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Do You Meet the Simple Seven?

In public health school, you learn there are three levels of preventive medicine. Primary prevention would be like trying to prevent someone at risk for heart disease from getting his or her first heart attack. Secondary prevention is when you already have the disease and are trying to prevent your second heart attack, and tertiary prevention is like cardiac rehab, where you’re just trying to reduce the complication rates. A fourth level was suggested in 2000, quaternary prevention, trying to reduce the damage from all the drugs and surgery from the first three levels. But people seem to forget about a fifth concept, introduced by the World Health Organization back in 1978, termed primordial prevention, which is being embraced by the American Heart Association’s 2020 strategic impact goals

Primordial prevention was conceived as a strategy to prevent whole societies from experiencing epidemics of the risk factors. The corresponding strategy at the individual level is to prevent the development of risk factors. Instead of trying to prevent someone with high cholesterol from getting a heart attack, why not prevent them from getting high cholesterol in the first place?

So, the American Heart Association came up with the simple seven, featured in my video, How Many Meet the Simple Seven?. These health behaviors or factors include not smoking, not being overweight, being “very active” (defined as walking at least 22 minutes a day), eating a few fruits and veggies, having below average cholesterol, normal blood pressure, and normal blood sugars. 

Their goal was to reduce heart disease deaths by 20% by 2020. Why so modest an aim? An improvement of 25% was deemed “unrealistic,” and 15% was considered insufficient; so, they decided on 20. If 90% of risk can be thrown out the window by engaging in simple lifestyle modifications, why is just 25% considered unrealistic? To understand, one must realize just how bad our diets have gotten.

The most common reason patients give for not complying with a cholesterol-lowering diet may be the presumption that they’re already eating healthy and so don’t need to change. But if you look at the status of cardiovascular health in U.S. adults, only about 1% of Americans have a bare minimum of healthy eating behaviors, such as five-a-day fruits and veggies, eating beans, whole grains, and drinking less than three cans of soda a week. What percentage of Americans hit all seven of the simple seven? 14,000 men and women were surveyed, and most had two or three, but hardly any had all seven simple health components. Just how low a prevalence was having seven out of seven? Only about 1 out of 2,000 Americans had all seven factors intact. And the one they were missing the most was diet.

Unfortunately, unhealthy behaviors extend into the medical profession. Just like smoking doctors are less likely to tell their patients to stop smoking, and couch potato docs are less likely to push exercise, or things like more fruits and vegetables; we need to role-model healthy behavior. This greatly enhances our credibility and effectiveness. Gone are the days of traditional authority when the fat physician, dropping cigarette ash down his gravy-stained vest, could credibly prescribe a change in behavior.

So What Diet Should Physicians Recommend? Watch the video!

Lifestyle medicine, the use of diet and lifestyle changes to prevent and treat disease, can be not only cheaper and safer, but also more effective. See, for example:

I’ve previously noted just how sad the Standard American Diet is in Nation’s Diet in Crisis. See how you compare: Calculate Your Healthy Eating Score

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 DeathMore 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.


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.

67 responses to “Do You Meet the Simple Seven?

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  1. We keep forgetting that most doctors do NOT have adequate nutrition knowledge, therefore that can’t effectively and efficiently correct a patient’s diet.
    What they can and SHOULD do is refer patients to a qualified dietitian/nutritionist.
    Unfortunately, people dismiss the idea of nutrition education or take it into their own hands by reading and following advice from questionable sources. Dietitians are often consulted when it’s already too late in the game or when a chronic disease is very advanced.

        1. So in your professional opinion if I am already eating a low-fat (about 10%-15% of calories), adequate protein (10%-15% of calories), whole food plant based diet high in leafy greens, whole grains, legumes, colorful non-starchy vegetables, fruits, and small amounts of high fat foods like nuts and avocado, with no refined sugar or refined oils, and no dietary cholesterol, that I would make my diet even healthier if I added lard to it?

          Can you explain to me the biochemical pathways that the added lard will improve my health. Again note I do not eat any refined oils. Not olive oil, not coconut oil, not canola oil. None. Lard would not represent a replacement for a current fat, but rather an addition to my current diet.

          1. I was being sarcastic about lard. Under no circumstance should you include lard in your diet and expect health benefits. Oils are better. Everyone needs a certain amount of fat, they don’t necessarily have to come from oils though. They can come from fish, nuts, seeds, avocado. Lard, butter and other saturated fats should be avoided. The point I was trying to make is that olive oil is NOT bad for you, but you don’t have to use if you chose not to, as long as you do include some healthy fats in your diet. I hope that clarifies it.

              1. Extra virgin olive oil is not heavily processed. The olives are crushed and the oil comes out. There are many studies showing the benefits of evoo.
                john s

                1. John: For olive oil, you take a whole product like olives and you suck out/press out/extract the fat. That’s pretty high processing in my book. It’s no different than pulling the carbohydrate out of beats (making sugar).
                  So, olive oil is highly processed/not a whole plant food. Who cares if it is health promoting? Sadly, the science on it is pretty damning. The studies that I have seen promoting olive oil (even extra virgin) are usually reporting relative results. In other words, olive oil is a healthier choice *relative* to even worse junk food – like say butter and other highly saturated and animal fats.
                  Providing a relative benefit doesn’t make olive oil (even extra virgin) actually healthy: Not if it is still promoting heart attacks. Not when the alternative foods are whole foods like whole olives, flaxseeds, kale, apples, etc which actually reverse heart disease. The only diet ever proven to reverse heart disease, the number one killer in America, is a low fat whole plant food based diet. To my knowledge, neither of the two researchers who proved this diet allowed oil of any kind. (Though I’m less sure about Ornish than I am about Esseslstyn.)
                  NutritionFacts has several videos about olive oil where you can learn what the science says about olive oil in and of itself. Of particular interest is the series on the Mediterranean Diet. I also highly recommend the following short video from Jeff Novick, who does a great job of putting olive oil into perspective:
                  There’s this one too:

                  1. When you crush olives, you get extra virgin olive oil.
                    When you crush beets, you don’t get sugar. You get beet juice. It’s red. It has antioxidants in it. I would still rather eat beets. You have to highly process them to get white sugar. I don’t like white, highly processed sugar.

                    I am not saying that people should not eat olives. I am sure that I eat more olives than 99% of all Americans. I prefer the whole plant food. However, people on this site are always complaining that people don’t eat this way. The meals have to be prepared in a way that tastes good, or the people we are trying to persuade won’t eat whole plant foods. Olive oil is useful in a culinary way that you can’t use olives.

                    I realize that there are people on this site who say that reversing heart disease is the only important health task. I realize that there are people who say you can eat as much flour as you want and sugar doesn’t cause health problems, but you can never, ever eat a drop of oil. I have to look at the totality of the evidence, not only look at what vegan doctors say.
                    John S

                    1. John: “I have to look at the totality of the evidence…” Does the totality of evidence include watching the videos I gave you? Because that’s some pretty compelling evidence when compared to the pro olive oil arguments/evidence. It has nothing to do with “what vegan doctors say.” It is about examining the evidence…
                      In this latest post, you seem to be mixing up the concept of taste and “culinary usefulness” with health. “The meals have to be prepared in a way that tastes good…” Olive oil is not healthy. That doesn’t mean that people haven’t learned to like olive oil. I get that they do. People can also learn to love their food without olive oil. Lots of people already do that too. People who limit or abstain from oils water saute their food and make oil-less salad dressings (that are *delicious*). Enjoying food with or without olive oil is a choice, not a genetic directive that governs food enjoyment. Plenty of anecdotes show that once people get the oils out of their diet, they tend to find greasy food unappealing when they go back and try it.
                      Here’s where you and I might agree: You can legitimately make the argument that a little olive oil in the context of an otherwise very healthy diet of whole plant foods would not hurt. I would agree that that is true for most people. But that still doesn’t make olive oil healthy. It just means that you can have a small enough amount of oil to not hurt you. Just like you can have a small enough amount of sugar… Where I am disagreeing with you is in your original post where you seemed to be making the argument that olive oil, as long as it’s extra virgin?, is healthy. That’s a claim that is not supported by the evidence. Olive oil is slightly healthier than worse oil choices, such as butter or lard. Olive oil is not healthy in general, especially compared to unprocessed whole plant foods.
                      On a different topic, but continuing to address your latest post: I’ve never heard anyone on this site say that heart disease is the only important “health task.” Interesting that you have that impression or have seen it somewhere. In reading your statement, I reviewed my own expectations and concerns for nutrition and health. When I pay attention to how olive oil affects heart disease, I’m not thinking that heart disease is the only health problem. There’s also diabetes, for example, which would be negatively impacted by oils. ( ) I also have a concern for obesity in general, which is negatively impacted by oils. (See the third video I shared.) I’m concerned about the many nutrient deficiencies faced by people, which can be caused in part by eating nutrient wastelands like oil. (see the first Jeff Novick video) Etc. In other words, I agree that heart disease is not the only issue. But this site hardly focuses only on heart disease. And neither do I. And the problems with oils go far beyond heart disease.
                      The reason heart disease is often mentioned when talking about olive oil in particular is because of the common myth (heavily marketed) that people think that olive oil is heart-healthy. In other words, heart health seems to be the reason people turn to olive oil. If they understood that olive oil is not particularly heart healthy, then they might be able to get to the point where they can take in all the reasons olive oil is not healthy.
                      It is also interesting that you think that people on this forum say that sugar doesn’t cause health problems and you can never, ever eat a drop of oil. I’ve never seen anyone claim that sugar doesn’t cause health problems on this site. Though I could easily have missed or forgotten such a claim, I know it is not a common claim. What forum participants tend to claim is that sugar does not cause diabetes. That’s not the same as saying that sugar is healthy or even neutral.
                      The only time I’ve seen someone say to “never, ever” have a drop of oil is when we are talking about someone with severe heart disease. The rest of the time, the “no oil” message is about helping people to understand how unhealthy oil is. That doesn’t mean that a few drops of oil, say drops of sesame oil on occasion, is going to be a problem for most people. A few drops of sesame oil is even an ingredient in one of Dr. Greger’s soup recipes if I remember correctly.
                      Bottom line: Based on your post above, I would say that you have a very different understanding of the health messages promoted on this site than I have. If you are interested in understanding the big picture promoted by this site, I recommend reading the book How Not To Die, paying particular attention to the information shared in Part 2.

                    2. As you know, I have already read How Not To Die. We have discussed it previously. I have also read a lot by Michael Klaper, and I know what he’s about. I examine the vegan evidence, but I also look at the non-vegan evidence. That is something that apparently very few people on this site are willing to do. I am not trying to join a vegan “club” that battles non-vegans. Squeezing lemon juice out of lemons isn’t highly processed food. Squeezing olive oil out of olives isn’t highly processed food. I get that you continue to say that olive oil isn’t healthy. The amount is rather important. I understand that we disagree. John S

                    3. John: I deal with so many people on this site that I am not able to keep track of all the conversations I’ve had. Your own comment made me think you were unfamiliar with Part 2 of How Not To Die. Glad you have read it.
                      I’m very curious how you think olive oil has anything to do with being a vegan issue. If it were a vegan issue, wouldn’t all the “vegan doctors” be promoting olive oil? Olive oil is vegan and an alternative to animal oils. If you haven’t seen Jeff Novick’s videos (he’s an RD), it’s worth a look.
                      As near as I can tell, this is not a vegan issue. This is a health issue. That said, to address your comment: I think lots of people here look at the “non vegan evidence.” They talk about it all the time, and we have people who participate here who are also followers of people like Mercola, a man who promotes and even sells meat. As I’m guessing you know, Dr. Greger himself examines the pro-meat, pro-dairy, and pro-egg evidence all the time. I myself have spent a fair amount of time on sites like the Weston Price Foundation and Mercola’s site and even some time on Denise Minger’s site.
                      I consider all fruit juices, whether from olives or lemons or apples, to be processed foods. You don’t. It’s just a word at this point. Whether ‘processed’ or not applies to olive oil is pretty irrelevant to the main point of whether or not the product is healthy. For the health thing, I provided a whole lot of evidence…

                    4. You said olive oil is “highly processed”. I don’t see how crushed is highly processed like white table sugar. Olive oil has polyphenols in it, especially evoo, and is a mono unsaturated oil. I don’t use very much.

                      My issue with the vegan doctors is that they ignore huge areas of evidence that is cited by non-vegan doctors. I have been put down on this site for defending Dr. Greger too much and not citing his bias due to veganism. To be fair, most of the paleo doctors fail to cite the evidence that the vegan doctors cite.

                      Klaper’s video wasn’t new. There are many good points in it, but I’ve seen them a zillion times before. I just look at evidence from both groups of doctors because they don’t mention the evidence that makes their side look weak. I think weighing the evidence from scientists who aren’t vegan activists gives me a broader picture and more information. I don’t have to worry about their hidden agenda. Then I can decide by myself instead of having you decide for me.
                      John S

                    5. John: You are welcome to your opinion on whether olive oil counts as a processed food or not. Using the ‘processed’ description is pretty much semantics for the point in hand. To my knowledge, there is no legal definition for the term ‘processed’, and I respect that you have a different opinion on whether the word applies to olive oil. The word doesn’t matter. Isn’t the real point of conflict whether or not olive oil is healthy? That’s where the evidence is important, and what I have been trying to stay focused on.
                      The issue I take with your latest post is labeling Dr. Greger a vegan activist with a hidden agenda. You said you read How Not To Die, so you know that description is clearly not true. For example, a “vegan activist” would not point out pro-dairy studies or explain when eating bacon is a good idea. Also, Dr. Greger explained in the book where his motivation comes from. If you need a reminder, I can find one of the videos on this site that talks about Dr. Greger’s grandma. Bottom line is that it is not appropriate to write falsehoods about someone on this forum. I say that as a moderator. You are entitled to your opinion about the information on this site. You are not entitled to make things up about people, including Dr. Greger.
                      To get back to the discussion: By your definition, the paleo people are meat activists. If you want to believe (falsely) in your heart that Dr. Greger has a hidden agenda, then you ought to recognize that the paleo people have just as much of a hidden agenda/bias also. You ought to be just as “worried” (aware?) about the validity of their material, which as you admit, is not actually backed up by solid evidence…
                      I’ll mention again, because you didn’t acknowledge the point: The topic of olive oil is not a “vegan topic.” Olive oil is a (processed) plant food. The whole side discussion about “vegan doctors” is particularly irrelevant as near as I can tell.
                      As for deciding anything for you: That’s never my intention. I’ve done nothing but respond to the points of your post, because you wanted to have a conversation with me. You replied to a post I made some time ago and in your post, you made claims that you did not back up. “There are many studies showing the benefits of evoo.” My replies have included a) providing the evidence showing that olive oil is unhealthy and b) directly addressing the concept behind studies which show olive oil benefits.
                      It’s your choice to eat as much fat as you want. I’m not trying to get you to stop eating olive oil. Saute and drench your greens all you want. I don’t care. I eat olive oil myself sometimes. I just don’t kid myself that it is healthy. Of course, you will decide for yourself (based on whatever criteria makes sense to you) if you think olive oil is healthy. If you want to make up your mind based on all the evidence, you might check out Jeff Novick’s videos as well as the videos on NutritionFacts which I referred you to. Good luck.

            1. OK, same question. You say that olive oil is not bad for you. How does adding olive oil to a diet that doesn’t contain any refined oil represent anything other than a reduction in the nutritional content of the total diet, and how can this not be bad for you?

              Whole foods contain varying amounts of non-caloric micro-nutrients, even animal foods, though those tend to have very bad micro-nutrient to calorie ratios. Whole plant foods in general have high micro-nutrient to calorie ratios. Thus any isocaloric addition of a nutrient free food like refined oil to a diet that initially contained only nutrient dense food must result in an overall reduction in the total nutrient content of the diet. Thus adding olive oil makes your diet less nutritious and so is bad for you.

              Also food is a total package. You maybe focusing on the DHA and EPA in fish, but you also get the cholesterol, saturated fat and animal protein that is also in the fish whether you want them or not. Plus many fish have high concentrations of mercury, PCBs, and/or other persistent toxins that bio-accumulate in the fish and thus will bio-accumulate in you.

              1. To truly understand a complex subject such as nutrition or human anatomy, it takes years of studying and practice. For me to try to summerize it within a few paragraphs here it would be impossible and raise even more questions. I do understand your logic and although in this case it is faulty, at least you are trying to make sense of it all and that’s a good thing. If you really want to have a deep understanding of the subject I would suggest enrolling in some accredited nutrition classes. I strongly believe that it should be taught in high school or even earlier. Unfortunately most education people get on the subject is from internet sources. I don’t want to put people down. Again, it’s awesome that people are taking an interest in it but it’s a whole lot more complex than most people imagine. It’s as if you read a lot on how to fly a airplane, but unless you go to school for it and PRACTICE it you will never be able to take off and land safely. Please take this as an advice and not as criticism

                1. Nikk luliu Crisan: I advise you not to use your education as an excuse not to reply to the content of someone’s post. The people on this forum range from biologists to doctors to RDs to people who call themselves nutritionists to nurses to every kind of lay person imaginable, including those who have studied this material in depth. We are all here to learn from each other regardless of our educational backgrounds.
                  There are people on this site (I’m not one of them) who will understand very technical replies–though many of us appreciate it when a topic is put in layman’s terms. If you post an opinion about nutritional science that is contrary to what someone else understands about the science, be prepared to be challenged. An appropriate response would be to explain your statement with supporting scientific evidence or to admit that you were wrong. Or you can choose not to reply at all. To say, “I know more than you. This subject is too complicate for you to understand.” is a very weak reply and not very respectful, especially when you know nothing about the background or knowledge of the person you are replying to. It is also contrary to the purpose of the forum. If you are not prepared or interested in replying, then no reply at all would be better than the replies I have been seeing from you.
                  I give this advice as a moderator of this site and as a person who has been participating for years.

                  1. I agree. No answer is better than participating in amateurish, uninformed posts. Silly of me to let myself be dragged in these conversations. I’m unsuscribing from it. All you pseudo scientists can have at it. Tata

                2. So basically you don’t have an answer as to how adding olive oil to a diet that did not already include refined oil or rendered animal fat healthier and instead you elected to talk down to me by saying that without your lofty background and practice I just wouldn’t understand. My PhD adviser made it very clear to me that if I couldn’t explain the results of my research at least in a summary way to a well educated person not in my field, then perhaps the fault lay with me and not the other person. So if you can’t give a high level answer to my question, perhaps you don’t understand the material quite as well as you think you do.

                  While it is true that my PhD is not in human nutrition, my training does allow me to understand the scientific method. Having been through the peer review process many times as both an author and reviewer has given me the insight required to read scientific papers critically, to see where their strengths are, where their weakness are, where biases and conflicts of interest can distort data and conclusions, and where the authors gloss over negative results and make unwarranted leaps from data to conclusion. I have applied that background to my study of human nutrition over the last 4 years. That study, as you say, does pull from internet sources such as NutritionFacts, but it also comes from reviewing hundreds peer reviewed papers related to nutrition. So perhaps not as structured as yours, my education in nutrition is not without rigor or discernment. As such I think you might be surprised how much of a technical explanation I am able to understand.

                  And even if I don’t understand your answer, there are dozens of health and nutritional professionals that participate in these discussion pages that will. So go ahead and give it your best shot.

            2. I would like to throw in here that there is sufficient fat in vegetables to account for sufficient fat needs in the diet. Broccoli is 10% fat, spinach 15% fat, asparagus 5% fat, winter squash 3% fat, kale 12% fat. The fish, nuts, seeds, avocado, olives are all extremely high in fat. It isn’t necessary to worry about including those foods to “get enough fat” in your diet. If you eat vegetables – all vegetables – and a variety of vegetables, there is no need to “add fat”. It’s built in already.
              Gosh, . . we don’t see elephants, elk, deer, giraffe’s, chimps, rhinocerous, rabbits, etc. wringing their collective paws (etc.) worrying about their fat source. It is already there.
              You can check out the fat content of any vegg you choose easily at this site:
              It will show you not only the fat but calories, protein (complete in vegetables), carbs, vitamins, minerals, etc.

              1. Re your points:

                1) “there is sufficient fat in vegetables to account for sufficient fat needs in the diet. Broccoli is 10% fat et. c”.
                Where did you get that information from?
                According tp the USDA National Nutrient Database for Standard Reference Release 28
                raw Broccoli contains less than 0.4 gram total lipids per 100 grams?

                Nutritiondata.self obtains its data from the USDA database so it should be the same.

                2) “elephants, elk, deer, giraffe’s, chimps, rhinocerous, rabbits, etc. (aren’t) wringing their collective paws (etc.) worrying about their fat source.”

                I think they are all herbivores, except the chimp, so there is just nothing much to learn from the comparison. The chimp is a distant cousin so it is the exception. I think the ratio of our colon/small intestine is much less than theirs …. somewhere along the line we evolved to having a shorter colon with most of our nutritional punch coming from the small intestine. Some suggest that occurred because of the addition of nutrient dense animal products to the diet, others that cooking made more more nutrients available from our food. Of course farming skills could have also had the effect of providing more consistent supplies of nutrient dense plants.

                If you look into it I think you will find Chimps et. c have longer colons than us and hence the herbivorous plants they eat have more time to ferment, the by products of which are short chain fatty acids. Of course we still do that to some extent. In man there is some disagreement about how the fatty acids are used …… the liver can convert some to glucose but my hunch is that some are also used as ketones (nerves and brain are built on ketones?)

                One thing for sure … mankind survived 1000’s of years because of dietary adaptability.

                IMO the diets of animals, our ancestors or ancient people who survived in niche environments aren’t entirely relevant to modern Wo/Mankind ….. we are living in unprecedented times. Avoiding man-made non-nutrients is just as important as sourcing optimum nutrients.
                What is helping or harming our health, in our fast paced, information intense lives, can only be revealed by our individual responses, analysis of our biomarkers and observation of our ke metrics e.g. vascular health.

                1. rada: Human colons are more like herbivores than anything else. The following page contains a nice table for comparing human anatomy to categories of other animals:

                  When looking at how much macro nutrients a food has, it is helpful to look at it in terms of percentage of calories. So, 100 grams of cooked broccoli has 35 calories, 3 of which come from fat. If my math is right?, that’s 8.6% fat. I would have said 8 or 9 percent and not rounded up myself. But 10% isn’t too far off in my opinion.

                  I’m not making an argument about whether broccoli has enough fat for certain needs. I’m just explaining where the number comes from.

                  1. Addendum: I just realized that NutritionData’s ‘calories from fat’ at the top of the page is not all that precise. So, if you look up 1/2 cup/78 g of broccoli, it still says that you get 3 calories of fat from 27 calories, which is about 11% fat. So, saying that broccoli is about 10% fat is probably close enough.

                    1. Thea,

                      Not to worry.
                      I think I understand you quite well and your meaning always comes across clearly.
                      It’s just a friendly exchange of opinion and resources … we are not writing our theses so there is room for error :-)

                      The reason I post is to provide another perspective and it’s socially healthy to interact with others with divergent viewpoints … so you’re doing a good job from my perspective.

                  2. Thanks Thea,

                    The anatomical comparison is interesting…. I’ll put it on my reading list.
                    Given that we are genetically closely related to one line of chimps it’s no surprise that we are anatomically similar in many respects.
                    According to evolutionary theory I assume that we are likely to have adapted our chimp features only in those areas that gave us a significantly improved chance of survival?

                    I’m not primarily trying to ascertain whether I am pre-disposed to plant or meat eating but rather to understand what the nutritional impact will be, for me, if I adopt either position.
                    So, in the context of this discussion my contribution is to share the observation that the research indicates that fiber filled diets reduce feelings of hunger therefore we must be getting some energy from the by-products of fermentation. The science further confirms the mechanisms, or possible mechanisms, for this.
                    Some research also indicates that plant food fibers are more efficient in this regard than supplemental fiber isolates.
                    My own personal experience confirms this i.e. I have tried increasing the amount of raw high fiber foods in my diet and felt the outcomes were good.

                    Re: “So, around 10% of the energy in broccoli comes from the fat.
                    I’m not making an argument about whether broccoli has enough fat for certain needs. I’m just explaining where the number comes from.”

                    Fair enough.
                    I think you have highlighted the crux of the problem.
                    I’m of average height/weight for a male, albeit an older one, but I am very active so mu calorie needs are probably above average.
                    Using Broccoli as the example, I would have to eat in excess of 6 kilograms per day to meet my energy needs…. not much fun or social licence there. So, t have to make choices about which of the energy dense foods I will eat to get my carbs up in a 39 min meal break?
                    For plant eaters the oily fruits and nuts are obvious contenders but Esselsteyn says no.
                    If we look at his protocol it had a lot of variables, some of them uncontrolled, but judging from his diet boo the most significant change in their diet was increased plant fiber (Esselstyns diet == the Kale diet?). So, once their gut adapted, they got a lot of fat from colonic fermentation?
                    If, for the sake of the discussion, we leave out the environmental risks associated with animal foods (endotoxins, pathogens et. c) then for non-vegetarians they have plenty of choice when it comes to energy dense food.

      1. Actually I DO know. I’m a college educated nutritionist. I spent 4 years of my life learning how to deal with people that question our qualifications. No matter what I will say here I’m certain that you know better than me and everyone else who takes science seriously. We don’t keep up with Dr. Oz so me must know nothing

        1. I read some of your other comments and still believe that you have much to learn even given the little we do know about nutrition. Your attempt at humour about switching from olive oil to lard says mountains about what your degree is worth!

          1. Yes I agree. My degree is not in comedy or creative writing. I lack in that field. Yet, I will express my opinion (and my frustration) about people who think that somehow dietitians are there to trick people. I, along with my colleges went to school to help people, not to push some special interests’ agenda. We learned to refute terrible information, and get people on the right track to the best of our knowledge, yet we constantly have to fight people that most need us

            1. Your certifying organization took donations from McDonald’s, Coke and Pepsi but I think what takes the “cake” is their public statement that no food is bad or good. No need to rebuttal with the rest of that statement that their are only good and bad diets…
              Considering that the donations were a mere million dollars such a large organization given what should be their purpose in life should have turned down those particular donations. And valid research does indicate that there are good and bad foods…I will not go so far as to say we should focus on today’s super foods or as they recommend consuming soy two or so times daily but for sure there are good and bad foods.

              1. Maybe Nikk might agree that there are better and worse foods.

                Between olive oil and lard, it’s a wash to me, but Nikk seems to note a difference in lard’s favor. What studies might lead to that conclusion?

              2. Just because there are unscrupulous people within an organization it doesn’t mean you should discredit a whole branch of science. There’s going to be corrupt, imoral doctors that will push medicine on you for comossions from pharmaceutical companies. Yet that doesn’t mean that modern medicine is completely corrupt and useless. Does it?

                1. Your sentence confused organization and science relative to my comments. Concerning nutritional science I think it will be 100 to 500 years till we really know the story but I have no problem with trying to learn.
                  Modern medicine is nearly useless. Would you like to try to prove that heart surgeries like bypasses and others are “curing” heart disease or leading to longer and healthier lives? Do most drugs that are pushed on people actually work better than diet changes would?
                  Are people living a longer useful life than in 1970 or just a longer life? The answer is not a pleasing reflection on the medical field, the government or the food industry. Useful life has in some quarters a very simple definition and people in 2015 are not doing as well as those in 1970 before all the “good” things happened to our food supply and behavioral customs which focus on sitting rather than even moderate activities.

        2. ‘We don’t keep up with Dr. Oz so me must know nothing.’

          As a long time follower of Dr Greger and decades-long enthusiast of nutrition znd healthy lifestyle, I take great offense to your statement above. You have made a sweeping (derogatory) assumption of our character and knowledge here on this forum.
          We may not know it all, but you will find here people that are willing to spend time, and a great deal of effort in shaping their own health destiny.

          shame on you for your dismissive quip

          1. The comment was directed at the people that attacked and dismissed the nutrition science opting instead for pseudoscience. It is insulting to have a degree and years of experience completely dismissed by people that think they just know better because they read something somewhere. You would feel the same and perhaps react similarly.
            There is no other field where people are more opinionated than the nutrition field. It’s hard to always be able to keep calm and answer politely. I don’t think you should personally feel insulted, since it was not you who tried to discredit science (at least not in a conversation with myself) so my comment was not addressed to you.
            If you go to a doctor’s office and start questioning his training and tell him that you read something on WebMd and you think his diagnosis is faulty and you know better, I wonder what his/her reaction would be…try to see that side as well

            1. If I went to a doctor and he told me I need to take a drug for heart disease or diabetes I would find another doctor. I will never have a stent or bypass so I guess I do not believe all doctors know more than I do just because I did not attend medical school. I believe a person can know more about nutrition than most doctors by reading Drs Fuhrman, Ornish, Esselstyn, and Greger along with the Blue Zones, China Study, Forks Over Knives and the Okinawan Diet. It will take much less than four years and costs is minimal compared with medical school.
              I do not really knock your profession but I am sure that if you really think about it many of the courses in a four year program were fluff and not related to good nutrition…I am a scientist but biology and chemistry are not my forte yet I do not really think they are necessary to learn from others about nutrition rather than doing the research in a lab.

  2. I don’t know if I’m carb-phobic but I find that heavy carb tends to bloat me and I’m not walking 17 miles/day like the good doctor. Perhaps I have an irrational fear but I try eating well for awhile and then inevitably fall off the wagon. Still trying, I totally buy into the science, just seems to be hard to put into practice. Appreciate all the work you do and I do have the book.

    1. Slick, it’s a minimum of 22 mins a day, NOT 17 miles a day! Also, speaking from experience, evolving from the SAD diet to a healthy diet is not necessarily a straight line up. It’s the trend that is most important. The question is: are you just ‘interested’ or are you ‘committed’?

    2. I would recommend challenging your system with one type of high carbohydrate food at a time to see if different types of whole foods high in carbohydrates effect you differently. And I would highly recommend that you don’t put any fat on the food, since significant amounts of fat can causes mild nausea. I know for certain that the queasy feeling I get after eating a big bag of popcorn at the movie theaters has nothing to do with the carbohydrates in the corn and everything to do with the fat it is cooked in. So maybe try a couple of large plain baked sweet potatoes as the only food in a given meal and see how you feel. Then try meal completely composed of other high carbohydrate foods and see how they make you feel.

    3. When you say “heavy carbs” I wonder the volume of whole food carbohydrates you are eating at one sitting. Dr. John McDougall suggests that you fill your plate from 1/3 to 2/3 with carbohydrate foods such as rice, yams or beans, and the remainder with vegetables, that means that from 1/3 to 2/3 of your meal would be non-starchy vegetables such as broccoli, mushrooms, cooked kale, onions etc. If you are eating salad, the veggies are a much larger percentage of the meal. This ratio of cooked veggies to carbs give you an idea of how much carbs to eat at a meal. You can eat as much healthy carbs as you want, just balance it with a similar amount of vegetables. Also, as Jim says, fatty foods like oils and nuts will slow the digestion. Personally, I find yams and potatoes and winter sqashes like delicata to be more easily digested than rice or bread.

      If your digestion is sluggish, choose fruit for between meal snacks, and /or have one meal a day that is mostly fruit. Also, drink plenty of water, for me that is about eleven 8 oz glasses a day. I do this by drinking a lot of water when I get up, and some every hour or so except for right after meals.

      Remember that the ideal daily intake of vegetables and fruits is upwards of 8 servings a day.

      1. Lilyroza – just wanted to thank you for posting. I am WFPB in diet but do feel like my system is sluggish sometimes . .. like slow transit time. Sometimes my abdomen feels so big and full but it been a while since eating and I feel hungry. Conflicting feelings at the same time. So perhaps not enough exercise. So I appreciate hearing your suggestion and am going to try them. Especially the water. Also, one thing I’ve been attempting is to eat on the earlier side – 5pm-ish or sooner rather than later – and then don’t eat again until the next day. Try to get 12 hrs of fasting time in. That seems to help too.
        Thanks a lot!

        1. I agree that exercise will definitely help tone every part of the human body. 20 minutes per day walking (outside of normal daily activities) is the minimum exercise recommendation, but keep in mind that 1.5 to 2 hours of exercise, including 1/2 an hour aerobic, is optimal for health. Also digestion and assimilation will be probably be improved by not overtaxing the sytem, ie, follow the Okinawan principle of Hara Hachi Bu.

  3. The levels of prevention presented in this article are generally (where secondary prevention interventions “are trying to prevent your second heart attack”) used by doctors who mainly treat disease/sickness. The public health, preventive medicine, and medical dictionaries use definitions like “Secondary prevention generally consists of the identification and interdiction of diseases that are present in the body, but that have not progressed to the point of causing signs, symptoms, and dysfunction. These preclinical conditions are most often detected by disease screening (and follow-up of the findings)” or “interruption of any disease process before the emergence of recognized signs or diagnostic findings of the disorder’. That is, early detection and prompt, evidence-based management. The preventive medicine approach would classify prevention of a second heart attack and cardiac rehab both as tertiary prevention.

    Vince Fonseca, MD, MPH, FACPM

  4. Hello,I am looking for something that can help Leber hereditary optic neuropathy (LHON). Only drug called idebenone has any effect at an early stage. Thank you.

    1. I don’t know anything about LHON, other than a quick synopsis I read just now. But it sounds like a fairly gradual degradation of the optical nerve. As such I would not be surprised in the slightest that chronic, systemic inflammation and/or oxidative stress didn’t play an important role in the progression of the disease. Of course inflammation/oxidation can’t be the sole causative factor since most of the population eats a highly inflammatory, very low anti-oxidant diet and thus LHON and other diseases would be rampant if it were. But that doesn’t mean that inflammation/oxidation in those with a genetic predisposition isn’t a key factor in whether the disease presents in the first place and determines the rate of progression once it does.

      A whole-food, plant-based diet is probably the most anti-inflammatory/anti-oxidant diet known, and so if inflammation/oxidation is a factor, then a WFPB diet could be an effective treatment modality. The nice thing is that you don’t have to wait until it definitively shown that diet plays a role, because there is no medical downside to trying it. And even if a WFPB diet didn’t slow or arrest the progression of LHON, it is clearly effective in preventing, arresting, and even reversing all of the top chronic diseases that are the cause of so much premature morbidity and mortality. So there is no downside and only upside to giving it a try. Many people, including myself, report substantial improvements in energy level, mood and other measures of a sense of well-being after adopting this diet. So if absolutely nothing else, a WFPB diet could help with the emotional strength and energy required to cope with the disease.

      I hope this helps.

      1. Thanks for the reply.
        The disease is a rare form of CoQ-Cytochrome c-reductase, I think you’re right inflammation / oxidation affects speed of manifestation of the disease. I am vegan and ask for my brother. I am looking for something that helps the absorption of coenzyme Q. Or something favoring the optic nerve as blueberries, black currants, cabbage, collard greens, kale and leafy green for recovery of Q10-

        1. I’m going to echo the suggestion of greens, greens, greens. And the blueberries sound good too. I know that greens are supportive and preventative for macular degeneration. I’m also going to suggest that the deep orange vegg like sweet potato and winter squash with as much deep color as you can find. would be complimentary as other beta carotens (different from the ones in greens) are in the deep orange vegg. I’m going to also suggest one more possibility. Can-C eye drops. These are technically for reversal of cataracts and DO work. They work because the ingredient is an antioxidant. You can read about it here and decide how you feel about it. –

          Best of luck to you!

  5. I get 8. Besides all the above, I get a happiness from knowing I get the 7 every day. And I feel much better than I use to, when I was eating less. It seems like a lot, but if you get creative in the kitchen, you would be surprised how easy it is.

    Also, I started using an app to count calories (there are many apps available for this), but mine was on my Samsung Galaxy S5, called, S Health. When I started adding what I was eating and not eating, it was like a light just got turned on. Now, I can gage how much and what I am eating to maximize my daily nutrition and excercise.

    And one very important part of this equation; water. It not just for showers, dishes, clothes and car washes, to name just a few; it’s for life.

  6. Hi,
    could anybody refer me to the story about Dr. Greger’s grandmother amazing treatment?
    what kind of disease and treatment she had so that she dropped wheelchair and lived 31 more years?

    1. She was sent home and told to put her affairs in order i.e., die of cardiovascular disease. She was in a wheelchair. I believe she was in her 60’s. She researched Pritikin and went to his program (was it in California?) and walked out of the program. She died in her 90’s. Pritikins program is, in essence, the same or very similar to Greger’s, McDougall’s, Ornish’s, Esselstyne’s. I, personally, love this story because it tells you that it is not to late to change your diet and recover health. Dr. Benjamin Spock, also known as America’s Pediatrician, also switched to a whole food plant-based diet in his later years when he was having health problems. Many or most of his issues subsided (I think he was in his 80’s when he changed) and he advocated the diet until his death. He also advocated that a WFPB died is suitable and healthy for children. My cousin – 29 – never ate meat as she did not like it. In her early teens, she became vegan. At 29 she just gave birth to her healthy baby who will be raised vegan. I gave up dairy in my teens – couldn’t stand the stuff. Everyone tried to guilt me into consuming dairy because of my bones. At 63 I am a healthy, no bone problem, post-menopausal woman. However,! I DO exercise and use my body. I just completed a construction project on my house. I lift, I sit on the floor and get up from the floor often. I go to th egym and make my muscles work. THAT is the thing that keeps one’s bones strong – it is the muscle tension and stress on the bone that makes them strong and triggers the bone to create osteoblasts that build the bone. This is also one of the reasons that men suffer less osteoporosis – because they are stronger and put use-impact on their bones.

      1. Thank you. It is strange that this case (from wheelchair to a 10-miles-a-day-walking, from end-stage-heart disease to 31+ extra years) is not well documented.

        1. It IS well documented. It is not well publicized. Also not well publicized are the 20 death-ready heart disease patients of Caldwell Esselstyn, M.D.’s who were also sent home to die by their cardiologists. Dr. Esselstyne put them on the same (essentially ) diet as Pritikin and these people are still alive today – 20 plus years later. There is an exception of one who dropped out and one of whom died of other causes. Dr. Dean Ornish has had the same success and his program (same as Esselstyne, Mcdougall, Fuhrman, etc) is now formally being used by Medicare in certain states. The documentation is completely there and completely realistic. What is NOT THERE is insurance companies adoption of these health-providing programs . . . .and why not you might ask? . . .because if they – insurance companies can show HUGE costs then they can also charge HUGE premiums. I am not making this up and this is not conjecture. I spent decades in health care. The whole point is to charge lots of expense because they – the insurance companies – then, can charge YOU a lot.
          It is despicable.
          I am not someone who is going off on a rant here on this site. I am someone who has spent years in the health “care” industry in case management getting care for individuals while the insurance companies do not want to pay but are also not willing to provide preventative care. And preventative care is NOT a pre-cancerous xray of some sort. Preventative care is TAKING CARE PROACTIVELY FOR YOUR HEALTH BEFORE YOU EVER GET SICK. WAY BEFORE YOU EVER GET SICK. BEFORE YOU EVER NEED AN X-RAY TO SEE IF YOU HAVE A TUMOR.

          Follow Dr. G’s excellent recommendations. Stop disease before you EVER get it. And share this information with your family.
          The health insurance companies are NOT your friend. They do not care and they are interested only in increasing their broad and deep coffers. Do not be confused about this.
          Thank you.

  7. I’ve been hearing a lot about lectins in grains and beans. It’s so confusing. How unhealthy are lectins for you? How long does one have to cook something to reduce lectins to a healthy level? It seems there is such a lack of information on lectins. Please do a video or blog on lectins, I’m really confused!
    Thanks :)

    1. Hi, I am a volunteer for Dr. Greger. I would agree–a video on lectins would be quite helpful. With canned beans, you should not have to cook them at all, as the lectin content should already be low enough to be considered healthy. With other legumes, cooking them until they are soft enough to chew easily will lower the lectin content down to a healthy level. Just don’t eat legumes raw, of course. I hope this helps!

      1. Hiya – question – A green pea is a legume as are peanuts. I love fresh raw peas on my salad and just hate them cooked. Love raw peanuts as well and ate them by the bagfuls as a kid. What is the lectin situation in these foods (if you know). Thx.!

  8. It MIGHT be an advantage for a Doc to refer patients to a Nutritionist…IF you could count on most Nutritionists to know what they are talking about. Unfortunately, most seem NOT to know.

    One case in point: ask the RDs at Kaiser Permanente (the ones in the D.C. area) what to eat. They will advise you to eat a better version of a Western diet – not a plant-based or even a Mediterranean diet. “And don’t forget your protein! Cheese sticks are a good source!” If you confront them with the article from Kaiser’s own medical journal that suggests plant-based diets for their patients (written by Kaiser Docs – ya know, the ones who don’t know much about diet?) they will tell you, “Well, everyone has their own opinion.”

    And this again is a problem with most RDs. They don’t take the time to read current literature and are as a result grossly uninformed of the important developments in the scientific literature over the past 10 or more years. One example: many RDs tell patients “Don’t eat too much fiber!” – because they learned 35 years ago that a plant compound in fiber (IP6) binds minerals. If they had continued learning they would know that 1) this has proven to NOT be the case, 2) IP6 is a potent anticancer agent that should NOT be limited in our diets, and 3) our ancestors ate diets that contained as much as 150 grams of fiber per day – TEN TIMES what we are now eating. As Dr. Grieger has pointed out, practically 99% of Americans don’t get even the low amount of fiber recommended by the IOM.

    In an age where current evidence is available to EVERYONE who uses the Internet (and where articles that summarize the state of the evidence are in most cases free to download from the NLM) Nutritionists who give people incorrect and outdated info are basically committing a form of malpractice. In other words, if you’re not staying current, you’re part of the problem – not the solution. And you should stop advising people until you know what you’re talking about!

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