What’s the Optimal Cholesterol Level?

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What’s the Optimal Cholesterol Level?

No matter where we live, how old we are or what we look like, health researchers from the Institute of Circulatory and Respiratory Health have discovered that 90% of the chance of having a first heart attack “can be attributed to nine modifiable risk factors.” The nine factors that could save our lives include: smoking, too much bad cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and veggie consumption, as well as a lack of daily exercise.

Dr. William Clifford Roberts, Executive Director of Baylor Heart and Vascular Institute and long-time Editor in Chief of the American Journal of Cardiology, is convinced, however, that atherosclerosis has a single cause—namely cholesterol—and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we could be stressed, overweight, smoking, diabetic couch potatoes, but if our cholesterol is low enough, there may just not be enough cholesterol in our blood stream to infiltrate our artery walls and trigger the disease. Thus, the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.

It was not appreciated until recently “that the average blood cholesterol level in the United States, the so-called normal level, was actually abnormal,” accelerating the blockages in our arteries and putting a large fraction of the normal population at risk. That’s cited as one of the reasons the cholesterol controversy lasted so long—an “unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level.”

Normal cholesterol levels may be fatal cholesterol levels.

The optimal “bad cholesterol” (LDL) level is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that’s where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That’s what we start out at birth with, that’s what fellow primates have, and that’s the level seen in populations free of the heart disease epidemic. One can also look at all the big randomized controlled cholesterol lowering trials.

In my video, Optimal Cholesterol Level, you can see graphing of the progression of atherosclerosis versus LDL cholesterol. More cholesterol means more atherosclerosis, but if we draw a line down through the points, we can estimate that the LDL level at which there is zero progression is around 70. We can do the same with the studies preventing heart attacks. Zero coronary heart disease events might be reached down around 55, and those who’ve already had a heart attack and are trying to prevent a second one might need to push LDL levels even lower.

Atherosclerosis is endemic in our population in part because the average person’s LDL level is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn’t recommend everyone shoot for under 100 is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would “financially overload the health care system. Drug usage would rise enormously.” But, they’re assuming drugs are the only way to get our LDL that low. Those eating really healthy plant-based diets may hit the optimal cholesterol target without even trying, naturally nailing under 70.

The reason given by the federal government for not advocating for what the science shows is best was that it might frustrate the public, “who would have difficulty maintaining a lower level,” but maybe the public’s greatest frustration would come from not being informed of the optimal diet for health.

It’s imperative for everyone to understand Dr. Rose’s sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study can be found in Barriers to Heart Disease Prevention and Everything in Moderation? Even Heart Disease?.

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:


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.

422 responses to “What’s the Optimal Cholesterol Level?

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  1. My Dad recently had his first heart attack, with barely any of the 9 risk factors: non-smoker, normal blood sugar, normal weight/flat stomach, low stress, daily 45 minute exercise. Normal cholesterol according to doctors, but not as low as 150. Good fruit and veggie intake, but could use a little boost. Moderately high blood pressure controlled by taking one drug. The point I guess I’m trying to make is that close enough doesn’t cut it. If we really want to prevent a heart attack we need to go for perfection!

    1. Was/is he taking any over the counter vitamins or other supplements? I’m convinced these can sometimes cause heart problems. These health food store pills have no long-term data to back them up. Maybe they help some people, but some others, I think, suffer the consequences. Eat a natural diet as humans always have.

      I had terrible heart-eactions to B12 pills, all the different forms of the pill.
      Spirulina and chlorella caused issues. Check to see what sort of fortified foods he is eating, what’s in them, whats being added to his supplements, etc. Lots of this stuff being thrown into human gut…..not natural! Eat foods humans always have. Look to the longest lived cultures on earth.

    2. I would strongly encourage looking for clues as to why it happened because you can’t treat what you don’t know exists. There are a number of blood tests which might give clues e.g. test for inflammation (CRP) would be the most obvious. If you google blood tests for cardiac risk, you’ll find the mayo clinic lists several others. If those don’t show anything abnormal, perhaps a blood homocysteine might be helpful.

      A plant based diet should take care of many such issues, but if not, there are non-drug ways (e.g. food or supplements) to help with many such abnormalities.

    3. VegGuy: re: “…not as low as 150…” That’s a perfect example of what this blog post is getting at. I can’t find it right now, but one of videos or articles on this site talks about the average cholesterol level of people who have heart attacks is something like 170.
      I don’t know that there is a “perfect” when it comes to all factors and being healthy, but we do know that being close to the optimal cholesterol level is not protective. A person really must be under 150 total and LDL under 70, but probably even better if under 60. Thank you for sharing.

        1. WFPBRunner: You made me look. (sigh ;-) ) I was able to find the video where I got that number: http://nutritionfacts.org/video/heart-attacks-and-cholesterol-dying-under-normal-circumstances/ That’s why I think it is so important that people understand what the safe level really is. People with human normal cholesterol levels do not get heart attacks (baring some congenital defect). But people with “low” levels compared to other people in our sick/high society do get heart attacks.

          The paleo people are always coming on NutritionFacts explaining how some big percent, whatever they are saying that day, say 1/3, of people who get heart attacks have low/normal cholesterol. But this is not true. They actually have high cholesterol. It’s just that “high” is a lot lower than most people think.

          1. We need more research.
            No smoking
            Not overweight
            1 hour cardio daily
            No oil
            Cholesterol 170 or even 200.
            What is the chance of having a heart attack. We have posts from people all the time who are unable to get their cholesterol numbers to 150 and 70. But maybe if they the person described above they are still bullet proof. We need that study.

            1. Good points. Dr. Esselstyn says the MOST important thing is to not eat anything that will damage the arterial endothelium, which thins the cap over existing plaque, leaving it vulnerable to rupture. When that happens, a the plaque contents spills into the bloodstream, an instant clot is formed, which can totally occlude the artery. Eating plant based no oil diet with NO added salt, sugar, caffeinated coffee, nuts and avocado and other foods with significant saturated fat – will strengthen the cap over existing plaque and prevent more plaque from forming.

              1. One thing at a time….Esselstyn says no nuts, seeds or avocado…Studies and “How Not To Die”, support nuts, seeds and avocado as extenders of life!
                The Seventh Day Adventists that consumed nuts and seeds lived longer on average than vegans not consuming them.
                Always comes down to the same thing, we are many years, if not centuries, from knowing exactly how to eat!!!!

                1. It’s a little bit blurred: Dr. Esselstyn spook in his book always from his programm and there was the rule no nuts, no avocados and he recomment this for all people those are already have developed a heart diseases – for those they haven’t yet he said a smal range of nuts and a smal range of avocado is fine as long they have not a elevated lipid level. Now you can say in turns because most of the people have a cholesterol level higher then 150 mg/dl, that we are all in a hiher risk and should not take nuts, seed and avocados… but on the ohter side, you are right, the Seventh Day Adventists showes nuts are good. I beliefe the way is a bit in the middle. We should lower our lipid level by using as less as we can fatty nutritions (and nothing others says Dr. Greger and Dr.Barnard with sprinkle a hand full of nuts over your salad). I imaging my self sometimes 2.000 years ago going trough old good Germany and thinking, how much nuts I would find? Not so often, maybe seeds more but it will be cost me much effords to collect them… not like today, I go to the store and collect 500 g for little bugs. and can do this every day… You know what I try to say? Maybe today is the difficulty to resist not to collect. ;-)

                2. There’s also the matter of the studies that show benefit to nuts. Especially with SAD eaters. Replace some meat and cheese with nuts, and for sure, you’ll likely see a benefit. Even the vegan Adventists who are not ‘no oil’ because the oils are highly inflammatory with too much Omega 6, so if they have a few nuts the Omega 6:3 ratio may be much better, especially with walnuts at 4:1. (There are some nuts that are not so good like almonds 17 1800:1). Esselstyn said if he ever told anyone they could have 3 or 4 walnuts, pretty soon they’d have nuts all over the house! Many of us are not good with ‘a few’ and I’m one of them! But when I look at Esselstyn’s results, achieved by keeping fat under 10% (Ornish kept his patients to 10% or less as well) then my choice is to follow that protocol. We all have choices. Many, like me, at SAD all of my life, and I am in the process of reversal. And now we know the disease is ubiquitous. Dr.
                  E talks of the autopsies on the casualties of the Korean and Vietnam conflicts
                  – 80% of the young Americans had gross evidence of CAD while only 1-3% of the
                  Asian soldiers had it. And since then there was another study here of young
                  people who had died from suicide, homicide or accidents. ALL the young people
                  had gross evidence of plaque – not enough to have problems, but it had already
                  started. (I have the references if you want them)

            2. This paper, C-Reactive Protein, A Simple Test to Help Predict Heart Attack and Stroke.by Paul M Ridket MD MPH from Brigham and Womens Hospital, is where Im placing my bets WFPBRunner. The paper is a dowload so I cant post, but its worth the google to get it. 16 mos ago I read this and changed to wfpb to lower my inflammation.. during an incidental emerg room exam 8 mos later, the cardiologist said I had the lowest inflammation levels he had seen in his career. Go Broccoli!

              Under 100 mg LDL and under 1.0 hs-crp is a good place to be

              If you cant get the paper I will try to get a link

            3. WFPBRunner: I couldn’t agree with you more about needing a better answer to this situation. I heard a live talk from Dr. Klaper once where he basically said that if someone is really eating the low fat whole plant food diet, they don’t need to worry about the cholesterol level. But I don’t know what backs up that claim. Solid research? Clinical experience? Theory based on his understanding of how heart disease works? I *want* to believe that if someone meets all those criteria, the cholesterol level doesn’t matter. We need some good studies on it.

              1. I may not be the example you are looking for but I have had total cholesterol levels of over 300 since first measured in my early 20s. I changed my diet to that suggested by Dr. McDougall with the addition of no added fat including rarely having avocado, tofu, nuts or seeds. I have MS and diabetes which is why I eat so low fat. I had the plaque in my carotids measured by ultrasound, not just a flow study. My levels after 5 years eating WFPBNF are almost normal homogeneous which is the first level from normal where there are 5 levels. At 64 years old I am very happy since my cholesterol stays up without taking statins. I am happy to be off of 13 prescriptions.

                1. Donna Reeves: WOW oh WOW!!! What a great story. Thanks for taking the time to share. Due to our new comment section, we often aren’t informed when people reply to our posts. :-( I just happened to see your post just now by accident. I’m so glad I did. What a nice story to read. I’m happy for you and will keep your story in mind when others wonder about this topic. Have a great day!

      1. I doubt the average of people having heart attacks is anything near 170 total. The average US adult male is not much under 200 and LDL around 120.

        1. The people having heart attacks is a biased sample of the total adult population. People taking statins are probably overrepresented in the heart attack group, and we know from a nutritionfacts article a couple of weeks ago that statins are good at lowering cholesterol but not so good at reducing heart attack risk.

        2. For example, in the UK, the typical person who has a heart attack tends to have the same cholesterol level that is seen for middle-aged and older people in the general population. Something that is not unique to the UK.

          A study published in the Lancet, included 5,754 patients from Australia and New Zealand who had already had a heart attack. The average cholesterol level of this group of people was around 220 mg/dl (5.7 mmol/l). Data from the World Health Organization Global Infobase shows that around the same time, the average cholesterol level for the general population was also 220 mg/dl (5.7 mmol/l). People who suffered a heart attack had the same average cholesterol level as the general population.

          1. Mark: You seem to be making the argument that people who have heart attacks have the same cholesterol levels as the rest of the population, and thus cholesterol levels are not an indication of heart disease. This argument is ignoring points that are explained in the article above / on this page (and which I believe have been specifically brought to your attention). To repeat:
            1) You are talking about societies where the average cholesterol is high / above human normal. In those societies, like the US and the UK, where just about everyone has high cholesterol, of course you will not see much difference in cholesterol levels between those who get heart attacks and those who do not.
            Since the explanation in the article above did not explain this point to you, I’ll offer an analogy: It is like a society where the average person smokes between 1.5 packs of cigarettes a day to 2 packs. At some point, the risks level does not continue to increase with additional cigarettes. Hence, adding more cigarettes from (I’m making this up to make a point) 1.5 packs does not change the risk level. It would be no surprise if people smoking 1.5 packs got cancer as much as people who smoked 2 packs. *However*, you can not conclude from such data that smoking is unrelated to cancer, because everyone is smoking. Similarly, if just about everyone in the UK has high cholesterol, then it is no wonder that people getting heart attacks have the same level as people who have not (yet) gotten a heart attack.
            But what if you were able to compare cancer levels to people who actually do not smoke? What if you were able to compare cancer levels to people who have normal cholesterol levels? That brings us to the second point:
            2) In societies where the people keep human-normal cholesterol levels (those levels we are born with) their whole lives, there is no heart disease problem. While it is not at my fingertips, there is at least one video on this site with that data. But we do get an overview from the article above. Please note the three points about birth, primates, and other societies in the following paragraph:
            “The optimal “bad cholesterol” (LDL) level is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that’s where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That’s what we start out at birth with, that’s what fellow primates have, and that’s the level seen in populations free of the heart disease epidemic. One can also look at all the big randomized controlled cholesterol lowering trials.”
            These two points together make it very clear that having high cholesterol levels puts someone at risk for dying of a heart attack. The key to understanding this point is understanding what levels count as “high” and what levels are truly human-normal.

              1. Mark: Did you know that there are societies where many people smoke a lot and yet do not get a lot of cancer? It is called the Asian Paradox. Does this mean that smoking does not cause cancer? No, of course not. We have too much evidence linking smoking to cancer to believe such a thing. Something else is going on in those cultures which counteract the bad effects of smoking. Again, that doesn’t mean that smoking does not dramatically increase your risk of getting lung cancer.
                Similar confounding factors would apply to the populations you are talking about. The evidence against *high* cholesterol is overwhelming. We can explain cultures like France other ways. As it happens, NutritionFacts has a video on the “French Paradox” : http://nutritionfacts.org/video/what-explains-the-french-paradox/

    4. Sorry for your father… I wish him à good recovery. His good lifestyle certainly helps.
      Maybe his “moderate Blood Pressure controlled with one drug” is the problem? And what about his salt intake? Maybe more than he thinks?

      1. Thanks, Brigitte. I’m sure there are plenty of things Dad can improve on. I agree with you on the blood pressure as the drug does not fix the cause. I also agree with you on the salt–he certainly may be eating more than he thinks.

    5. Out of interest does your father eat foods cooked in vegetable oils / seed oils? You can have a normal cholesterol profile but still have oxidised particles causing damage.

    6. Has he had his Thyroid function checked, this would be crucial because if it is impaired he will almost certainly have problems transporting lipids out of the blood steam which in turn will make them more prone to oxidisation

    7. As Dr Greger often says “moderation kills”.
      I know someone too who didn’t smoke or drink alcohol, was a badminton coach and played golf, no junk food but did eat the MAD diet (meat and dairy). He told me after his first heart attack he didn’t know eggs were bad. He changed his diet but it wasn’t in time. He died playing a sport he loved but his wife, family and friends are left inconsolable.

    8. Did he eat polyunsaturated fats (inflammatory)? How about taking anti oxidants like vitamin C? (Destroys free radicals, reduces inflammation). Linus Pauling showed that low vit C causes a scurvy-like problem in vessels and they start to crack, exposing collagen, which attracts lipoprotein (a) lp(a) to fill the gap. These cracks would start at high stress areas first, and those are precisely where you see the buildup, at branches in vessels. (I’m a mechanical engineer and can testify to that). If the problem was due to ldl deposits, then they would basically plug up the small capillaries. It also has been shown that plaques can start with damage to one cell (free radicals?). This was covered in Scientific American probably 40 years ago.
      So the advice to eat polyunsaturated fats is flawed. Saturated fats are stable and do not oxidize. It is no wonder that cholesterol levels have little connection with heart attacks.

      1. Robert: You wrote: “It is no wonder that cholesterol levels have little connection with heart attacks.”
        As shown on this page and many other pages on this website, cholesterol levels have a whole lot to do with heart attacks. In fact, for people who keep healthy cholesterol levels their whole lives (total levels below 150 and LDL below 70), they are almost guaranteed not to get a heart attack (baring some kind of genetic defect or something).

        Eating saturated fat bumps up both total and LDL cholesterol levels, a phenomenon also covered in detail on this site.

        So, why do some people think that there’s no relationship between cholesterol levels and heart attacks? Or saturated fat and cholesterol levels? There is a series of fun videos on this site covering the deceptive/misleading ways some studies (usually those studies funded by the animal industry) are put together.

        Studies can be easily created to show, for example, that saturated fat has no relationship to LDL levels, when what you are really seeing is a fatally flawed study using deceptive methods. Consider that cholesterol levels are known to plummet with certain diseases (like certain cancers) and certain traumatic events (including heart attacks!). Many of the studies showing no link between cholesterol levels and heart attacks fail to take these important and well-known biological facts into account. I saw one study that actually consisted totally of cholesterol levels measured in the hospital *after* a heart attack! Seriously.

        If you want a deeper dive into the misleading practices of “cholesterol deniers”, check out http://www.plantpositive.com. Plant Positive covers notorious deniers such as Taubes and Minger, etc.. He also covers (in great detail) the concepts behind the paleo and keto theories. In addition to heart disease, Plant Positive covers other diseases such as insulin resistance (diabetes/which is also covered in detail on this site).

        It’s fascinating stuff. I would encourage you to continue reading pages on this site as well as Plant Positive. All of the claims on these sites are supported with references to *valid* studies which actually back up the claims–which is not what you find from cholesterol deniers. Good luck.

      1. From Dr. Esselstyn who showed actual reversal of heart disease in 2 studies “It is not uncommon for HDL to fall when consuming plant based nutrition. Do not be alarmed. The capacity of HDL to do its job has been shown recently by scientific research that there is no relationship between the capacity of the HDL molecule to function optimally and its blood level. Recent research has confirmed that the HDL molecule can be injured and weakened when one is ingesting a pro inflammatory western diet and conversely it appears despite a lower than normal level to be optimized by anti inflammatory plant based-nutrition.”

    1. Scott, your “low” counts are probably a good thing, since we just read that “low” by our society’s standards is really normal and optimal by human standards. I usually tell people that if your LDL is “low”, it’s OK that HDL is lower than what some guidelines may recommend (60mg/dL). Think of HDL as cholesterol on its way out. If you don’t have much to start with, you don’t have much to get rid of. However, make sure you are getting a good amount of cardio exercise and an appropriate amount of sunlight when possible, as these two things can increase your HDL.

  2. what about LDL to DHL ratio which says you can have any LDL as long as you keep the ratio? is it still better to have low LDL than good ratio?

    1. As far as I understand if total serum cholesterol is under 150 mg/dL it provides protection from developing heart disease. In this context ratio seems unimportant.

    2. In light of the overall findings from the Framingham Heart Study, the evidence
      suggests that achieving a fasting blood cholesterol level below 150 mg/dL
      confers the greatest degree of prevention against heart disease. As Dr. W.P.
      Castelli points out, in 40 years of the Framingham study, there has not been
      one single heart attack in anyone with total cholesterol under 150 mg/dL. (I have subsequently seen that there may have been one or two, but 150 seems to be the magic number). The
      Framingham Heart Study also reveals that approximately 90 percent of all
      coronary deaths could be prevented if total cholesterol were kept below 182
      mg/dL, systolic blood pressure were kept under 120 mmHg, and no smoking or
      diabetes were present. The Framingham Heart Study began in 1948 under the
      jurisdiction of the National Heart, Lung and Blood Institute. Every two years,
      the study monitors 5,000 volunteers for a host of risk factors for heart

  3. I wish there were more studies on women and heart health. There is one I found, here https://www.ncbi.nlm.nih.gov/pubmed/24712525 I find the statement about eating a healthy plant based diet naturally lowering LDL levels to below 70 to be discouraging at best (for me ) and misleading at worst. Doctors here say that the correlation of LDL and heart events is strongest for men, and that women may not see similar results for their efforts.

  4. My last blood work was last week. While my cholesterol is going down, it is still high. I am getting more and more strict with my diet. Zero animal products in five years. No processed – I make it all myself and have for a couple years. Stopped the breads, crackers, pasta – only whole grains like quinoa, brown rice, barley. Beans every day, greens every day. Now I’m moving to more raw for cruciferous, kale, etc. Few questions for the scientists. All the cholesterol is being made by my body – I am not introducing even a microgram by what I eat. Why might my body think I need so much? I was reading that cholesterol is used to turn sunlight into Vitamin D so I’m encouraged that once winter is over I might try that to see if it goes down along with everything else I’m trying [I can’t imagine going out in below freezing temps without being covered]. My thyroid is completely gone – years ago but my medication / labs are stable so that won’t help me lower it. I was talking to a tech in a cardiology office – and he believes for some the introduction of DHA/EPA helps lower it. At Dr. Greger’s recommendation I’ve been taking it for a full two months already and will continue to do so. After this post I am scared. I’ve had one heart attack – albeit years ago [more than twenty] with zero symptoms of angina. Extremely low BP 106/66 yesterday. 5’8 130 pounds and steady for at least a year.

      1. I walk two miles a day as well as parking my car at least a ten minute walk each way and going quickly up three flights of stairs every time I’m in a particular building – several times a day. It is quick-paced, not casual. Exercise has never raised my HDL. I need to find out why my body thinks it needs to make more cholesterol – something must not be working that it keeps making so much. Like Dr. Greger says, treat the cause.

        1. On a personal note. If I walk 2-3-4 miles a day my cholesterol goes up. I need to really get my heart rate up. I inadvertently found this out this year after a foot injury. I wasn’t able to run my normal weekly mileage so I was walking. My cholesterol went from 150 to 180. Just something to consider. And I have been back running and had it retested and it is back down again to 150.

          1. I have zero interest in running. It has always felt like it was pounding my body. I find it painful as well as stressful. but thank you for the suggestions.

              1. I agree with WFPBRunner…vigorous exercise with lots of sweating each and every day. I’m 68 and I run up and down 60 floors/flights of stairs every morning on our outdoor fire escape in the full sun here in Bangkok with only my brief shorts on. Then I go lift weights for 90 minutes. RHR: 44, BP 108/68, BF: 9.5% WFPB: 100%

        2. Hi Brenda, I can imagine how frustrated you are. First of all, congrats on significantly improving your diet! I’m glad you’re doing all that walking and stair climbing, but are you actually getting aerobic exercise from it? That means exercising at 60-80% of your max heart rate. If you don’t want to use a stopwatch and calculator during your exercise, you can do the Talk Test to determine if you’re in your aerobic zone – you should be able to talk but not sing. If you can sing a song while you’re doing your walking, it’s not an aerobic workout. Aerobic exercise is what raises your HDL.

          Also, your diet sounds pretty good, but are you eating oils, nuts, seeds, avocados, or any other fatty foods? If so, your cholesterol should come down when taking these out. I hope that helps!

          1. i can’t use the heart rate gauge as I have tachycardia and have for decades. But I do walk quickly so I am tired and unable to sing. in cardiac rehab on the bike my heart rate could go to 190 in the red. I think I am walking about 3 mph as i can go two miles in 35 to 45 minutes. I do eat the small amount of walnuts on my steel cut oats – zero oil for five years, no avocado, coconut, etc. I can do 40 stairs before I am winded. I did cut out all nuts and my cholesterol went up so I am eating a little. I’m not worried about the HDL – just getting my LDL and total in a safe range. Thank you for the suggestions.

          2. Nuts and seeds are part of Dr Greger’s Daily Dozen. His videos explain Brazil nuts lower cholesterol better than drugs. Also look at his latest videos on avocados.

    1. I am definitely no scientist but would be worthwhile to find out your triglyceride levels. Cholesterol is made by the liver so when looking for possible problems I would start there.

      1. Before I went plant-based they were in the 600s – I don’t eat sweet anything except whole fruit. That is also why I eat zero flour products of any kind. Right now they are at 200 so still too high but better than they’ve been.

        1. You might take a look at this McDougall piece on triglycerides


          “One special note for those of you who are trying to lower your triglycerides; fruit raises triglycerides in sensitive people and needs to be severely limited – at least for several weeks – in people trying to lower triglycerides.7 Fruit (natural, dried, and as juice) is made of simple sugars and the primary sugar is fructose.”

        2. Brenda: Just to echo what @robert said. Dr. Forrester (if I correctly remember who wrote it) once posted that while fruit is generally healthy and good for most people, there are a few “special” (my word) people for whom triglycerides really go up when they eat fruit. It’s something you could test anyway. If fruit limitations help your trig levels, then you could decide what to do going forward, but at least you would know the cause of your problems. I’m not an expert, so this is just an idea.

          1. Thank you, Thea. I have cut back. Some days I don’t even hit the berries and three extra fruit servings. I do have blueberries each morning in my steel cut oats and always an apple. I would eat one of those tiny tangerines/clementines but not sure even one of those counts as a serving. Zero juice of any kind – Dr. Esselstyn told me that a few years back. I stopped crackers, bread, pasta and anything made with flour. It did get the triglycerides down but not all the way.

            I would really like to determine the cause. My body is producing this for some reason. i can’t take statins – very bad leg pain. It is nice to sleep a solid night without dealing with horrible leg cramps.

            1. Brenda: I hope you are able to figure it out. I’m totally with you on the value of a good night’s sleep. Plus, the risks of statins is concerning to me. On the other hand, with your excellent diet, you have to wonder if you need to really be all the concerned. There is a line of thought that if you are a healthy weight and eat a low fat whole plant food diet, you are also (largely) protected even if your body is not cooperating on the LDL department. I don’t know how much evidence we really have to back this up, but I do believe (for whatever my lay person’s opinion is worth) there is some merit to this argument. Good luck!

              1. I do think about that. All the studies were done on SAD eaters, right? I don’t have angina. Even at the time of my MI the cardiologist was shocked there was next to no plaque. But it was cholesterol that caused it – ripped up damaged endothelial lining causing the injury and blood clot. That was on the SAD diet. I’ve been WFPB for five or six years continually tweaking it then Dr. Greger posts one of these and I’m still double LDL where I should be and Total is 203. I write everything I’m trying down so I know what is working or what isn’t. The sun is something I’m really curious about – if our bodies use cholesterol to make Vitamin D and although I supplement my body wants more so it generates cholesterol then maybe in the spring it will go down. That won’t help for winter months unless I can find a way to get sunlight throughout the winter.

                That was one of the reasons for my original question – is animal cholesterol/ dietary cholesterol in any way different from what our bodies make. Are there studies where plant-based high cholesterol leads to coronary artery disease? i don’t think so. But if they are biologically identical then I need to get it down.

    2. similar story here. i am 29. not quite as active as brenda, but a very healthy WFPB diet for 3 years, vegan for 6, consistently low blood pressure, never smoked, never drank, test normal for blood sugar and thyroid, etc, though i had hypoglycemia symptoms when i ate processed food. family history of high cholesterol, apparently genetic in origin. my LDL and especially triglycerides were high when i was 12. they have been almost exactly the same ever since. i wish i knew why.

      1. That is hard for me to gauge given my family always ate horribly – German, Dutch and English. They were all quite overweight, smokers, sedentary and horrible eaters. However, my understanding of a genetic issue is where the results are in 3-400 total with no ability to drop it. I have gotten mine under 200 telling me it isn’t genetic. Prior to eating healthy I would notice if I ate eggs my cholesterol would go down – basically if I supplied it my body didn’t feel the need to produce so much instead of causing my levels to go up. I just haven’t figured out how to do that with whole food, plant based or how to turn it off.

    3. Hi,

      Bp 106/66 is not extremely low. It is perfect! Mine hovers between 95-115/55-69. Im WFPB for 1.5yrs. Stopped all medications on high BP, Diabetes & High Cholesterol. Latest HS-Crp was 0.2. HBA1C was 5.1. Total Cholesterol was 98. LDL 43. I am a Quadruple Bypass (2015) & 4 stents (2016) survivor. 37 years young.

  5. Two of my doctors (endocrinologist and internist) have said my LDL is lower than they like to see at 24. Should I eat more cheeseburgers? Just kidding. I’m type 1 diabetic, total cholesterol runs around 160, but by triglycerides explode at 300+. HDL stays around 40. I take a statin but don’t want to.

    1. Hi RickyV, I’m cannot advise you on medications on this site, but I couldn’t help but notice that you say you take a statin AND your doctors think your LDL is “too” low. Why then are you on the statin, since the statin lowers your LDL? You may want to discuss this with your doctors.

      1. Stephanie you would be surprised how many of my patients are on statins with very low cholesterol numbers. And that’s with being WFPB. (Or at least moving that way) the MDs tell them its protective.

    2. Hi RickyV, This is something you’ll obviously have to work with your doctors on but my question would be, if your total and LDL cholesterol are relatively low (as the numbers you’ve quoted are) and your triglycerides are high why are you on a statin? Statins mainly lower total and LDL cholesterol not triglycerides. In your scenario I would think they would have you on a mainly triglyceride lowering drug (if you’re going to use a drug) like fenofibrate or gemfibrozil. Just something you might want to bring up with the doctor whose prescribing the statin.

    3. You might want go easy on Fruits (2 servings max daily) & cut down on simple carbs injestion to monitor the TG count subsequently to see if it goes down.

      1. Hi Eric this is Dr. Daniela Sozanski PhD and Moderator of Nutritionfacts. I am in agreement with your comments, as low sugar intake can correlate with low TG; however I would be more concerned about the processed flour and sugar than about the fruit, especially moderate climate fruit, because of the great health benefits it brings; please check out articles on the topic at https://nutritionfacts.org/topics/fruit/; also, as long as the HDL is high and the TG/HDL and total cholesterol/HDL ratio stays below the concern limits there should be little risk.
        Regards, Daniela

    1. I’d be curious to know why your LDL is at 118 mg/dl. Are you stressed, chronically sick, or eating foods that cause inflammation? LDL is not just there to cause heart disease, it helps to heal damage to your arteries.

      Personally, I wouldn’t touch a statin because 95+% of people taking them don’t benefit by not having a heart attack or dying. These pills also come with side effects.

        1. I don’t have a crystal ball, but maybe either there is too much supply/production, or there not enough demand (going nowhere). Age is an important factor as many metabolic pathways slow down. Maybe it is related to hormones or low count of mitochondria. Look into exercise or maybe supplements.

          1. In mainstream media and on this site, it is touted that your cholesterol levels need to be at or below a certain threshold to prevent CVD. If your levels are too high then that can stress you out, which may not really be a good thing seeing that there are people doing the WFPB diet and not having LDL between 50 and 70.

            I would look at your actual absolute risk of having a cardiovascular event. Just search “CVD risk calculator” and choose one. These typically don’t take LDL but instead use total cholesterol, hdl, and blood pressure to make an estimate – try it with your current numbers and with the “optimal” numbers and see the difference. I think you’ll see that the real risk of you having some event is actually VERY small and you shouldn’t worry so much about it, especially since you are already having a WFPB diet.

            1. I did that calculation and with my latest HDL of 55 and LDL83 it says that I have an 11 % chance. Given that I am 70, and a man, that sounds not bad to me. The site warns me I should be on a moderate to high intensity statin. I have a total cholesterol of 152! I think they are peddling statins. Oh, and the difference, was a one percent lower risk.

    2. As long as it isn’t oxidised I wouldn’t worry. Are you losing weight? If so you might be breaking down your own fat and using it for energy (sort of keto like) and if that is the case, often your fat needs a transport vehicle to more the fat / triglycerides / cholesterol around your body and that is supplied by LDL.

      If you eat highly processed foods / carbs (breads, sugars, pasta’s etc..) and are using vegetable oils (canola, soybean and other seed oils) then your LDL is more than likely oxidised and potentially damaging.

      What are your Triglyceride levels? A better way to indicate if your LDL is good or bad is by your Trig levels. If they are high it is likely that your LDL is oxidised and bad. It Trigs is low then you are likely to have good non-oxidised LDL.

        1. The issue comes about when people try to simplify cholesterol into good and bad or in the case of this website just bad. Cholesterol is both good and bad. In fact the things we are measuring aren’t cholesterol but lipoproteins that carry cholesterol and triglycerides in our blood to our cells.

          Just to further confuse the matter it has been said that your cholesterol profile is tested as follows:

          We typically only measure your triglycerides, total cholesterol and high-density lipoproteins (HDL). The low-density lipoprotein (LDL) result is usually a derived value, total cholesterol minus HDL.

          So we aren’t even certain that LDL numbers are correct or not?

      1. Wegan,

        Indeed this is true and there are many other factors concerning the thyroid that would cause the dysfunction and allow for higher cholesterol levels. It’s interesting to note that even a slight decreased level of thyroid hormones can impact the cholesterol significantly…http://online.liebertpub.com/doi/abs/10.1089/thy.2016.0010.

        If you’re concerned with your iodine levels, the laboratory testing is fairly poor and inadequate to give you good direction. You might consider adding some sea veggies to your salads or sushi. Check your medications and eating in moderation the goitrogenic foods might also be a consideration. And finally if your pregnant….http://nutritionfacts.org/video/iodine-supplements-before-during-and-after-pregnancy/ Dr. Alan Kadish moderator for Dr. Greger

  6. I’m a huge fan of Dr. Greger’s and because of his work and this site, I’ve been vegan for four years and feel fantastic. I just wanted to say that I so much prefer reading all the latest info rather than the videos. Reading is so much quicker! Does anyone else agree with me or do you prefer the videos? Just wanted to add my two cents. I’m a big fan either way!

    1. Laurie, I too generally prefer reading the transcripts to watching the videos–especially because I like to cut & paste any information I want to retain in my files. But I’m glad to have the videos as well–especially because the document abstracts or texts and tables often provide additional details beyond what Dr. G focuses on. People vary in how they absorb information, and I imagine that visual & aural learners (and perhaps some foreign language speakers) prefer the videos to the printed page. We’re lucky to have both!

      Also, a big shoutout to whoever does the top-of-page graphics, many of which are eye-catching & creative.

  7. My father in law has been diagnosed with severe heart disease. I shared with him Dr. Caldwell Esselstyn’s book ‘How to Prevent and Reverse Heart Disease’, but the feedback I’ve received from him thusly is that the new research is saying there is no relationship between cholesterol or fat and heart disease – it’s all about inflammation in his view at this point. He gave me these links. Thoughts?

    – “Heart disease seems to have a lot of conflicting information with one large cohort study in 2016 apparently showing that low LDL INCREASES mortality rates for older people:”

    1. I wonder if stress could be a big part of the problem? I was plant based, got chest pain ( it showed up in my jaw when I walked slowly) and had one artery almost closed and needed a bypass operation. That was 2 years ago. I don’t have big time stress, I just get upset easily about little things. I think everything matters as far as our health is concerned. I am 76 years old. Is Dr. Greger still accepting donations?

      1. Nancy Nowak: The NutritionFacts site LOVES donations! There is a donate link near the top of the screen. (Black text with white background, sort of under the search box.) Thanks!!!

    2. Hello Tikune,
      I looked at your two links. There is no question that inflammation is a very important risk factor. Here is a review of the importance of CRP level as an independent risk factor for coronary artery disease: http://circ.ahajournals.org/content/circulationaha/108/12/e81.full.pdf

      At the end of the first article to which you have a link, they mention a number of important limitations to the studies they cite:
      1) The studies varied widely in adjustment for confounding factors that could be having an influence on the link between LDL and mortality, such as smoking, alcohol, presence of other illnesses, and use of medications.
      2) Only LDL cholesterol was examined. Levels of total cholesterol, trigylcerides, and the ratio of LDL to HDL “good” cholesterol could be having an effect and mediating the link between LDL and mortality.
      3) Most of the evidence for this review is for the link with all-cause mortality – not cardiovascular mortality. High LDL-cholesterol is believed to be linked with the development of atherosclerosis and cardiovascular disease. This review does not provide enough firm evidence to refute this link.

      Regarding the 2nd link: note that this is not a research article, rather it is the opinion of a heart surgeon. However, there are several valid points he makes, including that inflammation is a huge part of story as to what causes heart attacks, and that omega 3 to omega 6 ratio is important. However he says “The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak.” No single factor alone causes heart disease. Look at the huge number of videos by Dr. Greger about the pro-inflammatory effects of eating animal protein. It’s not just about saturated fat. But there is plenty of evidence that excessive saturated fat is harmful.

      I hope this helps, somewhat. The cholesterol issue is very complicated.

      1. Thank you for your response. I passed along links to a dozen or so relevant NutritionFacts.org videos and his response was the article sharing the heart surgeon’s opinion dismissing the role cholesterol and saturated fat plays in the promotion of heart disease. I don’t want to push the issue too hard and generate resentment but my wife and I are obviously both very concerned and just wanted to make him aware of the evidence showing that heart disease can be reversed with diet.

        1. Hi Tikune – I can feel your concern in your posts. I’m going to post 2 links to two of Dr. Esselstyn’s Youtube uploads. One is one of his full lectures. The other is one of his patient’s, Evelyn Oswald, who had heart disease so bad she was told to go home to put her affairs in order – the euphism for get ready to die. She was roughly 60 years old. She then went to Esselstyne and switched to a WFPB SOS-free diet (sugar, oil, salt). Well Evelyn finally did die this year at a very respectable age of 90. Thirty years longer than her cardiologist told her she had to live. Sometimes seeing a presentation is more helpful than reading an article. Hope this is helpful to you.
          Best of luck.

          1. Thanks, GEBrand. My wife and I watched both videos with great interest, but ultimately decided not to pass these along as helpful as I think they could be. We’re going to take Dr.Jon_NF Volunteer’s advice and not push any harder on this topic unless my father-in-law expresses interest in continuing the discussion. He has ~75% blockage in two arteries, one of which is the LAD, and his cardiologist has urged him to proceed with open heart surgery to replace a valve with a pig’s valve and bypass the two arteries. The surgery is scheduled for mid-January so all we can do at this point is hope for a successful operation. Nevertheless, we really appreciate the helpful resources and advice here.

  8. I see a lot of articles and ads recently regarding Lectin’s being the true culprit of heart disease and autoimmune disorders. Dr. Gundry a Surgeon, Researcher, and Author, is making these claims. drgundry dot com From what I understand, his teachings regarding optimum heart health indicates foods high in lectins, such as in beans and in many plant foods are to be avoided. But meat and eggs are OK to consume. Does anyone know if there is any research either confirming these claims or debunking them in Nutrition Facts or elsewhere? Thank you in advance.

    1. Vegan News Today: This claim seems highly unlikely. Most lectins are destroyed upon cooking food, which is what we do with say beans. And beans are associated with longer lifespan (http://nutritionfacts.org/video/increased-lifespan-from-beans/ ). So, it seems unlikely to me that beans would promote our number one killer, heart disease. The following video shows that beans lower cholesterol, making them very good for the heart: http://nutritionfacts.org/video/beans-beans-good-for-your-heart/ Meanwhile, we have a ton of evidence linking meat and eggs to increases in cholesterol and shorter lifespans…

    2. Legumes are the one common food to all the healthy and long-lived populations in the Blue Zones. Look at the populations with the least heart disease – predominately plant based, all using beans of one kind or another. And go to experts who have shown actual reversal of heart disease in peer reviewed studies like Esselstyn and Ornish. Meats and eggs and cheese and oils are damaging to the arterial endothelium, causing arterial constriction and reduced nitric oxide production, and also triggering the liver to produce more cholesterol. Yes, the arteries get inflamed, and the root cause is the food we put in our mouths.

    3. “Does anyone know if there is any research either confirming these claims or debunking them in Nutrition Facts or elsewhere?” As far as debunking them, yes. Everything on nutritionfacts.org. Go to the index.

    4. First off, I would NEVER put any faith in the opinion of a single individual, especially when he is invalidating tons of actual science. Second, this sounds like a classic paleo agenda pushing the meat and bashing that cheap source of healthy protein…legumes. It’s been proven with DNA analysis from fossil teeth that we’ve been eating them and grains for ages, unlike the paleo claim it’s only been since agriculture. And we surely know the detriments of animal products, so this claim scores high on my BS meter. There has only been one diet proven that can reverse most heart disease, WFPB, so I would just discount any other claims until proven otherwise.

  9. THERE ARE CONTRADICTORY INFO FROM DIFFERENT RESEARCH. A plaque has more other stuff like fibrin, dead macrophagues besides fat deposits, a calcified one is solid like a tooth, so what is the role of cholesterol in it? Also there are too many texts and research that shows cholesterol is NOT the problem but inflammation. Finally 17 Harvard researchers recently published all about good benefits of LDL that is a good defense against infection helps immunity and guards against cancer. Now I understand that high cholesterol is a marker of a clogged liver and that is a health issue that needs liver cleansing before it complicates certain other factors like triglycerides. Please check the images of atherosclerotic tissues, you see that they show kind of pathogenic diseases and show holes in outside, where colonies of pathogen may reside. Over 12 years ago researchers at the university of Florida with help of dentistry department found tooth bacteria in arterial plaques. Also whoever goes to a dentist for an extraction or any minimal surgery has to take antibiotics and the dentist points out “to prevent heart problems”. So I believe atherosclerosis is more of a pathogenetic disease rather than effect of cholesterol or LDL. The statistics show more fatality from CVD among those with low cholesterol than those with high levels. Finally low cholesterol is a danger for elderly as it helps narrowing of brain arteries and cause hemorrhage, such health problem after production of statins has been increased 70%.

    1. Shahram click above on topics and get familiar with the research listed under the various videos. You may change your mind when you read the science.

    2. I completely agree with you. Seems that when LDL becomes oxidised through eating a poor diet it becomes inflammatory. A diet consisting with lots of highly processed simple carbs such as breads, sugars, pasta etc… all contribute to increased fat (obesity) and then when you couple that with highly processed refined oils like canola oil, soybean oil and other vegetable / seed oils you are setting yourself up for metabolic damage.

        1. Based on my own personal n = 1 study you are incorrect in terms of saturated fat causing obesity and inflammation. I have personally increased my fat intake to around 120g per day with at least half of it coming from saturated fat and pretty much the rest of it coming from MUFA’s. Of course there would be a little PUFA but none from highly processed seed oils. Just what’s in olive oil, coconut oil and the other fats (animal fat) I’m eating. I have lost 16kg in weight, lost 18cm from my waist and my blood profile is continually getting better.

          Again, just with a quick look at the first link you posted it mentions rats etc… I’m not a rat but I won’t feed Sat fat to rats because it seems bad for them. It would be like feeding a vegan diet to a dog or cat. These animals are designed to eat what they eat and they eat meat if left to fend for themselves. They gloss over the fact that American’s eat loads of Sat fat but they don’t mention in what form they are getting it. I will bet you that you will find that the average Obese American that is consuming loads of Sat fat will be getting it with a side of sugar (McDonald’s burger, fries (cooked in PUFA’s) and a large soda to boot). That isn’t what I eat. I would eat a nice fatty steak with some tarragon butter and broccoli / spinach. Perfectly health, well balanced meal.

          Second one talks about mice etc… Not going to bother because the crossover isn’t one to one and they make mention in the abstract.

          As for the Plant Positive one, I watched a bit of the propaganda. Yes PUFA’s from canola oil can lower total cholesterol and LDL but I’m not convinced that is good. Like I believe (and there are plenty of studies I could link but choose not to because there are studies on both sides to prove / disprove) the LDL becomes oxidised with allows it to travel the blood a lot longer because the cell wall receptors no longer recognise it as LDL. This becomes problematic as it allows oxidised LDL to find its way into artery walls.

          PUFA is more likely to cause inflammation than Sat fats if the PUFA is from highly processed, highly refined seed oils such as canola, sunflower etc…. oils. These oils are already likely to be oxidised by the time the consumer uses it for cooking which further damages them. Sat fat is a stable fat that can withstand such heat through cooking and is unlikely to oxidise which will likely mean it won’t become inflammatory in the body.

          1. Cholesterol is so frustrating. My experience is the exact opposite of yours. Everything improved for me when I switched from low carb / paleo to WFPB. I was low carb for more than a decade. In just 9 months on WFPB, I have lost more than 30 lbs, inches off my waist, and dramatically improved my cholesterol numbers.

            1. Just goes to show that we are all individuals that require different WOE. I couldn’t maintain a WFPB WOE and I would probably wouldn’t have the results that you did.

          2. What about the studies done by Vogel? The olive oil caused 31% arterial constriction. The high fat meal caused barrowing of the brachial arteries for several hours after ingestion. These studies have been out there since about 2000. The saturated fat meal causes damage to the arterial endothelium and reduction in production of nitric oxide, the most powerful natural vasodilator we have in our bodies.

            1. I don’t know of this study bo Vogel. I will say though, that depending on what side of the fence you sit on and your views on diet you can find data / stats that confirm or deny every diet. One day a study will say that eating x is good then next day it is bad. One day it causes cancer the next it heals. Too often correlation is incorrectly associated with causation. A + B often doesn’t equal C. Sometimes C is causing A or B depending on what is being tested.

              I can only speak for what is working for me and me alone.

          3. Thanks for your response, Luke.

            Of course you can lose weight on such a diet. It can be useful, especially in obese people for example because “Diets low in SFA and cholesterol are less effective in improving the lipid profile in obese individuals and in patients with metabolic syndrome. In contrast, lean persons are more responsive to reductions in dietary SFA and cholesterol.”

            However, you can also lose weight on the Twinkie diet, the potato diet and I dare say the crack cocaine diet. And if you lose weight, your lipid, BP and glucose numbers will improve. That doesn’t prove that such diets deliver long term health.

            I understand your beliefs about what is a “Perfectly health, well balanced meal.” and why PUFA oils just must be unhealthy. Lots of people on the internet seem to share them. I m not aware of any credible health authorities that do

            PUFA oils probably are unhealthy IMO. Ditto PUFA margarines. But studies show that when they replace saturated fats in the diet, adverse events go down. And the science appears to show that the whole oxidisation/inflammation conjecture is simply nonsense as the reduction in adverse events following replacement of SFAs by PUFAs would indicate. PlantPositive’s video discussion set out the evidence showing this.

            But, yes, you can rationalise disbelieving such studies if you wish. I think it is called wishful thinking. Personally, I will stick with what the science says rather than what internet snake oil merchants and authors of sensational ‘health” books say. Have you never thought about why all those scientific panels on nutrition and health convened by the World Health Organization, World Cancer Research Fund and countless national dietary guidelines committees around the world, come to quite different conclusions than yours?

            1. The twinkie diet guy is on the coca-cola payroll so I wouldn’t trust his results. I find it funny how no one has replicated his diet?? Also, he opened up part of his diet list and it wasn’t all twinkies. He ate normal food too.

              As for the Aussie that is following a potato diet, yes of course you can lose weight following his WOE. His issues are well documented that he had issues with rubbish food so his change to potatoes will surely help him. I’m not saying that one way of eating is better than another but I will say that cholesterol isn’t the issue.

              A diet low in SFA may (appear) to improve cholesterol (not really a problem) in certain individuals but it really has no link to heart disease. There are many people that have improved their CAC scores by following a LCHF / Keto diet.

              As you say, I will stick to real people results from LCHF / Keto diets and the health markers they improve rather than the animal studies / science that you wish to follow.

              1. OK, Luke. I understand that you have your beliefs and that no amount of evidence is likely to make you change your mind.

                Pinning your hopes for long term benefits on short term improvements in biomarkers, arising primarily from weight loss and/or intensive exercise regimes, seems optimistic to me. As does believing that the long term practical results in humans will be exactly the opposite of those found in experimental animal studies and observational human studies.

                Your opinions about blood cholesterol also seem like wishful thinking given what the evidence shows… It is not just NF that is saying that high blood cholesterol is a key risk factor, this is the consensus scientific assessment. Even Dr Harriet Hall, no friend of either Dr G or vegetarianism, has pointed out the huge holes in the claims made by the self-proclaimed cholesterol sceptics

                As she points out, the views that people like you express are likely to put people’s lives and health at risk. It is not that setting out your beliefs and reasons for them is bad, it is that you express them with total certainty as actual facts. This can mislead people who have not spent much time looking at health issues or who do not know where to go to get reliable science-based information about health. It is bad enough that you choose to drink this particular variety of Kool-Aid but trying to persuade others that this is a healthy option is worse.

                1. Maybe your evidence won’t but then the evidence I could supply wouldn’t change your mind and nor should it. I’m not trying to convert anyone. I’m just of the firm belief that cholesterol isn’t bad and we shouldn’t be scared of it. We should be more concerned on what can cause lipoproteins to turn bad and cause damage though don’t you think? At the end of the day, we create LDL in our bodies to more cholesterol to the cells that need them when they need them. What’s oxidising them to allow them to do damage? I’m convinced it is sugar and oxidised PUFA’s as the main cause. Too much of both and together at the same time is a metabolic nightmare IMO (and others).

                  Not pinning my hopes on short term improvements but human history. I think the main thing I’m pinning my hopes on is real, unprocessed food. I cook everything I eat and nothing comes from a packet. No processed food (loosely use processed since everything has an element of processing but I’m sure you are intelligent enough to understand what I mean). I also grow some of my own veggies and herbs such as tomatoes, basil, oregano, spinach and lettuce. We have loads of fruit trees (citrus) and heaps of berries so I’m trying to be more and more self sufficient.

                  Everyone has an opinion on cholesterol these days but I’m still convinced that the only people that need cholesterol to be the big bad baddy is the pharmaceutical industry. I still think there are many silent doctors and researchers that continue to make biased claims that lowering cholesterol is good etc…. yet filling their pockets with dirty money IMO. Once cholesterol is vindicated and is widely known the multi billion dollar industry will be broke.

                  1. Thanks for your reply, Luke.

                    I have seen the arguments and studies used by people like Ravnskov, Kendrick etc to claim that high blood cholesterol is not a risk factor. I find them underwhelming. On the other hand, the science showing that high blood cholesterol is a key risk factor is overwhelming. It includes both observational and experimental studies plus the identification of particular mechanisms by which high blood cholesterol damages eg the cardiovascular system.

                    It is not just me who thinks this way. Every credible health authority on the planet that has examined the evidence has come to the same conclusion.

                    The idea that the pharmaceutical industry is behind this state of affairs is flawed on a number of levels. First, high blood cholesterol was identified as a health risk long before drugs to lower cholesterol were developed. Unless the pharmaceutical industry has access to time travel technology, the idea that the industry is behind the cholesterol issue is clearly wrong. Secondly, the idea that the industry has been manipulating the science and the data all over the world for 50+ years and nobody has ever blown the whistle on its activities, is literally incredible. Thirdly, this claim counterpoises a conspiracy theory against a veritable mountain of actual evidence.

                    Still, how else are you going to explain away the fact that all the evidence that shows high blood cholesterol is a risk factor?

        2. In the Sidney Diet Heart Study, the intervention group was instructed to reduce saturated fats to less than 10 percent of energy intake and increase safflower oil, a concentrated source of n-6 LA, from 6 percent to more than 15 percent of energy intake. The re-evaluation showed that the n-6 LA group had increased rates of deaths from all causes, including from cardiovascular and coronary heart disease as compared to the control group.
          Chris Ramsden, MD, of the U.S. Public Health Service, who was the re-evaluation’s clinical investigator, said that n-6 LA did lower cholesterol as predicted. However, the significant increased risk of cardiovascular and coronary heart disease calls into question whether guidelines to increase n-6 LA intake to between 5 and 10 percent, according to American Heart Association recommendations, are ideal or if they cause premature death.
          Two “extreme views” about n-6 LA prevail, Dr. Ramsden warned: The first is that increases of n-6 LA lead to increases of arachidonic acid, increasing inflammation. There is no evidence to support that common belief because tight regulation of the rate-limiting step involving delta-6 desaturase. The second extreme view is that because n-6 lowers total and LDL cholesterol, “the more the merrier.” Dr. Ramsden is calling for more research suggesting that the truth may lie somewhere in the middle.

          1. It us telling that Ramsden et al have to go back to studies in the 1960s and 1970s to cobble together this argument. His team did a similar revisionist reassessment of the Minnesota Coronary Experiment, for example..

            In the 1960s and 1970s (seed) oils and margarines were routinely hydrogenated. That is, they were high in trans fats. However, the dangers of trans fats were not really recognised until the early 1990s. Consequently, the Sydney and Minnesota studies did not, to my knowledge, even collect data about the trans fat content of the respective diets. This was understandable in the light of 1970s knowledge. It is not excusable today. The US FDA issued a preliminary determination that trans fats are not GRAS :(generally recognised as safe) in 2013 and Ramsden works for the US NIH, He can reasonably be expected to know this.

            It is therefore extremely misleading to suggest that any increased mortality/adverse events associated with (hydrogenated) oil and margarine consumption is an indictment of omega 6 fats. I wonder why Ramsden et al did not discuss the trans fat issue?

  10. Why is Colin Campbell saying that cholesterol is not the culprit in heart disease but it’s animal protein? That is we could eat coconut oil for example and not have problems?

      1. No no sorry I shortened the argument: I meant that Campbell said “it’s not the cholesterol but it’s the animal protein to create heart disease.” So I was thinking if that is true we could eat plant saturated fat without problem..or not?

        1. Bat Marty: The following NutritionFacts video points to a study or so showing that coconut oil raises cholesterol too: http://nutritionfacts.org/video/is-coconut-oil-good-for-you/ or http://nutritionfacts.org/video/does-coconut-oil-clog-arteries/ .
          Bottom line: The problem with animal products is not just the animal protein. I imagine that all the various substances (animal protein, saturated fat, cholesterol, lack of fiber, etc) in the animal products combine to be an even greater problem together/whole. But the saturated fat in and of itself (just like dietary cholesterol in and of itself) is known to be a problem.
          What do you think?

          1. Hi Thea, Yes I had seen the videos on coconut oil in this website in fact I am not using it in my day life, but I just wanted to point out a difference of opinion between Dr Greger and Colin Campbell about the primary cause of heart disease. One says it’s cholesterol the other saying it’s the animal protein. And I wonder what makes Campbell saying different..sometimes they do not agree like Greger saying Vit. D is necessary (supplementation) and Mc Dougall saying it’s dangerous or unnecessary..sometimes a reader that follows this whole group is (a bit) confused.. Thank you :-)

        2. Yes and no.

          If the saturated fat is in whole plant foods, then Campbell does not appear to think it is a problem. However, he also thinks that highly processed plant foods are unhealthy. So no coconut oil, no palm oil and no margarines etc No isolated concentrated nutrients even if thry are from plants.

    1. It’s true he says animal protein is the main culprit, but he puts the argument in terms of saturated fat, not cholesterol per se (although it’s a predictive marker). Cf.


      “I propose that this argument for or against saturated fat should have been moot from the very beginning of this research. Here’s why. The original hypothesis that dietary fat, especially saturated fat, is chiefly responsible for heart disease began with laboratory studies over a century ago[10] and the findings ere, at best, uncertain. Much more impressive evidence also was published to show that the early stages of heart disease, atherosclerosis, and its predictive serum cholesterol marker, were increased much more by dietary protein than by dietary fat, especially the protein in animal-based foods.”

      1. I recently saw Campbell in an interview and he was saying that, this is why I am asking…I was puzzled by that. If I find that interview I will post it here.

        1. You got me intrigued, so I searched and found
          where he states:
          “It should also be added that the ability of serum cholesterol to predict heart disease for individual people is not especially impressive, even though serum cholesterol is useful 1) for monitoring time-dependent change in disease risk for individuals upon dietary intervention (i.e, inter-individual variance is eliminated) and 2) for comparing health status of large populations. Dietary cholesterol is not a good predictor of heart disease or other degenerative diseases if this is based on the assumption that cholesterol specifically causes heart disease.”

          What interested me most was his differentiating population disease risk from individual disease risk. I noticed there were large variances in the cholesterol results in the graph shown in the video for each diet category. There seems to be an assumption that to have low CHD risk requires getting one’s cholesterol down to the mean, as opposed to perhaps being sufficient to lower risk, but that could well be unrealistic for many (as the discussions here indicate and which has been my experience too). It seems to me focusing on one marker in otherwise very healthy plant eaters could be counterproductive, causing unnecessary stress.

          1. Thanks David, good comments especially your last sentence. As you can see from this forum there are a proportion of people finding it difficult to get their ‘numbers’ in line and do suffer some anxiety/pressure because of it. But! the way I look at it, we are doing a whole lot right just by showing up here ready and willing to learn more. Look at the list that WFPBRunner wrote above about reducing risks if we are the correct weight, eating wfpb, exercising daily, not diabetic, taking care of blood pressure etc and wondering how people might fare if their numbers still were not in line. I’d say we are on the path, regardless. Dr Greger has a video about the Simple Seven. I find it helpful and encouraging

  11. Like some other people who have commented, I’m equally frustrated by my results. I have been a low-fat vegan for 5 years and have been vegetarian and also very health conscious about my diet since 1990. I exercise practically every day and eat right. My LDL actually went up from 105 in 2013 to 111 this past month. Total cholesterol went from 180 in 2013 to 207 this past month. I could lose 5-10 pounds. Could these few extra pounds be contributing to an elevated cholesterol or could there be some genetic component that keeps my numbers high despite a healthy lifestyle? I’m so frustrated.

    I just added four brazil nuts per month to my diet hoping this might help the next time I am tested.

    Thanks for any input.

    1. Connie: I can sympathize. I would be terribly frustrated too. Here is an “Ask The Doctor” page that I think might give you some direction: http://nutritionfacts.org/questions/what-can-i-do-to-lower-my-cholesterol-it-seems-ive-tried-everything/ Also, the topic page for cholesterol covers food known to lower cholesterol. You are already eating a very healthy diet, but maybe you could tweak your diet to especially include these foods: http://nutritionfacts.org/topics/cholesterol . Finally, I have some great resources for healthy weight loss if you are interested. — resources that expound on Dr. Greger’s recommended method of paying attention to low calorie density foods.

      1. Thank you, Thea. I’m open to hearing about anything that can help me. It’s so frustrating because compared to the SAD that most people in this country consume, I know I am doing well but it’s still not enough.

        1. I like to stay very lean too. (First read Dr. McDougall’s book “The Starch Solution”.) If I think I’m getting too many calories from starches, before my regular meal, I eat some nutrient dense, as opposed to calorie dense, food. So for example, if I’m having beans and potatoes for lunch, I’ll eat a can each of spinach, beets and green beans before I dive into the taters. If I’m having beans and rice for dinner, I’ll first eat a pound of microwaved broccoli. That way I don’t eat as many starches.

    2. I follow Esselstyn, and got my TC to 154 by following his protocol. No nuts, nut butters, avocado, coconut, tofu. He also insists on no processed sugars like maple syrup, no smoothies or juices which add to free fructose, no caffeinated coffee. I used to say my TC was genetic, until I started doing Esselstyn 100%. And he showed actual reversal of heart disease on his protocol.

      1. hi JoAnn, I have Dr Esselstyn’s “Prevent and Reverse Heart Disease Cookbook” here, and they do recommend maple syrup… pages 15, 20 , and 245. Maple syrup is the only sweetener besides actual fruit that they use. It is expensive however. Also, Silken tofu is used frequently in salads, sauces, salad dressings and desserts. No problem with soy milk either.
        Dr Greger (and Dr Ornish) do recommend small serving of walnuts, (dr ornish says 1 per day) and a tbsp of flax seed. Congratulations on your successes!

        1. Susan, Dr. Esselstyn has come out with several new guidelines since the book. Within the last year he said have tofu just for your birthday, not everyone else’s. He has also said that fructose damages the arterial endothelium and so any processed sugars will do that as well as smoothies and juices. Remember the cookbook is also for those without severe heart disease, and the guidelines I mentioned were for those with heart disease. I attended Dr. E’s 5 HR seminar in Cleveland this past July and he reiterated those guidelines.

          1. Thanks for telling me JoAnn. This is just one of the reasons I am very put off with Dr Esselstyn. The book says it is written for heart patients, indeed yhe title bears the name. The Prevent and Reverse Heart Disease Cookbook starts with the chapter ” Getting Started in your Prevent and Reverse Heart Disease Kitchen”. it is written for the cardiac patients. I was checking his website not long ago for on a question, and did not see any major changes but thats his perogative. The important thing is that you have designed a diet that works for you, and thats awesome.

            1. I follow Esselstyn so keep up with the science and watch his recent videos and talks and also have a friend who has made a miraculous recovery re her heart disease. The book is only about 9 years old but there have been changes. I too wish he kept the website more up-to-date but I’m sure he’s not hands on with that.

    3. Connie, when you say you “could lose 5-10 pounds”, what does that mean for your actual weight? Knowing how tall are you and what you currently weigh would be helpful. I don’t mean to be nosy, but I have known some people who have pretty optimistic assessments of their height and weight ration that are not fully warranted.

        1. Connie

          A BMI of 25 or higher is officially defined as overweight.

          Obese and overweight people are thought to have higher rates of cholesterol synthesis than lean people.

          Losing weight may therefore be an effective strategy to lower lipid levels.

          But there may be other factors also (ignoring the obvious risk factors – I am assuming you don’t use coconut oil or eat processed vegan foods containing trans fats etc). These include coffee drinking (which can raise cholesterol), some prescription drugs raise cholesterol (antidepressants, diabetes medications etc) and even thyroid problems. It might be useful to consult your physician if weight loss fails to improve your lipid levels.

          1. Tom, I know that a BMI of 25 is considered overweight which is why I mentioned that I could lose 5-10 pounds. I am far from obese. I do not eat coconut oil and very little to no processed foods and no trans fats at all. I saute in broth or only a spray of oil. I use minimal oil (or none) in any of my food. I’ve been reading about nutrition for years, including Dr. Greger’s website and book so I aim to live a healthy lifestyle. My thyroid results came back normal.

            My doctor has no issue with my cholesterol. For her, it’s close enough to 200 but as we know from Dr. Greger’s information, this is not considered a “good” number.

            This is all so frustrating because I eat cleaner than about anyone else I know yet still have this stubborn number that sits above or near 200. I did get down to 180 at one point – I’m not sure why it went up again.

            I can try losing a few pounds and see if that helps although I’m not sure how soon I can get another lipid panel done.

            1. Connie have you ever seen those scales that measure body fat percentage? It is really surprising how accurate they are. If my BMI was 25 I would be 25 pounds overweight for me. I am 5 7′ (difference between 125 and 150)

              Just something to consider so you aren’t so frustrated.

      1. I’m not sure what to do to identify if this is my issue. I do take turmeric supplements every day which would presumably help if I had any inflammation.

          1. I haven’t had my D tested recently but it was low in the past and I take 5,000 iu per day. My doctor wasn’t concerned – she said that they had previously overreacted about what is considered low. When I had my D tested in 2014 it was 22. I wish she had repeated it since I have been faithful about taking my D supplement.

            My B12 was recently tested and I came in at 895 pg/mL which is within the normal range.

  12. I have been able to drop my LDL from 172 to 108 in 9 months on a WFPB diet. I have found that a relatively low dose of niacin (250 to 500 mg) can drop my LDL to around 80. I would rather achieve this result strictly from food/exercise- and try to eat foods high in niacin- but have not been able to lower LDL as effectively as with the supplement . Any advice on long term use of a niacin supplement? Nine months probably isn’t long enough to fix 50 years of poor eating habits. Could I expect that LDL will continue to drop over the next couple of years (without niacin)?

  13. Has anyone in this discussion read the article on oxidized ldl, f2 isoprostane and myeloperoxidase? Life Extension Magazine June 2016. It is a worthwhile read when discussing cholesterol.

  14. I became a WFPB vegan 6 years ago. Despite almost no oils, my LDL has risen to 115 despite a CRP of .4 and triglycerides of 70. I also exercise and don’t drink or smoke. I am very discouraged and don’t know what else to do to improve my cholesterol. Any thoughts out there?

    1. Hello Barbara, I am a family physician in private practice. Thank you for your excellent question. I have had a few patients similar to you, who have switched to a WFPB diet and can’t seem to get their total or LDL cholesterol numbers down to optimal levels. Cholesterol is an extremely complicated and confusing topic, to me as well. There are so many different risky levels to consider: low HDL, high total cholesterol, high LDL, high triglycerides, high Lipoprotein A, high CRP. Yours, and other great questions, below, have made me realize I need to try to get a better handle on all this, and I will try to put together some type of summary. Stay tuned.
      However, from what you say, you should not be discouraged:
      1) Your CRP level is excellent. Here is a reference about the importance of having low CRP: http://circ.ahajournals.org/content/circulationaha/108/12/e81.full.pdf.
      2) Your triglyceride level is also excellent, which correlates w/ a lower risk of diabetes.
      3) You don’t drink, you don’t smoke, and you are exercising. You don’t mention your HDL level, but if that is high, it is protective against high LDL levels.
      4) I am willing to bet that you feel a lot better since making your dietary changes, or else you wouldn’t have stuck with it this long.

    2. Hi Barbara. I went WFPB about 9 years ago. I’ve not been able to get my cholesterol down below 200; my LDL remains at 99. When I first made the switch I was just overweight and lost 30 lbs. Then I gained it back and have now lost 23 lbs and am back at BMI =20.8. I mention this because I realize that I’ve had to tweak my WFPB diet to make it work for me. I’m definitely not going back to meat eating. I am post-menopausal 63 year old female whose only vice is my glass of red wine most, but not all, evenings. Here is what has helped me. I try to work out physically to keep muscle strength (muscle burns calories faster). I eat my starch-based diet most calories earlier in the day and eat only a light vegetable of greens and maybe a little tofu in the evening but always a large green salad, perhaps a sprinkling of sesame seed, perhaps a few chunks of pear. Green steamed vegg -broccoli, cauliflower, green beans, etc. I consume with no fat dressing. Because I am older and my metabolism slower I consume the legume beans, rice, etc earlier in the day. I’ve had to learn what a portion of beans and rice looks like – very different than what I thought.
      More recently, though, I have built into my day a daily period of fasting for not less than 12 hrs. which is done at night for the most part and – here is the important part – I do not eat again in the morning until I am good and hungry. I do drink no-calorie coffee or tea (stevia). I find that if my promise to myself is to not eat until I am really ready, I naturally end up fasting until – usually – noon or often longer. This means a natural fasting period of about 14-18 hours every day. There is nothing about this that is uncomfortable. I have just made a point to listen to my body’s hunger signals. I realize you are writing about cholesterol, but I think our caloric intake and cholesterol must be related. So I just wanted to share. :-)
      I don’t know yet if this is going to make a difference in my cholesterol levels as I’ve not had recent blood work. But I can tell you that when I hit a plateau in my weight loss to get back to my proper weight, it made a huge difference.

    3. I remember reading a study showing that ldl has not that much connection to heart attack than previously thought and lowering it under 100 was not necessary. And there are connections with low ldl and increased pneumonia. See spacedoc.net for many articles on cholesterol and statins.

  15. What about lipoprotein (a) which is genetic and apparently unaffected by diet or lifestyle? My partners father had his first heart attack at 39 and second one at 49 which killed him. My partner is WFPB no oil etc and his lipoprotein(a) is very high. My research has shown that so far nothing seems to effect the level of lipoprotein (a) and 1 in 5 people have a high level and aren’t aware because it’s not tested for in the normal run- of – mill cholesterol test.

  16. There are people with cholesterol levels as low as 100 and LDL’s lower than 60 that still have heart attacks. I agree that lowering cholesterol and LDL levels will lower your risk of a heart attack but I don’t think it will make you totally immune. There are so many factors such as magnesium levels in the blood. Vitamin D levels. People do not get enough sunshine. Gum disease can cause bacteria to migrate to the heart tissues. There are a zillion things that can go wrong and induce a heart attack. Psychogenic shock can produce a heart attack. This is where fear is so great that the nervous system just causes the heart to freeze up and results in a heart attack. You can’t put your entire trust into following the whole plant food diet. Sure, it helps, and it reduces the risk. But, nothing in this world is risk free. Of course we cannot talk about prayer as possibly improving health to a degree on this website because that wold be not politically correct now would it.

    1. John. The point is that high blood cholesterol is a key modifiable risk factor. That is why so much attention is paid to it. Quite rightly too.

      Also, this is a website about nutrition.

      And respect for people’s religious beliefs is in fact politically correct.

      Personally, though, I am not politically correct and I have no respect for people’s religious beliefs. So perhaps it is just as well that the focus here is on nutrition facts.

    2. Wow, .. You have got the issues very convoluted, mixed up, undelineated, enmeshed with other issues, and generally put all in one hodge-podge which is not the point of this site. No one on this site – or any other references and research – has ever said that one will be heart attack proof from all causes if they lower their cholesterol to an excellent level. Everyone with any ounce of common sense understands that if one participates in other unhealthy-for-the-heart behaviors – like alcoholism, or drug use (like cocaine for example) – that one can have a heart attack from other poor lifestyle decisions.
      This is a site for those interested in the subject of nutritional science and research as it relates to our healthy life and lifestyles. Any other topics of discussion on politics and theology – or whatever else – are for different sites.

  17. Is it not a scientific fact that our body makes its own Cholesterol to repair damage to our artery’s when we don’t eat cholesterol our body will spend extra time and energy making it. or we would die from internal bleeding . so why not address the real cause of high cholesterol. like poor food quality with added ingredients that damage the arterial wall hence the body will respond with cholesterol production this is the real Issue . sorry i just like real science not Misdealing Counter productive Information/Propaganda And if You Could Explain How the body removes excess
    cholesterol . we like most or your research Dr But You control the narrative and People Are not Stupid.

    1. I think you are confusing “real science” with the sales pitches of the snake oil merchants who infest the internet. Or with the highly sensational and highly misleading claims found in mass market “health” books.

      You would find it very informative to read the professional literature on this topic. A good place to start would be here
      (and the succeeding four parts in the series)

  18. I am taking cestor 10mg to lower my LDL choesterol but that sudden drop in LDL did cause Blood pressure to go UP, So I switch to 5mg and doing much batter. If I go lower then 100 my body is unable to handle it well there is feeling of coldness in the fingers and too much shivering. .. I thing we should have a way to measure total surface area of the internal body organs including all the cells Then depending on height and weight one needs to calculate how much of a thin or a thick coating is needed to cover that surface area and depending on that one can tell if 50 Optimal or 120 is Optimal Here is a article that High Cholesterol does not lead to heart attack http://www1.cbn.com/health/the-heart-attack-culprit%3A-cholesterol-isn%27t-to-blame.. Here is another that says people with high cholesterol live the longest https://www.vitalityherbsandclay.com/vital-health-newsletter-archives/11-benefits-to-high-cholesterol-levels.html

    1. Those sites are not reliable sources of information on health matters. In fact, they are wrong on these issues.

      The science clearly shows that high blood cholesterol is a key risk factor for heart disease.

      Also, people who have cancer, Alzheimer’s Disease, alcoholism, liver diseases, various viral and other infections, plus trauma of one sort or another, all experience declines in their cholesterol. It is no surprise therefore that such people have higher mortality. However, people who have have stable low cholesterol throughout life, or achieve lowered cholesterol though diet and life style improvements, or statin use, have lower mortality.

      1. Tom, you are so cynical. The first link is to an online store selling herbs and “soil healing” products and the second link is to an evangelical Christian TV site that interviews a physician pushing his fish oil products. Those aren’t highly reliable sources of scientific health information?

        1. Guilty as charged, M’Lud.

          In my defence, I did refrain from referring to damaged pottery and simple tools used to start internal combustion engines in the first half of the 20th Century.

          I console myself with the words of George Bernard Shaw “The power of accurate observation is commonly called cynicism by those who have not got it.”

      2. Hi Tom thanks for the response, I think we need level that to Doctor Michael Greger, M.D to Judge which study are reliable source and which are not reliable.This particular scientific study says High Cholesterol increases longevity http://balancedimmunesystem.com/cholesterol-bad/ . But just because something has a co-relation does not mean there is a causation. But if Dr Gerger want to explain this new Study NOW protein and LDL systensis perhaps that might help. It too complicated for me to understand http://www.nature.com/articles/ncomms13516

        1. Yes, your first link is to a website that is not a source of reliable high quality information on health matter,

          The argument it offers is about correlation. Many diseases and health problems cause cholesterol to decline. It is not surprising that people with declining cholesterol do not live as long as people whose cholesterol is not declining. The disease causes low cholesterol. Low cholesterol does not cause disease..

          The second link is to a very technical article that confirms that “The most effective therapy to date that reduces atherosclerotic cardiovascular disease,…. [is]… lowering plasma LDL levels, ”

  19. I have been Vegan for 1 year. I have had my lowest levels of LDL as a Vegan but it is not as low as the 70mg/dL recommended. I’m actually at 98. In Canada, people with history of an MI, target levels for LDL are 77 or lower. Ever since I became vegan, I have gained weight. With the same exercise regimen, I have gained 15-20 lbs in one year. Some of that weight gain may be muscle because of strength training but most is not. When I did eat meat, I ate everything and the amount of bread I ate as a carnivore was and is the same as a vegan. Bread has been my only junk food but I haven’t increased consumption. I’m not eating more simple carbs. I am eating more fats, but healthy fats. I rarely use oils, in fact I stopped cooking with oil and may use Olive oil once or twice a month. Obviously I am eating more fruits and vegetables but I have variety. I’m not in a rut eating only certain foods. I have variety. Confused on the weight gain. I may be eating more calories and I find that my meal sizes are larger. I find that if the size of my vegan meal was equal to a meal with meat, I don’t feel satiated. I have to eat more. Even though fruits and vegetables are complex carbs, is it possible that with excellent digestion that the extra carbs in a vegan diet can lead to weight gain? My cousin is professor in paediatrics and does research in familial hypercholesterolemia and has invented a pharmaceutical therapy, similar to PCSK 9 therapy. I wanted to try the vegan lifestyle to see what is my bodies minimum cholesterol production level to sustain normal metabolic functions. I just thought I could reach that level of 70 or lower without drugs, but “ain’t happening”.
    Any suggestions?

    1. Pat: The nice thing about your situation is that you already understand half the battle. I’m guessing from your post that you already understand about the importance of a whole plant food diet and have at least a sense of how to implement it. That’s half the learning curve. The other half is understanding the concept of calorie density and how to apply it to weight loss so that you don’t get hungry and you still get all the nutrients you need.
      Dr. Greger covers calorie density (http://nutritionfacts.org/video/eating-more-to-weigh-less/ ), but not in enough detail in my opinion for someone who wants to apply it for the first time. Doug Lisle, one of the experts in the Forks Over Knives documentary, gives a great ‘calorie density 101’ talk officially called: How To Lose Weight Without Losing Your Mind. I have watched the following talk from Doug Lisle several times and think very highly of it. And it’s free!!! And it’s entertaining! https://www.youtube.com/watch?v=xAdqLB6bTuQ
      As good as Doug Lisle’s talk is, it pretty much just gives you a solid understanding of the concept, but not enough practical information in my opinion. For starting to get the practical information, I recommend a talk from Jeff Novick,Calorie Density: “How to Eat More, Weigh Less, and Live Longer,” http://www.jeffnovick.com/RD/Calorie_Density.html If talks aren’t your thing, the following article from Jeff covers a lot of the same information: http://www.jeffnovick.com/RD/Articles/Entries/2012/5/20_A_Common_Sense_Approach_To_Sound_Nutrition.html
      Be sure to pay attention to the charts.
      I have additional resources. Let me know if you get through the above and want some practical tips.

    2. Try to understand that these websites like this , start with a agenda and then look at everything that try to prove their point of view , that is the “science” they talk about. Exactly the same if you went to a dairy site or beef site , they only look at what agrees with them . People that feel very strongly about animal and environmental issues , feel they are doing the right thing in going WFPB . A lot of people will get a placebo effect in doing so. However in the real world we must live in, where we have blood tests and weigh scales , they are not influenced by this placebo effect , you really see where you are at and what your lifestyle choices really get you.
      In order for you to understand why you gain weight you would need to know about how carbs and protein work in the human body .

      A while ago I listened to starchvore doctor, I think that is what he called himself , explaining how carbs will not make you fat , when he starting explaining how animals differ from humans , that animals can eat carbs and get fat and humans can,t , I had to exercise my rights and left the talk to those gullible enough to believe this charlatan .

      1. Thanks Ignatius.
        Something about the vegan diet is causing weight gain and like you said, that is how my body is reacting. I’ve tried the low calorie foods, low glycemic foods, high fibre foods but I am gaining weight. As I told Tom in this discussion, I think the fat, carb, protein profile is being skewed in that I am probably absorbing more carbs and fats and less of the proteins, but why, I don’t know. Even tried more protein shakes until I read there was more heavy metal content in these protein powders.
        I went vegan because of heart disease at a young age. I agree that certain animal proteins are inflammatory and I simply cut them out. But now the extra weight doesn’t help. I’m just confused and frustrated. Wondering if there is a vegan diet counselling program or website.

        1. Hi Pat
          I recommended Chronometer because it gives you so much information. You don’t have to enter your food for a long time. Try a week. You will find out if you are eating too many nuts for example. I have used it (or a similar app) in the past for information.

        2. Pat: I highly recommend that you take a look at the resources I posted earlier for you as some of the foods you are eating are calorie dense. The trick to being able to eat until you are full without calorie counting is to completely understand the concept of calorie density.
          In this latest post, you asked about a vegan diet counseling program or website. Here are a couple of options. One is Chef AJ who runs a Whole Plant Food Based program specifically for losing weight. That program does cost money, but I understand that it is very successful.
          Another option Dr. Greger also recommends in his book, How Not To Die. Consider going through the free program from PCRM (Physician’s Committee For Responsible Medicine) called 21 Day Kickstart. The program will “hold your hand” for 21 days, including meal plans, recipes, videos, inspirational messages, and a forum (moderated by a very respected RD) where you can ask questions.
          http://www.pcrm.org/kickstartHome/ (Click the green “Register Now” button.)
          Another recommendation that Dr. Greger and I share is to get Jeff Novick’s Fast Food videos for tasty, affordable, fast and healthy calorie density recipes. While not a program”

      1. I can’t see myself counting calories at every meal. I would be diligent for a while but can’t live my life counting calories. Everyone that I know that have counted calories have stopped doing so, mainly because it’s a nuisance and sometimes you just don’t have the time. Even without it, I remember that for about 2 months I cut out most grains and fruits and I gained weight???? I was making veggie smoothies galore and having lots of bean/legume soups. I was a walking gas bomb but I was gaining weight. I know my calories were low. But is it possible that the carbs are being absorbed much too easy and that the extra sugars in the blood get stored as fat in my body?

        1. As I said below. Just for a week. If you are gaining weight you are eating too much. Or not exercising enough. Have you started a new medication? Some can cause weight gain. Anything else different?

        2. I don’t think that your calories would have been low if you were eating lots of beans, other legumes and smoothies. They are filling but are also relatively high in calories.

          Plus, if you are making smoothies, you are increasing your relative calorie intake. Food in smoothies is very easy to absorb because the blending essentially does a lot of the “digestion” for the body. This means the body does not have to expend as many calories digesting food as it would if the food was not blended. Also, far more of the calories are likely to be absorbed from blended foods than minimally processed high fibre foods where I imagine that a greater proportion of calories is excreted.

          If you want to lose weight, not go hungry and not count calories, you might have to concentrate on bulky low calorie and minimally processed foods like green leafy vegetables, and starches like steamed or boiled potatoes (sweet or otherwise). 85% of the calories in the Okinawan diet came from sweet potatoes and the “Spud Fit” bloke also gets the great bulk of his calories from potatoes.

          However, you should really add low calorie vegetables and a little (underlined) fruit and nuts to any potato diet. Perhaps Dr G’s daily dozen can give you some ideas there. But for weight loss, without hunger and calorie counting you perhaps might instead follow Dr McDougall’s advice to focus on starchy foods eg

      1. Thanks Tom. I eat beans and legumes daily and I eat the same number (or less) of calories as I did when on a meat diet. I’ve tried to concentrate on picking out foods that may be higher in fibre, low on the glycemic index and lower in calories. But the weight gain still occurs. You mention fruits and nuts are high in calories. I understand that your implication may be that one can easily overeat on these items and lead to weight gain. In my situation, I am watching my diet and exercise. The only thing I can think of is that the carbs are being digested and absorbed easier than before, possibly the plant proteins less than before and so the profile of fats, carbs and proteins are not 30, 40, 30. Confused.

          1. Thanks for the link. The frustrating part is that in any study, there is probably a small percentage of people that for reasons unknown don’t fit the pattern of results of the research group. Other factors such as genetics, stress, disease, etc., which can affect results. I feel that I’m one of those people and can’t explain why. It’s going to have to be a trial and error approach for me. What is considered a low carb diet, anything less than 50% carbs? I plan to remain vegan but what ratio of carbs/fat/protein has been researched to effectively decrease cardiovascular events?
            The only other thing I can think of is the way the meals are planned, eg many small meals but carbs/proteins/fats are not “mixed” or balanced at each meal. I know the overall ratio for my day but some meals may be very high in fat or very high in carbs. I may have 5-6 small meals and 2 or 3 may not be balanced. Had a cholecystectomy in 2010 and several small meals helps but maybe my digestion is not optimal? For about 2 weeks I’ve been trying the intermittent fasting and no digestive upset, but I have 2-3 balanced meals in an 8 hour window. Only time will tell.
            Thea had some links for nutritional counselling which I plan to research. Do you have any links for this?

            1. Hi Pat

              There is no universally agreed definition of what constitutes low carb. However, current mainstream scientific thinking is that dietary carbohydrate content should be 45-65% of total calories. Taking this as a standard, anything below 45% would therefore be low carb and anything above 65% would be high carb.

              However, the traditional Okinawan diet, famous for producing large numbers of centenarians, was 85% carbs. The traditional Japanese diet, also associated with longevity, was 79% carbs.

              The Ornish Diet, which has been proven to reverse heart disease is apparently 70% carbs.

              Animal studies also suggest that high carb low protein diets maximise longevity:
              “The healthiest diets were the ones that had the lowest protein, 5 to 10 to 15 per cent protein, the highest amount of carbohydrate, so 60, 70, 75 per cent carbohydrate, and a reasonably low fat content, so less than 20 per cent,” Professor Le Couteur said.”

              None of this is conclusive evidence of course but multiple studies have shown that low carb diets
              are associated with higher mortality.

              As for nutritional counselling links, I can’t usefully add anything to Thea’s suggestions.

              1. Hi Tom.
                I was looking at your links. In some of my other searches I came across this forum, https://www.blogger.com/comment.g?blogID=9040807413744183436&postID=2494964705533033200&page=1&token=1482239393663&bpli=1

                A pile of beans, I think. But is there any merit that the studies on the Okinawa diet were incorrect and that the foods in their diet are actually different than what has been published? I know that individual accounts are not science.

                Is it also possible that their gene pool is the major factor for longevity and that diet plays a small role?

                I started to use your advice and trying a diet with more complex carbs, more than 50% and watching my fat intake based on calories because I may have said I was eating 30% fat before but may have based that on portions of food item. I think if I sat down and calculated calories, my fat intake would be higher. My ideal weight occurred when I was on a low fat diet. I assume the body will make all the fat that is necessary for minimal metabolic function, but should I consider A, D, E, K supplementation if my fat intake is low?

                1. The Okinawa Diet figures are correct. They come from official government surveys in 1949 (and 1950 for the Japanese data). At that time people were eating the traditional Okinawan diet. The confusion about the Okinawan diet arises from (deliberately?) misleading statements about what Okinawans ate in the 1960s, 1970s etc when Westernisation of the Okinawan was well under way. As one poster on that blog link notes about these criticisms:
                  “This is very misleading because the diet of Okinawa changed dramatically in the 60s and 70s. Consumption of meat and fat exploded, and by the mid 70s, life expectancy in Okinawa fell in relationship to mainland Japan:


                  The traditional Okinawan diet was very plant-based, predominantly vegetables and grains. You can see a detailed breakdown on page 71 of The Okinawa Program.

                  I have access to the full Shibata et al paper. The authors shoot themselves in the foot later by pointing out that none of the correlations were statistically significant.”

                  The gene pool may be a factor but the fact that obesity in Okinawa has risen and mortality has increased along with the Westernisation of the Okinawan Diet strongly suggests that diet is the key not genetics.

                  Dr G recommends certain supplements for people on a completely vegetarian diet.

                  However, you aren’t likely to be low on vitamins and minerals etc on a “low fat” diet. This is just Weston Price nonsense. In any case, you aren’t eating a low fat diet if you are eating nuts and beans. Even my morning porridge (rolled oats) delivers 14% of total calories as fat – even more if you cook it in soy or nut milk instead of water.

                1. Thanks.

                  This refers to an observational study by some people from a faculty of sports studies in the Czech Republic. It is not clear if they were students or staff. It was in a pay-to-publish journal journal which is now apparently closed.

                  If you are a saturated fat fanboy,it is fairly easy to cobble together an argument that compares data for low income people eating lots of fried potatoes and white bread and compares them with data wealthier people who eat a higher proportion of animal foods. Such comparisons are deliberately misleading.

    1. This is a website about nutrition and its effect on population health. Your query is more of a medical nature and near to seeking personalised medical advice. There are legal, ethical and professional constraints on providing such advice online to people who are not your patients and whose medical history you are not aware of. I am therefore not surprised that the moderators have not responded.

      This is something that really needs to be discussed with your partner’s treating physician. However,you might want to read this 2011 article

      “Lowering your LDL levels also lowers level of risk caused by high Lp(a). That’s because Lp(a) is carried on the LDL particle, and does its damage in the blood stream bound to LDL. The less LDL there is to bind to, the lower the risk. “When I see high levels of Lp(a) in a patient, I set even stricter LDL goals,” says Dr. Hazen. “In fact, in a recent study of 5,000 patients that came through our Preventive Cardiology Clinic, we noted that overall mortality was increased in patients with higher Lp(a), but that if we could lower their LDL by a certain amount, the incremental increase in mortality due to the Lp(a) was negligible ………. The data for reduction in cardiac events is strongest in statin therapy,”

      You might also want to check out the Lipoprotein A Foundation website.for summaries of the latest studies


      1. I wasn’t after any advice. Just wondering if Dr Gregor had ever addressed this issue. I have seen both of those websites but I’m pretty sure that the jury is still out on the best way to deal with lipoprotein a. There are a few conflicting ideas out there. Something they all seem to agree on is that you are born with it and diet and lifestyle make no difference.

        1. Aah,OK. I don’t recall Dr G doing something on this specifically.

          I am a bit dubious about the view that diet and lifestyle make no difference. First, the Cleveland article implies that drastically reducing LDL cholesterol also drastically reduces extra risk associated with high LP(A). It would follow that reducing LDL cholesterol by diet and lifestyle would be helpful.

          Second, there is some evidence that diet does drive down LP(A) – by 24% in this study:

          “After 2 weeks on the vegetable diet, lipid risk factors for cardiovascular disease were significantly reduced by comparison with the control diet (low-density lipoprotein [LDL] cholesterol, 33% ± 4%, P < .001; ratio of total to high-density lipoprotein [HDL] cholesterol, 21% ± 4%, P < .001; apolipoprotein [apo] B:A-I, 23% ± 2%, P < .001; and lipoprotein (a) [Lp(a)], 24% ± 9%, P = .031)}

          Note that, although that this abstract states "largely", the diet appears to involve radical changes to the usual Western patterns of eating. No "reducing" or "moderating" here which may be the case in other dietary trials.

    2. maryse: I didn’t know what that was and I forwarded your original post to your medical moderators. Due to the volume of questions, not all questions get answered.
      With your second post, I did some extra research. I think you are talking about what is also known as ApoA vs ApoB? Also discussed by people as light and fluffy vs small and dense LDL particles. If that’s rigth, NutritionFacts has covered this subject here: http://nutritionfacts.org/video/does-cholesterol-size-matter/ . One of these videos from Plan Positive may also be helpful on the subject (I didn’t have time to find the specific one I was looking for): http://plantpositive.com/display/Search?searchQuery=lipoprotein&moduleId=19496100&moduleFilter=&categoryFilter=&startAt=0 The bottom line is that the LDL particle sizes are not the big issue that some people promote.

        1. Thanks for the link maryse. I think you are right that I got the ApoA/B thing wrong.
          I read that article you linked to. Here’s the part that interested me most: “However, some authors have suggested that the risk of elevated Lp(a) is small, if LDL-cholesterol is not elevated. … Consistent with treatment guidelines, reduction of elevated Lp(a) levels should be a secondary treatment priority, after maximal lowering of LDL-C.”
          That’s right in line with the point of this blog post. In other words, I interpret the quote to mean that Lp(a) is a risk factor, but again, only a risk factor in the face of elevated LDL. That may be some hope for your situation since there is something that can be done about the LDL levels.
          One more thought: That Plant Positive link I provided in my original reply to you was to a bunch of videos that come up under a search for lipoprotein. No promises, but Plant Positive’s videos are detailed and with references. So, there may be something helpful for you to learn about this topic if you want to check it out.
          Good luck to you both.

          1. Thanks Thea. Thats what I have read as well. Just don’t know how he could get his LDL down without statins as his diet is pretty good. Lots of fruit and veg, whole grains, beans, some nuts and avo.

            1. maryse: I agree that his diet sounds excellent. Just in case you haven’t seen the following page before, I wanted to bring this to your attention. “What can I do to lower my cholesterol? It seems I’ve tried everything!” from http://nutritionfacts.org/questions/what-can-i-do-to-lower-my-cholesterol-it-seems-ive-tried-everything/ It may be that your husband “won” the lottery in terms of a genes that require extra measures???
              The page I linked to here contains several tips for tweaking a diet that may be the extra measures that *may* help your husband. Might be worth trying before resorting to statins??? Also, I wonder if he cut out nuts and avocado if that would help in your husband’s case. If he needs to lose weight (as explained in the link), that could also help. (My apologies if you already went over this/disclosed this. I’m getting all the conversations on this page confused.)
              I’m just trying to help. I realize that the point of your original post was to get Dr. Greger to cover this topic. I hope he does! It’s very interesting. That said, given the article you gave me the link for, I suspect that there may not be much that Dr. Greger could report on at this point. So, I was hoping I could offer some assistance. I believe that Dr. Greger keeps an eye on the comments. I’m guessing he will add this topic to his very long list of topics to cover. My reply to you does not come between that process.

              1. Thanks again for taking the time Thea. He does eat some avo and nuts and also one coffee per day so he’ll start leaving those out. He had a stroke 8 months ago which we are pretty sure was a result of discontinuing his warfarin which he was on for AF. So needless to say he’s back on the blood thinner and Flecanide after 2 months in hospital and rehab. They also put him on a statin in hospital which he stopped taking 3 months ago as we didn’t think his cholesterol was particularly high but after reading this blog I’m thinking it’s probably should be lower. We only found out about lipoprotein (a ) about a month ago when his doctor ordered a test.

    1. The US Institute of Medicine disagrees with him. And indeed there is experimental evidence that shows that replacing saturated fat with less unhealthy alternatives reduces adverse events and that dietary cholesterol raises blood cholesterol. Also, specific mechanisms by which eg saturated fat and cholesterol damage arteries etc have been identified.

      In any case, if we accept Campbell’s views, we have to avoid all animal foods and all highly processed plant foods.We would therefore be consuming very very little saturated fat and cholesterol. The argument is therefore entirely academic.

  20. I am a big fan and supporter of Dr Greger and is excellent videos. That said there is something in this article that I really disagree with. It is strongly implied, if not clearly stated, those eating a healthy whole plant-based diet can reach below 70 without really trying…
    I doubt there are 100 people on the planet that follow the recommended diet in “How Not To Die” better than I do. I exercise reasonable hard three times a week, 1.5 hours per session. I do not sit for long periods and walk many times when other people would ride…Last time my LDL was checked it was 130 and the total 190.

  21. This is at odds with Dr. Esselstyn who recommends LDL be brought to 80-85 level. Also, how important is the LDL compared to looking at Total cholesterol below 150 as per Framington?

  22. I forgot to chime in about HDL. As the LDL drops, it is normal for the HDL to go down too. From Dr. Esselstyn’s FAQ page: “It is not uncommon for HDL to fall when consuming plant based nutrition. Do not be alarmed. The capacity of HDL to do its job has been shown recently by scientific research that there is no relationship between the capacity of the HDL molecule to function optimally and its blood level. Recent research has confirmed that the HDL molecule can be injured and weakened when one is ingesting a pro inflammatory western diet and conversely it appears despite a lower than normal level to be optimized by anti inflammatory plant based-nutrition.”

    1. Very interesting article. At first I thought it was going to refer to some of the studies done in epigenetics where the environment, e.g. diet a person is on can turn on and turn off certain genes, but this research shows insertion and deletion of genes in various populations. I will forward this to our article retrieval team for Dr. G to peruse. Thanks!

  23. I don’t smoke, blood sugar is fine, decent body composition (5’10, 155 lbs), I walk for at least an hour every day and lift weights 3 days a week. I’ve been strictly following Dr Esselstyn’s dietary suggestions for just under four years (my last deviation was ice cream and hot fudge at my birthday in 2012). My lowest cholesterol ever was 207 total / LDL 155. I get it tested every six month. It tends to be closer to 225/170. None of my parents and only one of my grandparents had heart disease. I guess I’d be good candidate to follow and see what happens from a disease perspective.

  24. I’ve had really low cholesterol for as long as it’s been checked. So low it gets flagged as abnormal! Total is 98 (normal lower limit is 100 on the lab report) and HDL is 64, LDL is 24. Are there any down sides to low levels? And why even have a lower limit if the lower the better?

    1. My LDL is 36 and I cannot find any information on levels this low. I had the same questions as you. Glad I am not the only one. My HDL is 88.

  25. I eat strictly veg. My cholesterol last month was 233, up from 225 last year. I struggle to keep my glucose below 99 and DO NOT EAT SUGER. My husband eats a double bacon cheeseburger TWICE a day and a yogurt every night. No joke. His cholesterol last week was 170 and glucose was 81. WTF

    1. I hear your frustration about a slight rise in your cholesterol and keeping your blood glucose levels down despite being veg’n. There could be some genetic factors at play here. Consider that without a veg’n diet the readings might be much higher. Having said that, a couple of other things to consider. Did your HDL level also increase? If so, that might be the reason the total cholesterol changed and since HDL brings cholesterol from the arteries to the liver for repackaging this would be a good thing. Also, consider LDL cholesterol – if it didn’t increase that’s a good thing. The majority of research focuses on LDL cholesterol levels with respect to cardiovascular disease. As for your blood glucose levels, is this a fasting reading at 99? If it’s not, then the targets are actually a bit higher in people without diabetes. For example, 2 hours after a meal <140 is considered 'normal'. Hope this helps a bit.

      1. The majority of research focuses on LDL because they cannot crack raising HDL with a drug and yet your HDL level is the more significant treading to focus on hence the total to HDL ratio

  26. I thought I would share my success with lowering my cholesterol. Background: double by pass at age 50, female, LDL was 129 at the time, not over weight, not diabetic, no HBP, non smoker, no family history till now. I was put on a myriad of cholesterol meds all causing muscle problems. I went off meds and went WFBP expecting great results and was disappointed with my LDL being 128. Back to the drawing board. Check your thyroid hormones. Mine was low end of normal. I now take Dulse for iodine every day. I take cinnamon and one red yeast rice pill a day (only mild muscle problems with it). I take 1500 mg of slo niacin a day. I do have high LP(a). I also take 2000 mg L-Lysine for herpetic lesions and since I’ve been doing that LP(a) has gone down more. Not sure if it has anything to do with that or not, but interesting. I found that I also did better with some healthy fats in my diet like nuts and avocado. I do aerobic expertise 2-3 times a week. My LDL is now at 74. Still not under 70, but way better. Keeping reading sound evidence based research and some trial and error. Good luck!

    1. The Linus Pauling protocol involved vitamin C and lysine to lower Lp(a). However, I do not think that there have been any human trials of this approach.

      That said, a diet high in vegetables, fruits and nuts (like yours) is also associated with lowering Lp(a) levels.

      There is a also some indication that niacin may lower Lp(a).

              1. Yes Tom but at the end of the day you can trust duel nobel prize winning Pauling who had nothing to gain by backing the protocol or you can trust the drug company of your choice. My own experience is that when I am on Vit C my Lp(a) go’s down and when on two occasions I have come off it then it went back up.

                1. Well, Mark, I take vitamin C every day. If I don’t, I get frequent severe respiratory infections. I also up the dose and take lysine when I feel a cold sore coming on. They work.

                  Incidentally, Pauling did have something to gain since he patented his approach.

                  However, I don’t automatically believe Pauling, the drug companies or snake oil merchants and cranks with websites. I look at the evidence and the assessments of that evidence by panels of experts. Then I fact check. A credible source of information if you are interested in this sort of thing is the Linus Pauling Institute.

                  There was also an interesting article on the vitamin C, lysine and lp(a) question in a 2012 newsletter from the Institute (page 13).

                  1. Yes I use Flax on my porridge and have added to my vit C supp daily morning pink grapefrut. Some or all of these resulted in my lowest Lp(a) reading at 18, my highest a coupe of years ago when for a couple of months I had none of the above was 31

  27. There is some great work on here but it is sad to see how hard the Cholesterol hypothesis is pushed. Many people are going away with the idea that if they get their cholesterol down all is safe. The stats show they will have a shorter life and the evidence that they will be protected against Heart Disease is weak

    1. Mark: The evidence linking cholesterol levels to heart disease is not only strong, it is overwhelmingly strong. A tiny fraction of that evidence is linked to on this site if you want to see the evidence for yourself.
      As for the claim that people with low cholesterol have shorter lives, this is not true. What you are referring to is claims from dishonest and lay (some lay people like yourself are not dishonest, just repeating such claims) people who do not understand the science. The studies in question are measuring reverse causation. I’m sure you have heard that “association does not equal causation” and this is true. What we know in the case of cholesterol is that certain diseases, such as cancer, lower cholesterol. If you have cancer, of course you are not going to live as long. Reverse Causation: Disease causes low cholesterol (not low cholesterol causes disease). Here’s a great video to learn more about the evidence regarding cholesterol and reverse causation: http://plantpositive.com/blog/2012/3/27/cholesterol-cancer-and-depression.html
      People who maintain their whole lives human-normal cholesterol levels of a total 150 or below and LDL 70 or below do not get heart disease. It’s that simple and you can look it up. The evidence is all here.

        % WHO SMOKE 35.4% 23% 17.2%
        AVERAGE BP (SYSTOLIC) 130.5mmHg 131.2mmHg 123.3mmHg
        CHOLESTEROL LEVEL 5.2mmol/l 5.4mmol/l 5.1mmol/l
        % OF POPULATION WITH DIABETES 7.2% 7.8% 12.6%
        RATE OF CHD/100,000/year 45.8 143.7 150.7

        Perhaps most important thing in this study is that the rate of CHD in men in Japan was 62.4 (per 100,000/year) in the years 1980 – 83, when their average total cholesterol level was 4.8. Since then cholesterol has risen 9% to 5.2mmol/l; meanwhile the CHD rate has fallen by 27%. In fact, this trend of rising cholesterol and falling CHD has been going on since the 1960

        Can you point me to the overwhelming evidence that higher cholesterol causes heart disease please

        1. Mark: I’ve had many conversations with people such as yourself. I’ve found that such people do not actually look at the evidence that I spend so much time digging up. So instead, I invite you to investigate this site, which links to the source material if you are interested. Here are some pages where you could get started if you are interested: http://nutritionfacts.org/?fwp_search=cholesterol&fwp_content_type=video and http://nutritionfacts.org/topics/cholesterol. You would also do well to watch all the videos on the Plant Positive site. You will get a detailed education from those videos–time well spent. Good luck.

          1. I have seen most of the videos you have cited and they really consist of opinions from ‘expert’ cardios rather than proof. One would expect to find that heart attack patients have higher cholesterol levels than the average population when in fact they do not as numerous studies have shown.

            For example, in the UK, the typical person who has a heart attack tends to have the same cholesterol level that is seen for middle-aged and older people in the general population. Something that is not unique to the UK.

            A study published in the Lancet, included 5,754 patients from Australia and New Zealand who had already had a heart attack. The average cholesterol level of this group of people was around 220 mg/dl (5.7 mmol/l). Data from the World Health Organization Global Infobase shows that around the same time, the average cholesterol level for the general population was also 220 mg/dl (5.7 mmol/l). People who suffered a heart attack had the same average cholesterol level as the general population.

            1. Mark: The videos link to actual studies, not “opinions”. You can click the “sources cited” button to view the studies. I also recommend viewing Plant Positive’s videos for an excellent education in debunking cholesterol denialism. The evidence is all there if you are interested.

            2. This is a simplistic and misleading argument. Trauma lowers blood cholesterol. Even minor illnesses lower cholesterol A heart attack is a seriously traumatic event. .The fact that people who had experienced a heart attack had the same cholesterol level as the general population suggests that their pre-heart attack level was significantly higher.


        2. Mark,

          Indeed the statistics for Japan are when taken in terms of the information provided brings us back to ALL diseases with limited exception, specifically those induced from genetic or exposures that are substantial (cellularly speaking) are an interplay of many factors.

          I can’t agree with you more that simple cholesterol levels are not adequate for our discussion. You might reference the ongoing studies especially when we discuss cholesterol fractionation, and probably most importantly the new work on new sets of hormones, some from fat specifically being found that might ultimately become an overwhelming factor for many. There are numerous approaches to evaluating the literature and it’s interesting to read the Berkley Health lab ( http://golowcholesterol.com/tag/berkeley-heart-lab/) vs say Genova diagnostics ( https://www.gdx.net/product/comprehensive-cardiovascular-assessment-plasma-serum ) vs LabCorp ideas…. Some similarities and then reliance on different literature to substantiate their position. It’s clean that the very low levels of cholesterol below 130 leads to increased psychiatric and hormonal disturbances…..http://www.psychiatrist.com/jcp/article/Pages/2016/v77n02/v77n0214.aspx and http://www.jad-journal.com/article/S0165-0327(16)30508-0/abstract ( with a U sharped result) also you may want to reveiw … http://nutritionfacts.org/video/when-low-risk-means-high-risk/

          So do we have the whole story…probably not…. As a male your cholesterol level needs to be at a point where you can produce adequate testosterone….. levels seem to be in the 130’s range… but theres as usual more…http://onlinelibrary.wiley.com/doi/10.1111/cen.12997/abstract here’s a study looking at testosterone and arteriosclerosis/calcification. Speaking of which is it the exercise, diet, combination with supplementation that leads us toward wanting to see higher testosterone which results in better cholesterol distribution ? http://link.springer.com/article/10.1007/s40618-016-0480-2

          As a clinician I have seen overall better health with those who choose a much higher plant based approach to their diet and no I’m certain that thats only part of the story as most were non-smokers and did some exercise…..Just some additional thoughts… Dr. Alan Kadish Moderator for Dr. Greger

          1. Alan I certainly agree that a whole food pant based diet would slash the NHS burden here in the UK if everyone adopted it and I too eat mainly plant based with some fish

      2. The evidence from the WHO data does not seem to tally. I quote from Zoe Harcombe (could you explain this please)

        “The WHO data is split into men and women. I first did the scatter diagrams for average (mean) cholesterol levels and CVD deaths. Then I ran the Pearson correlation coefficient on these numbers. This gives us the term called “r”. “r” tells us if there is some kind of a relationship: an r score of 0 would indicate no relationship; an r score of 1 would indicate a perfect relationship. A negative r score is called an inverse relationship e.g. the price of concert tickets is likely to be inversely related to the number of concert tickets bought – fewer tickets being bought at higher prices.

        The “r” score for men revealed that there was a small relationship of 0.13 – however this relationship was inverse. The diagram and correlation shows that higher cholesterol levels are associated with lower CVD deaths and lower cholesterol levels are associated with higher CVD deaths. In women, the relationship is stronger – to the point of being meaningful. The r score was 0.52 – but, again, inverse. For women, higher cholesterol levels are quite significantly associated with lower CVD deaths and lower cholesterol levels are quite significantly associated with higher CVD deaths. Please note that I have added r squared on the graphs below (excel can do this for us) and it can confirm that you’ve got your r numbers right and r squared tells us the strength of any relationship we have observed.

        All you need to do is to look at the lines going down to the right and wonder how on earth we ever got away with telling people that cholesterol causes heart disease. High cholesterol is associated with lower heart disease and vice versa – for all the data available in the world. High cholesterol is not even associated with high heart disease, let alone does it cause it.”

        1. Mark: I’ve made it clear that it is not worth my time to debate with you. The evidence shows that populations which maintain human-normal cholesterol levels throughout their lives simply do not get heart disease. These are populations which eat a plant based diet. It is that simple. You know where you can find that compelling evidence and plus more evidence from different angles if you are interested in educating yourself. I also recommend you watch that video on reverse causation. It is an eye opener.

          1. You cannot couple cholesterol levels with eating a plant based diet to argue your case as its clear that a plant based diet lowers heart disease compared to standard diets. Whether it has anything to do with Cholesterol levels is debatable at best

            1. Hi – Could I echo, please, Dr. Kadish’s request that you post your references and data so we can all look at the same thing.
              Also a response to Dr. Kadish would be helpful to our discussion.
              Thank you.

          2. What you are describing is what is a correlation. It is entirely possible that the fact that these populations eat a plant based diet is irrelevant to the lack of heart disease it could easily be another factor or more likely multiple different factors working together that explain the lack of heart disease.That said I happen to agree with you, but that’s a really bad argument.

            1. Guest: Looking at those populations and what they eat is just one way that we know that a plant based diet, when eaten through one’s life, prevents heart disease, all else being equal. However, you are right that the above post by itself is not a strong argument for linking plant based diets to freedom from heart disease. If you were following the conversation, you would see that the main point of my post was about the relationship between cholesterol and heart disease. I threw in the part about plant based diets and probably should not have.
              Anyway, there is only so much one can cover in a post. If you would like to learn more about the relationship between diet and heart disease, I recommend going through the relevant pages on this site. Following is a nice topic/overview page for heart disease: http://nutritionfacts.org/topics/cardiovascular-disease/ And here is the overview page for cholesterol: http://nutritionfacts.org/topics/cholesterol
              Another great resource to learn more about the relationship between diet and heart disease is the book, Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure by Caldwell Esselstyn https://www.amazon.com/Prevent-Reverse-Heart-Disease-Nutrition-Based/dp/1583333002/ref=sr_1_1?s=books&ie=UTF8&qid=1482872710&sr=1-1&keywords=prevent+and+reverse+heart+disease

        2. Mark,

          Would you post this data? I looked at the Chapter 5 WHO report and did not find the data you’re referencing. Thank you….

          As a note, the idea of reducing the levels to below 130 will lead to higher levels of psychological/cognitive issues and advanced aging, due to hormonal disruption, to name two documented issues. (per my earlier response)

          I ‘d like to suggest a quick read of this piece by Rath etal that truly addresses a different approach to why vitamin c makes sense and perhaps how we should rethink the cholesterol controversy in toto…. http://file.scirp.org/pdf/WJCD_2016111610335652.pdf Please see the third question at the conclusion of the article.

          Dr. Alan Kadish moderator for Dr. Greger

          Dr. Alan Kadish moderator for Dr. Greger

          1. Taken from Zoe’s blog

            You go to the WHO statistics area of their web site and then pick data for cholesterol from risk factors (how judgemental to start with!) and then look under: Global burden of disease (mortality); All causes; Non communicable diseases and then G Cardiovascular disease (shortened to CVD). CVD deaths include ischemic heart disease and cerebrovascular disease – that means fatal heart attacks and fatal strokes to us. You find the most recent year where you can get both sets of data to compare like with like. This turns out to be 2002. You download their very user friendly spreadsheet data (CSV) – cut and paste it into an excel file and then try to remember how the heck to do scatter diagrams in excel!

        1. Mark: That’s what I thought you were asking for before. And that’s where my patience ends. You can find all that evidence on this site. Just click the “sources cited” button to the right of the videos. You have been given so much evidence, I’m not spending more time on this. It is all there for you if you care to look.
          I will take the time to clarify however: There may be the rare person who develops a problem outside the norms. For the vast majority of people, however, if they have total cholesterol below 150 ***AND*** LDL below 60 or 70 their whole lives, then they do not suffer from heart disease. I’m guessing that if someone artificially lowers their cholesterol through drugs (and diseases like cancer?), the effect may not be as good as lowering cholesterol naturally through a healthy diet–as the mechanisms involved and body parts addressed may be different. But even so, as Tom Goff showed you, heart attacks go down even when statins are used to lower LDL.
          Your posts are starting to cross a line. So, Now I Am Putting On My Moderator Hat. From what I can see: Your points around cholesterol have been thoroughly addressed–sometimes multiple times, mostly through the generosity of Tom Goff. If you wish to keep posting on NutritionFacts, please have future posts address new topics. Continuing to post the same information that has been thoroughly debunked wastes everyone’s time.

          1. Thea OK could you please suggest why we are not looking most closely at the better indicators namely Total to HDL ratio which outperforms the more simple total or LDL alone (see this huge study)


            I am also offended that you are taking humbris with me when I have politely asked for proof of your views. It will be a sad day when someone with slightly opposing views is censored on this forum but it looks like that is where it is heading according to your last post

            1. Mark: If I remember correctly, Tom Goff already addressed this point either elsewhere on this page or on another page.
              The only point I would note here is that you wrote “outperforms the more simple total or LDL alone” I would direct your attention to the word *AND * which I highlighted in my previous post. If you want to look at total cholesterol minus HDL, I understand that that is also a helpful indicator. Either way, cholesterol levels in the blood are a clear risk factor for heart disease. That is the point.
              Finally note that you are not being censored. You have had your say. You have had your disagreement. All of that is perfectly acceptable. What I am cautioning you against is repeating yourself after a claim has been addressed. At some point, repeating claims which have been addressed becomes troll-like behavior. You have not fully crossed that line yet, but you are heading in that direction. I was giving you a warning so that you could stop yourself from crossing that line. I would much rather you be a productive member of this community.

              1. Here is the problem I have with you analogy of average cholesterol per pop. If say the UK has average LDL of 3.5 and heart attack patients have an average LDL of 3.5 then this does not add up if LDL is the main driver of heart disease. You would expect the people with higher than average LDL ie above 3.5 to skew the heart attack victims such that the average for HA victims is greater say 3.9. The greater susceptibility of the higher LDL people would increase the average for HA victims. By contrast if LDL is not a cause then you would expect HA victims to simply have the same as the average for the pop’

                1. I am also puzzled as to why heart disease rates in the US and UK have risen since 1960 and yet average cholesterol levels have fallen significantly in the same period within the same countries

                  1. As far as I know heart disease death rates in the US peaked in the 1960s 1970s and have been falling since then.

                    However, this whole argument is based in an entirely false proposition – that cholesterol is supposed to be the only “cause” of heart disease. And that if it shown that it is not the only cause, then this must prove that it is a not a cause at all.

                    If you actually read the professional literature – as opposed to just believing everything you find on websites run by “alternative health” gurus – you would learn that there are multiple risk factors for heart disease. In Western countries though like the US and UK, the big 3 risk factors are smoking, high blood pressure and high cholesterol.

                    But can’t you give all this nonsense a rest? Everywhere I go on this site now, I see some more stuff you have in essence copy and pasted from crank websites. Can’t we just concentrate on nutrition instead of being bombarded by the latest piece of misinformation about cholesterol or whatever you have found on some dodgy website?There are many, many other websites where people actually believe all this tosh. Why don’t you go and play there instead of disturbing the grown-ups?

                    1. Tom Goff: Can you please change your last sentence. It is a good overall post, but the last sentence crosses the line. Thank you.

                    2. Disease rates is what I am talking about not death rates. yes we have become better at handling emergencies and dealing with heart attacks but disease rates are the more important measure.

                      There you go again getting personal and insulting

                    3. Do you have any evidence for your claims?

                      My understanding is that heart disease rates in the UK have been essentially unchanged for the past 30+ years.

                      However, even if your claims were correct, this is all a red herring because cholesterol is not the sole risk factor for heart disease. As has been pointed out to before, a simplistic comparison of average cholesterol levels and CVD prevalence (please show us the figures by the way) ignores potentially confounding factors. For example, haven’t rates of overweight and obesity increased significantly over that period? Hasn’t statin use also increased significantly over that period? The latter factor alone could explain deathg reductions in average cholesterol levels and death rates.

                    4. Inpatient hospital episodes
                      Overall, there were around 70,000 estimated inpatient
                      episodes of CHD in NHS hospitals in England and Wales
                      in 1961. This had increased to around 450,000 by 2008/09,

                      UK population from 1960 has changed from 55 million to 65 million

                    5. Thanks but in-patient episodes aren’t the same thing as disease rates ie prevalence. Also, can you link to or quote a credible source for those figures?

                      I couldn’t find any prevalence data for the US which is why I referred to hospitalisations and emergency department presentations in that country. Unfortunately, time series prevalence data is hard to find and comparability is always a problem. .

                      The number of in-patient episodes can be affected by all sorts of things like the number of available hospltal beds (or places)..In England for example, the total number of hospital beds declined by 51% between 1987-88 and 2013-14. It is only logical that in-patient episodes would also have declined (irrespective of prevalence. Therefore comparing in-patient episodes in 1960 and today does not tell us anything about heart dise)ase rates in the UK.

                      I therefore think that the claim that heart disease rates have been increasing is, like so many other claims that the self-styled cholesterol sceptics make, false. As noted in my earlier response, prevalence rates in the UK appear unchanged

                    6. There you go again Tom with your sneering ‘self styled’ comments to describe anyone who chooses to question the status quo

                    7. Making false claims and misrepresenting the facts and figures is hardly just a matter of questioning the status quo is it?

                      The facts have been pointed out time and time again. These people seemingly just ignore them.

                    8. Thanks.

                      He did not inspire confidence when he started off by saying that a deep fried Mars Bar contains hardly any fat! Good lord, the thing is deep-fried – how can it possibly contain “hardly any fat”? In fact, it apparently contains a whopping 15 grammes of fat.

                      He then goes on to discuss what he calls 10 contradictions in the cholesterol hypothesis. The first is a list of 27 associations taken from a single Scottish study with risk of all cause mortality. Things like BMI, total energy intake, total cholesterol, alcohol intake were associated with all-cause mortality but the association did not achieve statistical significance. Although the table he shows is about all-cause mortality, he says that this shows that everything we are told about risk factors for heart disease is wrong.

                      However, Kendrick does NOT mention the part of the study that shows that “The gradient with total serum cholesterol concentration38 was very highly significantly positive for all coronary heart disease, weaker for coronary heart disease deaths, and undetectable for all deaths.”

                      As an aside, I would note that since things like cancer, Alzheimers, alcoholism etc all lower cholesterol, the lack of association between all-cause mortality and total cholesterol is unsurprising.

                      His second “contradiction” is an unnamed Norwegian study which apparently shows mortality risk goes up as cholesterol goes down, It seemed to be a U shaped curve to me but, be that as it may, population studies of associations between cholesterol and mortality have a problem:

                      “…. results of a recent meta-analysis10 of cause-specific mortality (including unpublished data on noncardiovascular causes of death) from 10 large cohort studies and 2 international studies that concluded that reduced serum cholesterol is not related to excess mortality among cohorts of employed individuals, whereas population-based studies did show a relationship. The investigators proposed that the discrepancy in results was probably due to a higher frequency of risk factors associated with low cholesterol, eg, alcohol abuse and ill health, in population-based study samples compared with employed cohorts.”

                      Kendrick also mentioned some unpublished Framingham data which apparently only a few people have been made privvy to. Obviously I have no way of telling if his claim is correct or not. However, the Director of the Framingham studyb wrote ” It is concluded that even after these adjustments, nonfasting HDL-C and total cholesterol levels are related to development of CHD in both men and women aged 49 years and older.’

                      His third “contradiction” is Japan where he says fat consumption has increased, serum cholesterol has increased but CHD and stroke have decreased. This is true but:’The decline in CHD mortality is attributable to large declines in blood pressure levels and the prevalence of smoking, which may have offset the potentially adverse effects of increased total cholesterol levels during the past decades. High total cholesterol would need a longer incubation period to maximize the effect on CHD risk.54,55″

                      Anyway, time for a cup of tea and bed- it’s after 11 pm here. So far, I haven’t seen anything persuasive. I will see if I can fact check the rest of it tomorrow. However,it’s hard not to be very very sceptical of anyone who claims that there is hardly any fat in a deep fried Mars Bar.

                    9. The 27 point study was for heart disease and hear disease mortlaity not just simply death by anything as you suggest.n He also said that the data was backed up in numerous other studies which is true.

                      You are the second person to latch onto his mars bar joke which is all it was, a joke to break the ice on his talk.

                      “The increase (Japan) in total cholesterol levels and prevalence of high total cholesterol was observed primarily between the 1980s and the 1990s and plateaued thereafter.

                      The Kindrick data display from the BMJ was from 2007, how much longer do you want to see some change in heart disease rates.

                      There were 10 contradictions and you have questioned 3 I think or 4 if you want me to count the Mars bar

                    10. Watch the video. The table clearly refers to all cause mortality. Kendrick has misrepresented the data as the citation I provided demonstrates.

                      If you don’t like what the Japanese authors of that paper wrote, take it up with them. I am only quoting the local experts.

                      Yes, I have only looked at the first three. It takes time to fact check. It doesn’t mean the remaining 7 must be OK.

                      And the Mars Bar claim didn’t sound like a joke to me – nor did I hear anyone laughing.

                    11. It say 27 different factors for heart disease and death, clearly stated at 1 40 secs in

                      Look forward to your thoughts when you have time to watch it all

                    12. Thanks.

                      Go to 1.40 secs in the video and then freeze the screen. Then go to the top of the screen and view the title of the table which Kendrick is projecting there. It says – in black and white – all deaths.

                      Nothing there about heart disease except Kendrick’s accompanying commentary. In fact if you go to the actual study as I did, but I suspect very few of Kendrixk’s hapless audience did, you will find that the study says “The gradient with total serum cholesterol concentration38 was very highly significantly positive for all coronary heart disease,”

                      Kendrick is simply misleading his audience. Why should we believe anything he says?

                    13. In Framingham, once men reached age 50 – the age when risk of heart attack increases – there was no association between elevated cholesterol and heart disease. This latter finding was greeted with breathtaking silence by U.S. cardiology.

                    14. “This latter finding was greeted with breathtaking silence by U.S. cardiology.”
                      This is hardly surprising since cardiologists probably know considerably more about cholesterol than Kendrick evidently does. For example, they might know that older people are at higher risk of eg Alzheimer’s, liver disease, cancer, their immune systems tend to become less effective making them vulnerable to infections. Also alcohol use problems are apparently common among the older population.

                      All of these morbidities lower cholesterol levels thus confounding the association between cholesterol and heart disease in older people. How can someone like Kendrick who claims superior knowledge and insight regarding cholesterol not know this? Or not mention it, if he is aware of it?

                      Incidentally, talking about breathtaking silence and contradictions, just how do people like Kendrick explain the association between cholesterol levels and heart disease in young and middle aged people?

                    15. Kendrick’s fourth ‘contradiction” is the 2009 US study documenting the cholesterol levels of heart attack patients on admission to hospital (ie following their heart attack). This is presumably the same 2009 US study I referred in my earlier post to Thea.

                      We have already discussed this point in detail. Trauma including heart attacks causes cholesterol to decline. We would therefore expect people to have lower cholesterol levels after a heart attack. Yet he describes this as a contradiction. Why doesn’t Kendrick mention that heart attacks lower cholesterol levels?

                      His fifth “contradiction” concerns familial hypercholesterolemia. He refers to an obscure unpublished 1966 study and a survey of students with fathers who had proven heart disease before 55. He attempts to argue that hypercholesterolemia is not a risk factor based on two cases in one group and four in the control group in yet another unpublished study. I am no statistician but that argument sounds fundamentally flawed to me. Also, relying on that and an unpublished 1966 study to dismiss the findings of more modern peer reviewed studies is a very unconvincing argument. Here is a link to a rather more credible discussion of familial hypercholesterolemia

                      “Contradiction” 6. He then goes on to show WHO figures for deaths from heart disease and fat consumption. He then quite reasonably says that you can’t really draw conclusions for this data from different countries because of confounding variables. Then he continues, ” a lack of associations means it is not a cause. That is science”!

                      I can’t believe this bloke graduated from medical school because he clearly has no idea of how either science or epidemiology works. Perhaps, though, this is just another of his little jokes like a deep fried Mars Bar “contains hardly any fat”.

                      “Contradiction” 7. He then presents figures for Russia and Japan which show that the 3 key US and UK risk factors for heart disease don’t explain the differences between the Japanese and Russian figures. Or between those and the UK and US figures. Therefore this “proves” that UK and US risk calculators are “nonsense”, he says. Anybody with even the faintest knowledge of epidemiology and/or biostatistics would immediately understand just how wrong this claim is. His slide also has a reference to a study of the “Japanese paradox”. Of course, he omits the study’s conclusions:
                      “There are three possible explanations. One is the decline in population blood pressure level and the prevalence of hypertension during the years 1965-1990; the second is the decline in smoking rate in men and women; the third is that the serum total cholesterol level for middle-aged and elderly populations remains 5-15 mg/dL lower than that of the US elderly counterpart, although men aged 40-49 in Japan and the US had similar serum total cholesterol levels. It was also noted that elderly people in Japan, as observed in the Seven Countries Study, had far lower serum total cholesterol levels in midlife, i.e., around 160 mg/dL in the 1960s. This was not the case for elderly in the US where a higher serum total cholesterol level was observed in midlife.
                      In conclusion, the lower serum cholesterol level in the past of Japanese middle-aged and elderly people compared to Western counterparts helps to maintain the low CHD incidence and mortality supported by the declining trend in blood pressure level and smoking rate for both men and women.”

                      The possible role of alcohol abuse in Russia and its effect on reported heart disease death rates. is also ignored. There is considerable discussion of this problem in the literature but of course Kendrick does not mention it, eg
                      ” It has recently been argued that a substantial number of such deaths currently ascribed to cardiovascular disorders are misclassified cases of acute alcohol poisoning”

                      Contradiction 8.He then goes on to put up some figures from a whole range of countries which come from the MONICA study. He stresses that the key risk factors in the UK and US (high blood, pressure, smoking, cholesterol levels, saturated fat intake) do not explain the differences in heart disease death rates between all these countries, This shows he says that saturated fat and cholesterol do not have anything whatsoever to do with heart disease. Once again, he is displaying an apparent ignorance of epidemiology that is jaw-dropping. If people truly want an intelligent analysis of the effect of heart disease risk factors internationally and how these, including the MONICA study, have affected our understanding, this belwo is a good recent summary

                      “Contradiction” 9. Then looked at WHO data on cholesterol levels and deaths in women provided by another cholesterol ‘sceptic” Zoe Harcombe. This shows a trend for higher cholesterol to be associated with lower heart disease death rates. No mention here of potential confounding factors, of course. Don’t women in wealthier countries tend to have higher cholesterol levels and better access to health care for example?.

                      “Contradiction” 10. This was another large population study which again showed that people with low cholesterol had a higher rate of all-cause mortality. This is not anything new. As I have pointed out already (this has been known for at least 20 years but Kendrick does not mention it)
                      “…. results of a recent meta-analysis10 of cause-specific mortality (including unpublished data on noncardiovascular causes of death) from 10 large cohort studies and 2 international studies that concluded that reduced serum cholesterol is not related to excess mortality among cohorts of employed individuals, whereas population-based studies did show a relationship. The investigators proposed that the discrepancy in results was probably due to a higher frequency of risk factors associated with low cholesterol, eg, alcohol abuse and ill health, in population-based study samples compared with employed cohorts.”

                      All Kendrick’s claimed contradictions come from his own peculiar interpretations of certain observational studies. He singularly fails to mention experimental studies – these have almost universally shown that cholesterol lowering has resulted in reductions in adverse CHD events.eg

                    16. You just cannot resist slagging people off and Dr Kendrick is no exception. I can assure you he is medically qualified.

                      Thanks for the links the Nature one was interesting, I gave up half way through when not a single mention of total or LDL that we should be frightened off was mentioned. Plenty of HDL evidence however but of course HDL is harder to increase and the Pharma boys had a tough job with it so they focused on the softer LDL and just upp’ed the scare tactics.

                      Also from that link

                      “Over the past 25 years, but particularly the past decade, several important consortia of both prospective epidemiological studies and clinical trials have developed and published reports involving meta-analyses of traditional and emerging risk factors, genetic factors, and the role of risk-factor interventions, such as therapies to lower lipid levels and blood pressure, and dual antiplatelet therapy. The Emerging Risk Factors Collaboration incorporating 160,309 study participants (>1.3 million person years at risk) demonstrated the independent predictive value of C-reactive protein (CRP) for CHD and stroke in 54 prospective studies,87 the clinical utility of CRP and fibrinogen in CVD risk prediction,88 and the limited role of adding the novel lipid markers apolipoprotein B, apolipoprotein A-I, lipoprotein(a), and lipoprotein-associated phospholipase A2 to traditional lipid measures.89 This group also demonstrated that BMI, waist circumference, and waist-to-hip ratio modestly predicted CVD across 58 cohort studies, but did not improve risk prediction beyond that determined by blood pressure, diabetes status, and lipid levels.”

                      A lot of stuff in there that I have been crazily talking about

                    17. None of that stuff supports claims that cholesterol is not a risk factor.

                      Kendrick may be a doctor but he omits key evidence which shows his claims are wrong and he blatantly misrepresents the evidence his claims are based upon.

                    18. That is a more reasonable away discuss Kendrick rather than personal slurs. I must confess that I am beginning to get uneasy about this forum. As a donater to the site I have lots of time for its content but when I mentioned a contrary view to the usual cholesterol hypiothesis on here I was pounced on by the moderator and threatened. Meanwhile you seem to make remarks that on any other forum would be close to the bone and inflamatory yet you seem to go unchecked, I wonder why.

                    19. Mark: You are distorting what happened. You had repeated claims that were already thoroughly addressed. For example, you brought up the issue of low cholesterol and higher mortality at least twice (ie, reverse causation). You did the same for one or two other issues. It was getting to be a problem, and that’s when/why I said something. It’s hardly a situation of you “mentioning” a contrary claim and me jumping on you right away. You are ignoring answers and then repeating claims. As I said, that ends up wasting everyone’s time.
                      As for Tom’s comments, except for once (which I immediately addressed), Tom has been very careful to direct his criticism to third parties, not yourself personally. In addition, Tom’s his criticism of the third parties has been backed up by hard evidence.
                      This is also the second time Tom has had to explain to you that his criticism comes from noticing that the sources you keep linking to (to paraphrase) omit key evidence which shows the claims are wrong and also blatantly misrepresents the evidence the claims are based upon. It was also pretty obvious from the content of Tom’s posts about Kendrick that that was exactly what was going on.
                      You are the one who keeps wanting to extend these conversations. You keep doing so by bring in evidence from disreputable sources – ie sources that “…omit key evidence which shows the claims are wrong and also blatantly misrepresents the evidence the claims are based upon.” It is very appropriate to point this out to people so that they can learn where to get valid information from.
                      As I said before, having a disagreement is perfectly fine. However, part of that process is listening to and taking in what someone is telling you. If you try to listen and if you still don’t think the other person make sense, then the last part of the process is just letting it go. It doesn’t make sense to keep bringing up the same information that has already been addressed.
                      Bottom Line: At your request, Tom did you the courtesy of not only listening to Kendrick, but directly addressing all of Kendrick’s points, including pointing out where Kendrick is misleading you. As I see it, that was pretty nice of Tom.

                    20. The reverse causation argument, do you not think that studies controlled for this. It would seem an obvious thing to be aware of and not difficult to account for. Also I have been told that its impact is only in certain and few conditions.

                    21. Mark: I totally agree that it is an “obvious thing” to be aware of at this point in history. Yet the studies you are referring to did not control for it. That is the point. Actually, more to the point is that the people you are listening to, the ones who are using those studies to try to say that low cholesterol causes disease, are failing to acknowledge what we know about what the data means. Plant Positive, the site I referenced before, goes into a lot of detail on this.
                      As Tom quoted, there are quite a few serious health problems/traumas which cause a drop in cholesterol. If you will recall from Tom’s posts, even a trauma from a heart attack causes a cholesterol drop! Heart disease is our number once cause of death. Cancer is another example of a condition that causes a drop in cholesterol. Cancer also affects a sizable portion of the population. Consider also that cholesterol goes down whenever someone loses weight, and lots of serious health problems cause people to lose weight. These are all examples of reverse causation, examples that would affect a large, sizable portion of the population, not a “few conditions”.
                      As I see it, the only way you could really control for the problem of reverse causation is if you follow people forward in time. Viola. Those studies which follow people forward in time show that people who maintain human-normal cholesterol levels their whole lives are not more likely to get diseases. I don’t have a lot of links handy. I’m not good at finding studies the way that Tom is. However, one of the older NutritionFacts videos covers one study which addresses this point: http://nutritionfacts.org/video/can-cholesterol-be-too-low/ That video talks about how men with “low” cholesterol are less likely to get prostate cancer to begin with.
                      If you didn’t get a chance to watch the Plant Positive video I linked to previously, you might want to take the chance now. The video goes into the science about this very topic, including with references if you want to check the sources for yourself. In case you missed it: http://plantpositive.com/blog/2012/3/27/cholesterol-cancer-and-depression.html Here is a different video on cholesterol and reverse causation this very worth your time if you want to learn about this topic: http://plantpositive.com/blog/2012/3/25/tpns-40-41-playing-games-with-your-heart.html (Part 2, halfway down the page, is also relevant and full of great info.)
                      Mark, I answered your question in order to provide clarity for those reading this discussion. I am not interested in further conversation with you on this topic. I think the points you have raised have all been thoroughly addressed. If you want to learn more, you have been given a lot of resources by at least three people. Four if you count Dr. Greger.

                    22. There is a raging debate out here about cholesterol and you seem to think you have nailed it. I am not as easily convinced. We have two sets of data that say totally opposite things about total cholesterol and HD. One taken from the WHO database by Dr Zoe Harcombe shows a drop in HD as cholesterol rises whilst the MRFIT data shown by Plant Positive shows the reverse. One of these has to be wrong. I am also intrigued by the India conundrum whereby the south enjoy much less HD than the north and yet LDL levels seems to be about the same. The difference lies in the lower HDL levels of the north coupled with higher Tryglycerides. It would appear further evidence that LDL is probably not the best area of prime concern as has been highlighted by other authors. Reducing simple carb’s and getting Tri’s down and HDL up would be more favourable but the drug companies do not want us to focus on this


                    23. You continue to defend someone who makes false claims and misrepresents the evidence

                      You also weren’t pulled up for “mentioning” a contrary view. You were pulled up for spamming this site with multiple posts copy/pasting claims made by cranks.

                    24. You continue to defend someone who makes false claims and misrepresents the evidence

                      Also, you weren’t pulled up for “mentioning” a contrary view. You were pulled up for spamming this site with multiple posts copy/pasting claims made by cranks.like Kendrick.

                      You have also made a number of personal accusations about me – “sneering”, “slagging off”, “there you go again getting personal and insulting’ – that would have led to anybody else’s post being deleted. You have been shown extraordinary tolerance

                      You have also ignored the questions that I have asked you, while I have done my best to respond to yours.

                      You made an accusation that I am personal and insulting simply because you don’t like the “tone” of my replies. Leaving aside the fact that tone only applies to spoken words, all “tone” means is that you dislike the fact that those false claims are continually being exposed for what they are and you wish to divert the discussion away from the evidence and make it a personal dispute.

                      Yet you still complain that you are hard done by.

                    25. For what its worth Tom I think cholesteol has something to do with HD but not in the way you would like. I suspect that low HDL and high Triglyceride are the more likely areas to focus on but of course the drug companies wont do this as they cannot so easily crack the problem of raising HDL. In my previous post I mentioned that in India the south and north have the same levels of LDL but the north have greater amounts of HD. The difference is that the north have very low HDL and high Tri’s

                    26. I would have to check your first point but all the others are untrue. With regard to India here is the data link


                      It is kind of hard to blame LDL when two sets of people have contrasting HD rates but identical LDL.

                      Also if LDL is the cause then it seems to have some kind of homing device attached to it a kind of excocet LDL which causes it to attack not only arteries and not veins but only certain parts of arteries

                    27. Mark, your “Indian” link is confusing. I find it difficult to follow your argument. It shows that serum triglycerides are “dependent of the fat rich diet” It also talks about consumption if ghee which is high in trans fat and atherogenic. Where are you trying to go with this?

                      Also, you still seem to be talking about “the cause” of heart disease. This is the usual cholesterol confusionist argument.

                      Cholesterol is recognised as a risk factor factor for heart disease. it is not the only risk factor. The “cholesterol sceptics” pretend the argument is that cholesterol is :”the cause”. This is entirely false … like their other arguments. It is a straw man argument. But you have been shown this before. Multiple times . You continue to ignore it. The fact that there are other risk factors does not prove that cholesterol is not a risk factor.

                      Neither you nor they have ever explained why good quality experimental studies show that cholesterol lowering reduces heart attacks, strokes etc. Instead you rely on simple observational studies, and ignore confounding factors, to make a case.As kendrick does.

                    28. The why do the medical profession aggresively attack LDL as if it is the only cause. Why is it that heart disease patients in the UK get very little dietary advice and the little they get is of the wrong type eg eat more bread. Why is it other factors are never even mentioned let alone tested eg Homocysteine. Why is it that other more predictive tests even lipid tests are not used eg APOB/A ratio (please dont tell me this is not the case). If LDL is such a dominant factor requiring this dominantly led medical approach why do South and North Indians with exactly the same average LDL have wildly differing HD (just one of many examples). Why is it that the much touted PlantPositve link to the unfortunatley named Dietschy shows him to be clearly a mouth piece for Statin therapy on behalf of big Pharma?. Why have you ignored some of my points ?. As for your points I find it hard to fingers to keyboard when you claim cholesterol lowering therapy extends lifespan, even Dietschy admits that Statin therapy users have higher rates of Cancer and as for the Tribes quoted with low cholesterol, well they have a life expectancy of 45

                      Let us move on Tom, what do you think are the main causes of heart disease?.

                      I personally find the theories of two great scientists Pauling and Rath to be intriguing, Vitamin C and Lp(a) have sensible reasoning behind them.

                    29. “The why do the medical profession aggresively attack LDL as if it is the only cause.”
                      There is a difference between a risk factor and a target of treatment. Lowering LDL-C has been proven to reduce adverse events. Raising HDL-C has been proven not reduce adverse events.

                      “Why is it that heart disease patients in the UK get very little dietary advice and the little they get is of the wrong type’
                      Where is your evidence for this claim?

                      “Why is it other factors are never even mentioned let alone tested eg Homocysteine. Why is it that other more predictive tests even lipid tests are not used eg APOB/A ratio (please dont tell me this is not the case)”
                      This is not the case. And why bother asking me? The answers are in the various Guidelines

                      ” If LDL is such a dominant factor requiring this dominantly led medical approach why do South and North Indians with exactly the same average LDL have wildly differing HD ”
                      This question doesn’t make any sense. And the importance of individual risk factors vary from country to country and ethnic group to ethnic group

                      I have never heard of Dietchy and disbelieve any claim you make unless you provide actual evidence. After all, every other claim you and Kendrick make have been proved false upon investigation.

                      “Why have you ignored some of my points ?.” Rather rich since you have never replied to any of my questions nor have you acknowledged any of the evidence offered to you except to simply say it is untrue.

                      ” I find it hard to fingers to keyboard when you claim cholesterol lowering therapy extends lifespan, even Dietschy admits that Statin therapy users have higher rates of Cancer”
                      Mountains of evidence prove that cholesterol lowering reduces adverse events and does not cause cancer.

                      “what do you think are the main causes of heart disease?.”
                      Why ask me? I am not a biochemist, physician or epidemiologist Look at what the science shows about the main causes in the US for example

                      “I personally find the theories of two great scientists Pauling and Rath ……”
                      Rath? Really?

                    30. If you are now using big pharma supported Quack sites to discredit Linus Pauling and Docotor Rath then this exchange has to come to an end. Thanks for your time it has been most illuminating.

                    31. So now you enter conspiracy theory territory in a desperate attempt to defend an obvious quack like Rath. Where is your evidence that any of those sites are supported by “big pharma”?

                      And of course you misrepresent the facts by saying I am trying to discredit Pauling when neither I nor those sites even mentioned Pauling.

                    32. Even the quack sites are careful about attacking Pauling a duel nobel winner but they do attack the Vit C theory which means in turn they attack Pauling. Of course I am a conspiracy theorist, to not be one would mean you do not believe in conspiracies which of course would be ludicrous. I suspect what you mean is that the modern day tag of conspiracy theorist as a derogatory term used to label anyone who challenges the quo as some kind of nutter. You will be telling me next that Russia and China are threatening the US.

                    33. The current scientific assessment of Pauling’s vitamin C theory is pretty well summed up on the Linus Pauling Institute website (discussed previously).

                      Rath is an entirely different kettle of fish. It is really hard to understand why anybody would try to defend him.

                      Conspiracy theorists are people who attempt to dismiss acres of evidence by positing that it has all been invented or bought by some huge, improbable conspiracy. Or, alternatively, try to explain why there is no evidence to support their claims by saying it has been suppressed by some conspiracy. What is more, the lack of evidence is itself proof that there is a conspiracy to suppress the evidence.

                    34. There is little doubt that big Pharma have tried to discredit and even ban the vitamin supplement market. In addition to this they have a controlling power over medical research publications. Numerous publications that are in danger of opposing Pharma profits have great difficulty in getting published. This is not my opinion but that of free thinking doctors and research scientists.

                    35. My understanding is that most of the big phama groups own vitamin supplement companies. They are no angels certainly the conspiracy theories have no meaningful evidence to support them.

                    36. Tom Goff: I agree with Mark on his earlier comment that the conversation is over from any sort of productive perspective. Despite his post, Mark doesn’t seem to actually be able to let it go, but it was a good idea. The conversation is devolving. You may want to be the one to let it go??? Any person who isn’t hard-wired to believe in this particular conspiracy theory will be able to learn a whole lot from the discussion up to this point. You have likely helped a lots of people and can feel good about that even if there is no satisfactory ending.
                      If the conversation continues to devolve, I’ll have to step in in a hard way and would rather not do that.

                    37. Yes, we are going round the buoy for the third time and encountering nothing new. There is no purpose in continuing.

                    38. Incidentally, you made a remark earlier about your suspicion that raising HDL cholesterol is the way to go.

                      In the light of this, can I ask if you are a supporter of statin drugs since they raise HDL levels?
                      “While the major CVD benefit of statins is due to reduction in plasma low density lipoprotein cholesterol (LDL-C),[2] statins also produce moderate increases, ranging from 4% to 10%, in levels of high density lipoprotein cholesterol (HDL-C).[3,4] ”

                    39. Tom Goff: There were a couple of people recently on this forum who were concerned about their HDL levels. I pulled together some of the pieces of information that I have gathered over the years as part of an answer. One piece of my post addressed the idea of raising HDL and what effect that might have. I know you are talking with Mark and making a different point above, but I thought you would be interested in the following. You may already be aware of these references, but maybe not…:
                      Snippet from my post:
                      WHICH MATTERS MORE, LOW LDL OR HIGH HDL?
                      Moderator Rami found some great information for us. Here is what he shared with us some time ago:
                      “Low LDL matters far more than raised HDL. 108 randomized trials involving nearly 300k participants at risk of cardiovascular events. HDL levels found to play no significant role in determine risk. Primary goal remains to lower LDL.
                      Genetic studies of high HDL, high LDL, and low LDL. High genetically raised HDL not protective, while high LDL is damaging. Low LDL is protective
                      In this animal model study, atherosclerotic lesion growth regressed in a low LDL environment, but did not with high HDL.
                      WHAT ABOUT TRYING TO INCREASE HDL?
                      There are healthy ways to increase HDL (such as through exercise) and unhealthy ways to increase HDL (such as through eating saturated fat–see explanation from Ornish above). Exercise is a great idea for a bazillion reasons and may be helpful in a heart protective way if someone is having trouble getting to healthy cholesterol levels. However, in general, increasing HDL does not “…reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths.”
                      That quote is from Darryl, a well-respected and knowledgeable, long time participant here on NutritionFacts. I found a post complete with lots of references from Darryl on this topic. Here is another quote: “Two big meta-analyses from 2009 strongly question the therapeutic utility of increasing HDL, and the value of even measuring triglycerides.” To see the full post: http://nutritionfacts.org/video/bold-indeed-beef-lowers-cholesterol/#comment-1076732894
                      Interesting and compelling stuff!

                    40. No on the whole I am not in favour. The Med diet has been shown to outperform statins and thats before you throw a lot of other things into the mix along with diet. I do not think that any shown benefits of statins are due to LDL lowering, I agree with the idea that they have an inflamatory reduction benefit which gives some benefits to previous heart attack patients. The side effects are too much of a burden, you can reduce inflamation via more natural means

                    41. You know what has struck about this conversation is that you can find evidence that cholesterol levels are related to heart disease and I can find the opposite and the likely reason for this is that both are true in the sense that high and low cholesterol counts can results in heart disease. I think the reason for this is that cholesterol is not the cause of heart disease, its the oxidisation of the lipid which carries the cholesterol. The polyunsaturated molecules of the lipid are prone to oxidisation if the lipid stays in the blood stream too long so perhaps the uptake of cholesterol or lipids is the crucial factor. poor LDL receptor actiity is often signified by poor Total to HDL ratio and small dense LDL particles which could be why these two markers have appeared predictive.

                    42. Thanks Mark but we have already done this one.

                      Many health problems lower cholesterol – eg infections, liver disease, certain cancers, heart attacks, Alzheimers, trauma, alcoholism etc – which explains the association between low cholesterol and mortality eg

                    43. By the way it would appear that the moderator has blocked any further discussion on this vitally important topic. There are people betting their lives on this issue and a polite debate between two people is not to be allowed it seems

                    44. Mark: I don’t know why you are making this statement about a moderator blocking discussion. I just looked on the moderator’s page and none of your posts have been deleted recently. Further, I don’t know how a moderator can “physically” block just a line of discussion. It may be possible, but I haven’t seen it.
                      You have been given a couple of warnings, however. Since you bring it up, this is the third and final warning: You have brought up some issues multiple times. I think you have brought up the false issue of “low cholesterol leads to high mortality” a good 5 times. You have received in-depth responses to this claim, but you continue to bring it up. That sort of behavior is harassing, not “polite debate.” I’ve been super lenient with you. I highly recommend that if you want to continue the debate (you had said you would stop earlier…) that you bring up new/different topics–not just find one more page that backs ups the same claims you have already made and which have already been addressed. (You may not like the answers you got, but there’s no more to be said. The debate happened.)

                    45. My post was prompted by the fact that I posted some interesting research on this study but it seemed to disappear. I will indeed refrain from commenting on this topic from now on although I find this state of affairs very worrying as you seem to be saying that you are right and me and a whole raft of doctors and Phd researchers are wrong. Nothing wrong with that stance but to silence one side of the debate because you ‘own’ the forum is a little worrying for me. I have aired the reverse causation argument on cholesterol skeptic forums and they are happy to debate the issue. This is a very important area as people like myself are betting their lives on this argument, hence the need to get to the bottom of it. I will however take my questions elswhere

                2. Mark: Your logic would only hold true if the risk was linear and if the whole population on average were not in the risky group. But what we have in places like the UK is pretty much everyone with high LDL levels and a situation where risk is not linear. In other words, the following statement that you wrote above is faulty logic for this case: “The greater susceptibility of the higher LDL people would increase the average for heart attack victims.” See the smoking analogy from my previous post for my attempt to explain nonlinear risk more clearly.
                  Another way to understand nonlinear risk is to envision a graph where the horizontal axis is LDL and the vertical axis is heart attacks. Now envision a horizontal line of zero heart attacks all the way until you get to about 70 LDL. Starting at 70 LDL and up to say 75 LDL, there is a steep line going up where as LDL goes up, heart attacks go up. And then there is the key point: at 75 LDL, the line goes mostly horizontal again even as LDL increases. So from 75 LDL onward, the LDL goes higher, but heart attacks stay relatively the same. Once you hit the threashold of the (made up) 75 LDL, then you don’t really increase risk any more. (Much like there isn’t a big difference in cancer risk from smoking 1.5 packs verses 2 packs.)
                  That entire graph may reflect humanity’s risk in general, but what if the population you are looking at ranges from about 75 LDL to say 130. In this case, you would expect the average cholesterol level of people who get heart attacks to be the same as the cholesterol levels of the population in general–because the risk is not linear. It stays relatively flat after reaching a certain threshold. So, how do we know it is the cholesterol? One way (among others) is that we can look at healthy populations. Then we start to get some clarity on the relationship between cholesterol and heart disease. That’s how we know the whole graph, the parts below 70.
                  A VERY IMPORTANT POINT: I’m in no way saying that the numbers in the above made-up graph accurately reflects reality. Reality is more complicated than this. Also, as I’ve said before, we look at both total cholesterol and LDL together to see if someone is in the safe zone, not just LDL. The point of me describing that made-up graph is to try to help you understand what nonlinear risk means.

                  1. What you are saying is that if we have two bag of numbered balls representing the general pop and heart disease patients. The average number in the general bag is 3.6 but, according to you no ball in the HD bag can hold a number below lets say 2.5 ( or whatever) whilst the first bag does have plenty of ball with low numbers. This means that the HD bag is bound to have a higher average number, unless and this is the key point, no ball in the second bag is above perhaps 4 which if true would allow the average to be around the same as the first bag. Clearly this is not true as plenty of numbers in the second bag are substantially higher than 4 and if your theory that no numbers in the second bag are below 2.5 then the average in the second bag is bound to be higher than the first bag.

                    1. Also in addition to my point above stating that you are confusing risk with numbers of occurrances of heart disease, there would also seem to be within your theory room for a subsequent spike in risk when you hit the range of Hypocholstemenia (excuse spelling). Does this not strike you as rather convenient and somewhat hard to believe. Risk go’s on hold when you hit say 75, has a little sleep and then resumes climbing when you get to upper ranges

                    2. Mark: It’s not “my” theory. As Tom has explained to you, it’s the theory/conclusion that all the major health organizations have come to. Perhaps I’m not explaining it correctly. I’ll leave it as an exercise for you to review the information you have been given to get an explanation more directly from the sources. Here is a good place to start: http://nutritionfacts.org/topics/cholesterol

                    3. Mark: I’m honestly not understanding your ball example. But if I got even the gist of it, then no, I’m not saying that the UK has 2 bags of balls. I’m saying it has 1 bag. I’m also saying that’s a dramatic over simplification. I was just trying to explain nonlinear risk to you. If that doesn’t make sense, I’m out of ideas for explaining it further.

                    4. Thea I understand non linearity, trust me. Let me simplify it further. Imagine 25% of the pop have somewhere between 1 and 2.5mmol LDL, 50% have 2.5 to 4mmol ldl and that 25% have over 4mmol. Now if the people below 2.5mmol have zero risk or little risk as you say and then even if we accept your unlikely hypothesis that those above 4mmol have the same risk as those in the mid range, what do you expect the average mmol of HD sufferers to be ?. I would expect it to be above the mid point of the mid range for obvious reasons.

                      If on the other hand it is the same as the overall population average then one could easily imagine that ldl is not the dominant factor.

                    5. Mark: I fully understand what you are saying as you are making the same argument that I already addressed multiple times. I fully understand that you think that there is a sizable portion of the population with a healthy cholesterol level – enough to affect the averages. I don’t know if you understand what I’m saying or not as none of your replies have indicating an understanding or acknowledgement of the concept I have explain.
                      Either way, it doesn’t matter. I’ll let you argue it out with the World Health Organization and other institutions across the world, made up of experts who have studied the data and come to a different conclusion from yourself. I have no interest in continuing the discussion.

                    6. Thea I think you completely misunderstand what I am saying. I am saying that there is NOT a sizeable portion of the population with ‘healthy’ cholesterol levels. That is why the average should be skewed towards a higher average cholesterol level for HD sufferers. I think you hare confused over the Maths of statistical averages and as for the WHO data I have been quoting the WHO data in my previous posts as evidence against the Cholesterol hypothesis. See my comments under the French Paradox and the MONICA trial data and all the other paradoxes like the Aborigine and the Switzerland paradox to name but two.. You also have not really explained how cholesterol effect spikes at around 2.5 to 3 ldl but then settles and has no further increase in risk but then no doubt as I stated in my previous post, comes to life again for hypo sufferers

                3. Mark, you made this same argument six days ago and received an answer then complete with citations ie
                  “Trauma lowers blood cholesterol. Even minor illnesses lower cholesterol. A heart attack is a seriously traumatic event. The fact that people who had experienced a heart attack had the same cholesterol level as the general population suggests that their pre-heart attack cholesterol level was significantly higher than that.


                  Why did the people who made this comparison, that you repeat here, omit relevant facts like these? Are they deliberately trying to mislead the public or are they simply dangerously ignorant of the subject about which they claim superior knowledge?”

                  Why then keep repeating this flawed argument and why do you not acknowledge that you have already been given an answer?

                  1. Tom Goff: Thank you for repeating this post. I remember it from before, but I was focusing on the post as a response to the idea that lower cholesterol somehow causes increased mortality. I hadn’t read the quote well enough (nor checked which claim you were responding to) to note the last sentence and the mention of cholesterol levels in heart attack victims compared to the general population. That’s key!
                    I don’t think we ever saw Mark’s source for his claim. I had assumed that they did a study where they followed people over time and took people’s cholesterol levels before they had heart attacks. If Mark is referring to a study where they took people’s cholesterol levels after a heart attack, then there was no point to the entire discussion. If nothing else, repeating yourself helped me. Thanks! :-)

                    1. Thanks, Thea. Mark was apparently talking about UK data but did not provide a source, of course. In fact from the wording of his post, it wasn’t clear to me if was talking hypothetically or if he had actually seen some data.

                      However I do remember a vaguely similar US story from 2009 which is endlessly referred to on cholesterol confusionist websites. That is just an observational study (naturally, such sites aren’t quite so enthusiastic about referring to actual experimental studies which show that lowering cholesterol reduces adverse events). However, I imagine that there may be similar data for the UK so Mark’s figures aren’t implausible.

                      Those US cholesterol figures for heart attack patients were it seems taken upon admission to hospital – so after the heart attack had occurred.

            1. No, you have not been banned. You have been given a warning. All your posts are still here except the one post which clearly broke the rules.

              1. Thea I posted a question about Total to HDL ratios which given the evidence I sighted is a perfectly relevant and important question. What was it that I said that was problematic ?

  28. Cholesterol may not be the only risk factor but it is a key risk factor. Reported just a few days ago ………….

    “Reducing our cholesterol levels to those of a new-born baby significantly lowers the risk of cardiovascular disease, according to new research …… The scientists found that dropping cholesterol to the lowest level possible — to levels similar to those we were born with — reduced the risk of heart attack, stroke or fatal heart disease by around one third.

    Professor Kausik Ray, lead author of the research from the School of Public Health at Imperial, said: “Experts have been uncertain whether very low cholesterol levels are harmful, or beneficial. This study suggests not only are they safe, but they also reduced risk of heart disease, heart attack and stroke.”

    In the paper, the scientists examined levels of low density lipoprotein (LDL) cholesterol. This is considered to be ‘bad’ cholesterol, as it is responsible for clogging arteries.

    LDL carries cholesterol to cells, but when there is too much cholesterol for cells to use, LDL deposits the cholesterol in the artery walls.”

    1. The research was only for 2 years, hardly enough time to find out whether these people died of other causes eg Parkinsons, Alzheimers and other problems linked to crazily low cholesterol levels

      1. Research shows that Alzheimer’s, cancer etc cause cholesterol to decline – not the other way round. Also, long term statin studies show no excess mortality from lowered cholesterol.
        I am sorry but these cholestetol sceptics you like to quote, continually omit the key facts which refute their claims.

    1. There have been panels of experts examining this issue, ie best risk predictive factors, over many decades.

      The conclusions they have reached are set out in the various current guidelines and risk calculators freely available on the web. However, this ratio does seem to have good science behind it. Many doctors recommend lowering dietary fat and cholesterol to bring down apoB as they do for lowering LDL-C.

      However, the keto etc enthusiasts like to refer to some studies that have shown that dietary carbohydrate restriction can lower apoB levels. What they do not mention is that
      “beneficial lipid changes resulting from a reduced carbohydrate intake were not significant after weight loss.”

      1. The important words there being ‘after weight loss’. Furthermore
        “The 26%-carbohydrate, low-saturated-fat diet reduced triacylglycerol, apolipoprotein B, small LDL mass, and total:HDL cholesterol and increased LDL peak diameter. These changes were significantly different from those with the 54%-carbohydrate diet”

        And thats from 26% carb which is not particularly low carb it also does not specify what form the carbs took.

        1. Yes.

          Once you control for the effects of weight loss, not something unique to low carb diets, the low carb diet had no significant effect.

          1. But for sustainable weight loss you wont find a better method than wiping out all simple carb’s. As a sixty year old man I lost 30 lbs in 3 months and for the last 4 years now have had the same weght as when I was 20 years old and this is despite eating as much as I want.

              1. The problem with low carb studies is that they are usually looking at low carb ala Atkins which generally means increased protein via meat. The problem then becomes one of most people increasing factory farmed or CAFO meat which is generally all they have access to. What I am advocating is a whole food plant based diet with some fish and no simple carbs only complex carbs via mainly plant sources

                1. Well, the low carb diets studied are often high fat low carb and not high protein low carb. Also there is no evidence that organic free range meat is a healthy dietary option despite all sorts of passionate assertions all over the web that it must be healthy.

                  However, I don’t really have a problem on health grounds with a WFPB diet that includes some fish (although many people here do strenuously advocate an exclusively vegetarian WFPB diet). The 7th Day Adventist Studies found the lowest mortality risk was found in pesco-vegetarians and it is probably a good option for people who do not use supplements. I choose to eat a completely vegetarian diet plus supplements but this is for ethical as well as health reasons.

  29. Cholesterol is a lipid that is vital for the functioning of your body, without it you would die. When your level of inflamation is high and damaging your arteries it gets involved in patching things up but sadly ends up also getting all the blame. Sadly many people are desperate to lower their cholesterol but know nothing about their levels of inflamation. The average person here in the Uk does not even know what CRP is and this is perhaps not even the best marker to track. Who knows next we will be told that white blood cells are responsible for most infectious diseases after all they are evident in abundance when disease strikes.

    1. Mark: The argument that “…cholesterol is vital for the functioning of your body…” is a completely irrelevant point. Water is also vital for the functioning of your body. Yet if you take in too much water, you can die of it. The same is true for cholesterol. A certain amount is good for you. Go above human-normal levels (as what happens when one eats meat, dairy, eggs for example) and cholesterol causes disease, even to the point of killing you.

      1. And equally too little of it would be detrimental. Our bodies have evolved over millions of years to produce the correct balance of many things circulating in our systems, it is not out to get us if we eat one of the many healthy diets we evolved on we will avoid disease. My suggestion would be eat like a 7 day eventist or a pre 1960’s Ugandan farmland worker or …….. and so on.

        1. Mark: No one has too little cholesterol from eating a healthy diet. That does not happen. Only the opposite is the problem: certain foods raise cholesterol levels. As you say, our bodies will give us exactly as much cholesterol as we need when we eat the diet we evolved to eat. Thus, a concern about cholesterol levels that are too low is as much an irrelevant point as pointing out that cholesterol serves an important function. No one is trying to get cholesterol levels to a point that is too low.
          As explained in the article above, the goal is to get people to human-normal cholesterol levels, ie: the level we are born with, the level other primates have, and the level which societies which do not experience heart disease have.
          Further, we know exactly what patterns of eating leads to keeping human-normal cholesterol levels. Dr. Greger’s recommended Daily Dozen is a good example of what humans could eat long term for heart health.

            1. Mark: I don’t have time for that. You can find the references yourself on this site. Click the “sources cited” button next to the videos. Those are just starters. But it will get you started…
              You might also look at the videos on the following site for a great set of references: http://www.plantpositive.com

              1. Oh, is that what he meant! Thanks Tom!! I thought Mark was asking for a dozen studies to back up the information about cholesterol. If he was asking about the Daily Dozen, I would have replied differently. Thanks for picking up on that.

        2. There is no credible evidence that low cholesterol causes disease or increases mortality. This has been known for a long time…….

          “Results showed the expected association of elevated cholesterol with coronary disease. In addition, falling levels of cholesterol were linked to an excess risk of hepatic disease and cancer in particular, whereas low (<4.7 mmol/L, <180 mg/dL) but stable levels over time were not associated with excess risk. Their findings provide evidence that the association previously reported between low cholesterol and noncoronary mortality probably reflected the cholesterol-lowering metabolic consequences of long-term subclinical disease rather than a hazard associated with low cholesterol per se.

          This conclusion is consistent with results of a recent meta-analysis10 of cause-specific mortality (including unpublished data on noncardiovascular causes of death) from 10 large cohort studies and 2 international studies that concluded that reduced serum cholesterol is not related to excess mortality among cohorts of employed individuals, whereas population-based studies did show a relationship. The investigators proposed that the discrepancy in results was probably due to a higher frequency of risk factors associated with low cholesterol, eg, alcohol abuse and ill health, in population-based study samples compared with employed cohorts.

          Two additional pieces of evidence that suggest that low cholesterol is not a causal factor for noncardiovascular disease are the normal to extended life expectancy experienced by individuals with genetically determined hypobetacholesterolemia11 and populations with low average blood cholesterol levels, such as the Japanese and Greeks, who do not exhibit an excess of noncardiovascular disease deaths.12"
          Results showed the expected association of elevated cholesterol with coronary disease. In addition, falling levels of cholesterol were linked to an excess risk of hepatic disease and cancer in particular, whereas low (<4.7 mmol/L, <180 mg/dL) but stable levels over time were not associated with excess risk. Their findings provide evidence that the association previously reported between low cholesterol and noncoronary mortality probably reflected the cholesterol-lowering metabolic consequences of long-term subclinical disease rather than a hazard associated with low cholesterol per se.

          This conclusion is consistent with results of a recent meta-analysis10 of cause-specific mortality (including unpublished data on noncardiovascular causes of death) from 10 large cohort studies and 2 international studies that concluded that reduced serum cholesterol is not related to excess mortality among cohorts of employed individuals, whereas population-based studies did show a relationship. The investigators proposed that the discrepancy in results was probably due to a higher frequency of risk factors associated with low cholesterol, eg, alcohol abuse and ill health, in population-based study samples compared with employed cohorts.

          Two additional pieces of evidence that suggest that low cholesterol is not a causal factor for noncardiovascular disease are the normal to extended life expectancy experienced by individuals with genetically determined hypobetacholesterolemia11 and populations with low average blood cholesterol levels, such as the Japanese and Greeks, who do not exhibit an excess of noncardiovascular disease deaths.12"

        3. Further to the point about “Their findings provide evidence that the association previously reported between low cholesterol and noncoronary mortality probably reflected the cholesterol-lowering metabolic consequences of long-term subclinical disease rather than a hazard associated with low cholesterol per se.” below ……………. long latency diseases like cancer, Alzheimer’s etc take a very long time to present gross clinical symptoms.

          This is obvious from studies like the Honolulu-Asia aging study where it was found

          “Results: Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period.The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents.
          Conclusion: A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.”

          Claims that associations between low cholesterol and disease are causal are incorrect. Long latency diseases, as well as trauma, viral infections etc, cause cholesterol to decline. Not the other way around.

    2. This is typical cholesterol sceptic nonsense, Mark.

      Why do you believe all these claims found on websites operated by charlatans and cranks? Why on Earth would you believe that the worldwide scientific community after 100 years of studying this issue has got it wrong? And a tiny bunch of cranks who typically omit key evidence, and misrepresent other evidence, have got it right?

      In any case, cholesterol by itself causes inflammation eg

      If you are really concerned about inflammation instead of just parroting the standard cholesterol sceptic nonsense you might want to watch this video

      It is not just Dr G pointing this out, Harvard has also summarised the science on this

      You really shouldn’t spend so much time on websites operated by crackpots. You know the old saying, if you lie down with dogs, you get up with fleas. Why not look at what the actual science says instead?

    3. . In 1977 George Mann, a co-director of the Framingham Study, writing in the New England Journal of Medicine called it (diet heart hypothesis) ‘the greatest scam in the history of medicine.’ In my view, anyone with a moderately functioning brain, can easily see that it is nonsense.

  30. Way too much blah, blah in comments from people that just do not get the point….being average in a sick society may not be a good idea!!! Studies point to few, if any, heart disease in populations with long term cholesterol LDL of 50 to 70 or totals below 150. You can blah, blah till blue in the face about the average being a little below 200 but ignore the facts that one out of four people die of heart disease and we do not know what percentage of adults have it and die earlier of something else, all with average cholesterols between 180 to 250….
    If you are happy with the average statistics, go for it by why are you commenting like you know something the rest of us do not know? If you do not think cholesterol levels are relevant, ignore yours!

  31. in the Minnesota Coronary Experiment (MCE), substituting saturated fat with polyunsaturated fat was effective at lowering cholesterol levels. However, it had absolutely no effect on deaths for heart disease, and greatly increased the overall risk of death.

    The summary of this trial was, as follows:

    It involved 9423 women and men aged 20-97
    A cholesterol lowering diet was used, replacing saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine).
    The low saturated fat group had a significant reduction in serum cholesterol compared with controls.
    There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts.
    For every 0.78mmol/l reduction in serum cholesterol [Around a 20% reduction], there was a 22% higher risk of death [This is about a 30% reduction in cholesterol level]

    1. As I have pointed out to you before, the cholesterol sceptics – Plant Positive describes them, perhaps more accurately, as cholesterol confusionists – have to go back to the 1960s and 1970s, to find data to support their false claims. This is because oils and margarines were routinely hydrogenated in the 1960s and 1970s. In those days, people didn’t know about the dangers of trans fats. They didn’t even measure trans fat consumption, did they?
      So people consuming more trans fats had higher mortality. And this is the evidence that is supposed to prove cholesterol lowering is unhealthy? And to trump all the more modern evidence, produced when people knew about the dangers of trans fats?

      1. I think it is not helpful to label those that probe and question the relationship between Cholesterol and HD as confused people especially as it seems that I would not be allowed to do the same on here towards Cholesterol advocates.

  32. Although I have been on a plant based, whole food, no oil, non processed, no refined carb diet for over 4 months there is no reduction in my cholesterol. Perhaps the problem is that my cholesterol was lowered long ago with pravachol (statin) and zetia. So in order to stop these two lipid medications I decided to start a stringent plant based diet. As I said my cholesterilol and ldls did not decrease. My cholesterol is around 138 and my lds are around 60. So my lipds are great for preventing a heart attack. I just wanted to stop the lipid medications to see if a stringent diet would work. So far no change. Maybe I need to stop one of the medications (perhaps the zetia as that prevents the absorption of cholesterol). If my cholesterol remains the same then I could permanently stop the zetia. If that occurred I could then stop the pravachol (that prevents the creation of cholesterol in the liver). If my lipids remained the same that would indicate that the stringent diet was working and I could stop all lipid medications. Yes I know I need to discuss this with my doctor. I just want to know if anyone else had a similar experience,, where the lipid medications reduced your lipid totals so low medications could not reduce them further. However if you returned to an omnivore diet your lipids would likely jump. However if you stay on a stringent plant based diet maybe the lipids would stay low. Just want to see if someone one there shared a similar experience.

    1. Ken: Here’s an idea for you. Dr. Michael Klaper is a well known and well respected plant based doctor who works out of the True North Health Center and does phone consultations. I’m pretty sure he would help you safely wean yourself off the statins if that is what you want and if he thinks it makes sense for you. If you are interested: http://doctorklaper.com/contact
      One other thought for you: I have a friend who went 100% plants a few years ago. It took 3 years of slowly lowering cholesterol levels before she got the cholesterol to the level that she wanted. I’m not a doctor and do not know how often it takes people that long (for some lucky people, the switch to a plant based diet seems to have a much quicker effect), but in that context, 4 months is just getting started…
      Oh wait, one more thought: I haven’t seen any data around people who are both on a healthy whole food plant based diet and drugs. If I understand you correctly, you were taking statins for a while and those statins did in fact drop your cholesterol levels down to the human-normal levels. Then, 4 months ago, you went plant based and wonder why your levels did not drop further. Since you are already at human-normal levels, maybe it makes sense that you levels would not drop further? I don’t know. I’m just throwing the idea out.
      I can’t seem to stop. I thought of one more thing for you. If you stop the drugs and your cholesterol level starts to creep back up, you might want to check out the following NutritionFacts Ask A Doctor page: http://nutritionfacts.org/questions/what-can-i-do-to-lower-my-cholesterol-it-seems-ive-tried-everything/
      Hope that helps!

    2. Hello Ken,
      The cholesterol levels you mention (total of 138 and LDL of 60) are excellent. If I understand what you said, you took pravastatin and Zetia to get down to those levels; then you went on a strict plant based diet and had no further decrease in your levels. Now you are stopping your medications, but maintaining your plant-based diet, and are planning to discontinue one or both of your meds, if your levels don’t increase.

      I think that’s a great plan. I am not surprised that a vegan diet didn’t cause any further decrease in your already-very-low levels. Stopping Zetia first, and then Pravachol (pravastatin) is also the right order in which to stop them, since Zetia by itself probably doesn’t help much. Don’t be surprised if your cholesterol levels go up slightly after stopping your medications. As long as your total stays below 150 (or even a little higher) and your LDL stays below 70 or so, your coronary arteries will be pretty happy. Remember that even plant oils can raise cholesterol levels, so if you need to be really strict, your only fat intake should be from nuts and seeds in moderation.

      1. Dr. Esselstyn is a believer that plant based oils in nuts, seeds and avocado, in heart patients, can cause arteriosclerosis. Dr Ostfeld allows his patients to have two ounces of seeds. a quarter cup of nuts and half an avocado a day. Dr. Greger’s review of research studies seems to indicate that seeds, nuts and avocado have beneficial effects on arteriosclerosis and only animal based fats result in atherosclerosis. I have already lost about 15 pounds on the plant based program and prefer to eat the nuts, seeds and avocado to try to keep my weight up. I understand there are lots of benefits to a plant based diet in addition to preventing heart disease. However, I went on this diet to try to eliminate the cholesterol medications. After reading the literature from the vegan doctors I felt I might have been able to avoid a stent had I gone on a strict plant based diet in 2003. So I figure better late than never. However, so far my strict plant based diet for the last 4 months has not resulted in any reduction in cholesterol or LDLS. So I am frustrated at this point. I will try to keep on the plant based diet but it is hard to follow it when it has not achieved the results I had hoped it would accomplish. I guess with my doctors permission I could first stop the Zetia, stay on the plant based diet and see if my cholesterol and LDLS remain low. If successful I could then stop the pravastatin and see if my lipids remain low. I was just hopeful that others in the vegan community who were taking cholesterol medications that lowered their lipids, and who switched to a plant based program that did not result in cholesterol and LDL reductions while still on these medications, found that by dropping those medications the cholesterol and LDLS remained acceptably low. If enough of you were successful than I would be more motivated to try. Thanks!

        1. I just finished reading “The Big Fat Surprise”, why Butter, Meat, & Cheese belong in a healthy diet.
          It is a very highly researched book from 2014. I don’t know if Dr. Esselstyn has ever commented on it but brings out much of what’s going on in the subject of fat in the diet. Bottom line, saturated fat is not bad, in fact,it’s beneficial. Olive oil is a healthy fat and there is much more and no time to try a review here. Only that more confusion and you wonder who really knows what’s going on with food and diets. Only more controversy.

          1. ron: I agree that the book adds to the confusion. But it is not a well researched book. A person can list a ton of references and unless those references actually support the claims made in the book, the references are worthless. Following are links to part 1 and part 2 of a review of Nina’s book. The review dives into individual claims and checks the references. I think you are in for quite a wake up concerning that book.
            From Part 2: “Unfortunately there are quite a few instances of inaccuracies in the book ranging from simple citation errors to deliberate misrepresentations of scientific studies to outright plagiarism. These are bold claims that I am leveling against the author. I don’t take these lightly, and I stand by them. I have checked many of her references and the results of my efforts are below.”
            Part 1: https://thescienceofnutrition.wordpress.com/2014/08/10/the-big-fat-surprise-a-critical-review-part-1/
            Part 2: https://thescienceofnutrition.wordpress.com/2014/06/30/the-big-fat-surprise-a-critical-review-part-2/

            1. Thea, Thank you, happy healthy new year.
              So much to read and try and understand. What makes it so difficult are the number of people, Some like Dr. Greger who I totally believe in, as well as Dr. Esselstyn, Dr. Katz, T. Colin Campbell and a few others. Some I would like to believe in Dr. Hyman, Dr. Perlmutter, Dr. Barnard, Dr. Weil but what they say, not always so believable. Even my Dr.of over 40 years ago, no longer with us made alot of sense. It’s mostly stuff I read and don’t really know their credentials, so I”ll just stick to Dr. Greger who I sometimes find not always to the point. And of course you Thea..

    3. It takes time for your body to adapt to a new healthy diet. Your gut microbiota need to change before you can fully realise the benefits. It is not clear how long this might take

      “In a new study, researchers explore why mice that switch from an unrestricted American diet to a healthy, calorie-restricted, plant-based diet don’t have an immediate response to their new program. They found that certain human gut bacteria need to be lost for a diet plan to be successful.”

      1. Tom, thank you so much for taking the time and interest to respond to my inquiry. Do you have any suggestions for losing the human gut bacteria so that the plant based diet would be successful without having the need to continue the pravastatin and Zetia? Tom I am going to give you a bit more history of my particular situation, that can perhaps be helpful to you in making these suggestions. Not to worry. What ever I do I will certainly consult my doctors. I am 64 years old. My father died of a heart attack at age 55. As a result I made an effort to improve my chances of not having the same fate. I have been seeing the same cardiologist for 30 years. His advice to follow a low fat diet had a minimal effect in reducing my cholesterol. So he put me on 40 mg of pravastatinl which I have been taking for many many years. That lowered my cholesterol from about 240 to 180 and my LDLS from about 140 to 80. Unfortunately, that was not sufficient to reduce the arteriosclerosis that was developing and I needed a stent in my right coronary artery in 2003 (I had a 90-95% blockage and angina). At exactly the time I received the stent a new study came out indicating that the LDLS in people who had a predisposition for arteriosclerosis needed to be between 50 and 70 and the cholesterol under 150 . Adding 10mg of Zetia accomplished just that. My cholesterol has permanently been around 140 and lDLS aroung 60 since I started the Zetia. I had no further angina . Around that time I began reading about Dean Ornish but following his diet was not widely recommended, at that time. I just followed the advice of my cardiologist. I give him credit in that I have not needed a another stent and the angina has not returned.. Then a vegan friend turned me on to this site and I also read of Esseltsyn, Bernard, Fuhrman, McDougal, and again Ornish. So I was evaluated by Robert Ostfeld in the Bronx who put me on a plant based program ( he did not reduced the lipid medications.. I have strictly followed it for 4 months with no further reductions in cholesterol My theories why include: the meds make my cholesterol so low that the plant based program does not allow them to go lower, my stent prevents the diet from working (sought of implied by Fuhrman in Eat to Live), and now your theory of gut bacteria. While the answer to this problem is very useful to me it would be very useful to others in a similar situation, who were hopeful that a plant based, whole food, non processed, no oil diet would allow the lipid medications to be dropped.

        1. Hello Ken. I am not a clinician nor can I give advice of any kind. However, you are certainly welcome to my thoughts about what some of the factors might be (these are in no particular order)

          First, overweight is an issue for many people. Low fat diets are usually less successful in improving lipids in people with excess weight. Weight loss itself is often the most effective way to improve lipids.

          Second, some common drinks like cola and coffee raise cholesterol (as well as the well-known culprits like trans fats, saturated fats, refined carbohydrates, smoking, sedentary behaviour etc). In fact, a component of coffee has been called “the most potent dietary cholesterol-elevating agent known”

          Third is the gut bacteria issue already touched upon. These can affect the body’s own synthesis of cholesterol. Your gut microbiota will change in response to a WFPB but it doesn’t happen overnight.

          Fourth is genetics. Some people have genetically very high or genetically very low cholesterol. However, in between these two extremes. many people also have a genetic predisposition to higher cholesterol. Dean Ornish talks about 15-30% of the population having the apoE4 gene, for example, which is linked to high cholesterol levels.

          I honestly don’t know why you haven’t responded more quickly to WFPB diet – probably nobody does. However, it is not an unusual situation and you may have to wait longer to see changes

          All I would say is keep following your doctor’s advice about the prescription meds. Their efficacy and safety has been demonstrated over many decades.

  33. About 8 months in following Dr G’s daily dozen (or close to it). Last week’s blood results:
    HDL – 44
    LDL – 66
    Triglycerides – 100

    Is there any information on optimal HDL or triglyceride levels? Can’t seem to find it. thanks.

    1. vegluke: I am not an expert on the topic of HDL, but some of my favorite experts have had a thing or two to say on the matter. I synthesize the information below to mean we do not need to worry about HDL levels or HDL falling in the context of a whole plant food based diet, when LDL goes down or is at a healthy level.
      In other words, if you have high/unsafe cholesterol levels (total and LDL) overall, then also having high HDL can be protective. But in the face of healthy LDL levels (and yours look pretty good), the HDL level doesn’t seem to matter. I may be wrong about this, but see what you think.
      First, check out the following article from heart health expert Dean Ornish. He does a great job of explaining the role of HDL and when we need to worry about it’s levels vs when we do not. http://www.huffingtonpost.com/dr-dean-ornish/cholesterol-the-good-the-_b_870655.html “A low HDL in the context of a healthy low-fat diet has a very different prognostic significance than a low HDL in someone eating a high-fat, high-cholesterol diet.”
      Moderator Rami found some great information for us. Here is what he shared with us some time ago:
      “Low LDL matters far more than raised HDL. 108 randomized trials involving nearly 300k participants at risk of cardiovascular events. HDL levels found to play no significant role in determine risk. Primary goal remains to lower LDL.
      Genetic studies of high HDL, high LDL, and low LDL. High genetically raised HDL not protective, while high LDL is damaging. Low LDL is protective
      In this animal model study, atherosclerotic lesion growth regressed in a low LDL environment, but did not with high HDL.
      Quote from the comment: http://nutritionfacts.org/2016/03/22/the-effects-of-dietary-cholesterol-on-blood-cholesterol/#comment-2630127562
      There are healthy ways to increase HDL (such as through exercise) and unhealthy ways to increase HDL (such as through eating saturated fat–see explanation from Ornish above). Exercise is a great idea for a bazillion reasons and may be helpful in a heart protective way if someone is having trouble getting to healthy cholesterol levels. However, in general, increasing HDL does not “…reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths.”
      That quote is from Darryl, a well-respected and knowledgeable, long time participant here on NutritionFacts. I found a post complete with lots of references from Darryl on this topic. Here is another quote: “Two big meta-analyses from 2009 strongly question the therapeutic utility of increasing HDL, and the value of even measuring triglycerides.” To see the full post: http://nutritionfacts.org/video/bold-indeed-beef-lowers-cholesterol/#comment-1076732894
      When some people switch to a WFPB diet, both their LDL and their HDL goes down. Do people need to worry about HDL going down? I thought that Dominic (a participant on this site) had a really great post on this topic. Here’s a quote I find compelling: “In populations where CAD is just about nonexistent, people have both low LDL and HDL levels. These populations follow diets that are higher in whole plant foods and lower in fat and saturated fat than the typical western diet. Studies have shown that it does not appear that low HDL levels provide any vascular risk in individuals who attain very low concentrations of LDL – through diet alone or on extensive statin therapy.3,4.” To see the full post: http://nutritionfacts.org/video/paleo-diets-may-negate-benefits-of-exercise/#comment-1849535796 This post also includes a guideline (not sure where it came from) on how to better judge your cholesterol numbers rather than worrying about HDL levels by themselves.
      Dr. McDougall also has an article on the topic in one of his older newsletter articles: https://www.drmcdougall.com/misc/2003nl/sep/030900pugoodcholesterolworsens.htm The article includes these quotes:
      “Worldwide (comparing people who eat different diets) those who have the lowest HDL levels (like people in rural Japan, China, and Africa) have the lowest rate of heart disease…”
      “HDL cholesterol is a risk factor – not a disease. No one dies of low HDL – they die of rotten arteries.”
      “When you adopt the McDougall Program, you will watch your total cholesterol fall dramatically. As it does, both LDL and HDL levels will drop, as well. And as they do, so too will your risk of heart disease. And your health will improve dramatically. Unfortunately, because HDL doesn’t go up with a healthy diet some unenlightened physicians – acting like puppets for the pharmaceutical industry – give their patients a totally undeserved hard time.”
      I hope this information is helpful in allowing you to judge your own situation.

  34. About 8 months in following Dr. G’s daily dozen. Last week’s blood results:
    HDL 44
    LDL 66
    Triglycerides 100

    Is there any information on optimal HDL or triglyceride levels? I can’t seem to find it on the site. Thanks

    1. The AHA concludes that optimal fasting triglycerides are under 100

      There is evidence that HDL above 60 is protective while a level below 40 may increase risk. Also a low total cholesterol to HDL cholesterol is believed to be protective.

      According to the AHA, total cholesterol = LDL+HDL+ 20% of triglycerides.

      Your ratio therefore appears to be less than 3 which is very good.

      1. Thanks for the information Tom! I was more concerned with my HDL being too low (44) but maybe that doesn’t matter as much if the LDL level is below 70.

      1. Thank you Darchite. I thought Dr. G had indicated that if you have low LDL levels your HDL level doesn’t matter as much given that HDLs absorb LDLs and escort them from the arteries to the liver. In other words, is there a risk factor if LDL is say 60 but HDL falls below 40? Not sure if it was Dr. G or if I read in another place. Thanks again for the reply.

        1. Glad to help!

          According to this review and I quote:

          “With few exceptions, low HDL is an independent risk factor for CAD in case-control and prospective observational studies. In contrast, high HDL levels are associated with longevity and are protective against the development of atherosclerotic disease. In the Framingham Study, risk for CAD increases sharply as HDL levels fall progressively below 40 mg/dL. In the Quebec Cardiovascular Study, Many clinicians believe that low HDL is associated with increased CAD risk because it is a marker for hypertriglyceridemia and elevated remnant particle concentrations. The Prospective Cardiovascular Münster Study, however, demonstrated that the increased risk associated with low HDL is independent of serum triglyceride levels.

          In the United States, low HDL is present in 35% of men and 15% of women. Given the evolving epidemic of obesity, diabetes mellitus, and metabolic syndrome, the prevalence of low HDL will continue to rise. In one study, low HDL occurred in approximately 63% of patients with CAD. Low HDL is associated with increased risk for MI, stroke, sudden death, restenosis after angioplasty, and severe premature atherosclerotic disease in the proximal left main coronary artery. In one autopsy series, the average total cholesterol:HDL ratio and HDL level in men who died suddenly during exertion were 8.2 and 36 mg/dL, respectively.

          (…) The National Cholesterol Education Program (NCEP) defines an HDL level <40 mg/dL as a categorical risk factor for CAD"

          Taking these facts into consideration, I would assume, there is a risk.

          Hope this answer helps.

  35. Not so straightforward as described. In the recently published BMJ paper- http://bmjopen.bmj.com/content/6/6/e010401.full ” in free-living populations without pre-existing disease, higher LDL-cholesterol predicts a lower risk of death in those over 60, and (with more limited evidence) does not predict an increased risk of death from heart disease or stroke” – seems to be directly contradictory to the accepted wisdom here that very low LDL below 70 is the way to go. Any comments? Also see a more detailed analysis here https://profgrant.com/2016/06/14/the-new-bmj-review-of-high-cholesterol-and-mortality-in-the-elderly/

    1. Read the study. They compare people with high-LDL to people with low-LDL on statins who are on statins probably because of their high-LDL. We also know several disease can lower cholesterol. All in all the study’s poor design makes it impossible to draw any meaningful conclusions from.

    2. As I noted in a reply to Mark (above) ……..

      Many health problems lower cholesterol – eg infections, liver disease, certain cancers, heart attacks, Alzheimers, trauma, alcoholism etc – which explains the association between low cholesterol and mortality eg

  36. And also, I am not so sure about the reference to LDL of 50-70 at birth- That is based on studies done on cord blood samples, so is essentially a representation of fetal cholesterol levels. The values do rise to higher levels at 6 months of exclusive breast feeding, to around 100-120. Shouldn’t that be a representation of what nature intended for a homo sapien who is “eating properly” rather than fetal levels ? See reference values here http://ibfanasia.org/Article/EJCN_Lipid_profile.pdf

    1. Zorba74: You wrote, ” The values do rise to higher levels at 6 months of exclusive breast feeding, to around 100-120. Shouldn’t that be a representation of what nature intended for a homo sapien who is “eating properly” rather than fetal levels ?”
      In my opinion, the answer is “no”. Human infants experience rapid growth. That’s a good thing. Rapid growth is a bad thing for adults. Applying measurements from 6 month olds to what is appropriate for adult humans makes no sense tome.
      As for whether it makes sense to look at LDL levels at birth, I would agree that would be tenuous information at best if that was the only information we had. However, as Dr. Greger points out in the article, LDL levels at birth is just one of a long list of data points that helps us to understand which LDL levels are normal and safe for humans.
      That’s my 2 cents anyway.

  37. Hi there, this is a little off topic but i wanted to ask what the research says concerning fasting? I have come across some people who speak of great health benefits from regular fasts. Thanks for your time, i really appreciate the site.

    1. Hi NoumeaVeg, I am a volunteer for Dr. Greger. Thanks for your question–it is one that many people have asked recently. In the next few months, I believe Dr. Greger will be coming out with a series of videos on fasting, so make sure to stay tuned and watch for new videos! We’re all excited to see what the research says on this type of lifestyle.

  38. VegGuy, in case you’re still reading this: does your father have Factor V Leiden? We have horrible pipes in my family and my teenytiny, non-smoking mother is very sick with heart disease. The doctors told her after her 2nd heart attack at age 52 that the FVL may have been a contributor (though not as important as her genetics)

    Look, it’s a Life’s Not Fair issue: my friend’s father has a huge gut and puts bacon grease on his oatmeal…but his arteries are in excellent shape (close to age 80 now) and has no indicators of heart disease. Looks like your father (and you!) will have to aim for the ideal of below 150 total and 70 LDL cholesterol. Good luck. I hope your father will listen, as my mother has changed from an active 50 year old to the oldest, frailest 70 year old I know. Unfortunately she is convinced that, since her numbers were “good” according to traditional recommendations, that cholesterol totals don’t matter

  39. I appreciate everyone’s comments; but I’m really wondering if someone could help me. I’m extremely frustrated and I really don’t know where to turn anymore. Since adopting a whole-foods, plant- based diet all of my health markers improved significantly; including cholesterol to the point where my doctor has taken me off statins. However, my cholesterol is still too high and my doctor thinks it’s fine (second doctor who agreed). I’m only 31 and my total cholesterol is: 179 (HDL:46/LDL:137/T:135). This is NOT acceptable. While I was on statins my total cholesterol was: 110 (HDL: 44/LDL50/T:95). I’m basically being told that it’s well enough now. To maintain even this – has required significant lifestyle changes. I am committed to this new way of life, but if I’m going to put in the effort, I want the correct result. I must be doing something wrong still and I wish I could find the answer. I eat virtually no animal products, don’t cook with oil (nor consume it) and make almost everything I eat at home. The only thing I can think of is, I do like Triscuits, which I believe have soybean oil, but it says very low saturated fat on the nutrition label. I also make homemade bread and use 2 tablespoons of olive oil per loaf (usually eat about 2-3 loafs per month).

    PLEASE help me – even if there is a nutritionist or doctor, or test that would provide more context to understanding why I can’t get my cholesterol under control. Thank you SO MUCH – I would be forever grateful because this just isn’t really making sense anymore and I’m at the end of my rope.

    1. Chris: Good for you for getting as far as you have already. I also applaud your goal of getting to healthy cholesterol levels. I think at this point, your idea of consulting a doctor who really knows what he is doing is your best bet. Dr. Michael Klaper is a well-respected, well-known doctor in the plant based world who does phone consultations. I don’t know what he will tell you, but I feel that you will get some straight talk and practical help from Dr. Klaper.

      If you are interested, here is the page to find out about those phone consultations:

      I have no personal involvement with Dr. Klaper. I have just listened to several of his talks and know that Dr. Klaper is associated with the True North Health Center, another institution with a lot of respect. Here is the ‘About’ page for Dr. Klaper:

      Good luck!

        1. Chris, hope you could get in touch with Dr. K. I was unsuccessful in the past. GL.

          Also, your numbers don’t add up.
          46+137+27(20% of 135) is 210.

          1. Casper Gomez: That’s disappointing to hear that you have had problems with getting an appointment with Dr. Klaper. I appreciate you mentioning it since I refer people his way when I think a consultation with a qualified doctor is what someone really needs. His website still says that he is doing phone consultations, but now I wonder… I too hope that Dr. Klaper gets back to Chris.

            Thanks for the info.

            1. Yeah, I was a bit disappointed. I still love Dr K though. Could have been an oversight or something. Who knows.

              Dr McDougall’s front woman responded to all my inquiries and I even got answers directly from Dr McD (which I thought was so insanely kind).

              I won’t get into the nature of the inquiry since it was for someone else’s child, but so grateful for the time he took out of his busy day to provide 3 journal references about the condition with no guarantee my friends were going to sign up for his weekend. Crazy!! Love him.

        2. Also, Chris, it would be great if you could post everything you’d typically in a day or two, so we could see if there’s improvements to be made in certain areas.

          Let me give you an example. Ryan of Happy Healthy Vegans YouTube channel eats like 15 bananas a day. He also has high Triglycerides because of it. Just sayin

          1. Yes, thanks Casper!

            A typical day is:

            Breakfast: GoMacro Bar and piece of fruit, usually a bananas, oatmeal, whole wheat toast and jam or green smoothie (half and avocado, 2c greens, banana, TBSP flax and hemp hearts, Tsp amla powder and 1/4tsp turmeric with 3 TBSP Lemon juice.

            Lunch: typically, raw cut veggies, Annie’s Green Goddess Dressing (2TBSP) and triscuit w/hummus. Piece of fruit.

            Dinner: usually a recipe from forks over knives cookbook. Piece of fruit.

            1. Chris, you’re doing really well.

              Couple of points. First, I’d eliminate the GoMacro bars. Those Ingredients are not good. Plus, unnecessary fats. Second, I’d figure out why your numbers are 30 points off. If you’re at 179, and the LDL is lower than 137 then cool. If it’s 210, that’s not cool. Although many so-called experts in plant based nutrition argue they’ve treated “100’s” of plant based dieters with TBC well into the 200’s.

              One possible explanation if you’re actually eating really well daily is that you have an LDL receptor issue. That would require specific testing and not sure if your willing to take that approach.

        3. Chris,

          My pleasure, and I hope that Dr. Klaper gets back to you. (Let us know.)

          In light of Casper’s comment, I thought I would mention that there are some websites out there for finding local doctors who hopefully know something about plant-based eating and how to get healthy cholesterol levels naturally (when possible). I can’t personally vouch for these lists, but maybe you will find something helpful:

          –> Plant-based Docs – Find a Practitioner http://plantbaseddocs.com/listings/
          –> American College of Lifestyle Medicine – Find a Lifestyle Medicine Practitioner http://lifestylemedicine.org/Find-a-Lifestyle-Medicine-Practitioner
          –> Dr. Mcdougall – Find a Health Care Practitioner https://www.drmcdougall.com/doctors/

          Another bit of advice I often give (which you may already know–sorry if so) is to use this NutritionFacts.org site to look at what you can do to tweak your diet to specifically work on cholesterol. In other words, your diet sound amazingly, healthy and I fully believe you when you say you are eating a whole plant food based diet. However, maybe for some bodies, which are genetically prone or through decades of unhealthy diets prone to producing a lot of cholesterol, you have to eat a diet specifically designed to address the cholesterol issue.

          The point is, you could tweak your diet to add foods listed on this site which have been proven to lower cholesterol. Sadly, from what I was able to find, the topic pages here on NutritionFacts have gotten a lot less helpful in the latest versions. If I remember correctly, the cholesterol page used to contain a great list of the foods highlighted on this website which are known to lower cholesterol. Now you would have to do a lot more research, but you could do it. For example, check out amla:

          Also, you might check to make sure you stay away from foods which might raise cholesterol. You already know about saturated fat. Have you looked into the whole coffee thing???

          Just some ideas for you. I know you have already made significant changes and probably aren’t too happy about the idea of making more changes. But what if making a few more tweaks got you where you wanted to go?

    2. Hello Chris,

      I’m very sorry to hear about your struggles with your cholesterol, but will do my best to assist you. You stated that you’re eating a whole foods, plant based diet. Does this mean you are not consuming any oils, processed foods, or eating out at restaurants? These are all ways that saturated fat can creep into your diet and raise your cholesterol from what is optimal. Unfortunately for a small percentage of people, eating a plant based diet is not enough as they have genetically higher levels of cholesterol. In these cases extra care has to be taken by eating known cholesterol lowering foods, such as ground flax, amla, and okra. Consuming these foods daily may have an additional effect on your cholesterol levels, hopefully bringing it down to the optimal range. If that also fails, medications are usually the last resort.
      There is some great information in the link below for people struggling with exactly what you are right now, so I encourage you to give it a read and see which steps you can take to tackle your cholesterol levels.

      Hope this helps,

      Matt, Health Support Volunteer


  40. Dietary reduction of ldl to 70 may show excellent heart health but reducing it via a statin does not mean you will get the same benefit. Dietary reduction means lots of healthy foods providing magnesium, potassium, vitamins and other minerals. Statins only stop your liver from producing it, along with C0Q10 etc. And statins have several other side effects. Why don’t you cover any of this???

    1. Robert: The format for this site is to cover relatively narrow topics on each page. However, you can use the search box at the top of the screen to review related topics. For example, if you type “Statin” in the search box, you will see that this site covers muscle toxicity and breast cancer as problems related to statin use.

      This site also covers in detail what a healthy diet looks like in order to lower total and LDL cholesterol levels. This site also covers specific foods shown to lower cholesterol levels, which may help people who struggle to lower their levels.

      People who cannot get their cholesterol to safe levels (see article above for safe levels) via diet and exercise alone may want to use a statin, since statin use has proven to lower heart attack risk. Hence, a person facing this problem would have to weigh the pros and cons and make the decision that is best for them.

  41. how long for ldl cholesterol to drop to optomal levels. my ldl was at 5.5 it dropped to 3 in 8 months on plant based diet. but my angina has got worse. what to do

  42. Cornel,

    I’m sorry to hear that your angina is acting up. It’s not totally a numbers game as there are multiple factors that affect the CV system. I’d encourage you to see your physician and explore other considerations.

    Perhaps talking with him/her about issues such as stress, vitamin K2, more nitrate rich foods (see Dr. G’s https://nutritionfacts.org/2018/09/11/fennel-seeds-for-a-nitrate-boost/) and then (https://nutritionfacts.org/video/best-brain-foods-greens-and-beets-put-to-the-test/) and don’t miss adequate magnesium levels. (Remember to check the RBC magnesium not the serum levels…..

    This is a starting point, but I again would urge you to see your healthcare professional.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

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