Doctor's Note

 This is the second of a six-part video series on the Mediterranean diet. For some historical backdrop, check out out the first one at Why Was Heart Disease Rare in the Mediterranean? Here are the next four to come:

  1. PREDIMED: Does Eating Nuts Prevent Strokes?
  2. Which Parts of the Mediterranean Diet Extended Life?
  3. Do Flexitarians Live Longer?
  4. Improving on the Mediterranean Diet

For more on Dr. Esselstyn’s amazing work:

If the short-chain plant-based omega-3s in flax seeds and walnuts appear so beneficial, what about the long-chain omega-3s found in fish and fish oil? There are pros and cons. See, for example, Mercury vs. Omega-3s for Brain Development and Is Fish Oil Just Snake Oil?

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  • veganchrisuk
    • charles grashow

      SO – you believe in a dictatorship? You’re insane.

      • veganchrisuk

        I will redress my comments in layman’s terms, such that a person of your abundant intellect will be able to arrive at a satisfactory conclusion.

        My one and only point was that the vast majority of western societies (those that choose not to eat a healthy PBD) have only ever adopted a healthy diet when forced to do so, be that through lack of financial resources or in times of occupation. I don’t profess to know the answer (there are simply far too many variables to consider).

        I appreciate your concern for my sanity, but may I just point that there are laws that exist re libel, I know that as I’ve been in the legal profession for twenty years – I provide you with that snippet of information for free, as I doubt you could afford my hourly rate :-)

        • For future reference…

          Would the sentence, “That’s insane” instead of You’re insane” have different legal ramifications?

        • charles grashow

          Have a nice day. I’m otta here

          • veganchrisuk

            My apologies – I was having a bad day…..

          • charles grashow

            No problem – we all have our good and bad days.

        • charles grashow

          You are correct – your idea was insane not you – nevertheless I do not wish to associate with you anymore so I’m gone

        • etmax

          :-) so annoying when one is taken out of context :-) never thought I’d see it happen to a lawyer :-)

          • veganchrisuk

            One is not amused :-)

        • mik

          The only reason most people can buy all that crap so cheap anyway is because the government’s pay so much money supporting the farmers. If they stopped meat would probably rise 4 times in price and people would stop eating it so much and hospitals would be visited less frequently. In the end as always it all adds up to greed.

          What you want would happen naturally and just maybe our children would have a planet to live on. What was it they said? 5 Years ago it was a mathematically impossibility for a newborn to reach retirement if continue to consume animals the way we do now.

          To me it seems logic that this has to happen rather sooner than later. – The “party” is over, its time for humanity to take some responsibility for the planet we call home and not just push our shit to the next generations.

        • DonnaBianca

          Legal prohibitions against common bad habits always backfire and lead to a black market controlled by ruthless criminals. IF the government were ever to pass laws against the production of meat, I can pretty much guarantee that there would be armies of people taking to the streets to kill squirrels, rabbits, cats, dogs, and any other animal they could get their hands on, in order to take the corpse home and cook it up. Then there would be people raising cats, dogs, rabbits and whatever other innocent animals they could find — packed in tiny cages inside their dark garages — in conditions much worse than today’s factory farms.

          Eating dead animals is a disgusting habit, and the way they are currently raised and killed is cruel and immoral. But you cannot convince people by force. The government pointing a gun at their heads and forcing them to change their habits would only make them more stubborn — and more determined to stockpile automatic assault rifles to prepare for an armed revolution. It would be bad all the way around.

          What the government can and SHOULD do is to Stop Subsidizing Meat and factory farm animal abuse. AND charge them big bucks for land use and their horrible pollution of waterways. Subsidize organic farming of soyfoods, and also provide subsidies to small family farms that raise animals humanely and agree to random government inspections. That way, meat prices will rise to a point where it is not so affordable, and vegetarian and vegan foods will be a bargain. (Which is the way that it should be.) Hitting people in their checkbooks is a very effective way of getting them to rethink their bad habits

        • Nel

          You used the word ‘redress’ wrong.

    • UCBAlum

      Wait a second…

      Do you believe people should be forced to act in ways their government determines to be “best” for them?

      If so, do you not see any problems with your position?

      If not, how about this: Someone who doesn’t share your values is in charge and the thing you value is illegal. If you doubt that could happen, ask yourself who has power in this country at this moment? Is it corporations, or people? Is it billionaires who can now give unlimited money to politicians, or is it people? Is it the military industrial complex that keeps getting tens of billions of dollars of funding year after year after year such that our military is bigger than the next ten largest militaries combined, or is it the people?

      • veganchrisuk

        See above reply to Charles…..

        • UCBAlum

          It is true that some modern Western societies adopted a “healthier” diet during times of economic hardship, but from my perspective that only serves to point out the association between the “Western diet” and disease. It’s not in my mind an invitation to pass laws forcing people to eat what I want them to eat.

          And, we don’t have those “libel laws” here in the US, so you can call someone “insane” all you like. Maybe the fact that you aren’t allowed to say “negative” things about people in Europe is why you think it’s the government’s role to make people eat what you want them to, by force of law.

          I don’t though. It’s a slippery slope. I love many things about Europe but given its recent history I would think they would be compelled to pass fewer laws limiting people’s personal choices, not more.

          • etmax

            You have consider probably the issue of the bulk of health care in Europe being covered by the public purse. I for one can understand that people might consider ways of reducing the impact of people’s life choices on the cost of health services.

            In Oz we don’t cover cosmetic surgery and the likes but we do cover patching up cosmetic surgery gone wrong from a maintaining of life perspective. Interesting way of dealing with this are e.g. taking cigarettes and alcohol to the point that relates to the actual
            additional cost of smoking and excess drinking and then putting this into the health budget.

            Our government has done the first part but put the money into consolidated revenue so they have a reason to wince about the rising cost of health care. So rather than fines for bad food choices just tax the bad choices and put it into the health budget.

            That way people that make bad choices pay for correction of those choices and people that don’t, don’t. Very fair I think.

            There’s no force or threat of punishment involved, it’s only cost recovery.

            It’s not unlike having the cost of roads covered by fuel takes.

          • UCBAlum

            Yes but people pay one way or another so it doesn’t matter if they live in a country with socialized medicine or not. In fact, the costs of poor health choices are higher in societies without national healthcare. Though you may have a point if people don’t understand that they bear the financial burden of ill health, and they may not when government isn’t paying directly for medical care out of the taxes they collect.

            That aside, I’m certainly a fan of economic incentives via tax policy. I happen to live in the one city in the US that passed a soda tax, and I supported that measure wholeheartedly.

            I will also say, however, that while economic incentives work on the population level, they are rife with problems at the individual level. I see them as a brute force method to affect social change, where ideally that would happen through facts and education. But, the sugar tax counteracts the subsidies we’ve given the sugar industry for longer than I’ve been alive, and sugar does seem to be killing us rather effectively, so I suppose it’s a good first step. Changing our farming subsidy program and adopting sensible dietary guidelines and habits based on science instead of industry propaganda is next.

          • etmax

            :-) don’t get me started on ridiculous subsidies, we subsidise our tobacco farmers and then tax cigarettes to discourage smoking, what is that? One thing you have to remember is that at the individual level people are basically too stupid to be educated. take smoking for instance. smoking has dropped here more because of the price than than because of plain paper packaging. PPP helps but it’s a small drop on a hot stone.

          • UCBAlum

            “we subsidise our tobacco farmers and then tax cigarettes to discourage smoking, what is that?”

            That, I’m afraid, is politics. We do the same thing in the US because farmers have powerful friends in Washington who cry “job killer!” every time someone wants to cut a subsidy to what are now all multimillionaire farmers who can afford to lobby their politicians. It’s a horrible system we’ve set up, and it would be easy to overcome if this…

            “people are basically too stupid to be educated”

            were not so darn true.

            But, I am optimistic. Collective action problems can be overcome. I am seeing the beginnings of change.

          • veganchrisuk

            Again, I wasn’t promoting Government interference, I was highlighting the Great Depresssion and occupation as being examples in recent history whereby those eating a SADiet have increased their longevity.

          • UCBAlum

            On that we can agree. I think people on the whole will always indulge their sweet tooth or fat tooth or whatever, and I have no problem with that, but right now people don’t know what’s healthy and what’s not. Even if they did many don’t have choices, and really, how much choice do you have when you don’t have all the facts? And, we also have major structural hurdles that make unhealthy food choices cheaper and more available while healthy foods remain relatively expensive. I think the solution is in economics and public policy, and if that is going to be the solution, then education will have to be the foundation…and so here we are at

          • Alex

            Uh… public healthcare (the five best in the world), high cigarette tax, trans-fat bans, food labelling in consistent units and sizes, strict health claim restrictions, not rounding values down to 0%. Yeah, Europe is terrible. What recent history are you thinking about?

      • It would be refreshing if industry were ethical and only made and sold those things that were known to support life, rather than to try to fool the people into buying and eating things that do not support a healthy life. That is, I believe, how a sane world would operate. The quest for profits over life is insanity. Maybe that is what was meant by “thou shalt not commit adultery” – don’t adulterate those things meant for human (and animal) consumption. It is a pity that government ever entered the picture, but it’s obvious that industry is not very good at self-regulating. Self-regulation of any slice of society is ‘iffy’ as long as the greed factor is present. Unfortunately, government regulation of industry merely adds another level of corruption.

        • UCBAlum

          Government regulation of industry is all we’ve got, so we better make it work. If corruption leads to failure then the game is lost. That’s why the smart money is on making government work rather than throwing the whole thing out.

    • Brigitte

      And what about exemple and education?

      • veganchrisuk


        • Brigitte

          Hi Veganchrisuk!
          Please, could you be more specific about? So I’ll be able to answer to you.
          Thank you.

        • 2tsaybow

          Providing education of the masses by giving them information about what is really killing us all; that is a very good idea Bridgit!

          Some day my country may begin to invest in education and infrastructure again. I hope so, be have become such a dumb, rude arrogant crowd of people.

          The one thing that veganchrisuk assumes it that our government cares about the overall health of our society. In the USA it does not. Our politicians are behind the big agricultural corporations because that is who gives them money.
          Americans are eating what they are supposed to eat as far as our politicians are concerned.

          Now that the Affordable Care Act has been established health insurance companies may take action to give incentive the medical community. They are the only ones with a profit motive to make us healthy.

      • UCBAlum

        I find it telling that he does not understand your point.

        • Brigitte

          Hi UCBAlum!
          That’s my feeling too, but what point does he wants me to explain? I need a real question to answer to!
          I’m not an english speaker and, to read and express myself in english takes me a lot more time and energy than in french. So, thank’s for your understanding!

          • UCBAlum

            You’re welcome. I understood what you were asking without any trouble and I wouldn’t have guessed english is not your first language.

          • Brigitte

            Thanks a lot, UCBAlum, for your encouraging reply!

    • “Say Hello to America’s First All Vegan School, Thanks to Suzy Amis Cameron and James Cameron”

      • veganchrisuk

        That is certainly a step in the right direction.

        I don’t want to appear too negative, but with reference to the leadership they are encouraging, one can only hope that children raised and schooled in this manner will be less likely to succumb to perils of absolute power (with reference to those that are politically minded, and the future of the environmental movement). I say this based upon my own experiences, as I’ve found that in the majority of cases that those who think they know the answer or want to be in charge are quite often the ones that should not be so. Only this week we had two conservative MP’s step down for asking for payment to ask questions in the Houses of Parliament, not to mention all the recent scandals that involved some members of parliament taking up free board and lodgings at Her Majesty’s pleasure.

        For me, I always remember a famous comedy sketch from the 70’s or 80’s, whereby a man walks into a police station in London with the intention of obtaining a shotgun licence. The first question on the apllication is, “Do you want to own a shotgun?”. If the applicant answers “Yes”, then he is refused a licence and forceably removed from the building. I can’t help but apply this logic to the majority of politicians, based purely on my own life experiences – maybe I am just too negative, but life eventually wears you down when you see the worst people in society on a daily basis – you soon come to the realisation they they are not the worst people in society, they are simply society. Lets hope the Cameron’s have started a revolution……

    • broken1

      I do not agree with being forced. Eating is a personal choice. I do not care if people find themselves at a point where they have to make a choice of what to eat or die. If you’re able to follow good reason of medical research, but choose not to, knowing the outcome, but please do so and make room for those that do care about healthier living. Having said that I am vegan, and I have been for 2.5 years. And my GP doctor agrees that I do not need medications to keep me alive. Now, how many think that the government isn’t already tell you how to live? I do not like paying taxes and why should you wear a seatbelt? Not much choice there either. No, let’s not have the Feds telling us how to eat, but the use of animals as a source of food it not a necessity. It is, however, the greatest injustice perpetuated on another innocent living being.

      • veganchrisuk

        I don’t agree with being forced either, I was simply making the point that only in times of financial hardship or occupation have those of us eating the SADiet increased our longevity.

        I don’t like to pay taxes either (does anybody), but this is the system that we have voted for or against. I fully understand that you feel like giving up with people when they exhibit akrasiac behaviour, knowing the possible consequences, but we will not change the general publics perception by adopting a selfish attitude – I always remember this quote, “The only thing necessary for evil to triumph, is for good men to do nothing”. It applies to ladies too……

        You may not like wearing a seatbelt, but that is not just for your own safety. If you were to come to a sudden stop by way of a head on collision with another vehicle, or stationary object (turning signs, traffic lights etc) you could become a human missile and not only likely kill yourself, but also others on your flightpath – I saw a cyclist kill a padestrian directly outside a police station in London once, so these things do happen…..

        Apologies for the misunderstanding. Maybe I should read my comments before I post…

        • Thea

          veganchrisuk: This topic has probably run it’s course, but your statement, ” I was simply making the point that only in times of financial hardship..” really struck a chord with me, and I wanted to comment too.

          I think you are making such a valid and important point! I have long advocated for simply removing subsidies and using laws to make sure the full cost (including environmental externalities) of meat, dairy and eggs is incorporated into the price of the animal products. I think that would go a long way to naturally solving the problem without making the stuff actually illegal. Basic economics at it’s very best.

          If the full costs were incorporated, I think only the very top say 1% of people would be able to afford to eat the stuff. Not that I’ve done the math. I’m just guessing. Anyway, that’s my take on it.

          • Alan

            I would like to see that happen, but do not believe i will. The politicians have sold their souls to the meat and dairy industry through Lobbying which is nothing more than bribery.

          • Thea

            Alan: I’m with you on that. But hope springs eternal….

      • UCBAlum

        I understand your points and I agree with most…

        but in the interest of education and accuracy, seat-belt laws are state laws – at least they started off as such – and they save millions of lives, billions of dollars, and they lower your insurance premiums just like mandatory helmet laws and mandatory auto insurance laws…and like the new requirement that everyone have health insurance.

        That last one is a federal law by necessity.

    • DonnaBianca

      A legal ban on meat production would be a VERY BAD THING — especially for ANIMALS..

      Legal prohibitions against common bad habits always backfire and lead to a black market controlled by ruthless criminals. IF the government were ever to pass laws against the production of meat, I can pretty much guarantee that there would be armies of people taking to the streets to kill squirrels, rabbits, cats, dogs, and any other animal they could get their hands on, in order to take the corpse home and cook it up. Then there would be people raising cats, dogs, rabbits and whatever other innocent animals they could find — packed in tiny cages inside their dark garages — in conditions much worse than today’s factory farms.

      Eating dead animals is a disgusting habit, and the way these innocent sentient beings are currently being raised and killed on factory farms is cruel and immoral. But you cannot convince people by force. The government pointing a gun at their heads and forcing them to change their habits would only make them more stubborn — and more determined to stockpile automatic assault rifles to prepare for an armed revolution. It would be bad all the way around.

      What the government can and SHOULD do is to Stop Subsidizing Meat and factory farm animal abuse. AND charge them big bucks for land use and their horrible pollution of waterways. Pass serious legislation to protect animal welfare — ALL sentient animals, not just the ‘cute’ ones, and with NO exemptions for labs or farmers — and then ENFORCE those laws rigorously, with ten-year prison sentences for the felony crime of animal abuse, and 20 years in prison for the second offense. Subsidize organic farming of soyfoods, and also provide subsidies to small family farms that raise and slaughter animals in ways that are truly humane, IF they agree to submit to government inspections at random. If all of these measures are taken together, meat prices will inevitably rise to a point where meat is simply not affordable for most people; and vegetarian and vegan foods will begin to look like a bargain. (Which is the way that it should be.) Hitting people in their checkbooks is a very effective way of getting them to rethink their bad habits.

      In addition, public schools should provide vegan, vegetarian, and/or pescetarian lunches to all schoolchildren, free of charge, every day. That way the next generation won’t grow up with the stupid belief that they just can’t live without chewing on dead animals. Changing the public’s meat-eating habits is something that will not happen tomorrow. It will take many years or decades, including educational campaigns and exposure to vegan foods that people are irrationally afraid of. (Like tofu.) It’s something that will shift with the coming generations, and we should do whatever we can to accelerate that.

    • Alan

      Force is not the answer. Although it would be best for the individuals to not have meat and dairy, but it needs to be a choice. Now i can see a restriction put on people on food stamps as it is not their money, but the tax payers, Then we, the tax payers have to foot their Dr bills also after they eat the poison and get sick

  • So we could call the 1950s Mediterranean diet the ‘weeds and walnuts’ diet. =) I dig it!

  • Brett Sanborn

    Esselstyn says that smoothies are bad and that we should avoid them. Is the information below (from Ess’ website) hold any weight? Will you please address this in a future “Ask the Doctor”?

    “Avoid smoothies. When the fiber is pureed,
    it is not chewed and does not have the opportunity to mix with the
    facultative anaerobic bacteria which reside in the crypts and grooves or
    our tongue. These bacteria are capable of reducing the nitrates in
    green leafy vegetables to nitrates in the mouth. When the nitrites are
    swallowed, they are further reduced by gastric acid to nitric oxide
    which may now enter the nitric oxide pool. Furthermore, when chewing
    fruit the fructose is bound to fiber and absorption is safe and slow On
    the other hand, when fruit is blenderized, the fructose is separated
    from the fiber and the absorption is very rapid through the stomach.
    This rapid absorption tends to injure the liver, glycates protein and
    injures the endothelial cells.”

    • “On the other hand, when fruit is blenderized, the fructose is separated
      from the fiber and the absorption is very rapid through the stomach. ”

      How can that be? When a smoothie is made the resulting liquid is a combination of all the nutrients; the five is not separated from the rest of the food matter. In which case both the fibre and fructose and all other nutrients will be in the stomach at the same time.

      Or is it that the fructose will some how collect together and be digested first before the fibre?

      I don’t know the answers but that would seem unlikely

      • Ralph

        You need a blender and a centrifuge to separate the fat from the fiber. I’ve also heard recommendations to slowly sip smoothies and be sure to mix them with your saliva to ensure better absorption of nutrients. I imagine there would be a small difference between using a straw as opposed to drinking directly from the glass.

        • Alan

          For what it is worth ! I have noticed that when i drink or eat a smoothie – I do like to make them thick – that i do not feel as well as i do if i eat the same food without blending it. I figured that somehow the smoothie effected my blood sugar more so than the chewed food in its original form.

          • The one thing I’ve noticed over the years of taking a smoothie almost everyday for 6 years is that sometimes flatulence can be an issue due to the extra air added to the mixture caused by the high powered blender. I’ve recently been blending on a lower speed setting and it seems to improve the situation

        • Charzie

          I know some older people who use smoothies to get the fresh veggies and fruits into themselves because they have issues with teeth or jaws not being able to masticate their food properly. Surely sipping smoothies are better than not ingesting these foods at all, no?

          • Nadine

            That is my case. I can’t chew the greens like kale, collards, etc. (nor do I like their taste). By blending them in a smoothie (ala Nutriblasts) I get the benefit of the nutrition I otherwise would not get – or so I thought. I can eat spinach raw in salads and like it well enough, or can add it to cooked meals. Is that what I should limit myself to, then?

          • jj

            I have heard/read somewhere that chewing the smoothie or even juice to get saliva mixed in helps digest and intake the nutrients better.

        • John S

          THere is another solution to this problem. It’s called soup.
          John S
          PDX OR

          • Charzie

            Yeah but I meant RAW food specifically, for the properties inherent in it.

      • Mark G

        I looked at the abstract for this study, provided in your link. but I don’t see why you’re providing it. What’s your point relative to Brett’s question?

      • brec

        To elaborate on Mark G’s comment… the study indicates benefits from smoothies, but doesn’t compare consumption of smoothies to consumption of whole fruit.

      • Guest

        For anyone who isn’t inclined to click on the study above, reading through it will be worth your effort. Spoiler Alert:

        “RESULTS: FVPD [fruits and vegetables as puree-based drinks] significantly increased dietary vitamin C and carotenoids (P <
        0.001), and concomitantly increased plasma α- and β-carotene (P < 0.001) with a near-significant increase in endothelium-dependent vasodilation (P = 0.060).

        CONCLUSIONS: Overall, the findings obtained in the present study showed that FVPD [fruits and vegetables as puree-based drinks] were a useful vehicle to increase fruit and vegetable intake, significantly increasing dietary and plasma phytochemical concentrations with a trend towards increased endothelium-dependent vasodilation."

        And this was only after six weeks of drinking less than one cup of a fruit and vegetable smoothie a day. Had the study gone on longer with a more normal amount of smoothie, I'm sure the increased endothelieal function would have been significant.

        • Rob L

          I’m afraid I have no idea what this means:

          >> significantly increasing dietary and plasma phytochemical concentrations with a trend towards increased endothelium-dependent vasodilation.” >>

          I know in general what phytochemicals are and that they’re good, but the rest? For gosh sakes.

          • Julie

            Since the phytochemicals (healthy plant pigments) were higher in the blood, it means that more were absorbed when drinking a smoothie vs eating the whole fruit. And one of the many health benefits of phytochemicals is that they help our arteries be supple and less likely to constrict blood flow (increased endothelium-dependent vasodilation), thus reducing stoke and heart attack risk.

          • Darryl

            Endothelium-dependent vasodilation has been a topic of considerable interest, as non-invasive tests can provide an indicator of how responsive the inner lining of arteries is to flow and dilation signals like nitric oxide, in response to meals and dietary interventions. Its highly predictive of cardiovascular outcomes (1, 2, 3)

            The basic test (brachial tourniquet test for flow mediated dilation) is fairly simple. A pressure cuff is placed on the upper arm to block blood flow, and the diameter of the downstream brachial artery is measured before and after the pressure is released by ultrasound. A larger response to restored flow is greater flow mediated dialation (FMD), and is a proxy for endothelial function.

        • Charzie

          Thanks, you guys answered my question!

        • HOORAY! Thank you.

    • brec

      Just noting a couple of typos to ward off possible confusion:
      or our tongue -> of our tongue
      to nitrates in the mouth -> to nitrites in the mouth

    • I imagine you would certainly get more of the bacteria with chewing that just swallowing. The whole nitrate to nitrite to nitrous oxide is an interesting story see I’m not sure that simple sugars such as fructose or glucose or sucrose (one glucose and one fructose molecule) are bound to fiber or not. It is clear they are rapidly absorbed but their adsorption is moderated by the presence of the phytonutrients as opposed to the fiber see… I think Dr. Esselstyn’s point is that blenderizing foods is not as healthy as eating whole foods. I believe he would agree that eating smoothies made with healthy plants is a much improved approach than the standard american diet. As far as liver damage goes it is the dose that makes the poison. Our bodies can handle fructose and sucrose in lower amounts but many persons are getting it in higher amounts without the associated phytochemicals… Of course their are some conditions such as fructose malabsorption syndrome where fructose is a problem. If you are having problems or symptoms it is always a good idea to work with a knowledgeable health care professional.

    • Video on it’s way–stay tuned!

      • Brigitte

        Hi Dr Greger!
        What happens to the nutrients after the blending? Is it interesting to wait a while before eating it? Or the opposite? The fresher the better?
        Thanks again for your research and teaching. Very helpful!

      • Dear Dr.Greger,
        Can’t wait for this video. Closely related unanswered question I posted 1.5 yrs ago: After about a happy two months of daily very green (raw Kale, collards,spinach,tiny bit of watercress, red cabbage, seeds, banana, blueberries, almond milk sometimes lettuces, smoothies, I drank 2 (c. 50 oz) with straw and my tongue felt an “acid burn” as when one has too much pineapple of which there was none in my drink. Deep furrows too. I drank less daily and soreness regressed, but never did the acid burn feeling go away even when I had no smoothies for 3 days (during which time me 30-yr eczema came back that had disappeared after a month on WFPB diet. I can live with this feeling, but wonder if I should. Sometimes my tongue looks like what I see online, “geographical tongue.” My Kaiser doc had no clue. I tried a few days of using steamed greens in my smoothie, but noticed no difference. Has no one else reported a tongue reaction to green smoothies? It is such a delightful way to consume veggies!

      • Looking forward to it, Doc. I’ll reserve judgement and refrain from expressing an opinion until then.

    • Richard

      There is yet to be any scientific proof that Esselstyn does not have it right. Studies do show that very small fiber is only 2% less effective but that does not address the lack of allowing the saliva do it’s thing while chewing. Esselstyn has reversed heart disease so he must be doing something right…

  • Richard

    The pendulum swings. First olive oil was a health food and now it’s a poison. Probably the truth is in between.

    All meals should include some form of fat. It’s needed because some vitamins and nutrients are fat soluble and are thus better absorbed when fat is present. Curcumin comes to mind but there are lots of others.

    Of course, it may be best if the fat comes from whole foods as opposed from separated oil, but absent whole food fat, a bit of oil is just fine – and actually beneficial.

    • Nicole Jaja

      all whole foods contain all 3 macros (carbs, protein, fat). even a banana has 8% fat. a diet absent of whole foods is not a healthy diet, and bringing separated oils into such diet is not beneficial but detrimental.

    • etmax

      So far all I have seen is proof the more is not better.

      It’s well known that reducing calorific intake to low levels improves life without any regard for other factors. The figures sit around the 10 year mark.

      So what actually matters? All this talk about what we eat or how much we eat??

  • Jim

    The problem with the Esselstyn diet is it is HIGHLY restrictive and very difficult for most people to follow. You have to have a real scare such as a major heart attack or heart procedure to be motivated enough to follow this diet in my opinion. Remember this is a no meat, no fish, no dairy, no nuts, no oils diet. Yes, the diet can reverse heart disease but it does take some time. What can you do if you can’t handle such a restrictive diet? You can take a supplement that can replace what the diet will do. I have found that Nanobac TX is an effective way to eat normally and still have a substantial reduction in arterial plaque. Most people need a heavy dose
    for six to 12 months then they can go on a lower maintenance dose.

    • charles grashow

      EVERY patient in the Esselstyn study used a statin for the ENTIRE length of the study!

      • veganchrisuk

        I always thought the reverse was the case, and that he was able to ween them off their doses……

        • thorn324

          Esselstyn addresses the issue of drug (specifically statins) use in _Prevent and Reverse Heart Disease_ (p. 74-75). Quoting selectively from p. 74, I share this: “My own preference is one of the statin cholesterol-lowering drugs, which should be started when you begin the program. … If you reduce your total cholesterol to well below 150mg/dl, you may … reduce the drug dosage–and in some cases, eliminate it altogether.”

          • charles grashow


            Epidemiologic and evidence-based research has identified a lipid threshold for preventing the coronary artery disease epidemic. We have demonstrated that this threshold can be achieved and maintained with a plant-based diet and lipid-lowering medication when indicated, and that maintaining low lipid levels arrests and often reverses coronary artery disease.

          • veganchrisuk

            Thanks for clarifying….

        • Thea

          veganchrisuk: As thorn324 says, he does ween them off the drugs when he can. But he likes to start with drugs and diet, because “With severe coronary disease, we don’t always have the luxury of time.” He hits these very severe cases with both diet and drugs to make sure there no more cardiac events.

          It’s so perplexing to me when people point out that his patients were also taking drugs like that fact is some kind of smoking gun. They seem to be missing: The patients who chose not to make diet changes acted as a sort of control group for the study. Those patients didn’t make the diet changes, and they went on to have heart attacks even though, presumably, they were still taking the drugs. Esselstyn’s patients, those who stayed with the diet (and yes, also took drugs) did not have heart attacks. Also, Esselstyn sites a separate case study where a quarter of the people who were given massive amounts of statins and redued their LDL, *still* went on to have heart attacks. It’s clearly not the drugs which reverses heart disease. It’s the diet. You just sometimes might be wise have to give people drugs also if their disease is so far progressed that they very, very quickly need a lowering of LDL. The drugs assist with that.

          • veganchrisuk

            Thanks for the clarification.

      • Linda N

        Yes, and Statins are sheer POISON! They are mycotoxins. Essetially fungal toxins. Any physician who prescribes them is misinformed and doing the patient a great disservice. And that is putting it mildly. A holistic MD I know told a cardiologist friend outright that he was killing his patients with this drug. I agree.

        • charles grashow

          The sheer stupidity of that statement is off the charts. You are so uninformed it’s pathetic.

          • Linda N

            It’s obvious from your retort that you never even bothered to look up the information. A mark of true troll that they get hostile and call names rather than address issues.

          • Charles spends his whole day looking up information. You should see his Twitter feed. ☺️

          • Linda N

            “Give him a break.” Not sure I will do that as he has absolutely no manners, behaves like a troll, and is obviously NOT up to date on the dangers of Statins! What ever someone’s dietary preferences or thoughts on the cholesterol issue, the literature on the danger’s of statins are piling up by the day. Diet, lifestyle, and natural supplements can all help with cholesterol issues. I would NEVER take a statin even if my life depended upon it.
            Higher rate of type 2 diabetes,


            They block the pathway that manufactures CoQ10,


            and they activate a gene called atrogen 1 that causes muscle breakdown (Last I heard the heart was muscle!)



            And these drugs are indeed derived from isolating mycotoxins

            “In the late 1970s, researchers in the United States and Japan were isolating lovastatin from Aspergillus and monacolins from Monascus, respectively, the latter being the same fungus used to make red yeast rice but cultured under carefully controlled conditions. Chemical analysis soon showed that lovastatin and monacolin K are identical. The article “The origin of statins” summarizes how the two isolations, documentations and patent applications were just months apart.[5] Lovastatin became the patented, prescription drug Mevacor for Merck & Co. Red yeast rice went on to become a contentious non-prescription dietary supplement in the United States and other countries.”


            To each his own, but personally, not only would I never ever take a statin, I would never take red yeast rice either.

          • Linda N

            And here is a great article on the dangers of statins the medical profession simply does not want to tell patients. (Whatever one’s views on cholesterol, the subject here is the extreme dangers of statin drugs and the manipulation of statistics and the minimizing/ignoring of side effects to sell them. So read the article and all of its references with that in mind.) If you believe in lowering your cholesterol there are safer ways to do it! Including diet! :/




          • I think all of us can agree that statins, like any drug, have their negative side effects. And I would agree that most of us who frequent this site would prefer not to take them. If we can get all our lipids down to protective, atherosclerosis-reversing levels with a WFPB diet, more power to us. But it is important to recognize there are people who literally are not able to survive healthfully eating strictly plants.

            Not even PlantPositive, and especially not Drs. Greger or Esselstyn, have an anti-statin stance.

            Statins have saved the lives of many who have genetic familial hypercholesterolemia. There are some who despite following an optimal plant-based diet have dangerously high cholesterol levels and must take statins to further protect themselves from CVD.

            Furthermore, statins have pleiotropic effects which may have benefits beyond their cholesterol-lowering effects. Anyone following Thomas Dayspring on Twitter is becoming more aware that there are other particles and proteins in the blood that can be atherogenic, and statins may have benefits protecting against those. LP(a) is a prime example.

            As for Charles’s personality, that’s his responsibility not mine. But there are times when he helps me see through my vegan-oriented filter bubble, countering my confirmation bias, and enabling me to have a more balanced EQ (emotional quotient) and open-mindedness about diet. Sometimes a little bluntness can be a valuable wake up call to other points of view.

          • Linda N


            By the way, hyperlipoproteinemia type II-A is a form of familial hypercholesterolemia. See:

            When people tell me that there are no natural ways to treat familial hypercholesterolemia, I have to disagree. That is what drug companies want people to believe. Not directing this at you, but here we are on a vegan site purporting to almost claim that veganism can cure or prevent almost every kind of disease and they fail to look into other natural methods including orthomolecular medicine.

            The future of medicine will NOT be in designing new drug after new drug after new drug. The reality is that it will be looking into “INDIVIDUAL” biochemistry and figuring where the genetic snps lie and devising ways to give the patient the proper substrates, products or co-factors to bypass those genetic snps. Simplified way of looking at but hey.

            The last time I talked about individual biochemistry on this list, one of the “Team Members’ proceeded to throw a bunch of double blind studies at me claiming this was biochemistry. I guess they did not see the word “individual;” Double blind studies can be useful but they only apply to the percent of people the drug or intervention worked for. Say the 20, 40, or 60% as an example for which the intervention worked. What about the other 80, 60, or 40% the intervention did not work for.

            I suggest if you want more information on how this type of functional medicine deals with individuals as opposed to statistical populations, get the book “The Disease Delusion’ by Jeffrey Bland Ph.D.

            I had a friend with familial hypercholesterolemia for whom large doses of Vitamin C and flaxseeds did the trick without having to resort to statins. For others, other solutions might help depending upon their individual biochemical snps.

            BTW, here are some more links to Vitamin C and hypercholesterolemia


            Again, not specifically directed at you, but yes, the idea that a vegan diet is right for everyone is just plain folly. The fact that Plant Positive, and Dr. Gregor and Esselstyn do not have an anti-statin stance is not indicative that this stuff is not devistatingly bad. IMHO they have not looked far enough for alternatives because they cannot get past their vegan biases.
            Once again for those reading, I am neither pro vegan, nor pro paleo. I am pro-nutrition and pro REAL science that takes into account biochemical individuality. Most of the studies, blind, double blind or otherwise, that are passed off as science are really nothing of the sort when one digs deeper.
            My views only.

          • george

            Charles: Linda has a point. The biosynthesis of cholesterol and of coenzyme Q10 share some steps and statins lower cholesterol levels by inhibiting one of these steps. The unintended consequence of this is the potential deficiency of coenzyme Q10. Coenzyme Q10 is essential for energy production, besides being a powerful antioxidant that inhibits oxidation and glycation of LDL, two processes thought to contribute to cardiovascular disease. The sad thing is that doctors don’t even tell patients to take supplemental CoQ10 while on statins.

          • charles grashow

            I’m in total agreement with that. Statins also deplete Vitamin D as well. That’s why I take CoQ10, Vitamin K1, K2 as MK4 and MK7, D3 and other supplements as well

          • Petition for civility on this site. Being patient, kind, informative and/or supportive as the post demands makes being here so much more pleasant.

          • charles grashow

            Agree on that

            Get veganchrisuk • a day ago to agree also

            It appears that the only way to persuade the majority of the population to adopt a healthier diet is to remove/restrict meat and dairy by force or other means

          • veganchrisuk

            Charles, having spent the last few minutes reading through your comments, I have to agree with Linda N above – it is one thing to have an opinion, however there is no need for you to be so obnoxious and derogatory with other members simply because you disagree with them, notwithstanding your earlier comment re my post that I have subsequently answered this evening.

        • veganchrisuk


          • Matthew Smith

            I am really glad that you shared that statins are a dangerous natural product. The really strange thing is, there has been a nearly free cure for high LDL, low HDL, and high triglycerides for decades: Niacin. High doses of vitamin B3 (3 grams a day) can raise HDL by 30 percent, lower LDL by 40 percent, and lower triglycerides. I thought drugs, to be approved, must be better than what is available. Current LDL medication really only lowers it by low double or single digits according to this site and have dangerous side effects. It doesn’t work well. There was a smear campaign against niacin (the flushing, the burning) because it is so cheap and can’t be patented. Niacin can raise liver ALT test results. There have been reported cases of liver damage, which orthomolecular proponents say is an unrelated disease. It can cause nasuea, numbness, and tingling, the same symptoms as a Niacin deficiency. It also can “cure” schizophrenia according to Dr. Hoffer, who in a report said the only side effect is longer life. People are skeptical of taking more than minimum amount of vitamins, an avenue of despair for those who believe in orthomolecular medicine.

      • Hi Charles.

        • charles grashow

          Participants were asked to adhere to a diet that derived less than 10% of its calories from fat. They were to avoid oils, meat, fish, fowl, and dairy products, except for skim milk and nonfat yogurt. Grains, legumes, lentils, vegeta bles, and fruit comprised the major portion of the diet, which contained adequate amounts of vitamins, minerals, protein, and iron.’6~’7 A list of fat-free recipes taken from cookbooks and other resources that focus on weight loss, nutrition, and lifestyle changes to improve heart health18-26 was provided to each participant. Daily food diaries were kept and reviewed with the physician during biweekly visits. Participants were also encouraged to take a daily multivitamin and were asked, but not required, to moderate their consumption of alcohol and caffeine. There were no prescribed exercise requirements.

          Each participant also received an individualized prescription for a cholesterol-lowering drug. The most frequent regimen included cholestyramine, 4 g twice daily, and lovastarin, 40 mg to 60 mg daily. Time-release niacin was prescribed for a short while but was discontinued when many patients reported nausea, vomiting, and swollen ankles.

          Statins + skim milk and nonfat yogurt!

          • Thea

            Charles: The following is a direct quote from the book, page 20. “I asked them to eliminate from their diet almost all dairy products (in the beginning, I allowed them to have skim milk and nonfat yogurt, but have since eliminated all dairy products because of the potential tumor-causing properties of caseine and the contribution of animal protein to the process of atherosclerosis),…”

            It is important to understand the full situation.

          • charles grashow

            “eliminated all dairy products because of the potential tumor-causing properties of caseine”

            Statement has NO basis in fact

          • Thea

            I consider the evidence from the China Study to be compelling evidence supporting the statement. Plenty of basis…

          • kylemeister

            Note that what you are citing is from 1995; it isn’t the 2014 paper cited in the video.

          • Hi Charles. What do you think of Dr. Esselstyn’s larger study?


          • charles grashow


            Interesting study – curious at to why the do not show lipids for participants before and after.

      • Richard

        Charles, you read too many comic books, try staying with the facts….Ornish has also reversed heart disease without statins…

        • charles grashow

          Ornish used multiple co factors in his paper. How much was diet – how much was exercise, smoking cessation, relaxtion techniques, etc?

        • Nice follow up to the comments calling for civility, kindness, patience, informativeness, and supportiveness.

    • Alan

      Jim , I believe that anyone can handle a diet that restricted if they so choose. Problem is a lot, if not most people choose a bad diet over good health. It is all about choice not whether they can or not.

    • Nicole Jaja

      highly restrictive? i guess you haven´t seen Esselstyn´s cookbook, many recipes to choose from to eat. re-learning process is always hard, but that doesn´t mean that the diet is restrictive. on the other hand, mainstream weight-loss programs of 1200calories – where they DO eat meat, fish, dairy, nuts, oils – ARE highly restrictive and very difficult for most people to follow, as many people binge out.

      • Exactly. It’s not restrictive to eat low fat, whole food, plant-based. It’s just different. There is an abundance of variety to be had. Tasty and heart healthy!

      • Charzie

        I sooooo agree! Not only are calorie reduction diets seriously restrictive, but they do NOT work for the long term, and only cause rebound, guilt, and a lot of issues that compound instead of help the problem. I “dieted” my way up to 300lbs eventually, feeling like a lost cause with no self respect, because I couldn’t live on such a restricted diet. When I was diagnosed with diabetes, I hit the wall and had to find a better way, and the American Diabetes assoc. diet certainly was not it! Even adhering to it 100%, (similar to what I image a Mediterranean diet would be), I was still needing medication. Upon learning about a WFPB diet and giving it a trial for just a month, two weeks into it my blood sugars were normal, and I never looked back! There is definitely a period of adjustment and learning, but it is totally doable and very satisfying once you make the effort! My ONLY problem is that everyone eats differently…so it can be hard to deal with some issues, but it’s their loss, as I have come to accept. It’s frustrating watching people destroy themselves, but no one can be made to change their minds, no matter how badly I want them to! It has to be a personal decision, and is mine!

    • thorn324

      Jim, I know that I (and suspect that other regular followers of Dr. Greger) really wish you would define what you mean by “to eat normally.” If you mean the Standard American Diet (SAD), then I (and, again, perhaps others here) would disagree with your “normally.”

    • Charzie

      It’s not difficult at all once you make the mental shift! If a person will let their tastebuds run their life for them, oh well, it’s on them. Meat, cheese, eggs, all these things are simply flavors and textures we are familiar with and have emotional ties to. Most can be closely replicated or replaced with much better choices, but why won’t the majority do it, even when they fully know the facts? Because of the emotional connections that they refuse to deal with, yet try to defend with nonsense alibis! Why else would someone continue to eat a SAD with diabetes and lose his limbs, KNOWING full well there is a better alternative? I used to be diabetic, obese, and on tons of medicines, but woke up. Yep, and I am married to the guy who won’t!!! Nothing like a little lethal illness to drive home a concept’s reality in practice!
      Don’t kid yourself either, no pills are going to stand in for food! Food isn’t about just vitamins and minerals, there are all sorts of co-factors, enzymes, antioxidants and many other beneficial properties, some of which we aren’t even aware of yet! Again and again, they’ve shown that food does not equal supplements, yet everyone wants the easy fix, so they can justify and appease their needs. It is your life, after all…right?

      • Lawrence

        Hi Charzie. I really like your attitude and I congratulate you for making so many changes with such great success! You are so right about the taste bud and emotional ties to comfortable , yet oh so destructive, foods. I really wanted to share with someone who could appreciate this PBS Newshour report from this evening’s (2/27/15) show, and your comments seemed like the right place-thanks.. I’ll bet after watching this you’ll want to get your reluctant husband to take a good look at what happens to people who refuse to get over their taste bud and emotional ties issues or whatever it is (not presuming anything here). I wish you much success and really hope your husband comes around to following in your much lighter and healthier footsteps. All the best!

        • Charzie

          Thanks Lawrence, I appreciate your comments and the link, I am going to view it now. If I could get some help tying him down, maybe I can make him watch it too! LOL!

      • Fruitopia

        It’s not just emotional ties, meat and dairy contain opioid compounds that are physically addictive. This is why animals that grow up eating cooked meats will refuse to eat anything else. It is very difficult to get a domestic carnivore such as dogs and cats to switch to a raw meat diet. Even herbivores like sheep that have been raised eating cooked meats will refuse to eat anything else.

    • fred

      I’m already taking around 90% of those supplements individually. I do use EVO and eat fish…I especially love the Fukashima radioactive salmon as caught by the Chinese. I have maybe 2-4 oz meat at each meal. Nuts…minor amount of bread…little dairy…

      Ingredients list:

      I will say that I doubt that very many people could handle 5G of arginine at bedtime(the Egyptian study)…let alone the glutamine some recommend. I can manage maybe 2G of arginine/ornithine in the morning…couldn’t handle it before bed.

      My total chol is around 145.

    • Richard

      If reversing your heart disease is too difficult for you Jim please die without being a burden to tax payers. That is freedom of choice, on the other hand, so many sick and obese people who refuse to change their diet are a burden to society and it just is not right.

      • 2tsaybow

        Wait a minute. They are a profit center for our current social structure. The pharmaceutic companies profits, the meat and dairy industry profit, the fast food industry profits, big food processors (Kellogg, and others) profit, and members of the medical profession who are willing to participate profit. And best of all our lawmakers profit by taking campaign contributions from all of these people.
        You need to look carefully and who and what you are judging.
        Next time you walk down the street and see a homeless person, ask yourself what kind of society refuses to take care of the least of us. Why do we set up our poor and marginalized to become ill so that corporate entities and politicians can profit.
        You need to be nice and learn to have more empathy. Every person you see and meet deserves your understanding and respect no matter how fat, ugly or dirty they may appear to you. They are where they are because of the choices we have ALL made.
        Oh yeah, and you shouldn’t tell people to die. It’s not a nice thing to do either.

        • Linda N

          Thumps Up. 2tsaybow! Well said!

        • Joseph Gonzales R.D.

          Very well said indeed. Thanks 2tsaybow!

    • Joseph Gonzales R.D.

      I think you make good points and everyone has to decide for themselves how to help prevent heart disease. I would be a bit cautious with supplements and multivitamins. Sure, I am all for folks doing whatever they can to help prevent and reverse heart disease. Even if you feel the diet is restrictive I think the fact the research exists and we know it’s possible to actually prevent heart disease thru diet and lifestyle changes is absolutely amazing and yet still not enough folks know about it! Thanks for your comments here Jim they are warmly welcomed!


  • Maureen

    I would like to get more information about whether unheated extra virgin olive oil is a healthy addition to a diet. I love to eat air popped popcorn drizzled with unheated extra virgin olive oil. It has lots of polyphenols, right? So what is the problem? I know it’s not a whole food. Is it just a too highly concentrated source of calories? Or is all oil, even healthier ones, taxing on the cardiovascular system?

    • Nicole Jaja

      Esselstyn has found that all oils are bad for heart disease, even olive oils.

      • So glad you bring this up, and thanks to Boomer for giving me something to send to my oilers! Dr. Fuhrman uses tiny amounts of olive oil in some of his delicious recipes and is not worried that if we have a tsp we’ll take a ¼ cup of it. Rip Esselstyn, son of the great researcher said on a video (sorry I don’t know the link) that his dad works with such sick people that he takes the no oil stance as does Dr. McDougall, but Rip said it was fine in his diet to have tiny amounts. If I have this wrong, I would welcome correction.

        • Nicole Jaja

          Rip Esselstyn is not a medical doctor. he´s a firefighter, as far as i know. and his dad´s research and recommended diet is primarily for those with cardiovascular diseases. yeah, a tiny amount of oils won´t kill you, but the best results are with no oils whatsoever. besides, oils are completely unnecessary for health, they´re used just for palate pleasure. you´re better off eating whole olives.

          • What’s wrong with pleasure? If someone finds veggies more palatable and therefore eats more if them bcz of taste, I think that’s not a problem if the alternative is few or no veggies at all.

            Personally, I prefer whole fat sources like nuts and avocado, but others should do what works for them.

          • Nicole Jaja

            “What’s wrong with pleasure? ” uhm, everything. your taste buds does not equal health. although, food does need to be enjoyable for us, but there are healthier ways how to make veggies more palatable than drizzle oils on them. if someone does not care about their health, than they can do what they want with their own bodies. but passing on the mantra that “others should do what works for them” is very irresponsible health-wise, because it´s a slippery slope. better would be to give people the best option (which is no oils), or there are other options – vinegar, using just water with different types of cooking, or using herbs for taste, or you can make a dressing.

          • Preaching to the choir, Nicole. I prefer homemade dressing, too. But the people in real world is not going to go to those extremes. They have too many conflicting demands to balance.

            Pleasure is a survival mechanism. It’s basic human physiology. And enjoyment of food is a prime characteristic of the Blue Zones where many consume olive oil and (gasp) meat and even eggs fried in lard. So let’s be a little understanding that our way is not the only way to be healthy.

            Don’t let the perfect be the enemy of the good. Is it a slippery slope of that Dr. Greger is a supporter of Reducetarianism?


          • Nicole Jaja

            i don´t understand why are you even replying to me? you´re the one who´s preaching to me in the first place.
            i don´t care about people calling esselstyn´s diet to be “extreme”. if they´re so emotionally addicted to those food items, that doesn´t mean that i should comfort them in what they do. all i can do is give them information and they decide whether they care about their health enough to try it or they don´t. i´m not going to yell at them or physically force them to, just like i said, give them information and they decide. so i don´t understand how can you claim i´m preaching to the choir.

          • Preaching to the choir = I personally am on the same page oil-wise.

            But I’ve become less myopic in my dietary perspective.

            In the real world, your wealthy Whole Foods Store types have the wherewithal to live up to an ideal. But reality for the majority of the population is quite different, both in the wealth of finances and wealth of time.

            There are tons of ppl working 3 minimum wage jobs just trying to make ends meet. Helping such ppl to eat more healthy foods at home vs fast food in between jobs is difficult enough. Badgering them about olive oil is counterproductive, IMO.

          • Nicole Jaja

            again, all i can do is give people information. what they do with it, is on them. but i´m not going to comfort them in what they´re doing.
            and buying oils AND basic foods like rice, potatoes requires more money than buying rice, potatoes only. so people working 3 minimum wage jobs will even save money. definitely not counterproductive from my stance, actually the opposite money-wise.

          • Yes, Nicole, that is my understanding too. But a little (a tsp a week) seems like an acceptable amount for us who have no detectible heart disease or symptoms, and my brain scans of a fractured skull ( ice skating) showed that the arteries in the brain looked “clean as a whistle,” rare in a 62-yr old. My weight is fine, so now and then, just a tiny bit of olive oil seems ok. In 1979 I went on the Pritikin ultra low diet for 4 years, so giving up oils and being free to eat nuts and seeds feels like luxury on WFPB!

          • Nicole Jaja

            i don´t understand the need to consume oils. just like i said, we´re better off eating whole olives, avocados, nuts, seeds. if palate pleasure is where you draw your line, than it is on you. but no, i don´t support “but just a little won´t hurt you” mantra.

          • Joseph Gonzales R.D.

            I think it just depends where you’re at. Certainly a little could hurt you if you are already damaged and trying to fight heart disease. And yes it can add up fast, even in little bits unless careful, but on occasions when dining out or cooking with a tad of oil seldom at home is probably not going to be super harmful in healthy persons. I can understand the habitual concerns, where the more you get used to it the more you do it and some people do better simply avoiding oil completely. I always think overall diet it most important to consider. I totally understand your concern with oil and I commend you for being strict and following a well-respected program like Dr. Esselstyns. Thanks for your thoughts and giving such great tips for how to replace oils in your other posts!.

    • Alan

      From my understanding from watching Esselstyn, McDougall and others in the get well on a plant based diet movement that it is all fat. The plant based fat is not as bad as the animal fat but does cause problems with the cardiovascular system and can be a cause of weight gain.

      • Joseph Gonzales R.D.

        Good points, Alan. I will discuss this more, but the problem is that am Esselstyn approach with the inclusion of nuts has not been conducted, so we are left with good results from his studies (Ornish, too) and other RCT on Mediterranean-type diets showing health benefits of nuts. I wonder what nuts would do? Until we have that kind of data it is probably best to still recommend diets such as Esselstyn’s for patients with heart disease.

        • Alan

          Hi Joseph – I am thin and always have been. I myself do use some nuts and seeds. I try to limit them to 1oz maximum per day. I think that most people would benefit from a few nuts and seeds. But also i have read on posts by people that had lost weight while eating nuts but had to give them up to loose the few extra pounds to get to their desired weight. I also would like to see a well done study on the effects of nus on heart disease.

          • Joseph Gonzales R.D.

            Forgive my delay but I’ve posted this in many places that reflect what you say about nuts. An ounce a day seems very appropriate based on the data. ​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. explain the research on nuts and heart disease.

          • Alan

            Thanks for your reply and forgive me for my delay. I i looked at the posts you mentioned And some from Doctors notes also. I will continue with my nuts and seeds as the science shows the benefits from them.

    • Dasaniyum

      I may be mistaken but in terms of cardiovascular health, I think I heard from one of Esselstyn’s talk that vegetable oils are actually worse than butter.

      • Charzie

        I think it was hydrogenated vegetable oils specifically, which are altered to be solid at room temperature.

    • b00mer

      “It has lots of polyphenols, right?”

      Unfortunately this is a very popular myth. It does technically contain polyphenols, really any food product no matter how processed will likely contain some residual nutritional qualities of the whole plant, however for comparison:

      Green leaf lettuce: 4.4 mg total polyphenols per Calorie
      Extra virgin olive oil: 0.062 mg total polyphenols per Calorie

      This is about a seventy fold difference. Of course this doesn’t take into account other nutrients, with green leaf lettuce having infinitely more fiber, vitamins and minerals, and about eleven times less fat.

      • Arjan den Hollander.

        Excellent use of metric, lining up the dots gives a even more dramatic effect BTW. ;)
        Keep up the good work! :)

        • Charzie

          For spritzing oil though, you usually need a pressurized sprayer to force the oil out, a regular hand sprayer won’t quite do. They have a little pump on top to add air pressure inside the container. I used to use one quite a while ago, but they tend to clog if you don’t maintain and clean them regularly.

      • Charzie

        I want you to follow me around on my internet wanderings and post for me!!! Love it!

  • Matthew Smith

    I can see the WFPB (Whole foods plant based diet) is an effective intervention for those with heart disease. Half of those who die of heart disease didn’t see it coming. Does that mean we should eat less meat in our lives and less meat as we age? Cocoa has a very powerful effect in reducing heart disease, as can tea, nuts, aspirin*, one drink*, kiwi, exercise, whole grains, berries, citrus, soy, tomatoes, beans, (spinach, broccoli, or kale), flax seeds, apples, and beets. *not recommended here. Every piece of meat we eat can shorten our lives, add to blood pressure, add to weight, this site argues. Some plant foods can have the opposite effect. Some life style choices can add life to us, like meditating, swimming, being married, listening to classical music, going to church or prayer service, eating nuts, getting exercise, not smoking, flossing, and eating less food. I don’t think eating a WFPB is going to make anyone life forever, but can add quality to life. Beans, nuts, green tea, cocoa, berries, whole grains, fresh fruit, and vegetables can be a factor in adding to healthy lifestyles.

    • Joseph Gonzales R.D.

      Great points, Mr. Smith. Regarding your question ” Does that mean we should eat less meat in our lives and less meat as we age? ” I am not sure. What do you think? May be worthwhile, according to the heart protective effects you mention.

  • guest

    To set the good doctor straight on his facts. The Lyon Heart Study was a randomized trial. Dr Esselstyn’s amazing n=198 case series is not even controlled – he uses non-adherent dropouts as his control group (I’m sure you’ve heard of “healthy adherer bias”; the converse is also true – “sickly nonadherer bias”). The bias is very clear in this presentation. Disdain the Lyon Heart Study, even though it was a randomized trial leading to a very large reduction in cardiovascular events, and favor Dr Esselstyn’s small, uncontrolled, nonrandomized, retrospective case series.

    • largelytrue

      The good doctor was pretty straight at least in regard to the fact that the case series was not an RCT. Still though, I’d challenge you to pull out an ‘adherent’ group as sick as Esselstyn’s was at baseline that has anything like Esselstyn’s results.

      I think his study should be replicated as a better controlled trial. My main question is why, given how horrible the burden of heart disease is in the world, this is not being done? With or without small amounts of select animal products, the low-fat whole-food plant-based diet has all kinds of plausible grounds for thinking that it may be extremely well-indicated for heart disease. Exploring that possibility could lead to extremely empowering results for governments, individuals, and all kinds of private entities which bear the costs of poor health.

    • If you review this video, I think you will see that what Largelytrue says below is largely true. Your post reads a bit, well, snarky.

  • Ray Tajoma

    I don’t think “Heart” is as important as “BRAIN”. I personally rather have a heart attack than a Brain Stroke. Meat Eaters eat meat for “Protein” and think their BRAINS need meat protein to function properly. I think science will prove the REVERSE. That our IQ drops by eating cooked-burnt meat, dairy and eggs. Once the information is passed on to masses, they will stop eating meat automatically. No one would intentionally eat foods that lower their IQ – that is a no brainer !

    • Oh Ray, I wish that were always, or even often true! I have the impression, reinforced by my friends’ eating habits even after quadruple bypass, breast and prostate cancer surgery, and diabetes diagnoses, that many people do not change their eating habits. This makes me very sad. Dr. Greger has certainly persuaded many to make the switch and to maintain it. We are very grateful to him for his work that has changed our lives and those of at least a FEW friends.

  • AnnaleighBelle

    Since this is the latest thread, I’m just going to put this here – I’d love some feedback from the good Doctor –

    I was in a sprouting mood last night and couldn’t find my broccoli blend, so I remembered the nutrionfacts assessment that radishes have the myrosinase that cooked broccoli needs to create sulforaphane so I looked up the relationship between radish sprouts and sulforaphane and found this study.

    Not really Mediterranean diet related, but WFPB related. Apologies for being a bit off-topic.

    • HaltheVegan

      I have the same question. I have been eating broccoli sprouts, but if radish sprouts are, in fact healthier, maybe I’ll switch.

      • Joseph Gonzales R.D.

        I think variety is key. Perhaps one is not healthier than the other, it is just that broccoli receives more attention? Still, that dies not discredit the amazing research and support for broccoli and broccoli sprouts in the diet.

    • Joseph Gonzales R.D.

      Looks promising. When looking at what daikon radishes can do, it would make sense that other sprouts have high doses of sulforaphane. I think you’re onto something and there is more research on this topic. Your not too far off topic, I appreciate you joining the discussion!

  • JakeN

    Hey Team / Everyone !

    I have a question (somewhat unrelated to this video):

    I generally steam my vegetables as the only way of cooking them, and this has happened a number of times now; the water runs out on the bottom. Essentially the vegetables look fine but smell burnt. I am wondering about the safety in consuming these vegetables?

    Thanks in advanced!!

    • b00mer

      Jake, I don’t have an answer to your safety query, however do you have a microwave? I like to steam my veggies in a glass bowl with loose fitting glass lid in the microwave. A quart of broccoli takes about six minutes this way, and the water doesn’t run out so longer cooking vegetables like cauliflower never burn. And they turn out perfect and tender, not rubbery or weird at all. I have some 5 cup bowls which I consider good for two servings, and also some of the 2-cup bowls that are nice for a single serving.

      • JakeN

        So I am not sure if you can answer this or send me some links to studies but I am very curious about microwaves and cancer risk? A lot of people claim that microwaving food causes cancer while a large number of others say it just causes water molecules to boil inside the food (or somthing like that) and that there is zero risk / link. Could you possibly point me in some direction to find out more about this topic ?

        • Thea

          JakeN: Allow me to jump in here as this is one of my favorite questions. A few years ago, I did a lot of research on microwaves. I found a bazillion sites all repeating the same bad news about microwaves. But no real support for those views. Then I stumbled across some sites that seemed to have solid evidence to back up their position on microwaves. Here is my favorite site since it is pretty comprehensive and read-able:

          I hope that helps!

        • b00mer

          Hi Jake, microwaves are perfectly safe, according to every legitimate scientific source I have seen. The exceptions really are burns resulting from food heated in the microwave, since food tends to heat less evenly in the microwave and a hot spot can catch someone by surprise. I’ve seen plenty of people claim that they’re dangerous, but have seen absolutely zero substantiation to back up those claims. Below is a link from the World Health Organization that should put your mind at ease:

  • HereHere

    I appreciate the balanced comment that we cannot compare the case-series with the randomized controlled trial. The evidence points in a certain direction, but I’m glad that the limits of the research have been addressed so transparently. Great job, Dr. G!

  • peterpan

    Dean Ornish, sited in this video, suggests obtaining 70% of your nutritional needs from carbs and 10% from fats (assuming these are all whole nutritional foods). This low fat diet proposes that nuts and avocado be eaten very sparingly. Dr. Greger extols the virtues of both nuts and avocado. I’m assuming his suggestion would be for a more balance allocation of carbs/fats…perhaps 50%/30%. Would be nice to reconcile these differences as walnuts and avocado have become a part of my daily fare.

    • NFc

      As far as I know, Dr. Greger has only ever recommended up to a handful of nuts a day. A handful of nuts a day is still easily compatible with the idea of getting 10% of calories or less from fat when the rest of your diet is still mainly fruit, grains, beans, and vegetables, which are all normally pretty lean. Adding oil to the diet is an easy way to go over the 10% recommendation, but just having some nuts most likely wouldn’t do that as long as you’re not treating nuts as a meal. It doesn’t take a huge amount of nuts to see benefits from them, just an ounce a day or so

      • peterpan

        Hate to get picky but this doesn’t really compute. Imagine a 1600 calorie/day diet. 10% would be 160 calories from fat which equals about 18 grams of fat. That oz. or so of walnuts is already there. You can’t wake up to oatmeal with almond milk, have a salad with avocado for lunch, and black bean with tofu and quinoa for dinner. Way too much fat? Perhaps healthful according to Dr. Greger but heart disease in the making according to Ornish. Unless I’m reading all this wrong.?

    • Joseph Gonzales R.D.

      Good points. I think an ounce of nuts and/or 1/4 of an avocado (or a few slivers) is more on the cautious side regarding fat content. I personally do both, if not even more avocado or nuts due to physical activity needs. I think the differences are so minor, as long as we are filling up on whole plant foods.

  • Sharon


    Before you post again, read the original study (Leon) on the med diet. You will note that in this study, the independent variable was the consumption of “olive oil”. No other food was an independent variable…nothing but olive oil.

    If you don’t know what an independent variable is in a study, read the study to find out.

    Ph.D. (University of Chicago, Biochemistry)

    • largelytrue

      Try to post an educated and scholarly comment if you want to claim that you have a biochem doctorate and can use it in a useful way, Sharon. Myself, I’ve seen many references to biochem-type people with quite loopy ideas about diet and medicine. I suspect that they often have the engineer’s zeal and think that a small scale understanding of chemistry gives them mastery in understanding the pervasive effects of a chemical on the entire complex human body.

      Your misspelling of Lyon and lack of citations suggest that you aren’t really that familiar with scholarship on this topic, and your talk of a olive oil as the single independent variable in a trial that explicitly tried to explore contrasting dietary patterns suggests that you are ignorant of how this type of flagship study is conducted and the range of specific relationships between secondary variables that people will try to analyze over the course of many papers.

      I’ll give you the chance to explicitly link to the study that you have in mind and/or explain yourself clearly, though, before judging you as a fake persona or simply a crazy (or nutritionally deluded) person with a PhD in a topic that is only quasi-relevant and whose research methods are of limited use for exploring the nutritional epidemiology of complex chronic diseases. In case you were just referring very lazily to the 1994 study in the video sources, let me give you a snippet of the text to underscore what I mean when saying that the intervention (the independent variable in the trial design) was multifactorial:

    • Arjan den Hollander.

      If you make claims to have achieved a educational grade M.D., Ph.D or whatever other achievement, and you use it to empower yourself and elevate your opinion in the eyes of others, at the very least show backbone and sign with your own full name so that that can be verified.

      A persons words tend to be inherently worthless if that person cannot stand by them.

      And before you go off like ahh what the hell do you know,
      I’ve been a life long 38/40 point ADHD sufferer with almost no control what I blurt out sometimes, had my brain scrambled in a 9 month full blown psychosis once, went from 3 years curled up in a corner to more recently manic bouts, and still I own up to my actions and words.

      If I can do that, there shouldn’t be an academic on Earth, with his or her proven capacity for organized thought and self discipline unable to do that.
      If not, than what you are throwing up into the world isn’t worth the paper you write it on.

  • Frank Brettschneider

    I value Freedom in society over everything. Educate but don’t force! Those same government do gooder’s want to regulate the CO2 you exhale with carbon taxes. They start with a good idea and end with crushing regulations and taxes. Just look at the tax code. Now they are taking over the internet. Hold on to your wallet! It’s all great if you like government dependency.

  • Lilly

    In these trials, I don’t understand how researchers are able to get folks to adhere to a protocol that could mean adverse affects or possibly death. For the sake of the public’s need to know, a stat is a stat; but is it not immoral to have folks eat in a way that is highly suspect, and even more so given a particular person’s health issues? I have to wonder who signs up for this!

    • b00mer

      Lilly, I had similar thoughts and also a somewhat different perspective on this study. When the slide with the numbers of heart attacks, strokes, and deaths came up I found it heartbreaking, since an evidence-based protocol for heart disease reversal in the form of a low fat plant based diet could have been employed to prevent the vast majority of those events. I do hope that very soon, medical research prescribing any dietary treatment other than low fat vegan to heart disease patients will be considered unethical and be phased out. On the other hand, I don’t quite see the researchers here as getting these folks to sign up for the unhealthy diet; I feel like the researchers were able to at least get some of them to make a tiny improvement in their already horrible diet, but it seems the patients themselves were resistant to the idea of making big changes (towards the low fat protocol at least). On the other other hand, I’m betting most of these patients have never been fully educated on the potential of a truly low fat plant based diet and perhaps if they were, there would have been significant participation in that. It’s sad all around. But with large insurance programs and medicare getting involved in promoting wfpb diet, and increasing awareness through social media and high-profile wfpb eaters, I do think we’ll hit a turning point soon. Not soon enough for many, unfortunately.

    • Joseph Gonzales R.D.

      Hi Lilly, When researchers run these studies they always must gain approval from an Institution Review Board, who assure the subject’s safety. Nobody did anything wrong. These participants were already on their existing diets, and they signed up willingly, knowing that they may just be followed around in the study and not be asked to make diet changes. This is called the “control group”, and sometimes they are even upset that they didn’t get randomly selected to enter the trial (at least I have seen this in my own experience). The other half (the intervention group) are asked make the changes laid out in the video. At anytime the control group folks could change their diet, if is not preferred by the researchers, but it is always the participant’s choice.

  • Davi

    Hello! I just read this article… and could not believe. There is any scientific background to support this? It so crazy! P.S: Im a vegan, just would like to know your thoughts on this case.

    • Joseph Gonzales R.D.

      Davi can you repost the article I cannot seem to link to it. Thanks, Joseph.

  • jhk

    I just finished reading Dr. Esselstyn’s book, Prevent and Reverse Heart Disease in which he describes the reasoning and the diet criteria to improve heart function. He states that we need to eliminate ALL oils from our diet that come from items like olive oil, nuts, avocados, and hidden ingredients in some processed foods (i.e. cereal). I haven’t tried the diet yet, but want to give it a try. One question remains: I take Coenzyme Q10, vitamin E, and a saw palmetto prostate supplement, all of which have “other ingredients” that include trace amounts of oil, such as sunflower oil and/or medium chain triglyceride oil. Do these trace amounts terribly interfere with getting the full benefit of what Dr. Esselstyn is promoting? Also, has anyone actually tried his diet, and if so, what type of results/experiences can you share?

  • KT

    Hi Dr Greger and team! I’ve been trying to find studies comparing diets based on results, and not standards. I’ve found several that do that as well as others which compare each diet with the standards for recommended intake for certain macro- and micro-nutrients. But none of the studies have controlled for people eating “healthfully.” I can’t find studies where subjects were required to eat a “balanced” diet of any kind, be it vegan, vegetarian, or otherwise. I get questions from friends who want to continue consuming meat, because they feel that if they eat just 1/4 chicken breast per meal with veggies and fruit throughout the day, it constitutes a well balanced diet according to many doctors. While I can direct them to your videos to show evidence of what eating a quarter of a chicken breast a day can do, they still refuse to believe it without longitudinal studies linking eating a “well balanced” omnivorous diet to disease. Appreciate any help!