Doctor's Note

Given the importance of this message, I encourage folks to please share this video with those in your circles. I know it's scary, but hope it's empowering at the same time. The bottom line is that we have tremendous control over our medical destinies.

Heart disease is a choice.

How do we go about reversing our heart disease? I address that exact question in my new live annual review presentation More Than an Apple a Day. Or, for shorter snippets:

For more context, check out my associated blog post: Stopping Heart Disease in Childhood.

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  • Veganrunner

    Excellent video.

    I am still just speechless when people say that satuated fat and added cholesterol in our diets are necessary and harmless.

    Who are these people? Why would they make the decision to go against this common knowledge?

    • VegAtHeart

      I don’t know the full answer to your relevant question, but here is one thought:
      The question of what causes heart disease may be subdivided into two different questions:
      1- What physiological state increases the likelihood of heart disease?
      2- What lifestyle choices promote the physiological state that increases the likelihood of heart disease?

      There will often be different types of studies and arguments to answer each of these two questions, which may contribute to confusing people.

      • RC

        I was one of these people, before i got informed. my excuse to eat fatty foods was because something i read stated basically, “you need fat, your brain, nervous system and hormones are all made up by fats, without it you could not function”. So i took this as permission to eat all the fatty foods I wanted.

        6 mos ago i watched Forks over Knives and it changed my life. I am 100% plant based whole food diet now and have lost nearly 40 lbs (from 215 at my heaviest). That is all the evidence i need to keep eating this way for life.

    • Toxins

      People like to hear good things about bad habits, and they insist on believing it despite the evidence. Its common knowledge that we have no dietary need for these 2 substances.

      According to the national academy of science, saturated fat has the unique ability unlike monounsaturated fat and polyunsaturated fat to suppress LDL receptors which subsequently causes production of LDL.

      And from the Editor in Chief of the American Journal of cardiology, “As shown in ​Figure 1, most of the risk factors do not in themselves cause atherosclerosis…The atherosclerotic risk factors showing that the only factor required to cause atherosclerosis is cholesterol.”
      Figure 1:
      Full text:

      • Darryl

        Saturated fats also promote cardiovascular disease through non-LDL receptor related effects. A common saturated fat, palmitic acid, gives rise to the pro-inflammatory mediator ceramide, which compromises insulin function and promotes atherosclerosis. Similar effects are seen from diacylglycerol, another metabolite of saturated fats. And saturated fats promote transport of inflammatory endotoxins through the intestinal wall.

        • Toxins

          Thanks for the additional information! I am particularly interested in the pro-inflammatory effects of saturated fats in the diet.

      • Max

        However, just lowering cholesterol with statins does neither halt nor reverse progression of atherosclerosis.

    • Plantstrongdoc M.D.

      You are right. People can say that they dont care, that they have great insurance,they rely on medication, the surgeon or take the change etc, but claiming that meat, eggs and dairy are not harmfull is complete nonsense, and ignore the bulk of evidence. Satuated fat and cholesterol in our diets are not only unnecessary, but also harmfull. I have seen no reliable data suggesting anything else.

    • Wade

      Veganrunner: Sadly, there will always be “Flat Earth People” that will get more attention than they rightly deserve. A variety of societal factors conspire for this to happen. Evidence – over time – renders the fallacies and the promoters of them powerless and useless. Those of us who are informed with the truth about diet and its effect on good health must be diligent to influence others about the positive effects we have experienced. Sometimes by word, sometimes by deed.

  • Hardy

    Dr. Greger,

    What do you think about high-fat vegan diet?

    To control my cystic acne I eat an extremely low-glycemic diet. Most of my calories come from nuts, flax seeds, sesame seeds, tofu, supplemented by small amount of seaweeds, mushrooms, garlic, kale, leeks. Once in a while I eat a small amount of fruits, mostly berries.

    All the nuts and seeds I eat means I consume a lot of fat. Is such a high fat vegan diet unhealthy? Or it is only high animal fat diet that’s unhealthy?

    All the literature I’ve been able to find seems to lump vegan and low-fat together. I can’t really find any study on high-fat vegan diet.

    • Toxins

      A high fat vegan diet, even in the form of whole foods plant based, is not the most healthful diet. You can expect alot of omega 6 and saturated fat. Whats wrong with complex carbohydrates?

      • Brandon Klinedinst

        I’ve been eating a high-fat vegan diet for 3-4 years now, and all of my blood test parameters are excellent. As long as one is getting all the nutrition he or she needs, and from appropriate sources, a little extra MCT or stearic acid is not going to be an issue. Also it doesn’t matter how much n-6 he’s consuming, as long as there is a proportionate increase of n-3, which he is probably accomplishing with the flax, sesame, and tree nuts.

        • Toxins

          We cannot determine the healthfulness of this individual’s diet based on your interpretations of a high fat vegan diet.
          Tree nuts (excluding walnuts) and seaseme seeds are extremely rich sources of omega 6 and one can easily tip the balance of this delicate 4:1 omega 6:3 ratio.

          Concern also stems from the fact that it is difficult to heal athlerosclerotic lesions consuming a high fat diet, no matter what the fat is.

          A 2 year study looked at coronary artery lesions of the heart after consuming different types of fat. Polyunsaturated fat, Monounsaturated fat, and Saturated fat. They looked at angiograms a year apart after intervening with increasing one type of fat in each group. All 3 fats were associated with a significant increase in new atherosclerosis lesions. Most importantly, the growth of these lesions did not stop when polyunsaturated fats and monounsaturated fats were substituted for saturated fats. Only by decreasing all fat intake including the polyunsaturated and monounsaturated fats did the lesions stop growing.

          Of course, the information must be put into context, as the diet of these groups was not the healthiest, but even so, the results are thought provoking and still may be applicable.

          • Brandon Klinedinst

            Looking at individual fats tells us nothing about the effects of wholefoods. And the study you referenced has little bearing on a discussion for vegan diets; the study specifies it was testing fatty meats and dairy. Neither of these are vegan, so how can vegans extrapolate useful information from them?

            The fats in tree nuts and seeds come with a host of other beneficial compounds, many of which have been shown to ameliorate heart health. This would include high ratios of L-arginine (NO precursor), tocotrienols and tocopherols, magnesium, polyphenols (especially catechins and myricetin), and phytosterols, just to name a few. If you have any information showing that tree nuts and seeds worsen heart health, rather than help, please post here for us to read over.

            Coconut is also a high fat vegan food, but I have not ever come across and information linking whole coconut to problems with cardiovascular diseases. The MCTs in coconut don’t even have similar metabolism pathways as those of animals fats, so how can we arbitrarily class these together? Coconut is also a wholefood deal. It’s not pure MCT, it also has a very high fiber content, as well as a high phytosterol content.

            There is not sufficient evidence to start promoting low-fat diets for healthy vegans. In fact most of the benefits seen from promoting low-fat diets in non-vegans is probably from the fact that eating a low-fat non-vegan diet means cutting out more animal product.

          • Toxins

            To repeat what I had said
            “Of course, the information must be put into context, as the diet of these groups was not the healthiest, but even so, the results are thought provoking and still may be applicable.”

            I am not saying that nuts are not healthful, and I am not saying that some coconut is fine. I would strongly disagree that a diet where the bulk of the calories are based on tree nuts and coconut is MORE healthful compared with a lower fat, complex carbohydrate based diet. Complex carbohydrates from beans, whole grains, potatoes, etc. has an array of nutrients including the ones you listed as well, and due to the lower fat content of these foods, it is easier to achieve satisfactory omega 6:3 ratios.

            In addition, coconut has medium chain fatty acids which are still not established to be quite negligible, and despite this, coconut still contains long chain saturated fats. Coconuts and nuts can be included in a healthy plant based diet but basing ones diet where the bulk of the calories come from these foods is not optimally healthy for the reasons stated.

          • Daniel Wagle

            I got into this online debate with a Paleo adherent who was saying that whole grains are always bad, because of the sugar content. He thought that nuts were fine. I said that both whole grains and nuts were good. I consume a big bowl of oatmeal everyday to get complex carbs and often I consume legumes when I am off from work. I eat a lot of nuts and pumpkin seeds and ground flaxseed as well. I tend to have a higher fat, higher complex carb diet, which the amount of exercise I do enables me to do both. I used to have very high cholesterol and was taking a high dose of statins. Now that I weigh 100 pounds less, my LDL is 95, HDL is 77, the total cholesterol is 182 and triglycerides are 48 without taking any medicine. Should I be concerned? I am all for both complex carbs, as well as fat from nuts and seeds- I don’t take any plant food off the plate.

          • elsie blanche

            Toxins, thank you for sharing this. I think it is one of the most important group of words put together on this website.

            It is so easy (and fun) to eat a high-fat vegan diet, and just as easy to excuse oneself because it is plant-based. I, and I think others, needed to hear/read your words today.

          • Brandon Klinedinst

            Again, the amount of useful data that can be extrapolated from a study testing the effects of meat and dairy on cardiovascular risk is approximately zero when we’re discussing vegans. There is zero evidence, I repeat, zilch, that whole plant foods that happen to be high in fat are bad for our health in any way.

            I’ll tell you what. I’ll donate $50 to the 501c3 here, if anyone can show me a single study (just one) that any of the following foods have any negative impact on heart health (or health in general):

            Coconut meat
            Any edible tree nut
            Any edible seed

            Of course 4 of these 6 have been linked to being some of the best anti-cardiovascular disease foods known. The oldest lived individual in the world reported that she thrived off of the highest fat plant food – cacao. She passed on at the age of 122.

            Anyway, got my credit card ready here guys.

          • dan

            You sound really really silly here, but for starters, you need to define some more specific criteria for a link. If a really old person eating cacao is a great enough link to insinuate that high fat cacao is great, then maybe the saturated fat in it is plenty to imply that it is terrible. Sat fat has been linked to heart disease and cacao has been linked to sat fat. Of course you dismiss this argumentative line, but if you are going to credibly get your credit card out you need to put out with intellectual honesty, too, something that actually implies that the mind behind the card is reasonably open to change.

          • Brandon Klinedinst

            Dan, I am not “sounding silly” here. It’s called science. So let me explain.

            First and foremost, let’s recognize that in science, we use careful, controlled observation to prove something exist. We do not ever assume something exist and say that science has to prove it does not.

            In the context of our discussion here, this means that we must use science to show that a high-fat vegan diet is sub-optimal to a low-fat vegan diet, before we start promoting a low-fat vegan diet over a high-fat vegan diet. It also means that we do not suggest a low-fat vegan diet is healthier than a high-fat vegan diet, simply because science has not specifically proven false the idea that a high-fat vegan diet is equally healthy or healthier than a low-fat diet.

            Thus, the best anyone can say right now is that both low-fat and high-fat vegan diets seem to promote great health, and there is currently no data to allow us to decide if one has slightly more benefit than the other. I asked for anyone to provide information contrary to this, and if someone does, I will donate $50 to the 501c3, in the interest of applying science to human health, nutrition, and longevity.

            Secondly, when we organize studies, document them, and extract information from them, we are careful not to over extrapolate the information in ways that are not appropriate. In fact, the amount of definitive claims we can make from most studies are few and far in between, and the rest we say we need further study and research on.

            This means that because saturated fat as an unnatural, isolated nutritional factor, is causing health problems in test subjects, or that saturated fat intake associated with intakes from animal products is causing health problems, then we say that saturated fat as an isolate or as an indicator of animal consumption is strongly associated with said health problems.

            We then might say that we are interested to know if saturated fat found in plant foods (olives, edible tree nuts and seeds, coconut meat, avocados, and cacao) is associated with similar health problems (or any health problems at all) in the way that the saturated fats from animal products is associated with health problems.

            So at this juncture of scientific inquiry, we are unable to specifically promote a high-fat vegan diet over or under a low-fat vegan diet. At this juncture all we can say is that we are interested to know more, based on what we know we know (animal saturated fat kills), and based on what we know we don’t know (does plant saturated fat kill or heal).

            That being said, what evidence we do have on plant foods high in fats, especially saturated fats, is that they either have neutral effects on heart health, or grossly positive effects on heart health.

            In case anyone is interested to read, I’ll post some examples:


            (Cacao polyphenols and heart health, cancer, & diabetes and other metabolic disorders)


            (Nuts, blood lipids, and cardiovascular disease risk)



            (Table olives, their phenolics and tyrosol-esters, and cancer and cardiovascular disease risk)

          • dan

            It’s silly when you are mentioning the dietary habits of a single exceptionally old person. That’s of minimal weight in any scientific discussion that has data on whole populations, so I wonder why you lead with it. I also wonder why you aren’t directly answering the question about what would be a ‘legitimate’ study suggesting a link between olives and cancer. But it seems that for you a study of dietary components would be looking at the olive independent of its awesome olive-y context, while a study on populations might lump in olives with too much other context for your taste. So what do you need, an RCT in vegans? A retrospective study that specifically codes for olive consumption, what?

            Also, what is ‘edible’ in the context of your challenge? Bitter almonds and peach pits are edible in the sense that they find their way into the occasional batch of marzipan, but they have deleterious effects on health due to their high cyanide content and it is quite easy to eat to excess. Clearly in that context it doesn’t matter that cyanide is a mere component that may not have been adequately studied in special vegans, so why can’t we take, say, the acrylamide content of black olives as a stroke against their general healthfulness?

          • Brandon Klinedinst

            The old lady eating chocolate was just a cute little anecdotal story. Of course we can not make decisions or draw conclusions on it that would affect the lives of potentially millions of people. When asked for further explanation, I posted one (of many) of the studies on cacao and it’s health implications.

            Edible in the context of my challenge means it should be fit for daily human consumption. So as you explained, this would rule out bitter almonds. Small amounts of hydrogen cyanide can be formed from many of the foods we eat, and our bodies detoxify them as need be. Most foods have components in them that need to be detoxified. But you have to look at the “whole deal” to see what you’re getting. In the case of bitter almonds, a single almond can have as much as 9mg of pro-hydrogen cyanide. The LD50 is as low as 50mg. So if eating 6 bitter almonds a day might kill you off by day two, then let’s agree it’s not fit for daily consumption, and we’ll place it in the “inedible” category.

          • dan

            Okay, but how about the black olives? Fit for daily consumption, we could say, but shifting a high portion of daily caloric intake into black olives may not be the best choice over the long term. Are we really ruling out discussion of dietary components completely, and what about statistical comparisons between/among the dietary patterns of whole populations? For instance, if I were to produce a study correlating worse heart disease outcomes in Israel relative to other countries with their high consumption of high Omega-6 oilseeds like sunflower and sesame, would you have a reason prepared to dismiss the type of link that they are suggesting?

          • Brandon Klinedinst

            Shifting a high portion of daily caloric intake into any one food would not be the best choice long term. Variety is just as important as the diet being plant-centric and whole foods based.

            Olives that have been naturally fermented, versus having undergone unnatural curing processes, lack the acrylamide content. So again, a point we can all fall back on and agree to, the closer to nature the better.

          • Toxins

            I am not against the consumption of higher fat, whole plant foods, if in fact we are still discussing whole plant foods. I think people may confuse the data and adopt the same benefits to the oils of these foods which are well established to not be healthful.

            I also think its important to note that most studies where high fat plant foods replace calories or add calories on to ones diet, that person’s diet initially was not healthful. It is difficult to assign the same benefits of these foods to someone already consuming a diet comprised of low fat plant based foods. Perhaps there is benefit but perhaps also to a lesser degree considering that all whole plant foods have beneficial phytonutrient compounds.

            For example, English walnuts appear to be far more anti inflammatory than black walnuts most likely because of the high content of omega 3 and possibly other phytonutrients at play.


          • Toxins

            I find Jeff Novick to be extremely insightful in regards to nutrition and these issues. If you are unfamiliar with Jeff Novick, he is a very important and well spoken plant based dietician in the WFPB movement. He is one of the most knowledgeable people I know and has scientific grounds for all of his statements. He runs a forum with Dr. McDougall and has a special section devoted to common issues people ask, including topics such as nuts, coconuts, and cacao.


            Based on your responses, I assume that you have interest in understanding the topic fully and are looking for evidence based statements. I think you will thoroughly enjoy reading some of these topics Jeff Novick has shared.

          • Brandon Klinedinst

            Wow, looks like loads of information to read over. Thanks Toxins!

          • Brandon Klinedinst

            Aside from my other post, I do not know as much about the importance of omega-3 to omega-6 ratios. I mean, I know the basics of course, like n-3 being anti-inflammatory, with n-6 promoting inflammation if there’s too much of it compared to n-3.

            I wanted to read more about what ratio would be optimal, since I noticed my ratio is 2.5:1 according to cron-o-meter. Should I consider increasing my intake of omega 6?

          • Toxins

            The lower the better, of course we don’t want to get too low or we may get side affects such as the inability to heal well from cuts and other hemorrhage type side effects. Your ratio is good, consuming 1:1 is by no means unhealthful.

            The ratio is important because of competitive enzymes that convert ALA to DHA and EPA and Linoleic acid to Arachidonic acid. Too much of either and you will not get adequate conversion rates. Unfortunately, most foods tend to be high in omega 6 which is pro inflammatory.

          • DanielFaster

            At the very least one can say that at the present time there are no studies showing the effective treatment and reversal of heart disease or cancer with a high fat diet, whether plant based or animal.

          • Brandon Klinedinst

            There are many studies linking the consumption of raw cacao (or the least, very dark chocolate) to drastic improvements in cardiovascular health. More than drugs have accomplished.

          • DanielFaster

            And algae oil too. But supplements do not a high fat diet make.

    • I would echo what Toxins said. In my opinion the glycemic index can be useful but it can add some confusion into the mix. It depends on what your goals are. For instance glucose is very high glycemic whereas fructose is very low glycemic. Starches which are complex carbohydrates are long chains of glucose. Fructose is metabolized primarily by the liver to uric acid, triglycerides, and inflammatory aldehydes among other things. By backing off the higher fat plant foods and adding complex carbohydrates you should get adequate calories. If you do change your diet it will be interesting to see what if any effect it has on the cystic acne. Good luck with the acne.

  • Pete Greider

    Thanks, Dr. Gregor. Excellent piece.

  • Freaking Scary!

  • Plantstrongdoc M.D.

    This is a very powerfull video. We are not only responsible of our own health destiny, but also the health destiny of our children. Atherosclerosis starts in childhood. I am NOT saying that children should be raised on a low fat vegan diet, but the parents have a responsibility to limit the amount of junk they put in to their children – limit the burgers, pizza, cheese, candy etc and increase the vegetables, fruit and grains. Actually my smoothie experiment is a succes. High amount of kale, broccoli, beetroot and a little ginger in the Vitamix with some fruit, and my son loves it – and now it actually tastes of blended vegetables. Adults have a choice – if they are fully informed (and insured!) and choose to die or get a heart attack in the burgerbar, so be it, but the children does not have that choice.

    • Thea

      Plantstrongdoc: Thanks for the follow up on the smoothies you feed your kid. That’s so cool that you are are creating a kid who truly has a taste for veggies. You are doing him a huge favor.

      • Plantstrongdoc M.D.

        Actually he likes brussel sprouts and light steamed broccoli (7 years old). I am trying to convince him to eat beans, but that is a little difficult….

    • Although when I asked him in person, Jeff Novick told me we SHOULD raise our kids on a LFWFPB diet, but he recognized that it’s not easy, because of environment (school, peers, previous habits, etc.). We are more lenient with our 4 kids than we are with ourselves (not always low-fat, and sometimes less than whole food), but we do strive to keep their nutrition within Dr. McDougall’s plan guidelines as much as possible.

  • Facebook User

    This information needs to spread! Attend the North American Plant Based Healthcare Conference if you want to help others! Great video Dr. Greger. Looking forward to learning more…

  • Mike Quinoa

    One of your best, Dr. Greger—had me spellbound. Thank you so much.

    “Dr. Lewis Kuller, a professor of public health from the University of Pittsburg from his 10 years cardiovascular health study made the following statement in April 2006: “All males who are 65 years of age and older who have been exposed to the traditional western diet have cardiovascular disease and should be treated as such.” ”
    As profound as the above quote is, it looks like the years of age may have to be revised downwards.

  • Merio

    I think this video in one of the most important that i’ve seen here on …

  • Darryl

    I presumably built up arterosclerotic plaques for most of 39 years (even in ovo-lacto-vegetarian years). Ornish and Esselstyn’s recommendation of a very low fat plant based diet is central to my personal program to reverse the dames, and has certainly helped with lipid profile and blood pressure. There are numerous other ways besides fat content where plant based diets help, and one that Dr. Greger hasn’t gotten around to yet is the central role of subclinical vitamin K deficiency in arterial calcification. In humans, supplementing with about 3x the RDA halves the rate of calcification, while rats, high K intake reverses arterial calcification.

    So where to we get vitamin K? Dark green leafy vegetables, especially parsley, swiss chard, kale, collards, mustard greens, and spinach, which all have more than 500 µg (3 x the RDA) in every 100g (about 1 ½ cups raw).

  • Barry Honeycombe

    What is wrong with people who deny this message? I talk about this all the time and yet, people seem to scoff and dismiss it. Having seen my father have a massive coronary at 46 and then die at 61, I want to change my health destiny. I have been plant-strong since April 2013 and in that time have lost about 30lbs and made a huge difference to my health. I am off to get my cholesterol tested again tomorrow – lets see how much it has come down by.

    If you want to follow my journey and to get some PLANTALICIOUS recipes – take a look at my blog –

    • Thea

      Nice Barry! Thanks for your post.

  • Catherine J Frompovich

    Plant-based diet by all means. However, something being overlooked that is endemic and affects everyone, including very young children, is fluoride in municipal drinking water. Below are several published studies implicating fluoride in atherosclerosis / hardening of the arteries.

    Fluoride & Arterial Calcification

    Li Y, et al. (2012). Association of vascular fluoride uptake
    with vascular calcification and coronary artery disease. Nuclear Med Comm

    Song AH, et al. (1990). Observations on fluoric aortosclerosis
    by two-dimensional echocardiography. Endemic Diseases Bulletin 5(1):91-4.

    Stookey GK, Muhler JC. (1963). Relationship between fluoride
    deposition and metastatic calcification in soft tissues of rat and guinea pig.
    Proceed Soc Exp Biol Med 113:720-25.

    Susheela AK, Kharb P. (1990). Aortic calcification in chronic
    fluoride poisoning: biochemical and electron microscope evidence. Exp Mol Path

    The incidence of Moenckeberg calcifications in patients with
    endemic fluorosis. Fluoride 17(1):4-8.

    Varol E, et al. (2010). Aortic elasticity is impaired in
    patients with endemic fluorosis. Biol Trace Elem Res 133:121-7.

  • brec

    (Previously incorrectly posted as a reply to another comment.)

    A JAMA 2012 article, “Prevalence of and Risk Factors for Autopsy-Determined Atherosclerosis Among US Service Members, 2001-2011” provides some evidence that incidence of atherosclerosis in soldiers has substantially declined since the 1953 Korean War and later Vietnam War studies.

  • Robbie

    I have been Vegan for 7 months thanks to your 56 minute video.
    I switched to a 200mg Vegan DHA, which I take twice a day, but of course I am not getting the EPA I was getting in fish oil. Should I be doing something to replace the EPA?

    • Brandon Klinedinst

      Your body converts effortlessly between DHA and EPA as it needs. The problem is from getting EPA from ALA (the plant omega-3)

  • HereHere

    I ran into someone today who went to a nutritionist (MD with specialization in nutrition) who was pro-vegetarian, but claimed to her patient that some people are not evolved to handle a vegan diet, such as the Inuit. Anyone have any research on vegetarianism and genetics? I don’t know if she was referencing the disproven blood type diet, but it was before the paleo diet came out.

  • Fabio

    Scary but empowering indeed.

    Dr. Greger, I was wondering though if a very low cholesterol level could be a problem too for someone, like me, eating a plant based diet. I have a level of 95 total (not 195, but 95) and 50-55 HDL. Many people in my family have low levels, but no one like me, as I am the only veg*an.

    Now, I’ve read a couple of studies on Pubmed that suggest a correlation between low cholesterol and intracerebral hemorrhage. Any thoughts on this? Should I try to raise this level? How? Thank you so much.

  • Neutrino

    Dr Greger, I thought this article of professional (and possibly dangerous) naivety in this British Cardiologist’s assertions ( that the role of saturated fat is dramatically overplayed might interest/terrify/dishearten you. I can understand why the role of sugar should be addressed more (pursuant to Dr Lustig’s work on the subject), however it appears damaging when portrayed in the media that saturated fat is someone deemed de facto healthy/acceptable by the medical fraternity, confusing the consumer more with mixed/mis-information.

    • Toxins

      There is nearly 100 years of research showing that saturated fat and cholesterol are the causes of heart disease. Sugar has no part in forming athlerosclerotic lesions, and to think glucose, the primary fuel source of the body, will cause athlerosclerotic lesions is nonsense. This Meta-analysis looked at 21 different studies, and came to the conclusion that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD [heart disease].”

      Studies like this one are misleading.

      Here is Jeff Novicks take on the matter.

      One major problem with this study is they did not look at any studies where the saturated fat intake was less than 7%, which is the level recommended by the American Heart Association. Most of the diets had saturated fat intakes in the range of 10-15% (or more).

      So, just like the studies that criticize “low fat” diets, but never analyze any diet that is truly low fat and based on the principles of low fat, high fiber, whole plant foods, this study criticizes the impact of lowering saturated fat, but never looked at any diet that truly lowered saturated fat to the level recommended.

      Another problem with the study is what the subjects replaced the saturated fat with when comparing the 2. For many, if not most, it was with either (or products containing) hydrogenated/trans fat, while flour, white sugar and/or mono fats.

      People who replaced saturated fat in their diet with polyunsaturated fat (omega 3/6) reduce their risk of coronary heart disease by 19 percent, compared with control groups of people who do not.

      Lastly, studies on all-cause mortality trumps findings for subsets such as CHD and CVD. Most all-cause studies demonstrate a direct relation between saturated fat intake and all-cause mortality and the lower the better. Here is a list of studies showing just this.

      “the results of this study support earlier observations that dietary intakes low in SF or high in FV [fruits and vegetables] each offer protection against CHD mortality. In addition, however, our data suggest that the combination of both high FV with relatively low SF intake offers greater protection against both total and CHD mortality than either practice alone.”

      “The major finding of the present study is that the average population intake of saturated fat and vitamin C and the prevalence of smokers are major determinants of all-cause mortality rates. Saturated fat and smoking are detrimental, but vitamin C seems to be protective in relation to the health of populations…The potential effect of changes in saturated fat, vitamin C and the prevalence of smokers can be illustrated as follows. A change in saturated fat of 5% of energy is associated with a 4.7% change in age-adjusted all-cause mortality rate (Table 3).”

      “A high RRR pattern score, which was associated with high intake of fat and protein and low intake of carbohydrates, increased the risk of death. Subjects with a pattern score belonging to the highest quintile obtained on average 37·2 % of their energy from fat and 37·6 % from carbohydrates and thus did not meet current dietary recommendations (Institute of Medicine of the National Academies, 2002). Food groups that contributed to this unfavourable pattern of energy sources were red meat, poultry, processed meat, butter, sauces and eggs, whereas a high intake of bread and fruits decreased the pattern score.”

      From the National Academy of Science:

      “Saturated fatty acids are synthesized by the body to provide an adequate level needed for their physiological and structural functions; they have no known role in preventing chronic diseases. Therefore, neither an AI nor RDA is set for saturated fatty acids. There is a positive linear trend between total saturated fatty acid intake and total and low density lipoprotein (LDL) cholesterol concentration and increased risk of coronary heart disease (CHD). A UL is not set for saturated fatty acids because any incremental increase in saturated fatty acid intake increases CHD risk”

      “The saturated fatty acids, in contrast to cis mono or polyunsaturated fatty acids, have a unique property in that they suppress the expression of LDL receptors (Spady et al., 1993). Through this action, dietary saturated fatty acids raise serum LDL cholesterol concentrations (Mustad et al., 1997).”

      From the editor in chief of the American Journal of Cardiology.

      “As shown in Figure 1, most of the risk factors do not in themselves cause atherosclerosis [heart disease]…The atherosclerotic risk factors showing that the only factor required to cause atherosclerosis is cholesterol.”

      • Neutrino

        Obviously i was referring to the nefarious role of fructose at chronic consumption, inducing hyperinsulinemia; Leptin resistance; and metabolic syndrome. Sugar just happens to be the vehicle of fructose we have a particular penchant for in today’s society.

        • Toxins

          Perhaps lumping artifical sweetners into the equation then yes, but fructose from fruits has not proven to have any ill health efects.

          • Neutrino

            Well Toxins, that’s an ill informed assertion. See Dr Greger on – – and – – Fructose is fructose whether it arrives at the liver from a can of coca cola or from your minute maid orange. The fundamental difference when it’s consumed as part of a whole fruit is the fibre, which regulates the absorption of fructose and how quickly and at what intensity it arrives at the liver. There fructose is not stored as glycogen (as glucose is) but rather is metabolised by the mitochondria, resulting in uric acid, and in its interaction with Junk 1 results in a disruption of the role of insulin at the liver and a need for the pancreas to send more insulin to the liver, leaving increased insulin levels all over the body. A hyperinsulinemia state can disrupt leptin signalling at the hypothalamus which can lead to consumption problems.

            Artificial sweetners don’t have fructose in them, so there won’t be the biochemical disruption that chronic fructose consumption induces at the liver (although there could be hedonic issues, and issues with stomach peptides).

            I recommend Dr Lustig’s seminal lecture on the role of fructose –

          • Toxins

            Excuse me when I said “artificial sweeteners” I meant added sweeteners.

            The very point I was making was that when consumed from fruits, it will not be an issue for the implied reason that the fiber content slows the absorption and that whole fruits are more satiating then a food with added sweeteners so you would inherently get less sugar.

          • Neutrino

            I agree, the tide of fruit juice consumption is only compounding the fructose problem with the removal of fibre. This australian study differentiated clearly between whole fruit/vegetables and fruit juice in terms of colon cancer risk –

  • Peter Norris

    I have followed the Esselstyn diet for five years and have had significant reversal of arterial plaque (I am 68), from dangerous to mild-moderate. I have avoided oils almost completely during this time. However, I am aware that eating nuts or sunflower seeds would increase vitamin E intake and perhaps lower the risk of cognitive decline. Question, then: will the increase in fat from an ounce per day of sunflower seeds negatively affect arterial plaque? Esselstyn’s position on this is unclear to me.

  • Peter Norris

    I have reduced dangerous arterial plaque through five years of the remarkable Esselstyn diet. I am 68, though, and also concerned about cognitive decline, so would like to increase vitamin E intake. But I am uncertain whether nuts and seeds, because of their fats, would be safe for me to re-introduce. I would not want to jeopardize the gains I have made through the diet.

  • Geoffrey Levens

    I would love to know who, exactly, found “By age 10, nearly all kids have fatty streaks in their arteries”. Do you have a citation I can quote for that. Where and when??? Thank you

    • Thea

      Geoffrey: Underneath every video is a section titled, “Sources Cited” You can expand that section and see that a few of the titles look promising for being the source you are looking for. Beyond that, you are on your own. :-) Dr. Greger links to the full study when he can, but often the full study is not available free on-line.

      Hope that helps.

  • Alaa Shorman

    such a GREAT video.

    I am studying Msc in human nutrition ,,, and I’ve started to think seriously about studying fatty streaks among children here in Jordan for my thesis after watching this vedio , but until now I cant find a valid method to detect them on LIVING subjects without killing them!! or without being Invasive.
    so please I need help

  • Han

    What’s the status of atherosclerosis among vegans? How long does one have to be vegan before all damage is repaired?

  • Julien Brown

    Why was this unlisted, and relisted just now on youtube?

  • Dyan

    My friend said she had genetic high cholesterol, I think its called familial hypercholesterolemia? She was pretty adament that nothing can help except medication. Can a vegan diet help lower this?

    • Joseph Gonzales R.D.

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

  • Kimberly Lindsey

    How did the Bogalusa heart study measure cholesterol INTAKE at autopsy?

    • guest

      Please tell me you’re not one of the low-carb keto kooks coming hear to attack Dr Gergers work. It gets old and you will get a lot of push-back from users of this site so please. Just stop.

      • Thea

        guest: We have a high standard for posting on this site. Please refrain from name calling.

        From my perspective, the question is legitimate. If the question bothers you, just ignore it.

      • Kimberly Lindsey

        Hello anonymous overreactive person, I noticed a confusing statement in the transcript of this video and asked a question about it. Now, I follow up to point out that the original peer reviewed paper (obviously) does not report cholesterol intake, which is difficult to measure once participants are already dead. Dr Greger’s video about the paper also does not report that links to cholesterol intake were found. However, the transcript of the video contains the word INTAKE, which is both incorrect with respect to the original article and is also an inaccurate representation of the words spoken in the video.

  • Juliette