Doctor's Note

This reminds me of what the beef industry tried to pull. See BOLD Indeed: Beef Lowers Cholesterol?

Is our diet really that bad? See Nation’s Diet in Crisis.

Here are a few other important egg industry videos:

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  • Merio

    It seems that the journalist Gary Taubes twisted two of the studies of Geoffrey Rose at least for what i saw in this Plant Positive video (one is mentioned by Dr Greger):

    To me is a no brainer, dietary cholesterol = the less, the better…

    Anyway i start to read the CarbSane Asylum and i think is another site to read carefully…

    • Evelyn Kocur is a scientifically qualified blogger who happens to have a background of low carb dieting and still prefers to eat that way. However, she decries the LC/Paleo myths that abound on the Interwebs and has been debunking Gary Taubes’s GCBC for a number of years and now his media-smart acolyte Nina Teicholz. Who can blame her for abhoring his abuse of nutritional and biochemical science and scientists? Not to mention accurate history.

      Both she and Seth Yoder of The Science of Nutrition blog have taken on the absurd lynching party hunting for libelously hunting down every last vestige of respect for Ancel Keys and his contribution to the health of the nation, blaming him for everything from the current obesity/diabetes crisis to low-fat chocolate milk in public school cafeterias.

      Despite the omnivorous viewpoint, you’ll find a lot of common ground there. Feel free to congenially and respectfully read and contribute at either site.

      • Merio

        Thanks for your opinion, i think that more qualified bloggers and health professionals i read the more i understand on this field of reasearch…

        • Ancel Keys — The OTHER Minnesota Study

          This is a must read, considering the “Eat Butter-Scientists Were Wrong” TIME Mag cover and the whole pro-saturated fat, Keys was the devil incarnate media blitz.

          • Merio

            I will take a look, thanks for the link !
            I read the Time articles about butter and i found many errors that undermine the “eat butter” claim… so sad…

      • Brutus Maximus

        Taubs, Attias, Teicholz, Atkins. Does anybody else see a pattern here ? These good christians are master scammers, always ready to make a buck on the honest consumer’s back. It’s in the genes bro !

  • DGH

    Great explanation of the impossibility of demonstrating causal associations in populations where exposure to the risk factor in question is so extensive, with no possibility of unexposed controls (as with diet and cholesterol).

  • Suzanne

    I appreciate how Dr. Greger’s video points out Dr. Rose’s lesson that we must be critical consumers of research, regardless of quadrant. But I am
    surprised Dr. Rose was able to get his peer-reviewed article accepted by his peers (i.e., the consensus worldview of editorial boards) and to such accolades, as it steps on many toes. Those who have tried to publish controversial analyses know what I mean.

    Thanks to peer-reviews, only criticism that is not too critical makes it to
    publication. A worthwhile statistician might note this trend as regression
    toward the mean. That is to say that we may be sifting out the truly significant research and exempting it from publication because associations have the bias that peer-reviews are blinded and, therefore, without bias. However, the peer reviewers are not blinded to the content of the articles, only to the names of the authors.

    Social scientists have possessed inferential statistical techniques for
    decades prior to Dr. Rose’s 1985 publication and a critical (knowledgeable) consumer of research could have easily sorted this out if given the journal space. Yet even today, we seem surprised to find that data were not compared correctly in these or other studies.

    Indeed, it is a breach of trust for most of us consumers to learn of biased
    or under-educated researchers producing fatally flawed ‘research’ intended to answer important questions. This includes findings from scholarly medical researchers who tend to bend –if not outright violate– the laws of inferential statistics, such as conducting too many statistical tests on a sample or using overly large or indiscriminant samples (all of which invite spurious results) and who use inferential (i.e., sampling) techniques on populations instead of properly drawn samples. Because of the high costs of funding studies, it is often tempting for researchers to squeeze every last drop of ‘significant’ effects out of a study. It causes me to discount a great deal of what I read. Yet, I continue to support my associations because, frankly, at least I can know what is being put out as science.

    I am glad to know that considering the source is often noted on this website as a common threat to validity of published research. Understanding the publication process and political goals of the prestigious Association-based journal review boards suggests another unarticulated bias to consider. Critical independent thinkers would
    do well to mix up their sources of information. Big egos and big reputations, as well as big money, drive the publish-or-perish world.

  • guest

    Dr. G,

    I have concerns regarding B12 supplementation for some people. To begin with, concerns have been raised about B12 supplementation in those who already have prostate cancer

    And I also found the below excerpt regarding B12 with links:

    The link between high levels of B12 and cancer is easy to explain. Vitamin B12 stimulates cell division and it doesn’t distinguish between healthy and unhealthy cells. The excess vitamin B12 provides the extra energy needed by cancer cells.
    Troubling B12 cancer connections:

    One case was reported of leukemia resulting from a vitamin B12 megadose used in the treatment pernicious anemia.

    High levels of folate and B12 are associated with an increased risk of prostate cancer.

    Diets high in cholesterol, animal protein and vitamin B12 have been linked to certain kinds of stomach and esophagus cancers.

    Yes, I am concerned. Grateful if you could look into this. And the more I think about, maybe what is optimal is eating small amounts of B12 containing foods (like the Japanese do!) in order to get B12. Who knows.

    • Fruit bat

      The short answer is to take B12 supplements but don’t mega dose like some “health gurus” recommend. Take a sub-lingual supplement containing adenosylcobalamin (aka “dibencozide”) and methylcobalamin once a week. Let it sit under your tongue, or between your gum and lip above your front teeth, for five minutes. Also, take selenium supplements or eat a small handful of brazil nuts or one to two tablespoons of brazil nut butter a day, and eat 3-5 grams of kelp/kombu a day. Let me explain, bear with me:

      The natural source of B12 for vegans would have been lake and river water. Today, most freshwater is polluted and tap water is chlorinated. Chlorine is a B12 antagonist, so there is no B12 left in our drinking water. This is one reason why vegans need to supplement with B12, despite a plant based diet being ideal and natural. This may be why historically, vegans did not get B12 deficiencies, and vegans in developing countries drinking the natural water don’t get B12 deficient until they move to “developed” nations.

      Some people wonder if chlorinated water is also stripping our bodies of B12.

      It certainly does in an indirect way – we have iodine receptors in every cell in our body, and the abundant chlorine, flourine and bromine in our modern environment take the place of iodine. Since iodine is the second heaviest halogen, our bodies can’t displace the lighter halogens just by improving the amount of iodine we consume. We also have to consume copious amounts of selenium to remove them, while at the same time drastically improving the amount of iodine we consume. A lack of iodine also contributes to a lack of stomach acid, which is needed for the digestion of B12 (and other nutrients like zinc).

      So, most people are lacking in iodine, because (a) competing halogens (including chlorine) in the modern world take its place, which causes us to have an increased need, and (b) due to intensive farming methods since the end of WWII our soil is severely depleted of iodine and selenium (among other nutrients) which makes our food deficient.

      This lack of iodine is related to methyl-B12 in the following way: Iodine plays a role in B12 utilization! Iodine insufficiency = underactive thyroid = less T4 than normal, and T4 is needed not just to make T3 (another thyroid hormone), but is an integral part of converting riboflavin (vitamin B2) to its active coenzyme form “FAD” which is needed for proper methylation, which is needed to produce methylcobalamin, This is the form of B12 which is responsible for (among other things) lowering methylmalonic acid, this is what they test for in urine to test b12 status.

      Since livestock are supplemented with iodine and selenium, necrotarians will be getting a bit more selenium and iodine than vegans. Fish also have some iodine. Even though some aware vegans may be occasionally consuming sea vegetables and eating one brazil nut a day, it isn’t enough selenium to displace the lighter halogens, so the iodine from the sea vegetables will have little effect. I suspect a lack of iodine and selenium is the reason why vegans often have high or medium blood serum levels of B12, yet high homocysteine and methylmalonic acid levels showing a “deficiency” despite ample quantities in the blood. The conventional, unproven and untested explanation is that the B12 in vegan blood isn’t “real” B12, but I think an inability to utilise B12 due to a lack of iodine and selenium is much more likely.

      Not that it’s *specifically* a vegan problem: according to one study nearly four out of ten necrotarians have lower than desirable B12 (rising to 75% of elderly people) and 9% were deficient. Also, most of the population are iodine deficient. It’s just that due to livestock being supplemented it might be slightly less of a problem for meat-eaters.

      This would explain why, despite vegans having better health in every way than most average people, and that we live longer than most groups of people, some studies show that we don’t live quite as long on average as pescetarians – this could be because shellfish are a moderate source of in selenium and fish can be a moderate source of iodine. (It’s also undoubtedly because people who eat fish but not meat are likely to be doing so for health reasons, whereas vegans are usually doing it for ethics and some of them don’t give a fig about health).

      It also explains why, throughout recorded history, average (not rich) people in most parts of the world have eaten a diet mostly based on plants without problems. Flesh was for special occasions until the 20th century. Also, vegetarians and vegans have always existed, but pernicious anaemia wasn’t discovered until after water was chlorinated: this could be either because it wasn’t understood yet, or it didn’t actually exist yet.

      Therefore, you need to supplement B12 to make up for a lack of it in water – but don’t go overboard – and you need to ensure you’re getting ample iodine and selenium. Again, don’t go overboard, but the recommended daily allowances are way too low for these two.

  • Laloofah

    This brought to mind a quote by Jiddu Krishnamurti: “It is no measure of health to be well adjusted to a profoundly sick society.”

    • Madhava das

      thanks for being a critical independent thinker and varying your sources of information. This points out that great thinkers
      have figured things out long before the jonnie-come-lately scientists. Jiddu Krishnamurti was also likely thinking about spiritually sick society.

    • bob

      In the US it would be quite an accomplishment though? Sometimes you have to accept what little you can manage? Recognizing the sickness is a first and required step. Careful…there be crazy people out there…

  • Arjan den Hollander.

    The problem with the 20 year old is that he sees no ill effects at all.
    Or is completely oblivious to them. Maybe through lack of contact with the elderly in our perfectly segmented society.

    If I would have been fully aware of the damage I did during the 10 years of weed and 20 years of smoking I would not have done it.

    The forming of plaques is the same, you just don’t notice the things happening to you till you hit a bump somewhere and effects stack up.
    Stack up to a point where you go, hey this never used to be this way!
    But when you reach this point if ever 50- 80 % of the damage has been done.

    If a kind of amount of leasons”/plaques present “thermometer/barometer could be realised, people could visualize the impact of living badly.
    They could see their bio years tick away twice as fast as mrs. healthy.

    Taking actions toward healthy living suddenly gets goal oriented.

  • stevebillig

    Great video today! It’s the scam of misinterpreting the lack of variance among variables that don’t vary.

  • Vincit Veritas

    I have no more than three eggs a month, am I still terribly @ risk? I already have diabetes.

    • Arjan den Hollander.


      Completely removing eggs, and thus processed foods, was the first thing I recommended my mum.

      She is still unsuccesfull as far as I know. Clearly present in to many food stuffs to be able to let go.

      • Vincit Veritas

        I am, otherwise, a vegan. I cannot fathom eggs 3xs per month being disadvantageous. What do you think?

        • Arjan den Hollander.

          Not sure. I had a circulation scare when I quit smoking, sudden symptoms. Had to make changes.
          Eggs I thought were the best place to start. Haven’t touched one since. (7.5 months)

          I don’t want to call myself vegan, but appart from the 1 time fish or high quality beef a week effective I am. I’ve been slow to get here with less and less meat every month. Already with very good results. But from all the animal products eggs have just about the lowest appeal to me. Why do you choose eggs over grazed beef or something like it?

          Vegan = useless drama for me and I want no part in any of that. Even if I go 100% WFPBD I will not call myself vegan, ever.

          • Vincit Veritas

            I don’t eat meat for moral and ethical reasons. And, generally, it’s one egg a month–NO FISH-, but ofttimes I slip and have more than one whole egg. I don’t see where it is doing much, if any harm, in such limited quantities.

          • Arjan den Hollander.

            You don’t hold on to proteins for a week. So if you eat the eggs for that once a week that egg will make no big difference. There are vids here that the cholesterol does make a difference. So why eat it if it doesn’t benefit you?

          • Vincit Veritas

            I don’t have high cholesterol. I get protein form beans and lentils and other protein enriched veggies. I just like the taste of Einstein’s egg & cheese bagel–occasionally.

          • Schultze

            It isn’t. Enjoy life!

          • Timar

            Indeed, Schultze! This is by far the wisest and most refreshing comment I have read here for a while. Poeple here are stressing out about whether it is going to kill them if they eat one egg a month or not – well, maybe that one egg increases one’s likelihood of dying from CVD by 1%, but that is utterly neglectable given the health risk associated with constantly worrying about the stuff you eat. There’s plenty of psychological research showing that cultivating an anxious personality poses a much greater risk to your health than eating a modestly unhealthy diet (and it may be a major reason why in epidemiological studies, vegans tend to be less healthy than omnivores, who may eat a less healthy diet but probably also worry less)

          • fruit bat

            What is your source for the allegation that vegans are less healthy? What is your source for the claim that meat eaters worry less? Vegans tend to be more healthy than “omnivores” (necrotarians). We are the only group with an average body weight within the healthy range. We have less heart disease and diabetes. We live on average 7 years longer, and have only 40% of the cancer rates – despite most vegans having been meat eaters for most of their lives. Also, levels of cortisol – the stress hormone – are directly correlated with how much animal produce one consumes, so I don’t see how vegans could possibly have health problems from “worrying” even if we did worry more.

          • fruit bat

            Why eat eggs if you’re doing it for moral reasons? Only females produce eggs, 60% of chicks are male, and they are all killed (they are no good for meat, different breeds produce meat to eggs). 30,000,000 male chicks are killed annually in the UK alone. The Freedom Foods-recommended “humane” way of killing is to put them through a macerator that minces them alive. (For some reason this is considered more humane than gassing them with carbon dioxide). Chickens, like all livestock are fed partly or fully on fodder grown in the former Amazon rainforest. Growing food to feed animals to feed humans, rather than using the land directly to feed humans, is an epic waste of land and water.

            Occasional eggs (or the occasional anything) probably won’t harm a healthy person, but it will stop you having the enlightening psychological changes that occur when you live completely free of the animal system.

          • Why do you choose eggs over grazed beef or something like it?

            Cost? I saw a small chunk, 1/2 pound or so, of grass-fed beef at the health food store. Cost about $12.

            Also, eggs are technically vegetarian if not vegan.

            My mind goes back and forth with eggs. I sometimes think I’ll add an egg a week, Omega-3, but then I realize I’d be buying a whole dozen eggs for the sake of eating 4 or 5 during the month. So I don’t.

          • Ben

            But even in the omega 3 eggs, the omega 6 is so high the balance is poor, right? The arachidonic acid (long-chain omega 6) is so high that it more then cancels out the omega content, right? That’s my understanding. The omega 3 eggs are just a clever marketing ploy.

          • Local farmed eggs/farmers market. Not a big marketing budget.

            I have food sensitivities that have severely curtailed both the variety and amounts of plants I can eat. I can’t let ideology get in the way of my nutritional needs. At least a small amount of animal protein is necessary under my current circumstances, as much as I wish it were otherwise.

          • PS. With an LDL of 49, adding 1egg/week to the 1/2 serving of oatmeal I can tolerate is unlikely to kill me.

          • Ben

            I agree…

          • Ben

            Yes, I am just referring to eggs that are advertised to have omega 3 in them and yet it’s impossible to improve omega 3 status with eggs because of the excess arachidonic acid.

          • fruitbat

            One large 50 gram egg contains only 6 grams of protein. The same as found in 17 grams – a slightly heaped tablespoon – of hemp seeds. So while I agree that the occasional egg – or occasional alcoholic drink, cigarette, or chicken nugget – is not enough to harm an otherwise healthy person, it is also not enough to contribute anything that could be considered positive.

            Hemp is suitable for even the most allergy-prone people, is easy to digest, is cholesterol free, low in cancer-feeding methionine, and is a legitimate source of omega 3. Plant proteins are superior, unlike animal protein they are water soluble and are formed largely of amino acids, rather than ready-formed proteins which the body will then have to break down into its constituent amino acids.

            Men need 55 grams of protein and 2500 a day and women need 45 grams and 2000 calories. From eating fruit alone – generally low protein foods – you get about 37.5-45g of protein for 2500 calories. If you then eat a pound of leaves a day (easy enough in green fruit smoothies) that will give you an extra 10-15 grams of protein a day (add a handful of sprouted lentils and a tablespoon of hemp seeds and you get an extra 15 grams). This is the diet that I eat – that of our great ape cousins who we resemble so much (who are certainly not lacking in protein and are much stronger than humans). It has cured my bowel problems, sleep problems and heavy periods. I’m not suggesting you try it (unless you want to) I’m just mentioning this to point out that even a diet consisting of the lowest possible protein foods is not lacking in protein so long as you eat enough calories. Also, watery fruit and baby leaves are the easiest and quickest foods to digest for humans (with watermelon and grapes only staying in the stomach for 10 minutes) are perfectly suited to someone with digestive problems, and are safe for people with allergies/sensitivities.

            Regarding “complete” proteins (I know this will come up if anyone responds) I type all my food into cronometer, and I have never found a food that DOESN’T contain all eight essential amino acids. The archaic 80’s dogma about complete proteins is either based on whether a given food would provide all the amino acids if you ate 2000 calories of it, which nobody is going to do, or based on comparing its amino acid ratios to eggs, of all the many foods in the world. Complete proteins are a given if you eat even a small variety of different foods – even just a different variety of fruit or a different vegetable. I always have over 100% (usually over 150%) of the daily recommended allowance of each of the necessary amino acids, just from eating a variety of fruit and leaves – the “lowest protein” foods!

            If you’re worried about omega 3’s, take an algal omega 3 supplement. Fish are only high in these fats because they eat algae/seaweed, or eat other fish that ultimately consume algae.

            Eggs are not high in omega 3’s. One large 50g egg provides 39 milligrams of omega 3’s – you need 1100-1500 milligrams a day. Unless you want to eat 28-38 eggs a day, I suggest you find another source!

          • I appreciate your concern, fruitbat. I am not willing to divulge all my health issues in public. I was vegetarian for 20 years, near vegan. Dr. Fuhrman’s Eat to Live program, similar to your recommendations, which I started in 2010, actually exacerbated my previously unknown sensitivities. Forced to cut back on both the amount and variety of plants I could eat, bloodwork eventually revealed I was likely protein-challenged.

            I am not happy being forced to include animal foods back into my diet. I would love to return to a strictly 100% WFPB diet, but I have to deal with my reality which has trumped my desires.

    • Darryl

      The focus on cholesterol has perhaps blinded us to other problematic compounds in eggs, notably arachidonic acid, excess choline, and high methionine. There are studies suggesting intakes as low as 1 egg/week markedly increase diabetes risk and intakes greater that 0.5 eggs/week increase risk of lethal prostate cancer.

      With respect to cardiovascular disease, in the general population dietary cholesterol is poorly absorbed, but in those who’ve achieved low plasma cholesterol through their diet, rather efficiently absorbed. While your other diet habits are laudable, it seems likely that the incremental risk of eating eggs will be greatest in those that have reduced other risky behaviors the most.

      • Vincit Veritas

        I’ll cut to two per month, thanks.

        • Thule

          Did you try vegan cuisine recipes for eggs? Omelettes, scrambled eggs etc.

          The key for real egg taste is to use Himalayan Pink Salt. A book I have with a lot of recipes (including many egg ones) is the Everyday Happy Herbivore by Lindsay S. Nixon, fast and really good ones, you’ll swear you are eating eggs :)

          And added benefit — all the egg recipes use turmeric, a double win.

          • Vincit Veritas

            I’ll check Amazon. Thanks.

          • Ben

            I found it here:

            And if you read the reviews, they all say that it makes tofu scramble taste like real eggs. I guess it has a lot of sulphur and that seems to make the difference.

          • Thea

            Thule: I’m also a big fan of Everyday Happy Herbivore. But I didn’t remember the recipes with the kala namak. Thanks for pointing that out. I’m going back to that book to look for those recipes!

            Note: I’ve made a few other recipes with the kala namak now and am a big fan! I’ve had SAD eaters sniff a bag of the stuff and asked (without prior prompting) what they thought it smelled like. The vast majority get big eyes and say, “eggs”. It’s so fun.

          • Thule

            @ Thea:I might have the number of “egg” based recipes confused with the ones in her first book, The Happy Herbivore, but I know that was in her second book that she begun to use kala namak, a discovery for her, and applicable to all her previous egg

            If you have the first book take a look there too, I know that there are very good ones in that book (and perhaps more egg recipes than in her second book, would need to check) Either case, recommended recipes in both books. :)

          • Ben

            Another good use for the black salt is with Garbanzo beans you can make a wonderful “egg salad” spread. I used to make it but without the kala namak (black salt) now I can’t wait to try it with the black salt and see if it tastes even more like egg salad.. I believe that garbanzo bean egg salad recipe is also in one of the Happy Herbivore books.

      • Timar

        I agree wrt. methionine but what about choline? I thought you disagree with Hazen’s questionably theory on dietary choline/carnitine, TMAO levels and CVD? I hope you don’t get too entrenched into the vegan narrative, dear Darryl ;-)

        • Darryl

          There’s some intriguing circumstantial evidence around choline and diabetes, which I commented upon here, however there isn’t any mechanistic evidence as there is with say methionine and FGF21.

          Overall, it seems that the choline metabolic product betaine (high in beets & spinach) is a much better means of activating BHMT. Why these two should have distinct differences in outcomes is a bit mysterious to me.

          And no, I don’t buy Hazen on physiological range TMAO.

  • Dikaiosyne

    This is poorly done. The last segment of the video suggests moving to the far left under the distribution curve to go from low CHD risk to no risk. Yet you could also move to the far right under that same curve to go to CHD low risk. That is, increase your blood cholesterol levels to reduce your CHD risk.

    The pathology analogy to smoking is also poorly done since the compounds of tobacco smoke are mutagenic–actually causing genetic changes in the exposed tissues. Like getting sunburned in early life increases one’s risk of skin cancer due to DNA damage, so smoking and then quitting still places one at risk. I haven’t seen any studies evidencing that cholesterol is mutagenic.

    • Arjan den Hollander.

      Lack of circulation will result in poorer less ideal cellular function.
      Build of of rest products of processes higher than what it need be.
      Removal of waste also impeded will result in more genetic damage.
      And thus a mutagenic end result, even while the cholesterol itself isn’t.

      • Dikaiosyne

        “Lack of circulation will result in poorer function.”

        Well, then, increase your blood cholesterol level, since the graph clearly indicates the higher one’s blood cholesterol level the lower the CHD risk.

        “Removal of waste also impeded will result in more genetic damage.”

        Which study indicates that genetic damage is proportional to the amount of arterial plaque (a positive correlation)?

        • Arjan den Hollander.

          You are a smart guy right?
          Take a day to think.

          • Dikaiosyne

            Your assertions are empirical–not a priori–thus merely ‘thinking’ about this issue is fruitless.

          • Arjan den Hollander.


            A thriving city, you take away 1 element say copper.
            What happens with the efficiency of the city?

            What happens if you take away oxygen and all its roads are clogged full of waste?

          • Dikaiosyne

            Ground your assertions in empirical studies–not analogies.

          • Arjan den Hollander.

            Have you ever had a good muscle ache?
            That be a good example of less then optimal work.

            Im off to the gym, have fun with it.

        • Timar


          you really haven’t understood what this graph actually shows. There are essentially TWO possibilities why the curve declines with high cholesterol levels: 1. the curve declines because people with extremely high cholesterol are paradoxically protected from CVD (your interpretation), or, 2. the curve declines because THERE ARE NO people (surviving) with that high cholesterol levels. When there is noone with a cholesterol level of 400, noone can die of it – you see? (The graph shows the risk relation from a cross-sectional study, NOT a theoretical extrapolation)

          Now consider which explanation may be right ;-)

    • largelytrue

      On your first point, you are simply straight up wrong, Dik. Lower your cholesterol and the inference is that you most likely are in the Non-CHD part of the population. Raise your cholesterol and diagram suggests that you are much more likely to be in the population developing CHD. You need to compare the tails of the two curves.

      • Darryl

        There are good graphics that better demonstrate the relative risks than the one used in this video. From Framingham:

        But better still, from this enormous study:

      • Dikaiosyne

        The percentage of non-CHD at 150 is approximately the same as at 330–both of which appear to be around 4%.

        • largelytrue

          And what are the percentages for the CHD curve at these values?

        • Rose’s paper is really fascinating. Of note, I found this important point to keep in mind.

          Rose directs our attention to how data relate the occurrence of Down’s syndrome births to maternal age.

          Mothers under 30 years are individually at minimal risk; but because they are so numerous, they generate half the cases. High-risk individuals aged 40 and above generate only 13% of the cases.

          The lesson from this example is that a large number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk.

          Does that mean that most women should put off having babies until after age 40? Of course not. That would only end up increasing the actual incidence of trisomy 21.

          Likewise, suggesting that a population increase its mean serum cholesterol levels to the right side of the graph to the highest levels of serum cholesterol would likely cause even more absolute cardiac mortality than at the current average, not less, as […] suggests.

          Notably, Framingham’s William Castelli, MD, mentioned in this interview with Kirk Hamilton

          …in the Framingham Study… if you had a 300 cholesterol, 90 out of 100 of those people got a heart attack in the first 26 years. So that was a very dangerous place to be.

          On the other hand, Castelli mentioned that Framingham had about a 1/2 dozen people with TC under 150 in almost 40 years.

          One of them did have this high triglyceride/low HDL syndrome. The other four or five, we don’t know what they had.

          My best layperson’s guess would be they might have had that “little a” Lipoprotein Lp(a) that Dayspring talks about.

          At any rate, Castelli agreed in the interview that if everyone shifted to a strictly unprocessed plant-based diet would eliminate most heart attacks. Of course, he doubts that’ll ever happen.

          At any rate, the last thing he would recommend is boosting your serum cholesterol to 400.

  • george

    This video is very timely for me. I’m about 3/4 of the way through the book “Perfect Health Diet”. Just as Dr. Greger, using published research, convincingly makes a case for veganism, this book, written by two scientists at Harvard, using research, convincingly argues for consuming red meat, dairy products, eggs, and coconut products, and for not consuming whole grains, beans, and seed oils. I guess, since nutritional research is impossible to do accurately, anybody can pick data (Isn’t it called data mining?) to prove anything.

    • Merio

      I learn that even the best peer review journals could publish poor studies so i think that a skeptical view is the best way to fight against confusion…

    • Thule

      Follow the money, who pays for that “Perfect Health Diet”?

      The data doesn’t support it, unless they use the industry paid for “studies”

      Pure sophism.

      I would suggest the book Whole, by T. Colin Campbell, for the inside view.

    • Search CarbSane’s blog for the inaccuracies and inconsistencies of Paul Jaminet’s dietary recommendations. Search “Perfect Health Diet”, Jaminet, and “safe starch” since his stance on carbs seems to be changing with certain health problems.

      PS. Being an astrophysicist, even from Harvard, does not make one an authority in nutrition.

  • Darryl

    Dr. Greger, I believe you could do a fascinating video on the Mendelian randomization studies of the past decade to lay to rest all questions (by Taubes et al.) that LDL-C, triglycerides and inflammation are causal in cardiovascular disease. Papers from the last year with useful references: 1, 2, 3. They’ve also confirmed clinical trials suggesting HDL, CRP, and Hcy are coincident bystanders.

    • largelytrue

      I notice you leave dietary cholesterol out of that lifestyle prescription. Do you think all known, substantial effects of dietary cholesterol on serum LDL are potentiated by dietary fats?

      • Darryl

        Dietary cholesterol has effects on serum cholesterol that depend on one’s baseline serum levels. From Fig 2 in this study, you’ll see that added dietary cholesterol has the most marked effects on serum cholesterol in those consuming baseline cholesterol free (vegan) diets, but more limited effects in most of the population. So for most of the population, LDL raising C12-16 saturated fats are the major contributor to serum cholesterol, but to achieve the levels of LDL-C where atherosclerosis doesn’t progress (without the use of statins or intestinal parasites) generally requires both low-intake of LDL raising saturated fats and low/no dietary cholesterol.

        • Arjan den Hollander.

          You seem to have made it a point to inform yourself about fats. It has been a frustrating too chaotic a topic for me to absorb. Opinions and studies fly all over the place.

          Could you give me advice towards a fat intake profile?

          As it is now , 1 x meat/herring a week , nuts 50 – 100 gr and seeds 50 gr and a small bit of olive oil to fry my mushrooms with. 20 gr of flax a day to top it off.

          I still get leaner and leaner without weight loss.

        • largelytrue

          I’m aware of that study and have cited Fig 2 myself in the internet milieu, but it’s more the assurances in the discussion that helps to address the question, as in the second column on the page containing Fig 3.

          I think it’s probably true that dietary CHOL is a significant contributer to serum LDL even in the absence of fat, but may continue to read in that area. But more interestingly, I note that the paper notes an influence of P on VLDL and that may be a bit worrisome even if it supresses the influence of CHOL.

          I’m with you that dietary veganism is basically the best option, but I’d caution that your usage of “whole plant-based,” if one of many common usages, is really not the correct one. The whole reason why a different term has shown up is to distinguish this approach to diet from veganism in two ways. First, it includes nearly vegan diets. Second, it excludes certain kinds of dietary veganism. There may be a push by ethical vegans to advance their argument by pushing the idea that dietary veganism can be quite healthy, and in do so they may equivocate and represent dietary veganism as equivalent whole plant based. Similarly there are opponents of the nutritional message who will equivocate and identify “whole plant based” as veganism, an ethically inflected movement that can lead to compromised nutrition.

          To focus on a nutritional message, we need to draw some distinctions in our vocabulary. From there, we can note that purely vegan unrefined diets have some good things going for them among other possible WFPB diets, and we can note that ethical veganism as it is normally construed is perfectly compatible with nutritional excellence — especially when even the habits of the wealthy, educated, and hardworking classes of contemporary society set such a low bar.

    • Timar

      While these mandelian randomization studies offer a fascinating new approach, I think they haven’t brought about new insights into the epidemiology of CVD so far. They do not refute the growing body of evidence concerning the adverse health outcomes associated with low levels of cholesterol. I think it is our duty as scientists or scientifically minded persons to accept conflicting evidence, as it empirically approaches and not to ignore or dismiss it out of hand because it doesn’t conveniently fit without our own theoretical bias or “favorite interpretation of reality”.

      Take this recent Japanese study for example. After 10 years of follow up in the very elderly (a median of 85 years) and careful adjustment for confounders there is still this striking inverse association between TC and all-cause mortality, which other studies already have shown in younger age groups. I don’t think such observations can simply be explained away by reverse causation.

      • Darryl

        Having stiffened arteries is also protective against hemorrhagic stroke and dementia in the very elderly, too. Better cognitive outcomes for those with high blood pressure is one of the reasons for the relaxed hypertension guidelines in the elderly in the U.S.

        I suspect, as with the recent protein study, we’re seeing age-dependent pleiotropic effects, so I think there’s going to be a different optimal diet for the middle-aged attempting to achieve longevity, and for the elderly attempting preserve their remaining faculties. We probably need some better markers of aging, correlated with outcomes, to determine just when we should shift between different forms of damage control.

        With cholesterol in the very elderly, its difficult to say whether its having a direct benefit, or whether levels reflect an overall dietary pattern that may be not be providing sufficient growth signalling to avert frailty (after the long-telomere cancer danger years have passed).

  • lgking

    I am now reading that it is not necessarily cholesterol (LDL) that is responsible for heart disease, but high triglyceride levels.

    • Suzanne

      Using triglyceride level as a ‘marker’ of your current cardiovascular health would be wise in light of the data, however, I don’t think you can call it ‘responsible’ for heart disease.

    • largelytrue

      What about your source strongly supports this claim about causation? Because what I’m seeing is mostly a discussion that as biomarkers go, ApoB and LDL are largely concordant but ApoB may be a better measure of hard endpoint risks. When talking about triglycerides they explicitly say under “ApoB and Clinical Disorders” that:

      “Elevated TG in the absence of elevations in LDL/apoB is likely not atherogenic. As previously mentioned, an apoB measurement is required to diagnose hyperapobetalipoproteinemia”

      • LDL is a not directly measured valuation, but is calculated with the Friedewald equation which breaks down when triglycerides are >400, which can then make the LDL amount unreliable. Such hypertriglyceridemia is often associated with excessive calories balance, I.e., obesity, itself a risk factor for CVD. Junk carbs frequently are a contributing factor to the excessively positive caloric balance.

        I would not discount entirely the potential danger of high triglycerides. Framingham’s Dr. Castelli didn’t in this interview

        • Timar

          Is LDL really still calculated by the Friedewald equation in the US? I think this is unlikely since modern laboratories can easilly do routine LDL measurements and I know that LDL is always measured directly in Germany, even for the most basic lipid panel.

    • bob

      I keep getting the impression that it is OXIDIZED cholesterol that is the issue and the “cause” of plaques. In fact it’s possible that elderly people live longer when they have higher cholesterol? Of course…the population studied might eat the SAD diet.

      • Lipidologist Thomas Dayspring recently tweeted that oxidation of cholesterol is NOT required for the formation of plaque.

        As for the elderly, most evidence points to reverse causation. It is declining health conditions in the elderly which causes lower cholesterol, not vice versa.

        • Timar

          He TWEETED it? Gosh… let’s keep it scientific, please! (Even if I agree in this case that it is most probably reverse causation).

          • Yes, @DrLipid is very engaged on a Twitter. I saw him tweet about oxidation recently. Not sure he’s talked about reverse causation in the elderly.

            Meanwhile, he’s just had posted a series of short YouTube videos entitled Lipid Insights. Parts 1-5.

            He’s definitely a particle guy and quite the proponent of advanced lipid testing.

          • Lipid Insights


            I just watched Part 3. Did you know there’s an Apolipoprotein “little a”?

  • Da St

    Another case is sodium. The very high level of salt consumption in the western diet, due to easy availability, produces far higher levels of blood pressure in western populations than in populations with very limited access to sodium or salt. The western “normal” is very high compared to the normal of populations with limited access to sodium. Therefore changes in salt consumption have little effect on blood pressure because westerners consume so much salt that changes in consumption barely dent the relatively massive salt consumption–far, far more sodium than humans actually require.

  • Jim

    trying to explain this to a carnivore is like trying to explain to a religious person about evolution. they’re not going to believe that eggs are unhealthy

    • Timar

      Huh? Most religious persons I know have no problems whatosever to accept the fact of evolution (I’m an European, though).

      • Ben

        What he should have said is: “trying to explain this to a carnivore is like trying to explain to a religious *fundamentalist* person about evolution. they’re not going to believe that eggs are unhealthy”

    • What about an omnivore? Or a lacto-ovo-vegetarian?

      Eggs eaten in moderation aren’t unhealthy. See

      Vegan junk foods (grain dust + refined sugar + hydrogenated vegetable oils) are unhealthy.

      Maybe it’s the overconsumption of junk foods that’s bad for people, rather than animal produce per se. Now there’s a thought!

      • Hi Nige! Good to see ya!

        “Grain dust” LOL. Good one! So true that not all vegan or vegetarian foods are created equal. BK veggie burgers, fries, and Coke may be vegetarian, but they certainly are not healthy.

        You’ll find no love for vegJUNKtarian foods here at

        Dr. Greger is a proponent of a whole foods, minimally processed plant-based diet. Traditionally processed foods like tofu, tempeh, etc. make sense in this context, as well. No hard and fast rules here, though.

      • PS. I think most of the Seventh Day Adventists in the Loma Linda Blue Zone are lacto-ovo vegetarians.

  • Gregg Stern

    unrelated to above, the following is a very nice article I thought you would find interesting (if you have not seen it already)

  • DanielFaster

    Oh my! Here’s another BOLD study showing you can lower blood pressure by adding beef to your diet

  • Dermo

    Is the chart saying that you have the same risk of chd at
    180 as you do at 300

  • Would anyone like to explain the inconvenient facts in ?

    Over-eating grain dust combined with sugars & fats, also too much refined sugars, is bad for people. All of these things can be vegan.

    • Good call on the junk carbs, Nige. Dr. Greger does not recommend them even “in moderation”.

      [Disclosure: I’ll admit I indulge during one long weekend a year when I’m forced to eat at restaurants. I just got done with my 3 servings for the year just a month ago. OK, 4 servings. That’s it. I swear. ;-P]

      As for the research: Volek? Light and fluffy Krauss? Both industry-funded?

      However, they deserve consideration by someone with analytical research skills. I can’t do them justice.

      Meanwhile, perhaps these additional videos and the cited research will be helpful to you.

      Click on Sources Cited for the studies referred to in the videos.

      • I usually eat 2 eggs/day. I feel absolutely fi


        • We’re all free will agents. :-)

          When I heard 100 yr old Fred Kummerow ate 2 eggs/day I wondered how he could get away with that without getting CAD. Turns out he didn’t. He had a heart bypass at age 89.

          But still…

  • CommanderBill3

    I am unconvinced that low dietary cholesterol is necessarily
    healthier by itself when compared to a high cholesterol diet. Apparently the professional thought about dietary
    cholesterol is tending toward it being harmless at worst. The USDA is hinting ( ) dropping dietary cholesterol restrictions from its revised dietary guidance.

    It should be understood it is inflammation that is the root cause of arterial buildup not the abundance of cholesterol. Inflammation attracts cholesterol. Limited arterial inflammation cholesterol seems to become a none factor.

    Moreover and perhaps more importantly new research, ,seems to imply that the metabolic syndrome is a consequence of a high intake in carbohydrates and food with a high glycemic index, particularly fructose, and relatively low intake of cholesterol and saturated fat. This research indicates that cholesterol which is necessary for life is rather difficult for the liver to synthesis and the liver would prefer to obtain the body’s cholesterol needs through diet. This allows the liver to focus on
    its other critical functions.

  • Michael

    Thanks for clearing up this new cholesterol myth, I’ve been wondering about that for a while. There is a popular book out there saying cholesterol is good for you not bad sounds like bad advice and it is… excellent video!

  • Alan M

    I recently posted a picture of kale on FB which included a statement that said that it had no cholesterol. A friend added this statement to the comments “Nothing wrong with Kale but nothing wrong with cholesterol either, cholesterol is actually an antioxidant, it gets a bad rap because people aren’t totally informed about it HDL high density lipo proteins are sent from the liver to carry away extra fat from the blood steam to be brought back to the liver and recycled that’s why it’s considered the “good kind” LDL is low density lipoproteins are sent from the liver to injury sites to help repair cell walls after they have been damaged ex high blood pressure or high blood sugar damages cells in the vascular walls and cholesterol is sent there to repair those cells and patch up the wall of damaged vessels so they don’t keep degrade song and burst its the bodies survival mechanism so it’s not cholesterol that’s bad it’s a persons underlying inflammation that’s the real issue eating cholesterol has very little impact on your serum cholesterol most of it is used to make bile and excreted with waste during digestion if you have high cholesterol your liver is producing it at high levels to help repair damaged cells due to inflammation so cholesterol itself is not bad just saying”. Wondering your stand on this. I know our body makes all the cholesterol that we need. Thanks

    • Joseph Gonzales R.D.

      Hey Alan,

      Saturated fat boosts blood cholesterol more than dietary cholesterol, but dietary cholesterol still raises blood cholesterol slightly. Dr. G explains in this video “you can basically max out on your cholesterol absorption. After a certain level of intake, it’s just another match to the fire. If you’re already consuming the standard American diet averaging 400mg of cholesterol daily, even add two jumbo eggs to one’s diet, and it may already be a lost cause. But in people trying to eat healthy, those two eggs could shoot their cholesterol up 20 points.” He says there is a plateau effect issue and the postprandial (after eating) issue, which these videos also discuss, here and here.

      Cholesterol is important and has many functions, but like you said our body makes enough and it’s not a dietary requirement.