What You Need to Know About Preventing Heart Disease

Image Credit: Knar Bedian / Flickr. This image has been modified.

How to Prevent Heart Disease

Many of today’s lifestyle medicine doctors, myself included, were greatly influenced by Nathan Pritikin, the nutrition pioneer who started reversing heart disease with a plant-based diet and exercise back in the 70s. (More on Nathan Pritikin in Engineering a Cure,  Our Number One Killer Can Be Stopped, and The Answer to the Pritikin Puzzle.) But how did he come up with the idea of opening up arteries without drugs or surgery? We tend to think of rural China as a place with a fraction of our disease rates, but we may forget about Africa.

Pritikin was 43 when he was told by his cardiologist that he was going to die from a heart attack, so he began to live on a diet patterned after the black population in Uganda, a population living off plants that was essentially free from death from heart attacks. After curing his own heart disease with a plant-based diet, he went on to save the lives of thousands of others. What was the data that so convinced him?

Last year, the International Journal of Epidemiology reprinted a landmark article from the ‘50s that started out with a shocking statement: “In the African population of Uganda, coronary heart disease is almost non-existent.” Our number one cause of death almost nonexistent? What were they eating? Plantains and sweet potatoes, other vegetables, corn, millet, pumpkins, tomatoes, and “green leafy vegetables are taken by all.” Their protein was almost entirely from plant sources, and they had the cholesterol levels to prove it, similar to modern-day plant-eaters. “Apart from the effects of diet and of the blood cholesterol levels,” the researchers couldn’t figure out any other reasons for their freedom from heart disease.

These fifty-year-old findings are still relevant today. They showed “dietary intake to be a key, modifiable, established and well-recognized risk factor for heart attacks. This contrasts with the rather desperate search in recent decades for even newer cardiovascular risk factors.” We have the only risk factor we need—cholesterol. We’ve known it for 50 years, and we can do something about it. See One in a Thousand: Ending the Heart Disease Epidemic.

As you can see in the video Cavities and Coronaries: Our Choice, according to the Editor-in-Chief of the American Journal of Cardiology, the only risk factor required for atherosclerotic plaques to form is elevated LDL, or “bad” cholesterol in our blood. Dr. William Clifford Roberts is the distinguished cardiac pathologist who doubles as the Editor-in-Chief of the American Journal of Cardiology. More from him in Eliminating the #1 Cause of Death and Heart Attacks and Cholesterol: Purely a Question of Diet.

To drop our LDL cholesterol, we need to drop our intake of three things: trans fat (found in junk food and animal foods – See Trans Fat in Meat and Dairy); saturated fat (found in mostly animal foods); and dietary cholesterol (found exclusively in animal foods). More on lowering LDL in Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.

What Dr. Shaper discovered is that heart disease may be a choice.

Like cavities.

People who lived over 10,000 years before the invention of the toothbrush pretty much had no cavities. Didn’t brush a day in their lives, never flossed, no Listerine, no Waterpik—and yet, no cavities. Why? Because candy bars hadn’t been invented yet! So why do people continue to get cavities when we know they’re preventable though diet? Simple: because the pleasure people derive from dessert may outweigh the cost and discomfort of the dentist.

As long as people understand the consequences of their actions, as a physician what more can I do? If you’re an adult and decide that the benefits outweigh the risks for you and your family, then go for it—I certainly enjoy the occasional indulgence (I’ve got a good dental plan!). But what if instead of the plaque on our teeth, we’re talking about the plaque building up in our arteries? Then we’re no longer just talking about scraping tarter. We’re talking life and death.

The most likely reason our loved ones will die is heart disease. It’s still up to each of us to make our own decisions as to what to eat and how to live, but we should make our choices consciously, educating ourselves about the predictable consequences of our actions.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

103 responses to “How to Prevent Heart Disease

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  1. Yes, I concur with Veganrunner—another great blog post. Thank you, Dr. G!
    I do have one question, though: Are you saying that it would be wise, or at least possible, to abstain from brushing and flossing were we to abstain in turn from candy, soda, cakes, and the like? See, I eat a mostly whole foods plant based diet—all I eat that’s not a “whole food” is a slice of whole wheat bread every morning and a glass of unsweetened almondmilk at night. I don’t drink any soda or eat any dessert. But I daily feel the need to brush and floss, and I really can’t figure out why, given that I eat zero sugar, apart from the tiny amount they add to the slice of bread I eat. Could you help me understand this issue a little better? Is there something I’m doing wrong?

    1. Jane, he was making the comparison using something we all know – eating sweets and its predictable consequence: Cavities

      Similarly, eating SAD has a consequence: CHD

      Please continue to brush and floss.

    2. Cavities are not caused by sugar, They are caused by bacteria and bacteria feeds on sugar whether it is from candy or bread or potatoes, etc. Get rid of the bacteria and keep it gone and you will have no cavities.

  2. Hi Dr. Greger, your videos are great and have helped me a lot! I have some questions about cardiovascular diseases; I’ve hear some claims that high blood pressure might be a bigger issue than cholesterol, can that be true? How does diet influence high blood pressure, other than salt?

    1. Yeah, ummm…cholesterol in your arteries _creates_ high blood pressure. The one causes the other. Don’t want high blood pressure? Don’t eat animal products…because they create the plaques that build up on your artery walls. Too much plaque…smaller diameter for blood to flow through…Bernoulli’s principle of fluid mechanics…ah, but I get ahead of myself.

  3. According to Dr Colin Campbell, cholesterol is merely a marker for animal product consumption (.94 correlation) and is not the cause of heart disease. Dr Campbell believes its actually the animal foods which select for gut bacteria which produce TMA, which is then oxidized and eventually damages arterial endothelium. It may be possible to eat substantial amounts of saturated fat, as in coconut oil, and not develop dyslipidemia.

  4. Great post Dr Greger.A friend of mine in his early “70” was diagnosed by his cardiologist years back with plaque build up in his arteries and was told that he needed surgery to correct this plaque problem.He decided to go to his Naturopathic Physician for a second opinion and was told by him to take Serrapeptase 40,000 Units twice daily for 2 months and to then have another ultra sound to see if plaque was gone and after the ultra sound the plaque had dissolved and there was no blockage any more.I’ve been taking Serrapeptase ever since hearing of this,Dr Han A. Nieper an internist from Hannover Germany studied the effects of Serrapeptase on plaque accumalations in the arteries.My question to you Dr.Greger is if you’ve ever heard of this enzyme Serrapeptase and that it desolves plaque in the arteries?Thanks for all your helpful information. Dennis

  5. Copied from Wikipedia. Confused on “little meat” in diet.
    Most tribes in Uganda have their own speciality dish or delicacy. Many dishes include various vegetables, potatoes, yams, bananas and other tropical fruits. Chicken, fish (usually fresh, but there is also a dried variety, reconstituted for stewing),[1] beef, goat[1] and mutton are all commonly eaten, although among the rural poor, meats are consumed less than in other areas. Nyama is the Swahili word for “meat”.[2]

      1. Or more likely, you can eat very small amounts of wild meat (much lower fat and toxin content) and likely have less negative effects than if you eat more. But of course its usually the case that eating far less of something very unhealthy has less negative impacts. Calling that “healthy” is a big stretch.

        1. Could be. Though they have cattle, goats, sheep etc, and the meat if probably more fresh.

          The same stuff happened in Crete, and Japan (Okinawa). You can eat some animalstuff without having negative effects on heart health and have some positive effects of omega-3 + B12 also.

    1. I think the message from this post is “Monitor your cholesterol and keep it low to avoid heart disease.”

      Other vid’s here explain the science showing that all animal products are bad for you. If/when people choose to indulge in meat it should be considered a calculated risk, not good nutrition. There are no loopholes in science…unless you are a quantum mechanic :)

  6. Nice piece Dr. Greger, but I was confused by a couple of things. In a video you made a while ago you did an excellent job of tracking down why vegetarians and vegans had no better health outcomes (including heart disease as I recall) than carnivores at one point. Also as I recall you actually discussed the mechanisms behind atherosclerosis and argued that vegans needed to supplement their diets with omega 3 fatty acids (if they weren’t getting any or enough) and B12 (which is virtually impossible to get in a specifically unfortified diet). So how did the Ugandans avoid heart disease on a strictly plant based diet ? (BTW I’m a vegan happily taking my B12 !)

  7. I saw documentary that meat is brain food especially fish.

    mankind evolve from monkeys when their diet shfited to meat.

    So there may be some downside to vegetarian diet related to dementia.

    1. concern: I understand your concern. :-) But I would suggest that the documentary you saw is probably not all that accurate in several respects. For example, my understanding is that your brain “eats” glucose–not anything found in meat. Also, the concept that eating meat is what helped our ancestors to evolve into humans is by no means a scientific consensus. And there is *plenty* of evidence that this is simply not true. Here’s one source that I find extremely compelling:

      The link between fish and brain health is highly suspect. Here is info on one study:
      “…in a new review looking at omega-3 supplementation for brain health, researchers found no link between omega-3 supplements and the prevention or improvement of dementia.”
      Bosch J, Gerstein HC, Diaz R, et al. n–3 fatty Acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. Published online June 11, 2012.

      Lastly, I’ll point out that Dr. Barnard spent a lot of time reviewing all of the research on the topic of brain health vs dementia and Alzheimers. He wrote a book called, “Power Foods For the Brain, an effective 3 step plan to protect your mind and strengthen your memory” And after all that research, Dr. Barnard does not recommend that people eat *any* meat (or dairy or eggs).

      Hope that helps with your concerns.

    2. vegetarian diet related to dementia

      I worked in nursing homes from 1970 to 2005. All the dementia patients were meat eaters. The few people I know that developed dementia and are vegetarians are lacto-ovo and ate plenty of sugar, fat, cheese and other junk food. They didn’t know a what healthy diet was. They just didn’t eat meat.

  8. As we were gathering around the table this morning for our daily treatment team meeting a sweet 40 year old RN mentioned that she had just run a half marathon. I congratulated her and proceeded to tell her about the cherry juice exercise recovery study previously featured by Dr. Greger. She was very interested and I showed her the video. At that point the psychologist, also a runner, piped in, “Yeh, but I can’t stand the taste of cherries.” What he can stand is the taste of Diet Pepsi, which he guzzles throughout the day almost as often as I do green tea. For the majority of people I know, whether they be colleagues, co-workers, or patients, taste is the overriding factor in what people eat. Hence the coronary vs. cavity reference in today’s blog.

  9. Dr. Greger, of all the fine videos and articles you have created, I think that your finest has been publishing the notion that heart disease is a personal choice … that a person can choose whether or not to develop it. Also that it can be reversed if a person already has it. Given that the Heart and Stroke Statistics published by the American Heart Association says that about 70 percent of all people ages 60-79 have heart disease, and about 85% of all people age 80+ have it, it is stunning to know that so many of us are ill by the time we reach retirement. Absolutely stunning. We can only hope that your videos and articles reach more people so that they can learn how to manage their health through diet while they still have a chance!

      1. Let me help you out. It has little to do with animal products (though I agree we should minimize them). It has all to due with your genetic inheritance–and the body’s own propensity to make cholesterol.
        Diet does NOT significantly reduce bad cholesterol in many people. The crucial factor is genes.
        Recent study of 500 men who lived to between 95-110 years old. 60 % were smokers; half were overweight. Genes again.

        1. The study you cite looked at a group of Ashkenazi Jews. This population is noted for a number of unique genetic characteristics, but to use this miniscule group of outliers to draw any conclusions regarding the effects of diet is specious.

          1. The genetic makeup of the human is the critical factor here–not diet. Some people simply produce too much cholesterol, whether they eat steak or seaweed. For years I have eaten an almost vegetarian diet, often subsisting on beans and vegetables and whole grains–cannot lower my cholesterol to a disease-reversal level—can’t even come CLOSE (!) without horrid statin drugs that shut down liver production of chol. Please now, don’t tell me I don’t know me….

            1. You can lower you LDL. Read Preventing and Reversing Heart Disease by Dr Esselstyn and follow the diet exactly. Moderation kills. Watch his videos on YouTube. He reversed the heart diseae in very heart sick people. It works! What have you got to lose and everything to gain.

              1. Thanks for the comment–but I’ve already tried it,and Ornish. It can work–for some people, but many people simply cannot get low LDL from diet alone.

                1. I also have genetically high cholesterol (300-400 range) and yes, even following a very strict, healthy plant-based diet won’t get my LDL and total chol to the levels that most docs are happy with. However, when I looked at all my cholesterol readings from over the last 20 odd years I found that when I follow the FOK/Ornish/Essylstyn diet I was able to lower my levels of LDL and total chol and improve HDL and trigs. For the last 5-6 years I went on statins and allowed my diet to slip back to SAD (vegetarian style). Now I’m off statins for good (side effects are awful) and am transitioning back to a clean plant-based diet. I’ve never had heart disease (my father died of complications of it) and am a healthy weight, nonsmoker, female. Hoping to convince my doc that statins aren’t for me and to give plant-based eating another go. I think for some of us, even with an awesome diet, the numbers won’t get to where most docs want them, but I’m mostly convinced that it doesn’t matter if one sticks to clean eating.

                  1. Thanks sookiebird, for your comment. I stay on a mostly plant diet, but cannot take Essylstyn completely. That would mean no oils at all, no tree nuts, yogurts, etc. Just too hard for me. I too have had a terrible time with statins. I am able to lower my bad chol. with diet, but never really get under about 110 LDL. I need to get down to about 70.
                    My focus now is more exercise; that should also boost HDL.

                    1. Thanks barneygoogle for raising some good points. For people like us who have hereditary high cholesterol it’s hard to know what it all means. Hopefully there will be more studies to see if lifestyle choices will give us better outcomes despite the crazy high cholesterol numbers. I guess I see it as an odds game where the cleaner my diet is, the better odds that it will have a good effect. I also have trouble adjusting to a no oil diet, so I try to do a very low oil diet. I consume nuts and seeds in moderation as well.

                    2. Eliminating the oils is one of the keys. Dr Esselstyn says moderation kills. This is why he had such a hard time with his heart sick patients. He had to meet with them every week to a see what was keeping their cholesterol high but he eventually got it down. One of his patient’s cholesterol was high because he was putting oils on his salads. Cutting out oils is not that difficult. Very few people have the genetic makeup that prevents it if they follow the Dr E’s diet exactly. It’s not worth the heart problems down the road. Don’t give up. This has been proven to work. I wish you all the best in your health.

                    3. Dr. Esselstyn actually once called me on the telephone after I left an email on his site! He is a very dedicated man. I try to follow his diet, but just can’t make it 100 per cent. However, I use almost NO oils, sometimes a small spray of extra virgin olive oil. He said oils wreck the endolithium, the inner lining of the arteries.

                    4. You are on the right track. My approach was to follow it exactly to see if I could get there
                      and I did. I will do “anything” to avoid heart problems and other diseases as I have experienced them and they are much more extreme than following the diet. Good health to you and others.

                    5. barneygoogle…..Of course any degree to which you can adhere to a low fat vegan diet is better than no change. If you have genetics predisposing you to heart disease or high LDL, this is all the more reason to become 100 % compliant!! Once again, as with most people the addictive nature of oils becomes our undoing. A few nuts and little oil here and there is not an ideal diet for those with heart disease or potential disease. What is more important to you barney? Feeding the addictive taste of fats and sugars—-or staying alive? If you were critical, you betcha you’d cut those those oils and nuts out fast. Do you really want to get to that point? (read McDougall and Esselstyn). A brief story about me. I am 60 with a kidney transplant. Ordinarily kidney patients are highly lipidemic, a good majority of which die from stroke and CHD. Anti rejection drugs raise lipids quite high. Because I have high risks for CV disease, I follow a strict low fat vegan diet. My lipid numbers are better than most ordinary people in the US. Cholesterol 141, triglycerides 115, LDL 65, and I am taking highly cardiovascular damaging drugs. Now if a very low fat vegan diet can easily help someone like me, think how well it can work for those NOT taking anti-rejection drugs with high LDL numbers or those with heart disease. I recently had an angiogram. It is a long story why— but the result was No Plaques No Blockages. The results of a nuclear scan was FALSE Positive!!! I can can tell that these results are EXTREMELY unusual for transplant patients. While you are doing well barney, please correct your diet to a TRUE low fat diet BEFORE you experience any heart related events. (As you know heart disease is the NUMBER ONE killer in the ENTIRE world!!! You might be one of those people. Incidentally, LDL cholesterol according to my cardiologist is the number you should be watching to keep heart disease in check. Although I do think that Dr J McDougall has stated that total cholesterol is the most important number and that HDL contributes little to the overall disease risk. (HDL lowers as Cholesterol levels decrease). Thanks for letting me tell my story.

                    6. Incidentally, I have had kidney disease since I was 8 and now I am 60. I was vegetarian in the 80’s, vegan with non dairy fats in the 90’s, and low fat vegan in the 2000’s. I’m quite certain that doctors do not see this kind of longevity with kidney disease. I have read that many kidney patients die of heart attacks before they even get to dialysis.

                  2. Sookiebird: Good for you! It’s really not as hard as most people fear. And since you have done it before, you know what the learning curve is like. Just know that there are SO many good and easy recipes out there now that fall into the “clean eating” category. It gets easier to do every year.

                    It sounds like you already know how to avoid foods that raise cholesterol. I will suggest that you also search this site for foods that have been specifically shown to lower cholesterol. That way you can tweak your diet with the latest information that is specific to your situation.

                    Good luck!

                    1. Thanks Thea. I think adjusting to no oil takes a shift in taste/palate. I also live with 3 other people (hubs and two kids) who have different food preferences and that can make it tempting to splurge on the not so good foods. So my goal is to focus on the gift of WFPB eating and what it does for my body and not on deprivation:).

                2. familial hypercholesterolemia is one of the categories that you are referencing, and my professors would state that there is nothing you can do except medications for lowering the cholesterol levels. This distinction between a small percentage and the mass majority needs to be stated. (I wish I could state and site the prevalence rates, but it would take some reviewing my reference works)

                3. Possibly because they do not have the fortitude and determination to stick to this diet which requires significant lifestyle adjustment.

            1. Please stop it with the snarky comments. When you set up a rule (or diet) that 98% of the people can’t realistically meet–then castigate them for NOT meeting it–you are being the fool.

              1. Sorry if I have been offensive, barneygoogle, please forgive me. My point is only that in order to achieve the results, it takes an inordinate (and rare) amount of drive and will-power (and time). I do agree with you that 98% of us do not currently have the kind of dedication or force of will to do the diet to the degree that it must be done in order to achieve the reversal of heart disease – myself included. I only want to make it clear to other readers that the science is not in question – the fact that the diet works to prevent and reverse heart disease is certainly proven. The only thing in question is whether people are willing (or able) to fight the battle it takes to follow the diet (as written). Again, I apologize for making you (or others) feel antagonized. It was not my intent.

              2. Barney, I do not see any snarky comments. When people are faced with death, you betcha they change their diets. (For those without serious health problems, such as teenagers, motivation is usually lacking). I can tell you with great confidence, once you have eaten an Esselstyn or McDougall diet for a couple of months or sooner you will LOVE it. You won’t believe how you could have eaten all that crappy SAD food!! Promise!… (For anyone living their golden years, atherosclerosis is usually present). Nothing like present, eh?

        2. Barneygoogle,

          If you examine the book Engine 2 Diet by Rip Esselstyn, it doesn’t appear that “cholesterol in the blood is mostly manufactured by the body, not from dietary intake.” Subjects eating the Engine 2 diet for 28 days had substantial decreases in their cholesterol values. There is certainly a genetic link for the small percentage of people who have familial hypercholesterolemia.

    1. Just to make it clear to everyone reading barneygoogle’s comments, later on, he mentions that he wasn’t really able to actually follow the heart disease prevention diet (too restrictive for his tastes). As for me, switching from lacto-ovo-veg to vegan (NOT low oil) dropped 100 pts off my cholesterol. BUT, I am not a member of the very small minority of people who have a GENETIC (as opposed to diet based) propensity for high cholesterol.

      1. Please let me be clear. My goal was LDL under 70. That’s reversal, not just good health level at 100.
        I could not totally follow Esselstyn for very long, but I do follow it about 90%–adding avery little fish, chicken (4 oz every other day), yogurt and nuts. His diet is just not realistic for long term use by the vast majority of people. Much too hard, too time consuming, not gratifying, too tough for me.
        I followed Ornish; didn’t work. Followed Medit., and it didn’t work, but my numbers were almost as good as on Esselstyn. So now I combine key points of Medit and Esselstyn. Its realistic for me, with adding a small statin dosage. I now focus more on controlled exercise. That helps too.

        1. Barneygoogle, at first it seemed you were saying earlier that the prevention/reversal diet of Esselstyn does not work. As in, many people who are on it do not get benefit from it. But now I understand that you were saying it does not work for you, because you do not chose to employ it (since it is “too hard”). I absolutely agree. That diet is a major lifestyle change. You have to have serious motivation and drive (and time) in order to accomplish it. But the reason it does not work for you is not:

          1. because “Cholesterol in the blood is mostly manufactured by the body, not from dietery intake”
          2. or because “The genetic link is the strongest.”
          3. or because “Diet does NOT significantly reduce bad cholesterol in many people”

          4. or because you lack the genetic buffering capacity that affects longevity found in a very small, tightly cohesive genetic population (Ashkenazi Jewish study mentioned).

          It did not work for you, Barneygoogle, because you did not follow it. Following Esselstyn is like being pregnant. You follow it all the way, or you are not on the diet. There is no 90% pregnant, and there is no 90% Esselstyn. No judgement against you here – I, myself, have realized that Esselstyn’s diet would be the best for our hearts, but worry that I would not be able to sustain that eating pattern for any length of time, and so have not switched us from whole food (+ oil) vegan.

          But since this is a science based website, I think it is important that we be clear that this diet has been proven to work for heart disease, and we should not allow it to appear as if we are refuting the validity of the well-documented study(ies) on this subject.

          All that aside, I am sorry that you have to be on a pill that makes you miserable, and I hope you can find a way to be rid of it soon. Best of luck.

          1. Whoa. Please stop making specific comments about me? You don’t know me, or my life. It is people like you–who are well-meaning– okay, but cocksure about everything, who can do a lot of harm. Slow down.
            A plant based diet is good for health. I live close to it. I believe in it. Eating a plant based diet does NOT magically reverse heart disease. I tried it. No success. Not realistic for most people, anyway. I do NOT have hyperchol–either.
            Plant based diets MAY help reverse heart disease in a significant number of people—but that is NOT the same thing as offering a cure/reversal. Doctors trumpet their successes– and ignore their failures.
            We still do not know what diet is best for EACH individual, based on health, genes, etc. Why would anyone think one diet, one med, one lifestyle, is BEST for everyone? Then there are the issues of heart meds, exercise, stress, happiness–many factors go into reversing heart disease. I am writing a book on my own long battle.
            DON’T write the final chapter for me yet. My mind remains open to many possibilities. You should, too.

            1. You are the one making specific statements. It didn’t, work for you because you didn’t follow it. Everthing else you have said is your opinion lDr Esselstyn has proven that it works in two different trials with real heart sicks. Your words can affect others who need help. Be ca

              1. I ask anyone to compare what I have said, to your comments, and then judge.
                In fact, I DID try the plant diet for a year, with NO improvements. To me, it is not realistic to eat plants (and little else) for a lifetime. I cannot spend 4-to-5 hours a day shopping for and preparing fresh foods in fancy recipes for every meal. Maddening. Never again eat in a restaurant? Unrealistic. Never eat with family, unrealistic—I told that to Esselstyn. Its foolish and self-defeating to lash out at people who cannot do unreasonably difficult things–do you get that?
                My Penn Heart Center (one of the best in the world) doctor agrees with me.Yes, I do eat whole foods whenever possible, tons of vegs and salads, avoid oils (a la Esselstyn), and exercise daily. I believe exercise for me, is as important as diet. We’re all different. There is no one cure.
                I have read everything I can on the subject from Gary Taubes, to Weston Price, Weil, Null, Fuhrman, to Esselstyn and Ornish. I have talked to many fine heart doctors. Everybody cherry-picks their data. Why? There’s MONEY and PRESTIGE in it.
                Now, I agree, Esselstyn seems logical and honorable, but his studies are small. Much of what he says in his book is anecdotal.
                Like I have said—anybody here reversing heart disease? Hummm? Well, how did you do it? I WILL listen. You probably ain’t doin’ it eatin’ seaweed, or the bag it came in.

                1. Barneygoogle a WFPB diet actually isn’t that difficult. It doesn’t require a chef. It is just different from what you are used to so it requires some adjustment. So for 1 year you ate WFPB-no animal and added oils, nuts, avocado etc and your LDL did not get below 70? I am asking this because you said you followed it but then you said you eat chicken. I am just a bit confused.

                  Another factor is your weight. Are you lean?

                  It’s great you have added exercise. That should help a bit too.

                  1. A plant-based diet is very difficult for a meat eater. Big transition. Then, there’s the logistics: go to a super market–the kale, bok choy, collards, broccoli, all wilted or yellow as they sit there for–how long? What nutrition in weeks old greens? Cardboard tomatoes? What good are greens in cans? Most froz greens are low quality stuff, or processed. You need a Whole Foods store near you, or live on a farm to get fresh greens. And if you live in the northern climes, winter-time whole foods are always an issue.
                    How do you eat at nephew’s birthday party? Thanksgiving dinner with family? Christmas? The night out with friends at the diner? Very hard to live the diet 100% I get to about 90%, which I think is really good. The diet is too hard, and just sets you up for failure when you can’t make it fully work.
                    I went from Esselstyn to a stricter version of the Medit. Diet–without the cheap, industrial oils, as per Esselstyn. That’s as good as I can do. Some nuts, low fat yogurt, small, lean fish and meat portions. I can make that work.

                    1. OK but don’t say you have done the diet–because it doesn’t appear that you have.

                      To answer your question (and this may sound strange to you) it is only food! Holidays-I eat all the veggies that are offered without the turkey. Other people’s homes-I eat the veggies. Birthdays-I skip the cake. If you don’t make a big deal about it no one will even notice. Restaurants-veggies. “I am a vegan. I don’t eat animal products. What do you recommend?”

                      And the benefit is that my entire family eats better. Last night my husband made an entire meal of 6 different veggies all prepared differently with different spices. This thanksgiving my niece is hosting and she just reported it will be WFPB.

                    2. Vegans and runners are basically neurotic people. This becomes a sort of religion and makes you feel superior to everyone else. You completely miss the point about everything I have said.

                    3. You did not just say that! Might I recommend you start from the beginning of your posts and reread them. You might then understand if I actually “missed” your point.

                      You might want to be a bit more neurotic so you can improve your health!

        2. Barneygoogle, I have worked as a health coach since 2008 and worked with around 3k people. What I have found is that very few people have the true genetic factor to where a plant based diet doesnt bring LDL down. My whole family are on statins. And a good few have had the heart attacks and open heart surgeries that tend to follow with those high cholesterol numbers. But I chose to live differently and do have a LDL under 70 non-medicated. You might find that reading Dr Fuhrman’s Cholesterol Protection for Life might be helpful in answering some of your questions.

      1. Would recommend the works of Endocrinologist Dr. Ray Peat in regards to the effects of “pufas”. There is a difference between clinical vs. real-world effects of a food and also reductionism (removing all the beneficial parts of the plant to the point that it is easily oxidative in the body and problematic). Peat/ josh rubin, matt stone vs gregors.

        But for the mean time I trust the better conducted studies, (larger, blinded, randomized, cross-over, placebo, cohort ect..) and peer reviewed…… hence Dr. Gregors for the win. But we still need about a 100 years worth of studying the body to understand it to the point that we can make truly accurate suggestions/recommendations in my opinion.

  10. you know we have been eating healthy plant diet, my boyfriend had a heart attack on 22nd of Oct and on the 27th a triple bypass on his heart. The Dr. told me I was keeping him alive because we were eating healthy. He said I saved his life, but he has it in his genes, and needs medication for the rest of his life now. His mothers whole family, both parents and all of the kids died from heart attacks. I just wish he didn’t have to take all of those medications.

    1. Heart disease can be reversed. Go to Dr Esselstyn’s website and read the success stories. Then go youtube and !listen to his longer presentations. Read Dr Conway’s success Story. Being Vegan is not enough. You have to follow Dr Esselstyn”s pretty much all the way to get your total cholestol below 150. We all are built a little different and some can cheat a little more than others. Read President

      Clinton’s suçcess story by following this diet. Dr Esselstn says Heart disease does not need exist and. If does exist, it’s progression can be stopped and even reversed. He has proven this in two studies now with actual heart sick patients.

    2. So sorry to hear that, Susan. It must feel great to know that your efforts re his food intake have reduced the deadliness of his disease and genetic situation. “Healthy Plant Diet” isn’t specifically descriptive – not sure what that means, precisely – but if you are serious about your boyfriend’s health (as I know you are) and you are willing to make what may seem like EXTREME sacrifices for him and with him (food-wise) – if you are really brave – then do try Dr. Esselstyn’s heart disease reversal diet. It is not for the faint of heart, or the ones who lack self-discipline, but it is your only option if you want him off the meds. Yes, he clearly has a genetic propensity for heart disease, but in your hands is a solution that might possibly work even in the face of genetic predisposition. Even if the diet is not AS successful on your BF as it would have been on someone with better genes, it will still certainly have a positive effect, reducing his danger level, and probably reducing the amount of drugs he has to take. Best of luck – don’t become discouraged in doing good – you are a wonderful caregiver and your love shows.

      1. We need to consider food as the fuel for our bodies and not just something good to eat. We are driven by our addictiveness to sugar, fat, and salt and the pleasure it brings but you don’t have to be prisoner to these cravings just like a smoker or alcoholic. Studies have shown you lose these cravings after a couple of months and you begin to appreciate the taste of vegetables and whole grains. There are many websites with recipees and the book Forks over Knives is full or recipes.

  11. Another very important issue here (I believe) is chronic STRESS. I held a very stressful job for many years, and have had little or no support for my heart issues. This has a big effect on cholesterol, blood sugar and blood pressure, the core triangle which some people call metabolic syndrome. The body can’t regulate itself, and the heart pays.
    That elusive thing called happiness can be a great wellness pill.

  12. As a 3 yr. vegan, while I don’t disagree with anything written here on dietary cholesterol, there may be other mitigating factors on how each individual person’s digestive system handles bad fats, or any fat including free oils. Recently, in the cold far north, Dr. David Suzuki (The Nature of Things) added yet another documentary, to his decades long running shows on just this subject. It was all news to me.

    I’d be very interested if Michael and his team could view and perhaps respond. None of this is bad science. It’s just that that’s all it is, i.e., science *as we understand it*! How do we quantify the metaphysical factors that impinge on bodily health? Next millenia I guess, should we dumb humans escape the ravages of climate change and predatory capitalism. hahahahaha

    Here’s the free to watch CBC link: http://www.cbc.ca/natureofthings/episodes/the-cholesterol-question

  13. Recognizing Dr. Greger’s penchant for mirth and irony, I felt compelled to share this little tidbit and hope he sees it. As I was indulging in my daily noon ritual of carrots, celery, and apples dipped in hummus while reading this blog, on the right of my screen appeared an ad for Carl’s Jr. And not just any ordinary ad but a BOGO! Buy one “Mile High Double Bacon Cheeseburger” and get the second one free with the purchase of any large soft drink. Here are the vital statistics: calories 2710, calories from fat 1580, fat 176 g., saturated fat 66 g., trans fat 6 g., cholesterol 390 mg., protein 106 g., sodium 4700 mg., carb 180 g., fiber 6g., sugars 96g. Now THAT is a mouthful.

    1. Yikes! Those vital stats are pretty scary. I mean, look how much fiber a person gets. It’s almost like eating a whole grape I think. Waaaay to much! People will be running to the bathroom.


  14. I have been eating a plant based diet for 20 years and I am a great fan of the Nutrition Facts website. I am well read in plant based nutrition information as in Drs Barnard, Campbell, McDougall. I have excellent stats as far as cholesterol, blood pressure, and resting heart rate. I am a jogger and great exerciser.
    My problem is that although it is possible to prevent and reverse heart disease, diabetes, and other lifestyle diseases, I was not able to prevent glaucoma despite my healthy diet and exercise. When diagnosed with glaucoma I insisted that it couldn’t be possible and it was very frustrating that there was no lifestyle change that my opthamologist could recommend to control glaucoma. Very frustrating that I have to take medications and deal with side effects when a change in lifestyle will reverse a major disease such as heart disease. Is my doctor correct? Is there nothing that can be done to prevent further vision loss with glaucoma without medication. I am 62 and do not take any medication.
    Can anyone help me with this?

  15. Thanks Jean, I reviewed the videos on glaucoma.
    The reason I am mixing glaucoma questions in with an article on heart disease is because Nathan Pritikin states that glaucoma is a systemic disease caused by a Western diet, ie high fat. I am interested in the theory “one diet, one disease” and that all (most) disease, whether systemic or peripheral, is caused by eating animal foods and refined foods.
    Dr Greger, what are your thoughts on this?

  16. Who here has actually reversed/recovered from coronary artery disease? That seems to be the big issue.
    A plant based diet is good for health. I live close to it. I believe in it. Eating a plant based diet does NOT magically reverse heart disease. I tried it for a significant period of time. No success. (I do not have hyperchol–)Not realistic for most people–unless you have Bill Clinton’s money and chef.
    Plant based diets MAY HELP reverse heart disease in a significant number of people—fair enough—but that is NOT the same thing as offering a cure/reversal. Doctors trumpet their successes– and ignore their failures.
    My view is we still do not know what diet is best for EACH individual, based on health, genes, etc. Why would anyone think one diet, one med, one lifestyle, is BEST for everyone? Low cholesterol is no magic bullet, either. Then there are the issues of heart meds, exercise, stress, happiness–many factors go into reversing heart disease.
    What I’d like to hear from readers here—is what approach/combination worked for you? Did you manage to reverse heart disease? If you did, please tell me how. It’s very, very hard.

    1. To all those on this website. Please review the research paper by Dr Esselstyn below and make your own decisions about whether it is antecdotal. It can save your life.


      If you decide to listen to the recommendations of Barney here, at least do your own research first. I know of Dr. Jim Conway, an OrthopedicSurgeon in OKC whose heart disease was reversed. You can google and review his website. Also, Dr Crowe, a fellow surgeon of Esselstyn at the Cleveland Clinic, who replaced him got a complete reversal of his clogged coronary arteries and there are before and after angiograms to prove it. Dr Esselstyn did this with 18 patients and then later with 198. This is proof concept which is the highest form of scientific verification that you can get. He has the mediical tests and documentation to backup his work with his patients. Dr Gregger referred to Esseslstyn and said why not go with the diet based on the research that has been proven to work. Read his book and listen to his presentations on Youtube. Make your own decisions. My cholesteriol dropped from 220 to 113. Don’t worry about it being hard. If you’ve already decided to go Vegan as many of the readers have, the next step won’t be that difficult. It’s worth it to become “heart attack proof”. No other diet can cure you from heart disease, they can only slow down the progression and reduce your risk. I wish everyone the best including Barney as we are all seeking better heatlh. I hope he can find someone on this website who can help him as he has done a lot of research and needs answers. My family is a combination of meat eaters, Vegans followling Esselstyn, plain vegetarians, and Celiacs so if we can make it work anyone can. Based on my own reading of Dr Gregger’s research, this same diet will also help out on cancer and the other chronic diseases that American’s eating the SAD diet have at epidemic levels. Good luck!

    2. There is another way to approach this. My father died from a heart attack at 52. His brother 38. If I wait until I get heart disease to try the WFPB diet and other lifestyle changes that would be pretty stupid of me. At this point I feel I have no other choice but to follow evidence based choices.

      But what I also understand is that not everyone is as committed to these lifestyle choices. I see that in my own family. Some people have these genetic issues and still eat a SAD, are overweight and don’t exercise. The grown children of my uncle who died at 38 are obese, never exercise, and all have heart disease.

    3. “Not realistic for most people–unless you have Bill Clinton’s money and chef.”

      From Jeff Novick, RD: “Examples of some of my favorite simple recipes. Most all of them can be made in about 5 minutes, have less then 5 ingredients and cost much less than 5 dollars.”

      More on the basic recipe formula, cost and nutritional breakdown:

      1. Thanks for the info. I eat this stuff much of the time. But to deny oneself meat, fish, cheese, dairy, eggs, etc., all the time, is not realistic for 98% of the population.
        I notice also that NO ONE here has “personally” reversed heart disease by a plant-based diet. Its a lot of theoretical discussion–unless you have done it

  17. My boyfriend had a triple bypass on his heart on Oct 27th, the Doctor told us that because we are vegan it helped to keep him alive, but its still in his genes. His Mothers whole family died of heart attacks. But we are still vegan, only now he is on many medications, which I am not happy with

    1. Susan, have you read “Prevent & Reverse Heart Disease” by Caldwell Esselstyn? It advocates not just a vegan diet, but a low fat (<10% of total calories) whole foods vegan diet. This specific type of vegan diet is very effective at reversing heart disease.

      1. Yes I have. We have been vegan for 11 years. I have read that one and Dr. Joel Furhmans. So yes we are not eating and meat or dairy for years. I am very healthy, but I don’t have that gene in me. We don’t have any salt or sugar in the house. I make everything we eat, so we know what is in it.

  18. @Jean: Suzuki’s Nature of Things is one of the
    longest running programs around anywhere.
    The science there is first rate, not only from Canada, but ‘round the
    world including the USA. For anyone to *fully* critique that program in 3 days, as it ran the preceding Thursday, is simply
    not on in my opinion. BTW, I am unable
    to open your link. I cannot understand
    why Americans are unable to view that CBC program, as it makes no sense that
    a video, as important as this would be country specific. Anyone else have that problem? To state categorically
    that it is diet alone that induces atherosclerosis simply will not wear. The other hugely mitigating factors are how
    much exercise and what kind, as well as the ole ‘stinkin’ thinkin’ programs, we
    humans run through our mind. The last
    item is crucial to how our bodies behave.
    It is this aspect that no science can quantify and why the dynamic about
    the villain cholesterol, is *incomplete* in and of itself. I’m still a vegan though! hahahaha

  19. Your book appears to have the story wrong on Uganda according to the world statistics reported by http://www.worldlifeexpectancy.com/country-health-profile/uganda
    It does appear that their diet consist of a large quantity of starches and little meat but their CHD rate is higher than the US according to the url I included above.
    I view your videos often and like your approach to nutritional research so I do not take pleasure in pointing out Uganda.

  20. Hi Dr. Greger,

    I am sorry to bother you as I am sure you are very busy. My dad just had a heart attack about a month ago and he has not been feeling well ever since. He says his doctor told him that his heart is not pumping enough blood. I am not sure of his other symptoms as he is pretty closed off when it comes to discussing himself but I do know that he eats a lot of processed meat and meat in general. I have been trying to encourage him to adopt a plant based diet but he doesn’t seem to think it will help. He argues with me and says that his condition has nothing to do with his diet. I just am not sure what to do from here, I just know that I do not want to lose my dad. Am I wrong to believe that his daily consumption of meat may be contributing to his heart condition?

    Any thoughts that you could provide on this matter would be greatly appreciated.

    Look forward to hearing from you.


  21. Hello Dustin,

    I’m sorry to hear about your father. I am a family doctor with a private practice in lifestyle medicine, and also a volunteer for Dr. Greger on this website. You are NOT wrong — his high daily consumption of meat (and probably also eggs and dairy products) has almost certainly contributed to his coronary artery disease, which caused his heart attack.

    It is very frustrating, for all of us who are educated about the benefits of eating a WFPB diet, to watch friends, family, and patients get needlessly sick and sometimes even die, when we know that most chronic disease is avoidable by eating the right food.

    What I suggest is that you get him to watch (with you, if possible) one of the excellent movies out there which explain these concepts. Still one of the best ones is “Forks Over Knives.” It’s on Netflix.

    Dr. Greger also has an excellent short video (19 minutes) which explains how diet is linked with heart disease, and he makes a very compelling analogy comparing smoking in the 1950s and 60s with unhealthy diet today. He points out that there were lots of studies already published in the 1950s raising concerns about the risks of smoking, but the information was ignored because almost everyone, including doctors, was smoking — just like today we have lots of great studies demonstrating the risks of eating meat, and they get ignored because almost everyone eats meat, including doctors. Here is a link: https://www.youtube.com/watch?v=BF5UmQ8YXDk

    I hope you can get your father to watch one, or both of these. Ask him to just humor you, and see what he thinks.

    I hope this helps.
    Dr. Jon
    Health Support Volunteer for NutritionFacts.org

  22. PS: I should add that because your father has already had a heart attack, part of his heart muscle is basically dead, which is why “his heart is not pumping enough blood.” Eating a plant-based diet cannot bring dead heart tissue back to life. However, your father undoubtedly has coronary artery disease in OTHER arteries in his heart. And eating a plant-based diet can help prevent future heart attacks, and can even cause his other blockages to regress.

    As time goes by after a heart attack, the heart will often regain some function, because other coronary arteries (“collateral vessels”) can start to carry more blood and naturally by-pass the damaged heart tissue. So, hopefully your father’s heart will also recover some of its function. However, if he has a second heart attack, that could kill him.

    He definitely should follow up with a good cardiologist, hopefully someone who knows a lot about plant based diets. Look up Dr. Baxter Montgomery at Baylor, or Dr. Caldwell Esselstyn (Cleveland Clinic) or Dr. Kim Williams.

  23. Hi Dr. Jon,

    Thanks for taking the time to respond to my comment. I read everything you said to my dad and he is said he is open to watching the documentary and Dr. Greger’s video. I still think he is in a bit of denial but I am hoping that is just a part of the process. That being said, I think it helped a lot for him to hear everything you had to say being that you are a doctor. So I am very appreciative for all of your thoughts that you shared with me on this matter. I also want to thank you for referring several cardiologists.

    I can honestly not thank you enough. You are a great human being for taking the time out of your door to try to help my dad. Thank you.

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