Back in Circulation: Sciatica and Cholesterol

Preventing & Treating Low Back Pain With Diet

Low back pain became one of the biggest problems for public health systems in the Western world during the second half of the 20th century. The lifetime prevalence of low back pain is reported to be as high as 84 percent, and chronic low back pain is present in about one in five, with one in ten being disabled. It’s an epidemic.

Are people just lifting more heavy stuff? No. “[M]echanical factors, such as lifting and carrying, probably do not have a major role in this disease.” Atherosclerosis can obstruct the arteries that feed the spine, and this diminished blood flow can result in various back problems. This can be seen on special scans. Check them out in my video, Back in Circulation: The Link Between Sciatica and Cholesterol, where you can see the difference between normal and clogged spinal arteries. I also show what they look like on autopsy, where we can see the openings to the spinal arteries getting squeezed shut by cholesterol-filled plaques.

Now, we have MRI imaging that can show the occlusion of spinal arteries in people with back pain, and the degeneration of the discs. Researchers showed that patients with long-term lower back pain had constricted blood flow, and those with high cholesterol appeared to suffer with more severe symptoms. Those with narrowed arteries appear about eight-and-a-half times more likely to have suffered from chronic back pain. 

Although disc degeneration has multiple causal factors, with genetic, occupational, and mechanical influences, alteration in nutrition has been proposed as the final common pathway. This makes sense. The discs in our lower back are the largest “avascular” tissue in the body, meaning our discs don’t have any blood vessels. Thus, its nutrition just kind of diffuses in from the margins, making it especially vulnerable to deprivation. Using MRIs, we can measure the effects of impaired blood flow on that diffusion. Because of this vulnerability, discs degenerate far earlier than other musculoskeletal tissues; the first unequivocal findings of degeneration in the discs of the lower spine are seen starting around age 11. Nearly all kids have the beginnings of atherosclerosis by age ten (Heart Disease Starts in Childhood). By the early teen years, we can already see the disks starting to deteriorate. By age 49, 97% percent of the discs of those eating the Standard American Diet show at least grade-2 degradation.

Cholesterol plaques in the wall of the aorta obliterate the openings of spinal arteries. Structures with precarious nutrient supply, such as the intervertebral discs, may suffer and gradually degenerate, as well as herniate. There is a link not only between  cholesterol levels and disc degeneration, but also between cholesterol levels and disc herniation.

This compromised blood flow may also damage the nerve roots that come off the spine, causing sciatica. Sciatica is back pain that radiates down the legs, causing additional pain, numbness or weakness, and prolonged disability. Sciatica affects as many as 1 in 20 people. Independent of weight, clinical sciatica may be associated with blood cholesterol levels as well. The nerve roots, which are most commonly associated with sciatic pain, are supplied by some of the arteries most vulnerable to atherosclerotic plaque formation. Obliteration of these arteries by cholesterol buildup results in compromised nutrient supply to the nerve itself. That lack of oxygen to the nerve may play a role in the sciatic nerve crying out in pain. Reduced blood flow also hampers the removal of waste products, such as lactic acid, which can irritate the nerve endings, causing pain and deterioration. 

Sadly, low back pain is now common in children and adolescents, and getting worse. Similarly, children are now getting disorders like adult-onset diabetes. Teenagers, starting out their lives with a chronic disease; that’s why it’s never too early to start eating healthier.


Just like back pain can be an indicator of clogged arteries, so can erectile dysfunction: Survival of the Firmest: Erectile Dysfunction and Death. Thankfully, the clogs in our arteries can be reversed! See, for example:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of Death; More Than an Apple a Day2014: From Table to Able: Combating Disabling Diseases with Food; 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet; and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Discuss

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.


132 responses to “Preventing & Treating Low Back Pain With Diet

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  1. I’m wondering if the knee and hip replacement epidemic can also be explained by the same or similar reasons as the back pain in this article. Seems like more and more seniors are getting their joints replaced!

    1. yes, plus vitamin D. Knees and hips can repair themselves given good blood flow and adequate vitamin D levels. I had an experience when I was taking vitamin D supplements and my left knee suddenly got hot and stayed hot for several days. Afterwards, there was a lot less cracking from that knee during movement.

    2. It’s mainly because these medical treatment are around today. My co-workers who have joint problem opt for steroid injection or surgery. I told them I fixed my issue with nutrition but I am not able to convince anyone. I read that injection will eventually damage the joint while surgery will fix the problem for a while but the problem will come back. But people believe their doctors more than me. :(

    3. Wouldn’t doubt it as I was recommended for knee replacement and was nearly immobile before changing my diet. I won’t say I’m issue free and ready to run, but at least I can walk without a cane and the pain is much reduced. Just wish I knew about WFPB way earlier!!!

  2. This is off-topic but people may be interested to see these comments from Dr Mirkin’s newsletter of earlier today

    “Do Vegetarians Live Longer?

    Three recent large studies provide more support for a primarily plant-based diet. Two of the studies compared dietary protein from plants and animals and the third one compared dietary fats from plant or animal sources.

    Comparing Protein Sources:
    Researchers at Harvard monitored the records of more than 130,000 people for more than thirty years (JAMA Int Med, August 1, 2016), and found that:
    * every three per cent increase in calories from plant protein, compared to animal protein, reduced risk of death by 10 per cent, and risk for death from heart disease by 12 percent
    * eliminating unprocessed red meat dropped death risk by 12 per cent
    * a 10 percent increase in animal protein was associated with a two per cent increased risk for death from all causes and an eight per cent increased risk for death from heart disease
    * death rate rose markedly for those who smoked, drank excess alcohol, were obese or did not exercise
    * regular eaters of red meat died earlier than those who regularly ate fish or chicken

    Researchers from the Mayo Clinic in Arizona reviewed six studies involving more than 1.5 million people (Journal of the American Osteopathic Association, May, 2016), and found that:
    * people who restrict red meat, fish and chicken for at least 17 years lived an average of 3.6 years longer than those who ate meat regularly
    * eating red meat and processed meats is associated with earlier death, particularly from heart disease

    Comparing Fat Sources:
    Data from more than 126,000 participants followed for 32 years showed that increasing total fat intake is associated with decreasing risk of death (JAMA Intern Med, August 1, 2016;176(8):1134-1145). This may surprise you because previously researchers have associated increased dietary fat intake with increased heart attack risk. However, we now know that reducing fat intake by substituting sugars and other refined carbohydrates for fats actually increases heart attack risk. Heart attack risk appears to be increased primarily by eating too many foods and drinks with added sugars.

    Saturated fats from animal sources and trans fats (partially hydrogenated vegetable oils) appear to increase heart attack risk, while polyunsaturated and monounsaturated fats decrease risk. The Nurses’ Health Study and the Health Professionals Follow-up Study show that replacing five percent of saturated fat calories with polyunsaturated fats reduced death rate by 27 percent, and replacing five percent of saturated fat calories with monounsaturated fats reduced the death rate by 13 percent. Both omega-3s, found in deep water fish and many plant sources such as nuts, and omega-6 polyunsaturated fats found in most plants, are considered healthful. See my recent report on The Saturated Fat Debate.

    All foods contain mixtures of different types of fats. Foods are classified by the dominant type of fat in them:
    * Meat and poultry are classified as predominantly saturated fats
    * Most plants are classified as predominantly polyunsaturated fats
    * Olives, avocados, peanuts and many nuts and seeds are rich sources of monounsaturated fats

    My Recommendations
    Whether you are a vegan, a vegetarian or an omnivore, try to eat large amounts of unprocessed fruits, vegetables, whole grains, beans, seeds and nuts. I recommend that you restrict red and processed meats, sugar-added foods and all sugared drinks, including fruit juices and milk (which is high in the sugar lactose). If you are overweight, have high blood sugar levels or store fat primarily in your belly, you should also restrict all refined carbohydrates made from flour such as bakery products, pastas and most dry breakfast cereals.”

    1. Quite a number of years ago, a book came out called “Live Ten Healthy Years Longer,” which was based on experience from the Adventist Health Study survey. It actually found that vegans lived more than 10 years longer than people that were similar in their habits, but non-vegans. It also recommended simple things like not smoking, drinking, using drug and getting enough sleep, sunshine and fresh air.

      1. Indeed. There is Dr G himself for example. I suspect that much of it is genetic but this does not rule out insulin resistance being a modifiable risk factor even if a relatively small one.

    2. Nice website Tom. I hadn’t seen anything from Dr. Mirkin before. Love anything that promote healthy living through diet and exercise.

    3. Thank you Tom for this information. It just adds more data to verify that we are all on the right track by following a whole plant food diet. You always do excellent research.

  3. In the forth paragraph there is this link to study but the link doesn’t work. “By age 49, 97 percent of the discs of those eating the standard American diet show at least grade-2 degradation.” I would like to read that article. Thanks!

  4. Now that it’s Summer again, I’ve started experiencing leg and ankle cramps. Is this caused by sweating and a loss of electrolytes? What can I do to prevent these very painful experiences? Is there some kind of whole foods that will help, perhaps by replacing lost minerals in perspiration? I think I read that sweat contains mostly potassium and magnesium but not sodium.

    1. Thanks for your question Ron.

      According to the Australian Institute of Sport (AIS):

      “Cramps occur when a muscle involuntary and forcibly contracts and does not relax. While this seems to be due to an abnormal stimulation of the muscle, the exact mechanism is unknown.”

      (…) “Sodium is involved in initiating nerve signals that make muscles contract. While some athletes will incur large losses of sodium during exercise secondary to a high concentration of sodium in their sweat and/or high sweat losses, the evidence that this can lead to cramp is still inconclusive. (…) Cramp has been attributed to the depletion of potassium and minerals such as calcium and magnesium. However, this idea does not have strong support as very little potassium, calcium and magnesium is lost during exercise.”

      How can you help avoid it:

      “Allow adequate recovery and rest for muscles after hard training sessions.
      Increase strength and fitness. Stronger, fitter muscles are more resilient to fatigue and therefore cramp.
      Be cautious when changing speed or intensity especially during the later stages of exercise. Fatigued muscles take longer to adapt to increased workloads.
      Wear comfortable, unrestrictive clothing and footwear”.

      For more detailed perspective, please find the publication here.

      Hope this answer helps.

    2. Vit B12 supplementation fixed the cramp in my case. There may be other reasons as well but this is a start. In my case, I fixed with VIT B12 supplementation a while ago before I ate a lot of plant foods so I know that Vit B12 alone fixed my problem.

    1. Thanks for your comment Annie.

      I tried searching for an answer but was not successful in finding research related to your question.

      The only thing I came across was this publication. It links disorders of cholesterol synthesis (Conradi–Hunermann–Happle Syndrome) to scoliosis as manifestation of this problem. However, I’m not sure if this is very relevant.

        1. Well can’t hurt right? But scoliosis is structural. Make sure you keep yourself strong, and use a shoe insert (lift) to correct position of back. Again as stated above see a therapist who is good at treating this.

        2. Some random thoughts. Diet will help with the energy needed to build strength on the weaker side through daily exercises. Long term, diet could help with gene expression. Learning how to correct posture (stretching) on a floor mat could help with pain. Little by little (~3-5 years) the weak side could be ‘rebuilt’ (depending on degree). Probably high doses of vit K could help along but not sure.

  5. Back pain is also caused by people sitting at their desk longer. This is regardless of diet. You need to stand up and move every hour, even for a few minutes to go get coffee, to go to the bathroom, or just stand in your place and move your legs.

    1. Yes, this is exactly true. Sitting for long periods can really do a number on your lower back and hips … I know b/c I’m dealing with it!

  6. So if one has lower back pain – moving to a plant based diet may offer some pain relief due to drop in cholesterol (resulting in an unclogging of spinal arteries)? Has there been studies showing this? I was under the impression that disc degeneration was not reversible … It seems common for doctors to prescribe life long pain killers to deal with disc degeneration — would moving to a plant-based diet eliminate the need for these pain killers?

      1. In there past I have taken an advil or two… Other family members have it worse and take prescription pain killers as directed by their doctors… These are cases of confirmed disc degeneration…

        A month ago I transitioned to a WFPB diet after a two month battle with diverticulitis which gave me some incentive to make immediate diet changes … During the diverticulitis treatment I was on a restricted diet of clear liquids and soft foods which might have helped relieve my addiction to fat sugar salt… When got better my GI dr wanted me to eat minimum 40g fibre/day from WFPB foods. After eating that much food to get the fiber I found I really wasn’t hungry for anything else… Since this time (before diverticulitis) I have dropped 60 lbs … Stopped taking pepcid and my back pain has diminished… Pain is still there but I don’t even think of taking an advil now .. understood there are many reasons for back pain… And maybe not all related only to clogged spinal arteries… it still would be nice to know if WFPB diet can only help…

        1. It sounds like you are on your way to a pain-free back. You dropped some weight and fixed your diet. Yeah! Now get walking and get strong. Use perfect body mechanics and the back will heal. See a physical therapist who specializes in orthopaedics if you still have pain.

    1. Since going grain-free, I have also been pain-free : hip, knee, shoulder, & lower back pain caused by arthritis (& confirmed as such by x-rays.) Grain-free applies not just to diet, but also what you put on your skin – read the ingredients list on absolutely everything. Even inhaling flour (as I baked for my husband) was enough to return excruciating pain for 2 weeks. It sounds like a hard thing to do – at first I tried just gluten-free, but soon found that things like corn, rice, & oats also had to go – but it is so worth it!

    2. It seems there is some misunderstanding to what Dr Greger is saying. So he stated that disk degeneration and back pain can be caused by several causes / factors,but a common cause is due to clogging of blood vessels. So it’s logical to fix this first before looking at other causes. So before you try medications, surgery, etc., nutrition should be tried first.

      Another recommendation is to do some light flexibility exercise such as Yoga. I lose my flexibility as I age although I maintain a good WFPB diet.

      Although disc degeneration has multiple causal factors, with genetic,
      occupational and mechanical influences, alteration in nutrition has been
      proposed
      as the final common pathway. This makes sense. The discs in our lower
      back are the largest “avascular” tissue in the body, meaning our discs
      don’t have any blood vessels. Thus, its nutrition just kind of diffuses in from the margins, making it especially vulnerable to deprivation.

  7. When I was eating SAD I had menstrual cramps in my lower back. Now I eat whole food, plant-based and I never get cramps at all. I’m glad to understand part of the science behind that!

  8. What about those of us who have been vegan and plant based for several years and the back pain has not improved? I am 55 and have suffered from low back pain all my adult life. Have never had surgery or taken medication. I never had high cholesterol, not even back when I ate meat. I have been a plant based vegan for almost 5 years now, I do yoga, and am otherwise healthy. What else can be done? I need some relief!

      1. I have seen at least two orthopaedic doctors in recent years and neither one had answers for me.

        I didn’t specifically look for someone who treats backs as a specialty, didn’t realize there was such a thing, but if there is a solution I’m willing to try it. Thanks.

        1. A bone scan to look for damage to the bones, a tumor, or infection, or to find the cause of unexplained back pain. An electromyogram and nerve conduction study to check how well the spinal cord, nerve roots, and nerves and muscles that control your arms and legs are working.

    1. You might investigate the following:
      1. Dr. Bookspan http://www.drbookspan.com/BackPainArticle.html
      She’s a research scientist who specializes in extreme physiology, has worked with Navy Seals and is also a world class kickboxer! Very opinionated but all of her material is free (she also sells books on Amazon). Her opinion is that almost all chronic back pain is posture based and provides specific remedies.
      2. Prof Stuart McGill’s Back Mechanics. He’s a professor of spine biomechanics at U of Waterloo, and his book is a detailed do-it-yourself guide to diagnosis and rehab. In terms of standard views on the cause and nature of back pain, his book is the best I have found. He’s worked with many professional athletes.
      3. Dr. Sarno’s theory that most *chronic* back pain has nothing to do with back abnormalities e.g. disk herniation, posture or conditioning. His views are controversial but he’s helped many people, including me many years ago when I had a weird problem with my upper back and right arm. Turned out to be a result of stress. Once I realized that and ignored the problem, it disappeared.
      4. Hannah Somatic Exercises, e.g. http://essentialsomatics.com/hanna-somatics-exercise-video-library/
      Basically the idea is that most pain is from chronic muscle contraction, which one has to learn to release through various gentle exercises unique to the method.

      Both Bookspan and McGill are quite negative on various yoga postions, especially anything involving flexion and rotation of the spine, as well as various standard exercises e.g. crunches, sit ups, all of which can cause disk degeneration in many people over a long period of time (people vary in their tolerance to these kinds of exercises).

      That’s a lot of options to investigate. I know because I am also searching for a solution.

    2. Have you try an inversion table? It will open what gravity closed. If you are in good shape look into antigravity boots and a ceiling pull bar to hang from.

    3. http://www.easy-immune-health.com/vitamin-b-12-deficiency-symptoms.html

      Could YOU have Vitamin B 12 Deficiency Symptoms and not even be aware of it? While it sounds a little crazy,, there are many research studies estimating that up to 20% of the elderly in the US have undiagnosed vitamin B 12 deficiency! And that is just the elderly population, what about YOU! You don’t need to be elderly to be deficient. Vitamin B12 deficiency symptoms are considered fairly rare- and it is this false belief that causes doctors to not even look for vitamin b12 deficiency symptoms- even when they are staring them practically right in the face.

      Unfortunately, these signs of b12 deficiency are often mistaken for other problems- sometimes even devastating debilitating problems such as Alzheimer’s Disease, Multiple Sclerosis, and Symptoms of Fibromyalgia. Even worse, these problems can occur in the presence of normal or even increased Vitamin B12 Levels due to a genetic defect called the MTHFR Gene that can also lead to Vitamin B6 Toxicity, even when not taking B6 Supplements.

      Chronic Pain

      The Facts about Vitamin B12 show that chronic pain conditions can also be vitamin B 12 deficiency symptoms. Particularly back pain, Peripheral Neuropathy and Symptoms of Fibromyalgia.

      That Vitamin B12 Deficiency is one of the Reasons for Back Pain one of the most exciting, yet entirely overlooked problems associated with vitamin B12 deficiency. Back pain affects almost 1/3 of the entire population. Yet, in some cases it is simply another one of the vitamin B 12 deficiency symptoms.

      Pain Related to Vitamin D Deficiency can ALSO have these same symptoms and are often related due to the inability to absorb nutrients. So, if you have Chronic Pain, then get both your Vitamin D Level AND your Vitamin B12 Levels checked!

      Read more: http://www.easy-immune-health.com/vitamin-b-12-deficiency-symptoms.html#ixzz4H5mrVDhx

  9. I just wanted to clear something up before we start thinking a WFPB diet is the cause of a disc herniation. This article is specifically talking about non-specific low back pain.

    I find this so interesting. And it makes sense. Why not? All tissues are better off with WFPB eating.

  10. I am 66 female and eat a dreadful diet of mainly sweet junk food. I try and try to eat as Dr Greger recommends but my cravings always get the better of me. I have a lot of hip pain, not arthritis, and lower back pain, also I can get bad sciatica. After reading this article I am even more determined to eat a whole food plant based diet. I have no idea if I have high cholesterol as I have never been tested but I would be very surprised if I didn’t. My question is this. How long would it take for my arteries to clear up enough to relieve my pain? I have to walk every day at least twice as I have a young dog and I would love it if I could walk without pain and discomfort.

    1. Dr. Greger has related the story of his grandmother in many of his annual addresses, such as this one:
      http://nutritionfacts.org/video/how-not-to-die
      She seemed to show a lot of improvement in just three weeks.

      I think you should probably get a few books on WFPB diets; there’s Dr. Greger’s How Not to Die, of course (I think there he will have a cookbook out soon), and there are others; they might be available at your local library. You might need a good blender; a lot of people like Vitamix but I do okay with an Oster. A pressure cooker for beans is nice to have, also. The electronic ones out now are convenient and not much more expensive that a stove-top version. You should probably track your diet in some way – keep a food diary, use an app – for at least the first few weeks. I find an electronic kitchen scale to be indispensable, but others seem to do fine without one.

      Dates and prunes are very sweet and can be eaten in moderation. You can make ‘truffles’ out of dates, cashews, and cocoa powder for an occasional treat.

      As for sweeteners, erythritol seems okay (in moderation, I would assume):
      http://nutritionfacts.org/video/erythritol-may-be-a-sweet-antioxidant/
      I use Swerve brand, which is a blend of erythritol and oligosaccharides. Some people use pure powdered glycine as a sweetener.

      I suggest making sure you get a morning smoothie with blueberries, kale and flax. You can add in other things (spinach, other fruit, a little sweetener), but I’d leave out dairy or soymilk.

      It would be interesting if you had your cholesterol and lipids tested now and again after doing WFPB for a couple of months.

      Hope this helps.

      P.S.
      Lentils!

        1. The proteins in both milk and soymilk tend to bind with polyphenols. I find those in blueberries to be particularly healthful so I try to make sure they are as available as possible (and so I also take first thing on an empty stomach). That being said, I think there is some variation among individuals as to how biologically active these constituents are, so your mileage may vary. I do around 60 grams of wild blueberries per day and I seem to notice a big difference in how I feel (and in my hair growth, fwiw).

          1. Almond and hazel nut milks contain around a gram of protein per serving, where soy milk contains 8-10 grams. So almond or hazel nut milk could be a way to keep some of the creaminess of some type of milk without the protein. But as with any commercial product you have to be aware of added ingredients, especially added sugar. If you are using it to make a smoothie, you really don’t need added sugars since the fruit in the smoothie provides plenty of sweetness.

            One on-demand way to add a little fat and creaminess is to blend in some soaked cashews (which can be soaked overnight in the frig so they are ready first thing in the morning) for some instant nut milk. A tablespoon of raw cashews only contains 1.4 grams of protein. Cashews are nice because they blend smoothly with no pulp, especially if you have a powerful mixer like a Vitamix. In fact if you use a Vitamix you probably could skip the soaking step. Just put the water and cashews in first, blend for a while and then add the rest of the ingredients and blend.

    2. Also going gluten and maybe even grain-free may help you as it did Rob (please see Rob’s response to Tommy Hanks, above). Some people also find that their sugar cravings abate when they go grain-free. Might be worth a try — a few weeks should be all it takes to see results if grains are a factor for you.

    3. Hi Clare, I’m 63 and female and I can give you some things that helped me:

      1.) See your doctor to make sure you are not diabetic already. Get some blood work done! Tell your doctor you want to make some major changes in your diet and exercise and get some pointers that are specific to your needs. If your doctor treats you like a little old lady, find another doctor. (I’ve always heard we should look for a hairdresser whose hair we like; we also should choose a doctor who is fit and healthy.)

      2.) Get the sweet junk food out of your kitchen. Don’t eat it up! Send it out in the trash then don’t buy more. Don’t even go down the junk food aisles in the grocery store. I lost track of how many half-gallons of ice cream I melted down the kitchen sink with hot water until I finally quit buying it. At first you will feel some withdrawal symptoms from all that sugar. My withdrawal symptoms lasted about a day. Hang in there.

      3.) The green smoothie idea is a good one. Buy some rainbow swiss chard, in the greens section of the produce aisle. Rinse it. Rip the green leaves off the center stem and throw the leaves into a blender. (Throw away the green stem.) Fill the blender about half-full with greens. Add half a glass of cold water to the blender. Blend it up. (You might need to add more water to get the blender to turn.) Add half of a banana. Now add a couple handfuls of frozen strawberries. Swiss chard and strawberries seem to like each other, and the banana makes it smooth and creamy. The color isn’t what you’re used to. Red and green don’t make a very pleasing color, but it tastes surprisingly good. Green smoothies are the first thing I did on my road to better health. I noticed a difference in only 3 days after making smoothies for breakfast.

      4.) Find a grocery store that has a good produce section. When I shop, I stay in the produce section until the bottom of my large cart is literally covered with fruits and vegetables. Only then do I move on to get a few other things, mainly canned goods, nuts, seeds and frozen fruits and vegetables. (Watch for frozen wild blueberries — they’re great!) I eat a small amount of fish and meat, but my grocery bill has gone down considerably since I started eating a much more whole-food-plant-based. Don’t buy ANYTHING with ingredients you can’t pronounce or don’t recognize as actual food.

      5.) Ask your doctor how much exercise you can safely do, then do it. I’ve always loved to walk. Now I’m (slowly) learning to love to run.I do shorts bursts of running, called intervals, and I’m noticing a big difference in how I feel. To keep myself from quitting, I make myself accountable by emailing my exercise log to a brother, who cheers me on.

      6.) I rely on starch-based foods like oatmeal, whole wheat pasta, potatoes and beans to feel satisfied after a meal. Yukon gold potatoes are great, and most stores carry them now. They’re small and cook up fast in the microwave or oven. Cover them with organic frozen corn and you won’t really miss the butter you’re not using. The Yukon potatoes have a fairly creamy texture even without added fat. It’s a new way of cooking, but I’m having fun with it. .

      7.) IF you allow yourself an occasional treat, make sure it’s a small one and eaten out someplace — not from food you’ve taken into your home. Nobody’s willpower is strong enough to resist junk food in the fridge.

      I don’t know how long it will take for any reduction in your pain. If you go to other websites for people who’ve tried whole-food-plant-based diets, you can read testimonials that should give you some idea. Everybody’s different, which is why you need a good doctor who can help you along. All I know is, I’m feeling better than I’ve felt in years. I hope you do too!

      1. One more suggestion that I find to work for me: I either eat all meals at home or pack my own healthy lunch- and I don’t carry any cash on me. When I go out, I’ll have to use a credit card if I’m tempted to buy a candy bar- and that’s too foolish for me to do.

      2. This is all good advice, when we went whole food , we would ban certain products from our grocery cart . The first thing we banned was butter.lol Then we found we were eating a lot of peanut butter so we banned that too . Steamed zucchini is really good and easy on the stomach for breakfast , rice and beans for lunch or salad with lots of berries and small tomatoes . For supper potato and various vegs or a bean salad is good too . If your a late night snacker like my wife , why not really kill that by cooked whole oats with a plant milk and maybe teaspoon of maple syrup .
        Cheers!

    4. Clare Watts: I think you have already gotten some great replies. I thought I would add my own 2 cents to address a very specific part of what you wrote: “How long would it take for my arteries to clear up enough to relieve my pain?” I can’t say what would happen in your case, but I can say that some people with circulation related pain have the pain clear up fairly quickly according to what I read. At the same time, it may take longer for the arteries to actually clear up. I think NutritionFacts has a video about this somewhere. So, if you started eating a healthy diet, you might get some pain relieve fairly quickly, but you won’t significantly lower your disease risk/risk of harm for a while. For example, I have a friend whose body took 3 years before her cholesterol levels went into the safe zone. But she started experiencing other benefits much, much sooner than that.
      .
      I hope you are able to walk your dog pain free very quickly. It is worth a try!
      .
      Do you want some tips on resources for transitioning to a healthy diet? Or do you have that covered?

  11. These facts raise some questions in my mind.

    We are one of the most highly vaccinated populations along with N Korea. Since aluminum has a great possibility of clogging watershed vascular systems, how does unvaccinated populations compare?

    Does N Korea have similar stats?

    How does the many other sources of aluminum play into fine blood supply blocking of single cell pathways to watershed areas?

    Many people are familiar with the results of aluminum when added to a liquid. You see this effect every time you “flock” (aluminum) pool water. Coagulation. It is clear this is the same effect on blood from the free articles available on the net. Vaccines are a direct route. Ingestion from the many sources of aluminum such as baking flour additives, aluminum cookware etc. might not effect coagulation.

    A very thought provoking article. I wish I had access to more research on the subjects.

    Maybe physical therapy helps by initiating angiogenesis?

    I too suffered and veganism along with exercise and avoiding any aluminum as made a world of difference in my case. SO much so that I take no drugs, not even OTC.

    I am SO grateful for your research Dr Greger!

  12. Dr. Greger is consistent. He blames human’s illness to cholesterol in the blood. Is there a proof of a cholesterol cause, not anecdotal?

    1. More accurately said I think, is excess cholesterol. The medical term is hyperlipidemia. And in case one doubts its deleterious impact, look at the multi billion dollar statin industry, or heart disease, still our number one killer (I believe)

      1. We should not use familial hypercholesterolemia as for most people. Familial hypercholesterolemia people have much low or no LDL receptors. LDL will circle in blood forever. Besides, older familial hypercholesterolemia people have the same CVD death ratio as normal older people.
        In addition, what are plaques in the arteries? Why not in vein? Why are plaques in below endothelium? How did the LDL get oxidized?

        1. “Besides, older familial hypercholesterolemia people have the same CVD death ratio as normal older people”
          Most people with familial hypercholesterolemiia do not survive to become”‘older people”, at least not without intensive lipid lowering therapy, and what helps them to have the same death ratio is that very same lipid lowering therapy.
          These arguments sound like pretty desperate attempts to avoid engaging with the evidence to me. Do you actually find them convincing? It would be interesting if you applied the same criitcal analysis techniques to those individuals who claim high blood cholesterol is harmless or even beneficial

          1. As I said, we should not use familial hypercholesterolemia as disease model for the general population. Their cholesterol level is at least five times of the general population. It is abnormal.

              1. As you know, most of the familial hypercholesterolemia people are unrecognized and untreated. Results of most of the famous studies, including Framingham and MR.FIT, are skewed because they did not separate FM from the normal population.

                One more note, in study of Carew TE, Schwenke DC, Steinberg D. Antiatherogenic effect of probucol unrelated to its hypocholesterolemic effect. Proceedings of the National Academy of Science USA 84, 7725-
                7729, 1987, scientists can educe fatty streaks of FM with anti-oxidants without lowering cholesterol. On the other hand, lowering cholesterol does NOT reduce the fatty streaks.

                1. You are assuming, then, genetic hypercholesterolemia is harmful but hypercholesterolemia which is the result of diet and lifestyle is completely harmless (or possibly beneficial)? Where is the evidence for this?

                  Thanks for the reference but let me repeat that lowering high cholesterol reduces mortality and other adverse events. Both in general populations and in people with familial hypercholesterolemia.

                  1. The usefulness of statin drugs is their anti-inflammatory property, with many side effects. However, you can obtain the anti-inflammatory effect from food.

                    1. My belief is that diet and lifestyle changes are the best approach but that there is a role for drugs depending upon individual circumstances.

                      You wrote “The usefulness of statin drugs is their anti-inflammatory property”
                      This is apparently not what scientists believe. Do you have any evidence for this? Sure I have seen people on the internet claiming this but that does not mean it is true. Unsupported claims, no matter how plausibly expressed, need to be rigorously fact-checked.

                      “The beneficial effects of statins are the result of their capacity to reduce cholesterol biosyntesis, mainly in the liver, where they are selectively distributed, as well as to the modulation of lipid metabolism, derived from their effect of inhibition upon HMG-CoA reductase. Statins have antiatherosclerotic effects, that positively correlate with the percent decrease in LDL cholesterol. In addition, they can exert antiatherosclerotic effects independently of their hypolipidemic action. Because the mevalonate metabolism generates a series of isoprenoids vital for different cellular functions, from cholesterol synthesis to the control of cell growth and differentiation, HMG-CoA reductase inhibition has beneficial pleiotropic effects. Consequently, statins reduce significantly the incidence of coronary events, both in primary and secondary prevention, being the most efficient hypolipidemic compounds that have reduced the rate of mortality in coronary patients. Independent of their hypolipidemic properties, statins interfere with events involved in bone formation and impede tumor cell growth.
                      http://www.ncbi.nlm.nih.gov/pubmed/12067471

                    2. Yes. This is one of the issues physicians consider before prescribing statins.

                      It is one of the reasons why I believe diet and lifestyle changes are best.
                      However, like everything, there are advantages and disadvantages to everything. Reducing mortality and stroke risk etc are big advantages.

    2. The evidence identifying high blood cholesterol as a risk factor for a number of diseases is pretty overwhelming. That is why scientists and health authorities around the world accept that it is. The evidence is much much more than anecdotal. There is both observational/epidemiological and experimental evidence demonstrating this. That is not to say that high blood cholesterol is the sole cause of eg cardiovascular disease. It isn’t. But it is a significant risk factor.

      There are plenty of resources out there showing this but these might be a good place to start reviewing the evidence:
      http://www.jlr.org/content/47/7/1339.long
      https://www.nice.org.uk/guidance/cg181/evidence/lipid-modification-update-full-guideline-243786637
      http://circ.ahajournals.org/content/circulationaha/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf
      http://www.ncbi.nlm.nih.gov/pubmed/22343265

      There is however plenty of obfuscation out there from people selling sensational fad diet books, publicity seekers and tof course he poor souls who believe them. This is because some diseases like cancer, malnutrition, Alzheimers, certain liver diseases and viral infections cause lowered cholesterol levels. Individuals with these diseases are more likely to die. Some of these claims therefore argue that high cholesterol is “protective” in older people. You will also see weight loss in people with such diseases and you will see similar claims that being overweight is “protective”. However, it is the disease that causes the low cholesterol not the other way around.

      This “reverse causation” effect has been known for decades but it does stop making the same old sensational claims ..
      http://circ.ahajournals.org/content/92/9/2396

      1. And Tom, don’t forget all the corporations, ranchers, and animal feed farmers out there whose livelihoods depend on keeping the cholesterol “controversy” alive so that people don’t realize that they are eating their way to an early grave and stop consuming their products. Those folks have all banded together into lobbying and “research” organizations. The research arms fund studies by captive researchers that are carefully crafted to give the desired results, even to the point of making stuff up in the conclusions that their own study’s data doesn’t support. And the lobbying arms make damn sure that no government health organization ever issues dietary guidelines based on the unbiased science (i.e. “science” that these organizations didn’t fund) because they know without a doubt that guidelines not based on corporate research would absolutely show that their products eaten in anything but the smallest amounts represents a long term harm to human health.

        1. Jim Felder and Everyone Else Who Wants Some Food Justice: There is a petition into the White House to “Instruct the Centers for Disease Control to write the National Dietary Guidelines, not the Department of Agriculture.”

          The petition is not getting a lot of promotion, so I don’t know if it will go anywhere. They have to get 100,000 signatures in a total of 30 days in order to force a While House response. But hey, it doesn’t hurt to try.

          If anyone wants to sign: https://petitions.whitehouse.gov//petition/instruct-centers-disease-control-write-national-dietary-guidelines-not-department-agriculture

      2. The first reference was a statin study, not the “evidence identifying high blood cholesterol as a risk factor”.
        The second one was a clinical guideline, not the “evidence identifying high blood cholesterol as a risk factor”.
        The third one was a guideline in treating blood cholesterol, not the “evidence identifying high blood cholesterol as a risk factor”, either.
        The fourth one was a study on 95 CVD patients. This is an association at best.
        The fifth reference did show a low TC to be a manifestation of tumor activity…

        1. The first reference was not a statin study even though it did discuss statins. The title alone should have given you a clue as to what it is about.even if you chose not to read the paper itself.

          The second reference was indeed a set of clinical guidelines. Again, if you had bothered to open the document and just glance at the contents pages, you would have seen that it sets out the evidence regarding cholesterol.

          Similarly, the third reference was also a set of guidelines. It too set out the evidence.

          The fourth study showed an association but was nevertheless an interesting example of the (possible) mechanisms by which high cholesterol can adversely affect cardiovascular health. To repeat “At multivariate analysis, LDL cholesterol was the only independent predictor of IMR, even after adjustment for the extent of epicardial coronary atherosclerosis and fractional flow reserve values.”

          The fifth reference did as you say link declining cholesterol with certain cancers (and alcohol abuse).

          Those references appropriately addressed your original question.

          They show that there is a wide and convincing array of evidence identifying high blood cholesterol as a significant cardiovascular risk factor. They also show that counter- claims that high cholesterol is somehow protective is based on a simplistic interpretation of the evidence – to use your words “just an association at best”. In this case, an association that confuses cause and effect.

          1. High serum cholesterol is an association with CVD, not necessarily the cause. Where is the proof of cause of high serum cholesterol?

            1. Jason Huang: From what I can pick up, based on your definition of “proof”, humans have no proof of a link between smoking cigarettes and cancer and COPD. Do you also deny those links? (Because the exact same type of evidence exists for nutrition as we have for cigarettes. It’s just basic science…)

              1. Have you heard of methanol poison? The tissues of a dead cigarette smoker was found the same as those who die of methanol poison. Smoking, either tobacco or wood smoke, contains a significant amount of methanol. When the brain tissues of a dead multiple sclerosis patient was dissected, the tissues looked the same as those artery plaques. Multiple sclerosis patients die of sever hardening arteries in the brain.

                  1. Tell me what kind of proof you ask. Poisoning some people and then dissect their body?
                    At least, MS plaques in the brain artery and vein looked the same as those atherosclerosis plaques. Early MS patients who stopped the source of methanol can reverse and cure their MS.

                    1. Jason Huang: Ah! And people who lower their cholesterol levels clear out their arteries and no longer get heart attacks…

                    2. Have you wonder that high cholesterol in blood is a sign of underlining illness? When someone improves through life style changes and recover from illness, the serum cholesterol returns to the level the body needs. Why do we fixate on serum cholesterol as cause, not the underline illnesses?

                    3. Jason Huang: Yes, I have carefully considered your first question. And the answer is pretty clear. Also, I feel that you have been given the answer to this question already. You might want to review the resources that Tom Goff gave you. You might also review the other studies referenced on NutritionFacts. The information in Dr. Esselstyn’s book is easy to absorb. Or if you want an in-depth understanding of the issue and the flaws behind cholesterol denialism, start watching the videos on the Plant Positive site. Or even think about the conversation you and I just had about what counts a proof. The evidence is enormous, which makes it hard to answer in a 30 second sound bite in a post. It’s up to you.

                    4. What I have learned through study, when one changes his/her life style and getting sufficient non-soluble fiber, he/she is protected against methanol poison.

                      As you already know, when methanol gets into body, it is free to travel in blood vessel everywhere including the brain. When methanol reaches alcohol dehydrogenate class I (ADH) sites, the methanol is converted into formaldehyde. ADH sites are blood vessels (under endothelium), eyes, breasts, stomach, lung, intestines, and liver. Since the formaldehyde is mostly acidic, it will attach to nearby cells.
                      If one has a good diet with plenty fiber, the probiotics in the large intestines will convert fiber into alcohol. With a low level of alcohol in the blood, the ADH sites are prevented from converting methanol into formaldehyde.
                      This is why good life style including good diet can prevent or reverse most chronic diseases including CVD.

            2. Hi Jason. The answer to this question is in the references/links that I have given you previously.

              In particular, clinical trials demonstrate that LDL-lowering therapy reduces total mortality, coronary mortality, major coronary events, coronary artery procedures, and stroke in persons with established CHD. Benefits have also been shown for people without established CHD but who are assessed as at risk. These benefits cannot be represented as mere associations.

              There is no controversy about this. The evidence is so convincing that every health authority on the planet accepts that high serum cholesterol is a risk factor for cardiovascular problems. Sure there is a buck to be made form selling books etc to people telling them that their high cholesterol is OK but apart from fad diet books and crank websites, there is virtually no debate about this.

              However, you do see demands for “proof of cause” like this on the internet.Usually by people who in the same breath demand that we accept their opinions based on the flimsiest and most spurious of evidence. As rationalwiki comments

              “It is often said that proof is for alcohol and mathematics, as these are really the only areas where proof has any real meaning. “Proof” is something that the opponents of science are always clamouring for, yet is not actually something that science suggests it will give – specifically in the common sense definition of “proof” that suggests that a claim has been proven 100%.
              Surprisingly to some, science does not deal in proof, in spite of the word being associated with science a whole lot more than perhaps it should be. Scientists will throw around phrases like “we’ve just proved our theory” when they should know better, but this can be excusable human nature. With some theories its very difficult not to think of them as proven (Newton’s laws of motion, for instance, which always have and always will describe the behavior of objects within the limits of those theories.) Science as a method, however, deals not in proof but in evidence, and perhaps disproof when the evidence contradicts a hypothesis.”
              http://rationalwiki.org/wiki/Proof

              1. To make the argument simple, have you considered what causes the rise of cholesterol in blood?
                More than 70% to 75% of total cholesterol is produced by your body. The rise doesn’t happen for no reason/cause. This is why blindly suppressing cholesterol is anti-life.

                1. If you want to keep the argument simple, let me do that for you.

                  The evidence shows that lowering high cholesterol through diet and lifestyle changes, or drugs, decreases mortality and other adverse events.

                    1. I wrote “or drugs”. Diet and lifestyle changes are best, yes.

                      However, sadly, some people will not make the needed changes to their diet and lifestyle. They prefer to use drugs.. Or they have genetically high cholesterol and need drugs to lower cholesterol to safer levels.

                    2. Statin drugs shunt many important hormones our body depends upon, including stress hormone. All hormones are made of cholesterol.
                      I would prefer life style changes including diet.

                    3. Cholesterol is a precursor of all the steroidal hormones, certainly.
                      I agree with you that lifestyle changes including diet are preferable

                2. Jason Huang: You got a good reply from Tom Goff, but I thought I would put in my own 2 cents.
                  .
                  You write that our body makes 70 to 75% of total cholesterol. I don’t know what you mean by this. What we know is that our body makes *all* the cholesterol we need, not a percentage of it. No one is talking about “suppressing” cholesterol below what is normal for humans. The problem is that our bodies can make not just what we need, but *more* cholesterol than we need (than is good for us) when we eat an unhealthy diet. Thus, as bagman747 told you, the issue is about *excess* cholesterol. It’s not about suppressing cholesterol below what is normal and healthy for humans.
                  .
                  (What is normal for humans? You can find at least one video on this site explaining how we know that normal cholesterol for humans is total 150 or below and LDL 70 or below. Normal cholesterol levels are the levels that we are born with. Normal cholesterol levels are the levels that people are not only born with, but which they keep their entire lives (no progression with age) when they eat primarily whole plant foods.)
                  .
                  No one said that cholesterol rises for no reason/cause. Cholesterol rises beyond human normal levels when we eat an unhealthy diet. That’s why eating a healthy diet of whole plant foods is the answer. A healthy diet (whole plant foods) is the only diet proven to reverse cholesterol excess (and clears up arteries). (See Dr. Esselstyn’s work.)
                  .
                  We know that a diet that includes any appreciable amount of cholesterol and saturated fat (ie, animal products) raises cholesterol levels above human normal. That’s why not eating animal products leads to the healthy level of lower cholesterol levels and eventually clears up arteries. It is about getting back down to healthy levels. It’s not about artificial suppression below what is normal/healthy for humans.
                  .
                  Some people have messed up their bodies so bad or they are born with a special condition (what you have been talking about with Tom) that a healthy diet does not work to lower their cholesterol levels to safe levels. In those cases, drugs may be called for. But certainly the first line of treatment for high cholesterol should be a healthy diet, because the drugs have bad side effects and a healthy diet has good side effects.

                  1. I know unhealthy diets can increase cholesterol as the same as stress. As you know, human hormones are important to our life. Hormones are made of cholesterol. Why do we want to force reducing cholesterol without life style changes?

                    1. Jason Huang: I don’t understand how your reply is a reply to my post. High levels of cholesterol are directly linked to death – by heart attack – sometimes without warning. Reducing cholesterol to normal levels with diet (what you may be referring to as life style changes) is the best idea, as I said.
                      .
                      Hormones being important is irrelevant to the conversation. Water is also important to our life. But too much water can kill us. Just like too much cholesterol can kill us. You seem to be back to this idea that I’m promoting “suppression of cholesterol”, when what we are really talking about is just getting a person’s excess cholesterol back to normal levels. Ie, those levels that are heart-attack proof.
                      .
                      One more thought for you: I find it hard to believe that people living in say rural China with their very hard lives do not experience a great deal of stress. And yet, they have almost no heart disease. I’ve no doubt that stress can contribute to heart problems when high cholesterol is present, but stress is not the main issue when it comes to heart disease. There are several risk factors for heart disease, but none of them matter in the absence of chronic high (above human normal) cholesterol. (There’s a video about that somewhere on NutritionFacts.)

                    2. How high do you consider high? There must be underlining causes to make serum cholesterol go high. They don’t go high for no reason.

                      We are not talking about familial hypercholesterolemia here.

                    3. Jason Huang: What is high? I just answered that. High is the levels known to cause heart attacks. (Normal are the levels that heart attacks do not happen.) High are the levels above which we are born with. High are the levels that happen when we eat an unhealthy diet. (Correct: there is a reason cholesterol levels go chronically high. Bad diet causes chronically high cholesterol.) The generally recognized cut-offs are a max of 150 total cholesterol and max 70 LDL, though some experts recommend lower even lower for the LDL and some think a little higher might be OK in the context of a healthy diet.
                      .
                      All of these statements are fully supported by multiple videos and even more studies which you can find on NutritionFacts and the other resources you have been given.

                    4. I cannot agree that one standard of serum cholesterol for all ages.
                      Did you know that low (under 150) serum cholesterol is prone to infections? Half the people with heart disease have “normal” cholesterol? And half the people with elevated cholesterol have healthy hearts?

                    5. Jason Huang: re: “Half the people with heart disease have “normal” cholesterol?” That’s one of the myths. That statistic is only true only when “normal” cholesterol is defined as average for sick populations like Americans. When normal is defined as human-normal as I explained to you, there is no heart disease. I don’t think this conversation is worth pursuing as you want to keep repeating the same myths without looking at the actual data provided. That’s up to you…

                    6. This is not a myths. If you looked into the details of the most quoted, Framingham study, you would find that cardiovascular disease struck people had cholesterol level as low as 150 mg/dL. And the average cholesterol level of the heart disease group was only 11% higher than that of the group without heart disease. The study also found that the cholesterol was important for the relatively few who had had a heart attack before the age of 48.

                      In 1992, forty-four years after the Framingham project began, study director William Castelli, M.D., wrote the following in an editorial in the Archives of Internal Medicine:

                      “In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol . . . we found that people who ate the most cholesterol, ate the most saturated fat, [and] ate the most calories weighed the least and were the most physically active.”

                    7. Jason Huang: re: “…people had cholesterol level as low as 150 mg/dL…” But not below. Which is the point.

                      The link between saturated fat and elevated cholesterol levels is very clear. Check out Plant Positive if you want to know what the body of evidence tells us.

                    8. Jason Huang: I’ll make one more observation concerning: “…the average cholesterol level of the heart disease group was only 11% higher than that of the group without heart disease.” That just reinforces the point that even small elevations in cholesterol levels are of concern. Best if everyone got their cholesterol levels to safe levels = total below 150 and LDL below 70 (or even better, 50 or 60 according to some experts).

                    9. This “saturated fat and elevated cholesterol” is really old school.
                      Even Ancel Keys, who proposed the hypothesis, himself understood that cholesterol in the diet was of no importance. In 1997, he stated, “There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

                    10. Jason Huang: That’s an odd reply since my post talked about the link between saturated fat and elevated cholesterol. I didn’t mention in that particular post talk about dietary cholesterol and yet you replied with a quote about dietary cholesterol and it’s relationship to cholesterol in blood.
                      .
                      However, since you want to go there: Studies show that dietary cholesterol does raise blood cholesterol, but saturated fat raises blood cholesterol even more. And the two together (saturated fat and dietary cholesterol) raise blood cholesterol the most. Ie – eating animal products is directly tied to elevated cholesterol levels which are directly tied to death. Again, you can find plenty of supporting evidence for these statements on this site and Plant Positive’s site.
                      .
                      I don’t know where that quote came from, but Ancel Key’s studies stand up strong. Really, take a look at Plant Positive for a thorough debunking of the cholesterol denialist information you are invested in. Here are some great videos explaining the criticism’s of Ancel Key’s work and what is really there: http://plantpositive.com/display/Search?moduleId=19496100&searchQuery=ancel+keys Plus, the focus on Ancel Keys is really odd given the giant number of studies that followed that work and which just support it.
                      .
                      You have to acknowledge the reality that even your own data that you quoted above points to what a healthy cholesterol level is. Even your data shows that total cholesterol levels below 150 means no heart attacks. That’s great news for people who just want to skip the whole heart attack thing. I don’t understand why you don’t see that as pretty significant. Especially given all the other information we know:
                      > people are typically born with total cholesterol levels below 150
                      > people who maintain those birth levels (ie, normal human levels) through their lives do not get heart attacks
                      > people who maintain those low levels eat a whole plant food based diet
                      > people who eat animal products have their cholesterol levels go up above the levels they are born with and those are the people at get heart attacks
                      > massive amounts of data supports these statements

                    11. “Even your data shows that total cholesterol levels below 150 means no heart attacks” is your statement, not mine. All I said was: people who had heart disease had cholesterol level as low as 150 mg/dL.
                      Plant Positive has many not-so-true claims. This is not the forum for debating/debunking Plant Positive.

                    12. Jason Huang: Your statement: ” people who had heart disease had cholesterol level as low as 150 mg/dL” means that people below 150 did not have heart disease. And that’s the point. The information is pretty powerful.
                      .
                      Plant Positive backs up all his statements with original research just like Dr. Greger does. The work on that site is a very in depth scholarly work. If you haven’t seen any of the videos, I highly recommend them. You might start with the videos on Ancel Keys since that person interests you. See above links.

                    13. That is your conclusion.

                      The study, “Low Serum Cholesterol and Mortality”, said otherwise.
                      http://circ.ahajournals.org/content/92/9/2396, I quote,
                      “a stable low TC level (< 160 mg/dL) is a significant risk factor for mortality, … low TC, independent of the risk factors considered in this study,
                      appears to be a manifestation of tumor activity or the consequence of
                      chronic liver disease."

                    14. Jason Huang: What does liver disease and tumor activity have to do with the statement “people below 150 did not have heart disease”? And it’s not my conclusion. You said it yourself.
                      .
                      Since you are switching topics to the whole mortality issue, I will point out to you that Tom Goff already answered the confusion about the link between mortality and cholesterol in his first post to you. To summarize: It is well known that diseases cause lower cholesterol–*not* that lower cholesterol causes diseases. Even your own quote above makes this point. Please refer back to Tom Goff’s link for further information. Here’s the clincher: other studies that follow people forward in time show that those with the lower cholesterol levels and which stay lower have lower mortality compared to people who started out with the higher cholesterol levels.
                      .
                      What this means in layman’s terms: Starting out with low cholesterol? Can you keep it low going forward? If so, then you increase your chances of living longer! Good for you.
                      .
                      The data is clear. You can ignore if you want.

                    15. My point is that low cholesterol level is not the goal of a healthy life. You will get early death for low cholesterol. Please remember cholesterol is essential for life. Everyone knows it is the oxidized cholesterol. We should reduce/minimize oxidized cholesterol, not driving the cholesterol as low as you can.

                    16. Jason Huang: I just explained how low cholesterol does not lead to early death–quite the opposite. Please review my previous post. Even your own quote from that study backs up what I said then and am saying now. Do you understand what reverse causation is?
                      .
                      And to say once again: The goal is not to “drive cholesterol as low as you can” per say. The goal is to drive cholesterol to levels that are healthy for humans: ie: those levels which are known to prolong life and prevent heart attacks.

                    17. It is not as simple without health life style..
                      I have read Dr. Esselstyn articles. I found all his diets require high non-soluble fiber.
                      I have not found any diet can improve health without fiber.
                      The non-soluble fiber is at least associated with improve/reverse chronic diseases.

                    18. Jason Huang: To summarize our conversation so far. Together (with your own studies as supporting evidence) we have established that:
                      .
                      A) There are cholesterol levels that make us safe from heart attacks. While something of an arbitrary number, the safe levels are total cholesterol levels below 150 and LDL below 70. And if you do some research on this site, you will find that those are the levels that we are born with. Also, in societies which do *not* get heart disease, those are the levels that people maintain their entire lives. We also find that those very same societies eat whole food plant based diets.
                      .
                      B) Cholesterol levels which incur heart disease protection do nothing to shorten lifespan. The myth that low cholesterol levels increase mortality was started by people who ignored or did not understand the basic scientific concept of reverse causation. This is explained in your own study as well as the link provided by Tom Goff.
                      .
                      In your latest reply, it seems you want to step back and examine the big picture for the hearth-healthy diet. Are there any major problems? You say you took a look at the diet recommended by Dr. Esselstyn and noticed that the diet includes what seems to you to be a lot of fiber.
                      .
                      I’ve read your post probably at least 10 times over the last day, and I can’t quite figure out from your wording if you are concerned about the fiber or not. Either way, I think you will be interested to know that fiber can help flush out excess cholesterol. For an overview of fiber and its impact on human health, check out the NutritionFacts topic page for fiber. Rob did a *great* job of summarizing the information! http://nutritionfacts.org/topics/fiber/

                    19. I am glad that we all agree that lifestyle change is more than important than reducing serum cholesterol.
                      The reason I did not express my opinion was that I wanted to see if there were anything other than the mainstream standard talking points: cholesterol is the culprit of human diseases.
                      I know the importance of plant food in human diet. It is essential but conditionally insufficient.
                      “…fiber can help flush out excess cholesterol” does not happen in real human biology. The fiber has its use in health, but not flushing cholesterol.
                      Modern human’s chronic diseases have their etiology. Cholesterol is not one of them. Cholesterol is a bystander in a traffic accident.

                    20. Jason Huang: Did you even watch it or read the transcript? The focus is on estrogen, but it also addresses fiber and cholesterol to back up the statement. Just like you don’t want to judge a book by it’s cover, you don’t want to judge a video by it’s title.

                    21. Jason Huang: I just realized what you said with, “I am glad that we all agree that lifestyle change is more than important than reducing serum cholesterol.” That’s not exactly what the data shows, nor is it what I have been showing you over the last X posts.

                      It’s not a question of one being more important than the other. The data shows that reducing serum cholesterol is vital if someone has excess cholesterol. We may agree on something, though. We agree that best way to reduce serum cholesterol is through lifestyle change. But we only agree on that if you define lifestyle change as eating a whole plant food based diet (the only diet proven to reverse plaque build up in the arteries) and hopefully also exercise if possible.

                    22. People with excess cholesterol in blood have their underlining etiology. As I said, cholesterol shows up when there is a stress or/and inflammation. It is not the cause of stress or inflammation.

  13. As a substitute teacher, I think the increase in back pain among kids and teens is related to the fact that many of them now carry backpacks. Some teens have several very heavy books in them, and they carry them all day long.

    1. In addition, bad posture / sitting slouched / and what many chiropractors will soon call “the millennial epidemic”, cell phone neck, all can cause or exacerbate existing conditions.

  14. I’ve been vegan for a long time, and have a physical job where I bend down all day. But I must admit after lowering my fat intake substantially, as well as getting rid of the vegan junk food, my back has been much better over the last few years :)

  15. Thank you Dr. Greger for this information on cholesterol. This data is more proof that the cholesterol deniers out there are spreading lies and confusion about nutrition and health. This is a serious matter to me, because to deny that cholesterol has nothing to do with atherosclerosis is a “crime” because we are talking about life and death. If you listen to some of these “confusionists” on this topic and decide to eat meat, cheese, eggs, and dairy it could have negative effects on your health and may even shorten one’s life.

  16. I think one conclusion we can draw from this article by Dr. Greger is that there are probably a lot of health issues that are caused by poor circulation due to elevated cholesterol levels that are plugging up arteries. In 9 months I have been able to lower my total cholesterol from 253 down to 138 by going on a vegan diet. My pulsatile tinnitis has cleared up for the most part. I am assuming it is due to improved circulation. Pulsatile tinnitis is a condition where you can hear your heart beating because one of the small arteries in your head or neck or around your ear has a partial blockage due to a bend or due to cholesterol partially blocking the flow of blood. There is a group on FaceBook that is dedicated to pulsatile tinnitis. This is different than typical tinnitis where you hear a high pitch ringing sound that is constant. With pulsatile tinnitis you hear “whoosers” as they say among those on the FaceBook group for pulsatile tinnitis. “Whoosers” is the internal sound of your heart beating. It drives a lot of people nuts.

    1. John Axsom: That’s fascinating. Thank you for taking the time to explain the difference between typical tinnitis and the pulsatile tinnitis. I had not known there were different types.
      .
      It’s amazing to me how many conditions people manage to fix when they start eating a healthy diet. It’s easier to prevent a problem than to reverse one. So, diet is not a magic pill guaranteed to work on whatever condition a person is struggling with. But going on a healthy diet sure does help an awful lot of people with an awful lot of conditions. Really amazing.

    2. I agree that so many things that modern medicine views as individual diseases are likely at their root the single disease of an injured and diseased vascular tree. Even if vascular disease isn’t the sole direct cause of some disease, it might be the insult to the body that exposes a weakness or flaw in some part of the body that would have never become an issue in somebody with a healthy vascular system.

      Have you shared your results with your FaceBook group, and if you have are others moving in the same direction you have? I would think that just about anything would be worth trying for a few months if it help the hope of getting rid of such a maddening condition.

    3. To add our own story, my wife suffers from Restless Leg Syndrome. This is a movement disorder that causes suffers to have an irresistible need to move a leg or arm. It isn’t the same as muscle spasm where the muscles move without being commanded. It is a cruel and heartless conditions that most often happens when a person is tired and sleepy and requires them to get up just as they are falling asleep or after a short time being asleep and forces them to march in place sometimes for hours rather getting the rest they need that would help them avoid the crushing fatigue that brings on the bouts.

      The only drug that helps is the same one they use for Parkinson’s patients. It has to be taken 3 hours before going to bed to be effective, BUT it made her into a zombie unable to function within 30 minutes, not to mention that she felt both drunk and hungover for the first couple hours the next morning. HOWEVER, one day about 6 months after starting a WFPB diet she was so exhausted that she just had to lay down and try take a nap fully knowing that in 10 minutes she would almost certainly be right back up marching because she hadn’t taken any medication. Well she slept over two hours! She experimented at reducing the dose of the medication and was still able to sleep and was eventually able to completely eliminate the medication (oh happy day!).

      I don’t know that vascular disease underlay this condition but there are some clues that it might. Onset is usually not before someone is in their 30s or 40s and then gets progressively worse as they get older with more frequent episodes that last longer. Sound like a familiar disease trajectory. My speculation is that in some people an artery into a key part of the movement center of the brain becomes restricted by plaques reducing blood flow and thus oxygen to some key bit. Most of the time there is enough oxygen, but when a person falls off to sleep their breathing slows and blood oxygen saturation falls off a little. At some point that oxygen gets low enough to cause that bit of the brain to malfunction causing it to send the signal that some bit of the body has to be moved, no arguments allowed. Another hint that the root cause might be vascular is that while she is still able to sleep without medication, the condition will still flare up from time to time. With a little bit of detective work on her part, she found that it would only flare up when she had eaten a meal that was higher in fat than usual. We know from brachial artery tests that a single high fat meal will stress the vascular endothelium causing it to not release as much nitrous oxide and so not allow the arteries to dilate fully. Also as the fat content of the blood goes up the viscosity of the blood drops. Both effects can reduce the blood flow and thus oxygen flow.

      She mentioned this to her neurologist on her very last appointment with him. He just brushed her off and said that diet has absolutely nothing to do with Restless Leg, that she shouldn’t have stopped her medication without clearing it with him first and that she would be back soon because he was right and she was wrong. Five years, never been back.

      1. Jim Felder: WOW. That’s an amazing story and good analysis. I did not know of the horror of Restless Leg Syndrome. I’m so glad your wife is not suffering that any more. The power of a WFPB diet rises again.

    1. The diet can be summed up as don’t eat anything that had a mother, came from a mother, or “grew” in a factory (i.e. highly processed former plant food such as sugar (in any of its many different aliases), white flour, vegetable oil (including olive oil, sorry)). So if a food comes in roughly the same form that it came out of the field (even if it has been chopped up a bit), and you eat enough to meet your caloric needs, then your probably in good shape.

      Dr. Greger has resisted outlining a highly specific “eat this, don’t eat that” diet that all the diet book authors love to indulge in, because beyond the broad guidelines to center your diet around unprocessed, whole plant foods and avoid animal foods and highly processed plant foods to the greatest extent that you can manage, the science isn’t proscriptive about the daily details, and Dr Greger is all about not going beyond what the science says. However, he did break down and gave us his personal conclusions and decisions about what he and his family eats in his book “How Not To Die”. As Julie says he has distilled the second half of his book down into the “Daily Dozen” things he tries to get in each day.

      BTW, this diet, as you will see if you look back to the August 5th video you will see that this very same diet is effective for many more conditions than just avoiding and treating lower back pain. It has been proven to be effective in preventing, halting and even completely reversing the chronic diseases that are the responsible for 14 of the top 15 causes of premature death and disability in the US.

      I strongly recommend watching as many of the videos on this website as you can. There are hundreds of hours, so it would be no small undertaking to watch all of them. But Dr. Greger has helpfully organized them into different health topics. Click the “Health Topics” link at the top and then navigate to the topics of most interest to you. The videos listed might not seem like they directly address a given topic, but are included in that health topic because the results of the studies summarized in those videos also have direct bearing on the given health topic.

      1. Amazing detailed information Jim, thank you for taking the time to explain. Many things that my body had been telling me over the years, was my queue, but I didn’t listen enough and now am quite ill.

        I was reading about your wifes RLS, and I know mine may have been a less serious case but I was also able to resolve my problem by doubling my hydration. It took 3 weeks after having it between the age of 28-42, I rarely have a situation when it keeps me up unless I realise I didn’t hydrate sufficiently that day.

        I appreciate how you express the discomfort your wife has been going through, and it’s wonderful to hear your support through and through. It makes so much of a difference, even when I read it all the way from Australia :-)

        • Reply•Share ›

    2. Amazing detailed information Jim, thank you for taking the time to explain. Many things that my body had been telling me over the years, was my queue, but I didn’t listen enough and now am quite ill.
      I was reading about your wifes RLS, and I know mine may have been a less serious case but I was also able to resolve my problem by doubling my hydration. It took 3 weeks after having it between the age of 28-42, I rarely have a situation when it keeps me up unless I realise I didn’t hydrate sufficiently that day.
      I appreciate how you express the discomfort your wife has been going through, and it’s wonderful to hear your support through and through. It makes so much of a difference, even when I read it all the way from Australia :-)

  17. My only issue with this article is that it does not take in account all of the biopsychosocial factors that contribute to low back. Most low back pain is non-mechanical in nature and it has been shown in numerous studies that disc degeneration/arthritis does not equal pain. Pain is much more of a response from the brain than it is an indication of damage on structures aka Pain does not equal damage. I 100% agree with everything here, but state that diet reaches far more than just decreasing damage on tissue, which is how plant based diet truly helps with low back pain.

  18. I suggest looking at a recent book “Vitamin K2 and the Calcium paradox.” It may explain the circulation

    problem and osteoporosis… check it out.

  19. I was skeptical at the title but the notion of blood flow to parts of the body is convincing. However, after 20 years of lower back pain, sometimes debilitating, I happened to try sleeping on the floor for a week. I’ve been pain free for six years now. I’m convinced that our style of mattresses are killing us, slowly, as a chronic cause (like animal protien to arthritis). I regularly sleep on the floor and my back is great.

  20. I am a chiropractor, and after being in practice for 40 years I think it is very likely that poor circulation is a cause for the need for so many joint replacements.

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