve been a WFPB vegan for slightly over a year, before that various versions of vegetarian for about 40 years. My cholesterol is now ~160; before going vegan it was about 180 or so. My triglycerides are low but my HDL is nothing to shout about, ~48. My diet is quite good but it is not low fat as I eat a fair amoung of nuts. I also do a lot of exercise, in fact 2 or more hours per day, including aerobics (walking, hiking, jogging, some interval work), weight training, and flexibility/balance-type exercise (I’m 68 so the later is important). I doubt I can get my cholesterol down even farther. But then I am not sure I need to, either. Regarding fat, I am not convinced a really low fat diet is optimal, at least in my case I lose too much weight (my BMI is only 18.5-19 as it is). I simply cannot eat enough nonfat food to keep my weight up given my activity level.

          • Charlie Michael Morrison

            I wish my BMI was 18-19. I am at about 25. I used to be Obese. It was around 44 or so. Not sure really but guessing as I didn’t even bother with the weight at the very beginning. When I did start looking at it I was 5′-8″ and 265. I have found that when I eat plenty of beans I gain a little weight
            .

          • David Johnson

            Well, you seem to have made excellent progress. I happen to have a slender frame and even with pretty intense weight lifting do not build large muscles.

            I am surprised eating lots of beans results in weight gain.

          • Joy Schwabach

            For me it’s just the opposite. Beans are filling and so good for you! If you don’t have lots of fat with them, I don’t see how they’d lead to weight gain. A half cup of cooked lentils is only 140 calories. That’s typical for many beans. Garbanzo beans are a little higher but still great. There are really great recipes in the book, “The Plant-Based Journey.”

          • David Johnson

            Right, that’s why I was surprised Charlie Michael Morrison mentioned “a little weight” gain.

          • http://www.imvc.org/ Charlotte Fairchild

            Fiber can cause constipation. Magnesium can help. Epsom salts are cheap.

          • David Johnson

            You mean if one is dehydrated? I get lots of fiber and my experience has been the opposite but then I am careful to stay well hydrated.

          • http://www.imvc.org/ Charlotte Fairchild

            Some fiber does not leave the body easily with hydration apparently.

          • http://www.imvc.org/ Charlotte Fairchild

            Most women don’t know that if they crave chocolate Epsom Salts can stop the craving. Most women don’t know that magnesium can stop cramps and help the blood. Most men don’t menstruate. Men don’t even see the same spectrum of colors that women do. Men and women are not the same.

          • David J

            And vive la différence! :-)

          • http://www.imvc.org/ Charlotte Fairchild

            Dried are better. The whiter the bean the less yeast/mold and more alkaline.

          • http://www.imvc.org/ Charlotte Fairchild

            There is yeast/mold on beans, as in nuts (less in almonds). Yeast causes inflamation and expansion.

          • Sebastian Tristan

            BMI isn’t very precise. Mine is about 25 but I have very little fat, most of the weight is lean body mass. I weight around 75 kg for 1.75 m.

          • Fred

            http://www.newsmaxhealth.com/Health-News/seniors-weight-BMI-death/2014/03/26/id/561762/

            A new study suggests that current body mass index (BMI) recommendations may be unsuitable for older adults.

            Caryl Nowson, a professor of nutrition and aging at Deakin University, led a research team that examined the relationship between BMI and risk of death in people 65 and older. The findings indicated the lowest risk was among those with a BMI of about 27.5, which is considered overweight by the World Health Organization. Mortality was said to increase “significantly” among those with a BMI between 22 and 23, the normal weight range.

            “It is time to reassess the healthy weight guidelines for older people,” Professor Nowson said. “Our results showed that those over the age of 65 with a BMI of between 23 and 33 lived longer, indicating that the ideal body weight for older people is significantly higher than the recommended 18.5-25 ‘normal’ healthy weight range.”

          • JCarol

            As I’ve watched my parents, in-laws and others move into the quite elderly range (think late 80s and above), I noticed their appetites – and therefore their weight – decreasing. That trend tends to hold true until they pass away.

            Perhaps it isn’t so much the lower BMI that kills them as it is their bodies getting ready for the natural process of releasing their souls. Would they have passed away later if they’d maintained a higher weight? Very hard to say.

            On the other hand, having spent too much time in nursing homes and assisted living facilities over the past five years, it was anecdotally clear that the thinner residents were typically the spriest, most engaged and least in need of physical assistance.

            Living longer isn’t necessarily my aim. I’m hoping to live healthy and reasonably independent until I do pass on.

          • Fred

            Possible that the studies above were done on victims of the SAD diet and big pharmas many prescriptions? Not sure. Do agree that in my experience the thinner people seem to last the longest. My BMI is in the overweight range…as I get older I’d expect that to lower.

            A problem I see (limited experience) is the institutional food the people in nursing homes get fed…white bread…overcooked veggies…a hamburger patty that seemed to have extra sugar in it…etc.

            My experience says that as you get older and aging accelerates…you either make reasonable efforts to focus on remaining healthy…or you get sicker faster?

            I’m “into” life extension…but in reality I’d settle for squaring the curve…and having a few more healthy years…less suffering.

            People I know who buy into “let the doctors take care of things” just stay on the corporate food train…and will probably end up on quite a few prescriptions as time goes by. They will do the typical things older people do as they see the coming of the end of their life…but not the rational things they could do.

            This site in very valuable in terms of overall lifestyle factors…but I sense that say after 65 or so….metabolically things change. Getting hints here and there…more protein…etc….avoid muscle weakness…etc. Protect the brain….stay mobile and independent. The sharks will start to circle?

          • Alan

            I have never seen them interview a fat person that just turned 100. Always thin.

          • http://www.imvc.org/ Charlotte Fairchild

            Daniel Amen, MD says fat people have smaller brains. Their brains increase if they lose weight.

          • sf_jeff

            Good points. There are lots of things that can cause weight loss and choosing to lose weight shouldn’t be statistically conflated with the other causes.

          • David Johnson

            Thanks. I’m 68 so fall into the “older person” category. I took a look at an overview of the work at

            http://www.deakin.edu.au/news/latest-media-releases/2014/carrying-extra-weight-could-be-healthier-for-older-people

            and noted she stated: “”Rather than focussing on weight loss, older people should put their efforts into having a balanced diet, eating when hungry and keeping active.”

            I think this is key: I am very active, pay close attention to my diet, and am very active, so I am hoping I am an outlier. She does not address older people who fall into that group.

            But as an aside, to keep my weight constant at my college weight, as it is now, I do seem to have to eat plenty of fat, ~25% of calories per day, which is why I am a bit skeptical that very low fat diets are optimal for everyone.

          • Wilma Laura Wiggins

            I believe it is key what type of fat we eat. I believe oils are really bad for us, until proven otherwise. I do note that Vietnamese cooking and Japanese cooking do use some oils, mostly peanut traditionally I think. In general, they seem to be thin and relatively healthy populations. It seems that heavy on the vegetables and starches, low on the processed, animal and sweet points to healthy or at least healthier.

          • http://www.imvc.org/ Charlotte Fairchild

            Peanuts come from where? Not Japan. Peanuts have a high concentration of mycotoxins. Many people are allergic to peanut oil and seeds.

          • Wilma Laura Wiggins

            Sounds like there is something wrong with that research to me. I certainly would doubt the necessity to reassess the guidelines based on one or a couple of studies.

          • Joy Schwabach

            Dr. Furhman debunks these stories. The problem is that nearly all Americans are on the standard diet. So the only thin ones are those with cancer and other horrific problems. So thin gets associated with high mortality.

            I’ll bet those Seventh Day Adventists (and the Okinawan Islanders who didn’t switch to the SAD diet) are thin!

          • Alan

            I am A Seventh Day Adventists. I am on a whole foods plant based diet and am thin. But i was when i was on the SAD diet. I feel much better now and am healthier. All the Seventh Day Adventists that i know that eat a good diet are thin. A fair amount of the Seventh Day Adventists eat way to many sweets and the canned fake meats, that i call the Image to the Beast. They have a lot of the same diseases as the rest of the SAD eaters.

          • http://www.imvc.org/ Charlotte Fairchild

            Do Inuits live long? They are not thin. They don’t eat greens.

          • sf_jeff

            First of all, that is Newsmax, home of inflation mania extremism. Getting your news from Newsmax is almost like getting your news from Fox News. Second, such an experiment has to be designed very carefully. People with cancer have very both lower weights and higher morbidity. This doesn’t mean that the low weights are causing the morbidity. Cancer is now thought to exist for years before it is diagnosed and treated.

          • Wilma Laura Wiggins

            Just want to say Good Job – you are really doing a great job on staying healthy by the sounds of it. Enjoy the rest of your life. You’re probably right about the fat, although “very little” extracted oil is a bit of a red flag. About cholesterol,, studies show if it is too low death from all causes is increased. It doesn’t sound like you need to worry about it.

          • David Johnson

            Thanks very much!

          • srini

            My story is similar to yours… i dropped my tot cholesterol from 160s to below 130 with CRON diet and a well-rounded exercise program.. and all my lipids have stayed low in over 15 yrs, even though I am not strictly following CRON for the last 10 yrs (but a close approximation with exercising). With protein & unsaturated fats (nuts, olive oil), i have no problem maintaining weight (BMI-21.5). I switched from whey protein to plant protein after coming across this website.

            However, my mother was a vegan (very little dairy and eggs) for over 30 years, but never could keep cholesterol down (>200, even with medications) and eventually died of heart attack. I am sure everyone has similar anecdotal examples within one’s limited sample population that may not fit the observations of many of the studies cited here. The obvious no,no (cigarettes, saturated animal fat, etc) are easy… for those foods that have subtle influence, it is good to learn potential responses of different human bodies to input diets, Then we need to figure out what works for each of us by trial and error.

        • Charlie Michael Morrison

          Exercise will bring it down even more. The no oils, and such is great but exercise and stress reduction I believe also helps.

          • http://www.imvc.org/ Charlotte Fairchild

            Daniel Amen, MD says our brains are 60% fat and we need fats.

          • Charlie Michael Morrison

            You don’t need those fats from oils and animals. Anyone that says you do don’t know anything about nutrition. You get fats from plants as well but they are healthier and won’t give you things like heart disease and Alzheimers.

          • http://www.imvc.org/ Charlotte Fairchild

            Olive oil and coconut oil and grape seed oil and nuts give many fats.

          • http://www.imvc.org/ Charlotte Fairchild

            Olive oil and coconut oil. Yes. I stopped cooking with oils. I use parchment paper.

    • Joy Schwabach

      I’ve been a vegan for four years. I got my cholesterol down from 297 to 200 once but it tends to creep up to 240 or even 270 and I’m not sure if it’s too much cashew butter, too much fruit, or too much whole grain bread. My best –200– didn’t seem all that different from my normal greens, beans, onions, mushrooms, nuts, seeds and berries diet. I know I didn’t have a single dessert for six weeks and that helped but it was very extreme –greens for breakfast and total calories around 1000 per day. In other ways, my health is fantastic. BMI of 19. No more shingles (I’d had them twice). Skin –no more dryness, bumpiness. No colds or flu –no flu shot ever necessary. Eye pressure -great! I’d had high pressure before. Blood pressure – wonderful! Usually around 120/80..

      • Tobias Brown

        I’m pretty sure that Dr Greger calls for below 115 blood pressure though 120 is close. As far as your elevated level at 240, 200, 270 etc, sounds like a special case. Not sure why it might remain that high. Maybe it’s normal for some people and not a concern.

      • Joseph Gonzales R.D.

        Hi Joy. Thanks for sharing! I am not sure if you’ve seen this video but Dr. Greger addresses LDL cholesterol and oxidation. Take a look if interested. I am writing an RD post on “how to lower cholesterol” with important points from Dr. Greger for those who seem to have tried everything and LDL is still high! Stay tuned…

        • JCarol

          Thanks for the tip – I watched the video.

          I’m very interested in your upcoming RD post. Where will I be able to find it when it’s published?

          • Joseph Gonzales R.D.

            You can always check in my RD page to see what’s new, but we’ll usually make a post on FaceBook or I’ll let folks know about it individually. Here it is: What can I do to lower my cholesterol? It seems I’ve tried everything!

          • JCarol

            I had no idea there was an RD page! Thanks for pointing out the obvious!!!

          • Joseph Gonzales R.D.

            Haha. Yes, there is! Please check back, as I am posting new questions almost daily and will be until the end of the year!

          • JCarol

            That sounds a little omiious. What happens at the end of the year?

          • Joseph Gonzales R.D.

            Nope, just some goals for 2015 :-) I’ve been wanting to vamp-up that section for a while! If you have thoughts on good topics please let me know! Coming soon are discussions about oxalates, potentially contaminated sea vegetables, and prostate cancer/ovarian cancer and dairy.

          • JCarol

            I went back to review this again and the link is broken. :(

          • Joseph Gonzales R.D.

            I think Dr. G is editing so it’s temporarily down. I’ve made a similar comment on this page if you’re interested. Note that when I say “focusing on saturated fat” I mean focus on reducing saturated fat. It’s more clear after reading the question I am answering. Let me know if you have any questions? Thanks JCarol.

          • HemoDynamic, MD – NF Volunteer

            Your link, “What can I do to lower my cholesterol. . . ” is broken. Leads to “Page not found.”

          • Joseph Gonzales R.D.

            I think Dr. G is editing so it’s temporarily down. I’ve made a similar comment on this page if you’re interested. Note, that when I say “focusing on saturated fat” I mean focus on reducing saturated fat. It’s more clear after reading the question I am answering. At any rate, please let me know if you think it’s off in any way. :-) Thanks Hemo!

          • HemoDynamic, MD – NF Volunteer

            Looks good! Keep up the great work!!

          • new-vegan
          • Joseph Gonzales R.D.

            Ya sorry about that it will be up asap and I can send out a reminder!

          • Alan

            I clicked on that link and got – page not found.

          • Joseph Gonzales R.D.

            It’s being edited and will available shortly, but you can still see older posts . Sorry about that, Alan.

        • Joy Schwabach

          Thanks so much Joseph Gonzales! Perhaps the reason why some people with normal cholesterol have heart attacks is mainly due to their oxidation levels. It would be nice to know whether any of those 100 year-old Okinawan islanders have high cholesterol, (but no oxidation).

          • Joseph Gonzales R.D.

            Good point! Have you seen the video on Okinawa diet? It’s really great. And Dr. Greger does touch on oxidation and LDL levels. I have not heard about those with normal cholesterol levels having heart attacks due to oxidation. That’s interesting! I’d love to learn more.

          • Joy Schwabach

            I’ll watch those again. Thanks!
            I have read many times that people with normal cholesterol levels still have heart attacks, and given Dr. Furhman’s comment about the difference between oxidized cholesterol and non-oxidized, I figure the normal LDL people had oxidized normal cholesterol.

        • sf_jeff

          Some people believe that oxidized ldls can come from bad mitochondria.

          https://www.youtube.com/watch?v=ntWTZtfDcXo&list=PL5U_0Xj9MRPj8llC8bWILDRf5k9vnwQtE

      • JCarol

        You and I could be twins, Joy! Although a pretty strict vegan, when last checked my total cholesterol was 236, triglycerides 179, HDL 51 VLDL 36, LDL 149 and Total cholesterol a disappointing 4.6. My BP is excellent though, usually running 90-100 over 60-65. While these results were dissatisfying, they did show a marked improvement over where I was pre-plant based diet, so there’s some comfort to be taken there.

        I tried taking a statin a few years ago but soon wound up prone on the couch with muscle aches that mirrored my worse fever/flu experiences. Trying a different statin did the same. Even if I could takes statins I’m not sure that I would, but that doesn’t appear to be an option.

        I’m due for blood tests next week and am eager/anxious to see what they reflect.

        • Joy Schwabach

          Thanks so much JCarol!

        • fencepost

          A possible explanation can be found in the book “Stop America’s #1 Killer” by Thomas Levy, a cardiologist. Lots of research citations in that book, and there are straightforward ways to test whether Levy’s explanation explains your situation. It made a big positive difference for me.

          • Joy Schwabach

            Thanks.

          • JCarol

            I took a quick look on Amazon to get a sense of Dr. Levy’s direction. He advocates taking vitamins, primarily plenty of C, correct? Can you give a synopsis on the rest of his theory?

          • fencepost

            Adequate vitamin C is needed to maintain the integrity of artery structure and health. In the absence of adequate vitamin C, our bodies will create cholesterol for its anti-oxidant properties (implying that elevated cholesterol levels are a symptom of an underlying fundamental health problem). Our vitamin C levels get depleted by stress and toxins. Toxins can come from diseases/infections, heavy metals (e.g. mercury), and what we eat. Levy claims that dental work is a major source of toxins and that anyone who has had root canal work, for example, is at a much higher risk of cardiovascular disease.

            The level of vitamin C that is “adequate” is not knowable in advance, because we do not know our stress and toxin levels. The solution is to take vitamin C in sufficient quantity to induce discomfort in one’s bowels. The idea is that the blood will absorb all it needs and any surplus stays in the intestines where it retains water in the intestines and feeds microbes so gas, bloating and diarrhea occur. In a healthy adult, this bowel tolerance level is in the 10-20 grams vitamin C per day range. With a little practice, the typical adult can get close to the bowel tolerance level without significant discomfort. Do an Internet search on vitamin C bowel tolerance to learn how to do this, how to protect your teeth from the acid, etc.

            Vitamin C can be taken with an IV, but I have no experience with that.

            I strongly suggest you read the book, even if just for Levy’s explanation of the biology of our arteries and the roles of vitamin C in arterial health and our immune system.

            I view Levy’s thinking as complementary to the WFPB concept. Both are part of a broader explanation of the bigger picture imo. One link that ties the two together is Essystyn’s reasons for getting his patients to eat 6 large servings of green vegetables per day (to supply sufficient antioxidants to neutralize toxins).

          • JCarol

            Thank you for taking the time to explain this to me. I will investigate the book further and up my Vitamin C intake. Lucky for me, I’ve got lemon, lime and orange trees in my back yard!

        • Lauren Culp

          Surprise! You girls have a triplet sister! I’ve been on a WFPB diet for four years and my cholesterol still hovers between 182 and 231, with my last check in April being 222 with my highest LDL ever at 140! Great BP, weight about 135 lb. standing 5′ 11″. I’m believing that the way I eat is helping even if the numbers don’t reflect that. I feel great! My husband, by the way, eats what I eat and even cheats occasionally and his total cholesterol is below 150. It can be very frustrating. I’m glad to see I’m not alone. I use very little oil and very little sugar. My mom is 81years old but she has had (and survived) triple bypass surgery, a stroke and two heart attacks. I think there must be a genetic component.

          • JCarol

            You may be right about the genetics, Lauren. I’ve gone to a much more very restrictive version of my vegan WFPB patterns in the last couple of weeks to see whether my numbers will budge. I even gave up my single daily indulgence. My heaping spoonful of much beloved – but totally crappy for the body – artificial coffee creamer. Am using pureed cashew nuts and I’m here to tell you they make a very pathetic substitute.

          • Joy Schwabach

            How about soy milk with lots of real Trader Joe vanilla? I find vanilla helps everything. My sin has been a handful of chocolate chips. Now I’m reading “The Plant-Based Diet,” in which the author, such a nice person, said she had a daily chocolate habit that was started being a twice-daily habit. So now she grabs a handle of frozen blueberries. I’m doing it too! They’re like little blueberry popsicles. I’m going to try to do my very best for six weeks and then get a cholesterol test. But my diet is so good, I’m not worried even if my numbers are high.

          • JCarol

            Hi Joy… I miss the creaminess more than the sweetness. Coffee is much less appealing now, so I’m barely finishing even one cup which probably isn’t a bad thing health-wise. But to be honest, my morning coffee isn’t a joy that I want to give up. Sigh…

          • Joy Schwabach

            This article https://www.drmcdougall.com/misc/2007nl/may/statins.htm points out that doctors used to say anything under 300 cholesterol was fine. Statins can be dangerous. Read this: https://www.drfuhrman.com/library/risks-associated-with-statin-drugs.aspx

          • Lauren Culp

            Thanks Joy,
            Great articles!

          • Joy Schwabach

            You’re welcome, Lauren!

          • Joy Schwabach

            My husband’s cholesterol is lower than mine and he weighs 250 and is 5’10 and eats the SAD diet!

        • new-vegan

          JCarol, which blood and urine tests are important to take?

          • JCarol

            Hi NV, I’m getting a standard blood panel for my annual physical and also requested my B-12 levels checked because I’m a vegan. I don’t know if other tests should be done – that’s a very good question!

      • Russell

        Joy, I don’t know if this will help you, but I’ve experimented with increasing and lowering the amount of nuts and seeds that I eat. At lower levels (at 50 grams/day of total fat, 5 grams saturated fat/day), my LDL is at 85. At higher levels (100 grams/day total fat, and 10 grams saturated fat), my LDL is 120. In fact, before I added a lot of fiber, it was even higher — 136. So, you might try experimenting with reducing ALL fats and getting fiber up to 40 grams or so. On the other hand, there’s a big correlation with lower CVD and nut-eating, so… who knows? The chart doesn’t tease out the vegans/vegetarians who eat a lot of nuts, from the carnivores. Nor does it look at LDL, only total cholesterol, in other words, a heavy nut eater with an HDL of 80 is not contrasted with someone who has a HDL of 45. Big gap in our knowledge.

        • Joy Schwabach

          Thanks so much Russell!

          • Russell

            You may be a hyper responder to fats and cholesterol, like me. When I experimented with 4 eggs/wk some low-fat diary, and fish 2x/wk, my LDL shot up 50 points, to almost 170. When I cut them out, I dropped back to 120. Then when I cut out my fattiest veggie foods, like cashew butter and got down to 50 grams a day of fat, that’s when I plummeted to LDL of 85. Good luck, and let me know what happens! By the way, almond butter, hemp, flax, and chia are all pretty great on saturated fats…. though hemp is high in total fat. I haven’t figured out how much of the problem is TOTAL FAT vs. saturated fat…. still experimenting with that one.

          • Joy Schwabach

            Thanks! I sure am going to cut down and see what happens. McDougall’s 10-day Meal Plan Recipes sure look tasty!

      • Daniel Hunter

        Hi Joy, I’m wondering how much sat fat vs soluble fiber is in your diet? I have the e4 allele of the APOE gene and so my cholesterol clearance is impaired. Since gradually dropping my daily sat fat intake below 10g and upping my fiber intake to over 70g, my cholesterol (stuck at a little over 200) has been dropping steadily over the last 2 years, now at 165.

        • Joy Schwabach

          Gosh, that’s good news! I thought I had a lot of fiber, but nothing like 70g. I’ll see what I can do. Thanks so much.

          • Daniel Hunter

            YW! Hope it helps! :)

          • Daniel Hunter

            Also, if that doesn’t work, pay attention to sat fat (hidden in nuts, seeds and added oils). And if that doesn’t work, I don’t eat any processed grains and I keep my fruit intake low (because I’m diabetic controlled w diet and exercise) and that might have some bearing on my success.

          • Daniel Hunter

            Joy, I wanted to compare the relative influence of sat fat and fiber intakes with my serum cholesterol labs and to my great surprise, I found that at low cholesterol intakes, sat fat intake rules, not fiber. I made a little chart comparing my daily cholesterol, fiber and sat fat intakes over the last three years with my TG and non-HDL cholesterol labs. When I multiplied my sat fat intakes by 10, they tracked my non-HDL cholesterol almost perfectly (with a little time lag when intakes are changing rapidly).

            You can see for yourself here: https://dl.dropboxusercontent.com/u/96885971/Dietary%20Influence%20on%20Serum%20Lipids.PNG

          • Joy Schwabach

            Great research! Thanks so much! That’s really fascinating. I typically don’t use oil but I love fruit and don’t have to worry about blood sugar, it’s always low. But if the low fat approach doesn’t work, I’ll try low fruit next.

          • HeartHealthy

            The information you have provided on your self experimenting is incredible, and should help everyone understand what causes LDL to rise.

          • Daniel Hunter

            I’m glad you were able to understand it. Being a mathematician by training, I don’t often have an appreciation of how to communicate my results. :)

          • Matthew Smith

            You could try 2 grams of Niacin daily. It is being striped from your grain anyway.

            “Nicotinic acid reduces LDL-cholesterol levels by 10 to 20 percent, reducestriglycerides by 20 to 50 percent, and raises HDL-cholesterol by 15 to 35 percent.”

            http://www.medicinenet.com/script/main/art.asp?articlekey=9487

          • Daniel Hunter

            Watch out for niacin. Although effective, it definitely gave me acid reflux – actually burned away the lining of my throat. I was using the SloNiacin at 250 mg before bed. Stopped and symptoms cleared up, never to return.

          • Matthew Smith

            I have never heard of this effect. Have you considered if it is the slow dose preparations? No one ever told me it is safe to take more vitamins than are described on the bottle label. I heard Niacin is good for high triglycerides. I took 500 mg of slow release Niacin. Nothing happened. I read that Dr. Hoffer put many mentally ill persons on high dose (3+ grams a day) and they made an improvement. On two grams a day my triglycerides fell by half and my health has made a cascade of improvements. I possibly have lived with a Niacin deficiency all my life. I finally have HDL in the normal range.

          • Linda N

            And niacin also eats up methyl groups so be careful with it. It is probably the explanation as to why it can cause liver damage in high enough doses.

            “Nicotinic acid (Niacin USP) requires SAMe to be metabolized. SAMe is a major methyl donor.
            Thus, when one consumes niacin, SAMe gets used up and methyl donors drop.” http://mthfr.net/overmethylation-and-undermethylation-case-study/2012/06/27/

            This can help with excessive methylation but at the same time if one takes too much niacin, it can create undermethylation or shut down methylation altogether.

            Personally I would never take such large doses of niacin.

          • Matthew Smith

            Many sites say Niacin is good for blood lipids, but don’t describe dosing. Over or under methylation can be a major cause of disease. No one told me that to use Niacin for triglycerides I might have to take more than just one pill a day. I was 32 and staring Statins in the face until I found high dose Niacin. Now my blood lipids are perfect. Scientologists have found Niacin too, they use Iodine and Niacin to make their members smarter. we are told. Niacin is a cure for pellagra which can be the basis of many mental illnesses.

          • Matthew Smith

            When Dr. Hoffer told patients to take high dose Niacin therapy, he told them to ask him, “How dangerous is it?” When they asked him, he would say, “you are going to live a lot longer.” High dose Niacin added two years to heart patients lives in the Canner study. That was just after a one year intervention. Who knows how long it could add if you did it longer or throughout your life. Here is a video which alludes to Hoffer’s discovery that Niacin can add to longevity. https://www.youtube.com/watch?v=jDizPUF3K_0

        • Thea

          Awesome! Great job. I’m sure that type of advice will help not only Jody, but others as well. Thanks for sharing.

      • http://www.DonForresterMD.com/ Don Forrester MD-NF Moderator

        I wouldn’t focus on the numbers so much as the proper diet. You can review some of NutritionFacts.org’s videos on cholesterol and try to decrease further such as increasing soluble fiber and phytosterols or reducing saturated fats. However it would also be helpful to know your HDL and Triglycerides to help sort the matter out. I have patients who consume alot of fruit which drives up there Cholesterol. If your HDL is elevated you may want to look at your LDL/HDL ratio for reassurance. Dr. McDougall’s newsletter articles… September 2002 on Cholesterol and May 2007 on Statins may help. The problem is we don’t have any good studies on cholesterol and heart attack rates in patients who go on plant based diet who have not had coronary disease. Given that it is hard to discuss risks. Dr. Esselstyn’s outstanding paper demonstrating the 6% recurrence over 4 years was done in a population with clinical cardiovascular disease. Not mentioned in his paper was the fact that 90% of his patients were on statins. As a referral center he treats patients and understandably doesn’t recommend taking them off the drugs that are given by referring physicians.
        Blood pressure is an excellent indicator of arterial health. In populations that are active and plant based they tend to run 110-115/ 65-75. I would consider that normal. Studies have shown that changing to a healthy plant based diet with adequate B-12 will lead to a fairly rapid decrease in BP over days to weeks due to improvement in Nitrous Oxide system. This is why it is important to monitor BP if on anti-hypertensive medications. At the McDougall clinic patients are usually reduced on day one and monitored daily. Further long term decreases in BP are most likely due to cleaning out the cholesterol blockages. As Dr. Ornish and Esselstyn showed in the 1990’s that can take years. Keep up the great work I’m sure your arterial tree is benefiting as are your other organ systems. Also don’ t forget to maintain your fitness through appropriate aerobic, strength, flexibility, stability and balance. Good luck.

        • Joy Schwabach

          Thanks so much! When last checked, my LDL was 173, triglycerides were 87 and my HDL was 60. I get a ton of exercise. It’s not unusual for me in a single day to do five miles of walking, 30 minutes of fast cycling, an hour of rowing, plus an hour of yoga. I’m an exercise nut! I just checked my blood pressure. It was 112/76.
          I take Dr. Furhman’s multi vitamin, which includes B12, magnesium zinc and a few other things. Also his DHA algae oil. I don’t take any medications.

          • Thea

            Oh gosh. I envy your exercise ethic. Great job. I aspire to do even a fraction of what you do.

          • Joy Schwabach

            Thanks Thea.

        • S Slavin

          I’ve been plant based for a few months now (although not vegan), with a focus on BP related foods (hibiscus tea, beats, nuts) and am not sure I see a change in BP, the primary reason I changed my diet.

          I did lose about 15lbs but my bp still seems to be 145/90, although often if I sit with the cuff around my arm and try again in a few minutes, I can get 130/80, or even dip into the 120s. So it’s hard to tell what the actual bp is since the initial reading always seems high (perhaps due to anxiety).

          What are the studies showing a rapid decrease in bp when switching to WFPB diet?

        • Joy Schwabach

          The article you mentioned is fantastic! Here’s the link: https://www.drmcdougall.com/misc/2007nl/may/statins.htm

        • HeartHealthy

          Dr. Forrester, There are many people who want to confuse the benefits of Dr. Esselstyen’s diet by saying “was it the diet or the statins, or a combination of the two that improved his patient’s health”. The real truth is, it was the diet. They don’t dig into his papers, book, and presentations to figure this out, or they have an ulterior motive to try and discredit his work.

          I think you hit it on the nail on the head when you said, “As a referral center he treats patients and understandably doesn’t recommended taking them off the drugs(such as statins) that are given by referring physicians which would have been the “standard care of practice” for heart disease when statins hit the market. These patients had been under cardiologist care for a long time which likely included statins and their condition worsened. It wasn’t until they went on his diet that they saw such great improvement. Also, when the few patients that couldn’t stay on the diet quit, and they were returned back to the care of their cardiologists, their standard care would have included statins. However, their condition worsened when they went off the diet even though they were most likely on statins.

          His diet even improved people who had arterial blockage in other parts of the body besides the coronary arteries. One of his patients had lower leg pain due to blockage so bad that he couldn’t walk across the skywalk to the Dr’s offices without stopping many times, but after being on the diet for approximately 8 months he was able to cross the skywalk
          without stopping. This was proven by the before and after pulse volume tests that had been performed on him when Esselstyn tested him when he first came into the study program. This particular person never took any statins so his
          recovery was solely due to the diet alone as he really had no exercise program. As Esselstyn said, this scientifically demonstrated, “Proof of Concept” of the diet. This demonstrated that blood flow could be improved and restored to any part of the body such as blockage to the smaller arteries in the lower legs, or ED, or even to the brain as we have seen in Dr Greger’s articles. If we can keep our arteries clean and good blood flowing throughout our life we can avoid a lot of the chronic diseases besides just heart disease and strokes. And as Dr Greger recently said in one of his articles, people don’t start showing the symptoms until they reach middle age, and start to age. So, up until that time they think they can eat anything they want and still get good exams and good blood tests, and then they later get blind sided when they hit 65 or earlier when they develop a some serious chronic condition.

      • S Slavin

        What was your BP before you got it down to 120/80 via diet?

        • Joy Schwabach

          Typically the top number was around 130, not sure what the bottom number was. Once or twice in a doctor’s office, the top number was 158. It can still be around 140 in a doctor’s office. Doctors make me nervous.

          • S Slavin

            Ah, I get nervous too. My first reading is almost always higher then the subsequent few readings.

      • Alan

        On the flu shot. I had one when i was 19. Never had one since and since i have been a low fat, low protein vegan i DO NOT get sick, period. No flu no colds no sickness !!! Praise the Lord for His Genesis diet !!!!!

      • Alan

        By the way in regards to my last email – i am 60 now and have been without illness for several yrs now. Five or six probably.

    • Joan

      I have been discouraged with how slow my cholesterol has dropped since going plant based two years ago. I went from 194 (which my doctor thought was wonderful) to 186 eight months later. Then I heard Dr. G’s video on adding flax to oatmeal and for a solid year I had oatmeal with flax meal every day. That got me down to 170. I attended a lecture by Dr. G. last month and when a question about stubborn cholesterol came up he mentioned how dark chocolate had lots of cholesterol. That was one weakness I had and was limiting my 85% chocolate bar use. I also eat a lot of fruit being in California’s break basket (or fruit basket) and someone told me that fruit can cause a rise. I’m beginning to think there isn’t much I can eat.

      • Joseph Gonzales R.D.

        I’ve reposted something Dr. G told me when people were asking about cholesterol. See is this helps? Lower cholesterol with diet. There are definitely foods you can eat and tons of choices! I do not believe the fruit is damaging. Watch Dr. G’s video on FRUIT it may surprise you.

      • Tobias Brown

        Dr Greger has one video on dried apples being very useful for lipid profiles. I expect that being in very good cardio shape and lower on the BMI normal scale helps immensely too. (I will know in a few weeks the relative value of diet vs. weight loss & exercise as my brother, who didn’t switch diets but got his weight way down and exercises had similar higher LDL. This will give me so great clues to how much benefit there is in losing 10-15 pounds.)

    • Mick

      After going vegan which was only 4 months ago (why, oh why not earlier) my cholesterol dropped in 2 months from 176 to 126 – perhaps it was even faster but the tests were two months apart. Tryglicerides dropped from 200 to… 84. This 176 number was possible only because back then I was practically a vegetarian for a few months already. But these little quantities of food of animal origin were enough to cause high cholesterol and triglicerydes…

      • Tobias Brown

        Very interesting.

    • Charlie Michael Morrison

      I am below 150. My total cholesterol is below 150. They had me on statins before I went to whole foods plant based diet. About the time I went on a plant based diet I stopped taking those statins and more medications as well. A few months later I saw results from my plant based diet that I never saw from prescriptions. I reversed my diabetes of 22 years and cholesterol, and high blood pressure and more. I follow much of the advice from this site as well as McDougall, and Barnard, Essylstein, and Cousens. I use no oils and eat a very low amount of fats and no processed foods. All Whole plants and nothing else.

      • Veganrunner

        Great job Charles! Don’t you feel wonderful! Absolutely fabulous!!

      • Rami Najjar – NF Moderator

        Very cool!

      • HeartHealthy

        In addition and to support your comments, the video
        says the Framinghart Study reported that 1/3 of all heart attacks occurred in
        people with supposedly “optimal cholesterol” between 150 and 200 over
        a 26 year period. Also, that no person with a cholesterol below 150 ever died
        of heart disease.

        Many of these unfortunate people thought they
        were healthy according to the guidelines and probably had no indications that
        they had heart disease until the moment the heart attack occurred, and probably
        many of them died during that first heart attack.

        This is what really matters. If you get your
        cholesterol below 150, there is high probability you are not going to die from
        heart disease or even sudden cardiac arrest, particularly, if you follow a low
        fat whole food plant based diet as recommended by Dr Esselstyn and Dr McDougall. If you are following these diets, and have done everything you can to reduce your cholesterol, and you still have to take statins then you should feel good that you are protected.

        I happen to believe that the low fat whole food plant diet is the key to it along with the elimination of all oils, meat, dairy, and eggs, but we won’t know for sure until other studies are
        completed.

        Dr Crowe, who replaced Esselstyn at the
        Cleveland Clinic who had a cholesterol of 156, ate a healthy diet(though not plant
        based), exercised regularly, had no other symptoms such as high blood pressure, and no history of heart disease in his family, but still developed severe blockage in his
        LAD artery so bad that it couldn’t be bypassed. With no options, he met with
        Esselstyn, who happened to be kicking off his study. He went on Esselstyn’s
        diet and was the “model student of the diet” and his heart disease completely vanished. As Crowe told Essestyn with
        tears in his eyes , “Something lethal is gone”. This was proven by
        before and after angiograms which showed the blockage had been removed by the
        diet. This is direct scientific proof of the diet. This is not anecdotal as Dr E had these same measures of progress with his other patients, although not to this extent, and he also had very low rates of re-occurrence of heart disease as compared with the standard care of practice, and he later followed this up with a larger study getting similar results.

  • Slim055 .

    Slim055 1 second ago
    http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf

    “642 Cholesterol. Previously, the Dietary Guidelines for Americans recommended that cholesterol intake
    643 be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation
    644 because available evidence shows no appreciable relationship between consumption of dietary
    cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report.
    2, 35 645
    646 Cholesterol is not a nutrient of concern for overconsumption.”

    The system is in denial, turning their back on the problem. This is the “bottom-line” being disseminated to health clinics across the USA today. WFPB diet is being dismissed as quack science, Just one more dietary fad. Critics are even trying to write off Caldwell Esselstyn by amending irrelevant, unschooled opinions to his Wikipedia biography:

    “Dietary work[edit]
    Esselstyn has conducted research into diet and heart disease and – in common with his contempories Dean Ornish and T. Colin Campbell – has devised a dietary program which he claims can prevent heart disease. Commenting on the diet, Harriet A. Hall has written that the claims made for it are misleading and that the evidence on which it is based is “pretty skimpy”.[7]”
    Show less

    • Tobias Brown

      So, do you agree?

      • Slim055 .

        The short answer is, NO. With some minor reservations, I find the WFPB community is uncommonly dedicated toward truth-telling. In my own case I have first-hand confirmation that their principles of regaining and maintaining your health are valid.

    • Joseph Gonzales R.D.

      Yes, it’s unsettling to say the least.

  • Bob

    Unfortunately, dropping the recommendation to 150 likely will have no effect on the American diet but would line the pockets of BigPharma by getting 12 year olds on statins.

    • Tobias Brown

      That’s like saying we shouldn’t change diets to plant-based because there’s some effort involved in making the switch. We can both lower the standard to 150 and attack fraudulent medical practices and take on big Pharma.

    • http://www.vegannursepractitioner.com Vegan Nurse Practitioner

      It has been known to be 150 since the 2nd World War, the government decided though that americans were too stupid to eat in a way that would keep it at that level, so they recommended a higher level so the people would not frit, nor would the meat/dairy industry complain

    • Gary

      What’s a few statins when children just got approved for OxyContin?

      Aug 14, 2015 – FDA approves OxyContin for kids 11 to 16 The Food and Drug … of the painkiller oxycodone,

    • Joe Caner

      The best way to lower one’s cholesterol is by not lining the pockets of Big Pharma, Big Med, Big Ag, Big Fabricated Foods or Big Franchise Retail Foods. The best way is to frequent the produce aisle of your grocery store, farmer’s market and/or organic cooperative and switch to a WFPB diet. You’s save a bundle of green now and in the future by going green.

  • Julie

    I love the graph (1:37) showing that 35% of heart attacks occur in people with cholesterol levels between 150 and 200 mg/dL.

    • lilyroza

      On the graph, what do the numbers 20/100 mean?

      • largelytrue

        Those are the absolute risk measures for each category of serum cholesterol, which is why they are given in that fractional form which suggests readings like “20 cases per 100 people”. If you are in this dataset and have serum cholesterol above 300mg/dL, you have a horrible 10% chance of evading CVD, whereas if you instead have serum cholesterol between 150 and 200 mg/dL, you have a mediocre 80% chance of evading CVD.

    • Dean Pomerleau

      The graph is very misleading. See my reply to this video above for the explanation.

  • Noe Marcial

    this myth of “under 200 you are ok” is so deep into society and doctors. and some people don’t mind to dye with a heart attack as loong is a great life.. but they would mind if along the life they lost of intellectual capacity or have sexuals disfunction…bouth relate to collesterol..

    • Noe Marcial

      it is obvious that the guidelines means millions and millions of dollars to health care system to drop cholesterol without drop meat consumption until 150 you have to intoxicate the public with “medicine” and that’s expensive.

    • Dean Pomerleau

      I’m a vegan with a total cholesterol of 130, but that doesn’t change the fact that this video, and particularly the graph Dr. Greger uses in it at 1:37 is misleading. The real data shows that under 200 indeed IS ok, relative to below 150. See my post above on this thread for an explanation as to why this plot is misleading, and what the real data says.

  • Noe Marcial

    about “the extreme free radical production”, are foods that can produce such a thing as a cigarette does? i mean i know what are the anti oxidants foods, fruits and beverages thanks to NF. but which are the worst foods in terms of free radical production?

    is there a simple correlation calories vs antioxidants or it is more complex?
    it will be good to know how much oxidative stress happens in our body after a high calorie low antioxidant meal or after an Ice cream .. or how much affect our emotional stress to the oxidative stress in our body.

    after all is that part of oxidation of the cholesterol, and the CVD, right? please correct me if i’m wrong

    • Julie

      Yes, you are right, Noe. The oxidation from free radicals, whether from foods or emotional stress or cigarettes or environmetal toxins etc, is all part of the oxidation of cholesterol and CVD.

      Free radicals in foods are primarily found in fried foods, alcohol, cooked and processed meats, refined (or rancid) oils.

      • Noe Marcial

        its not related also with high dense calories foods?

  • Carolynn

    Help! I went vegan for 4 months with no statins. My cholesterol shot up to 280. (From 180). On statins and a diet with rare “tastes” of meat and dairy, I am at 170-180. I would hate to take more statins, any suggestions?

    • Bob

      Get rid of the junk which has partially hydrogenated oil aka trans fat.

      • Carolynn

        I eat no processed food. Only organic fruits and mostly organic vegetables. Make my own bread with organic flour too. Grow broccoli sprouts and eat a clove of garlic a day. I pay serious attention to Dr. Greger. As I said, only a rare taste of meat which means one or two small bites. I am 69. Father died at 66 with heart disease.

        • Larry

          Simple carbs (like bread/flour) will always impact your cholesterol numbers in a negative way. The “whole” part of a WFPB is important.

        • Thea

          Carolynn: Sounds like you are making a great effort. And it’s great that you are trying to do more. Like S Slavin, I often recommend that people in your situation look at the videos on this site that show foods that are known to lower cholesterol. You might be able to tweak your diet to specifically include foods that your body needs. Not saying that your diet is unhealthy now. Just that you might be able to change your diet slightly to help your particular condition.

          Also note that Joseph reported above that he will be doing a special RD post on this topic that I think will be filled with advice for people just like you. Keep an eye out for that. (I’m assuming it will be posted under “Nutrition Questions” , “Ask the Dietitian” links at the top of this page.

          Good luck! With your determination to do this, I have no doubt you will make it.

        • V

          I had really very good results lowering my cholesterol a few years ago following (relatively simple) advice from the book “Cholesterol Down” by Janet Brill.

          This was before I had become aware of the value of a complete WFPB way of eating.

          The things from the book that really worked for me were eating oatmeal (especially steel-cut oats), more beans, flax seeds, and eating almonds every day. I also took psyllium in capsule form then, but have since stopped.

          Hope this helps!

          http://www.amazon.com/Cholesterol-Down-Simple-Weeks-Without-Prescription/dp/0307339114

          • Carolynn

            Yes, it helps! Thanks for reminding me to start eating oatmeal again now that winter is here. I have been eating the flax (ground fresh every day) and occasional beans. (I will ramp up the beans) also I do eat 1 1/2 oz nuts daily including almonds, walnuts and pecans (per Dr. G’s recommendation). I am a small woman, 5’3″ and 115 lbs. It really is hard to eat all this food, including all the greens and veggies every day! I will get another lipid profile done in 6 months to see if all this has made a difference. I’m sure it will!

        • Joy Schwabach

          I’ll bet your cholesterol isn’t the oxidized kind, and that’s the only dangerous kind. It would be interesting to know if some of those 100 year old seventh day adventists have high cholesterol. As mentioned in a Dr. McDougall report cited on this page, doctors used to say under 300 cholesterol was fine. I’ll bet that’s because in those days, hardly anyone had heart disease because they didn’t eat many processed foods, so there wasn’t this big worry there is today.

    • S Slavin

      Have you tried cholesterol LOWERING foods? Eating healthy is one thing, but you should also try to proactively eat things that are good as opposed to only avoiding things that are bad, I believe Dr. Gregor has many videos on foods that can potentially lower cholesterol.

      I’ve also seen quite a few people mention how sugar causes your own body to produce cholesterol (forgot if it was Dr. Gregor or a commentator on here), so perhaps keep an eye on sugar intake?

      On top of that, what was the 280? Was alot of the “shot up” due to good cholesterol, or the bad cholesterol went up as well?

      • Carolynn

        Thank you for the suggestions, I will look at all those videos. LDL moved from 103 down to 90 and HDL stayed around 65. (“pattern A” LDL-large buoyant, supposed to be OK type). P.S. I don’t eat sugar either. I do use Splenda. Not good, and maybe I better eliminate that too. My main question is wondering if I have some nasty genetic issue that can only be controlled with the statins. I only take 10 mg 4 days a week. This is fascinating stuff for me, a retired Medical Technologist.

        • S Slavin

          Hm, Splenda is one of those things people will pounce on – I doubt it causes cholesterol issues but I doubt it helps things either. You can usually stop sweetening all together (i.e. tea and coffee) and get used to it, and otherwise you can use things like honey and maple syrup which may be better sweeteners ( http://nutritionfacts.org/video/the-healthiest-sweetener/ ).

          I remember a video ( I think this one http://nutritionfacts.org/video/how-fiber-lowers-cholesterol/ ) where Dr. Gregor explains a lack of fiber can slow down digestion and give cholesterol time to get into the blood, and he suggests higher fiber to speed up the flow inside the intestines.

          If you’re eating plant based I’m sure you’re getting fiber but you may want to be sure to eat things like beans (but be careful with salted canned beans), There are tons of other videos he has, once you watch one there’s usually references under “Doctors Notes” to the related ones, Perhaps a good starting point: http://nutritionfacts.org/video/nuts-and-bolts-of-cholesterol-lowering

          • Carolynn

            Thanks, I have a nice day of video watching ahead!

        • mbglife

          According to my 23&me genetic results I am predisposed for high cholesterol. Several years ago I switched from vegan to the paleo diet for a year. Big mistake. My cholesterol went from 117 with HDL higher than LDL to 218 with LDL higher. Lots of other results went bad too. I changed back and the next year’s physical had me back about where I was before. So my point is that genetics aren’t everything (I’ve read they account for only 20% of the outcomes). And although everyone is different, what works for me is to keep experimenting with WFPB foods that improve my health. The good thing is that the testing is usually pretty tasty.
          Good luck.
          Mark

      • Linda N

        Not only sugar, but for many people, grains, even unrefined grains, cause their cholesterol, and especially their triglycerides to skyrocket. Once again, a one-size-fits-all diet is the biggest myth of all! Those who cannot get their cholesterol under control might do well to read “The Statin Disaster” by David Brownstein, M.D. Inflammation is the biggest contributor to abnormally high cholesterol levels, and the body is making cholesterol to counter the inflammation. While a diet high in plant-based foods in generally anti-inflammatory, for many, but not all, grains and beans, can be very inflammatory. Food allergies and sensitives, can also cause inflammation, and for others it is a chronic low level infection of some kind.

        Each person has to be a sleuth, and work hard to discover what is going on with themselves individually instead of buying into the idea that a vegan diet (or a paleo diet as the case may be) is the answer to all their ills.

        • Matthew Smith

          Dr. Brownstein wants people to know that high cholesterol can be a symptom of an Iodine deficiency. Iodine is very alkalizing for the body, he says. Iodine is a potent inflammation fighter, I think he would argue. I haven’t read his book. Having adequate Iodine stores can greatly improve the quality of your life, Iodine experts would argue.

          • largelytrue

            Uhhhh…you haven’t read his book and are talking about this guy whose beliefs you “think” you know as the lead example of what you think that all iodine experts would say?

          • Matthew Smith

            Well, his book is not available on Amazon. I am assuming that Linda N., like many people here, in citing Dr. Brownstein, has taken Iodine supplements or is taking Iodine supplements, like me. Dr. Brownstein is an iodine specialist. I am proud of Linda N. if she has taken Iodine. Dr. Brownstein would only be famous if you have taken Iodine. “I took small doses of Iodine and can no longer feel my heart beat,” I might say. “My eyes are open now, father,” I might worship. The hardest part of taking Iodine is the first dose. What happens if you had a heart attack? What happens if you lost your heartbeat and had to go to the Emergency room without medical coverage? It could cost over $4,000. What happens if you had to go to the Emergency room after taking Iodine and didn’t know what to do, didn’t have any friends, didn’t have any shock training? Dr. Brownstein believes the lack of Iodine is a public health crisis. He also knows that high doses of Iodine can cause a “weak pulse.” Does Iodine make everyone unable to feel their heart beat? Can you, largelytrue, feel your heartbeat? Have you considered taking Iodine supplements? They are very good for and are recommended here. (1/2 teaspoon of Iodized salt a day). I gave some Iodine to my dog. He too, had a much softer heartbeat after I gave it to him. I couldn’t really feel it when I put my hand on him. Do you call taking Iodine supplements “dipping” too? Dr. Greger describes a coffee shop in Australia that put kelp in their coffee being raided by swat officers. Maybe too many people dipped there. “Oh my goodness, I had some coffee and now I can’t feel my heartbeat!” When I was away at college I think they put more Iodine in the water than I was used to and I also couldn’t feel my heartbeat there. I guess it came back. I didn’t notice this then. From Dr. Brownstein’s website:

            “Statins are the most profitable drugs in the history of Big Pharma. Statins fail to prevent or treat heart disease for almost everyone who takes them and they are causing more harm than any other class of medications. In fact, statins are effective for approximately 1% who take them. In other words, statins fail 99% who take them.

            Cholesterol is not a harmful substance. In fact, it is an essential substance that is needed by every cell in the body. We cannot live without adequate amounts of cholesterol. You will learn what steps you can take to prevent becoming a heart patient and how to holistically treat heart disease. Dr. Brownstein will show you why the cholesterol = heart disease hypothesis is a failed paradigm.

            Statins are associated with a host of serious adverse effects including ALS, breast cancer, cancer, congestive heart failure, kidney and liver damage, memory problems, muscle weakness, neurological disorders such as Parkinson’s disease and thyroid disorders.

            This book will show you why statins should be pulled from the marketplace.”

            Too little Iodine can lead to high Cholesterol, I learned here from a possible dipper. Iodine might be very heart healthy. We don’t know. You can watch some internet videos of Dr. Brownstein. He seems very calm. He must have dipped. I desire to know what his experience was like. Good luck with what you do with this information.

          • Linda N

            Thank you Matthew. High Cholesterol can be for a variety of reason, iodine deficiency included.

        • S Slavin

          This is a very important point. Those saying sugar is a cause of cholesterol say it’s due to inflammation caused by sugar which causes the body to release cholesterol.

          If other foods cause inflammation then it makes perfect sense that those too would affect cholesterol numbers.

      • Matthew Smith

        Some of those foods include, as recommended here: a vegan diet, grapefruit, beans, four Brazil nuts once a month, a handful of nuts most days (almonds), some cocoa, whole grains (Cheerios or oatmeal), flax seeds, Strawberries, kiwi, formerly red mold rice (a drug, not a food), and amla powder or tea.

    • Wegan

      Thyroid? Iodine deficiency? Many are deficient due to industrial halogens in the environment. Iodineresearch.com has more.

      • Carolynn

        Hello, I take thyroid meds for hypothyroid. There must be a lab test for iodine level, I will look.

    • Julie

      Carolynn, I would try ditching the bread. In addition to the other healthy foods you listed, make sure beans are on the menu.

    • Joseph Gonzales R.D.

      Hey Carolynn I just made a post about this since many folks have been asking. What can I do to lower my cholesterol? It seems I’ve tried everything!. Please read and let me know if anything helps? Others have been making great suggestions here as well. I do hope you find some answers!

      • Tom Goff

        Hi Joseph – I get a Error 404 message when I try to click through to your post.

        • Joseph Gonzales R.D.

          Ugh I know so sorry Tom maybe I should remove all posts that have a link my hope was the post could just be edited and I can put back up however Dr. G is out of the country and swamped so I am patiently waiting. I’ll let everyone know when it’s back up!

    • Joy Schwabach
  • Noe Marcial

    its thats graph showing the amount of people with hart attack or the percentage of risk of suffer a heart attack? i mean i suppose that more cholesterol it is more risk for a heart attack, right?.. and in the graph some body with 300 seems in less risk of somebody with 200..thats seems wrong…
    is there a graphic on the risk of suffer of a heart attack according to cholesterol levels?

    • Joseph Gonzales R.D.

      That graph is a bit hard to read. No, it does not mean that there was less risk for those over 300mg/dl. Better graphs are found on in this video on cholesterol.

  • S Slavin

    Hate to say it but that burger looks really good..

    • lilyroza

      Isn’t that bacon on a glazed donut? Ugh. Such things don’t tempt me.

      • S Slavin

        Ya over time you lose the cravings…but I haven’t yet. I wouldn’t eat it, but I would drool over it. Gotta be honest with myself :)

    • RalphRhineau

      Well, each to their own… looks like the burger on Krispy Kreme monstrosity that celebrichef Paula Dean unleashed on the world. To me, that’s enough to gag a maggot.

  • Leslie

    Pressure cooker and saucepan suggestions….

    Can anyone recommend a good NON-TOXIC/NO LEACHING OF HEAVY METALS pressure cooker to cook beans in?
    How about a good, non-toxic pot to cook grains and other stuff in? I am concerned about the the leaching of heavy metals in some of these items. Thanks!

    • Joseph Gonzales, R.D.

      I think stainless steel is best. Teflon and even cast-iron may not be the best choices, but interestingly when I think of food itself some products actually have a lot of metals like aluminum and mercury.

    • mbglife

      Last year I spoke with a customer service rep at Pyrex. She said they still make a line of glass stovetop pots for those who don’t want to cook with metal. You might want to check with them.

    • Joseph Gonzales R.D.

      I think stainless steel is best. Teflon and even cast-iron may not be the best choices, but interestingly when I think of food itself some products actually have a lot of metals like aluminum and mercury.

      • Joshua Pritikin

        Interesting. I’ve heard plenty of bad things about teflon, but what’s wrong with cast-iron?

        • Joseph Gonzales R.D.

          For men, they only need like 8mg of iron per day so too much can be harmful. But if you recall there is a huge difference between heme and non-heme iron. If you’re super low than perhaps it’s okay. The main thing is avoiding sources of aluminum and copper based on data showing links between these metals and Alzheimer’s disease. Some tips for prevention here.

          • Joshua Pritikin

            Have you heard anything about anodized aluminum?

          • Joseph Gonzales R.D.

            I have not! What the heck is it and how does it related to diet? Thanks Joshua.

          • Joshua Pritikin

            Ah, anodized aluminum is probably the safest and least expensive non-stick surface. They make the pot out of aluminum and then glaze it with a 1-2mm layer of anodized aluminum. This layer is highly resistant to corrosion. I am not aware of any peer reviewed research, but here is some general information, http://www.only-cookware.com/what_is_anodized_cookware.html

          • Joseph Gonzales R.D.

            I see. Thanks for sharing.

        • largelytrue

          Main issue is just in maintaining the seasoning for those who prefer to cook without oil or for cooking acidic things like tomatoes. With pressure cooking and no desire to sear meat in the pan, you are doing wet cooking and sticking is not much of an issue, so stainless steel is altogether more convenient and practical. Cast iron pots are hard to machine precisely, so you’d only see these on the interior pot of an electric pressure cooker, if that.

          The general rule is that while aluminum is lighter, cheaper, and adequate for pressure canning, to pressure cook you want a stainless steel surface. Because stovetop pressure cookers are often pretty big and maintaining steady pressure is highly valued, even heating is desirable. Aluminum has a much better thermal conductivity than steel, so look for clad pots where at least the bottom part has a nice thick/wide sandwich of aluminum and stainless steel.

    • thorn324

      As Joseph G. wrote, stainless steel is best for non-toxic cookware. As far as a pressure cooker goes, I’ve been pleased with my Fagor Duo 8-quart stainless steel pressure cooker; even the 6-quart size of the same brand/model allows plenty of room for cooking 1 pound of dried beans. (Btw, this is the brand/model that was recommended by America’s Test Kitchen, publisher of Cook’s Illustrated Magazine. ATK does extensive testing before making a recommendation. In my experience, they were right on the mark when they suggested this 2nd-generation—that is, *non* “jiggle-top—pc as best.)

      The glass pots mbglife mentioned are Corning’s “Visions” cookware. They are attractive and come in various sizes & styles. I owned a set and got a lot of use from them. Some caveats about them: (1) they are best used for foods that have a lot of liquid since I found them very prone to scorching, even with moderate heat on the cooktop. (A “flame tamer” device between the pots and the heat source helped a bit—but only a bit since the diffusion action of the tamer also cuts down on the amount of heat.); (2) though I wouldn’t call Visions cookware fragile, exactly, I would say that they break fairly easily if dropped. For example, my original 6-piece set of three pots & three lids became, due to breakage mostly within a stainless-steel sink, a 3-piece set of one pot & two lids! So you might be better off getting a good quality stainless steel pot (or set of them) for stovetop cooking.

      Finally, it is possible to get a good quality rice cooker that can be used for all types of grains. Be careful, however, to avoid those with aluminum bowls. (I myself have a Zojirushi rice cooker that has a nonstick lining of the sort that doesn’t flake or leech into the grains.) I hope this is helpful in your search for healthy cookware.

    • Thea

      Leslie: Chef AJ recommends the Instant Pot, which is an electric pressure cooker and has a stainless steel bowl. I had a conversation with (I think it was b00mer) some time ago and she said that the Instant Pot had become her favorite pressure cooker even though she had the stove top kind already. At the time, I had the stove top kind already myself: the wonderful Kuhn Rikon (which is also stainless steel and bigger than the Instant Pot and more versatile in some ways–but expensive, but bigger)

      But b00mer’s arguments swayed me since she had experience with both kinds. And sure enough, now that I have the Instant Pot, it is the first pressure cooker I reach for and I love it. It does beans great. Plus other things. I’ve used it to cook quinoa, barley, etc. And soups. And even home made vegan “pepperoni” and “sausage”. All came out great in the Instant Pot.

      If you are interested in the Instant Pot:
      http://www.amazon.com/gp/product/B00FLYWNYQ?keywords=insta%20pot%20pressure%20cooker&qid=1444842591&ref_=sr_1_1&sr=8-1

      The author of my favorite pressure cooker book (highly recommend!), Vegetarian Cooking Under Pressure by Lorna Sass, once recommended the Kuhn Rikon. If you are interested in that, check out: (They have two different kinds of lids. Make sure you get the easy/more recent kind. And if you are only getting one pot, I recommend the 7 quart.)

      http://www.amazon.com/Kuhn-Rikon-Duromatic-Efficient-Pressure/dp/B000AUOC7W/ref=sr_1_2?ie=UTF8&qid=1444842895&sr=8-2&keywords=kuhn+rikon+pressure+cooker

    • Joe Caner

      What to Look for in a Pressure Cooker and the Test Kitchen’s Recommended Brands
      https://www.youtube.com/watch?v=IiCUKA7dDUs

    • MarthaLA

      InstantPot uses stainless steel inner pot, no worry about scratching a nonstick coating on aluminum. The DUO60 7-in-1 is great! Easy to use (once you figure it out – some don’t read the manuals). Electric pressure cooker, slow cooker, yoghurt maker, rice cooker, saute’-er, warmer (keep warm), delay start, programs for soup, meat/stew, beans/chili, poultry, rice, multigrain, porridge, steam. We can ignore the meat and poultry :-) . You can find $50 and $60 discount codes for ordering from InstantPot.com (PlantFueledTrucker has $60; I think Chef AJ has $50, FB Plant-Based Instant Pot People has $50. The latter FB page is active and helpful with questions and problems. Amazon occasionally runs specials of $50, $60, or more off if you can catch them. Price at this moment $130.19.

  • Joshua Pritikin

    In case interested viewers want more detail, the plot displayed at about 1:15 minutes is found in the Castelli article, not the article displayed in the background in the video.

    • Joseph Gonzales R.D.

      Good catch I saw that as well. Do you think it’s super confusing to the point Dr. Greger should redo it?

      • Joshua Pritikin

        I don’t have a strong feeling. The chart is actually not from the 1996 article either, but a reprint from W.P. Castelli. Cholesterol and lipids in the risk of coronary artery disease — The Framingham Heart Study Can J Cardiol, 4 (1988), p. 5A. So maybe adding a note would suffice.

        • Joseph Gonzales R.D.

          Sweet thanks! Ok well if numerous folks start asking we know where to send them!

  • Lori

    Dr. Greger: Coronary artery disease runs rampant in my family. For obvious reasons I *want* to switch to a plant-based diet, but I experience severe G.I. distress when consuming plant-based foods. I’m not talking a little bit of gas, which some insist is normal; I am referring to severe adverse reactions including excruciating spasms, crippling pain, major gas, multiple bowel movements that often include loose stools. I have been tested extensively and was diagnosed with IBS. I recently contacted Dr. Esselstyn hoping he would be able to offer some suggestions. He said switching to a plant-based diet normally improves IBS symptoms and in all his years of work in the field he has not encountered anyone like me. Per Dr. Esselstyn I am an anomaly. Can you offer suggestions? Many thanks!

    • Joseph Gonzales R.D.

      Hey Lori. Gosh I’m so sorry how frustrating! It seems like you’re trying so much and having little success. IBS is a complex disease brought on by stress mainly (at least we think), but diet and lifestyle can play a big role. Have you talked with your doctor about diet? We have some videos on peppermint, kiwifruit and cayenne pepper so first take a look at those videos. It’s good to know you’ve been in touch with Dr. Esselstyn. It may be that certain foods are triggering flares, so one way to reduce the symptoms is to pay close attention to foods that tend to give you problems. An elimination diet may really help, but it’s a bit complex and really best to work with a personal dietitian. Is that an option? What plant-based foods are you eating that you feel huge amounts of gas? There are ways to prepare your foods to limit that sort of thing. Soaking beans, nuts, and cooking your veggies could really help. Sometimes eating less raw fiber and more simple cooked foods can have a great impact. It’s a bit of a boring diet (rice and green and orange vegetables mainly, some fruit, maybe well-cooked lentils) but it could help. This is based off a study we published on migraine headaches where we implemented an elimination diet portion. I have many friends with crohns disease and their food triggers vary so it’s good to know what affects you. You may find it’s nothing, but hey even finding that nothing bugs you is a good thing because at least you know it’s NOT the food! Seldom that’s the case and folks are able to identify something. Let me know if you can already identify some foods and maybe let me what you’re eating right now? I’ll work with ya a bit but if possible seeing a dietitian will be the best thing for you. Thanks Lori. Best to you.

    • Name

      Hi Lori, I know you are asking Dr Greger, but I can’t help but respond when I read your GI symptoms because they were identical to mine. I use to get the worst cramps and diarrhea after going to all you can eat salad bars! I believe I had a bowel obstruction from years of SAD eating and the high fiber foods were having a hard time passing through the colon and so could only pass in small, loose, frequent amounts. After a series of colonics, the pain and cramping instantly disappeared and I could have normal BM’s. I work in a hospital and bowel obstruction is quite a common diagnosis.

    • MarthaLA

      Here is Dr. McDougall’s search page: https://www.drmcdougall.com/google-search/ Type in irritable bowel syndrome and you’ll find a slew of links on his website, including personal testimonials. Dr. McDougall has apparently dealt with innumerable cases, so his work might be more useful than Dr. Esselstyn’s input (a surgeon). You could even email him with enough info for a doctor to work from and he will likely get back to you (if he’s not away). He is a plant-based doctor, though he likes to emphasize starch-based. Read up from the search page links first, I think. Good luck. Oh, and people who have not been eating much fiber may need to add a little at a time to give their systems time to catch up on how to handle it. I don’t have that problem, so this is just from general reading. Good luck.

  • Panchito

    Diet alone is not everything. For example, people that are overweight and go vegan are still going to have problems till they go down in weight. Just looking at a single number as indicator of health, while still being overweight, gives people false assumptions and false hopes if they are not aware of the bigger problems and the illusions of focusing attention on specific numbers. Somehow society is obsessed by the numbers made in measurements while ignoring other factors that can be more important. When I go to the gym, I see overweight people carrying notes, books, etc., writing down everything but they don’t do much exercise. Thus, they are kidding themselves if they think the numbers are doing good to them.

  • Tina Max

    I also am experiencing a high cholesterol level, approximately 220 with an HDL of 60. The HDL readings
    used to be 100. I am a strict vegetarian, only eating vegetables, fruit, seeds and nuts. I do indulge in a sugary vegan dessert on occasion so I don’t know what gives?

    • V

      Can you describe what you mean by the term strict vegetarian? No eggs or dairy? Could coconut or other oils be contributing factors?

      • thorn324

        Absolutely yes!

      • tina max

        Yes, no eggs or dairy. I do saute veggies in olive oil with garlic very frequently.
        Perhaps that is the reason? It seems my cholesterol has always been on the high side, even in my younger days. Thank you

    • Joseph Gonzales R.D.
    • HeartHealthy

      Tina, Don’t
      give up yet. Have you tried following
      Dr Esselstyn’s diet to the letter which includes elimination of all meats,
      fish, all dairy, all oils, nuts and seeds, all processed foods, all refined
      grains such as white flour, white bread, and white rice, all sweet drinks
      including fruit juices and smoothies, and coffee, etc. Dr Greger recently did an excellent video on
      what drinks cause insulin spikes which you could listen to if you feel like you
      have drink something sweet. You may even find it necessary to cut back on certain
      fruit. I know there are anomalies and
      you could be one of them, but most likely it’s because you are eating something
      that is causing your cholesterol to stay up. Even processed foods which say no
      cholesterol can have up to 0.5 grams of Sat Fat in them. Also, don’t eat plant food plants like avocadoes
      which are high in fat. If you have read
      Dr E’s book and watched his presentations you will appreciate the full benefits
      of doing this. Some people just have to be more judicious than others because
      their bodies are good at making and storing cholesterol and their clearing
      mechanisms are not as efficient. Keep experimenting until you find out what you
      can eat and what you can’t. Be sure to
      take your Vitamin B-12 and your 2 tablespoons of ground flaxseed with breakfast
      or some other meal. And even if you are unable to get totally there, you can take
      great satisfaction in knowing that your diet is probably going to help lower
      your risk of CVD regardless of what your numbers are.

      Also, there could be other health reasons you
      can’t get your cholesterol down such as hypothyroidism which can be associated
      with high LDL so you could also get your Dr to check this out with a blood test
      if following the above diet doesn’t work. I have got my total cholesterol down
      from 220 to 103 following this diet. I’m not doing this just to help out on
      heart disease but also to help on cancer, and all chronic diseases. There are
      no side effects of eating this way such as you hear whispered on every drug
      commercial on TV.

  • Dan Collins

    my level is over 250 but i have graves disease and had my thyroid removed going thru thyroid storm…cant take the statins and heart is strong for 50, but this concerns me if graves is pushing my levels up…any suggestions? GREAT report glad i found it

    • Joseph Gonzales R.D.

      Tough case! My new post What can I do to lower my cholesterol? It seems I’ve tried everything! addresses thyroid, but not Graves and the extent of statin usage. I hate to just refer back to your doctor, but I am afraid any useful suggestion is out of our scope here. I still believe that your diet may help in other factors. So even though cholesterol is high, apparently due to Graves, that’s no reason to ditch the healthful vitamins and minerals and plant chemicals you get from eating plant-based foods! You feel me? I’ll see if our volunteer doctors here have more to add. Gosh forgive me I wish I knew more about Graves disease. Thanks for sharing Dan and best to you.

  • Dean Pomerleau

    Dr. Greger, despite being a vegan with a total cholesterol of 130, I found this video to be very misleading and disappointing. The graph you use from Dr. Esselstyn’s paper which shows that 35% of heart attacks occur in people with total cholesterol (TC) below 200 mg/dL, but virtually none occur in people with TC below 150, is very misleading.

    Why? Consider the following.

    Imagine a similar plot of height vs. # of heart attacks. Assuming heart attacks are totally independent of height, you’d still see a similar bell curve of the number of heart attacks plotted against height, for the simple reason that height is distributed in a bell curve. So fully 50% of heart attacks would occur in men below the median height of 5’10” in the US, and furthermore only a tiny fraction of heart attacks (~3%) would occur in men shorter than 5’2″, which is two standard deviations below the median. Does that mean that having a very short stature makes you heart attack proof? Of course not, it just means that there aren’t many men shorter than 5’2″ to contribute to the total number of heart attacks.

    This graph: http://www.ifcc.org/ifccfiles/images/142image002.jpg from [1], shows a much more accurate picture of the relationship between total cholesterol and heart attack RATE (as opposed to NUMBER OF HEART ATTACKS) from data across multiple studies. It shows that heart attack mortality rate is pretty much asymptotic below 200 mg/dL. It’s only when you get up to a total cholesterol of about 225 mg/dL that you see CHD mortality rate rising significantly, after which it goes through the roof.

    So despite what you (and Dr. Esselstyn) suggest, keeping one’s total cholesterol below 150 mg/dL DOESN’T appear to provide much cardiovascular benefits relative to keeping it in the range of 150-200 mg/dL.

    [See: https://www.crsociety.org/topic/11314-total-cholesterol-and-heart-attacks/ for more discussion]

    Don’t get me wrong. I love your work and I’m a strong advocate for the benefits of a plant-based diet for health and longevity (not to mention for the welfare of animals and the planet). But sometimes it seems you let your perspective on diet and health get in the way of honest science.

    –Dean
    ————————-
    [1] The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine Vol 13:2 (2003)

    THE ROLE OF LIPIDS IN THE DEVELOPMENT OF ATHEROSCLEROSIS AND CORONARY HEART DISEASE: GUIDELINES FOR DIAGNOSIS AND TREATMENT

    Victor Blaton

    Department of Clinical Chemistry, Hospital AZ Sint-Jan AV, Brugge,
    Belgium

    pdf: http://www.ifcc.org/…40206200306.pdf

    • Joseph Gonzales R.D.

      Thanks for your post, Dean. Your input is important to us. The graph was from the Casteli study, not Esselstyn. Regardless I’ve looked into it and asked Dr. Greger about the data. He’ll get back to you at soonest, but I know he is super swamped at the moment! Thanks for your patience.

      Best wishes,
      Joseph

      • Dean Pomerleau

        Thanks Joseph. Sorry to impune Dr. Essestyn. I’ve edited my post to fix the error. Thank you for bringing this to Dr. Greger’s attention. I’ll be very curious to see how he responds.

        –Dean

      • Noe Marcial

        it is a very good point. always good to go deeply into science to brake any belive or dogma that we can be creating in our self. so one may make some assumptions that later one the facts brake. trus is always moving

    • largelytrue

      Dean, the graph from the Castelli paper shows two bell curves for those with CHD and those without. Probability density for the CHD curve is close to 0 below 150mg/dL, while this isn’t the case for those without. Thus as long as the total number developing CHD is roughly on the same order as the total number that don’t (which it is in this graph) we’d infer that the ratio between the number of people with cholesterol below 150mg/dL who did develop CHD and the number of people with cholesterol below 150mg/dL is around zero. This is an absolute measure of risk given that you have cholesterol below 150mg/dL and is not like your example of height, where the number of short people with CHD is erroneously compared with the total number of people with CHD.

      When Greger says that few with levels below 150mg/dL get heart disease, he almost certainly means that proportionally few within that group do, that the rate for developing heart disease given levels below 150mg/dL is zero. His interpretation of the graph is therefore correct.

      • Eric Driscoll

        I’ve been a vegan for 33 years (now 63 yrs old) tot chol <150 and LDL <75. But what about those on the graph whose tot chol is between 150-300 and who are in the non-CHD group and don't have (yet?) CHD? And what about those who have a normal to lower BMI who don't have (yet?) CHD? It's hard to convince those with obesity to change let alone those who "seem" healthy. Or paleo fans who insist there is no correlation between tot chol and CHD? The graph doesn't show the effect of age or weight/BMI. If chol is as important as the literature suggests, then presumably the older one is, the risk of developing CHD eventually increases if your chol levels are higher than optimal and you don't yet have CHD. Is there literature that teases out these factors?

        • largelytrue

          You mean, roughly, people with what we’ll call ‘elevated’ cholesterol who are in the group that avoids CHD for the equivalent of 26 years of followup from the Framingham study? Your point that Castelli doesn’t present a tightly controlled model is valid, of course, but he isn’t studying the detailed fractions of TC in that figure either; there are factors that make the predictive power of serum lipids inappropriately weaker as well as those that make it inappropriately stronger. This evidence has to be taken in combination with other evidence that helps to patch some of the flaws.

          What would we say to people who trust in that figure as a model of their ~26 year risk and think that this means that they are now in a group that is entirely protected from CHD because they’ve gone for the equivalent of 26 years’ followup in the study without a CHD event? I’d point out that this person is being unreasonable. Not only are we extrapolating beyond the specific predictive window shown by the figure, but this person is having us assume that not having an event so far proves that they won’t have one subsequently. It’s much more rational to note that CHD events are preceded by a period of chronic buildup and increasing risk, so just like some of the people in Framingham who didn’t get a CHD event for 25 years’ followup and got an event in their 26th, many of the Framingham people who got counted as part of the non-CHD group in that plot will be expected to move out of the non-CHD group later on due to atherosclerotic progression and other age-related factors. We’d need additional, specific evidence to conclude otherwise, and if we did so without such evidence we’d be engaged in special pleading.

          That’s the thing with some of the positions that you are highlighting, like those who wave away the risks of their obesity or assert “no correlation” between TC and CHD — and what does that even mean? Correlations of all sorts can be observed spuriously even without causation, and I thought that “correlation is not causation” was repeated often enough in the actively opposing camp that it was actually understood. At any rate, your examples are denialist positions, in that they show an obvious motive for backwards reasoning, and that they also don’t merely quibble with the WFPB prescription, but go further in denying fundamental mainstream science. Simply laying out facts and evidence might not work for these people, but I might try to see if there is a debunking resource or an authoritative position statement available to counter their position. Depending on how they respond, I can then decide how to continue the discussion, if at all.

          As for literature that teases out the probability of developing CHD over time given a multitude of lifestyle factors, I recommend that you have a look at the resources from Greger’s and especially Darryl’s comment. I agree with Darryl that non-ecological epidemiology on people with TC below 150mg/dL is quite sparse, though in response to your question I’d also add that multivariate adjusted models are extremely common in general. Any major prospective study this days will have tried to measure a good selection of likely explanatory variables, at least at baseline.

      • http://nutritionfacts.org/ Michael Greger M.D.

        Thanks for chiming in! I’m out of the country at the moment and so sometimes it takes me some time to get back to folks. For additional lines of evidence check out my video Optimal Cholesterol Level

      • Dean Pomerleau

        The fact that the cholesterol distribution curve for people without CHD is shifted left relative to the cholesterol distribution curve for people with CHD is suggestive that having a lower total serum cholesterol reduces CHD risk.

        But I stand by the claim that it is very misleading to conclude from this graph that having TC between 150 and 200 remains dangerous, while a level below 150 makes one virtually heart attack proof (as many have claimed).

        Dr. Greger’s other video (referenced below) on the topic of cholesterol and heart disease does a better job. But the left image of this graph (from Grundy, 1998) shows what I consider the real story – namely that CHD as a function of total cholesterol is relatively flat between 150 mg/dL and 200 mg/dL:

        http://www.ifcc.org/ifccfiles/images/142image002.jpg

        See this thread for more discussions on this Dr. Greger video:

        https://www.crsociety.org/topic/11314-total-cholesterol-and-heart-attacks/

        –Dean

        • largelytrue

          Yeah, I know you’ve shown plots from another paper where the relationship between serum cholesterol and CHD shows flattening or diminishing returns, but these data don’t cover risk over the entire lifespan (like the Castelli paper also) and they don’t cover the range below 150mg/dL either, and they show nonzero risk between 150mg/dL and 200mg/dL anyway. That is, taking your figure at face value, it confirms the hypothesis that having TC between 150 and 200 mg/dL remains dangerous.

          J-curves and S-curves that slope again after becoming flat are common enough in complex systems, which is why it isn’t warranted to extrapolate too carelessly to a specific functional form outside the data window without other information to help. I agree with you and Darryl that these data must be placed in context, and that a naive reading of the graph can lead to numerically literate but scientifically unwarranted propositions. This type of study usually has a huge number of covariates that are not well explored within, and part of the variance will actually prove to be best explained by factors that correlate with TC in this population but not others. The model is incomplete, and doesn’t represent the best model for explaining all available data, but it is still instructive. I more strongly support the idea of lowering cholesterol through lifestyle factors that show strong associations between the resultant cholesterol lowering and lowered risk of CHD, rather than lowering cholesterol through any which way. For that matter I’d also encourage many people to be a little more cautious about before settling the issue with a TC measurement. More complex lipid panels are widely available and are generally covered gratis or with low copay because of the financial prerogative to promote healthier lifestyles. These data on LDL, HDL, and so forth should also be considered, to the extent that one has access to the required expertise that is required to do so.

          Many do decide that cholesterol under X makes them completely heart-attack proof, but this is often due to soft and wishful but uncurious and unskeptical thinking. People like to think in absolutes, in other words, especially when the absolutist position is egosyntonic. I agree with you if what you are saying is that we should give up this rigid absolutism in favor of a more nuanced probabilism if we really want to understand heart disease (though many people don’t), but disagree with you presently if you think that no significantly lowered CHD risk for nonmedicated TC below 150mg/dL over the entire lifetime is the most probable conclusion. I’d like it if the thinking moved beyond this raw comparison of figures, but even if we leave it as it stands your figure isn’t compelling for that position when standing alongside Castelli’s. Castelli’s figure actually shows data for people with TC below 150mg/dL, which is exactly the sort of thing that we’d want to change our views about this range if they were previously based on the figures from Grundy’s editorial, whose data don’t go below TC of 150mg/dL.

    • Darryl

      There have been very few prospective studies of coronary risk at cholesterol levels below 150 mg/dl, but this one suggests the linear relationship seen in the aggregate of studies may continue, all the way down to Castelli’s magic number (the cohort with mean cholesterol of 182 mg/dl had 4.5 times the risk of the cohort with mean cholesterol of 147 mg/dl).

      I share skepticism on “heart-attack proof” claims centered purely around cholesterol levels.. Medicine can achieve < 150 mg/dl in some patients with just high dose statins, but their coronary risk isn't reduced anywhere near 100%, more like 30%. Esselstyn's pilot trials have much better results, and I suspect this points to benefits from reducing post-prandial endothelial inflammation (LDL cholesterol is just the building block of plaques, it takes inflammation before fibrous caps rupture into vessels). In the pre-statin era, cholesterol < 150 mg/dl reflected lower levels of LDL-raising saturated fat and dietary cholesterol in the diet, but also lower levels of pro-inflammatory factors and sometimes higher levels of anti-inflammatory ones: from greens to microbiome-feeding resistant starch to intestinal parasites like helminths.

      • Dean Pomerleau

        Darryl,

        I agree with you that inflammation is a very important contributor on the pathway from elevated LDL cholesterol in the bloodstream to CHD and eventually heart attacks and strokes. Thanks for pointing that out.

      • Linda N

        “more like 30%” And that 30% is RELATIVE risk, NOT absolute risk. Only absolute risk really tells us anything. And the absolute risk is like 1-3% if that. Practically at the level of chance. And the number needed to treat is sometimes around 300 or more to theoretically prevent one heart attack. So statins fail 97 to 99% of those who take them. Plus the side effects are horrendous. Statin can create diabetes, muscle damage, and block the pathway that creates both CoQ10, and the steroid hormones. So reducing the cholesterol numbers to such low levels (by statins at least) really doesn’t do anything.

        Also those with lower cholesterol levels had HIGHER overall mortality rates in almost every single one of these studies as well.

        • Darryl

          I don’t disagree with any of your points regarding statins. It appears most can reduce their risk of ED, heart attacks & ischemic strokes by at least 90% through diet alone, and diets that radically lower LDL also tend to reduce endothelial inflammation.

          Addressing your last point, both the healthiest (like many on risk-lowering plant based diets) and the sickest have have unusually low cholesterol. The high mortality among the sickest may create the false impression that low cholesterol is a risk factor, whereas the causation is in the other direction (those with failing bodies produce less cholesterol). When studies ensure their cohorts have no preexisting sickness at baseline by excluding the first few years of followup, and follow them for long enough, then outcomes better reflect true risks. This in the case in studies like Whitehall II, where 18 years of follow up suggests lowering cholesterol in middle age lowered coronary mortality in old age. Alas really long term followups are a rarity.

          • Linda N

            One study, and I would really like to see more than the abstract to be able to go through the real figures, because in most of the other studies, overall mortality rates rose with lower cholesterol levels. We are all going to die eventually of something. I just want my quality of life while I am living to be good to great for a long time before I kick the bucket. There are also many ways to die besides heart disease. Cancer, ALS, etc. plus long term just existing with diseases such as alzeimers etc. No nice way to spend ones remaining years. Many studies show a connection to low cholesterol levels and Alzheimers and others do not. Recent studies show that elderly women with higher cholesterol levels live longer with better quality of life that those with lower cholesterol levels. (It is late and I cannot find the studies right now)

            Of course many of those with the lower levels could be on the deadly statins and not from a decent diet, but I am just not that concerned with reasonable cholesterol levels and don’t feel the need to lower mine excessively.

          • Tom Goff

            Linda, Dr Kirk McAnsh raised much the same points you have. You might want to look at that discussion. High cholesterol in mid-life raises your risk of Alzheimer’s as well as heart disease. It is known that a number of chronic long latency diseases including certain cancers, Alzheimer’s etc lower cholesterol. They also result in weight loss. That is why you will see claims that being overweight and/or having high cholesterol is “protective” for older people.

            The association in older people between low cholesterol and low weight and Alzheimers or cancer or mortality is thought to be because declining cholesterol and weight loss are early pre-clinical symptoms. That is, having low cholesterol and not being overweight do not cause these diseases – the diseases cause declining cholesterol and weight loss.

    • Johanna Martin

      Are there not studies of other countries where people are on mostly a plant-based diet, their cholesterol is low, and they don’t have heart attacks? Just wondering….

      • Dean Pomerleau

        Yes, of course. But those same populations might have other traits that differ from ours, like being short in stature. Does that mean being short protects one from heart attacks? Of course not. Correlation is not causation. Only well-controlled clinical trials can show causal relationships. The graphic in Dr. Greger’s video shows correlation between having cholesterol below 150 and avoiding heart attacks, but not causation. I’m not saying low cholesterol DOESN’T prevent heart attacks, just that his illustration to support this notion is very misleading.

        • Johanna Martin

          In my mind, the different diets of other populations might tend to make me think that diet might be a cause. If you don’t look at suggestive studies of various populations, it’s difficult to make a decision about what is true. Don’t we need to take all the studies into view and make a decision based on all the studies we look at? And hasn’t cholesterol been extensively studied?

        • Rami Najjar – NF Moderator

          It is impossible to conduct a randomized trial of such grandeur to show heart disease, it simply is not feasible. No study now or in the future will ever do this. Therefore, when a mass abundance of studies show the same association repeatedly, one can make the educated assumption that yes, cholesterol is indeed a significant causal factor for heart disease. No we cannot be 100% certain, but for practical public health recommendations, it is appropriate. Outside of that, the biochemistry of the atherosclerotic process is well understood and cholesterol is a critical player in the story.

          • Dean Pomerleau

            Rami,

            I’m a big fan (and frequent financial supporter) of Dr. Greger’s work. And I’m in no way suggesting that serum cholesterol is NOT an important causal factor for heart disease. I too believe that it is. What I’m saying is that the graph Dr. Greger used to support this claim in this video is irrelevant and quite misleading. Moreover, it is an example of the kind of “twisting the evidence to fit his pro-vegan agenda” that I hear critics claiming in order to discount his (IMO admirable and generally accurate) message.

            –Dean

  • sms

    I’ve been mostly vegan, (probably 95% plant-based or so with only an occasional egg or cheese in some prepared dish), since July of 2014 and still have a cholesterol level in the 190s. Last test was April 2015. Disappointing. Not sure what I should do about it. I also exercise regularly.

    • Guest

      Get rid of the eggs, cheese and any source of cholesterol and saturated or trans-fat. Check the label of any packaged foods you eat. They may have saturated fat. The Heart Association says no more than 5% of your calories can come from saturated fat. If you eat 2000 calories a day, that’s no more than 11 grams of saturated fat. Eat flax seeds, beans, oats, cooked carrots,beets and broccoli to lower cholesterol.

    • Joseph Gonzales R.D.

      For those who have tried everything and still seem to have high cholesterol Dr. Greger usually gives this advice, which I sum-up in a new post: What can I do to lower my cholesterol? It seems I’ve tried everything!. See if that helps and please do let me know! Thanks.

  • Joe Caner

    Alright! Nothing says please die a premature, decrepit, disease ridden death like bacon cheese burgers served on trans fat ladened, sugar enriched, sugar fortified, refined flour pastries deep fried in rancid oil. I’d rather die than to give those things up! They’re yummy. :-)

    • charles grashow

      Why must the choice be between the meal you describe and a WFPB diet? I eat an omnivorous diet – whole foods based – that is nothing like the SAD.

      • Joe Caner

        The short answer is that you don’t. If one desires to reduce their cholesterol to heart attack proof levels, then it would seem prudent to refrain from ingesting cholesterol altogether. I suppose one can eat a nominally omnivorous diet and have one’s levels tested often. The choice is entirely yours.

        • charles grashow

          Blood test results – drawn of 5/11/15 (Quest Labs)

          Medications – 20 mgs QOD Atorvastatin, 90 mgs/day Armour Thyroid, 70 mgs Testosterone Cypionate 2x/week, 5 mgs/day Enalapril PLUS a boat load of supplements

          TC – 129 mg/dl
          HDL – 54 mg/dl
          Direct LDL – 67 mg/dL
          Triglycerides – 36 mg/dl
          Non-HDL Cholesterol – 75 mg/dl
          Cholesterol/HDL Ratio 2.4

          Apo A1 – 137 mg/dL Reference Range 94-1
          Apo B – 56 mg/dL Reference Range 52-10

          ApoB/A1 ratio – 0.41
          Risk, Male: Optimal < 0.77

          Homocysteine, Serum 10.3 umol/l Reference Range <11.4
          Liproprotein A <10 nmol/l Reference Range <75

          • Joe Caner

            Enviable numbers. Live long a prosper.

          • Veganrunner

            Charles you are on a statin and blood pressure medication. Many people here have gone WFPB in order to forgo the medication. Yes your way of eating animal and taking medication is an option but you are keeping company with people who tend to want to achieve health without medications.

          • charles grashow

            I have genetics which predispose me to having high blood pressure and high cholesterol (not FH)

            For example – I’m + + on the C825T, + – on both the M235T and A1166C, + – on the TAQ1B, + – on both the C677T and A1298C and + + on the H72Y

            I’ve gotten to the point where the genetics have overtaken diet with regard to certain things SO taking very small doses of medications is necessary.

            Diet works up to a certain point only,

          • Veggie Eric

            “Testosterone Cypionate” – Whew! That’s a powerful anabolic steroid Charles?! Are you on testosterone replacement therapy? Back in my yolo 20’s when I was body building my fav anabolic stack/cycle was just that… “intramuscular Testosterone Cypinate and oral Anadrol”… Made my nuts shrink and gave me liver ‘pangs’. I’d watch out man, if you have low testosterone, messing with Cyponate will only worsen your bodies ability to produce testosterone naturally… unless you don’t care about your nuts and plan on being on the “cyp” the rest of your life. Interesting….

          • charles grashow

            Yes – I’m on HRT – and no the dose I’m taking is not that high – 140 mgs/wk. BTW – injections are subQ not IM. Blood tested and doctor prescribed. Age 61 it helps greatly.

  • Psych MD

    I have a friend who has also become my de facto patient, mainly because he abhors all that is entailed in getting in to see a doctor. He is a 62 y/o lawyer, 5’10, 230 lbs. He is muscular so a healthy weight would probably be around 180. He has moderate hypertension. His personality is marked by significant repressed hostility. His lipid values are as follows: total chol. 221, HDL 42, LDL 132, Triglycerides 234. He has tried to follow the dietary advice that I have passed on from this site (including amla) which resulted in no change in any of the above parameters. His mother is obese and has had a stroke. Given these factors I told him he does have multiple risk facotrs for a cardiac event (though has never had symptoms) and suggested he see a real primary care physician. I went on to predict that whomever he sees will likely recommend statin therapy. He watched the documentary Widowmaker on Netflix and asked me to order a coronary artery calcium scan. I didn’t know much about it but went ahead. Amazingly he had a score of 1.19 in one artery and 0 in the other three. The interpretation was “very low risk of coronary artery disease.” Needless to say he was quite relieved.

    Then there is this article from Johns Hopkins: http://www.hopkinsmedicine.org/news/media/releases/study_shows_value_of_calcium_scan_in_predicting_heart_attack_and_stroke_among_those_considered_at_either_low_or_high_risk

    It would seem that a CACS, which is a relatively inexpensive, noninvasive test that directly visualizes arterial plaque might be more effective means of risk assessment than serum lipids which seem to be more of a surrogate indicator.

  • http://www.ML-Ei.com/ Dr. Kirk McAnsh, D.C.

    Assuming we can prevent heart attacks by lowering total cholesterol levels below 150 with prescription drugs, what does that do to our brain (which is made up of cholesterol)?… Do we “:get” something worse than a heart attack, i.e. Alzheimer’s?… What does such low cholesterol do to our quality of life by decreasing the precursor to testosterone?…

    • Tom Goff

      This is misleading speculation for which there is no evidence. In fact, what evidence there is suggests that statins may be protective against dementia.
      http://www.alzdiscovery.org/cognitive-vitality/condition/statins-for-management-of-high-cholesterol

      As for quality of life, are you suggesting that population with traditionally low cholesterol like the Japanese or hunter gatherer groups had poor “quality of life” or low testosterone? That’s all quite untrue as far as I can tell – of course, that doesn’t stop some people with websites claiming such things but it’s always sensible to fact-check such statements. That’s what is good about Dr Greger’s site – his videos are accompanied by a list of the sources/citations supporting his words. He has some good videos on cholesterol and Alzheimer’s which are well worth watching eg
      http://nutritionfacts.org/video/cholesterol-and-alzheimers-disease/

      • http://www.ML-Ei.com/ Dr. Kirk McAnsh, D.C.

        Tom, I think you missed my point. My point was that statins MAY increase Alzheimer’s by decreasing cholesterol, not that statins could decrease Alzheimer’s. :-)

        • Tom Goff

          No, I don’t think I did miss your point. If low cholesterol increased Alzheimer’s risk. then people whose cholesterol is lowered (by statins or diet) would have increased risk. They don’t. If anything, they have lower risk. Also if low cholesterol were a risk factor, you would expect populations with average low cholesterol levels like Africans would have higher Alzheimer’s rates than populations with higher average cholesterol levels like African Americans. They don’t
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212027/

          In fact high cholesterol in mid-life is a recognised risk factor for Alzheimer’s eg
          “An association between cholesterol and the development of AD was suggested in the early 1990s and ever since, an increasing amount of research has confirmed that there is a link between cholesterol and the development of AD. A high cholesterol levels in mid-life is a risk for AD and statins, i.e., cholesterol-lowering drugs, reduce this risk.”
          http://www.sciencedirect.com/science/article/pii/S0047637405002381

          There is an association between low cholesterol in older people and Alzheimer’s. But declining cholesterol is likely to be a pre-clinical indicator of Alzheimer’s rather than causal. Certainly there is reason to believe that “an alteration in cholesterol metabolism could play a pivotal role in early stages of AD.”
          http://www.hindawi.com/journals/bmri/2006/073976/abs/

          See also this discussion:
          http://www.medscape.com/viewarticle/740572

    • Rami Najjar – NF Moderator

      “Given the capability of all tissues to synthesize sufficient amounts of cholesterol for their metabolic and structural needs, there is no evidence for a biological requirement for dietary cholesterol. Therefore, neither an Adequate Intake nor a Recommended Dietary Allowance is set for cholesterol. There is much evidence to indicate a positive linear trend between cholesterol intake and low density lipoprotein cholesterol concentration, and therefore increased risk of coronary heart disease (CHD). A Tolerable Upper Intake Level is not set for cholesterol because any incremental increase in cholesterol intake increases CHD risk.”
      http://www.nal.usda.gov/fnic/DRI/DRI_Energy/542-588.pdf

      There is no reason to make that assumption, after all, high cholesterol is strongly linked with Alzheimers.

      http://nutritionfacts.org/video/cholesterol-and-alzheimers-disease/

  • Psych MD

    In my own situation I checked my lipids on 9/27/13 with the following results:
    Total chol 146, HDL 70, LDL 68, Trig 40. I checked again on 1/28/15 and the relative figures were 162, 85, 69, 40. So, interestingly, despite the fact that my total chol went up, it was virtually all due to an increase in HDL. The main change in my life, aside from reaching the age of 62, has been stricter adherence to a “Greger Diet,” (easier to say, and type, than whole food plant based) and strength training exercise

  • Mac

    Suppose, for the sake of argument, that, having seeing this video, all American adults took action and lowered their cholesterol level below 150. Still, some people would get heart disease. An expert would then write an article suggesting that cholesterol level be below, say, 125 in order to prevent heart disease, starting the cycle all over again. Point: Heart disease, like most degenerative diseases, has many risk factors; the cholesterol level is just one of them.

    • largelytrue

      There would be very legitimate criticism of this hypothetical “expert” because the new data would be based on a situation where people have only been followed for a short time after a sudden, large, and obvious cultural shift in eating patterns, making one post-shift cholesterol measurement a dubious way to model total risk. You are speculating too much.

    • Rami Najjar – NF Moderator

      Below 150 is not 100% protective, but it does provide significant protections. Diets that tend to increase cholesterol are also inflammatory, which has significant implications in the atherosclerotic process. Therefore, these issues tend to go hand in hand.

  • Han

    Did I hear that right? Do doctors nowadays have to swear the oath of Hypocrites?

  • John Dineen

    Some of the commenters have indicated they are vegan but still have high cholesterol. I would humbly suggest they carefully read (or re-read) Esselstyn’s “Prevent and Reverse Heart Disease”. Being vegan does not in and of itself solve the cholesterol/CHD problem. Rather you must reduce fat intake to ~10% of total calories – and yes, being vegan is very helpful when trying to obtain this level since starchy vegetables (rice, potatoes, corn, and bean are all near or below 10% fat whereas animal foods are much higher. Once done and your cholesterol plummets very quickly. At least this is what the literature says. Also, anecdotally it is very true for me personally; when I was a high-fat vegan eating lots of nuts, olive and tropical oils, my cholesterol actually went up to 225. When I ate unprocessed plants, my cholesterol dropped in a matter of six weeks to 144 – all without any medication.

    So, being vegan is only part of the story – a great first step – but not the full journey.

    • Darryl

      Counterpoint: the lowest I achieved on a low-fat vegan diet was around 170 mg/dl, which is close to that achieved in Dr. Ornish’s landmark study after 12-months (4.45 mmol/L = 172 mg/dL). Traditional societies with much lower cholesterol also have the benefit of low-baseline BMIs (19-22, vs 28.4 for Ornish and ~30 for me) and other cholesterol lowering factors like parasites.

      It was only with the addition of ~2 oz/d high-phytosterol almonds to my diet that I lowered cholesterol from the 170 mg/dl range to ca. 160 mg/dl (as determined bimonthly at blood donations). This is a typical response seen in a number of studies (1, 2, 3, 4, 5), My hope is that with further weight loss, circulating fatty acids will fall, with LDL cholesterol in tandem.

      • John Dineen

        Well the paradox here is that while we may like to predicate our behavior on peer-reviewed “science” in the end, we all do what seemed to work idiosyncratically for ourselves.

        For me, happily, there is convergence with what I like and what I believe and with the positions of Esselstyn, McDougall, Ornish, Barnard, Campbell, and Nathan Pritikin.

        I am not aware of controlled studies showing any benefit of nuts in managing CHD. There are observational studies but no control.

        Nonetheless, if you find what works for you to be different, then who am I to judge?

    • Tom Goff

      Good point, thanks. Of course, not all starchy vegetables are very low fat. Even oats cooked in water are about 15% fat (by calories/energy),and chickpeas are 13%.
      http://nutritiondata.self.com/foods-garbanzo000000000000000000000.html

  • rappinronreagan

    Why are we still talking about cholesterol levels? This is 2015 not 1980. It’s widely accepted that cholesterol levels do not matter. I also thought the China study had been debunked several times over. I feel like I just stepped into a time machine.

    • 2tsaybow

      A lot of people die of heart disease in the United States. Here is what cholesterol can do to your arteries. http://nutritionfacts.org/video/cholesterol-crystals-may-tear-though-our-artery-lining/
      You want to have low cholesterol. It is best to lower it by not taking drugs. To do this you need to eat a diet low in fat, particularly saturated fat.

      • ron

        How about the more recent studies that approve of healthy saturated fat like coconut oil?

        • 2tsaybow

          I doesn’t cause a spike in inflammation in your arteries the way animal products do, but it does raise your cholesterol. Here’s one of Dr. Greger’s videos on coconut oil: http://nutritionfacts.org/video/does-coconut-oil-clog-arteries/
          I use it on my wooden spoons, cutting board, and on my skin and hair. I don’t cook with it anymore though.

          • Joseph Gonzales R.D.

            FYI – Update on coconut oil :-)

          • 2tsaybow

            Great article! Thanks for taking the time to look into this Joseph!

        • Joseph Gonzales R.D.

          What studies? I think they are hard to come by. I looked for a long time and posted an update on coconut oil if you’re interested. I am always trying to learn more about it so please let me know if you find alternative studies. Thanks!

    • Veggie Eric

      No, The China study was not debunked but rather attacked by those seeking to profit from the sales/consumption of meat, eggs and dairy. The attacks have little to do with weather the China study was right or wrong but more to do with threatened industry profits. There is a clear financial motive to attack the China Study and It’s sickening the way Dr Campbell and his research have been maligned by the profit motivated opposition. sad to say that in todays world capitalism trumps truth and honesty. Fortunately for us Nutritionfacts.org is a port in the storm of confusion. This site is so valuable in seeing through the rhetoric of the meat, egg and dairy industry.

      In reality the China study is one of the most valuable pieces of information we have regarding the ill effects of animal products specifically animal protein turning on and off cancer at the +/- 20% ratio. Those that attack the China study have clear goals to tamp down any negative information about meat, eggs and dairy.

      ” It’s widely accepted that cholesterol levels do not matter” – This is absolutely false and a dangerous myth perpetrated by those who seek to gain financially from confusing the public about the dangers of consuming dietary cholesterol, There is a concerted effort underway to white wash the danger and damage done by dietary cholesterol consumption and when profits are on the table those seeking to profit will stop at nothing to keep them rolling in. The fact that you are here posting that ” It’s widely accepted that cholesterol levels do not matter”. is proof that the deep pockets on the animal products industry is highly effective at confusing the pubic. Again thankfully Nutritionfacts.org does not pander to any lobby and it’s research is unaffected by industry. There is no broccolli lobby paying Dr Greger to promote eating your peas and carrots.

      • rappinronreagan

        Well if anybody can find me any peer reviewed medical documentation that concludes dietary cholesterol levels causes heart disease. I would be happy to look at it. I would agree that the factory farmed antibiotic filled animals people eat today contribute to poor health, the same as I feel about soy products. The devil is in the details.

        • Tom Goff

          There’s a mountain of evidence about dietary cholesterol raising blood cholesterol,and high blood cholesterol being a significant risk factor for cardiovascular disease (and Alzhimer’s and certain cancers). The ATPIII report for the US National Cholesterol Education Program summarised much of the evidence in the Rationale section:
          http://circ.ahajournals.org/content/106/25/3163.full?sid=39f5c6f7-64b7-42c0-ab3a-b91f3e511f66

          And studies have shown us for decades that added dietary cholesterol raises blood cholesterol in most people except when their baseline dietary cholesterol and/or baseline blood cholesterol is already too high (I say most people some people are genetically hyporesponders to dietary cholesterol). This of course is why many modern studies funded by the egg and dairy industries look only at the effect on people whose baseline cholesterol is too high (unfortunately, in the US, that is most people). They already know that little or no effect will be seen.

          “Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is modulated by baseline dietary cholesterol. The greatest response is expected when baseline dietary cholesterol is near zero, while little, if any, measurable change would be expected once baseline dietary cholesterol was > 400-500 mg/d. People desiring maximal reduction of serum cholesterol by dietary means may have to reduce their dietary cholesterol to minimal levels (< 100-150 mg/d) to observe modest serum cholesterol reductions while persons eating a diet relatively rich in cholesterol would be expected to experience little change in serum cholesterol after adding even large amounts of cholesterol to their diet."
          http://ajcn.nutrition.org/content/55/6/1060.full.pdf+html

          This 1979 discussion of the relationship of dietary cholesterol to atherosclerosis is also well worth reading:
          http://ajcn.nutrition.org/content/32/12/2664.long

          • rappinronreagan

            Of note in the links you sent was the year of the studies. Its old stuff so although I think everything known should be considered, Its outdated. I also thought it interesting that in what you provided it actually pointed to elevated triglycerides as a risk factor and went on to say this is often found in individuals with a high carbohydrate diet hmmm. Further we know some people have high total cholesterol despite diet. Many vegans have cholesterol well over the “recommended” levels and many paleo type eaters have perfect cholesterol profiles. Of note since it was already brought up that the meat and dairy industry are corrupt and are pushing bad science to bolster sales, how about AMA?? Lets scare people about cholesterol. Why? Statins. This has to be the biggest money make on par with chemotherapy. Honestly we could probably post links back and forth all night but at the end of it all we will have a pile of links each saying something entirely different. In the end each person has to find what works for them and their health. We should just be thankful we live in a place where we have a choice.

          • Tom Goff

            2+2=4 is old stuff too. It is still correct.
            Yes, there can be multiple causes of high cholesterol although dietary saturated fat and dietary cholesterol are thought to be the two most important factors for the majority of people (genetics can also be important). High blood cholesterol was identified as a problem long before statins were conceived so this particular conspiracy theory, that the cholesterol argument was invented by statin manufacturers, is more ridiculous than most.
            As for the AMA theory , well, the author of the 1992 meta analysis is Australian, so I doubt he is part of any nefarious AMA plot.
            As for the links, you were the one who asked for peer reviewed documents linking high cholesterol to heart disease. There are thousands of references in the ATPIII report I cited – both old and new. And I don’t believe that there is any solid evidence that dietary cholesterol is beneficial. There are multiple factors in the causes of both high cholesterol and heart disease including smoking, exercise, viruses and the gut biome. This doesn’t obscure the fact that blood cholesterol is a very significant factor in atherosclerosis,and there is a huge evidence base for this. No serious scientist or health authority doubts it.
            That’s why some people dream up cholesterol conspiracy theories – it’s the only way that they can try to explain away the mountain of evidence linking blood cholesterol to cardiovascular risk

          • rappinronreagan

            2+2=4 is math so that isn’t really an applicable analogy. The rest is just conjecture on your part. I didn’t see anything in what you posted that provided Proof” high cholesterol numbers cause heart disease. I say as does the latest research that there is no correlation between heart disease and cholesterol numbers. It seems pretty well accepted to me that particle size is what matters regardless of the numbers be they 120 or 320. Getting your cholesterol checked as is typically done in the standard blood panel is completely useless. I have had “high” cholesterol my whole life and I have experimented with doing a strict vegan diet just to see and I discovered that my cholesterol dropped minimally what shot through the roof though was my triglycerides hmmmmm. Currently I have some meat and dairy products perhaps twice a week. I have not tested a strict paleo diet as of yet so perhaps that will be next. Really that’s all that matters, what works for each person individually.

          • Tom Goff

            It’s a perfectly valid analogy since, apparently, your major reason for ignoring some important major studies is that they are quite old. By the way, what are your reasons for ignoring more recent evidence as set out in eg the July 2014 UK guidelines
            http://www.nice.org.uk/guidance/cg181/evidence/cg181-lipid-modification-update-full-guideline3

            and the 2013 US guidelines?
            http://circ.ahajournals.org/content/129/25_suppl_2/S1.full

            You wrote that new research shows no correlation between heart disease and cholesterol. No credible health authority anywhere in the world agrees with you on this as the above guidelines demonstrate. This is because cross-sectional studies in essentially dietary homogeneous populations (and presumably these are the types of studies you are referring to) are insufficiently powered to detect such associations. There’s a good video on this here from Dr Greger:
            http://nutritionfacts.org/video/when-low-risk-means-high-risk

            and another helpful but somewhat longer video by Plantpositive on the topic is here:
            https://www.youtube.com/watch?v=AZK2J5ln5jg

            You also made a comment about “proof”. There is no such thing as absolute proof in this field. There’s no proof that smoking causes lung cancer, for example, but there is strong evidence. Just as there is strong evidence that high cholesterol is a strong risk factor for cardiovascular disease.

            And the particle size idea, implying certain LDL cholesterol particles of particular sizes are harmless, that you mention was effectively disproved years ago.
            “Previous studies showing that smaller low-density lipoprotein (LDL) size is associated with greater atherosclerotic risk did not adequately control for small and large LDL particle correlation. …….. Both LDL subclasses were significantly associated with subclinical atherosclerosis, with small LDL confounding the association of large LDL with atherosclerosis.”
            http://www.atherosclerosis-journal.com/article/S0021-9150(06)00259-0/fulltext

            This subject has been extensively studied over the years. A major review in 2008 found “In summary, only LDL particle concentration, as measured by NMR, was consistently found to be associated with incident CVD after adjustment for lipids (and other risk factors). Other specific measures have been found to be associated with incidence or progression of CVD by only a minority of studies.”
            http://www.ncbi.nlm.nih.gov/books/NBK254170/

            and “Limited evidence suggested that LDL subfraction analysis is not a consistently strong predictor of CVD compared to other known risk factors”
            http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0026967/

            More recently, Dr Greger has produced a good video on the topic also which refers to relevant research since 2008:
            http://nutritionfacts.org/video/does-cholesterol-size-matter/

            This video is also worth watching:
            https://www.youtube.com/watch?v=_wmidN8rYkU

          • rappinronreagan

            Not that it’s really relevant to the discussion but math is not up for debate. You are not correlating research. It’s math. So not an accurate analogy. Thank you for the links. I have seen many of them before just as I have seen research to the contrary. I have picked my side you have picked yours. It makes no difference to anything. You can have a total cholesterol of 400 and live to be 100 just as you can have a number under 200 and have a heart attack tomorrow. I recently worked with a guy who is in his 60’s eat No fruits or veges aside from potatoes eats at McDonald’s or jack in the box for lunch Every day I mean every day and he had is cholesterol Checked at work and it was under 200. No fruits or veges eats fast food daily and gets no exercise and he is under 200. Meanwhile I work out 4 times a week eat very little processed food lots of fruits and veges green smoothies etc. and I have never been close to 200. Cholesterol numbers and their diet and lifestyle factors are a bunch of BS.

          • largelytrue

            Thank you for the links. I have seen many of them before just as I have seen research to the contrary.

            I take your word when you say that you’ve seen many of them. Forgive me for interjecting, but as a third party I want to point out that the difference between you and Tom Goff in this discussion so far is that you don’t emphasize your “research to the contrary” when backing your position. In your most recent comment you instead seem to present soft emotional pushback, which is typical of someone who wants to avoid thinking about something:

            “You can have a total cholesterol of 400 and live to be 100 just as you can have a number under 200 and have a heart attack tomorrow”.

            Even if this were true (which persons do you have in mind that have lived to 100 this way?), it’s basically irrelevant to the discussion at hand which is based about likelihood and probability. It’s surely possible to live for a long time as a heavy smoker, but it isn’t particularly likely. Smoking still matters a lot as one out of many determinants of expected longevity. Same for steroids, methyl-mercury exposure, and a host of other hazards.

            “I recently worked with a guy who is in his 60’s eat No fruits or veges aside from potatoes eats at McDonald’s or jack in the box for lunch Every day I mean every day and he had is cholesterol Checked at work and it was under 200.”

            This anecdote, if true, could represent a statistical outlier for genetic or other reasons, and even if it were true, it doesn’t mean that this person’s diet isn’t exposing him to a risk of heart disease. The very theme of the video here is that TC below 200 is not necessarily good enough.

            “Meanwhile I work out 4 times a week eat very little processed food lots of fruits and veges green smoothies etc. and I have never been close to 200.”

            The last of your anecdotes, and one that isn’t necessarily surprising in one whose behavior is based on the thought that it’s pointless to try to lower cholesterol through lifestyle — especially when you haven’t excluded the possibility that you may be genetically susceptible to higher cholesterol. I think you get the point here that the real BS here is using this handful of weak anecdotes to claim that “cholesterol numbers and their diet and lifestyle factors are a bunch of BS”.

            Far from merely seeing the links, I’m concerned that you should have actually processed them diligently with effective reasoning. This applies as much to the links from Goff that you claim to have seen, as well as the links from the opposing camp that you also claim to have seen but have not produced. Because you aren’t sharing scientific evidence and have reasoned so poorly in your most recent post, it’s quite reasonable to doubt that you have not based your position on a careful reading of science. Beside that, Goff has put a lot of effort into providing evidence for you and trying to keep the discussion centered around what can be found in the scientific literature. When you refuse to even begin to rise to that level while arguing the truth of your position, it’s not only insulting to the other interlocutor, but it is unprofitable to you as well. Discussions grounded in careful thinking and scientific research are very likely to make us better at holding onto the right beliefs for the right reasons.

          • Tom Goff

            It’s a valid analogy because your argument appears to be that research findings that are over 20 years old must be either wrong or irrelevant simply because they are over 20 years old. No offence but that seems quite illogical to me and the analogy highlights that illogicality.

            I agree that genetics can be important, so can other lifestyle factors like exercise and smoking etc. These all affect mortality and morbidity risk. Recognising that doesn’t mean that blood cholesterol can’t also be a factor. Health and longevity are multifactorial.

            Regarding your other comments. You are quite right. Individual variability is a fact. Some people have a high blood cholesterol “set point”. Some people with high cholesterol can live long lives. Just as some people can smoke all their lives and live to over 100. Such individual examples however don’t demonstrate that either high cholesterol or smoking are not risk factors. One of Dr Greger’s other videos, on saturated fat, highlights the effect of this inter-individual variability on the results of cross-sectional observational studies and why informal observational studies like yours (you and your co-worker) will show no correlation between diet and cholesterol levels. Experimental studies are needed to identify risk factors.
            http://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/

            That is why experimental studies on the effects of changing diet or cholesterol levels on mortality and morbidity risk are so important. Given that multiple studies have shown that reducing blood cholesterol by diet or drugs results in fewer cardiovascular events and lower mortality, this is not a matter which can be seen as simply a difference of opinion.

          • rappinronreagan

            Math is not debatable it’s a fact it is what it is. Research is not math.

          • Tom Goff

            Nobody said it was – that’s why it’s an analogy.

          • rappinronreagan

            An analogy has a correlation to the original statement. I said the research was old as in outdated meaning there is much newer research availble. I am not disputing it for its age sepcifically. Math is not being researched we are not finding new answers to old math it is decided. Cholesterol is not decided. If it were there would not be so much conflicting information. But on a positive note My new Omega juicer is on its way how cool is that! Maybe we can debate high speed vs low speed juicing or blending vs juicing. There is always something to argue about.

          • Tom Goff

            You need to look at a dictionary for a definition of the term analogy.
            None of the newer research refutes the older research I cited. All the newer research does is look at what happens when people with high baseline cholesterol are fed added dietary cholesterol. These same studies were done decades ago so that we know what happens – added dietary cholesterol has little effect on blood cholesterol. That’s why producers of high cholesterol foods keep funding such studies.
            There’s no conflicting information about blood cholesterol and CVD risk – that’s why no credible health authority anywhere on the planet disagrees with the proposition that high blood cholesterol is a significant risk factor.

          • rappinronreagan

            1.
            a similarity between like features of two things, on which a comparison may be based:
            the analogy between the heart and a pump.
            2.
            similarity or comparability:
            I see no analogy between your problem and mine.
            You must be trolling me now because if you think you made an analogy you are high. The rest is another troll on your part. Research shows no correlation between high cholesterol and heart disease. It just isn’t there sorry. Say it a few more times it might come true.

          • Tom Goff

            “Analogy (from Greek ἀναλογία, analogia, “proportion”) is a cognitive process of transferring information or meaning from a particular subject (the analogue or source) to another (the target), or a linguistic expression corresponding to such a process.”
            https://en.wikipedia.org/wiki/Analogy

            Thanks for the link. However, aren’t you making my point for me? I wrote that no credible health authority anywhere in the world disputes that high blood cholesterol is a risk factor for heart disease and cited eg UK and US national guidelines, as well as articles from the professional literature. Your link however was to an internet blogger who has no particular expertise or qualifications and apparently doesn’t even realise that the video “Fat Head ” is simply one long litany of falsehoods that was obviously made by a conspiracy theorist.

          • rappinronreagan

            I think I see a pattern here. Are you voting for Hillary or Bernie?

          • Tom Goff

            The pattern is relying on the facts and scientific evidence instead of wishful thinking, conspiracy theories and wild speculation. And I’m Australian.

          • rappinronreagan

            OK you rely on your facts and scientific evidence, I will rely on mine. I assumed you were a liberal based on your desire to drag out a senseless argument trying to prove yourself right and your belief that you have a monopoly on the truth. Or maybe you just work for a pharmaceutical company pushing statin drugs to unsuspecting folks laying awake at night worrying about their cholesterol levels.

          • Thea

            rappinronreagan: I have flagged your post. It is unacceptable to use personal attacks on this site. To see the rules for posting on this site, go to FAQ section.

          • rappinronreagan

            I think “attack” is a bit strong. Where in there do you see an attack? Perhaps my views differ than yours so you want to delete my post. That is the only attack I see.

          • Thea

            rappinronreagan: I can say from the bottom of my heart that I don’t ever want to delete anyone’s post. I’d much rather spend my time doing something that helps people. And anyway, this site welcomes good, honest debate of the issues. Differing opinions never deleted just because of the differing opinion.

            However, accusing someone of being a pharmacy industry rep and “pushing statin drugs to unsuspecting folks laying awake at night worrying about their cholesterol levels” is an attack on the person, not the issues, and is against the rules of this site. If you can not understand that, you may want to be especially careful about your posts on this site.

          • Thea

            Tom Goff: I have been following this conversation. As a volunteer for this site, I want to express how impressed I have been with how you handled this discussion. The quality of your posts, including links to real research and good solid logic, were top notch. Just as I was itching for someone to bring up the smoking analogy, you did. Etc. And ***just as important,*** your tone remained incredibly respectful throughout, when many others would have broken before now.

            As something of an aside, I wanted to share a thought with you. While your 2+2=4 analogy was right on point, here is a second example to explain it that might help someone else in the future (not for the current conversation). If I had this conversation in the future, I might say something like: “If I gave you a bunch of solid research showing smoking was unhealthy, but that research was years old, would you say that the research is not valid because of it’s age? No, because at some point, we know the answer to a question. We don’t need yet one more study showing once again that smoking is bad for us. It would be a huge waste of money.” It is another smoking analogy, but the smoking analogies fit so well in so many ways. Anyway, I’m just sharing what was running through my head when the 2+2=4 point produced such confusion…

            Thanks for participating on this site and in this conversation. While you may not have helped this one person, there will be many others reading this conversation who you will likely help a great deal. Some people have legitimate questions about these types of issues and want to see a debate. Your posts will help someone like that.

          • Tom Goff

            Thanks Thea. You are very kind. Actually people like rappinronreagan are very helpful for my self-education in nutrition and health.
            They force me to go away and do some in-depth fact checking and research. Virtually all of their claims evaporate once they are subjected to serious examination, of course. Many claims are just plain false while some are half-truths that deceive by omission. But people believe what they want to believe I suppose and there are always others who will seek to profit by cobbling together half-way plausible justifications they can sell to those who want to believe.

  • charles grashow

    https://thescienceofnutrition.files.wordpress.com/2014/08/concerning-the-possibility-of-a-nut.pdf
    Concerning the Possibility of a Nut
    William P. Castelli, MD
    Framingham Heart Study
    National Heart, Lung, and
    Blood Institute
    5 Thurber St
    Framingham, MA 01701

    ” For example, in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol.”

    “In view of this, this study fails to describe a relationship of those traditional dietary constituents, saturated fat and cholesterol, known to have an adverse effect on blood lipids, and thereby, on the subsequent development of coronary disease end points.”

    • largelytrue

      And? What are your thoughts on these quotes that you’ve mined out of their context? Have you explored any of these claims beyond the very brief statements shown here?

      • charles grashow

        These are quotes by Castelli – how were they taken out of context?

        • largelytrue

          Is just snipping these two short quotes out of the multi-page text presenting them in context? Presenting the bare quote and none of the the other thinking or text is pretty much the definition of taking something out of its context.

          • charles grashow

            Tom Goff charles grashow • 11 hours ago

            Some fuller quotes from Castelli’s letter:

            “in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. The opposite of what one saw in the 26 metabolic ward studies, the opposite of what the equations provided by Hegsted et al2 and Keys et al3 would predict. Only the international comparisons showed that the world could be lined up on cholesterol intake or saturated fat intake,and it would correlate with the rate of CHD.4”

            “Eventually, diet intervention trials were done, and where the follow-up got out beyond 3 years, they all show the same thing. The larger the percentage fall in cholesterol, the larger the percentage fall in CHD.5”

            “In Framingham, for example, we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least, and were the most physically active.”

          • largelytrue

            Right, thanks for assenting to those additions by Tom Goff. I still am critical of your original comment for providing none of your own reasoning and for avoiding the context in Castelli’s paper.

    • Tom Goff

      Some fuller quotes from Castelli’s letter:

      “in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. The opposite of what one saw in the 26 metabolic ward studies, the opposite of what the equations provided by Hegsted et al2 and Keys et al3 would predict. Only the international comparisons showed that the world could be lined up on cholesterol intake or saturated fat intake,and it would correlate with the rate of CHD.4”

      “Eventually, diet intervention trials were done, and where the follow-up got out beyond 3 years, they all show the same thing. The larger the percentage fall in cholesterol, the larger the percentage fall in CHD.5”

      “In Framingham, for example, we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least, and were the most physically active.”

  • LAURALEAH

    With the misinformation being provided to the public, such as eggs and meat not being as bad as we thought, I fear most Americans will have a battle determining how to get to 150!!!! I am striving for that number!!!!!

    Another great video!!!!!

  • Rebecca Cody

    Does Dr Greger ever refer to the diets discussed in the Blue Zones books? Those healthy centenarians ate less than 2,000 calories daily, mostly plants, lots of beans, but they almost all eat some meat and eggs and some fat. Not a lot of either, but their diets and lifestyles have served them well. And, interestingly, almost as many men as women survived to 100 or more in several of the zones. The books don’t talk about their cholesterol levels, so that would be interesting to know about.

    • 2tsaybow

      The author of those books was on Bill Maher several weeks ago. He said that the the most current science says that we need to see animal products as radiation exposure. When you consume it, determine how much exposure you want. It is the lack of consumption of these things that makes people healthy.

      • Rebecca Cody

        He made that reference in the book, too, but he went on to say we need to know how much of those animal proteins we can eat safely.

        The only Blue Zones people who had among them total vegans was a small percentage of Seventh Day Adventists in California, and they were not as long-lived as those in that study who ate a small amount of animal protein.

        I’m not advocating for animal protein. I’m really not attracted to it, except I miss good cheese, but those studies do pique my curiosity. And I know that, in hoping to improve the health of big groups, most people will not willingly or quickly give up meat, eggs, fish, and dairy, but many would cut way back. So it would be good to know how much is safe, and what is the tipping point where it becomes more dangerous.

        Of course, if animals were raised naturally instead of by the nasty factory method, I think they would be less toxic to us all.

        • 2tsaybow

          I am suspicious of all of our animal products not only because of the evidence we’re talking about, but also because in the US we really have terrible oversight over these industries. Even those companies that are selling organic meats and other animal products have the same problems with oversight.
          As far as that cheese craving, throwing nutritional yeast on things helps, but if you like to cook look at soybeans and their many qualities. I know that soybeans have a lot of fat, but because of that when you blend them in a high powered blender they have a remarkable creaminess to them. They can then be used like bechamel sauce. Sometimes I make a “chili con queso” where I saute (really kinda steam) onions, green chili, and tomatoes and then add the blended soybeans and spices. It’s really very cheesy-like. Because of the fat, I don’t do it often, but it’s nice to take to a pot luck or to have when our kids come over to watch a football game.

          • Thea

            re: blended soybeans. Great idea! Thanks for sharing.

        • Tom Goff

          In the 7th Day Adventist study, only “pesco-vegetarians” had lower mortality risk than strict vegetarians – .81 versus .85. We can speculate based on other evidence this is due to better B12 and vitamin D status and better omega 3/6 ratios in “pesco-vegetarians”. Perhaps that is the tipping point – anything more than several fish meals per week.

          However, given the associated risk factors with fish consumption, it might well be more sensible to address the B12, vitamin D and omega 3 issues directly instead of via fish consumption. Dr Greger has a number of helpful videos of fish and fish oil consumption.
          http://archinte.jamanetwork.com/article.aspx?articleid=1710093
          http://nutritionfacts.org/2015/07/23/why-would-eating-fish-increase-diabetes-risk/
          http://nutritionfacts.org/video/red-fish-white-fish-dark-fish-atrial-fibrillation/
          https://www.youtube.com/watch?v=q7KeRwdIH04

          • Rebecca Cody

            It’s true that those Adventists now in their 90s and older lived for many years in a world where fish were safer to eat than now. The figures could well change over time as those now eating from our contaminated oceans grow older.

            And, thanks to the woman who sent the “cheese” recipe. It sounds tasty.

    • Thea

      Rebecca: re: “Does Dr Greger ever refer to the diets discussed in the Blue Zones books?”
      I believe that both the traditional Okinawa diet and Adventists in California are on the Blue Zone list. And Dr. Greger has covered both of these diets in at least a few videos. There was even a video very recently on the Okinawa diet. While they ate some animal products, the amount was *very* small. If you are interested:
      http://nutritionfacts.org/video/the-okinawa-diet-living-to-100/

  • dino48

    Dr.Greger,
    is it possible that cholesterol is the body’s means to repair damaged
    arteries. In other words, cholesterol is not the “bad guy”,
    just like firefighters are not the “bad guys”, and yet you see
    them at each fire? I’m paraphrasing an argument used by meat-eaters… much as I resent
    their lies, this argument doesn’t seem to be a logical fallacy, imho.
    I’d appreciate your opinion,
    backed by a proof, just like you always do… this is an honest question.

    • Tom Goff

      This simplistic analogy is a nice story but that it is all it is. It certainly doesn’t explain why mortality goes down when blood cholesterol is reduced by diet or drugs. You might want to look at this video below for Dr Greger;s views on the role of cholesterol in causing heart attacks. He cites the evidence to support his views whereas the “firefighter” story offers no evidence. All it offers is a deceptively plausible tale. .
      http://nutritionfacts.org/video/cholesterol-crystals-may-tear-though-our-artery-lining/

      • Thea

        ooops. I see you already replied with the same link (and with a nice explanation). I normally try to read all my e-mail before replying, but sometimes I just can’t help myself and jump in.

    • S Slavin

      This is interesting – perhaps it’s the inflammation that causes issues, including the high cholesterol, but not the cholesterol itself.

      Have there ever been studies on people with lots of inflammation but low cholesterol and their risk for cardiovascular issues?

      • Rami Najjar – NF Moderator

        Inflammation certainly plays a role in expediting the process, but it is not required for plaques to form. I should also add that inflammation tends to occur on diets that promote high cholesterol.

      • Tom Goff

        Cholesterol by itself causes inflammation. But there are other causes also. In the end, it gets down to diet (and genetics). CNN ran a story on this back in 2008:
        “Inflammation appears to be aggravated by a poor diet. Research shows that high-calorie, high-fat meals cause a sudden spike in CRP and other inflammatory markers because they flood the body with blood glucose and triglycerides.

        “The inflammation is due to a fundamental problem of using the wrong fuel for the engine,” says Dr. O’Keefe. “We’re not designed to burn this stuff, and when we do, it throws off all these inflammatory by-products.”
        http://edition.cnn.com/2008/HEALTH/conditions/10/16/healthmag.cholesterol.inflammation/index.html?_s=PM:HEALTH

        You might also want to watch this 2012 video by Dr Greger
        http://nutritionfacts.org/video/garden-variety-anti-inflammation/

    • Thea

      dino48: I think this video may answer your question. See what you think:
      http://nutritionfacts.org/video/cholesterol-crystals-may-tear-though-our-artery-lining/

    • largelytrue

      Lies unfortunately can avoid the main logical fallacies, if they follow from premises that are lies.

      See what you think about Plant Positive’s counterargument to this kind of claim here

  • http://www.vyvazenezdravi.cz Martin Novotný

    This is not my first negative comment up here – I simply cannot help, but argue… Anyone educated on this topic knows that it is not total cholesterol, but LDL, triglycerides and particular ratios (incl. total cholesterol) that show risk of developing heart disease! This video and lot of other “popular media” articles will only help big pharma developing statin-based drugs. I am always amazed when I see clients coming to me with blood tests where the only blood lipid marker measured is total cholesterol telling me that their doc is pushing them to go for statins, otherwise “they cannot help them” and if refused “they risk their health”.

    • 2tsaybow

      I don’t see any other negative comments from you so maybe you are thinking of another website. But don’t worry about arguing, Dr. Greger wants healthy discussions as well as healthy people.This site promotes the use of a whole food plant based diet to lower your cholesterol, not statin based drugs. If a doctor doesn’t understand nutritional information or a WFPB diet, and you want to keep that medical professional as you adviser (Why?) then refer him to pcrm.org where he can educate himself. Maybe you can talk him into putting some of their documentation in his office. Kaiser Permenente also has a program if you are a member of that MCO. Any doctor working with KP should be informed about the use of a WFPB diet instead of drugs.
      As far as the dangers of overall cholesterol here are a few of Dr. Greger’s videos on the subject.
      Leading causes of death: http://nutritionfacts.org/video/uprooting-the-leading-causes-of-death/

      Breast cancer cells being fed by cholesterol: http://nutritionfacts.org/video/cholesterol-feeds-breast-cancer-cells/
      Cholesterol Crystals may tear through artery lining: http://nutritionfacts.org/video/cholesterol-crystals-may-tear-though-our-artery-lining/

      There’s also a new article in forksoverknives.org about the President of the American College of Cardiology going completely vegan after finding out that his LDL cholesterol was 170 even though he was eating the diet most doctors recommend (Fruits, veggies, whole grains, and chicken breast with not skin.)http://www.forksoverknives.com/why-the-president-of-the-american-college-of-cardiology-wants-heart-disease-patients-to-eat-vegan-diets/

      • Thea

        2tsaybow: Great post. Also, I wanted to say thanks for the link to the new Forks Over Knives article! I really enjoyed reading it and hadn’t been aware of it before.

        • HeartHealthy

          I agree, when the President of the American College of Cardiology endorses a plant based diet for prevention of heart disease this should mean something. He saw the benefits to himself when he changed from what he thought was a good diet to a plant based diet.

      • http://www.vyvazenezdravi.cz Martin Novotný

        Hi there, thanks for your answer! First of all, 99% of docs in my country do not speak any English or it’s on very basic level (they might understand some headline news on CNN website, but they cannot read any medical journals or specialised websites, I am afraid… And it is not my doc (I see her only once every 2 year when I ask for blood report as I have right to ask for it due to my health insurance – otherwise I wasn’t sick for past 17 years), those are the doctors of my clients that I coach. I am a member of Dr. Weatherby’s FMTown and gone through intensive blood chemistry reading classroom with him and that is one of the basis of my coaching (blood report outcome). I am not arguing that high cholesterol isn’t a problem, but it is just a part of equation. Also, I do not like when someone broadcasts the message that (for uneducated) dietary cholesterol equals blood cholesterol. After all, H. Jay Dinshah, ex-president of American Vegan Society died on heart attack… This might not be 100% true for those with high cholesterol (incl. those with high LDL/trigs/CRP, low HDL), but for a healthy individual this formula is simply not correct. And for those with health risk markers, no one talks about the fact that it was not saturated fats (high quality ghee, butter, lard) that stands behind their problem – it was a diet full of processed food (not only processed meat, but processed food as such), over consumption of sugar (incl. HFCS) and oils rich in Omega-6… I do not try to convince my clients to go away from vegetarian diet – I rather inform them about consequences of continuing without looking at possible deficiencies (no doubt, there might be some and it is not only about B-12…) and danger of non-fermented soy products. With regards of vegan diet – short term it is clearly beneficial, esp. for someone going from “McDonalds diet”, long term (years, not months) it is rather detrimental (my observation), esp. on hormonal system and overall vitality… To sum it up – I like more Dr. Greger’s reports on advantages of veggies consumption than disadvantages of animal produce consumption (provided he does not differentiate on quality/source/frequency of consumption ;-)

        • 2tsaybow

          Hi,
          I understand from my research and from the information provided on this website that a person needs to take a B12 supplement and some type of Omega-3 which can be found in flax seed if they are on a whole food plant based diet.
          I found a European based website that is really great. It’s called Gut Microbiota Worldwatch. It has English, Spanish, and French translations.

          The problem with animal products is not only the cholesterol but also the inflammatory response that takes place after consuming them. Dr. Greger addresses this in several videos as does the website I just linked to.

          Here’s a quote from the GMW website:

          “Stanley Hazen of Cleveland Clinic, USA, for example, studies how bacteria produce trimethylamine (TMA) when they feast on choline, a nutrient found in abundantly in eggs and meat. TMA is further metabolized to produce trimethylamine N-oxide (TMAO), which is linked to inflammation and atherosclerosis. Mice who can’t change TMA into TMAO are protected against the disease. This suggests that TMAO is an undesirable metabolite that kick-starts the inflammatory process, resulting in a higher risk of heart disease.”

          Dr. Greger addresses Jay Dinshah death in this youtube video: https://www.youtube.com/watch?v=aFFWstlfDRk

          Basically it’s the Omega 3’s that were lacking in his diet. You do have to be careful if you’re going to eat only whole plant foods. If you want to review dietary recommendations for vegans, you can find that at the Physicians Committee for Responsible Medicine website PCRM.org

          • http://www.vyvazenezdravi.cz Martin Novotný

            Hallo there again, yes, vegan/vegetarian diet, if not done properly, can damage health – not by delivering inflammatory agents (I do agree with you that what is considered as “meat diet” does deliver a lot of negative substances to the body), but missing some critical nutrients that only animal products (in quality and frequency that does more good than harm) or chosen supplements can deliver. With regards of Omega-3’s ALA is not exactly the same as EPA/DHA as the length of chain is different so I would definitely consider both. I’ve studied gut microbiome at the University of Colorado and even have a public lectures on this topic – no doubt that prevalence of Firmicutes in someones gut (along with extremely low diversity), as seen in “meat-eater’s gut” have truly negative influence on a lot of health parameters, not only those connected to GI tract. And B12 plays critical role in a lot of metabolic processes. If for nothing else, B12 is worth to consider from “nature sources” or as a supplement. I do not eat soy at all and fermented natto soy beans as the only non-animal source of B12 (not counting some mushrooms where real content is minuscule) is disgusting…

          • 2tsaybow

            Hi again,
            Thank you for answering back!
            I do take a B12 supplement and I eat flax seeds daily for my Omega 3’s. I am well aware of how necessary those two nutrients are in my diet. Dr. Greger discusses this subject extensively in his talk about why Jay Dinshah’s died and what vegans need to consume to prevent brain damage and death. https://youtu.be/aFFWstlfDRk
            Many years ago I had a vegetarian friend who consumed lots of processed foods, coffee, and tobacco who died of colon cancer. The doctors could find nothing in his colon when he became ill. When he was hospitalized the last time they performed surgery and found that the cancer had grown on the outside of the colon.

          • http://www.vyvazenezdravi.cz Martin Novotný

            Hi there, yes, each of the “dietary lifestyles” can go wrong if you do not use common sense and some basic rules. What I try to teach my clients is that if they go to 75+% plant-based diet they shall not think of “burger made of veggies” – a lot of times it falls down to eating soy products in different forms as a meat/milk substitutes. That it the worse thing they can do for their health – being oestrogen dominant has consequences for the future. But again – if someone has a cancer, I focus on cancer, not on losing some weight or have thyroid in 100% condition and I do respect all the science findings on isoflavoniods so even soy is part of my recommendation. Bio-individuality and specific conditions is what counts. There is no diet that would be a match for 100% of population.

          • Tom Goff

            There are alternatives to Natto, including Tempeh which can provide B12. It’s essentially tasteless. However I eat Tempeh and also take a B12 supplement.
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895704/
            http://www.whfoods.com/genpage.php?tname=newtip&dbid=36

  • Rodrigo Cardoso

    Traduzido e Legendado em Português / Translated to Portuguese:
    http://nf.focoempatico.net/tudo-com-moderacao-ate-a-doenca-cardiaca/

  • NickJL

    When reading some peoples comments I notice that their interpretation on what Dr Mc Dougall and Dr Greger are saying is drifting. Maybe some should go back to the beginning and re-evaluate the advice. We all drift from time to time but starting back at the beginning can often be refreshing and it removes the treats that we have slipped in.

  • user1

    Hi,
    Someone please explain this. I heard that the reason why people with less than 150 cholesterol don’t die of heart disease is that they die of OTHER things.
    Does anyone have any longevity data for cholesterol, and relation of cholesterol and other causes of death?

    Thanks

    • Tom Goff

      It depends on why they have low cholesterol. If it is because of alcoholism or malnutrition, then, yes, such people may well have increased mortality. If people have declining cholesterol levels that cannot be explained by deliberate dietary changes or statin use, the fall in cholesterol may be an early symptom of certain chronic diseases such as cancer or Alzheimer’s. So, their non-cardiovascular mortality risk will be greater also. However, people with long-term low cholesterol and people who have had their cholesterol lowered by targeted dietary changes or statin use do not exhibit greater non-cardiovascular mortality.

      This article describes the relevant research findings better than I can:
      http://circ.ahajournals.org/content/92/9/2365.full

      • user1

        Thank you for this. I appreciate it!

  • user1

    Also, if someone can please help me understand. Both Malcolm Kendrick and Anthony Colpo have books called “The Great Cholesterol Con”. Can someone please provide an unbiased analysis of these two authors’ arguments compare with Dr. Greger. Thanks.

    • guest

      Can you please not troll this place with those two paleo bloggers? Seriously, they are known for attacking Vegans on youtube and trolling Vegan websites looking for conflict. Colpo swears and calls Vegans horrible names and has a rep for being offensive. This comment sections at Nutritionfacts are a nice place to get away from that type of Vegan/Paleo ugly bro-science fighting. Plenty of youtube videos to get into Paleo/Vegan cholesterol fighting wars but not here please. Dr Gerger is a Vegan and so are many on this site and its just not the place for that. Thank you.

      • user1

        I understand your concern. That’s not my intention. Which is why I’m not asserting anything, rather, just looking to get a better understanding on how there can be such diverse claims by authors. Thanks.

    • Tom Goff

      There are some useful Amazon reviews of these two books here
      http://www.amazon.com/gp/cdp/member-reviews/A1598TJPLP5YLJ/ref=pdp_new_read_full_review_link?ie=UTF8&page=3&sort_by=MostRecentReview#R2FTDWR8QZ2FPB

      Both Colpo and Kendrick have agendas and (perhaps deliberately) omit or misinterpret evidence that doesn’t suit their agendas.

  • hmmmm

    “Our culture mourns the loss of Cecil the lion, 2 but consumes Bessie the cow, millions of times a day.”

  • Sebastian Tristan

    Cholesterol of 90? Mine is 143 and I was proud of it…

  • dieteticsstudent

    I’m wondering–the video says that 35% of people who had heart attacks had cholesterol levels between 150-200 mg/dL, and this being a reason for why a low fat diet should be consumed. But wasn’t it published recently that dietary cholesterol has very little to do with cholesterol levels in the body? So shouldn’t we be more concerned of where the fat is coming from rather than the fat itself?

  • http://www.imvc.org/ Charlotte Fairchild

    I am going to snack on walnuts right now!

  • Shakirin Al Ikram

    I have had three heart attacks with yo-yo Diabetic sugar levels. Now I follow loose regimes of apple cider vinegar early in the morning and purple sweet potatoes (as well as other colours) for breakfast, no meats just soup and broth (rice or oats) for lunch.
    I was on medication for diabetes and heart problem but I have slowly reduced their intake and hopefully to stop them eventually by herbal and vegetables-fruits diet.
    I’ll be seeing the Cardiologist tomorrow to check how my heart condition will be since my June visit.

  • mike66

    Interesting observation I’ve made on myself since starting a plant based diet. Especially now since I’v really hit my stride with eating well and exercising. While on my morning runs, I notice that during holidays and special occasions when my eating is not always optimal. My finger tips in my right hand, thumb, pointer and middle finger start to go numb. Now that I’ve been on this plant based diet for a while now it’s only in the extreme tips of the fingers. It used to go down to the first joint. Like I said it only happens when my diet is not near optimal. For example my daughter may make a batch of cookies and the day before some sort of family gathers where I may indulge a bit. Things like that. Doesn’t seem to take much to go backwards!

  • mike66

    …….and yes my fingers would go numb in both hands while running in the beginning when I first started this way of eating. Now it’s just when I indulge a bit for a couple days. Only in the extreme tips of my one hand. At first I thought this was normal because I read other people would feel the same thing while exercising. Now I see from experience that it actually poor diet!!