Doctor's Note

This is the third of a six-part video series on the Mediterranean diet. For some historical backdrop, check out out the first two at Why Was Heart Disease Rare in the Mediterranean? and The Mediterranean Diet or a Whole Food Plant-Based Diet? Here are the next three to come:

  1. Which Parts of the Mediterranean Diet Extended Life?
  2. Do Flexitarians Live Longer?
  3. Improving on the Mediterranean Diet

The PREDIMED study got a bad rap because of how it was reported, but it’s an extraordinary trial that continues to churn out useful results.

More on nuts in:

But what about nuts and weight gain? See Nuts and Obesity: The Weight of Evidence.

I’ve got lots more on olive oil coming up, but I did do one already:
Extra Virgin Olive Oil vs. Nuts

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  • Peter Westphal

    Here is another study on the benefits of nuts consumption:

  • darren

    Sorry if you’ve addressed this somewhere else, but this question has been bugging me for a while and this video is tangentially related to it!

    In the video below you mention that a the ratio for omega 6 to omega 3 ratio should be 4-1:1 for optimum health, but you regularly mention that nuts have a protective effect on health even though the high omega 6 offset even a high amount of omega 3 in diet, at least according to anything I could find online(e.g pecans are about 22.1 )

    Does the fiber prevent an excess of omega 6 from being absorbed or does the fat in nuts work differently to the more refined omega 6 people would consume on a standard diet?

    40 Year Vegan Dies of a Heart Attack! Why? The Omega-3 and B12 Myth with Dr. Michael Grege

    • Julie

      From my understanding the fiber does not inhibit omega 6 absorption. The fatty acids in fresh raw nuts/seeds are whole and unadulterated, while the fatty acids in refined oils have been altered and damaged during the complicated process of extracting oil from a seed/nut. So it’s definitely recommended to get fats from whole sources (nuts, seeds, avocados) but even then I think it’s important to follow the 4-1:1 omega 6 to omega 3 ratio. Excess omega 6 will flood the pathway that promotes inflammation.

    • That video was recorded more than a decade ago (you can tell by how much hair I have :). Much has changed in the field of nutrition. For example, doubts have been raised about the cardioprotective benefits of omega-3’s. See for example, my video Is Fish Oil Just Snake Oil?. If nutrition was a static field, a site like wouldn’t be necessary :)

      • Charzie

        Okay, than if I recall, this video was all about why plant based diets don’t seem to extend life expectancy or protect us from the effects of SAD as expected. So this begs the question of WHAT exactly is the current explanation to replace this theory, if any?

      • darren

        Good point, there’s a damn lottery’s worth of variables in play so I should keep checking back.
        Thanks for getting replying so quickly :)

    • Lawrence

      I first watched this presentation a couplefew years ago as I transitioned to WFPB and the takeaway message I got was simply 1) take a B-12 supplement regularly and 2) eat two tablespoons ground flax seed every day. And, nothing I have seen since then has contradicted that advice. But, you have to keep processed oils (loaded with omega-6’s) to minimal/zero as they will gobble up all the enzymes necessary to convert dietary omega-3’s (flax seed) to EPA/DHA.

  • HemoDynamic, MD – NF Volunteer

    Test. New tag added to name.

    • Veganrunner

      Dr Hemo you officially joined the team!

      • HemoDynamic, MD – NF Volunteer

        That’s right, I’m officially unofficial. :-)

        • Veganrunner


    • Joevegan

      I’m not surprised; your input has always been very good, many times I’ve checked your links or agreed with your advice. We need more doctors like you. Thanks for volunteering.

      • HemoDynamic, MD – NF Volunteer

        You are too kind. Have a great day! :-)

    • Looking good!

  • I was avoiding nuts for a long time since I thought they got caught in my diverticulosis pouches. That and the high omega6/3 ratio of most nuts/seed outside of flax and hemp (4:1-3:1). But after listening to doctor Greger talk about the cardio benefits shown in these studies I’ve thrown caution to the wind and started adding daily nuts/seeds to my diet. I soak them raw along with some apricot kernels in water over night. Another great video Dr. G.

    • george

      Veggie Eric: I’m intrigued by your consumption of apricot kernels. I thought they contain a compound that breaks down in the tummy into a cyanohydrin, which reacts with water in the presence of HCl to give hydrogen cyanide. Am I missing something?

      • Hey George, apricot kernels have been touted for Vit B17 and having strong anti-cancer properties. I’m aware of the cyanide issue but just like apple seeds what is truth and what is hyperbole? That’s why I’d love to see a video to clear up the public confession. Here’s some reading to confuse you and me even more. ~~>

        • largelytrue

          There is no vitamin B17. Laetrile and amygdalin are promoted as such to try to give them an aura of legitimacy, but if the deep fringe weren’t calling them ‘vitamin B17’ nobody else would have a reason to identify them by that name. To add to your “confusing” reading:

          • You lost me when you posted a reference to “”… That is a blog opinion site set up by a not so trustworthy guy and is a know anti-alternative medicine site that has ZERO credibility. I’m all about ncbi… but “Quakewatch”? no… just no.

          • largelytrue

            Quackwatch provides some counterpoint on the history of the treatment that you wouldn’t get if you stayed deep in anti-mainstream sources. What blemishes its credibility to ZERO while also allowing non-zero credibility to a random discussion on Medical News Today?

          • True, you have a point about not shooting the messenger. I personally would have given the article more credibility if it had not come from quackwatch though. Barrett and that site have a shady history… did you notice there is no message board or forum or comment section? That’s on purpose because he’s not looking for input or spirited debate. He’s using the site as a saop box for his own personal opinion about non-alopathy treatments of any kind.

            If you’d like to read up on him ~~~>

          • largelytrue

            It’s been some time since I visited that page — which from the looks of it, doesn’t have a forum or comment section either, in case that matters to you. From what I recall I also looked at Barrett’s response to Tim Bolen:

          • Well, lets keep it in perspective… Barrett is a diet denier, meaning he does not believe diet has any medical validity along with chiropractors or any natural alternative treatments. He would not approve of this site or its contributors. See for yourself… Send him this video on strawberries and cancer and see what he has to say about it…


          • largelytrue

            The problem when you make such sweeping and unqualified statements is that they can be easily picked apart as not aligning with what the person actually says. See for instance an article by Barrett here:

            It doesn’t seem to me that he’s arguing that nutrition has no medical validity.

            You can openly speculate about what Barrett might do and declare your confidence in that opinion, but it does little to inspire confidence in the idea that he’d actually do that. ‘Greger’ has 0 hits on both Quackwatch and Nutriwatch, so it’s not clear to me that he really has his guns out to destroy the site:

            The strawberry treatment has gone to a Phase II trial, by the way:

            Of course I think that the “outspoken skeptical doctor” or “quackbuster” genre carries some important biases, and biases about nutrition in particular, some of which are legible in the article I linked. I also think that there is enough nonsense out there in the alt-med world that an adversarial model is sometimes appropriate. When you need to examine both the available indicating evidence and the available disindicating evidence on a treatment, you are often limited to those who care enough about the topic to invest their time in an extensive argument. Where people are willing to accept a therapy on little to no evidence, they rely implicitly on other standards like sound character, intellectual thoroughness, and lack of monetary bias. It’s entirely reasonable to look for blemishes in the promoter’s character under such circumstances.

            I don’t think that Quackwatch is always right, nor do I think that someone is a quack just for being listed on the site. The articles deserve a skeptical reading in which one gives greater credence to verified citations and less credence to mere opinion. Moreover, I think that like most sites advocating Skepticism of Nonsense, the use of Quackwatch is strongest when investigating comparatively simple questions where the available evidence is relatively unambiguous. They are less good at addressing issues like nutrition, not only because of any bias to declare that diet is not that important, but also because the topic is inherently complex and there is a lot of available research to consider. People who are strong at poking holes in stuff are not so strong in a situation where one can selectively cite research to superficially make just about any case. Still, though in erring toward the mainstream, a site like Nutriwatch is not necessarily going to land far off from the general ideas of this site, because the mainstream view actually is that the best sorts of diets emphasize unrefined plant foods.

            I still don’t visit the site much or try to hang on Barrett’s every word, in large part because very few bits of medicine interest me (I’m not

          • Well, I guess we will just have to agree to disagree. I’m not a fan of quackwatch and apparently a lot of people share the sentiment.

            see here ~~>

            Barrett is not an expert any more than you or I. He is an internet blogger with a site he built to share his opinions on what he personally deems quackery. You could go out and make a personal blog site just like him or Jimmy Moore or any other blog site and soap box your opinions too.

            We are all on our own health journey to find what works best for our unique health situation. Some folks are farther along in that journey than others. I personally stick to more credible resources like nutritionfacts, McDougall, PCRM and tend to stay away from sites like his… to each his own. Thanks for responding.

          • largelytrue

            If you stick to those sources, then how did the idea of ‘vitamin B17’ enter your brain? Did you get the idea from an expert?

            You appeal to popularity in justifying your opinion of the site. How popular is McDougall? How many of those negative reviews on SiteJabber (of all random places to look for an opinion) were focused criticisms based about the quality of argument with legitimate examples? Is there a reason why a website listed under “alternative medicine” which is actually very anti-alternative would tend to gather negative reviews, apart from the non-veracity of its claims?

            Characterizing Quackwatch as a ‘blog’ is pretty disengenuous, in my opinion. It certainly doesn’t meet the criteria for a personal blog, which is the prototypical type of blog. Do blogs publish newsletters? And if we want to call it a blog, then is NF a blog? Is McDougall’s site a blog?

        • Joseph Gonzales R.D.

          not sure where B17 came up, but I would take serous caution here. An accidental swallow of an apple seed is not the same as cooking-up apricot pics or however they used them. Just dont think the science is there. this is old but relevant.

          • Veggie Eric

            Thank you good sir, I appreciate it. Looks like I will be discontinuing the apricot kernels and sticking to just good ol nuts n seeds.

    • Darryl

      Dr. Greger has a video on this very topic: Diverticulosis & Nuts

    • etmax

      I like many others suffer from diverticulitis and have for decades, first being diagnosed when I was about 14 (almost 60 now). The only time I’ve ever had issues with nuts (never having been told there was an issue) was from 1993-2013 when I had a bowel intolerance to peanuts. No other nuts caused the same problem, and the issue went away somewhere around 2012/2013 and was never there before 1993. I have to say that having no understanding of how bad my DV is compared to others that have nut issues I have to say I find no issue with nuts. Maybe if you have a low fibre diet and have nuts there are issues? I have no idea, but welcome insight from anyone who might know.

      • Cherry Downs

        etmax, I am 77 years old and have had DV for about 25 years. I have no problems with thoroughly chewed nuts except peanuts. (Nut crunchiness satisfies my psychological craving) Through trial of elimination, time and reintroduction I have learned peanuts cause diverticulitis in my colon. I have also learned through this same trial technique that I am also sensitive to GMO foods ( pesticides on/in them?) Gluten ingestion will put me in the Hospital with acute inflammation of G I system, cranial nerve 6 and acute diverticulitis. All very painful. G I and neurological symptoms are distinct, consistent and constant with GMO food ingestion, only prednisone, time and a “clean” diet will make them go and stay away. Being very aware of how foods I eat affect my body is a obsessive necessity in my life.

        • etmax

          ? peanuts cause DV or the pain and inflammation associated with it? Seems like you have a multi-source sensitivity. Gluten intolerance causes a lot of bowel damage. A pharmacist once told me that peanuts support a particular mould growth that some people can be sensitive to. Anyhow, like I said my sensitivity has magically disappeared.

  • RJ

    Note to Admins: Transcript is from another video from last week.

    • Tommasina

      Thanks, RJ! Just fixed it.

    • Tommasina

      Thanks, RJ! Just fixed it.

  • Tobias Brown

    Please clarify: If we’re eating an excellent plant diet, is adding nuts important? Many of us find that we can’t stop eating them until the bag is empty. So, we simply keep them out of the house? Should we train ourselves to consume nuts moderately? Are they that important, adding that much of a health benefit?

    • Good question. I consider nuts and seeds to be an essential element of a well designed vegan diet. In my practice, I elevate nuts and seeds to be an official food group. The underlying logic of food groups is that each food group has a broadly distinct nutrition profile, high in some nutrients and low in others. By including all the food group is your daily diet, you have the best shot of getting all the nutrients your body needs. Since nuts and seeds, as a category, have a unique nutritional profile (particularly regarding healthy fats and certain minerals and other phytonutrients), that makes them a great candidate for official food-group-dom. (People who lump nuts and seeds into the “protein” food group [of course protein is not a food, it’s a nutrient] must be smoking who knows what. Nuts and seeds have the same proportion of protein as do grains, and I don’t see anyone assigning grains to the “protein” food group.) Another way to answer the question as to the importance of nuts and seeds in the diet, just take a look at all the NutritionFacts videos on the health benefits of nuts and seeds. It’s mind-boggling. You would not want to be without them.

      Regarding the danger of overeating nuts and seeds, they are “dangerous” in that regard since they pack so many calories in a small package. The solution I recommend is to use nuts and seeds as an ingredient, not as a snack. I recommend making a mix that fits your tastes (mine includes almonds, walnuts, cashews, sunflower seeds and pumpkin seeds -plus some raisins for a little sweetness). Add a small handful to your oatmeal in the morning, to a salad, to a stir fry (after cooking), to a dessert parfait of soy yogurt, mixed cut up fruit and a little granola. Used as an ingredient, you avoid the danger of sitting in front of the TV with a bucket of nuts and mindlessly eating that bucket of nuts. About one ounce (between 1/4 and 1/3 cup) is a good amount for the day. Also, that mix gives you “instant variety” within the nuts and seeds food group, which is a corollary to the eat-all-the-food-groups daily advice.

      • Brux

        I seem to remember some video here where they tested giving people more nuts and finding that they either lost weight or did not gain weight, so perhaps there is not a problem with eating more nuts than one intends?

        • Yes, there is something surprising and not fully understood about adding more calories from introducing nuts and seeds to a diet but not gaining weight. But do not be deluded into thinking that more and more nuts and seeds leads to more and more weight loss. Keep the nuts and seeds to 1 to 1.5 ounces a day. That will deliver the benefits without overdoing the calories.

        • Joseph Gonzales R.D.

          Thanks for these great responses! Nuts and seeds can certainly fit into a healthy diet. I think for some, eating too many nuts and seeds can be a problem, especially as some of you noted when they are covered in candy or roasted in tons of oil.

          Here is a great video by Dr. Greger that explains the research between nut intake and body weight.
          Make sure to checkout the bottom of the video’s “Doctors Note” to see more links and info. Lastly, a follow-up to that video is “Solving the mystery of the missing calories”which may also help.

          Joseph Gonzales R.D., Nutrition Director

    • D.A.

      Switching to raw unsalted nuts may solve this for you.

      • Suzanne Hinds

        I can easily overeat roasted & salted or candied nuts. Raw nuts as a snack do not have the same appeal to me. I sure wish all the plant based dr’s could agree on the nut issue. We just started adding them back to our diet…my skin was getting so dry from zero fat. I also felt like I was having more memory issues after being following a fat/nut free diet the last few years. We plan on using the nuts mainly in our salad dressings.

    • Richard

      I probably eat 5 oz. of nuts a day and don’t find I’m gaining weight. I guess it all depends on how big the empty bag was when it was full :-)

      • Tobias Brown

        Doesn’t this level of nut consumption drive your omega-6 level through the roof? Inflammation, no? Unless you eat lots of ground flax seeds. But do you want to consume such a high level of fat 20%, 30%. Maybe you’re 6′-5″.

        • Richard

          Dunno. From looking at all of Dr. G’s videos on nut consumption, one theme emerges – mortality and cardio problems in general go down as nut consumption goes up. How far this curve remains valid is unknown to me. The highest consumption I noticed in one of the videos was 100g of almonds. And, at that level, it was so far, so good. I suspect my 5 oz consumption is OK but maybe we need further clarification as to how much is too much. Also, as Dr. G commented above, maybe Omega-3’s are not what they’re cracked up to be. Thankfully, Dr. G will keep reading the reports and will let us know of updates.

          • Tobias Brown

            I second that emotion. :)

          • Joseph Gonzales R.D.

            Hey Richard, can I weigh-in? 5 oz may be fine for you depending on what kind of activity you are doing and what other foods you eat. It’s easy to get caught up in studies like these and focus only on the fats. I think what you said and how you framed it is spot on ” From looking at all of Dr. G’s videos on nut consumption, one theme emerges – mortality and cardio problems in general go down as nut consumption goes up.” but you certainly dont wanna overdo it. 5 oz gives you a whopping 821 kcals, 70 grams of that fat! 5 oz almonds facts
            Many folks dont need that much, and that could be far too much. An once or two for the average person daily is probably best. Again, really depends on the other foods you combine with this, your lifestyle, activity levels, etc. So glad you are reading and watching videos here. We’ll try to post more info on nuts! Thanks!

          • Richard

            Hmmmm. Got me thinking. I’m going to cut back to 2 oz. or so.

    • Joseph Gonzales R.D.

      Hard to say, Tobias! As I am responding to others about this it seems to be a theme that these suckers are super high in fat and easy to overdue. Surely, the right kinds (flax, walnut, Brazil nuts) and right amounts are important, but that goes for all food groups. I would say there is something to be said about eating nuts/seeds moderately, about 1-2 ounces a day. I posted a few comments above regarding the benefits of nuts and seeds.

      • Susan J.

        For those of us on the Dean Ornish Cardiac Reversal Plan, nuts are not allowed. At this point I am very confused given mention of the heart benefits of nuts in this discussion thread. It is also very puzzling as to why nuts would decrease strokes but not heart attacks (according to the video). Is there an explanation for that?

        • Veganrunner

          Hi Susan J.
          If you look at Table 3 at the end of the video Dr Greger specifically is mentioning strokes because it was statistically significant for strokes. (P value) It doesn’t mean another bit of research wouldn’t be statistically significant for heart attack– just not this particular reference. Does that make sense?

          • Susan J.

            I really appreciate your quick response to my query. I do apologize for still not understanding. Why wouldn’t cardiac and stroke events share the same issues biologically?

          • Susan J.

            I really appreciate your quick response to my query. I do apologize for still not understanding. Why wouldn’t cardiac and stroke events share the same issues biologically?

            Susan Johnston
            Mobile: 714-658-6970

          • Veganrunner

            It seems as though it should right? But that isn’t what was determined in this particular study. Maybe Dr Greger has another video coming out. He does that often. But either way the study he is referring to had significant findings for stroke only. It is unfortunate it wasn’t a better study. To have that many participants is not an easy task. But promising for stroke all the same. And if you go under topics you will see other videos on the benefits of nuts.

  • Susan J.

    Fascinating! Puzzling as to why nuts would decrease strokes but not heart attacks. Is there an explanation for that?

  • thorn324

    Thank you for this 3rd video in the Medi-Diet series. Since each member of the nutty (!) group was give 8 oz. of nuts per week, didn’t you mean to say at the very end that x-number of strokes could be prevented simply by eating *one* ounce of nuts per day rather than “by adding half an ounce of nuts to one’s daily diet”? Sorry for being such a nut-picker … er, I mean nit-picker, but it seems that this is a significant different, no?

  • Johnny

    Fat soluble vitamins = A, D, E, K
    Mmmmmm nutrient dense fat

    • Johnny

      Try googling what foods these vitamins were discovered in. Id bet more of these vitamins were in the meditteranian diet than SAD

  • mdouble

    Very significant findings

  • UCBAlum

    No lower cholesterol or lower heart disease risk from nut consumption? I thought that’s where we stood on nuts. Is it because nuts couldn’t overcome the negative effects of a high fat diet, or maybe something else? And in spite of the high fat diet and the negation of all the other nut benefits, stroke risk still decreased? I’m kind of confused about what this study means.

    • Psych MD

      The amount of nuts consumed in this study (25 g.) was a fraction of that consumed in the dozens of other studies cited in previous videos. Therefore, I suspect it may have been a dosing issue.

      • UCBAlum

        I don’t think so. I’d have to look it up, but my recollection is that a very small number of nuts – less than a palm full a day – was associated with the benefits I mentioned. I recall that some benefit – I believe using NHANES data – was found with one serving a week or at least less than one serving a day. What I am certain of is that 25g per day is way, way more nuts than was shown beneficial in the past studies Dr. Greger showcased. I don’t have the time right now but it seems like it would be easy enough to look those up.

        • Psych MD

          Here is the link to the study referenced which looked specifically at the effect on lipids, not mortality. Mean consumption was 67 g. per day and the cholesterol lowering effect was dose dependent.

          • UCBAlum

            Of those on a Med diet, the group eating 1-3 servings of nuts per week ate 4.9 grams of nuts per day and enjoyed a hazard ratio of 0.38 with respect to all-cause mortality compared to those eating a Mediterranean diet and no nuts.

    • Joseph Gonzales R.D.

      Good point. You would think they may have seen lower risk of heart disease in the nut group since the stokes were significantly decreased. Not sure about seeing lower cholesterol because of the high-fat diet. I think you’re right, the nuts couldn’t lead to any benefits (besides reduced stoke risk) most likely because the high-fat diet. I am sure other factors were involved. What I see from this study is, adding a half ounce of nuts to an already fatty diet may even still help prevent stoke risk. I would certainly look to other research on nuts because you are 100% right about where we stand on nuts.

  • James Sloane

    Okay, so this study shows that nuts can occasionally prevent a few strokes in people who are candidates for cardiovascular disease, “folks at high risk for a heart attack, about half were obese, diabetic,
    most had high blood pressure, high cholesterol, but had not yet had
    their first heart attack or stroke.” Further comments in this video indicate that they ate a high fat, high cholesterol diet replete with meat and lacking in fruits and vegetables. My question is what does this diet have to do with me? I eat a whole foods plant based diet, am at normal weight, spectacularly good blood pressure, good fasting blood sugar, have no risk factors for heart disease and get sufficient exercise. Why should I eat nuts? Contrary to the studies, I gain weight on them and what further benefit would they be to me, an already healthy person?

    • Joseph Gonzales R.D.

      Good questions, James. It’s hard to say how this study links to your diet, directly. Not sure it can. You clearly wouldn’t qualify for the study, which is a good thing! :) The whole-foods diet must be working. I think so long as you get the right fat intake you’re fine. Plenty of fat and even omega 3s in soybeans, other beans, leafy greens and broccoli. Vitamin E in mango, etc. Really depends on the amounts you eat, right? I’m not saying they don’t cause weight gain for you and I am sure many folks can overdo nuts and seeds in their diet, but it is interesting to see from the research in this post I made about nuts and weight gain , they appear to not cause substantial weight gain. Also, nuts and seeds offer antioxidants and phytochemicals, so perhaps another reason to eat a tad.

  • Pat

    When I was a kid there was another child in my younger brother’s class who had an allergy to oranges and milk. He was the only kid I know growing up with who had a food allergy. Now days, it seems like every other child has food allergies, especially allergies to nuts. Seems to me also that the rate of autism and attention deficit disorder have also substantially increased. Anyone know what gives here? Could it be air or water pollution, all the vaccinations kids get these days or the food additives and colors that they consume?

  • Cal

    My problem with nuts is I have difficulty putting them down. I consume a pound of almonds in 1-3 days. One handful just isn’t enough. At least they are unsalted. I indulge about 3 times a year. I have a cup of almond milk on my cereal

  • Cassv

    How does a type 2 diabetic back off of R and N insulin to adjust to vegan or plant based diet?

    • Jen Drost, Physician Assi

      Hi Cassv, thanks for the question. I know this probably isn’t what you want to hear :(, but here’s the short answer: when I saw Dr. G. answer this question live, he said he doesn’t recommend that we try adjusting our own insulin at home! The reason? Because the whole food plant-based diet (WFPBD) is SO effective at reversing diabetes (and therefore eliminating type 2 diabetics’ need for insulin), the risk is that after starting a WFPBD, blood sugar can get normal (yay!) in less than 2 weeks, but in those interim 10-14 days, people still usually need insulin, just in lower amounts. And it’s very individualized, so to avoid LOW blood sugar (from too much insulin) during the transition, best to let your doc know what you’re doing and let her/him adjust insulin accordingly. It’s a delicate balancing act in the couple of weeks it takes to completely get off insulin, and if not done safely, low blood sugar (from too much insulin) could lead to dizziness or imbalance (leading to falls). Too risky to try on one’s own. We want to keep our awesome viewers SAFE and healthy and happy! :)) Hope this helps–and wish there was a one-size-fits-all magic algorithm :( Good luck!

  • JosephOlstad

    I have a general question about interpreting stats used in so many of these videos. Statements like, “eating so and so cuts your chances of so and so by a half/third/ or whatever.” I’m already WFPB and if I add up all those stats in my situation, I’m in the “negative” chances for acquiring half a dozen diseases which doesn’t make sense. Can you clarify this anomaly. As a practical example that spurned the question, nut are suppose to reduce heart attack or stroke (can’t remember which one) by something like a half. If my chances of getting a heart attack are already in the netherworlds, will nuts really cut the chances significantly more or do these stats only apply to those on the SAD? Even if I was on the SAD, can one combine these stats to actually come up with a number representing their particular chances of getting so and so disease? Thanks for your help.

    • jj

      We need a clarification about what percentages really mean. Not much. I have heard Dr McDougall talk about the percentage used in statistics in research. Don’t have the time to find how he explains it. As I understand it 2 people in a 1000 versus 4 in 1000 results in a 50% better outcome. Would like some one with better knowledge explain this to us.

      As I understand it most if not all studies are done on unhealthy people not WFPB. Please correct me if I’m mistaken.

      • Joseph Gonzales R.D.

        You are thinking right! The numbers can be manipulated as you laid out, and when we discuss epidemiological research there can be no “cause and effect” such as, eating A leads to disease B. However, what is great about Epi data is that we can see trends. For example, those who ate more of A, typically identified with less B, compared with those who ate less A. You get double points because not all studies are done on healthy populations. Some conducted on WFPB diets are the Seventh Day Adventist studies, which show promising results for WFPB diet and lower disease risk.

      • Joseph Gonzales R.D.

        Hi, JJ. I may have a better answer for you. There is a difference between relative risk reduction and actual risk reduction, and Dr. Greger talks about the latter in this video. You can say there’s pros and cons to describing it each way, but either way a reduction in risk is a reduction in risk, especially when the side effects are all good! And to the second part of your question, study populations vary widely depending on what researchers are studying.

    • Joseph Gonzales R.D.

      Hi JosephOlstad, I too have trouble deciphering statistics. You are not alone! When Dr. Greger mentions stats within this study he simply is referring to the trends in the literature. The folks who ate nuts, added about 1/2 ounce per day, seemed to cut their risk of stroke in half. You are absolutely right that these folks in the study were not following a WFBP diet (if you recall folks ate a pretty high-fat diet) so in theory folks on a WFPB diet cannot compare themselves to folks in this study. It is hard to say what your risk would be if adding an ounce of nuts to the diet while already eating WFPB. This is why we need more research! I don’t think you can combine these stats and apply it to other diets or people, unless the diet and population in the study were comparable. When you mentioned the SAD diet, perhaps there are some similarities between that diet and the high-fat diet seen this this study, but that is a hard comparison seems how this was a Mediterranean-style diet not an American one. I wound’t use this study alone to compare disease risk. Hope that helps! Joseph

      • JosephOlstad

        Thanks so much for the reply. Sorry I did not read further down the post. I would have seen that you answered a similar question. Feel free to direct us down the blog post so we don’t eat up your time answering duplicates. BTW, welcome to the party.

        • Joseph Gonzales R.D.

          You’re welcome. Good plan for future :) Thank you!

  • JackXXL

    So the new US dietary guidelines will say cholesterol is not a dietary nutrient of concern for over-consumption. As I understand it, 1 in 4 people do experience a significant rise in serum cholesterol from consuming cholesterol in their diet. So this seems to be an irresponsible blanket statement to make. But more importantly, based on everything I have seen and read on this site, research generally supported the notion that dietary cholesterol raises serum cholesterol in humans – full stop. Is this research now out-of-date, superseded by newer research that negates it or what?

    • Psych MD

      I don’t recall if Dr. Greger addressed this question on this site already, but he did in the conference I attended last week. My understanding was that for the typical American eating the SAD, additional dietary cholesterol is not a big deal because the average adult cholesterol in this country is already in the unhealthy 200+ range. On the other hand, someone who eats a healthy diet and has a cholesterol of 150 would have a very significant rise if the same amount of cholesterol were added to the diet.

      • Joseph Gonzales R.D.

        Hmmm good question, Psych MD. I didn’t hear the lecture so I cannot say for certain, but here is a video that refers to your comment “the typical American eating the SAD, additional dietary cholesterol is not a big deal because the average adult cholesterol in this country is already in the unhealthy 200+ range.” It seems there is this plateau-effect with cholesterol where one may “max-out” on cholesterol intake. Another awesome video on the cholesterol here, when low risk means high. You are thinking right. Awesome post — thanks for your input!

        • JackXXL

          Thanks Joseph & Psych MD. I think I get it: When the norm is abnormal, normal is not optimal. In fact it’s dangerous. I think I’ve been maxed out for years…….”until now”. I’ll find out from my next lipid profile next week :)

          • JackXXL

            Wow my LDL is down to 2.33 after only 2 weeks of whole food veganism. My triglycerides still need work though – not surprising at a BMI of 30.

    • Joseph Gonzales R.D.

      Good questions, JackXXL, and a tricky discussion. The actual 2015 DGFA has not been released, what has been released are the findings by the scientific committee appointed to review current guidelines and literature for the USDA. Dr. Greger talks about optimal cholesterol levels, here. It is true that dietary cholesterol itself does not significantly raise blood cholesterol. It seems saturated fat has a much more of a dramatic impact and may significantly boost blood cholesterol. Dr. Greger mentions the 2010 Dietary Guidelines when he discusses information on cholesterol . Some health groups are also confused by the committee’s findings, you can read more about their take here.

  • Megan Markowski

    This is unrelated to the video, but I have a question for Dr. Greger, I have recently read a study on the effect of eating tofu on Dementia called “Brain Aging and Midlife Tofu Consumption”.
    Linked here:
    Many studies say Tofu is beneficial to the brain, so why is this one different?
    Should tofu be a cause of concern for men or do the benefits outweigh the possible cognitive decline?
    Thanks! :)

  • Nigel

    Can you direct me to one of Dr. Greger’s video where he describes how prospective and case-controlled studies are done? Thanks.

    • Joseph Gonzales R.D.

      Good question. not sure there is a video on research methods or statistics. Try this link by fellow Registered Dietitian, Jack Norris. He does a great job laying out how to interpret studies, standards in research, and definitions of what you are asking. Should totally help.


      • MarthaLA

        I’ve been wishing Dr. Greger would post a permanent page explaining types of studies and their relative importance. This link you’ve provided is so helpful. Thank you for posting that.

  • SDrake

    Hi Mr Gonzales & Dr Greger
    Do you know of any research on neutropenia and specifically how to treat it either through diet or other mechanisms? (low white blood cells/underpeforming bone marrow function). The condition is chronic and illness (viruses mainly) revolves around a 4 week cycle. Any feedback greatly appreciated.

    • Joseph Gonzales R.D.

      Hi, SDrake. Hard questions to answer. We don’t have any info on neutropenia from what I see. I am part of an Oncology Nutrition dietetic practice group of the Academy of Nutrition and Dietetics. This is a great article about neutropenia and diet. Very important you discuss foods with your doctor, however. Also suggest seeing a dietitian if able. Let me know if this helps?


  • Derrek

    I don’t know what to think. Some people say reverse osmosis is healthy while some don’t think it is. Here’s a study on demeralized water from WHO. . This is an article about it:

    Is there scientific evidence that distilled water and reverse osmosis pulls nutrients from the body and is unhealthy? I’m wondering what I should do. Fluoride is harmful as it is added to the water supply and all the pharmaceuticals.

    • Joseph Gonzales R.D.

      Hey Derrek. Thanks for your post. Another member, Jonathon, mentioned this very same thing today! He had a great post. I commented here. I don’t have all the answers to your questions. Perhaps the research has not been done? And even so it remains inconclusive. I am thinking we need a water post in the future. Stay tuned…


      • Psych MD

        Using the other NF (ie. Netflix) rating system as a guide, the expansion of staff here has added an additional star.

  • Alex

    Hi Dr. G, Had you previously referenced these same studies (funded by Spanish oil and nut industries) months or years earlier, wherein you discussed the poor methodology, and are now only reinterpreting the protocol and findings? Sincrely, Mr G.

  • Derrek

    This is more of lifestyle but also would about like deadorant? I have a bad body odor and my parents insist I use Axe. They say the homemade stuff and healthy stuff doesn’t work. Any opinions?

    • Joseph Gonzales R.D.

      Lots of studies on anti perspirant and aluminum in deodorants,. Kind of a mixed bag. There is enough research to avoid aluminum-containing deodorants, and of course no risk other than smelly armpits :)

  • Jay Rosenbergstienroth

    Vote up for Dr Greger to do some videos debunking the junk science people use to claim humans “evolved” to what we are because we ate meat.

    • Joseph Gonzales R.D.

      Will look into, thanks!

  • JakeN

    Hello friends. Please feel free to offer your advice, expertise, support, etc!

    I am just over 5 11 & only 135 lbs. I am very skinny, experience fatigue quite a bit (which seemed to diminish a bit with supplementation of B12), have digestive issues, acne & trouble sleeping. Beyond stress (which is significant) I am unsure what I can possibly do..?

    I eat lots of greens, vegetables, sweet potatoes, yams, oatmeal, (red) rice, black beans, sometimes quinoa, ground flax, and some fruit. I work at my local farmer’s market so I take advantage of cheap / ‘free’ local, organic produce and purchase only bulk, organic whole grains (as they are fairly cheap anyways). That is pretty much my diet though, whole grains and a large diversity of (mostly steamed) vegetables. I also supplement Vitamin D3 (5000 IU / day) & B12 (500mg / day). I also did buy an iodine supplement though stopped using it because one drop is 400mg which I later found out is too high and can cause problems (?).

    I started using Cron-O-Meter to make sure I am getting adequate intakes based on their recommendations and make a point to score atleast 97% a day.

    Any ideas what could be causing any of these problems. I have trouble exercising because I lack energy and the ability to recover. I recently went to get a physical check-up and CDC and everything cam back totally fine.

    Lastly, I currently pay to see a therapist which I have been doing for months now which has been very helpful as well.

    Anyways I just thought I would share this because I have no idea where to go to attempt to solve any of these problems. It is extremely hard being in high school, working full time hours and having trouble sleeping, experiencing fatigue and it doesn’t help to have acne and digestive issues.

    Just thought I would mention. Anyone feel free to offer any input, resources, etc. All support is appreciated ! :)

    • largelytrue

      “Digestive issues” is good as euphemistic language, but unfortunately it is probably too vague to help in refining hypotheses around diet. You explain that you experience a lot of stress, that your schedule is busy, and that visiting a therapist has helped with your problems somewhat, so I think there may be a strong psychological component here.

      That said, you still may want to search for dietary sensitivities. It could be that one of the things that has made you a skinny person is a tendency to some sort of inflammatory digestive disorder such as IBD or celiac’s, which (along with your age and sex) could help explain the tendency to break out as well as the “digestive issues”. Working through that possibility, preferably with the help of a physician or dietician, may be useful insurance. Temporarily shifting your starch consumption to something less optimal, such as white rice, would be useful in the long run if it helped to find items in your current diet that are causing you problems at present.

      No, I am not qualified to diagnose you and you haven’t given enough information to have a chance of diagnosis anyway, but I am still suggesting an elimination diet as a possible strategy. While these are not diagnostic and can lead people to wrong conclusions about how diet affects them (underlying sensitivities can fade with time, for example, and an irritant may only be present in certain varieties), if there is something in your diet that is causing inflammatory symptoms at present, a trial-and-error approach may be able to modify your diet into something that doesn’t cause these symptoms. I’d be cautious, and prefer to rely on credentialed experts to guide you, but if nothing else an elimination diet is a low-tech strategy that you can conceivably implement for yourself and IF your problem is largely dietary then you may be able to patch it this way.

      I know I’m not giving you the highest-quality information here, but since you hint that you are in a difficult situation, sharing my thoughts seems like it may be better than nothing. Of the iconic plant-based doctors, McDougall is one of the most focused on a general practice and is also pretty keen on the idea of seeking out food allergies using elimination diets (in part due to the strong preference to avoid medication). You may read some of his thoughts about the matter here:

      As an aside, your supplements are pretty huge given your age. You may want to try to review recommendations, and while acne is a pretty non-specific symptom and may simply be explained by age, sex, genetics, and imperfect cleanliness, the dietician Jack Norris is willing to state that acne-like symptoms may occur with large doses of B12 in some people:

      You may also review your vitamin D needs, particularly if your weekly schedule routinely gets you out into the sun. Greger did a nice series on the topic, and maybe you’d find this video particularly interesting:

      Anyway, keep going, and intellectually growing.

    • Joseph Gonzales R.D.

      Hi Jake, Sorry for the delay I meant to respond. For starters, I think it is a complex issue and very personal. Gosh man, hard to go through all of this, let alone in high school!! I have to say, check with your parents/guardians and your family doctor, but I always recommend a dietitian. Your doctor can help find one or I can. I can only give suggestive advice, okay? Promise me you only take note of my thoughts and share them with the right people before making any drastic diet changes. I

      I read largelytrue’s comments and agree an elimination diet could help if that is your main concern, but keep in mind it can be very restrictive and perhaps cause even more stress to an already stressed environment, from what you tell us. One thing at a time perhaps…

      Iodine Recommendations

      150/mcg = 1,050/week. So maybe 2.5 drops per week? not sure absorption or other foods eaten.

      Digestive issues can be triggered by many things. Diet is not always the answer, but it may help. Simple foods can be healing. All depends on the bowel movements too, bud. ;-) Maybe you are getting too much fiber? I sw you mention that elsewhere. It can be a thing, as seen with tons of cruciferous veggies. If so, maybe try more tofu, creamy peanut butter, white rice, Cream of Wheat, or grits, well-cooked fresh or canned vegetables, sweet or white potatoes without skins, non-dairy yogurts. I am not saying ditch all the fiber or other foods you mentioned, but to balance the fiber intake it may help. Some herbs like slippery elm and marshmallow root (mucilaginous herbs) have been found to coat the stomach. You could also look into a probiotic.

      Changing gears, you mention a lower body weight as well, so it’s hard to say eat more when you are feeling crummy. Perhaps when you are feeling better, focusing on more variety and more food in general can help maintain a healthy body weight. A few nut creams or mushrooms gravies could be good. Especially on top of potatoes. If this is an allergy or food sensitivity thing you’ll have to do more work. We ran a trial looking at food triggers. You may be able to glean from that paper’s dietary protocols.

      Most important. Manage the stress, buddy. however that looks best to you, try to manage the daily grind of school, work, and play.

      I wish you the best of luck, so glad you come here and ask such important questions as a young smart lad. Thanks, Joseph

    • MarthaLA

      Hi, Jake. My commenting is mostly to express encouragement to keep doing what you’re doing, which appears to be, in part, eating a whole-foods, plant-based diet. I do wonder how long you have been eating this way, to still have acne (which WFPB is to be generally expected to correct). Perhaps you had not been on such diet very long at the time of your posting (2 months ago now).
      I would think your working full time hours at a farmers market would involve a good bit of exercise, if you are shifting crates of veg around and such like, not to mention scooting from class to class in high school (I suppose you do?) and getting to and from work and school, etc. However, perhaps you can add in some basic exercise to your daily activities, like getting up and down more, you know, taking stairs instead of elevator type things, doing stretches, doing a few ‘curls’ with the crated veggies as you carry them from one place to another, whatever. You don’t need to be working out on machines at a gym to be exercising adequately.
      You don’t define the ‘digestive issues’ you mention as a concern.
      Am wondering if you are getting enough calories and nutrients; I think we all ‘grow’ until — what is it — 21 or so? Whereas, I think cronometer and similar recommended intakes are probably for full-grown adults (physical adulthood, I mean).
      Am also wondering why the Vit D3? Are you in the far north, like Alaska, maybe? Deprived of sunlight?
      Anyway, I hope the past two months has meant improvement for you. Hey, the school term must be just about over, things should ease up a bit.

  • Bill Franks RD

    Dear Jake N,
    Keep looking for answers. Food allergies/sensitivities are worth exploring and if they are the cause you will feel much better in short order. It may be something else entirely, so keep looking for answers until you are satisfied. All the best

  • Bill Franks RD

    Back to nuts in the Mediterranean Diet: What type of nut, What portion of nut, How often should nuts be taken? I did read a caution from Joseph Gonzales RD as to how energy dense nuts are and to keep the portions small. Would it be possible to have the nut intake described as a total of daily calories? This would make my life easier when I’m working with vegan endurance athletes. Keep up the good work.

    • Joseph Gonzales R.D.

      Hey Bill Franks RD! Thanks for posting this. I like all nuts and seeds because I feel they all have something different to offer nutrient wise. For example, Brazil nuts have selenium. Walnuts more omega-3s. It seems you don’t need much to reap the benefits, maybe an ounce a day (a handful). ​Honestly, I am not sure what endurance athletes need? I would assume they could have more. I am no “athlete” but I play hockey and before games I eat more than a handful. Easy for my to blend them into smoothies and I fin that works for me. Everyone varies. Do you know any of the plant-based RDs out there? Matt Ruscigno RD works with athletes and he may have more tips.

      Here is a great video by Dr. Greger that explains the research between nut intake and body weight. Make sure to checkout the bottom of the video’s “Doctors Note” to see more links and info. Lastly, a follow-up to that video is solving the mystery of the missing calories, which may also help.​

  • cj

    What kinds of nuts are alluded to in this video, just walnuts or other?

    • Joseph Gonzales R.D.

      Hi CJ. All of the studies can be found in sources cited. I check the links and this is what I pulled. Hope this helps!

      “Participants were randomly assigned to three interventions: MeDiet with VOO, MeDiet with mixed nuts or control group (low-fat diet). The two groups allocated MeDiets receive intensive education to follow the MeDiet and supplemental foods at no cost. VOO (1 l/week) is provided to the first group and 30 g/day of mixed nuts (15 g walnuts, 7.5 g hazelnuts and 7.5 g almonds) to the second group. In the control group, participants do not receive education on the MeDiet, but are given advice to follow a low-fat diet.”

  • Troy

    I’d like to ask the doctor a question. Are the omega 6 fatty acids in nuts, harmful, harmless, or helpful?
    Thank you for all your hard work.

    • Joseph Gonzales R.D.

      Still need omega 6’s because they are “essential” fats. 17 grams of Omega 6 fat is required to meet adult male needs, according to the Institute of Medicine. Check out more on omega fats in Dr. Greger’s videos!

  • Nanc

    I read your book How Not to Die and have recommended it to many friends and family members. My husband and I eat a plant-based diet and are currently implementing many of your suggestions. I don’t recall that you addressed the specifics as to whether nuts should be organic, soaked and dried. Also do you recommend soaking beans and grains to sprout them before cooking?

    • Thea

      Nanc: If I remember correctly, this site does have at least on video about the improved nutrition of sprouted foods. However, most people recommend soaking in order to remove “anti nutrients” like phytates. What they don’t know or don’t say is that most of the phytates disappear with cooking and for the little bit of phytates which might be left, phytates are likely good for you: Also note that there are lot of videos on this site about the benefits of grains and beans and I don’t remember any cautions being made about soaking them first before eating.
      The way I put this all together is: if sprouting is fun for you, by all means, do it. But if you would rather not, you would still get a very healthy meal eating those foods without the soaking. I’m not an expert in these matters, so take that for what it is worth.

  • Michel Bien

    If I remember correct there is data available on people who scored higher on the food questionnaires used in this study, measuring how well they followed the med diet vs hard endpoints.

  • kikime

    I love nuts and seeds but the more I read about how to eat them, the more confused and reluctant to eat them I become. First it was- eat them raw. It took me some time and effort to get used to the taste of raw nut but I managed it. Then I read that we should not eating them raw but ‘activate’ them by soaking them and dehydrate them. That made me stop eating nuts (now eating only Brazil nuts because according to this recommendation they don`t need soaking). I can`t afford dehydrator and I hate soaked nuts. Please tell me is dry roasted nuts and seeds give you the benefits of eating them!??