Doctor's Note

It’s imperative for everyone to understand Dr. Rose’s sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study in Barriers to Heart Disease Prevention.

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  • tbatts666

    Informative video as always. Thanks dr g!!

    I have never seen those linear regressions on ldl lowering studies. Interesting.

  • Rohan

    I find it hilarious that paleofantasist Loren Cordain co-authored the paper showing that optimal LDL-C is between 50 and 70…

  • HemoDynamic, M.D.

    Interestingly, in my experience, I have had a couple of patients that have had very low cholesterol levels with one having a stroke and another having multiple MI’s. They both, however, ate the SAD way. I will find one of the files I have on the carotid Ultrasound of the gentleman with the stroke and post his cholesterol levels in a follow up. I think I remember his Total cholesterol at 125 or something like that. Stay tuned. . .
    Point being in my experience it doesn’t matter what your cholesterol levels are, if you eat the SAD way you increase your risk tremendously of cardiac and vascular disease.
    Nice work Dr. G and crew!

    • Umm. HIPAA?

      • HemoDynamic, M.D.

        No Hippa Violation if identifying data is not disclosed.

      • Jeremiah

        Mac, HIPAA is violated only when patient IDENTITY is given. Otherwise the simple medical facts could be applied to anyone and, hence, anonymous.

    • Richard

      “SAD” ??? What’s that please.

      • pbdoc

        standard american diet

      • Ashley Galloway

        The Standard American diet is rich in animal protein, fat, salt and sugar; and low in fiber and health-protecting plant foods. Check out Dr. Greger’s video discussing the SAD diet and how to calculate your healthy eating score:

        • Sean MacLeod

          Ooooh good post!

        • Jesus Baptista Júnior

          Thanks for your answer.

    • Rob

      Possible high burden of Lp(a)?? I have a gentleman with pristine lipids, 6 time ironman, ultrarunner etc.. Who is just ate up with CAD. CAC score was over 2500. His Lp(a) levels both Lp(a) mass and Lp(a) are sky high. Infact most of his LDL is Lp(a).

      • spfldo .

        High carb load will drive Lp(a) and Insulin Response problems, which cause atherosclerosis problems. High endurance exercise program e.g., marathon is a driver of inflammation and is particularly troubling for the cardiovascular system with lactic acid buildup. LCHF and eliminating grain oils, among other things help.

    • pbdoc

      SAD diet definitely increases your risk of developing vascular diseases, yes. One of the main reasons is due to increased cholesterol. What were the serial measurements of your patients’ cholesterol over his life-time? That is very important. His most recent tc of 125 is not of much consequence, but rather the totality of cholesterol his arteries have been exposed to since childhood (in addition to hyperglycemia, htn, etc).

      This is a nice article talking about the causal exposure model:

      • spfldo .

        The SAD diet is a disaster but saturated fat and protein is not the problem. The biggest problem is the high carb load of the average American and the resultant epidemic of inflammation, insulin resistance and diabetes. Some other factors are the quantity of food, factory foods i.e., edible product, with high levels of Omega 6, particularly grain oils and low levels of Omega 3s, both of which are essential for life but the proportions are all wrong. Look into the low carb high fat i.e., Paleo lifestyle for solutions.

        • Ed

          I don’t think you’re going to find much of an audience for the “Paleo Diet” here.

          • spfldo .

            One of my favorite quotes, “You never know when the lunatic fringe will become the cutting edge”. I’ve tried it both ways and everything in between. LCHF is my recommendation. Listen to Dr. Newman, you may need to rethink a few things.

          • Ed

            It may be your recommendation, but it’s still a fad diet. I’ve eaten a whole foods, plant-based diet for over two years, and I’m doing quite well. Plenty of whole grains (gasp!), beans (gasp!), fruits, vegetables, and the occasional nuts and seeds (gasp!).

            I’m still waiting for my Wheat Belly and my Grain Brain. Instead, I’ve lost 60 pounds, and I haven’t felt this good since I was a teenager. I won’t be changing my eating habits anytime soon. If only we could meet again in ten years. It would interest me to see if you’re still eating the “Paleo” way.

          • spfldo .

            Well, I’ve never been overweight but if you were overweight by 60lbs, no doubt whatever you are doing now is better than what you were doing. I’ve had three heart attacks and a couple bypass surgeries (family history), the first twenty one years ago. All before “LCHF” and reading Gary Taubes’, Why We Get Fat … book. I can tell you that carbs, particularly grains (gasp) drive insulin, will reduce HDL and change lipid size to the more dangerous small LDL and increase LPa.. Saturated animal fats drive the HDL numbers up as well as TC but lipids will be changed to larger “safer” size. I have the blood test results to prove it. Of course you can’t draw conclusions from one sample but it dovetails with evidence I’ve seen in researching this for twenty years. You’d be better off listening to the wisdom of the crowds than the medical establishment. I’m just some guy looking for a solution and I put my money where my mouth is. I had two slices of bacon, two brats, eight oz. cottage cheese, two free range eggs over easy and washed it down with a glass of whole raw milk this morning. I’m 60 years old, 6’1″ and 174lbs., same as when I was eighteen, have six pack abs and feel better than I have in years. I’ve been seriously LCHF for four years and I’d love to get together in ten years. Good luck to you.

          • Ed

            I have much to say in response to your post, but I don’t have the time right now.

            However, I will say that dairy products are excluded from the Paleo Diet, but you said you drank a glass of whole milk this morning. Your diet seems more like a “high saturated fat diet” than a “Paleo Diet.”

          • spfldo .

            Thanks, been there seen that, disagree with that but I appreciate the time, effort and thoughtfulness you’ve put into your response. This is what I believe, ” We have a healthcare system that doesn’t care about nutrition and a food system that doesn’t care about health”. I hope you have a chance to read what this guy has to say. Again, good luck.

          • spfldo .

            Thanks for the effort, I’ve seen Dr. Greger and don’t agree. I’ve had blood tests and a vegetarian diet drives my already low HDL numbers into the ground and does not lower LDL. Inflammation e.g., tendonitis, prostatitis, back pain and other ailments have all disappeared with the elimination of grain oils and limiting sugar and bread. I hope you read the attachment, It’s pretty much what I believe. Good luck with your health, keep an open mind and I hope you find the key.

          • lele23

            It’s not just about a “vegetarian diet.” Oreos, soda, and plenty of processed foods are vegetarian. Whole food, 100% plant-based, and no oil is the way to go for optimal health, heart-wise and otherwise.

          • Linda N

            “If insulin was so universally awful, why do you think the body would produce it at all?” Well we could say the same about cholesterol. If it is so universally awful, why would Mother Nature/GOD/Evolution (take your pick) create a body whereby the liver creates cholesterol and the intestines are programmed to reabsorb it. All of ones steroid hormones have the cholesterol molecule as their backbone. This, of course, does not mean, in my book, that one eat no fruit and veggies, and instead eat globs of bacon, butter, sausages and the like. As always balance is the key, and I see no balance in the pharmaceutical rush to get everyone’s LDL down to 70 or below. That view certainly sells Statin drugs however!

          • Ed

            Hi Linda. Yes, of course both cholesterol and insulin are required components for a functioning human body. But, that doesn’t mean we should be consuming cholesterol, and that doesn’t mean we should have high levels of cholesterol in our blood. The research seems to indicate that having lower blood cholesterol means less CVD. In one of the big studies, nobody who had a total cholesterol under 150 had a single heart event.

            I’ve been eating 100% whole foods, plant-based for 2 years now, and I just recently got my cholesterol levels tested:

            Total cholesterol: 91
            LDL: 44
            HDL: 32
            Triglycerides: 75

            I’m pretty satisfied with my results here, and they were accomplished without any medications whatsoever.

          • Linda N

            Well I am very happy to hear that you are satisfied with your cholesterol levels being that low, and you have to do what is right for you and what you believe in. As for me I would NEVER allow my cholesterol levels to get that low. Knowing what I know about the importance of cholesterol to bodily and brain functions, having a cholesterol level that low would scare the living hell out of me and cause me to take serious immediate remedial action. Of course I would never seek to get my cholesterol that low in the first place. But again, you have to do what you believe is right, and I truly wish you well with your choice.

          • Ed

            If you could point me to any science that indicates that low cholesterol is bad for you, I would appreciate that. I’m aware that people with familial hypocholesterolemia (extremely low cholesterol), actually have longer lifespans and much lower incidence of CVD than “normal” people. That’s pretty good evidence that low cholesterol is better.

            The human body knows how to make all the cholesterol it needs. It doesn’t require us to eat cholesterol and saturated fat to artificially increase our blood cholesterol levels. I’m not losing any sleep over my brain function. IMO, worrying about low cholesterol levels is a classic case of looking for problems where there aren’t any.

        • Trueselfnow

          I’m guessing you haven’t seen the Dr. G’s vids on “Paleo”. Regardless of whether one diet is healthier than the other. Meat diets are the least sustainable and most environmentally destructive. Why not just choose the diet that is healthiest for ourselves, our planet and the animals. A triple win yes?

          • spfldo .

            All I can see between my house in Ohio and the Colorado Rockies are corn and soybean deserts, not much habitat for wildlife. Personally, I don’t think grain or grain oils are fit for human consumption. The Global warming scam is a huge grab for trillions in taxes and subsidies and will barely put a dent in CO2 or any warming trends we may see in the future. You do know that global temperatures haven’t risen in like eighteen years and that records going back 600 million years show that current CO2 levels are as low now, as any over that period of time. In fact they have been higher by a factor of twelve or fifteen. If you really want to help the wildlife and the environment, all those corn deserts need to be converted to pastures and hay fields with a diversity of grass fed animals. At least you can find wildlife in a hayfield. Try that in a GMO corn field. Please pay particular attention to Dr. Mercola’s article and read about Dr. Joseph Kraft’s research on insulin resistance, he’s done the foundational work on IR and wrote a book titled Diabetes and You, very powerful. edition

          • lele23

            Who do you think eats most of that corn and soy? Farmed animals.

            I agree with you about grain oils (or any type of oil). But grains? Ridiculous! Grains and legumes are the basis of the diets of the longest-lived, healthiest communities on Earth (the “Blue Zones”), where little or no meat is consumed.

          • spfldo .

            Thanks, I’ll check out Dr. G

        • 4Baccurate

          Probably refined, not unrefined, carbs are the problem.

    • Sunny

      What is a SAD diet?? What does SAD mean?

      • lele23

        It’s the standard American diet, which contains a typical amount, by American standards, of meat, dairy, and processed foods, and fewer servings than optimal of fruits, vegetables, legumes, and whole grains.

        • HemoDynamic, M.D.

          Thanks for replying! I work full time, two teenage boys in sports and a wife that also works full time and goes to school part time, so it is hard for me to always get back to my comments. I appreciate your help!

          • lele23

            You’re very welcome!

    • Synergy

      Could just be a rare statistical outlier. Or, it could be that the reading of 125 is not representative of their typical cholesterol, or that they experience large fluctuations. Also worth considering is the possibility of undetected cancer or some other such disease known to have cholesterol lowering effects.

      • HemoDynamic, M.D.

        I’ll try to find that study today and post it. The number for T Chol was their typical cholesterol number. But in my experience he is a statistical outlier. I like your thinking about the possibility of cancer. I will never know that answer because I don’t see him as a patient anymore but great thought.

        • Synergy

          You mention total cholesterol was typical for that patient, but how was the HDL/LDL ratio? A patient could have a low total cholesterol while still having a high LDL and really low HDL, which would be problematic. Obviously, you know this, I’m just clarifying my train of thought.

          • HemoDynamic, M.D.

            To your point look at the image I posted above. Pt’s HDL/LDL ratio was very low 1.8.
            Crazy stuff.
            I appreciate your input and thoughts!

      • HemoDynamic, M.D.

        Synergy, below is the follow up Carotid Duplex scan (Ultrasound) of the carotid arteries. The Red arrow on the left of the image shows the Right Carotid artery where a plaque ruptured and was the most likely cause of this patients stroke. On the right is the patients cholesterol level and it is very low: Total Cholesterol of 129 and LDL of 75. Remember goal of T. Chol: <150 and LDL: < 70.

        Interestingly as Synergy mentioned above maybe the low cholesterol was because of cancer. As you can see on the image of the Carotid scan he had a history of Throat cancer but it was removed and "in remission" as far as we knew at the time. And you can also see he stopped smoking at age 16 and pt was then 65.

        Again my point is eating the SAD diet definitely increases ones risk for SAD outcomes.

        Stay healthy my friends!

        • James Wald

          Was this patient taking statin drugs to lower their cholesterol numbers? Those drugs are only about 5% effective over 5 years [see so it wouldn’t be surprising that they still suffered a stroke. I went 100% WFPB and got down to the same total cholesterol with a better HDL/LDL ratio and an empty medicine cabinet.

          • HemoDynamic, MD – NF Volunteer

            Patient was not on statins or any other cholesterol lowering drug. His cholesterol levels were his everyday cholesterol levels.

    • Darryl

      LDL cholesterol provides the building blocks and endothelial inflammation the wrecking ball in cardiovascular disease. The standard American diet contributes to both, and its a lot safer to stand next to even tall walls when there’s no demolition crew.

      • And the endothelial inflammation is due to the oxidation of the LDL cholesterol?

        • Darryl

          My understanding is that other stimulants of innate immune response (endotoxins, saturated fats, Neu5gc etc.) initiate endothelial inflammation and migration of monocytes into the vascular wall, which differentiate into macrophages releasing free radicals and inflammatory cytokines, and foam cells sucking up LDL and becoming plaques. Most of the oxidation of LDL is catalyzed by the macrophage free radicals, but from there OxLDL further contributes to differentiation into foam cells. Its considerably more complicated, but overall not a purely linear progression: some products later in the disease mechanism provide positive feedback to earlier steps, and is a canonical example of the pathological cycles of inappropriate innate immune response we’ve discussed elsewhere.

          • Wilma Laura Wiggins

            Thanks Darryl but I think it would be more helpful if you could put this into lay terminology.

          • Darryl

            What I meant here is that oxidized LDL is an important part of the inflammatory feedback loops that turn our local cops on patrol (monocytes) into the foam cells that gobble passing cholesterol and become atherosclerotic plaques. However, I haven’t seen evidence that oxidized LDL is the only cause or even the primary one for these transformations. Endothelial inflammation from a variety of causes initiates the disease process, but high LDL perpetuates it.

          • Thea

            Oh! That’s very interesting. Thanks!

    • Ed

      Was it an ischemic or hemorrhagic stroke?

      • HemoDynamic, M.D.

        Ischemic stroke from a ruptured plaque. See posted image above showing the Carotid duplex scan of the pt’s carotids. Check out his cholesterol as well.

    • HemoDynamic, M.D.

      Below is the follow up Carotid Duplex scan (Ultrasound) of the carotid arteries. The Red arrow on the left of the image shows the Right Carotid artery where a plaque ruptured and was the most likely cause of this patients stroke. On the right is the patients cholesterol level and it is very low: Total Cholesterol of 129 and LDL of 75. Remember goal of T. Chol: <150 and LDL: < 70.
      Interestingly as Synergy mentioned below maybe low cholesterol because of cancer. As you can see on the image of the Carotid scan he had a history of Throat cancer but it was removed and "in remission" as far as we knew at the time. And you can also see he stopped smoking at age 16 and pt is now 65.
      Again my point is eating the SAD diet definitely increases ones risk for SAD outcomes.
      Stay healthy my friends!

      • Rami_RD2B

        Jeff Novick has pointed out that while being below a total of 150 is highly beneficial, it does not make you 100% protected. Those in the framgingham heart study (where the idea of 150 or below came from) had about 5-6 patients who still got a heart attack. Its all about risk reduction.

        • HereHere

          This is a very good point to raise, thank you. I also noticed in the video above, the vegan average was just under 70 for LDL, but the deviation was almost 30 points. I’m not sure if that is the range, or a standard deviation – my research skills are rusty. Even so, that means a significant number of vegans have LDL that is too high. I wonder what the factors are – probably too much refined fat, but perhaps sugar also plays a role.

          • James Wald

            A great way to improve your HDL/LDL ratio is exercise, and I suspect most vegans (and everyone else) are sedentary. After going 100% WFPB I added regular exercise to shift that ratio.

          • HereHere

            I should be safe, then, as I do sprint triathlons. It gets me exercising pretty frequently.

    • HereHere

      Very interesting. I wonder (a) how the gentleman’s cholesterol was so low on the SAD diet, and (b) why his low cholesterol levels were not cardioprotective.

      • HemoDynamic, M.D.

        We now know that if you eat the SAD diet that your HDL is dysfunctional. I learned that from Dr. Caldwell Esselstyn. Dr. Greger may have a video on that as well. It was very interesting to learn that it’s not the cholesterol level that seems to matter. IT’S THE DIET! (I’m not yelling just placing extreme emphasis on ‘It’s the FOOD.”)

    • GodBlessAmerica

      Cholesterol is useless. It’s the protection provided by the plants….phytonutrients, vitamin C, etc.

      • HereHere

        If this is the case, (and I suspect you are right) I would like to know the mechanism of action. Just quite curious about this. What are the phytonutrients (or other plant nutrients) doing to the blood vessels exactly?

    • What about for people with familial hypercholesterolemia. Could they improve their condition by eating a whole-foods plant based diet?

      • HereHere

        I am a layperson, I would think so. I think you have asked in the right place, but nobody has answered you with the research to back it up. Pretty sure a plant-based diet helps everyone who has hypercholesterolemia, whether familial or not.

    • 4Baccurate

      Was the gentleman’s stroke hemorrhagic? If so, he could have been taking aspirin or had a dietary salicylate buildup in his system, which increases the fragility of blood vessels in the brain…

    • Rami Najjar – NF Moderator

      Any updates on that?

      • HemoDynamic, MD – NF Volunteer

        Updates on what?

        • Rami Najjar – NF Moderator

          Were you not going to post numbers?

          • HemoDynamic, MD – NF Volunteer

            I did a long time ago. Check through the comment section here and you will see my post with the picture attached. That was back when we allowed image uploads

    • 5ko

      So what is clogging the artery if cholesterol levels are low? What is causing the high blood pressure? My father has high blood pressure and low cholesterol.

  • newsjunkie

    Dr. G, I attended two Engine2 conferences last year, one at which you spoke. I have been following Dr. Essylsten’s diet and one thing that I believe that is not stressed enough is to not eat any sugar. I just got my cholesterol checked and it jumped to 250, and this is while eating only plants, no added oil, no nuts, no avocado. But I have been putting a lot of sugar in my tea. So now I have jettisoned the sugar, and will get retested in two to three months. I am really scared, as before my first Engine2 conference a year ago, my doctor found via a Calcium CT scan I have atheresclerosis.

    • What were your lipid numbers before you started the Engine2 diet?

      • newsjunkie

        What’s so weird is that my cholesterol went down 100 points when I first started the diet to 228. I gave up the nuts and avocado and was really excited to get my blood results and am so discouraged (just got the new results a few days ago) that due to my genes maybe I need statins. But I read something by Dr. Essylsten recently about how sugar also needs to be jettisoned (something I’ve been ignoring) so I have stopped it. I am also now trying to eat at least one head of kale a day. My bad cholesterol this go round jumped SIGNIFICANTLY and is up to 198!! I am really scared.

        • HemoDynamic, M.D.

          In my experience and in Dr. McDougalls and Dr. Neal Barnards, in people who eat a whole food, plant based diet very low in fat (and take B12) just don’t have Heart Attacks. I have people with Total cholesterols in the 250’s and LDLs of 150 (familial hypercholesterolemia)

          • newsjunkie

            Thank you, HemoDynamic, M.D! That makes me feel better. My internist found that my thyroid level was low (I had skipped a few doses of my synthroid) and he thought that also had something to do with the spike in my cholesterol. I want to be heart attack proof: My dad had his first at 56 and died of a massive one at 72, my mom survived hers, my dad’s sister dropped dead of a massive one at 60.

          • I agree with HemoDynamic MD that stabilizing arterial disease is more about diet with some help from regular exercise and of course not smoking. We don’t have studies on persons who eat a whole food plant based diet and still have “elevated” cholesterols by today’s recommendations. In my clinical experience elevation of cholesterol can be partly due to fruit and sugar in some individuals. Remember sugar is one glucose molecule and one fructose molecule. The latter is metabolized primarily by the liver see.. and Thyroid is another factor as your doctor pointed out. I’m not sure it is possible to be “heart attack” proof but the data is clear you can certainly lower your risk to a very small number through proper lifestyle interventions.

          • Arjan den Hollander.

            Dr. Forrester. In browsing your website I came across Lupus. I’ve been a bit under the weather past week and in this weakened state I pretty much have that butterfly pattern on my face now where I only had 2 stripes on my cheeks past year. History of high protein in urine, sensitive for psychosis, photosensitive, knee problems, flare ups inflamed toes & finger tips, all in all pretty likely. I’m going to contact an old friend who I squatted a building with in the study years he is a M.D., this is just becoming too ridiculously complex now, I hope he’ll have me because the next doctor who says go do something with how you plan your day is gonna have a very rough day himself.

            My question, is there something in WFPBD that might make this condition worse?
            Would blueberries and acaii be bad for me now?

          • Matthew Smith

            Have you seen this link? A doctor was so sure that animal saturated fats were related to the explosion of MS in the post World War II world that he showed that they were the cause. He found that the vegan diet was effective as any treatment for MS. Lupus, Parkinsons, Fibromalygia and other neurological disorders might be related and the WFPBD could help. In World War II they used to treat emotional health with Niacin (VItamin B3 and Vitamin C). Dr. Hoffra, deceased, turned this into his profession in Psychology and had great numbers of patients in remission.. See this link Between the plant based diet and Vitamin B3 I think this site gives people hope.

          • Arjan den Hollander.

            Hmmm, I’m watching the McDougall video linked by Adrien about the Swank diet, and unaware of this but after the rice diet video on this site I started giving that a try a week before Christmas. With adding 3 days before magnesium I was able to go visit my mother 175 km drive away, this move to the rice diet was after I noticed myself physically recoiling when I made eye contact with women, lovely creatures don’t get me wrong. I was so overloaded that the slightest of extra stimulation of the brain literally stunned me, that was very worrying. The magnesium had the same (side)effect as diazepam, I loathe downers in general but not taking it wasn’t an option anymore. Choline a week later made me open for input again after the sedation and the hot scalp and glowing upper spine went away.

            Now from what I take from McDougalls presentation the low fat, I settled on 15% instead of 5%, might have been a solid contributing factor too. I did let the low fat slip a little bit again past 3 – 4 weeks, still moderate in almost all definitions but more around 20 I’d guess, 15% was pretty trying combined with the flax and 30 grams of walnuts. Had to settle on 20 – 20, and start measuring the sesame oil grams to get keep within the 15%.

            Update: My old friend offered to take me into his practice 70 km from here, I’m much relieved already. Had a nice conversation, tinker time.

          • newsjunkie

            Thank you, Don Forrester MD. Dr. Essylsten told us that being exact is the key and I have not been exact when it comes to sugar, including that in fruit.

          • Is Esselstyn telling people not to eat fruit now?

          • lele23

            Pretty sure he means added sugar.

          • pj

            Dr E has said that for some people they may need to limit to 3 fruit serving a day to lower the tri #… I am one of those people. Maybe because for years I was a raw foodist with a diet the contained almost all raw fruit… not what my mentor recommended… for me it was just easier to eat… So, no, Dr E does NOT recommend NOT eating fruit…

          • newsjunkie

            Thank you, Don Forrester MD!

          • HemoDynamic, M.D.

            You’re doing great! Keep it up! And even if you unfortunately meet an untimely demise (it does happen to some) you are living with the highest quality of life by taking care of yourself!

          • newsjunkie

            I hope i don’t meet an untimely demise!!

          • HemoDynamic, M.D.

            I hope so too!

          • tbatts666

            Low thyroid hormone will increase your cholesterol.

            We are behind you. Do well keeping you hypothyroidism under control.

          • newsjunkie

            Thank you. I am going to be more diligent in taking my synthroid.

          • b00mer

            Hi newsjunkie, I just wanted to share my tea experience when going vegan. I used to drink a pot of black tea with (dairy) milk every morning. When I first went vegan (apparently before I figured out how to buy non dairy milk) I immediately switched to green since it doesn’t require milk. Eventually I got sick of the green because it’s just a bit too astringent for me first thing in the morning, so I switched to white. To me the white tea with nothing added is as smooth as black tea with milk added. There’s very little astringency. Also I get a fruit/vanilla flavored blend and it actually tastes slightly sweet without any sugar. Years ago in my black tea with dairy milk days I would also add nutrasweet. Now tea with any kind of sugar/non-sugar sweetener actually tastes worse to me, and has a noticeably unpleasant aftertaste compared to plain tea. So if you can get your taste buds readjusted without the sugar, who knows maybe you’ll grow to like it better that way too. Fyi there are several varieties of white tea and I’ve found some are just as tart as green, but if you can find a nice smooth variety I think you might really enjoy it. It can look quite expensive by the pound, but it’s also much less dense than black tea. I can get about a 2 month supply for $18 at my local tea shop and I use a tablespoon per day.

            Also, if you want to go the commercial almond milk route, I personally think the blue diamond unsweetened has the least pronounced almond flavor of any I’ve tried. However, if you want to decrease fat altogether, keep in mind that almond milk, while low in calorie, is still mostly fat by caloric percentage, which might add up if you drink a large quantity of it. If you want a much lower fat milk, you might consider rice or oat milk. While they can be more expensive in the store, they are both dirt cheap if made at home. Personally I’ve found the oat milk to have a little too much oat flavor and also a gelatinous quality which I didn’t care for. However homemade rice milk I find quite dandy.

          • Devin Wiesner

            A couple years ago I stopped consuming sugar or anything sweet. The first month was challenging, after that it was quite easy. During that first month, I realized that I had developed (over many years) a habit of eating something sweet after each meal. As time went on, my taste buds changed I was able to taste sweetness in plain oats, lettuce, spinach…I’m not advocating that you avoid fruit entirely, there are certainly nutritionally dense fruits (that I now consume) in my daily smoothie. Best of luck to you.

          • newsjunkie

            I have been putting Westsoy unsweetened soy milk in my tea and decaf coffee, and drink about a carton a day (32 oz). Could this be a contributing factor too?

          • VL

            I think it might be. Wastsoy unsweetened has 5 g of fat per 8 oz serving, one of those is saturated. Esselstyn recommends non-fat soymilk or oat milk in his Prevent and Reverse Heart Disease book.

          • newsjunkie

            I am going to give that up too. Do you know of any good-tasting almond milk? I REALLY don’t like it!

          • Thea

            newsjunkie: Chef AJ shows a ***super*** easy way to make your own almond milk in the following video. She says it tastes way better than anything you can buy:

            Sorry I don’t have the minute mark where the recipe is. You’ll have to jump around, but hopefully can find it pretty easily.

          • Minute 28:00. Spoiler: AJ uses almond butter. Very quick!

          • Thea

            Thanks MacSmiley! I didn’t have time to find the spot. Very kind of you to do it.

          • My pleasure, Thea! Chef AJ is quite amusing.

          • Try the unsweetened Silk almond milk, and let us know what you think.

          • newsjunkie

            I will and let you know!

          • Ursula2007

            Make your own – it is SO much better! Half a cup of almond meal (Bob’s Red Mill makes a great one), packed tightly, to 2 cups of water. Blend for two minutes, then strain through a nut milk bag. Delicious!

          • vegank

            It’s really hard giving up added sugar but worth it. The “withdrawal symptoms” and headaches lasted 8 days for me but you won’t have cravings after that. It also helped with going Whole food as you tend to eliminate the other kinds of food naturally, like refined flour for example. The immediate and long-term improvement in my health(including energy, skin , sleep and mood) was quite unexpected. Seeing a documentary about how people’s blood-flow turns “sticky” with sugar consumption was more than enough to make me give it up.

          • newsjunkie

            Thank you, I haven’t had sugar now for a few days and don’t miss it! Drinking tea with erythritol or nothing, and finding I prefer nothing :)

          • newsjunkie

            In this video, Dr. Ornish says he takes 3 to 4 gms fish oil a day. I just bought some in the hopes it will help.

        • Hmmm. Interesting that your numbers went up AFTER giving up nuts and avocado. Those are heart-healthy foods, especially the nuts (1 ounce/day). Perhaps adding them back into your diet will get you back on track?

          • newsjunkie

            Nuts and avocado, according to Dr. Essylsten, should not be eaten by people with heart disease and should be eaten in limited quantities by others because they are not heart-healthy.

          • I’m familiar with Dr. Esselstyn’s position on nuts. And I respect where he’s coming from. However, if you watch Dr. Greger’s videos, you’ll see an alternative viewpoint based on the science. And you’ve got to deal with the reality that the changes you have made according to Dr. Esselstyn’s program may not be the best for you as an individual.

        • Kevin George

          how about your TSH?

          • newsjunkie

            exactly right. My doctor said my TSH was low and wants to retest me in two to three months. I had skipped my synthroid a few times in the week before the blood test last week.

          • Kevin George

            I ask because my friend went vegan two years ago, and TSH values quickly jumped massively and cholesterol raised. She’s was able to fix these problems by supplementing iodine, gradually increasing the dose and was able to get her tsh back to a normal value with a massive dose of iodine(100mg/day) and its cofactors(selenium).
            Not sure but synthyroid I guess solves the same problem but I think you can take both.

            I noticed with the vegetarian adventists study that the pesco-vegetarians women faired quite a bit better than vegan women. I this might be because women require more iodine and seafood has it.

          • Rob

            The LDL receptor is thyroid mediated. If TSH is off than you cannot really trust your lipid panel results.

          • newsjunkie

            Thank you, rob! That is what my doctor said.

          • Wegan

            Thats a relief!

          • Wegan

            I had a shock last week. I got my blood test back and it was TSH 5.8 LDL 177. No symptoms, well my hair is a little dry. T3 and T4 levels are within range. I assumed I was super healthy because I had been eating mostly vegan for years, then vegan for the last year. I don’t use salt, I totally stopped eating fish about a year ago, I eat seaweed but not all the time. The medical establishment says wait and see for subclinical hypothyroidism because there is no such thing as iodine deficiency in the developed world. Wait and see until you need our drugs that is. I ordered Iodoral and will take 1/2 a tablet per day for a month then go up from there. Of course it could be autoimmune so I am avoiding gluten in case there is any truth to that connection. If it turns out it was the iodine I will eventually switch to a daily serving of dulse. With flax and amla and turmeric and blueberries etc. I wonder how widespread iodine deficiency is and how many failed vegans it caused.

          • Kevin George

            THeres a video here that says 80% of vegans are deficient. Although Greger is very conservative when it comes to what he says about iodine and warns about the dangers, but those dangers seem to only come from other nutrient deficiencies… mainly selenium.

        • tbatts666

          We are behind you! Taking sugar out of the diet is tough. Dr G at some point recommended eryrithritol as being the best sweetener if you are having a tough time.

          Remember to supplement b12z

          • newsjunkie

            Thank you, tbatts666, I am using erythritol now (although yesterday was my first day using no sweeteners, and it wasn’t so awful)…

    • Julie

      newsjunkie, Just a reminder that stress itself is not good for us. I learned recently that just being stressed when getting our blood drawn will alter the results (for the worse). Meditation, relaxation exercises, walking in nature–anything that relaxes you should help improve your health and cholesterol numbers.

      • newsjunkie

        thank you! I am taking a mindfulness-based stress reduction class based on Jon Kabat-Zinn’s teachings.

    • Renee Bornfreund

      The average American consumes 156 pounds of sugar annually. It is prevalent in processed foods, soft drinks and a common add in for coffee and tea. Sugar has an adverse effect on the body and puts us at risk for diseases such as obesity, heart disease and especially Cancer. While there are sugar substitutes, the best is to completely eliminate added sugars from our diet. Once the addiction subsides so do the cravings. You might consider adding cinnamon or cardamon to your tea.

      • newsjunkie

        Thank you! I have started using a great substitute called erythritol after seeing a video on this site. Is there a study that shows that too is bad for me?

        • KWD


          While Dr. Greger has highlighted erythritol as a safe alternative sweetener, he does address three ways that using alternative sweeteners can still contribute to weight gain here:

          Additionally, Dr. Greger published a note of caution about using erythritol in this Q & A post: ( that found erythritol can increase “gastrointestinal symptoms” depending on how much fructose is also consumed.

          I’m confident Dr. Greger will let us know if additional concerns are found too! Hope that helps.

          • newsjunkie


          • Thea

            KWD: ooh, you have helped me! Your posts have been really fantastic. This one just happens to be one that has helped me personally. :-) Thanks!

          • KWD

            Thanks, Thea! I’m glad to hear that.

          • newsjunkie

            fyi I just had my first completely unsweetened cup of tea and it wasn’t so bad.

          • Thea

            newsjunkie: That reminds me of my own progression to drinking tea. When I was a kid, my only exposure to tea was in Asian restaurants and I was allowed to put in as much sugar as I wanted. I wasn’t shy. But that first, over-sweet exposure to tea turned into me liking tea naked many years later. I honestly don’t think I would enjoy tea the way I do today or be able to drink it at all if I hadn’t had the early sweet exposure.

            I’m glad you gave the sugar-free version a try. You may never like it as much as you like the sweetened kind, but you may find you can tolerate it well enough.

        • It is best to cut out all added sugar. Do you know what your fasting glucose level is? I eat a whole food plant-based diet hardly ever use added sugar but I consume plenty of fruits, which probably make up 70% of my diet. My glucose level is 92mg/dl in the range of 65-139mg/dl. My HDL is 51 and my LDL is 51. Cut out the added sugar and drink plenty of water.

          • newsjunkie

            wow, awesome cholesterol! I don’t know what my fasting glucose level is. I am cutting out all added sugar for sure!

          • Thanks. It is good that you are cutting out additive sugar but you should also know you glucose levels. Ask your doctor for your most recent blood test. Your glucose level should be on there.

    • yogini

      i too have jettisoned the sugar – the very last vestige of SAD indulgence – because i’ve just learned i have extensive calcification in my coronary arteries. left anterior descending (aka the widow maker) is the worst. just shy of 60, i’ve been vegan for 12 years, LDL of 65, well with-in weight range, no smoke or alcohol, exercise daily (yoga and walk), and all the other good stuff for healthy living. most definitely hereditary. doing baby aspirin, red rice yeast and arjuna daily. dr wants to see my LDL around 40. any and all fine points of information is most beneficial – and appreciated – as i’d like to stay as holistic as possible for as long as possible.

  • [reposted as a reply]

  • Clint Stevens

    Are people not being told what are the optimal cholesterol levels so they will become cardiology patients?

    • Rob

      No. It’s that most providers have a very rudimentary understanding of lipidology.

  • Rob

    I believe it would also be worth mentioning ApoB or LDL particle number as well. We do know that both of these are better indicators of CV risk especially when the LDLc and LDLp are discordant. Ultimately it’s the number of ApoB containing lipoproteins that’s drives CV disease and not just the cholesterol they traffic. It’s the entire Lipoprotein that penetrates the vascular wall, becomes endocytosed by the macrophage ultimately forming the foam cell etc.. Granted folks who have “normal” LDLc but yet high LDLp typically have elevated triglycerides.

    • Rami_RD2B

      Hi Rob, if you haven’t seen Dr. Greger’s discussion on cholesterol size, please see here.

      • Rami,

        Rob is not talking about lipoprotein size but about the number of particles that shuttle the cholesterol. He’s referring to the number of vehicles, not the size of the trucks.

        He’s talking about a subject Thomas Dayspring champions: When LDLs are busy trafficking triglycerides, the body generates more lipoproteins to compensate for the shortage of vehicles in order to get the same cholesterol transportation job done.

        Although I tend to believe Dayspring on this matter, I am suspicious of the financial interest he has in the company that makes the NMR machines needed to assay the particles.

        I also vehemently disagree with his buddy-buddy relationship with Gary Taubes/Peter Attia/Nina Teicholz (can’t the man do a minimal amount of fact checking, for goodness sakes?) and hid endorsement of Atkins/LCHF animal-based diets to counter IR/discordant dyslipidemia. That’s the diet he is personally following.

        • Rami_RD2B

          I misinterpreted his post and assumed particle number was a reference to size. Thanks for the correction. Also, this is my new profile name MacSmiley. You may know me as “Toxins”.

          • Oh, hi , Toxins! What’s up with the change in handle?

          • Rami_RD2B

            To come off as less aggressive, my name and thumbnail was changed.

          • Sounds good to me.

      • Rob

        Ditto on what Macsmiley said. When I draw a lipid panel (Atherotech) I do focus more on LDLp. Size is not relevant once you know how many particles you have. Even a large LDL particle is plenty small to penetrate the vessel wall. An example of this would be people who have Familial Hyoercholesterolemia, they are at a very high lifetime risk of CV disease and will typically have large particle size. I also try not to get caught up fretting over HDLc. Typically it’s low due to elevated Trigs and will rise as Trigs go down. I do dislike though referring to LDL as bad and HDL as good. Cholesterol is cholesterol. It’s the vehicle that is different. Very little of your HDLc is derived from cholesterol that has been pulled from the vascular wall.

  • Tobias Brown

    How many years does it take for LDL to base once you start on a strict plant diet? My first few months were amazing. The next two years squeezed only 10 additional points. This isn’t bringing me quite as low as I want to go (but I’m close). McDougall’s interview with Pritikin suggests that it can take up to five years.

    Are home tests for cholesterol levels effective?

  • Clem K

    I’m confused, this video says low cholesterol is the most important, but then this video says the SBP > 115 is.

    What gives?

    • KWD

      Clem, Thanks for posting this as it made me go back and review the content more closely. It seems that the two videos focus on different risk factors to major life threatening events; namely hypertension vs. atherosclerosis.

      In re-watching the “Flax Seeds for Hypertension” video, the reference to SBP > 115 is this statement from Dr. Greger: “Because having a systolic blood pressure over 115—that’s the top number—may be the single most important determinant for death in the world today.” Death, per the transcript, refers to death from strokes and heart attacks: “a drop like that could cut stroke risk 46%, heart disease 29%”.

      In today’s video, the reference to cholesterol being the single cause of atherosclerosis is the opinion of, “Dr. William Clifford Roberts…. Executive Director of Baylor Heart and Vascular Institute and long-time Editor in Chief of the American Journal of Cardiology.” Further, the transcript summarizes, “thus the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.”

      So, I would say that it’s not that one is more important than the other but that elevated measurements of either SBP or cholesterol are indicators of separate risk factors to be considered in maintenance of overall health.

  • Siberspeer

    My numbers were 200 total, 110 LDL, 36 HDL prior to my diet change. 2 years later my numbers are 170, 90, and 53 respectively. I haven’t seen a change since the first 6 weeks of a plant based diet. I’ve gone over my diet with a microscope and can’t find anything else to change. What next? How do I hit the numbers they are suggesting?

    • Rami_RD2B

      How much fat are you consuming in your diet? Tracking your intake with can be an extremely helpful tool.

    • Julie

      Siberspeer, What are your triglycerides? Your HDL is 31% of total cholesterol which is awesome (up from 18%; should be above 25%). Triglyceride to HDL ratio should be below 2, so if your triglycerides are below 105, you’re good. Now LDL is only 20 points away from 70. Exercise and omega 3 supplements (vegan algae is very bioavailable) can help reduce LDL.

      • Siberspeer

        My triglycerides are 62. I do a tablespoon of flax meal every day for omega 3 and I don’t think I can do more cardio. But thanks for the reply.

        • Rob

          Your lipids are better than the vast majority of folks out there. It sounds like you’re really making positive health changes. Keep up the good work, keep watching the great info that’s posted here and don’t fret over your LDL of 90. Chances are its a calculated LDLc and inaccurate anyway.

  • Snafu8

    My original numbers were Total 200, LDL 110, HDL 36. After 2 months on a plant based diet they were 170, 90, and 53 respectively. That was 2 years ago and they haven’t changed. I’ve gone over my diet with a microscope and I can’t find anything else to remove. I try to be very strict but something isn’t working. My numbers are good, but they aren’t in the ranges that are suggested above. 50 to 70??? I wish. What else can I do?

  • Rick

    PLEASE comment on the new cholesterol guidelines when they come out — I wonder who is on the comittee?

  • Jason Huang

    Does anyone here question the validity of the lipid theory?
    Clinical data do not support the lipid theory.

    • You’ve been listening to Gary Taubes/ Nina Teicholz perchance? If yes, I suggest you check out the fact checkers:

      Evelyn Kocur

      Seth Yoder

      And James Krieger has done an excellent job deconstructing Taubes on the subject of insulin.

      • Jason Huang

        Why did you assume everyone questions the lipid hypothesis was in Taubes camp?

        What about “Honolulu Heart Program” study?

        What about ” Japanese Lipid Intervention Trial”?

        • Because of their recent prominence and influence in the matter. The whole “lipid hypothesis” denialism started with Uffe Ravnskov, and all his inaccuracies have been echo-chambered by Taubes/Techolz/the anti-vax Weston A Price Foundation and others. What they say certain studies suggest is often just the opposite.

          Plant Positive addresses the Honolulu and Japanese studies you bring up.

          • Jason Huang

            Most heart attack patients’ cholesterol levels did not indicate cardiac risk

          • Rob

            This is true, though much of that is just the guideline levels are not physiologic. As Dr Greger said in the video physiologic LDLc levels are around 40 or so though for a low risk person the guidelines consider 130 to be normal. The other reason is related to what I said earlier about the particle number. You can have a low LDLc but still have a huge number of athrogenic particles trafficking that cholesterol. And then there are other factors such as Lp(a) levels.

          • Jason Huang

            There are many papers showing the association between stress and high LDLc/Lp(a). Shouldn’t we ask if the diet factor is not as nearly important as physical and psychological stress?

          • Thea

            MacSmiley: I thought your first post was so helpful because you gave references to specific fact checkers. I was going to ask why you didn’t include Plant Positive. Happy to see you snuck him in here. :-) All those sources together make for some really powerful evidence.

    • What do you mean by “the lipid theory”? the theory that lipids do what?

    • What do you mean by “the lipid theory”? the theory that lipids do what?

      • Jason Huang

        Quote from Wikipedia:

        The lipid hypothesis was described in 1976 as the premise that
        “measures used to lower the plasma lipids in patients with
        hyperlipidemia will lead to reductions in new events of coronary heart disease”.[1] Another formulation is that “decreasing blood cholesterol… significantly reduces coronary heart disease events”;[2] this discussion is also referred to as the “cholesterol controversy”.[3] It is closely related to the saturated fat and cardiovascular disease controversy.

      • Jason Huang

        Quote from Wikipedia:

        The lipid hypothesis was described in 1976 as the premise that
        “measures used to lower the plasma lipids in patients with
        hyperlipidemia will lead to reductions in new events of coronary heart disease”.[1] Another formulation is that “decreasing blood cholesterol… significantly reduces coronary heart disease events”;[2] this discussion is also referred to as the “cholesterol controversy”.[3] It is closely related to the saturated fat and cardiovascular disease controversy.

  • Cristina Sebastian

    I am totally puzzled. Not long ago, I attended a conference of a very trustworthy doctor, specialized in nutrition and plant based diet. He assured that the numbers for high cholesterol risk were exaggerated, and that Big Pharma has been lowering them in order to get more clients for their statins. He said that you can have 350 total cholesterol and be fine. So I stopped worrying about cholesterol. Now that I read this, and I remember my last blood test showing HDL 74.8, LDL 136 and total cholesterol 223, I wonder… how? and do I really have to worry? I eat a good, balanced, varied plant based diet. Why is my cholesterol that high? I only make little exceptions like dark chocolate every now and then, I love bread and cereals but always dark and organic. I love coconut milk as well, but surely that doesn’t give you cholesterol as there’s no cholesterol in vegetable foods? Please help!

    • Hmm. Who is this “very trustworthy doctor”??

      • JHoltz

        Any doctor who speaks against bigpharma is a trustworthy doctor to me. As for Christina’s point, I wonder if the reference range for cholesterol is different in other countries.

        • Any doctor who speaks against bigpharma is a trustworthy doctor to me.

          Sounds ideologically dogmatic to me. Anti-Big Pharma ideology has directed people to bogus supplements and all kinds of alt-med woo, some of which can be quite harmful.

          Dr. Greger would agree that lifestyle change should be first line defense and prevention, but that drugs have their proper place and can even save lives.

          • Psych MD

            Excellent point. It is interesting how “Big” has somehow become synonymous with “Bad.” If it weren’t for “Big-Pharma” we’d still be lobotomizing psychiatric patients.

          • fred

            “We” are chemically lobotomizing psychiatric patients? Patients “appear” to be improved…but they are subjectively zombified. They have no real interior life. Makes it easier for the nurses and orderlies? The patient is in a form of suspended animation…zombified. I think that around 40% of people in nursing homes are psychiatric patients? The other 60% probably get some of the same drugs. Makes it easier for the nurses and orderlies?

      • Cristina Sebastian

        Hi Mac! Well, he is a Southamerican doctor, expert in nutrition (plant based), I can’t remember his name now, but at the conference he was presented as an expert with more than 30 years experience, everyone was saying how good he was, and everything he said (basically most things Dr Greger says), made lots of sense to me, so I was surprised to hear about the cholesterol thing, which I have heard from other Naturopathic doctors as well.

    • Julie

      Remember that saturated fat raises cholesterol, even vegan forms. Coconut and chocolate (cocoa butter) are very high in saturated fat. Also, I’ve heard ratios are important. At 34%, your HDL is well above the recommended 25%+ of cholesterol. Triglyceride/HDL should be below 2 so if your TG’s are below 110, you’re good. Exercise and DHA/EPA (vegan source = algae oil) also help reduce LDL.

      • Cristina Sebastian

        Thanks very much Julie! The thing is my HDL is just above the recommended level, and my LDL is within the safe limits, but my triglycerides are very low. Does that make sense? I excercise quite a lot, and regularly, and take a vegan DHA/EPA. Thanks again!

    • Tara Martine

      Cristina, there are a lot of factors that can play into your lipid numbers. Reducing saturated fat, trans fat, cholesterol, and animal products in your diet will be the best way to reduce your total cholesterol. Ideally, you want total cholesterol to be <150 mg/dL. Studies show that in populations where cholesterol is <150 mg/dL, heart disease & heart attacks are very rare.

      LDL cholesterol is an independent risk factor for cardiovascular disease. The lower your LDL the better. Ideally LDL should be <70 mg/dL, as these are the levels shown to correlate with reversal of atherosclerosis. You can reduce LDL by increasing consumption of beans, fruit, vegetables, whole grains, nuts, & seeds. Decreasing processed oils, saturated fats, trans fats, & cholesterol intake will help reduce LDL.

      HDL is your “good” cholesterol. It is involved in transporting cholesterol back to the liver, which ultimately results in less cholesterol buildup in plaques in the arteries. For every increase of 5 mg/dL in HDL, there is a decrease in risk of 11%. HDL may be increased by weight loss, quitting smoking, & increased exercise (ideally 1,500-3,000 calories burned per week).

      Triglycerides are fats that may be stored or burned for energy. High triglycerides are an independent risk factor for heart disease and can contribute to atherosclerosis. Ideally triglycerides should be maintained <90 mg/dL. Weight loss, decrease in intake of refined oils, animal fats, alcohol, sugar, and processed foods can reduce triglycerides. Exercise, fiber rich foods, fruits, and vegetables also help to reduce triglyceride level.

      Studies on children show us that the sooner we start making these types of changes the better. This Dr. Greger video explains how heart disease actually starts in childhood and that kids as young as 10 years old have fatty streaks inside their arteries. Unbelievable but true!

      • Rob

        Tara, the amount of cholesterol that is trafficked by HDL that comes from the vascular walk is infatisimly small. Reverse cholesterol transport is a minor roll of HDL. It’s likely main purpose as far as lipids go is transportin CE to the steroidogenic organs. HDL also gives a fair amount of its cholesterol to LDL particles via CETP.

      • Cristina Sebastian

        Thanks very much for your detailed explanation, Tara, much appreciated! The thing is I am vegan, and have been for many years, my LDL is low and my HDL is high, but my total cholesterol is 230. I am really not that worried, as my vegan diet is very balanced, but you can’t help getting confused when you hear respected professionals say the very opposite thing from one another. I guess I’ll just continue with my ways and eat what I like without worrying too much. Probably the stress of wondering if you are doing the righ thing is worse than anything else. :)

    • Joevegan

      A plant based diet may not lower your cholesterol, but a low fat (10%)whole-food plant based diet may help. Coconut milk has a lot of saturated fat…not good for lowering cholesterol.

      • Cristina Sebastian

        Thanks Joe! Still, coconut products have good press as being the only saturated fat that is good for you. I really don’t know what to believe anymore. I think I will just eat anything I please (plant based, of course) in moderation, and that will probably keep me healthier than worrying about if this or that is good or bad.

  • Julie

    Many cardiologists also recommend LDL below 70. But what about ratios, LDL particle size and number? Cardiologists place importance on these as well. HDL should be 25%+ of total cholesterol and the triglyceride/HDL ratio should be below 2.

  • donmatesz

    Not everyone who eats a plant-based diet will get their total cholesterol under 150 or their LDL below 70. At 3:37 in the video Dr. Greger refers to this study which found “Mean and standard deviation for TC were 208.09 +/- 49.09 mg/dl in the group of omnivores, and 141.06 +/- 30.56 mg/dl in the group of vegans (p < 0.001). LDL values for omnivores and vegans were respectively: 123.43 +/- 42.67 mg/dl and 69.28 +/- 29.53 mg/dl (p < 0.001)." The mean and deviation values indicate that in this study vegans had TC ranging from about 110 to 171 mg/dl, and LDL ranging from about 40 to 100 mg/dl. IMO stating that we all should have cholesterol under 150 mg/dl is like saying that we all should be less than 5'8" tall because research shows that shorter people live longer. The fact is each of us is a unique individual with a signature low cholesterol just like a signature fingerprint. Eating a plant based diet will probably get your TC as low as YOU can go, but it might not be as low as someone else's. That doesn't mean you won't have protection against atherosclerosis. All of these reports deal with means and averages, Your own mileage may vary.

  • Cristina Sebastian

    Thanks Donmatesz, this is helpful! I also have to say that my tryglicerids level is very low, so that must mean something.

  • Alan

    My guess is the reason that they do not lower the ideal cholesterol level is because of the money that would be lost by the meat and dairy industry !!!!

  • charles grashow

    I eat a whole food diet that includes meat, dairy and eggs in addition to fruits, veggies, nuts, seeds, etc. I take 10 mgs Atorvastatin/day in addition to other supplements.

    Last blood test was 9/2/2014 – I will be going for another blood test next month

    Fasting Glucose – 83 mg/dl
    hs-CRP – 0.9 mg/l
    TC – 120 mg/dl
    HDL – 54 mg/dl
    TG – 50 mg/dl
    LDL (calculated) – 56 mg/dl

    LDL-P – 1011 nmol/l
    LDL small – 184 nmol/l
    LDL medium – 164 nmol/l
    HDH large 5946 nmol/l

    ApoA1 – 138 mg/dl
    ApoB – 59 mg/dl
    ApoB/A1 ratio – 0.41

    HA1C – 5.7% of total HGB

    Homocysteine – 9.9 umol/l

    CAC – 47 (taken 2/14 – up from 30 in 12/07) so the rate of progression has slowed to a crawl) Plaque is on the LAD (the widow maker)

    • UCBAlum

      I shouldn’t be surprised someone would try to sell a “take a pill and eat whatever you want” solution over eating right, but I am. I think your post is an implicit acknowledgement that your diet is “eating wrong”, am I correct….or would you like to backtrack a bit? Or, maybe it’s just someone passing along information to others…in which case I would like to point out the following:

      I get the same result eating vegan, and for that I get a ton of health benefits…unlike those who take Atrovastin, which face a ton of potential harm, including:

      difficulty with swallowing
      fast heartbeat
      muscle cramps, pain, stiffness, swelling, or weakness
      puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
      skin rash
      tightness in the chest
      unusual tiredness or weakness
      Blistering, peeling, or loosening of the skin
      dark-colored urine
      joint pain
      large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
      red skin lesions, often with a purple center sore
      red, irritated eyes
      sore throat
      sores, ulcers, or white spots in the mouth or on the lips
      lower back or side pain
      pain or tenderness around the eyes and cheekbones
      painful or difficult urination
      stuffy or runny nose
      Abdominal or stomach pain
      back pain
      belching or excessive gas
      general feeling of discomfort or illness
      heartburn, indigestion, or stomach discomfort
      lack or loss of strength
      loss of appetite
      trouble sleeping
      Appetite increased
      black, tarry stools
      bloody nose
      bloody or cloudy urine
      blurred vision
      continuing ringing or buzzing or other unexplained noise in the ears
      difficult, burning, or painful urination
      difficulty seeing at night
      excessive muscle tone or tension
      fruit-like breath odor
      groin or scrotum pain
      inability to have or keep an erection
      increased body movements
      increased sensitivity of the eyes to light
      increased sensitivity to touch or pain
      increased thirst
      increased urination
      loss of bladder control
      loss of sexual ability, drive, or desire
      menstrual bleeding occurring earlier or lasting longer than usual
      mental depression
      pale skin
      pinpoint red spots on the skin
      slurred speech
      swollen or tender lymph glands in the neck, armpit, or groin
      unable to move or feel face
      unusual bleeding or bruising
      weight loss

      • charles grashow

        ZERO side effects.

        • UCBAlum

          I did not mean to imply that side-effect free equals risk-free. The drug you are so pleased with carries substantial risks…and for what….so you can continue to eat the foods that caused your disease in the first place and caused the situation in which you now have to take Atrovastin?

          Do you see any problem here?

          • charles grashow

            I have more information than you could possible imagine and I choose not to follow a vegan diet/lifestyle whuich I believe is not the healthiest. If my next CT scan shows plaque regression what will you say then??

          • UCBAlum

            Putting aside for now the issue of whether or not I can imagine the amount of information you possess, I would welcome a comment from you in the future letting me know that a CT scan shows plaque regression. If that happens, reply to this comment and we won’t have to deal in hypotheticals. I have only seen that happen to people on diets far stricter than yours, so I would certainly have to cross that bridge when and if I came to it. For what it’s worth, I certainly hope that for you, but based on your diet I don’t think it will.

          • charles grashow

            I will save this page and reply when I take it. However, there are studies that show plaque regression with ultra low LDL with statins.

            Effect of a Combined Therapeutic Approach of Intensive Lipid Management, Omega-3 Fatty Acid Supplementation, and Increased Serum 25 (OH) Vitamin D on Coronary Calcium Scores in Asymptomatic Adults

            William Davis, MD, FACC,1* Susie Rockway, PhD, CNS,2 and Mary Kwasny, ScD3

            The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS ≥50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides≤60 mg/dL; high-density lipoprotein ≥60 mg/dL; and vitamin D3 supplementation to achieve serum levels of ≥50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%–29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%–71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.

            Our findings lend support to the concept that dietary changes and the addition of omega-3 and vitamin D3 supplements to pharmacological therapy targeting LDL cholesterol 60, HDL 60, and TG 60 mg/dL may slow or reduce progression of coronary calcium scores in a substantial proportion of patients. The precise parameters that will be necessary to achieve consistent reductions in coronary calcium scoring have yet to be determined. Whether or not reductions of calcium score will also yield concomitant reduction of coronary events is a tantalizing, but unproven, prospect.

          • UCBAlum

            Thanks for the citation. I will check it out. And thanks also for being open to revisiting this conversation if you get some plaque regression.

          • charles grashow

            The fact that the plaque burden has only gone from 30 to 47 in 6 years plus the fact that I lowered my SFA consumption and started the statins 2 years ago leads me to believe that the progression has slowed dramatically. Arterial plaque normally progresses at a rate of 20-35% per annum so the next step should be regression. We shall see

          • UCBAlum

            Based on what I know those are indeed far better than average numbers, but it sounds like your goal is reversal, which is admirable and I believe likely doable based on studies done over the past decade that to my amazement still don’t get as much attention as they should given the prevalence of heart disease in the US. But, you’ve no doubt seen them, and you’re here at, which is a great resource. You’ve probably also run into doctors like Esselstyn and McDougall who promote diets that do the very thing you’re trying to do. I look forward to hearing how it’s going down the road.

          • Rob

            I would think your LDLp would need to get somewhere below 750 before you saw regression.

          • charles grashow

            I’m curious as to why my LDL-P is slightly over 1,000 even though my ApoB and LDL-C are both <60. Any thoughts?

    • jason

      Ha1C number is a bit high.

  • UCBAlum

    You’ll hear no argument from me about the negative impacts of cholesterol on artery health…

    but is it true that dietary cholesterol has no significant impact on blood cholesterol, and what do you make of the government’s plan to withdraw its warning about eating high amounts of cholesterol or high cholesterol-containing foods in its official dietary guidelines?

    • dogulas

      The USDA has massive conflicts of interest. Its job is to promote U.S. agriculture industries, not public health. We’re idiots to accept dietary guidelines from the milk and meat industries.

    • pbdoc

      They are being influenced by the egg industry and a couple poorly interpreted studies by david katz I believe. Hence, they’re just loosening their recommendations on dietary cholesterol intake.

      It is in fact very true that dietary cholesterol impacts blood cholesterol – but only does so substantially when blood cholesterol is not high. So if you have high cholesterol (lets say from eating meat dairy and eggs everyday) and you add 1-2 eggs on top of that unhealthy diet, you will not see a significant rise in blood cholesterol. However, if you give someone on a whole food plant based diet 1-2 eggs, you’ll see their cholesterol rise considerably. Just like if you took a 1pack a day smoker and gave him a few extra cigarettes, think it would make that much of a difference to his lungs? No, but give someone who’s never smoked before a few cigarettes a day and you’ll see significant damage pretty soon.

      • UCBAlum

        Makes perfect sense but it also makes me fear for the future of humanity.

    • RAslam RD

      You raise an important question in light of the recent news that the 2015 Dietary Guidelines for Americans may drop the recommendation to limit dietary cholesterol. I wanted to expand on the points that pbdoc brought up in response to your question.

      One issue with the research on the relationship between dietary cholesterol and serum cholesterol is that many studies have not accounted for the effects of baseline dietary cholesterol. Serum cholesterol rises if you add foods high in cholesterol to a diet that was low in cholesterol to begin with. However, if you are already eating a diet high in cholesterol, adding more may not raise your serum cholesterol further. This meta-analysis illustrates the problem when baseline dietary cholesterol is not accounted for.

      As Dr. Greger discusses in this video the Institute of Medicine has not set a Tolerable Upper Limit for cholesterol (or saturated fat and trans fats for that matter) because any intake of dietary cholesterol above zero is linked to an increase in LDL (bad) cholesterol.

      One of the arguments that is being made for changing the Dietary Guidelines for cholesterol is that, compared to saturated fat, dietary cholesterol does not have as much of an effect on heart disease risk. This may be true, as this meta-analysis shows, reduction in dietary cholesterol by 200 mg per day did reduce serum cholesterol, but replacing saturated fats in the diet had a greater effect. However, saturated fat and cholesterol are often found together in the same foods, and one can argue that it may be just as useful, if not more so, to study the effect of whole foods, rather than focusing on a single nutrient.

      I think the major response of the media to the news about DGA dropping its cholesterol restriction has been, “Woo-hoo, eggs are safe to eat again!” So it may be of interest to look at some of the studies on egg consumption. The Framingham Study did not find an association between egg consumption and serum cholesterol levels, however they also note that none of their subjects actually had a low dietary cholesterol consumption. The Physician’s Health Study did not find an association between egg consumption and increased risk of heart attack or stroke but did find a significant increase in all-cause mortality with higher egg consumption and the effect was greater for those who have diabetes. Egg consumption has also been shown to increase atherosclerosis and diabetes as Dr. Greger discusses here and here.

      Hope you find the information useful!

      • UCBAlum

        I did find it useful – thanks. I’ll look forward to the longitudinal study of 20 vegans that measures changes in cholesterol that result from feeding ten of them eggs daily.

  • jj

    Personally I think, and this has no validity, that in our reductionist way of thinking that stressing the cholesterol level has taken too much importance over emphasizing a healthy diet and lifestyle.

  • Arsenic Concern

    OFF subject. Had a hair analysis. Slightly raised arsenic level. What does anyone know about the validity of hair analysis and how to lower arsenic levels? There are several videos about arsenic in food products but nothing I found that says how to reduce the levels once they are in the body. Will have my water tested again but it has never shown any before.

    • Lauren Bateman

      Arsenic Concern: See Dr. Greger’s video: which has the latest information in it. The best we can all do is limit as much as possible further consumption of chicken and foods poisoned from the environmental dumps.

      • Arsenic

        I’ve been WFPB for 5 years McDougall style, no processed food. No meat for 20 years before that. Last 5+ yrs have been very careful about eliminating food with toxins.

        • Lauren Bateman

          That’s wonderful, Arsenic: I hope you’ve realized many health benefits; relax, then: no need to worry :)

          • Arsenic

            Thank you, Lauren.

      • Don’t organic farmers sometimes use chicken poop for fertilizer? Fortunately some of the arsenic in chicken feed was recently outlawed.

    • lele23

      Arsenic, if present in the groundwater, clings to the outer layer of rice. The reason it’s present in some areas in dangerous amounts is due to run-off from the chicken industry. Unfortunately, in the U.S., much of the rice grown (in Arkansas and Louisiana) happens to be downstream from poultry farms. To minimize the amount of arsenic in rice, rinse it before cooking, and then cook it in lots of extra water (like cooking pasta) and drain off the water. Or buy rice grown in other parts of the world, such as India or Pakistan, where arsenic amounts are negligible.

  • Adam

    The study referenced in the clip showed the mean LDL for vegans was 69.28, right at the cutoff for optimal LDL levels. So, It appears half of all vegans will need to be on statins in order to lower their LDL to the optimum range.

    If so many vegans on a strictly plant based diet need cholesterol lowering drugs to reach the recommended target LDL, there’s no doubt it would prove frustrating to the average person to try and lower their LDL cholesterol with diet alone. And sadly, even if the entire population went vegan, in order to bring everyone’s LDL down to the heart attack proof range, drug therapy would still be necessary for half of us. Am I missing something?

    • Lauren Bateman

      It’s much more optimistic, actually, Adam: the whole food plant based only, or vegan diet, is optimal: Dr. Greger says vegans ‘nail it’ under 70, and ends with saying that all folks deserve to know this WFPB lifestyle answer to our epidemic, so they don’t get frustrated finding out they weren’t informed of this vital true answer :)

    • dogulas

      Being vegan says nithing of exercise. I would feel comfortable assuming that most vegans could get their LDL down to an optimum level with significant exercise. Vegans can be unhealthy as crap.

  • dogulas

    So if my LDL is in the 40’s or lower, should I be worried at all? For example…37… :) (total cholesterol 99)

    • Lauren Bateman

      That’s right, dogulas: no worries at all should you have; just maintain all you are positively doing in your daily lifestyle!

      • dogulas

        I wonder if people who tend to have lower cholesterol have ancestry who lived on greater amounts of meat long ago. That would sure be interesting.

        • Lauren Bateman

          Interesting thought, who knows? The great news is you have a healthier than most cholesterol, which reduces your cancer risk too; good for you :)

    • Thea

      dogulas: The following NutrionFacts video addresses the question of low cholesterol numbers:

  • Interesting. Yay for vegan diets! Now, we need to get our loved ones on board.

  • Matthew Smith

    Dr. Greger has shown that the vegan diet, whenever you can use it, for as long as you can use it, can reduce your heart disease and improve your life and fix heart disease risk. This video suggests only vegans, a minority in today’s society, have ideal numbers for LDL, but does again validate their lifestyle choice for heart health and suggests that they alone will never have a heart attack. Only vegans though have this benefit, in contradiction to the federal government’s assertion that eating cholesterol does not raise cholesterol, something that ironically seems to be the opposite of truth, that cholesterol eaten is jealously guarded. To lower cholesterol, this site recommends: nuts (particularly almonds), whole grains (like Cheerios), flax seed meal, kiwi, grapefruit, red yeast rice, dried apples, amla, and beans like chickpeas. Perhaps eating some of these foods can endow a partial benefit. There are some activities that can reduce heart disease risk, like eating beans, drinking tea, eating nuts, eating whole grains, taking an aspirin a day*, drinking one drink a day*, eating cocoa or dark chocolate, eating kiwi, getting 10 minutes of exercise a day, eating soy, eating citrus, eating tomatoes or juice or paste, eating leafy vegetables (spinach, broccali, or kale), eating flax seeds, and eating beets. *not highly recommended here for the healthy. This video offers specific advise on how to lower heart disease risk.

  • newsjunkie

    Thank you to everyone who has commented on my post. It has been so incredibly helpful and have already decided to make further changes in my diet, namely to stop my final guilty pleasure– putting Westsoy unsweetened soymilk in my tea or decaf and adding sugar or erythritol. Thanks to everyone for your suggestions, as you know it is very difficult in our society to eat a whole food, plant-based, no-oil added (and for me no sugar added) diet. Anyone know of a decent-tasting almond milk? I can’t STAND it!!

    • Lauren Bateman

      Newsjunkie: I hope it gets easier for you — are you noticing any health benefits? I find it easy at home, since it’s just what’s okay to consume, instead of all the bad choices to avoid ‘out there’. Do you like almond butter, or have whole almonds at home – and a blender? 2-3 tablespoons of either in a blender with water — whirls up to a nice almond milk you might like. Just enjoy trying each until you find what you like, or a different nut milk like hazelnut, hemp, or oat, etc. — you might like more :)

      • newsjunkie

        Thanks for the suggestion! I am noticing health benefits such as feeling great!

        • Lauren Bateman

          Sure thing! Awesome ~ happy for you!

    • JohnG

      I don’t get that you are trying to cut out nuts from your diet and want to drink almond milk.

  • editor_d

    I’ve been eating WFPB/non junk food vegan for 3 1/2 years now and my LDL is 98 with triglycerides at 208. I exercise 2-3 times a week and weight only 145lbs at 6″ tall. It’s a bit frustrating to see these numbers but the hell if I’m going to start eating meat again.

    • Lauren Bateman

      I hear you editor_d — I do the WFPB non junk food vegan lifestyle too and still need lower numbers. I agree, and the science supports not going back to meat: that would certainly be the wrong direction to go, for all the preventive reasons.
      What I am going to try is daily exercising half an hour, at least, by walking nonstop outside. Want to be my cyber partner on this?

  • tkramer

    My question is: does’ high body-fat’ generally mean ‘high-cholesterol’, and therefore ‘low body-fat’ generally means ‘low cholesterol’…?

    I try to keep my body fat levels at around 10% via WFPBD and daily exercise.

  • Tobias Brown

    Say a person stays on the standard American diet… How strongly is cholesterol level correlated with BMI or body weight? Or, do skinny people who eat SAD have similarly high cholesterol levels as heavy people?

    • jj

      My neighbor slim on low-fat SAD cholesterol runs 225-250.

  • R. Mati

    Please need some help… and it help other like my case too…

    My total cholesterol level were 6.8 mmolL and I was told that is from my gene and there is nothing I can do much about it, so I decided to go vegan for the last 7 months … and guess what …. the Cholesterol when up to 7mmolL I WAS SHOCKED.

    Now the doctor wants to put me on Statin as I have family history of heart attacks.

    I am 42 and never smoked and I have lost 15 Kg and I am planning to lost another 5 Kg so that I will be in my optimal weight.

    Do I need to continue with the Vegan diet or should I take the Statin…

    Thanks Dr. G

    • Wegan

      It could be that the thyroid issues are making your numbers look high. Are you eating seaweed for iodine?

      • R. Mati

        I am eating sushi from time to time.

  • Treehouse in paradise

    Thanks to you, Dr Gregor, Dr McDougall, Dr. Esselstyn, et al; my labs came back today and my LDL is 85. So grateful!

  • mlev5

    Has it been proven that for people with high cholesterol… taking statins will lower their heart attack risk? Live longer?

  • tkramer

    A doctor at the Red Cross where I go to give blood tells me this: vi) “Cholesterol in food has no impact on cholesterol in the blood and we’ve known that all along.” Ancel Keys.

    He is in his late 70’s. and eats 3-5 raw eggs a day.

    Ancel Keys, the same man who did the brilliant Minnesota starvation experiment, spent the 1950’s trying to show that cholesterol in food was associated with cholesterol in the blood. He concluded unequivocally that there was not even an association, let alone a causation. He never deviated from this view.

    Cholesterol is only found in animal foods (it is a vital substance for every living creature). Hence the only foods that Keys could add to human diets, to test the impact of cholesterol, were animal foods. Given that he concluded that eating animal foods had no impact on blood cholesterol levels, it follows that animal foods per se have no impact on blood cholesterol levels (not that high cholesterol is a problem – quite the contrary – but that’s another story).

    There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products etc for any cholesterol that they may contain, or for any other reason.

    The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.

    Ref 1: EH Mangiapane, AM Salter, Diet, Lipoproteins and Coronary Heart Disease: A Biochemical Perspective, Nottingham University Press, (1999). (See reference 159 The Obesity Epidemic)

    • UCBAlum

      My total cholesterol hovered in the mid to high 200’s all my life. 40 years…until I went vegan…

      and it dropped and stayed below 150.

      That must be because animal foods have no impact on blood cholesterol.

      • tkramer

        “There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products etc for any cholesterol that they may contain, or for any other reason.”

        UCBAIum…I don’t buy it either, but this info is out there and being given top billing by ‘experts’.

        • UCBAlum

          It’s unfortunate. The USDA is tasked with promoting US agriculture in the US and throughout the world, which means it’s a business advocacy group, and there exists a revolving door between the chemical and processed food industries and USDA senior management, which means corporate managers driven by maintaining and increasing the profits of their companies and their industries are setting public policy.

          Their bunk permeates other groups like the AMA, the result is death, and that’s just for starters.

          Death is literally the cost of setting dietary guidelines not by the guidance of health promotion but by the benefit of the food and agriculture industries. And the benefit is what? What are “we” getting in return for all that death? That would be protecting the profits of some companies, so “we” aren’t really getting anything. “We” just suffer the cost of this public policy failure.

          The result is also massive human misery. I wonder if the millions of teens now obese with what we used to call “adult onset diabetes” but stopped because we’re in the midst of an epidemic of childhood-onset diabetes are happy. I wonder if the person who can’t walk a flight of stairs because of their diet-caused diabetes or heart disease or obesity is happy, or an optimally productive member of society.

          I would strongly suggest they are not, and our public policy – specifically the promotion of profits over health – is clearly to blame.

          Out of disgust, people are beginning to revolt against the tobacco company-esque tactics of processed food, chemical company, and beef, dairy, and other industry advocacy groups. GMO labeling laws, sugar warning labels, A sugar-sweetened beverage tax in my city and I’m sure in the future others, and of course the myriad dietary advocacy groups and websites like that exist to fill the void left by a failed public policy.

          And when it’s all said and done, you know who will be the casualties? That will be the millions of people – men, women, and children – who sickened and died, or lived in misery because our government failed to do the thing a government needs to do, which is advocate for the health of its citizens and set policy accordingly. It will also be society as a whole, because untold trillions in human capital and national wealth will have been squandered as they were replaced by misery and disease.

          And the casualty will also be faith in the idea of collective self-government itself. If our government lied to us…failed to step in and give us the truth…failed to give us information to protect us and protect our health…and not only that, our government actually told us stuff they knew to be untrue because doing so led to higher profits for some, and they did so knowing it would lead to disease and death…well, I’m afraid that’s something that just can’t stand, and you can make a strong argument that our 250 year old experiment in self-government has failed.

          Dramatic, yes, but not overly so. There is in my view just one thing that could end this country as we know it. That thing is a loss of faith and distrust that results from being lied to repeatedly, covertly, and intentionally, by people looking out for their own self-interests willing to do so even if it leads to death and misery for millions of men, women, and children.

          /rant, though I could continue.

    • largelytrue

      A doctor at the Red Cross where you give blood “tells” you material that is exactly as if it were copied verbatim from this site: ?

      • tkramer


      • Hmmm, as in lifted word for word! This myth? BUSTED!
        Thanks LT

        • tkramer

          Wasn’t lifted. Was attempting to ‘quote’…neglected the ‘quotes’. Reference at the bottom of unquoated quote.

          • b00mer

            “Attempting to quote” with a fictional story inserted about being told all of this by a raw egg eating red cross doctor?

    • I would agree that our bodies are designed to help us survive. I believe that the balance of science over the last number of years supports that we should minimize the intake of animal products. Looking at it from a systems perspective our biological system is a “hind gut fermenting herbivore” who was a “hunted gatherer” until we invented weapons to hunt. Our food has changed substantially over the last 100 years. Given processing and the addition of chemicals to our food either directly or via the environment we need to minimize the intake of persistent organic pollutants. We can consume many things that are harmful but we don’t get sick immediately. Not only is it a matter of time but also amount (i.e. the dose makes the poison). Cholesterol is necessary for our bodies but taking in more than we need may not be the approach which leads to the best long term health.

    • Darryl

      There’s most definitely an effect of dietary cholesterol on serum cholesterol as determined in metabolic ward studes, only the effect size within “normal” dietary variation is small (100 mg add’l might be expected tor raise TC 2.2 mg/dl) compared to the effect size from other modifiable factors, like dietary saturated fats. For those of us on cholesterol free diets and with very low blood levels, dietary cholesterol is more efficiently absorbed.

      The current wave of Mendelian randomization studies, in which genetic predispositions to elevated risk markers are correlated with clinical events, offers best evidence to date that elevated LDL plays a major causal role in cardiovascular disease in humans: (1, 2, 3, 4).

      Your body isn’t actively trying to kill you, but nature seems indifferent to our fates after our reproductive years. The modern era, with increased dietary cholesterol and saturated fats (both of which increase blood levels), and decreased dietary phytosterols and intestinal worms (which formerly reduced cholesterol levels) have dramatically increased life long exposures to elevated LDL.

      • I might have already asked this. What is a metabolic ward study?

        • Darryl

          Metabolic ward studies are medium term (days to months) nutrition studies where all food is provided to subjects, commonly conducted with volunteer prisoners in prison hospitals. These are the most “controlled” studies in humans, but due to their high expense and some ethics concerns with incarcerated subjects, are less common than in their 1950-70s heyday.

    • Thea

      tkramer: re: “The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.”
      Your logic escapes me. The body makes bone and cells and blood too. And too much of any of those things or when put in the wrong place will kill you. We are talking about disease, which could be thought of as a natural process going awry. For example, when a body makes say too many red blood cells or not enough of them. The fact that your body makes cholesterol is irrelevant.

      Another way to think about it: Your statement is a strawman argument when the questions are: 1) Does dietary cholestrol lead to increased cholesterol in the body? and 2) Is increased cholesterol in the body an indication of increased risk for heart disease and early death? We have clear answers to both of those questions. You can find out some of the science behind these questions and answers here on NutritionFacts. This video is one great example. But since Ancel Keys work is so important to you, I highly recommend taking a look at the videos from who directly addresses Ancel Key’s work as well as the questions being discussed. It will be an eye opener for you.

  • M85

    My LDL is 51 after one year of being a vegan.

  • smith

    there is this diet call balance point diet that cut out grains ( which is a staple of all vegan diet ) and the heart turn back the clock by 30 years.

    Then, for two weeks, he played the guinea pig. He drenched everything from kale salads to steamed okra with olive oil and ate only the most low-fat proteins such as fish and egg whites. Every day, he kept his dietary intake within the above percentages and cut out all grains, starchy vegetables and saturated fat — fat originating from an animal sources — to solve his cholesterol problem.

    Cholesterol, a soft, fat-like substance both manufactured by the liver and supplied by diet, helps maintain health by circulating through the bloodstream to generate cell membranes and some hormones. But too much cholesterol can stick to vessel walls and clog blood flow enough to produce a heart attack or stroke.

    Doctors measure cholesterol in two basic ways. High-density lipoprotein, or HDL, carries cholesterol away from the arteries and is therefore dubbed “good cholesterol.” Low-density lipoprotein, or LDL, clogs arteries and is considered “bad” cholesterol. Those with unhealthy cholesterol counts ultimately aim to bring good cholesterol numbers up and bad cholesterol numbers down.

    Selby’s doctor balked at measuring his cholesterol counts after just 14 days. But the results seemed to back the Boulder man’s health hunches.

    His “bad” cholesterol LDL levels dropped from 117 mg/dl to 75 mg/dl, and the “good” cholesterol levels rose from 83 mg/dl to 106 mg/dl. The American Heart Association recommends that people at high risk for heart disease keep LDL numbers below 100 mg/dl and HDL numbers for men at 40 mg/dl and 50 mg/dl for women.

    “This has sort of been like my DaVinci code,” Selby said.

    When he shared the good bill of health with his coffee klatch at 6:30 a.m. the next day, they probed him for more information about his BalancePoint Diet.

    By this spring, 10 of them — five women and five men, ages 28 to 69 — decided to try the diet for two weeks and get their before and after cholesterol counts measured at Boulder Community Hospital. The two participants already taking statin drugs to improve their cholesterol continued taking that medication in conjunction with following the diet.

    Like Selby, they carried around olive oil and scales to accurately weigh foods to the gram. Then, they logged their food diary information into a data base. By the end of the two-week pilot trial, all reported improved cholesterol readings, Selby said. The participant reporting the most dramatic numbers dropped 81 points in the LDLs.

    On its Web site, the AHA notes that some studies show monounsaturated fats such as olive oil lowering LDL cholesterol “slightly when eaten as part of a low-saturated- fat diet.”

    • b00mer

      Spam troll copying and pasting from a website that sells $400 “programs” to lower cholesterol.

  • Andrew

    I was diagnosed a type 2 diabetic years ago and went vegan about 6 months ago. After my last annual check up the Simvastatin was removed from the daily pills and the Glucophage reduced by half to 500mg a day. Another check up in 3 months to see how i am doing.

    • Lauren Bateman

      Andrew: Awesome, keep up the great efforts! I wonder what lifestyle are you doing each day. Have you looked up and watched the videos about the whole food plant-based way, ground flax seeds, cinnamon, and today’s about fiber? All exceptionally stabilizing for blood sugar …

  • Noé Marcial

    Doctors in Spain encurrage patients to eat eggs and meat when total cholesterol is under 70 ml-dl.. actually its call it hypocholesrolemia (and doc take it that way from 160 ml-dl). Knowing that the normal cholesterol should be lower, when it will be to low acording to the new studies?

    • noe marcial

      the argument it is that low cholesterol level drow to depresion.. but if you check thats studies they didnt look in the leveles of Omega 3, and it may be that low fat eaters also eat low leveles of other nutrients aswell. sorry for my english!

      • Tom Goff

        I understand that Spanish studies showing links between low cholesterol and suicide were contradicted by a subsequent US study which actually showed a lower risk of suicide in people with low cholesterol.

        Statin studies show no increase in suicide in people with resulting lower cholesterol. In the light of this and the US study above, it is likely that associations between low cholesterol and depression.suicide are due to confounding factors. Possible confounding factors include malnutrition, heavy drinking, heavy smoking, cancer and other chronic diseases …all of which are believed to result in low cholesterol.

  • Lauren Bateman

    Noe Marcial: I understand your English :) . I agree, they probably weren’t putting ground flax seeds on their whole plant foods every day!
    And, good ideas for more whole research. In the meantime, for your interest, see videos Can Cholesterol be Too Low? and, Don’t Forget Fiber

  • Tobias Brown

    What if your LDL is on the high side (134) but your HDL is very high and you have a low ratio (2.6), should you be concerned if you have a total of 234?

  • Markoff Cheney

    Nice to hear William Burroughs again.

  • JakeN

    Hey Dr G and others!

    So I 17 years old, and have recently become a vegan having watched your videos. No, not a vegan that eats vegan bags of chips but a diet with a lot of fruits and veggies. I recently found out though I was not consuming nearly enough calories per day (only 1500 generally). In any case I have started to consume a lot of brown — and now — red rice to bring up my caloric intake.

    In any case the reason I am commenting is because I am seeing mixed messages about how much cholesterol we need. I don’t think I am getting ANY from my diet and am wondering if this is a bad thing and how to get it to optimal levels?

    Beyond this if anyone could point me in the direction of a video demonstrating a meal plan almost to help me figure out what to get. I have been consuming a ton of vegetables, but never getting full and not enough calories. I also have chronic diarrhea, (with undigested food in my stool sometimes), really bad acne and other issues. These all started much before I became vegan; though I have been working at farmer’s markets and into the health food world for a while and was under the impression I was eating healthy.

    If anyone could help me out that would be amazing & very much appreciated !



    • 3yrvegan

      Hi Jake,
      I’m curious, how long now without dairy? And are you eating plenty of beans?

      • JakeN

        Hi, I have been dairy free with a a few (10 maybe) uncontrollable dairy intakes. So it has been quite a while.
        Just started consuming beans. I am curious though how much beans per week is ideal? I would really LOVE to find some sort of plant based meal plan (ie. Breakfast – rice & beans & veggies , lunch – sweet potato & beans, etc.)

    • Hi Jake,

      Let me say that there are a lot of variables here (physical activity, time being vegan, medications (esp. antibiotics), typical day of eating, etc), but let me try to give you some general help and let me know if it sounds good.

      It is very rare for you to not have enough cholesterol in your body. Our bodies are extremely efficient and would never let our cholesterol get so low that it could hurt us. It is just up to you to eat a well balanced diet, so along with lots of fruits and veggies make sure to throw in some whole grains, beans, legumes, etc. Here is a great resource to help you on your new journey to a plant based diet. Definitely use this as a guide for your meals.

      As for you never getting full, i would say that depending on your plate size, this is a good thing. We never really want to eat until we are “full” just eat until you are satisfied. How you eat can have a big effect on your fullness and digestive health. If you are a very fast eater you will not feel as full and you may have diarrhea and see chunks of food in your stool. This is especially true for high fiber fruits and vegetables (they need some good chewing). Practice some Mindful Eating techniques and really chew your food to see if that helps.

      At 17 years old, I say that acne is pretty common, but keep up the clean eating and living, and you might see a change. If you ever think about consuming dairy again, watch this. What we eat is a huge part of our health, but our environment also plays a huge role. Environmental toxins from our home, hygiene products, etc can have an impact on our health as well. Check out the EWG website to see which products are best to use. They give great science based guides on all of our everyday products. The idea here is that acne is an immune response, so decreasing potential autogens or pro-inflammatory chemicals can decrease acne.

      Well Jake, I threw a boat load of info at you, so let me know if you have any questions or need some further clarification. I wish I was as health conscious as you when I was 17, so I definitely admire your thirst for knowledge and health! Wish you all the best.

      • JakeN

        Thanks a lot for taking your time to respond ! I really appreciate the information and resources.

        Mainly right now I just want to make sure I am getting a balanced diet, getting all the nutrients, etc. that I need. Honestly, I haven’t taken any B12 so I am certainly deficient but plan to order some online to get it nice and cheap.

        Thanks again for the resources, it is very much appreciated and extremely helpful !

    • Loren
      • JakeN

        Thanks, Dr Mcdougall has some great info !

    • Thea

      JakeN: This is one of my favorite questions! You have made a decision to make a change. Now you want to know how to do it right. Good for you!!

      I have some resources that I think you will find very helpful. First, here are Dr. Greger’s overall nutrition recommendations. It’s not quite the meal plans you are looking for, but it gives some great general advice that you will want to keep in mind, including B12:

      As for how to put together meals that are good for you, check out the following graphic from PCRM, Physician’s Committee For Responsible Medicine. What I like about this graphic is it’s simplicity. It shows how you don’t have to make healthy eating be all that complicated. I would recommend adding a side cup of 1-2 ounces of nuts and seeds to the graphic. But other than that, it is really helpful.

      If you generally follow the PCRM guidelines, it should help eliminate your hunger issues. You need to get enough calories, and that is hard to do *only* eating such bulky foods as veggies. You want at least half of your food to come from whole starchy foods of grains and legumes. Plus, as an active teen, who may need more calories relative to your body weight compared to an adult (I think), those nuts and seeds may be especially important for you as they are calorie-dense foods.

      I can do even better than the Power Plate to address your meal plan request. How about 21 days worth of meal plans, recipes, videos, inspirational messages, and a forum where you can ask questions! 21 Day Kickstart is a free program, from PCRM, which you can sign up for in the following link. You don’t have to follow all of those recipes/plans. But it will give you a good idea of what a healthy diet looks like when it comes to the details of what to actually eat:
      (Click the green “Register Now” button.)

      I have a couple more suggestions: Check out the book, The Starch Solution. This seems to work very well for lots of people, is very healthy, and includes recipes in the back of the book.

      Get a copy of Jeff Novick’s Fast Food DVD series. Jeff does a great job of giving simple (10 mintues!), tasty, extremely healthy recipes, all in a mini cooking show format. Here’s one to get you started:
      The burgers and fries DVD is a good one too.
      I believe that other people have addressed your cholesterol concern. Since your body makes all of the cholesterol that it needs, you don’t have to consume any in your diet. In fact, consuming cholesterol is not healthy.

      I hope this helps!

      • JakeN

        Thank you SO much for the response ! I will check out these resources and really look forward to putting all of this incredible wealth of knowledge and information to practice. I want to make sure I do it right ! After all, it is my health (which isn’t doing great— largely due to stress) which is the greatest investment I can make.

        Thanks again!

  • Dr Scott

    awesome-you just made all of the peeps who want to push statins extraordinarily happy. and cholesterol levels that low have been associated with many other disease-Love plant-based diets with adequate protein but this video is slanted and garbage. those levels are currently only part of the guidelines for people that have already had a cardiovascular event or have a “cardiac equivalent” like diabetes….plenty of patients who get their levels here still have heart attacks and strokes- I have seen it… simple carbs are the REAL problem…

    • largelytrue

      Sure, people can get their levels down low and still have heart attacks and strokes, especially if levels over the lifetime were very high and if the diet still has factors which advance the disease process in a more acute way. LDL is a major substrate of atheromas over the long term but I don’t think that anyone would propose that it is the only thing that can cause existing plaque to rupture.

      You seem to be proposing an all-or-nothing fallacy. Just because some patients still face risk when lowering LDL through statin therapy does not mean that lowering LDL to low levels is unimportant, let alone that statins’ lipid-lowering effects aren’t valuable in the therapy of some patients. For that, you do have to look at the amount of cardiovascular risk reduction and weigh it against the risks posed by the statin. I would be among the first to say that statins have some bad effects and that a healthy diet is preferable, but for patients who do not change their diet, a statin may be prudent. Or at least, you haven’t presented evidence which would move my views further away from that position, given that your post really hasn’t presented any evidence at all.

    • UCBAlum

      You seem angry and you aren’t convincing. The “real” problem? As opposed to the fake one we’re focusing on here? And what are you arguing about the “association” between low cholesterol and certain diseases? I can’t imagine your point. Honestly, your post comes off as reactionary and overly simplistic.

    • Tom Goff

      “cholesterol levels that low have been associated with many other disease” – you aren’t aware then that many chronic diseases (including cancer) and traumatic injury cause low cholesterol? Not to mention some viruses, parasitic infections and heavy smoking and drinking? As for statins, obviously they are not an ideal solution but this meta analysis indicates net benefits and shows that there was no consequent increase in cancer or other all-cause mortality (also indicating that the observed associations between low cholesterol and “many other diseases” is probably not causal):

      “This meta-analysis included individual participant data from 22 trials of statin versus control (n=134,537; mean LDL cholesterol difference 1·08 mmol/L; median follow-up 4·8 years) and five trials of more versus less statin (n=39,612; difference 0·51 mmol/L; 5·1 years). Major vascular events were major coronary events (ie, non-fatal myocardial infarction or coronary death), strokes, or coronary revascularisations. …………..

      Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0·79, 95% CI 0·77-0·81, per 1·0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories (RR per 1·0 mmol/L reduction from lowest to highest risk: 0·62 [99% CI 0·47-0·81], 0·69 [99% CI 0·60-0·79], 0·79 [99% CI 0·74-0·85], 0·81 [99% CI 0·77-0·86], and 0·79 [99% CI 0·74-0·84]; trend p=0·04), which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0·57, 99% CI 0·36-0·89, p=0·0012, and 0·61, 99% CI 0·50-0·74, p<0·0001) and in coronary revascularisations (RR 0·52, 99% CI 0·35-0·75, and 0·63, 99% CI 0·51-0·79; both p<0·0001). For stroke, the reduction in risk in participants with 5-year risk of major vascular events lower than 10% (RR per 1·0 mmol/L LDL cholesterol reduction 0·76, 99% CI 0·61-0·95, p=0·0012) was also similar to that seen in higher risk categories (trend p=0·3). In participants without a history of vascular disease, statins reduced the risks of vascular (RR per 1·0 mmol/L LDL cholesterol reduction 0·85, 95% CI 0·77-0·95) and all-cause mortality (RR 0·91, 95% CI 0·85-0·97), and the proportional reductions were similar by baseline risk. There was no evidence that reduction of LDL cholesterol with a statin increased cancer incidence (RR per 1·0 mmol/L LDL cholesterol reduction 1·00, 95% CI 0·96-1·04), cancer mortality (RR 0·99, 95% CI 0·93-1·06), or other non-vascular mortality."

  • Gadea

    Statin Drug Scandal: Cholesterol-lowering Drug Researchers Start Backtracking;

    By Health Impact

    • largelytrue

      You might be interested in Plant Positive’s critique of the first episode in that infamous two-part series on Catalyst:

      Also, the article you linked to has a very manipulative and biased headline. There is nothing in the text about any alleged “backtracking” by researchers.

  • I just wanted to add a few figures based on the current recommendations for the USA & UK.

    According to this video by Dr Greger, the latest research shows that optimal LDL cholesterol levels should be between 50mg/dl – 70mg/dl (in the UK that equates to 1.29mmol/L – 1.81mmol/L).

    The UK’s cholesterol guidelines show the desirable levels to be below:
    – 5mmol/L (193mg/dl) for Total Cholesterol.
    – 3mmol/L (116mg/dl) for LDL.

    The USA’s cholesterol guidelines show the desirable levels to be below:
    – 5.18mmol/L (200mg/dl) for Total Cholesterol.
    – 2.59mmol/L (100mg/dl) for LDL.

    Again, I thought this might be useful for others reading this to know what the current UK & USA cholesterol guidelines say are desirable levels.

    • Thea

      Scott: What a helpful post. It does a great job of pointing out how problematic the USA and UK’s guidelines are. Those guidelines claim to be “desirable levels”, when in fact, they are way too high.

      These bad guidelines lead to confusion. They lead to people understandably making the argument: “Look at the stats show that a huge percentage of people with ‘desirable levels’ of cholesterol still get heart attacks! So, cholesterol has nothing to do with heart attacks.” Instead, what is really going on, as you point out, the official guidelines are way too high. The NutritionFacts video on this page shows where the safe levels are. Those government figures are more like “averages in our sick society” levels. That’s not helpful for people trying to figure out how to eat healthy.

  • Tom Goff

    The ATPIII report for the US National Cholesterol Education Program comments:

    “low LDL-cholesterol levels are well tolerated. LDL cholesterol as low as 25–60 mg/dL is physiologically sufficient.8 Animal species that do
    not develop atherosclerosis generally have LDL-cholesterol levels below 80 mg/dL. The LDL-cholesterol concentration in the newborn infant is approximately 30 mg/dL, indicating that such low levels are safe.
    Moreover, persons who have extremely low levels of LDL throughout life due to familial hypobetalipoproteinemia have documented longevity.9”

  • Dr Orestes Gutierrez

    The optimal cholesterol level for every individual is unique for the reasons outlined below.

    China study data suggests that it is relative: “What made this so surprising was that Chinese levels were far lower than we had expected. The average level of blood cholesterol was only 127 mg/dl, which is almost 100 points less than the American average (215 mg/dl). …Some counties had average levels as low as 94 mg/dl.”

    In the China study those that ate a lot of animal foods and had a total cholesterol 130 had heart disease because their natural baseline was closer to 90. Furthermore, Total cholesterol and LDL cholesterol are important factors but a recent studies implies that HDL cholesterol level is perhaps the most important factor.

    One can surmise that the “optimal” blood level for each individual is unique and dependent on different environmental factors and ethnicity. For example, one study noted that “shorter adult leg length” was associated with higher LDL and total cholesterol.

    Also of note, lipid levels vary depending on ethnicity.

    Based on the above data, personally, I have no concern with heart disease. I have been vegan since 1998 and I run about 50 to 70 miles per week. I am 5’ 11’’ and 163 pounds and have been the same weight since high school. My lipid panel checked this week was HDL 88, LDL 87, Total cholesterol 188 and TG 60. I am 38 years old and have been checking my lipid panel every year for about 15 years and it has always been excellent and I have NEVER had a total cholesterol below 150. Currently, I am not convinced that a global policy of driving everyone’s total cholesterol below 150 is prudent. I evaluate each patient’s lipids in a case by case basis and help them find their baseline.

    • largelytrue

      I don’t really see what in your post points to the hypothesis that adults have widely-varying levels of critical serum cholesterol, where I mean ‘critical’ in the sense that would identify the worst levels possible that still carry minimal risk. Yes, the ‘baseline’ cholesterol under fixed developmental and pharmaceutical conditions will vary from one person to another, but what makes you conclude that this variation in this baseline level doesn’t modulate risk?

      You present a cross-sectional study showing that more people being admitted for CAD have HDL below the recommended target than those who have LDL above the recommended target for LDL. About the same numbers of people have LDL<70 as are on lipid-lowering medications, and the authors state that high LDL was associated with the non-use of lipid-lowering medications. Is there perhaps a confounding effect here, where people with low LDL tend to be unhealthy in other ways, which is why the statin bandaid was put on their still-unhealthy lifestyles?

  • Ursula2007

    I’ve been vegan for five years and still have an elevated cholesterol level, so apparently just following a no-cholesterol, plant-based diet is not enough. Dr. Greger, what else do you recommend as a way to lower my levels? I would like to avoid drugs. Do you ascribe to Dr. Esselstyn’s regimen? FYI, I am 56 and overweight.

    • Thea

      Ursula2007: I think it is worth considering Esselstyn’s diet because he has been proven so successful. Sticking with whole foods and low fat (with the exception of nuts) makes sense to me.

      But I have another idea too. How about tweaking your diet to include those plant foods which have been shown to lower cholesterol? In other words, when you went vegan, you gave up foods that are bad for your health. How about now, focusing on *adding* particular foods that are likely to help with your particular concern. There are several videos on this website that lists these foods. (I can’t get a good enough search to bring up only those videos. So you have to look around.) I think that trying multiple of these foods/approaches rather than just one makes the most sense.

      Good luck.

    • Tom Goff

      Thea’s advice is sound. However, you may also need to lose weight before your your cholesterol improves:

      There is an interesting article on being overweight and its effects on lipids like cholesterol. It is quite technical but it concludes:

      “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”.

      It is therefore possible that your system and metabolic response to eating a healthy diet won’t result in optimal cholesterol numbers until you are in a healthy weight range

  • Evan

    Since being a vegan the past year with increased exercise, reduced calories, legumes at every meal, my cholestrol has gone up. While my good HDL has gone up , my bad has as well (tri’s took a dive as well as BP). I’m wondering how this is possible to go from a guy who ate steak and pizza 4 to 5 nights a week, to someone eating nothing but veg’s, cooking without oil, and juice fasting for the first part of every day( actually I did the same as an ominvore ) , eating nuts, and a gluten/ soy based mok meat now and then, lost 40 lbs as well. Any advice ? I’m totally confused as to how this would be possible and was shocked when I just got my numbers. Makes me wonder if something else is wrong systemically, but blood tests didn’t indicate anything.

    • Tom Goff

      That is a puzzle. But it was only one test, I assume? It may just be an outlier. Also, is it possible that you were in some way stressed at the time? Stress can raise cholesterol in some individuals eg

      Another possibility is the mock meats, I gave up eating mock meats when I saw the ones I had been using, and which were advertised as suitable for vegetarians, actually contained eggs. Trans fats and sugar are other possible possible causes of raised cholesterol and may be found in some margarines in the US

      Hyperthyroidism is also a possibility (as is anorexia bit I’m assuming your “reduced calories” aren’t that reduced!).

      You should really discuss this with your physician.

      • Evan

        Unfortunately my Physicians advice is to go on statins, something I became a vegan to avoid. As for the Mock meats ( beyond meat and litelife ) ,the ingredients don’t appear to be bad. And the use is a few times a week and minimal in quantity. I don’t do sweets but infrequently ) As for Hyperthyroidism wouldn’t a complete blood work up indicate that ? Lastly stress is always a given when I visit the Dr.. My old diet was super carnivore and loaded with pizza, cannot imagine how that gave me better cholestorol than eating legumes and veggies till them come out my ears. Perhaps it was a fluke , but I was expecting very low cholestorol, not higher.

        • Tom Goff

          I am sorry to hear that. I have a couple of thoughts:

          1. Stress, smoking, alcohol and coffee (if you don’t use paper filters) all raise cholesterol.Re coffee see this
          Also trans fats in margarines and some vegan/vegetarian foods raise LDL cholesterol
          The figures show that wholefood vegans have on average very low cholesterol. But not all of us are average. Perhaps you could focus on foods that actively lower LDL cholesterol like oat groats, steel-cut oats or rolled oats (old-fashioned oats)? This link might help ..

          2. I don’t know what your weight is (or was) but this could be a factor if you are overweight. There is an interesting article on this. It is quite technical but it concludes: “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”. It is therefore possible that your system and metabolic response to diet won’t work normally unless you are in a healthy weight range

    • R. Mati

      I was on Liptor for about 10 years and my total Cholesterol was 4.5 mmol/l ( 174 mg/dl ) then I decided to change my diet and be vegan and eventually stopped the Statin.

      I was shocked to see my Cholesterol when up I have being doing the blood test every 3 months :

      6.6 mmol/l ( 255.22042 mg/dl),
      6.8 mmol/l (262.9 mg/dl)
      7mmoll (270.68 mg/dl).

      Really confused and I don’t want to take the statin again on the same time I don’t know how to lower my munbers.

    • Tom Goff

      I knew that smoking and alcohol can also raise cholesterol but I didn’t know that (black) coffee can do this also. Perhaps this might be a factor in your case?
      “….cafestol is the most potent dietary cholesterol-elevating agent known, said Dr. David Moore, professor of molecular and cellular biology at BCM, and Dr. Marie-Louise Ricketts, a postdoctoral student and first author of the report. Cafetiere, or French press coffee, boiled Scandinavian brew and espresso contain the highest levels of the compound, which is removed by paper filters used in most other brewing processes. Removing caffeine does not remove cafestol, however.”

  • Chris

    I have scar tissue on both kidneys, because of this I have HBP, and my cholesterol is over 200. I am 129 pds and on a vegan diet with excerc
    ise 3x a week. I am seeing a ND for help trying to lower these numbers, What else is there to do, my numbers havent gone down.

  • mike66

    Wondering if it’s a matter of losing enough weight, getting to within your BMI to get down to the optimal cholesterol 140?

  • CDAHealth

    Does anyone have a comment on the federal dietary guidelines committee removing the recommended restriction on dietary cholesterol?

  • CDAHealth

    Thank you for posting the article Thea it was very helpful. In the news I am reading that there is no correlation between cholesterol and negative health effects. How are they getting away with this? They are stating that Cholesterol is no longer a “nutrient of concern”.

    • UCBAlum

      In my lay opinion, your post exemplifies the problem with the new dietary guidelines.

      They actually aren’t saying there is no correlation between cholesterol and negative health effects. They’re saying the effect of dietary cholesterol on blood cholesterol is such that people don’t need to be concerned with dietary cholesterol…

      and the critique I’m seeing is that this leads to confusion in the public’s mind between dietary cholesterol and blood cholesterol, which we do need to be concerned about.

      • CDAHealth

        interesting, thanks for the feedback. That makes sense.

    • Tom Goff

      I think that this decision is based on a lot of recent “research” funded by eg the American Egg Board which appears to show that additional dietary cholesterol has no effect on the serum cholesterol of people eating a normal US diet. However, it has been known for many decades that the effect on serum cholesterol of additional dietary cholesterol is dependent upon baseline dietary cholesterol eg

      “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."

      Most Americans already consume significant amounts of cholesterol. This "old" cholesterol science has therefore allowed producers of high cholesterol foods to fund modern studies that they know beforehand will produce results that appear to show that added dietary cholesterol has little or no effect on the serum cholesterol of Americans. To be fair though, we also know that there is considerable individual variability in the response to dietary cholesterol – some people are hyperresponders while others are hyporesponders.

  • Joseph

    I am 54 and have been a vegan for over 3 years now, am not overweight, and exercise moderately and yet my cholesterol levels are still fairly high: Total 206 and LDL 123. What gives? Any ideas?

  • Martin Van Lear

    wow this one really clears up a lot of confusion out there, and yest i have watch all of plantpostives videos, which were amazing of course. HOWEVER, can anyone comment on idea that cholesterol does not cause heart disease??? the argument is that the brain is mostly made up of cholesterol and if you lower cholesterol too much, you start to have memory problems, decreased brain function,etc. : those such as dr david perlmutter (grain brain), dr. mercola, the entire weston a. price foundation, and dr. stephanie senuf. they would probably say that you can eat all the eggs you want bc cholesterol doesnt cause heart disease…in fact, heres a CNN report that says cholesterol doesnt matter! anyway, wonder if dr g could comment or maybe do a video as a rebuttal to these theories. thx.

  • Ray Tajoma

    That’s why I don’t trust the government – it’s like a wolf in sheep’s clothing. Lecturing about lower and middle class, but caring only for super rich and Big business monopolies.

  • John Reid

    What would you say to an individual whose total cholesterol has not budged from the 280 range (HDL about 110) despite being on a rigorous whole food, plant-based SOS (no added sugar or salt and almost no added oil) diet for more than four years. I have heard of a number of cases, especially among females, of people whose cholesterol numbers don’t move despite an optimal diet and a well above average, consistent exercise regimen. The recent release of research results dealing with the issue of the amount of dietary cholesterol compared to that naturally produced by the individual is very interesting in this light.

  • Erryl Mendenhall

    A week or so ago, NBC news said that the gov’t was going to drop the recommendation to avoid cholesterol from its dietary recommendation. They were keeping sat fat… and sat fat and cholesterol tend to be in the same animal based foods. It has been known for quite awhile, though, that a person’s cholesterol is not a good predictor of heart disease… and that cholesterol lowering drugs don’t increase life expectancy. There is just no substitute for eating a plant based diet.

    • Alex

      “a person’s cholesterol is not a good predictor of heart disease.”

      …that is when the average is already dangerously high. A single bullet loaded gun is a poor predictor as to who will die from a game of Russian Roulette. While an unloaded gun (low cholesterol) is an excellent predictor as to who will survive.

      Or like my father says “I’ve been eating this way all my life and I’m still alive”. Existential indeed. I expect Atkins said the same until the last.

      • Erryl Mendenhall

        Good comment. I have known people, like my wife, that do not eat well and have low cholesterol and low blood pressure. I hope she lives a long time, but I would feel a whole lot better if that low cholesterol was from following a plant based diet (it isn’t),

        • Alex

          I’m kinda in the same boat. My lady is in perfect shape (perhaps too thin). I suspect she’s very healthy, but I’d like her to go (semi-) vegan for my sake. I’m tired of cooking twice and eating the ‘other option’. We have no idea our cholesterol levels.

          • Erryl Mendenhall

            It seems like it is usually the female of the couple eating healthy and the male eating steak and eggs. Glad to hear there are at least 2 of us.

  • rhart

    I’ve given up dairy and need to replace the 1/2 qt of milk daily with some other form of protein for my post workout protein shakes. I’m using Whey protein now but it is still dairy. What should be the base for my protein shakes? Eating a bowl of beans after the gym doesn’t seem interesting. Age 72 and still damn healthy eating fish and plants and working out 6 days/week. Thanks in advance for help.

    • Mike

      I use a pea/rice protein blend. You can buy them separately and mix them. Both together rival whey in amino acid richness.

    • Thea

      rhart: Good for you for doing so well. I wish I really worked out 6 days/week.

      I’m wondering why you think you need a protein shake at all? How about just a healthy shake/smoothie? If you work your way through the following article, you will get a very good idea of the needs humans have for protein, including active humans.

      I would say that there’s doesn’t appear to be a need to add special protein to the diet. Contrary, it seems more likely that we would be wise to make sure we don’t get too much protein. Older people may have higher protein needs than younger people. But that still doesn’t mean that older people can’t over-dose.
      >> Check out the January 2004 newsletter and the article on protein overload:

      Something to think about. This could free you from both your worry of needing to have protein over-rich foods and from eating that whey.

      • Thea

        rhart: I meant to also add: If the above information doesn’t seem compelling to you and you still want a protein-ladden shake, some people like to add hemp seeds, which are supposed to be high in protein. Other people use vegan protein powders *marketed* to athletes or just for general health. Here is page that lists 7 brands of vegan protein powders:

        Again, I wouldn’t recommend or use them. But if someone felt that they really needed it, I would expect these products to be a whole lot healthier than whey.

        Good luck.

      • rhart

        Wow. I read carefully the Bluejay article and learned a lot. I did not realize the level of protein in veggies. I still need extra protein to get to my 75g per pound but I’m now comfortable kicking the Whey protein and going with pea protein or tofu smoothies. Very Very helpful and informative. Thank you

        • Thea

          rhart: Awesome. I refer people to that article all the time. You are one of the very few people who actually read it. I’m so glad you did. I found it so incredibly helpful myself. Best of luck to you.

  • josephofoley

    Will Dr. Greger comment on the latest government pronouncements about cholesterol?

  • folk_singer

    There is a large number of heart specialists that rely on oxidized LDL measured with the VAP test, not total cholesterol. The claim in this video is way out in left field, unlike most of your vegan claims, which I can confirmed from unrelated sources. Claims like this require multiple studies, preferably, Cochrane meta-analysis. The likelihood of a single cause for heart disease is nil given the complexity of human metabolism. Too low a cholesterol number is much more of a risk factor, since vitamin D is produced from it.

    • largelytrue

      “Too low a cholesterol number is much more of a risk factor, since vitamin D is produced from it.”

      I challenge you to support that, specifically with a numerical cutoff about what may be too low. Leaving aside the subtext behind your appeal to what is basically the vitamin-cure-all du-jour, what evidence is there that the body can’t regulate its cholesterol well without exogenous forcing from saturated fat and dietary cholesterol?

      There can be very important causes in complex systems. Wildfire has complex structure, but without oxygen in the air, there’s no fire. Similarly, cholesterol is a large fraction of plaque, and LDL is the vehicle which delivers most of the atherosclerotic material to the intima where macrophages respond. LDL is a rate-limiting step in much of the atherosclerotic process and we’d expect that by lowering the concentration, lower atherosclerotic progression would result and that the regressive processes would be larger in comparison, all else being equal.

      Your admission that the body is a complex system is precisely why you should be cautious in extrapolating from preferred biomarkers for distinguishing people with high risk of CVD from those with imminent risk. When the usual biomarkers are already bad, of course you may have to use something else, but that doesn’t mean that these sort-of “tie-breakers” should be used in other circumstances where the more reliable risk factors differ vastly.

      LDL less than 70mg/dl is probably good, and even if there aren’t large amounts of controlled experimental data to show this, you should consider the many other ways in which this idea is plausible. You should also consider that the most recent Cochrane meta-analysis of 5 statins for the primary prevention of CAD concludes that this treatment is indicated, and that the treatment of the hyperlipidemic patients in the studies resulted in LDL lowering of around 40mg/dl on average.

      The Lifestyle Heart Trial by Ornish et al also got fairly close to LDL of 70mg/dl in the treatment group (mean 86.56mg/dl), though their sample was small. On the other hand, weight loss during one year was not exactly ideal and it looks like many of the experimental patients were still overweight at the end of 1 year.

  • Anji

    Is it possible to have too low cholesterol? My husband’s doctor told him that his was the lowest he had ever seen. My husband also has low blood pressure. He does get light headed dizzy spells regularly. We are vegan and eat a wholefood plant based diet and have done for many years. Any suggestions what would pick up his blood pressure? It is 90/55. My husband is 58 years old. He is 5’7″ and weighs around 60 kg or less.Thank you.

    • Rami_RD2B

      Please see here regarding cholesterol being low.

      One would have to be below a total cholesterol of 10 or even less to begin experiencing the ill effects of cholesterol deficiency. this occurs only in those that have genetic disorders.

      Is he on BP medication?

  • Beth Aaron

    Beef Magazine contributors and comment section shows an impending sharpening of knives to cut off any medical information regarding cholesterol. The government itself is sending two messages. Saturated fat bad, cholesterol OK; How can anyone decipher the real truth and not get frustrated and day the heck with it? For me, what I eat isn’t just about me but most others it is.

  • GodBlessAmerica

    CVD is a nutrient deficiency, which is guaranteed in the SAD. Cholesterol is just a side effect of damage caused by inflammation, it is the repair substance the body uses to patch the damage caused by inadequate vitamin C and the proper amino acids needed to maintain the large coronary arteries. Diet has very little to do with cholesterol levels, the body makes it. The brain needs it…..decrease your cholesterol with drugs and studies show you get increase suicides and violent behaviors.
    Eating a plant based diet means higher nutrients, vascular protection and your body isn’t inflamed so you need less cholesterol to patch up any damage. High cholesterol indicates hypothyroidism…….look it up

    • largelytrue

      Cite reasonably high-quality research backing some of your claims. For instance, show me a study showing that treatment with statins is associated with violent behavior. Identify the “proper” amino acids which are somehow abundant in comparatively low-protein plant based diets which lower cholesterol. Show me studies where vitamin C supplementation lowers cholesterol. Explain why it is that adding egg yolks to a diet containing zero cholesterol would raise serum cholesterol. Last I checked, this wouldn’t do anything to reduce amino acid intake and it wouldn’t do anything to lower vitamin C intake, so what’s the deal, there?

      Lastly, but most importantly, what’s your credible reference for the claim that cholesterol is a repair substance. If it’s a repair substance, why is plaque jammed full of it, and why does it provoke an immune response where the macrophages ultimately die on-site and inflammation worsens?

      • GodBlessAmerica

        I suggest you read the book, THE GREAT CHOLESTEROL CON, which lists the research studies I am referring to. It will answer of your questions better than I can here. And like me, make you angry for the lies. After teaching the ‘low cholesterol diet’ prescribed by physicians for over 25 years I have been enlightened to the scam. As the media and then MD awareness catches up to the facts it will be every interesting. As far as vitamin C, look up the patent Linus Pauling, 2 time noble prize winner, was granted in the 1990’s which uses Vitamin C, L-Lysine, and L-Proline to heal the arterial damage and remove the plaque within the artery…essentially resolving CAD without Big Pharma profits. (Which is why doctors don’t know as they are educated and controlled by Big Pharma (and their swat teams the FDA & CDC) BTW, cholesterol is a response to inflammation, not the other way around. A study done in the late 1970’s by a Dr. Margaret Flynn at the Univ of MO found that 3 eggs daily, did not raise cholesterol. I was her student.

  • Teri Balsimo Angeletti

    The New York Times admitted last week that “there is no real evidence that eating dietary cholesterol is bad for you”. Could you please comment on this news article?

  • Lesli

    I agree that physicians still look at this incorrectly. I have adopted a plant based diet for about a year and have had high LDL and cholesterol levels for some time. My HDL is also high, and my physician says that due to this I am not a risk for coronary issues. I disagree. I had my lipids checked 3 months and 6 months after adopting a vegan diet, and do not eat junk food, yet my levels have only decreased minimally and remain elevated. I am concerned as to why, and my physician does not seem concerned as he feels I am not a risk. I plan to recheck again in May, but wondered if you had encountered this in others or have thoughts as to why!!

  • Marjorie Leon

    I was listening to NPR yesterday and this interviewer was discussing “no direct link between eggs and dietary cholesterol to heart disease”. Two doctors bantered back and forth discussing how “people” (presumably the public) jump to conclusions and that eggs and other high cholesterol foods have NO bearing on our heart disease risk. I almost fell over! I am interested in hearing what everyone thinks of new cholesterol recommendations.

  • Marjorie Leon
  • Paul

    Hi, what’s your opinion on the new dietary guidelines for cholesterol. Now all of a sudden they are saying they got it all wrong and eat as much eggs butter and so on because cholesterol is all of a sudden good for you.

  • Alex

    I wonder if you could comment on the recent FDA and earlier AHA proposals to de-prioritize or eliminate dietary cholesterol (DC) labelling? Is it really not an issue? Is there only a typical correlation between DC and high saturated fats in the same foods? What is the current understanding of the direct and indirect causes of high levels of bad cholesterol in the blood?

    • Thea
      • Alex

        Thanks Thea. Very useful info. I wonder if consumption to results have been quantified/iable. A la >X mg/kg of dietary cholesterol tends to raise while <X mg/kg tends to lower blood cholesterol levels.

        • Thea

          Alex: re: “… while < X mg/kg tends to lower blood cholesterol levels." Dr. Greger has identified foods which have been shown to lower cholesterol, but none of those foods actually have cholesterol in them. I think the best you could hope for is trying to find an X amount of dietary that at least doesn't raise cholesterol.

          re: Showing that dietary cholesterol tends to raise serum cholesterol
          I think we have a lot of evidence of this, but it does get complicated since dietary cholesterol almost always comes connected with saturated fat, animal protein, and other undesirables. Food is a package deal. So, how much of the problem of an increase in cholesterol and related increase in heart disease risk is directly related to the dietary cholesterol and how much is related to the other factors of eating animals?

          Or (what I think) how much is related to the entire animal food with all those factors working together? We do have *plenty* of evidence that eating animal products raise cholesterol. Since only animal products have cholesterol in them, telling people to avoid eating cholesterol is a no-brainer and a reasonable way to work around political injunctions against educating people on the science that links animal consumption to various diseases, including heart disease, stroke, etc. That's one reason the new guidelines are such a travesty.

          If you are interested in details of the scientific evidence we have that links dietary cholesterol to serum/blood cholesterol, I recommend checking out Plant Positive:

          I'm not sure which video would specifically interest you, but you might start with this one:

          • Thea

            Note: There were some weird characters in the post above that probably got sent out/included in the related e-mail for anyone who got it. I was able to fix/get rid of the characters for the post on-line here. So, if someone wants to read my reply without needing a decoder ring, come here directly to the page/site.

          • Alex

            “weird characters in the post above”

            Yeah, my greater-than/less-than signs cannibalised the HTML. I corrected my own post with & lt ; (no spaces) but messed you up downstream. Sorry.

            Thanks again, Thea, for generously offering your time, expertise, and links. You’re fighting the good fight!”

          • Alex

            Wow. It’s amazing such studies pass peer review. Are the peers also drinking buddies? Thanks for the link.

  • JosephOlstad

    I can’t wait to hear Dr. G respond to the removal of cholesterol as a “nutrient of concern” by the 2015 Dietary Guidlines Advisory Committee.

  • Ok, let’s cut to the chase. This video is 2 weeks old now, so my query may not have a wide response. What are the LDL-C numbers of the commenters to this video? Mine is 87. I’ve been vegan for 3-1/2 years. How long does it take to get below 70? Is anyone’s LDL-C lower than 70? Even here north of the 49th, Health Canada specifies a number higher than 50-70mg/dL.

    Maybe the newest member of Dr. Greger’s staff, Joseph Gonzales R.D. could comment, perhaps offering his personal LDL-C #.

  • Teresa Giovanna

    Could you please respond to this recent article that seems to be making a lot of headlines. I have a feeling that it is very misguided but I’m concerned that an uninformed public will take it at face value

    Thank-you for all you do!!!!

  • @Theresa. Your page link is an advertorial for W.Gifford Jones M.D. An advertorial milady is an ad dressed up as an editorial. There’s nothing free about canadafreepress. It, like facebook and Google, are ad companies first and foremost. Hey it’s nothing personal, it’s just business. When the USDA wants to delist cholesterol and the GOP wants to desist from science in their new bill, you know that these criminal corporations will do anything to remain in the black.

  • erne


  • D.A.

    Maybe you will have enough interesting research some time to do a video on Sphingolipids. Here’s a fun start:
    –relates to Plant Ceramides, which apparently relate to aging, heart health & cancer.


    I received this information from AARP this morning:

    I believe it to be quite contrary to the information that you provide on your website.

    The article was written by what appears to be a journalist and does not have any scientific references. I would appreciate if you would comment on the article.

    I very much appreciate the work that you do.

    Best Regards,

    Don Pitts

    • Joseph Gonzales R.D.

      Thanks for reporting this, Don. I think you hit the nail on the head that this is not a scientific evaluation of all of the evidence. The article does throw out some references, but again, not enough to claim saturated fats and butter is “back”. So much information on cholesterol here.

  • Ryan

    Dr. Gregor, can you please debunk this reference I found indicating no link between saturated fat and cardiovascular disease?

    10. Siri-Tarino, P.W., et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition 2010;91:535-546.

    It was referenced here.

    • Joseph Gonzales R.D.

      Interesting. From the conclusion I think the researchers explain “our meta-analysis showed that there is insufficient evidence from prospective epidemiologic studies to conclude that dietary saturated fat is associated with an increased risk of CHD, stroke, or CVD. However, the available data were not adequate for determining whether there are CHD or stroke associations with saturated fat in specific age and sex subgroups. Furthermore, there was insufficient statistical power for this meta-analysis to assess the effects on CVD risk of replacing specific amounts of saturated fat with either polyunsaturated fat or carbohydrate.”

      Hope that helps. Also, Dr. Esselstyn published research showing how a plant-based diet can be a way to reverse CAD. Meat can cause inflammation and saturated fat appears to have other deleterious effects such as increasing the risk of heart disease.

  • atom

    I’ve been vegan for about 17 years, and my LDL is about 69.5 mg/dl (measured last year at 1.8mmol/l). My GP said it was the lowest cholesterol level he’s ever seen… But if the “optimal” range is 50-70, why is mine so high?

    • tiredntrue

      According to Dr. John McDougall and many others, all veganism is not created equal and fat consumption, even non-animal, still matters. If you check out his website you’ll see he even recommends against eating any isolated oils (soybean, olive, coconut, etc.) or even certain high-fat plant foods many consider extremely healthy such as avocados. Maybe lowering your fat consumption would lower your LDL even further?

  • Surfer2u2015

    I am so confused here. If you look at the article on Dr. Mercola’s website today titled “Why You May be Better Off Ignoring Conventional and Low-Fat Dietary Guidelines,” I just don’t get it, and I’m trying to understand. There must be another factor for atherosclerosis related to endothelial dysfunction. I not arguing either way, I am simply completely at my wits’ end with the polar opposite presentations of endless studies on fats and cholesterol related to heart disease. Again, I suspect there has to be another variable we are missing. What explains the incredibly low heart disease rates among non-Westernized diets of, for instance, the native Eskimos who ate almost exclusively meat and saturated fat, or the the Masai people of Kenya who eat large quantities of ruminant milk and meat, and the Jamaicans who eat large amounts of saturated fat in the form of coconut oil? All three of these populations, all consuming high saturated fat diets, were relatively free of heath disease, when especially compared to the epidemic happing in America. So I am in quite a quandary here given the multitude of variables that exist (and maybe it does not matter in context to the SAD with respect to simply lowering cholesterol as the only answer here in the states???). For example, is it inflammation caused by pollutants, pesticides and herbicides; could it be conventionally grain-fed, contaminant laced feedlot raised animals and products derived therefrom; an imbalance of omega 3 and 6 fatty acids, the elimination of omega-6 fatty acids by the inclusion of saturated fats and exclusion of omega-6s; GMO’s with RoundUp, refined carbohydrates, sugars, fructose, etc., etc., etc. I’m simply trying to understand what is the underlying variable that confounds the seemingly endless research, studies, and conclusions drawn therefrom on the polar opposite sides of the spectrum.

    Does anyone else here feel whipsawed with all this?

    • Joseph Gonzales R.D.

      Nutrition research is very complex, but eating food doesn’t have to be. Our site differs widely from Mercola. He sells stuff. We don’t. We like folks to make up their own mind based on the research provided. I think Dr. Greger does an amazing job offering the latest science, for free, and giving dietary suggestions.

  • Surfer2u2015

    Here’s a link to the article where I pulled some of my commentary from. Please, I am NOT trying to do dueling studies B.S. here. I simply am trying to figure out what is going on with the two polar opposite conclusions based on the studies.

    I am raising a lot of this because of my own research into Lipoprotein A. Incredibly enough, I switched to a vegan regimen recently and then read this about soy (it raises Lipoprotein A???). Can anyone see why I am genuinely struggling with this subject? Any help or advice?

  • Alex9

    Dear Dr. Greger,

    I have been following a whole plant low-fat diet for over 2 years now with lots of fruits, berries, legumes, sweet potatoes, veggies, greens, nuts, no processed foods etc., but my cholesterol levels have not improved, e.g. total cholesterol was and still is around 220, LDL around 150, triglycerides 150-200, A1C 6.0 to 7.0 etc. I was never overweight (at 5’7″ I am 145 lb), never smoked, exercise daily. Still I had a quadruple bypass 7 years ago.

    I am completely puzzled why the diet had virtually no expected effects.
    My doctor is puzzled too, so I am planning to start to take statin drugs (Lipitor).

    Is there any hope to make diet work for me?

    • Joseph Gonzales R.D.

      Hi Alex. Someone at the top of this tread has similar concerns. I think my comment to her will serve you well. Let me know if it helps?


    • Joseph Gonzales R.D.

      Hi Alex. Let me see if I can help. For those who have tried everything and still have high LDL, try focusing on the saturated fat sources (coconut oil; cocoa butter, and yes even nuts). 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 does include some nuts but I would try avoiding or keeping to a single ounce a day. 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. See if any of those tips help. How frustrating if doing everything right and still not having success.

  • Bawaite

    I am a type 1 diabetic and also have an elevated level of lipoprotein (a). The information I have is that lipoprotein (a) may be a particularly pernicious form of cholesterol and that one’s level is determined by genetic factors and is not affected by exercise or diet (or statins). The only thing that can reduce it is niacin. My level was initially 64, but taking a dose of 3,000 mg of niaspan originally brought the level down to just below 30, in the normal range. However, in more recent years, my level has incrementally increased and is now up to the 80s, even though I am still taking 3,000 mg of niaspan daily (which is quite expensive).

    Have you seen any information in your reviews of nutritional studies that questions that lipoprotein (a) levels are not affected by diet (or exercise)? I understand that as a general matter of coronary health, if I can’t keep a normal or healthy lipoprotein (a) level, it is especially incumbent on me to do anything else to put the odds in my favor, so in that sense, eating a plant-based, whole-foods diet can be effective. I’m wondering if you have seen anything that suggests that diet might have some affect on lipoprotein (a) levels? Or perhaps, in the alternative, have you seen anything suggesting, as in the video, that if one’s LDL level is kept sufficiently low, then plaque buildup isn’t triggered, so perhaps an elevated lipoprotein (a) level isn’t such a concern?

    • Jen Drost, PA-C, NF Volunteer

      Hi Bawaite, sorry you’re dealing with that-but so happy to hear about all of your healthy lifestyle choices. PubMed search showed of the 2015 literature showed that daily exercise and almond consumption may improve lipoprotein A levels. Dr. G. plans to make a video about lipoprotein A in the future…till then, here’s a favorite piece about a bonus benefit of almonds.

    • Joseph Gonzales R.D.

      Hi Bawaite thanks for reposting. Jen gave some hints below and I might also suggest Dr. Forrester’s comments and links on diabetes, here. See if these resources help?

    • Joseph Gonzales R.D.

      Also, PCRM has a fact sheet on type 1 diabetes. And one study found a connection between risk of type 1 DM and cow’s milk protein in infants. This study does not reflect adults and how they can manage Type 1 DM, but I use it to show there seems to be a link between cows milk and risk of Type 1 DM in infants. If this study holds true I think avoiding cow’s milk and dairy protein may be helpful for those with type 1 diabetes.

  • Brenda Somers

    Brenda Somers

    Jun 1, 4:31 PM

    I know Dr. Gregor says that the amount of sat fat in the diet should
    be Zero or as close to it as possible. I have an intake of about 7gm
    daily from the following:
    32g peanut butter (peanuts
    & some salt and I pour off the oil on top), 1/2 oz almonds, 1/2 oz
    walnuts, 1 tbsp hulled hemp seeds and 1 tbsp either sunflower seeds,
    chia seeds or pumpkin seeds. All seeds and nuts are raw and certified
    organic if possible.

    I eat a very healthy whole food plant based no oil added diabetic
    diet. Five months ago my total cholesterol was 159 & LDL 88. I’m
    trying to get cholesterol below 150 & LDL below 70 and don’t want
    the plant sources of sat fat to work against this.

    Also, I’m 69, weight 130 (have kept off a 100 lb weight loss for 15 months) and was diagnosed Type II diabetic in Nov 2010. My A1C has been 4.9-5.0 for the last 18 months.

    Thank you for your help and for such a wonderful, informative blog.

    • Joseph Gonzales R.D.

      Hi Brenda,

      Thanks so much for reposting. It’s impossible to have zero saturated fats, as all foods have a bit of fat in different ratios. You are wise to keep it low, though. My go-to Dr. Greger answer (paraphrased) for those who have tried everything and still have high LD, try focusing on 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. Maybe some of our doctor’s who help reply on our site can help answer better, but I’d start there. Let us know if anything helps and do make sure to check in with your doctors about all of this.


      • Tobias Brown

        Thanks for these references.

      • JCarol

        I am very familiar with Dr. Esselstyn’s research and follow his advice closely, but hadn’t previously heard of Dr. Jenkins or his portfolio diet for lowering cholesterol. I’ll give his advice a whirl – particularly by replacing other WFPB starches with oats and barley, and by taking Metamucil three times a day. Perhaps this will move my cholesterol and triglycerides in a downward direction.

        Thanks for posting this and for pointing me to it.

  • Mike

    I have cholesterol of 198 with an optimum plant based diet. Is it recommended to use statins to get the ldl below 70?

  • savannahjan

    I’m 60 years old and have been a strict vegan for 2 years now. My total cholesterol is still 220 only dropping 31 points, with triglycerides of 170, even with very little added sugar and daily flax seeds and citrus. What else can I do to keep from going on cholesterol meds? What would be the safest, least harmful of these meds?

  • IndyThreeWheel

    My last test showed my LDL-C was 48 and my total Cholesterol was 110. I am on a low fat (Esselstyn) plant based diet and I am taking 20mg of Zocor per day. My Primary Care Doctor is recommending I cut my dose of Zocor in half while my Endocrinologist is saying I will benefit from a LCL-C level down to 25. I currently have no heart condition but my father had a heart attack in his late 40’s and I am 58. Should I cut my Zocor doseage in half, keep it the same or stop taking Zocor?

  • 4Baccurate

    I read somewhere that inflamation causes the rise in cholesterol that causes atherosclerosis. Some fruits and vegetables high in sulphonamides and/or salicylates, I suspect in some individuals to be primary causes of inflammation which (a) alters endothelial function; (b) causes inflammation. Dr. Greger… Could you possibly discuss the contribution of salicylates and sulphonamides in (a) diet; (b) cardiologist-prescribed drugs (c) sulphonamide and salicylate pesticide- and herbicide residue on foods—- as a major contributor inflammation and its sequelae? Examples of foods high in sulphonamides: onion, garlic, LOSARTAN. Examples of foods high in salicylates: olive oil, tomato, spinach, lemon, vinegar, coffee, tea, CERTAIN BLOOD PRESSURE DRUGS, ASPIRIN. Lots of systemic implications (that is, wherever we find endothelial tissue: pancreas, kidney, eye, vasculature…..)

  • tom b

    I have high cholesterol; above 375 w/o medication with moderate dietary attention and more recently low 200’s while taking up to 3 cholesterol lowering medications, being on a 100% vegan plant based diet for the past 5 months, and getting regular exercise. I weigh 155 lbs, 5″8″ and have been diagnosed with Familial hypercholesterolemia.


    > I had a stent in my LAD in 2008 at the age of 48 but never had prior heart symptoms. Since that time I’ve taken steps toward improving my health; lost weight, stopped smoking, lowered stress, exercised regularly and improved diet (past 2 months in addition to 100% plant based vegan diet, little consumption of nuts/seeds, practically no processed food products and practically no oil).


    > I desperately want to make additional improvements to my cholesterol levels without taking more medications. I am just not seeing the cholesterol lowering benefits from practicing a strict plant based diet as indicated in various books, talks and websites but do not know why.

    Most recently, the use of berberine &/or PCSK9 Inhibitors was brought to my attention in an attempt to get my cholesterol lower. Any direction would be appreciated.


    > Tom

    • Thea

      Tom: I’m sorry to hear you are going through all that. It’s so hard to make a change in the first place and then find that it doesn’t seem to help? That’s so frustrating!

      There are a few people like you out there. I don’t know for sure what will work, but Joseph has a page dedicated to this very problem with some great tips on how you might be able to make progress with your cholesterol levels.
      I hope this helps.

  • Shari Wigginton Thompson

    I have had a Heart attack 5 years ago and I will tell you there are so many variables that cause Heart disease some folks have high LP(A) and other genetic risk factors everyone is a individual and it is not a 1 fit for all. I eat a Dean ornish Spectrum diet it works for me my Total is 148 LDL is 38 HDL is 68 Tris are 141 LP(A) is 7 this diet works for me because I am APOE 3/4 4’s need a lowfat diet and Paleo will drive up the numbers and damage the Blood vessels.

  • Michaela

    Hello everybody. I have a question about familial hypercholesterolemia (i guess, that´s what it is…): My husband and I eat strictly plant based since October 2015. Today his blood analysis shows a total cholesterol of 230 (HDL 57)… :(! He is running 3 times the week. We don´t use coco oil. What else can we do?? I am really desperate…
    Thank you very much for every idea and regards from Germany!

    • Thea

      Michaela: Hello in Germany! I have some suggestions, but when it comes to a genetic predisposition to high cholesterol, there may be only so much that can be done. I was sad to see you use the word ‘desperate’. There is no point in worrying yourself about things that can not be controlled. (That’s just my 2 cents.)

      And you are working on things that you can control–such as your diet and exercise. That’s great! I would point out that you have not been eating a plant based diet for very long. I have a friend who started out with very high cholesterol. It took 3 years on a strict vegan diet before her cholesterol numbers got down to safe range. So, one of my suggestions is to hang in there and keep going.

      My other suggestion is to check out the topic page on this site for cholesterol. You are already staying away from foods known to raise levels. But maybe you could tweak your diet to focus on foods that specifically lower cholesterol?

      Finally, here is a page that gives extra advice to people who have been on a whole food plant based diet for a while and still can’t get the cholesterol down. Maybe this page will give you some ideas.

      I hope this helps.

      • Michaela

        Dear Thea,

        thank you so much for your encouraging words!
        We keep on doing our best and I try to adjust some little more things in the diet. -and try keeping calm. ;)!
        Have a happy Easter!

  • AnaClaudia

    This inflo is so helpful and lifesaving! In this matter i have a question. Can we be sure that if we do not give our body any cholesterol at all, the SREBP2 will make the HMGCoA (i am not sure if the enzime is spelled correctly in english, padron me) to be synthesised in such low rates so cholesterol natural levels (50 to 70) will stay that way? I mean, couldn’t it have a sharp rise and so we would lose control of cholesterol and LDL levels? Thank you.

  • Riya O’Connor

    I recently had a cholesterol test with very poor numbers. I have been vegetarian for years, recently began a whole food, plant based approach. My doctor told me diet can only reduce the numbers by 20%, which would not be enough to get me to a safe range. He knows I am against medication and didn’t push it, but only 20%? He mentioned genetic causes for the high numbers but not how to bring them down.

    • Thea

      Riya O’Connor: I have some suggestions for you. Have you read the Prevent and Reverse Heart Disease book by Caldwell Esselstyn? That’s a truly great book, easy to read, and include a whole lot of recipes at the back of the book so that you will know exactly what to eat.

      If your higher cholesterol really has a genetic component, you might have to do a bit more than what is in the book. (Though I still recommend starting with the book.) One of the extra steps you can take is to research the cholesterol videos on this site. You will find several videos that mention specific foods which are known to bring down cholesterol numbers. So you could further tweak Esselstyn’s diet to make sure to include the foods mentioned on this site.

      I would expect the two steps above to work. But if your body is so very naughty as to still not bring your cholesterol down far enough, you can try the suggestions on the following page. This post was written by an RD, Joseph, who used to be on staff here at NutritionFacts. “What Can I Do To Lower My Cholesterol? It Seems I’ve Tried Everything!”

      Finally, I would caution that sometimes diet changes take a while to work on cholesterol numbers. I have a friend who had high cholesterol for three years in a row after switching to a WPBF diet. Each year, the doctor tried to get her on meds. Each year she refused as each year, her numbers were getting lower. Until this year when her numbers were just fine! So, it can take awhile… Whether it is wise to wait that long and just go with diet or not, I can’t say.

      I’m not an expert, but I believe that your doctor is very wrong about how far diet can reduce numbers. There are so many success stories out there who have done better than 20%, I wonder where your doctor got that 20% number. I can’t say whether you should include meds in your efforts or not. But I know if it was me, I would do the diet thing first. Those meds have some truly scary potential harms to the health and cost a lot of money.

      Good luck. I hope this helps.

  • John Schumaker

    Is it possible for your Total Cholesterol to be too low? I recently participated in our yearly company health fair where I had my finger pricked and a small amount of blood examined to tell me my Total Cholesterol, HDL, LDL, Triglycerides and Blood Glucose. Afterwards I met with a “nutritionist” to go over the results. My Total Cholesterol came back at 100 and the “nutritionist” recommended that I add more fat into my diet. I recently (within the past 3-4 months) switched from a vegetarian diet to a whole food plant based vegan diet. Physically I feel better than I ever have. Should I give credence to what the “nutritionist” recommended or am I consuming a healthy diet and don’t need to worry about making any changes?

  • Dimitra

    I would like to know your opinion about low serum cholesterol levels and depression and suicide. It seems that low cholesterol levels lead to a decreased serotonergic activity.

    Thank you

  • nani

    My husband (56) has since young very high Cholesterol levels and also high blood pressure, but exams showed no plaque building.(He is trying a HFLF diet, but has always been a vegetarian eating lots fruits and vegetables (but also some cheese and olive oil))

    I have also read about other such cases: “I am a 72 yr old female and have had high cholesterol for as long as I can remember (20-25 yrs.). It’s never been under 250 and sometimes 300. A few years ago I had a 64 slice CT angiogram which determined that I had no plaque buildup.”

    How is this possible?

  • nani

    Is there may be a relation between lack of vitamin D and having high cholesterol (and high blood pressure)?

  • Suman Noor

    What can I do to lower my cholesterol when a low fat vegan diet is not working? I have been on a whole food, plant based diet for three years now. PlEase advice.

    • Thea

      Suman: I’m not an expert, but I have some ideas for you.

      1) Is your weight ideal? Someone who is overweight may have cholesterol problems just from that situation. I first learned this from Tom Goff who wrote: “There is an interesting article on being overweight and its effects on lipids like cholesterol. It is quite technical but it concludes: “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”. [Tom gave a link that started with … but I don’t have the whole link. Maybe Tom will read this and help out again.] It is therefore possible that your system and metabolic response to eating a healthy diet won’t result in optimal cholesterol numbers until you are in a healthy weight range.”

      A lot of people lose weight switching to a vegan diet, but not everyone does or not everyone makes it to their ideal weight. I can give you some great advice for lowering your weight the healthy way if you are interested.

      2) Do you have genes that just keep you with extra high cholesterol? If so and if your diet is mostly whole, low fat plant foods, then maybe you don’t need to worry? I don’t know that we have any data on people who have been eating a low fat whole plant food diet for many years an yet their cholesterol is still too high. But I heard Dr. Klaper once say to not worry about it. He thinks that if you are eating the right diet, then you cholesterol won’t oxidize and you won’t get a heart attack. (Assuming I understood him correctly.) I don’t know if Dr. Klaper has hard data on this assertion, but it makes sense to me. I believe you can research this topic and then do tests to figure out what your genes are.

      3) Do you eat a lot of fatty plant food? I was listening to a lecture recently from Dr. Jim Bennie and he told a story about a patient who was vegan for a while, but who still had high cholesterol. It turns out that that person was eating multiple avocados a day. To be optimally healthy, I think you need to go low-fat, not just whole plant foods. So, moderate your intake of avocados and nuts and skip the oils (olive oil, coconut oil, cocoa butter, Natural Balance etc.)

      4) Were you eating a less than ideal diet for many years before becoming vegan? It seems (to my lay person’s brain), that some people’s bodies are all messed up after eating a bad diet for decades. So, my theory is that just switching to a vegan diet is not necessarily going to get your body to stop producing massive amounts of cholesterol. Or maybe your body produces more for a bit to compensate for the change in diet? To address this, you might focus on those foods which have been specifically shown to lower cholesterol. You can find those foods from various videos on this site. (Or maybe someone can help out and provide a list!)

      And then, if that doesn’t help, I like to refer people to Joseph’s excellent advice on what to do if you have tried everything and you still can’t lower your cholesterol: (Joseph was an RD who used to be part of the NutritionFacts staff)

      Hopefully some of those ideas will help.

      • Tom Goff

        Hi Thea
        Some of these links might be useful
        “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”

        “Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals.”

        The food most commonly used to lower cholesterol is oats.and particularly oat bran. You can try a homemade breakfast cereal of rolled oats and oat bran (cooked together in water not milk) . Add some cinnamon for taste and perhaps berries or grapes.

        Unfortunately coffee raises cholesterol, so moving to plain unsweetened tea may be helpful also. However, some people for genetic reasons have high endogenous cholesterol production and diet changes may not help much. But for most of us, losing weight, going on a strict WFPB diet and giving up booze and smokes (and that coffee habit) will work wonders.

        • Thea

          Awesome. Thank you. Another great Tom Goff post!

      • Thea

        Addendum: The last paragraph on the topic page for cholesterol includes a great list of the foods known to specifically lower cholesterol as highlighted on NutritiionFacts. Such a great page in general. Well worth checking out:
        Someone named “Randy” gave or recently updated this topic page. He/she did an really good job. Thanks Randy!

      • Matthew Smith

        The safest, most effective, cheapest, most effective statin for high cholesterol is Niacin, in doses of two grams a day. It brings all cholesterol levels to Ideal, including HDL, LDL, and triglycerides. Niacin or any Nitrogen elements are lost from food by heating. If you do not support Niacin supplementation, foods for cholesterol include
        nuts (particularly almonds),
        whole grains (like cheerios),
        flax seed meal,
        red yeast rice,
        dried apples,
        amla, and
        beans like chickpeas.
        and the Vegan diet.
        You are a star.

    • CatholicGinny1

      I too suffer from high cholesterols and being mostly wfpb did not work, so since January 1, I am in 100%. Dr. Fuhrman has said that until one reaches an ideal weight. even a low fat food intake does not mean you are on a low fat diet. As you lose pounds, your body is metabolizing the fat on your hips and gut, so technically you are still on a high fat diet. Dr. Esselstyn does not allow his patients to even have fatty plant food no nuts or seeds Good luck!

  • Nanschy

    What am I doing wrong? I have been an organic vegan for 4 years and I can’t get my cholesterol to come down from 260. I do take medication for hypothyroidism which I understand can affect my results. I do not eat sweets or wheat, I do not smoke or drink alcohol. I am desperate for help!

  • LaraH

    I really really would like to know if there is any science behind the claim that TOO LOW levels of cholesterol may lead to hormonal imbalance??
    So far I cannot find any, yet I see this claim all over the place.

    HALP :(

    • Tom Goff

      You will certainly find lots of charlatans, crackpots and the plain deluded with websites who make this claim for their own reasons. And it is true that cholesterol is an essential precursor for a number of important hormones including vitamin D. However, the human body makes all the cholesterol that it needs from a healthy WFPB diet. Populations with average low cholesterol levels aren’t known for suffering from hormone imbalance diseases nor are individuals with genetically low cholesterol levels.
      The situation can be complicated by the fact that some diseases actively lower cholesterol and this may also affect hormone production (certain cancers, Alzheimer’s,alcoholism etc).
      I think this is just more idiotic speculation and wishful thinking by these people. As far as I know, the only identified consequence of very low cholesterol is:
      “Loss-of-function mutations in the PCSK9 gene lead to an increase in the number of low-density lipoprotein receptors on the surface of liver cells. The extra receptors can remove low-density lipoproteins from the blood more quickly than usual, which decreases the amount of cholesterol circulating in the bloodstream. Studies suggest that people with reduced cholesterol levels caused by PCSK9 mutations have a significantly lower-than-average risk of developing heart disease.

      Researchers suspect that normal changes (polymorphisms) in the PCSK9 gene are responsible for some of the variation in blood cholesterol levels among people without inherited cholesterol disorders. In particular, scientists are working to determine which polymorphisms are associated with relatively low levels of cholesterol in the blood and a reduced risk of heart disease.”

  • Lauren Culp

    I have eaten vegan for 5 years and yet my cholesterol levels are nowhere near optimal. Is there any studies that a whole foods plant based diet is still preventative for CAD even when cholesterol doesn’t drop like a stone?

    • A Newton PhD RD

      Hi Lauren, you cholesterol is influenced by a number of factors as well as diet. Your cholesterol values may also be reflective of family genetics (does your family have a history of CAD?) as well as exercise, weight, etc. Do you currently do any physical activity, are you within a normal weight? All these things may contribute to your cholesterol (but a big one may be genetic predisposition).

      • Lauren Culp

        Thanks for the reply. I believe it is genetic. I am 5’10” and weigh 135 lbs, with a BMI of 19.4. I exercise 3-4 times per week, but I’m aiming toward 6-7. My mom had triple bypass surgery at 76 and since then has had two strokes and two heart attacks. I will continue to search for the answer right for me. I eat a whole foods plant based diet and am trying to limit oils and fats as well. I’ve just started writing everything down to try to keep my fats under 20%. I was hoping that even with higher cholesterol the vegan diet would offer protection. Thanks again.

    • DrAlex

      I agree with what Dr. Newton said, but I just have one thing to add. Think very specifically about your diet. Just because someone is vegan, doesn’t mean they’re eating the best…there’s plenty of “bad” vegan food out there (i.e. vegetable oils, processed foods) that can still wreak havoc on your cholesterol levels. I’ve seen it in myself! My total cholesterol will vary from the low 130s up to the 180s, but I know when it’s in the 180s it’s because I haven’t been eating the best…vegan, yes, but it’s usually when I’ve been eating out more than I should and so much more oil and processed stuff is used. You might think about reading Dr. Esselstyn’s “Prevent and Reverse Heart Disease” book. He talks a lot about cholesterol and how his individual patients’ cholesterol levels will bounce up when they cheat just a little. It’s kind of amazing the difference a little oil here and there can make. Just a thought. Good luck to you.

  • outdoar

    Late to the discussion, maybe a genome selected diet the next cutting edge science here?

  • GadflyRadio

    My LDL cholesterol was at 142 on February 13 of 2015. On May 7 of 2015, I went whole food plant based. 0n Aug 27 2015, my LDL had dropped to 120 mg/dL. On Feb 3rd I went on an elimination diet, to address my inflammatory arthritis, and I stopped eating nuts, and stopped using oils, and ate only quinoa, buckwheat, amaranth, sweet potatoes, and green and yellow veggies and three or 4 four servings of fruit. On March 22, 2016, my LDL was 126 mg/dL. I went up 6 points. I would love to get it down to 70 but how? What else can I do? I am working out three times a week and the gym, and am strictly adherent to my diet. How long should it take for me to see my LDL drop? Why did it go up? Before February, I was drinking around 30 ounces of soy milk a day. And then before I began my elimination diet, I substituted soy milk with almond milk, but the new almond milk formulas all seem to have canola oil. Is this what make my LDL go up between August of last year and when I went on my elimination diet? I am mystified.

    • Steve Koelzer

      Fish oil, specifically DHA blocks the biosyntheses of cholesterol, saturated fatty acids and releases them from where they are stored

  • coffeeking

    At 316, my cholesterol level is very high. My LDL is 226! I am a 35 year-old male, and I weigh about 145 pounds.

    This is my first time being tested. The doctor has prescribed 10 mg of Lipitor. I don’t like the way the drug makes me feel, and I am concerned about the effect it has on liver function.

    I have moved to an almost exclusive plant-based diet, and I am getting more daily exercise. I don’t want to take Lipitor. Should I take it to bring my levels down though? Can I go off it when they come down?

    • Thea

      coffeeking: I have read so many negative things about statins that I personally would only go on them except as a very, very last resort. And even then, given their questionable efficacy, I don’t know if I would. Instead, I would carefully read Dr. Esselstyn’s How To Prevent and Reverse Heart Disease book and then go on his diet, being very strict with myself about keeping with it. Because I would understand that I have a very serious problem. (So, “almost” exclusive plant based would be a step in the right direction. But for a serious problem, I might take things a bit more seriously than that.) The nice thing aout Dr. Esselstyn’s book is that it includes recipes in the back. So, you can see exactly how to eat to lower cholesterol levels.
      I’m not a medical expert, so take that advice for what it is worth. Hopefully you could find a doctor who understands nutrition and who could work with you from a place of knowledge to help you make this decision. Good luck!

  • deane

    Can someone, preferably a MD, ND, or RD, or someone that knows a bit about cholesterol, comment on the video below. Just click the “12 – Cholesterol Facts” on the right side of the screen and you’ll just get the cholesterol part of the video. Gabriel Cousens M.D. is a Vegan psychiatrist and his views on cholesterol appear to differ to this website ( . I’d just like to know if what is says stacks up or not. He appears to have references to studies that back up the claims in his presentation.

    • Rami Najjar – NF Moderator

      The video is not loading well, but I browsed through the transcript. Based on the claims made through out the entire transcript, this individual seems to be fraudulent. His talk of biophotons and enzymes are whimsical and not grounded in science. His misunderstanding of heart disease and misinterpretation of studies regarding cholesterol is also improper. I would not view this individual as a reliable source of information.

  • Arun Mukherjee

    I would like to know the Canadian equivalents of the measures you have used Dr. Gregor. My husband’s blood text showed 2.o5, and our family doctor wants to increase his statin dosage. We have been on a whole foods plant based diet for two and a half years now (no coconut oil or coco butter) and all other results are fine. Looking for advice.

  • Kent Lang

    Wouldn’t it be possible to sue the Federal government?

  • Drumnadrochit

    Many, Many thanks to Dr Greger & the team…… After persuading my 72 year old Mum to read ‘How not to die’ she reluctantly agreed to try changing her eating habits. 2 weeks later she came back from the doctor’s & announced that for the first time since being diagnosed with high blood pressure 50 years ago, her BP was down from her usual levels & her doctor had agreed to monitor her progress. A month later she has been able to cut down her meds & is a convert to the WFPB diet.

  • Sarah

    What do you say to people who argue that dietary cholesterol doesn’t raise cholesterol levels. Someone just shared this link regarding eggs and cholesterol… I don’t know how to argue this…

    • Thea

      Sarah: I just quickly glanced at the article, but what little I did see, it is full of the same type of miss information you see all the time on paleo/atkins sites. It could be a talking point paper for a cholesterol confusionist foundation. I’ll share some general info on the topic. You can find corroborating (scientific) backing for all of these points on this site. (I just don’t have time to find the exact videos right now, but you can find it all.) Or you can spend some time on the site for a wonderful and in-depth look a these issues.
      Here’s the deal: Most humans are born with total cholesterol at 150 or below and LDL at 70 or below. Cultures which maintain these levels throughout their lives have almost no heart disease. And studies show that people who maintain these levels naturally (statin drug effectiveness is in question) are basically heart-attack proof.
      While cholesterol serves an important function in the human body, our bodies make all the cholesterol we need. No one with a normal body has to ever worry about having too little cholesterol. (Even most people who have genetic abnormalities which naturally make *extremely* small amounts of cholesterol tend to go on to live normal happy lives.)
      However, there are serious, well-documented health problems with having too much cholesterol in our blood. How do we get too much? Eating foods with cholesterol and saturated fat (ie, meat, diary and eggs) greatly raise our serum (blood) cholesterol levels, spiking it for several hours after a meal. It’s possible that some plant foods that are high in saturated fat alone (since plants do not have cholesterol), such as coconut and chocolate and palm oil, also raise cholesterol levels in our blood.
      It is natural for cholesterol levels to come down at least a bit after say 4 or so hours after a meal high with cholesterol and saturated fat. However, what if you are someone who is eating meat, dairy and eggs in every meal? Then you are living a great deal of your life in the danger zone. The danger zone is the elevated levels of cholesterol where heart attacks happen. Another consequence of eating meat, dairy and eggs is that over time, people start to get elevated levels of base/fasting serum cholesterol.
      Living in a society that lives day after day, year after year, decade after decade with elevated serum cholesterol until heart disease is the number one killer of our people, we have learned something about how our bodies work in terms of consuming and generating too much cholesterol. Many of us have an upper limit. In other words, our bodies do allow us to live in a danger zone, but at some upper level, our drowning bodies start to make less cholesterol despite increased inputs so that our serum cholesterol numbers level out at an upper limit. The article you referenced talks about a “set point”, but this is misleading. A set point is a point our bodies must maintain to be healthy. We may have a healthy level of cholesterol, but our bodies allow us to go way beyond that healthy level when we consume unhealthy foods. In other words, for the article should never have used the term ‘set point’.
      But the topic of the upper limit is important to understand, because some researchers use this information to lie to us. When you eat meat, dairy and eggs, your cholesterol levels will go up and up and up — UNTIL it levels off. What this means is that if your body is already saturated with unhealthy levels of cholesterol, you can add extra eggs to your diet and have only a minimal effect on the cholesterol levels in your blood. (On the other hand, take a person with truly healthy starting levels of cholesterol and feed them say eggs and you can watch the blood cholesterol levels sky rocket.) The meat, dairy and egg industries capitalize on this well known biological phenomenon to design bogus studies that “show” that eating cholesterol does not raise blood cholesterol or heart attack risk by feeding say eggs to people who already have high cholesterol. It is equivalent to a smoking study which compares people who smoke say 2 packs a day to people who smoke 2.5 packs a day. Hey look, the danger is the same! (doh)
      At some point, your risks from smoking level out. Smoking has put you in the danger zone and adding one more cigarettes is not going to significantly raise your risk even more. But that does not mean that smoking is healthy. The same logic works for meat, dairy and eggs. You can maximize your disease risk so that adding a bit more does not increase risk even more. But that does not mean that meat, diary and eggs are healthy. Obviously.
      Shame on Huffington Post and John Berardi for continuing to push cholesterol myths and confuse people about the health impacts of eating eggs. John is helping to spread the meat, dairy and egg talking points, while ignoring that the studies and logic he is basing his article on are fatally flawed. I do have on hand a list of NutritionFacts videos you can check out which go over the various ways in which these studies lie.
      On this page is the article that talks about how we know that dietary cholesterol affects blood cholesterol (and yes, it is harmful):
      Also, I would like to direct you to the last third of this video at PlantPositive. I would swear he has another video that also addresses the serum cholesterol question, but I couldn’t find it. But this one I think will be of interest to you:
      Look for: “This study of cholesterol absorption is valuable because the subjects in it were semi-vegetarian. They weren’t vegans. They did ordinarily consume eggs, fish, and dairy. For these people who had lower than average cholesterol, dietary cholesterol did raise their blood cholesterol.” and “You can see quite clearly that cholesterol feeding did raise LDL bad cholesterol markedly in these semi-vegetarians.” and “It was known in 1957 that vegetarians who did not eat eggs and dairy had lower cholesterol than those who did.”
      Also very important is the part about how saturated fat and cholesterol work together to make everything worse. Since those two components are, I believe, always eaten together in whole animal products, the effect of eating animal products is worse than just eating cholesterol or saturated fat separately. Look for the part that starts with: “The effects of dietary cholesterol are variable. For one thing, saturated fat consumed with cholesterol causes it to be more effective at raising blood cholesterol.” The first part of Dr. Greger’s video also covers this point.
      Finally, I’ll leave you with this fact: The *only* diets proven in clinical trials to reverse the plaque build up in blood vessels are whole plant food based diets. We are not talking about slowing down or even stopping the progression of heart disease. We are talking about reversing it so that people go on to live their lives without having any more heart attacks.
      Does that help?

  • Sue Stauffacher

    question regarding cholesterol tests

    I eat a mostly low-fat vegan diet (occasional forays into egg and cheese land), but my LDL was surprisingly high… 97. My question is, I would like to experiment on myself to lower my LDL by trying some of Dr. Greger’s suggestions: brazil nuts, apples, but also cutting out eggs and/or cheese for specific periods of time. How long should I go between blood tests to see if I’ve made a difference? Thank you!

    • Thea

      Sue: Your post came through with an incomplete, single word at first. I’m not sure people are going to see your question. Maybe post again??? (Just trying to be helpful.)

      • Sue Stauffacher

        You are so sweet, Thea, but I see it in total up there…can you see it now? I did post a single word before realizing what I thought was the title of the post was the post itself. Maybe you saw that and not my edited version. Thank you for your concern. Best, Sue

        • Thea

          Sue: Yes, I see it. I saw the whole post when I went to investigate your original post. What I was trying to say is that there are a LOT of people on this thread who might be able to answer your question. I think most people set up their Disqus to get an e-mail when there are new posts on a page they have commented on. *But* disqus only sends out original e-mails/sposts. Disqus does not send out the updated version. So, only people who come to this site and scroll to the very bottom of 400 posts would actually see your real post. I thought it was such a good post, I wanted to make sure everyone sees it.

          Of course, with our conversation, people now know that you put out a good post. I’ll just repeat your post/question here so that people on this thread will hopefully see it. That makes more sense than yet another e-mail going out to the group beyond this post. :-)

          Please respond directly to Sue:

          “question regarding cholesterol tests

          I eat a mostly low-fat vegan diet (occasional forays into egg and cheese land), but my LDL was surprisingly high… 97. My question is, I would like to experiment on myself to lower my LDL by trying some of Dr. Greger’s suggestions: brazil nuts, apples, but also cutting out eggs and/or cheese for specific periods of time. How long should I go between blood tests to see if I’ve made a difference? Thank you!”

          • Sue Stauffacher

            Now I understand, Thea! Hmmm, I haven’t received any response. Maybe I will try again in a few days. This is my first time trying to get into a discussion. I’m a plant-based chef who has no formal training in medicine or nutrition, but I know a boatload about how to cook delicious tasty unprocessed, no added oil food. I hope I can help answer someone else’s question… any suggestions for me?

    • Thea

      Sue: Here’s my answer: I’m not an expert, and I don’t know. I’ve heard stories, though, of people who have had dramatic results quickly when they changed their diet. But I also have in my head the story of my friend who went vegan, and it took three years before her cholesterol dropped to safe levels. Every year, the numbers went down, but they didn’t go down far enough for a long time.

      I share this with you to be helpful, not discouraging. I think you totally have the right idea on what to do to fix the problem. I’d hate for you to get discouraged if the process takes some time. Hopefully one of the medical professionals who participate on this site will jump in with their experiences. Or maybe someone will have a study or two to share which covers speed factors.

      Here’s a NutritionFacts page that you might also find helpful: “What can I do to lower my cholesterol? It seems I’ve tried everything!”

  • Mitch West

    I’ve been eating a WFPB diet for about 8 months now, feel great, and LDL dropped from 118 to 98. Does anyone have experience with how long it takes to “fully drop?” In other words, should I expect that it will probably not go below 98, even though I am eating as “clean” as possible? Also, does anyone know if “LDL particle number” and “LDL particle size (small, medium, large)” are real risk factors or bogus science? Thanks!

    • Thea

      Mitch West: The following NutritionFacts video answers you last question: Bottom line: bogus science.
      For your first question of, “How long?” I don’t have any statistics or insight from a professional’s experience. But I can tell you that I have a friend who went from high cholesterol to safe cholesterol over 3 years. So, it can take a while. I imagine that the rate of improved cholesterol levels differs for each person depending on a number of factors. Those factors may include diet specifics and individual genetics.
      Eating WFPB is just awesome and puts you way ahead of most people. However, if you have a specific goal of lowering cholesterol, the devil may be in the details. So, you may want to scour this site to tweak your diet to emphasize those foods known to lower cholesterol and avoid those foods that may increase cholesterol. Or just keep going as you are going. Obviously you are doing something right! You could see how it goes.
      Congratulations on the progress you have made so far! You should be proud of yourself. :-)

      • Mitch West

        Hi Thea-
        I can’t thank you enough for your prompt response to my question. I am a HUGE fan of Dr. Greger’s and know that he has forever changed my life and that of my family. Thank you for sending me those links; I had indeed seen those (I watch as many videos as possible!). Because of my family history of heart disease, I want to make sure that I pay particular attention to my cholesterol; and I was surprised to hear that my results of my “Cardio IQ” blood test showed my small, medium and large lipoprotein subfractions all in the “high risk” category. Particularly given that my LDL had dropped 20 points. There is SO much misinformation out there; but I really do thoroughly trust Dr Greger. Thanks again!

  • elyse sokoloff

    Recently, the Physician’s Committee sent a press release stating that the Dietary Guidelines had reversed their position on cholesterol and had, in fact, strengthened their warning against it. I’d find that encouraging but I can’t find anywhere where it says they did that. Does anyone have any information?

    • Tom Goff

      The US 2015-20 Dietary Guidelines have not changed but they have recently (June 2016) been issued as a PDF document. Thy state
      “The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM,[24] individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”

  • Jayden Bennett

    Hey Dr Greger, during my nutrition lecture, my lecturer used this study to say that dietary cholesterol does not increase risk of CVD. Was hoping you could make a video on this to make sense of the claims.

  • Julia Anthony

    This article makes me think Dr. Atkins was a closet cereal killer:0)

  • Steve Koelzer

    Oct ’16 and just saw this vid. and not reading the 416 comments for time constraints. First, the LOW limit, 30-35- of cholesterol is associated with getting cancer, so there is a lower limit RANGE. The body takes care in regulating its making cholesterol at the rate-limiting step, (HMG CoA synthase) wherein STATINS are used to block its further steps to make cholesterol. Second, if you eat animal fats its cholesterol becomes absorbed (part of which may be used to make bile saponifiers (to break fats into smaller particles for higher surface area so pancreatic released lipase breaks down fat esters to absorb, etc.). In the bile cycle (bile is reuptaken and reused) it can turn into certain carcinogenic metabolites. Third, the cholesterol then goes to the liver and can suppress its manufacture by attach to cell surface receptor which regulates its biosynthesis there (in the liver). Of course the liver packages the fat(s) into spheres of various dimentions and squirts them into the circulatory system. This goes on and on but the last point is that essential oil has a job to also impede the rate-limiting step unto cholesterol. That oil is DHA, or docosohexaenoic acid the omega-3 oil 22 carbons long, which your liver can make from essential precursors like linolenic acid, an omega-3, very high in flaxseed oil. It is what I used 30 years ago to rid my plaqued arteries (and I was consuming NO trans fats and taking selenium since ’72 to also rid mercury, etc.). Meat is currently not advised for longevity. Fourth, body cells need membrane mobility to allow receptors to move around. Cholesterol helps to modulate the dynamic viscosity of cells’ lipid bilayer, keeping it in the Goldilox zone (typo intended). The omega-3 DHA (highest in electric fishes) enhances such mobility requirement especially in brain, and for insulation and in the grey matter, etc. DHA liberates stored fats, and a host of other things

    to protect the brain wherein cholesterol is not so much needed.

    • Thea

      Steve Koelzer: The first part of your post seems concerned with low cholesterol and a belief that having low cholesterol might promote cancer. Are you familiar with the concept of reverse causation? This concern you are talking about first arose due to what you aptly describe as an association. However, upon further investigation, we have seen that serious diseases such as cancer cause serious drops in cholesterol.
      In other words, low cholesterol does not cause cancer. Cancer causes low cholesterol. I’m not aware of any evidence showing that people who start out with low cholesterol have higher rates of cancer going forward in time compared to people who start out with more cholesterol.

      • Steve Koelzer

        Of course. Well, I may be right or wrong but I learned of ‘too low cholesterol’ causing cancer ~20 or 30 yrs. ago and would be pressed to retrieve source(s). It is known that metabolic sequelae are grouped and the biosynthesis of fatty acids, cholesterol and the like are collectively expressed in lieu of the opposite set of genes for catabolic energy, i.e. they are reciprocally facilitated and inhibited as needed. So a search of recent ‘low cholesterol’ gave these: (epidemiology) The cancer risks and life shortening effect of low and very low cholesterol among Asians. “Those with very low cholesterol had their life span shortened by 5-6 years. While reverse causation with pre-clinical cancer cases could be responsible, the fact that the cancer risks remained after excluding first three years of cancer implied low cholesterol is an independent risk factor or risk marker for all cancer. In this Asian community (>500,000), low cholesterol should receive as much attention as high cholesterol.” -and- The Role of Cholesterol in Cancer (15 April 2016)

        The roles played by cholesterol in cancer development and the potential
        of therapeutically targeting cholesterol homeostasis is a controversial area in
        the cancer community. Several epidemiologic studies report an association
        between cancer and serum cholesterol levels or statin use, while others suggest
        that there is not one. Furthermore, the Cancer Genome Atlas (TCGA) project
        using next-generation sequencing has profiled the mutational status and
        expression levels of all the genes in diverse cancers, including those involved
        in cholesterol metabolism, providing correlative support for a role of the
        cholesterol pathway in cancer development. Finally, preclinical studies tend to
        more consistently support the role of cholesterol in cancer, with several
        demonstrating that cholesterol homeostasis genes can modulate development.
        Because of space limitations, this review provides selected examples of the
        epidemiologic, TCGA, and preclinical data, focusing on alterations in
        cholesterol homeostasis and its consequent effect on patient survival. In
        melanoma, this focused analysis demonstrated that enhanced expression of
        cholesterol synthesis genes was associated with decreased patient survival.
        Collectively, the studies in melanoma and other cancer types suggested a
        potential role of disrupted cholesterol homeostasis in cancer development but
        additional studies are needed to link population-based epidemiological data,
        the TCGA database results, and preclinical mechanistic evidence to concretely
        resolve this controversy.

  • Tucwebb

    Forgive me if this has been addressed and I have missed it. How does alcohol consumption affect cholesterol levels?

    • Cathleen

      It’s hard to confidently answer this question because there are no randomized controlled trials (to my knowledge) that look at various levels of alcohol consumption and the affect on cholesterol or CV disease. The studies are mostly observational, so no cause and effect. Such studies suggest that light to moderate consumption of alcohol decreases the risk of coronary heart disease compared to drinking no alcohol or to heavy consumption. One contributor to this effect may be the increased HDL (good cholesterol) level seen with moderate alcohol consumption. This is not seen with heavy intake. Intake limits should be 1 serving for women and 2 for men per day. Of course, there are enough negative effects of alcohol intake that I am NOT suggesting anyone should take up drinking for their health! Hope that helps.

    • payoung

      This is purely anecdotal but I remember when I was just starting out as a PA in surgery almost 30 years ago and I noticed that alcoholics never had high cholesterol. I was told the reason is because alcoholics often have impaired liver function and since the liver is where cholesterol is made people with liver disease don’t make large amounts of cholesterol. That said, I completely agree with Cathleen’s response below. It’s probably not a good trade off to increase alcohol intake in an effort to decrease cholesterol.

  • allen scott

    Just what I was looking for. Thanks for the info, super helpful. Just look at the service Its pretty easy to use. I think you can get a free trial if you ask for it.

  • peter

    Hasn’t it been debunked that dietary cholesterol substantially increases serum cholesterol? Just a quick pubmed search will show this? At most dietary cholesterol mildly increases serum cholesterol. Then why does Dr. Greger emphasize the need to cut dietary cholesterol such as egg yolks? The bigger focus should be on saturated fats.