How Much Nutrition Education Do Doctors Get?

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How Much Nutrition Education Do Doctors Get?

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physicians May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that “nutrition receives little attention in medical practice” and “the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training.” They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease—our number-one killer—and provide potent protection against other leading causes of death, such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And, it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn’t get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to “weed out” students. Shouldn’t we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: “The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course…[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician.”

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But, if doctors don’t know what they’re talking about, they could actually be contributing to diet-related disease. If we’re going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There’s still a lot to learn about the optimal diet, but we don’t need a single additional study to take nutrition education seriously right now. It’s health care’s low-hanging fruit. While we’ve had the necessary knowledge for some time, what we’ve been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the “Million Hearts” initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. “But why stop at a million?” a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world’s most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent—but also reverse—the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren’t even taught these concepts while they’re in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we’re not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world’s leading killer.

I’ve previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

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:

Discuss

Michael Greger M.D., FACLM

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


67 responses to “How Much Nutrition Education Do Doctors Get?

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  1. A great addition to this article would be information on Registered Dietitians, who must take numerous hours of coursework in nutrition, as well as complete a yearlong internship practicing in the fields of community and clinical nutrition, as well as foodservice, and finally must pass a national board exam to earn their credentials and license. These are the nutrition experts in the healthcare setting and should certainly be utilized by the physicians who lack this important knowledge.




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    1. My first appointment with the VA saw me spending time with a dietician. After we talked a bit, she realized I didn’t need the basic advice she had to offer as it was evident that I had spent many hours learning nutrition and was plotting my own course.

      And while I think proper nutrition is a best practice, I think, for me anyway, an additional way forward is through science… not the crazy stuff like implanting a hardware interface in my body, but things like aged proteins that no longer do their job. Either replacing or resurrecting these, along with other approaches like personal antibodies for example, are where we are heading with cheap, cheap health care.

      Not becoming ill is one’s first line of defense, but for aging we require interventions and those things are getting closer each day.

      I don’t know if it will be the current President or another one in the future that mimics the upheaval going on now, but if people start to realize that the Pharmaceuticals are not our friend as they would have us believe, they will not be able to count on friendly government to keep the cash flowing in.




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      1. Doctors can get all the nutrition education in the world (and we get more than you imply) and still it won’t matter if we only have 10 minutes with each patient to discuss nutrition and people don’t want to change. Lots of people know what they should be eating and what they shouldn’t and choose to eat the bad stuff because its what makes them happy (or at least what they think makes them happy). Patient autonomy is key. I can educate for an hour, but if a patient isn’t ready to change its like talking to an echo chamber. We also have nutritionists to help guide our patients who are willing to change and want a referral. I use them regularly in my pediatric office. Furthermore Biochemistry and Organic chemistry are important to understanding why the body needs certain vitamins and minerals. These subjects certainly are not irrelevant. Stop trying to dumb down the Physician by saying we don’t need these classes. Nutrition is integrated into other parts of our education and those of us who train in primary care have regular discussion on the importance of nutrition at certain ages. I am busy trying to accomplish simple goals like decreasing juice and added-sugar intake with my patients at a young age. I don’t know what further training you think I need to accomplish this lofty goal, but whatever nit-picky, ivory tower ideas you have about nutrition are so beyond where my families are in their stages of change. On a personal note I lost 60lbs in my young adulthood and kept off 40 for a decade. I know a thing or two about healthy changes. I also majored in Kinesiology and took courses on Nutrition, exercise physiology, and physiology of obesity. Additionally I have multiple papers on exercise and aging and deconditioning.
        Perhaps adding more nutrition would be beneficial, but at the sacrifice of what other important part of our curriculum?!?! Should we add another year to our 7+ years of training? Stop drinking the doctor hating kool-aid and perpetuating people’s ideas that we don’t know what we are talking about.




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        1. Sorry doc, you’re really missing the point and it’s quite scary. Having moved back home to care of my diabetic father, his worst enemies are his doctors and the ignorance Dr. Greger speaks of. This article is spot on, though I think he should be even harder on his colleagues considering where we are at.

          Your patients look to you for advice yet all we hear is the standard excuses along with a lack of confidence in yourself and your patients. Thank god my 85 yr old dad just doesn’t trust you guys so he listens to me. He’s been vegan now for a month, a hardcore Italian don of a dad, complete with thick accent and a stomach that enters the room before the rest of him. Despite his love of fine cheeses, wine, prosciutto and BBQ, he now eats healthy and has lost 20 pounds in under a month, feels better, and yes, he does “miss the cheese” …but wait, I gave him some Daiya and solved that issue pretty quickly too, lol.

          Why is it me helping him, where are his doctors? He has at least five of them and yet I am the one saving his last years? Why I am the only concerned about the 10 drugs he has to consume daily, each fighting the other and slowly killing him. Most recently, and what spurred my returning home, was the development of heart arrhythmia – all these drugs and yet he gets worse and worse as time goes on…old age eh?? Yeah, right. No one is telling him what to eat and not to eat to save his life, to save his heart, to save his legs, his eyes. Some days he cannot feel his hands or walk and I’ve seen what I never saw my whole life, that stalwart and leather skinned man cry. So please, do not tell me people don’t want change, they don’t want to feel like shit is what they want pal. Now it’s on me to learn all this and teach him how to take back his life, together, and we are having a great time in fact, surprise…thank god also for doctors like Greger. I am so proud of my dad and I get the doubt but in the end, the desire to change won out with barely a fight in fact.

          My sisters are struggling with all this too as they cannot understand a diet like mine, they still believe the low carb hype – and who is telling them that this diet is ok? Their doctors, who else, and they checked with them when my dad started to lose weight believe me…the advice the doctors gave them was straight bro-science from a blog, antiquated and dangerous, straight up. If you had the education Dr. Greger spoke of you’d understand it was your duty to tell every patient they can take control of their health and if they choose not to it is exactly like smoking, they will remain sick and have to hope for the best medication has to offer, which is usually a long list of side effects no one wants.

          Thankfully, there are also doctors like Greger, Baxter Montgomery, Joel Khan, Dean Ornish, Caldwell Esselstyn, Garth Davis, Neal Barnard, Michael Klaper, John McDougall, Joel Fuhrman, Alan Goldhamer, Hans Diehl etc etc etc… these are the real deal doctors, rock stars if you ask me. Too bad you don’t have as high a standard for yourself, you should be criticizing your colleagues and medical practice as it is today >not the article.

          Yes it’s tough, yes people want to stick to old habits but that is precisely why they need you more than ever. If you haven’t noticed, we are in a crisis of lifestyle and you’re on the front lines whether you like it or not doc.




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          1. Marcello Di Santo,

            Wow! Thank you, thank you, thank you! For what you’re doing for your dad and for your words. Your dad and your sisters are blessed to have you taking charge and helping. You are an example for your entire family.

            The two women I knew who had the same type of aggressive, triple negative breast cancer I did seven years ago both took the ketogenic diet route and both – even though many years younger than me – lived only about 18 months after diagnosis.

            Keep speaking out and telling it like it is. The world needs to know.




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          2. Thank you for the list of doctors, I knew of seven of them and will now look up the others. Am 78 and have been on the WFPB NO OIL diet for 18 months so hope by now it is helping to clear my arteries. Good for you looking after your dad. I live in the UK and have not been able to encourage anyone else to try this way of eating.




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        2. Emily, did you reply to the wrong post? I ask because I was not referring to doctors anywhere in my post. I was however referring to the hold that Big Pharma has on our lives and pocketbooks.

          Yes, there are some medicines that may actually be beneficial to some and there are many in the public who believe in pharmaceuticals to the point of discounting any other therapy. I’ve seen that in my own family where members have died under the treatment of modern medicine. I can’t say definitively if they would still be alive had they followed my thinking and advice, but they essentially cut me off before I could advise them for the most part.

          But now that you mention it, if their doctor had given them the advice I referenced, they would have taken it and followed it religiously.

          Doctors, again in my opinion, are doing their jobs as taught them. I for one have no problem with that for my personal well-being. I actually had a doctor who does not know who Ray Kurzweil is. My new doctor, or rather her nurse, actually asked me to write down my regimen for the next scheduled appointment.

          That’s a sign of progress, but I feel I will have to spend a lot of time explaining the reason behind each pill or action I take. There is so much new out there that health care is about to explode exponentially… and our well-being and pocketbooks will be the better for it.




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        3. Emily – bless your heart for trying to make a difference nutrition-wise.  But you are a rare bird among your medical colleagues. I am 73 and have “fired” numerous MD’s for not having a clue about basic cellular biology, and only superficial knowledge about diet, life style and nutrition.  I have found some enlightenment among the functional MD’s, whom are now the only MD’s I will engage with.Paul




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        4. I’m a breast cancer survivor and have been eating well for over 3 decades. When I say eating well, I mean Whole Food Plant Based, Macrobiotics and healthy vegan eating. There were times in my past that I fell off the wagon and ate lousy stuff, but hey, I’m human. I’m cancer free now for over 11 years and never felt better. I agree with Dr. Gregor’s blog about doctors not knowing enough about healthy eating. While I realize that not all doctors are uneducated about nutrition, in my opinion, and with all of the doctors that I’ve seen in my past surgeries, most are. It’s up to us as patients, to remove that facet from the doctor’s visit and do our own research, perhaps connect with a diet coach that can help you make good decisions and simply learn how to cook better, healthier foods to fuel your body.

          My doctor knows that I’ve been plant based for a long time. I’m rarely in his office except to get my annual check up and blood tests every 6 months to check my cholesterol, B12 and D3 levels. That’s it! So I avoid talking to him about diet because he’s not educated in that area. He thinks I should be eating fish and chicken and drinking milk and eating eggs every day. Not to mention that on my chart it states that I’m lactose intolerant, these choices couldn’t be further from anything I’d ever put in my body. So I don’t ask him for any advice on what I should eat. It’s my body and I’ll be in control of what I feed it. I don’t blame him. He wasn’t educated in nutrition, he’s old school and believes in the old food guide.

          We simply have to stop giving doctors all of the power over our health and wellness. It’s our responsibility to make sure we stay well and do the research ourselves. If we don’t like the doctor we have, or if they don’t agree with our choices, get another doctor. I did!

          Thanks Dr. Geger for all of the tireless work you do. Because of you and your book “How Not To Die”, I’ve become a Certified Whole Food Plant Based Nutrition Consultant and have many clients that have switched over to Whole Foods. The difference in their lives has been nothing short of amazing. I recommend every client I have get a copy of your book and sign up for your nutrition facts. So grateful for your knowledge and your writings.




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          1. Here’s a great analogy.  When you take an ill pet to the vet, the vet will usually ask what you are feeding the pet.  Get it? Food matters.  Have you ever had your MD ask what you are eating?  Not me either.  What would they do with the information if they did ask?




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          2. Rosanne,

            You’re doing great and I applaud you for taking charge of your health. I think the problem is with the vast majority of people who THINK their doctors know how to advise them on nutrition, ask for advice, and actually receive nutrition advice regardless of whether the doctor knows anything about nutrition or not. That needs to be corrected!

            Also, I’ve heard from many doctors online and in person whose advice leans far toward Paleo, not whole food plant based. Doctors like that do give advice, but it unlikely to be the best, or most studied legitimately, information for their patients.




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    2. The Registered Dietitan Nutritionist should see patients in physicians practices. My husband developed pancreatic cancer and had to ask several times to see one. Take them out of the basement offices and take advantage of their expertise.




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    3. The problem is nutritionists enroll in programs that are supported by the meat and dairy industry and don’t have the knowledge themselves that a species appropriate diet for humans is primarily fruit and a few nuts and seeds and tender leafy greens. It isn’t rocket science, however.

      What I would like to see is for “science” to finally do some studies on the benefits of raw plant foods versus cooked foods a/k/a dead foods and admit that eating raw live plant based foods not heated over 118 degrees is far more healthful than cooked plant foods. Raw vegans have known this for centuries. Also the quickest way to reverse so called incurable diseases is to detox your body of all the animal product residues that your body has not been able to get rid of by eating simply water rich fruit.

      Our bodies are 75% water. How can they possibly benefit from dry cooked foods? Not only are we the only species that eat dairy after being weaned off mothers milk but we are the only species that cooks our food.

      I’m sure it could probably be proven that cultures where there is little cooking of food where primarily fruit and fruit-like vegetables with seeds are consumed have always lived the longest.

      For a good starter resource on raw veganism, check out Dr. Robert Morse on YouTube with a doctorate in Biochemistry as well as Naturopathic Medicine who is also a master herbalist on YouTube. He wrote THE DETOX MIRACLE SOURCE BOOK and is a hard core purist in the belief that Nature has all the answers and mankind,when it comes to what to do for “Incurable” chronic and degenerative conditions, simply can NOT improve on Nature.




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      1. Vesanto Melina has a good Youtube talk, done for the Vegetarian Society of Hawaii, that discusses what is true and what is not about a raw vegan diet.
        She bases everything she says on published research, and is largely favorable, but probably not 100% in sync with raw only eating.




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    4. UNFORTUNATELY, even dieticians don’t have all the answers. A good friend of mine who is morbidly obese is currently seeing a registered dietician. And guess what? This party is recommending a LOW CARB DIET!! Really? No mention of loads of vegetables, whole grains, nothing. Low carb to me is high fat, high protein, and worse. Yes, we need carbs, but the right ones. Whole wheat carbs are what’s needed. Low carb is a great way to eventually get sick.
      Another good friend also has a weight problem.Low carb is what she’s also doing to lose weight. We go out to dinner and she has a BIG steak, no potatoes because it’s carbs, and a small serving of vegetables. On occasion she’ll have a small side salad. And yet she STRUGGLES to lose weight! Tried talking to her years ago, and no soap.
      I’ll say it again—low carb is dangerous. And according to the National Weight Loss Registry (if I got the name right) they have a web site where folks who’ve lost weight and KEPT it off can share how they did it. BUT they must document their weight loss. In one of Dr. Greger’s books about the dangers of low carb, it was said that LESS THAN 1% OF FOLKS LOSE WEIGHT AND KEEP IT OFF ON A LOW CARB DIET.
      Just because you have a degree in dietary doesn’t mean you have the answers either.




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  2. Halleluja! My son-in-law is completing his residency next year. He said he received maybe a 3-hour lecture on nutrition. How very sad and quite scary.

    He fully intends to augment his knowledge in that area and to practice integrative medicine along with my daughter who is a health coach.

    Thanks for adding to the discussion on how poorly trained our physicians are in the area of nutrition. Hopefully the medical schools begin to listen.




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  3. This article should be MUST for all to read! I feel this subject along with how big $$ keeps the truth concerning proper health care from the masses is actually criminal. I personally have experienced the reversing of coronary artery blockage by a whole food, plant based diet. I’m now 80 years young, in excellent health and work a full time job and exercise every morning. GREAT JOB Dr. GREGER !!!!

    Gene in Colorado




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    1. So good to hear your comment. I had a coronary calcium scan two years ago and have been on WFPB NO OIL diet for 18 months. Am 78 and fit, how did you find out that the blockage was reversed. CASCANS are very expensive in the UK, I just hope it is working, all my blood levels are good.




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  4. I totally agree with what Dr. G says but I believe that there would be more benefit if the general public had more nutrition classes in high school. The media wants you to believe that the mainstream medical system is the place to go for healthcare when it reality, they really suck at preventing diseases. Just Google search “number needed to treat statins” and you’ll see that chemically lowering your cholesterol is highly unlikely to save your life and you have a much better chance of being sick for the rest of your life from taking the drug. Many of my relatives are taking multiple medications and are sick most of the time. I’m trying hard to educate my relatives on this issue and have managed to get my Mom off of her statin because they were causing her to have memory problems. I even critique the doctor for prescribing that garbage because she is not at high risk, not obese, does not have diabetes and has never had a heart attack. The best part is when that doctor even said that lifestyle could not fix high cholesterol – PURE IGNORANCE OR EVIL! Why not just skip seeing the doctor, save the copayment and eat whole natural foods??? Take charge of your health!




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    1. One question I wish plant based doctors would address is the fact is that even women eating whole food plant based diets (sans salt, oil, sugar) can suffer sharp increases in cholesterol levels at postmenopause. Some of us can’t tolerate statins, (or only limited doses) and so are left with the increased risk associated with higher cholesterol and declining estrogen levels.




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      1. Thanks for your comment Susan.

        I believe Dr Greger is simply referring to the general population, where a whole food plant based diet seems to be a great solution for this problem. However, each case is different and individual considerations should also be taken into account.

        Hope this answer helps.




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        1. Thanks Darchiterd, I can well see how the wfpb eating plan would work wonders with the general population But you know, in all the years I have been reading/watching the plant based docs, I have never seen post menopausal cholesterol increases addressed… not even my own physicians have addressed it. (the dont mind spending time in instilling fear over rising cholesterol though !) It’s not like we are a minority Darchiterd, we’re half the population, and menopause happens to the majority of us women. And it isnt a small increase either.. can be 20 to 30 %. It would be nice to see the question raised, and the topic of estrogen decline and effects upon our health discussed – and what we can do about it ! Perhaps you could slip a note to Dr Greger in the suggestion box?

          Thanks for all the info and encouragement that you so generously offer up here Darchiterd, it’s very much appreciated.




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      2. Thank you Susan, I am a woman in my late forties. My wieght has shot up @30# in past 2 years and total cholesterol has shot up 40 points. I eat primarily a plant based diet. I need help lowering cholesterol and don’t want prescription meds which my doctor is pushing. Menopause has changed my body even though I haven’t changed positive lifestyle choices. Thanks for bringing this to attention! Helen




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        1. yw Helen. As far as I know, we can suggest topics through the ‘help’ system at NF so I’ll give it a go.

          Re the weight gain and rising cholesterol levels, thought I would just mention that I get my tsh blood test (for hypothyroid) done at least once a year since I saw my mom go through similar problems long ago. She was hypothyroid as it turned out and did feel much better on medication. You have probably already considered this however. (that’s another topic I would like to see covered – hypothyroid : recommendations with respect to nutrition)

          All the best to you Helen, and thanks for chiming in!




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          1. Susan and Helen, – I, too, am a post menopausal woman (63) whose cholesterol has risen. It is very frustrating and I am quite unsure how to handle it. I am completely WFPB (10 years), no oil, cook without salt and luckily have never had a sugar problem. My blood work numbers are all normal except cholesterol, BMI is 21. Like you, I don’t want to take statins and so far am not. I continue on a WFPB diet because I believe it’s ultimately healthier than not.
            I agree with you both that I would like to see Dr. G take up this topic on women’s health and increasing cholesterol post menopause. I agree that women are 51% of the population and this is both a significant amount of our population and should be a topic of focus and concern.
            In the meantime, I’ve started taking a product made by NatureMade called CholestOff. The reviews on it are encouraging. It contains high amounts of plant sterol and stanols that supposedly reduce your cholesterol. I’d rather do this than statins. I can’t yet fully recommend as I’ve just started this regime myself – but I thought I’d share.
            http://www.naturemade.com/supplements/cholestoff/cholestoff-plus#xwTwwurWurvkBJtT.97

            So thank you Susan for bringing this up to Dr. G and let’s hope he will take a look at this predicament that so many of us are in.




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      3. Susan, I remember seeing my naturopath post menopausal and my cholesterol was elevated also. She told me she was not concerned. It did lower when I reduced my carbohydrates to about 30 g per day in an effort to lose weight. Lowering the carbohydrates worked but I suspect aggravated another condition. I now am unconcerned what my cholesterol total number is. I am eating healthy and that is what I concentrate on. Not the number.




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        1. Thanks for your comment Blue! Come to think of it, I experienced the same thing in a way.. Prior to a blood test (2nd one after going wfpb) I had been eating very lean.. vegies and fruit, but no grains or beans, and the test came back better. Adding in oats or bread products would elevate cholesterol levels. This is a hard road to travel for longterm though since I am slim to start with.
          I like that you focus on enjoying your healthy diet and not the numbers Blue.. great advice!




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    2. Jesse,

      I could not agree more! Nutritional information can start in Kindergarten and first grade. Why not? We don’t need to rely on others to be advocates for our own health. Nutrition should be taught throughout the K-12 years. Add some epigenetics courses on how each of us can be responsible for our own individual health needs — great combination. Even my 6th grade granddaughter is getting genetics information in school!

      In our family, I was the one who did the research and passed it on to my three children and now to my eight grandchildren. They pass information to their friends.

      On a side note, I see that Fred Kummerow just died a few weeks ago at the age of 102. He was not a vegetarian, but definitely a whole foods person.




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    3. Well done JesseR, I sometimes get the feeling I and a few people are the only ones in the world who have wised up to the anti cholesterol rubbish. In fact, lowering it is positively dangerous.
      So many health professionals are still living in the dark ages, I suppose they will say they do not have the time to read up latest information.
      In which case they should stop practising and do a course on absorbing the latest new facts.




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      1. Torastone,

        If you will watch the introductory videos on NutritionFacts.org you’ll see how carefully Dr Greger checks the latest published nutrition research, how he makes sure the information isn’t simply marketing dressed up to look like research, and how he then bases all his writings and videos on the most accurate, up to date information available.

        And yes, he does espouse a plant based whole foods diet to lower cholesterol, because the research shows how that is the only way to reverse heart disease, diabetes, many autoimmune and other diseases.

        Much of what you may have read by people whose mission in life has more to do with selling books than actually helping people improve their health, quotes phony “research” by the various animal factory advocates that falls apart under scrutiny, or they misquote good research.

        They had me fooled for a long time, too. I even took an intensive year-long nutrition class and became a nutritional therapy practitioner based on such teachings. Two years of eating pastured beef, chicken and eggs and wild-caught salmon brought on the rapid growth of a large breast cancer that had not been detectable a year earlier.

        Eventually I read T Colin Campbell’s *The China Study* and learned how animal protein stimulates the growth of cancers. The other two women I knew who had the same type of breast cancer (triple negative) ate meat and only lived about 18 months after diagnosis. Both were quite a bit younger than me. I changed my diet and am healthy seven years later.

        I also learned about reversing heart disease through whole food plant based eating. My husband had heart disease when we met, and a triple bypass shortly after we were married. A few years later, eating that same meat and fish-heavy diet, he had one carotid artery 100% blocked and the other 80%.
        After we changed to low fat whole food plant based eating he reversed that blockage to 50% and will soon have a Doppler exam to determine if it has been reversed further.

        So – be sure you know whose words to trust. Don’t fall into the trap of believing good news about bad habits you may not want to change. That can be a killer!




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  5. the printing companies for the medical books are owned or associated with Pharma.. Pharma has infiltrated every aspect of the medical industry it has gone on since he inception, they also sit on the boards of medical colleges that say yeah or nah on research .. J D Rock was the first to do this here and overseas and everyone followed .




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  6. Dr. Greger,

    Love your site and have bought and given away 23 copies of your book.

    However, in this bloq you say “most deaths are preventable and related to nutrition.”

    Perhaps you meant to say premature deaths? I don’t think any death is preventable with our current technology. Heh.

    Ray Seakan




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  7. ““The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course…[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician.”
    Dear Dr. Gregor,
    Thank you for your undying commitment. I agree with your take on the lack of nutrition courses in med school. However, the above quote is not the one I would have chosen. Organic chemistry is probably THE MOST important course for those who want to understand nutrition. Remember, that’s where you learned that sucrose consists of a molecule of glucose combined with a molecule of fructose and that fact allows a much better understanding of high fructose corn syrup etc. And teaching nutrition without teaching the Krebs cycle seems incomplete . Furthermore, in the hands of a good teacher, organic chemistry is a beautiful exercise in logic rather than wrote memorization. (Once you know how electron pairs act you can arrive at syntheses etc.)
    Thanks again for all you do. I especially enjoy the manner in which you point out which studies are invalid due to lack of a control group and which studies failed to be repeated. Your arguments are very compelling. I have been following a vegan diet since I found your site 11 months ago.
    William H. Healy, MD




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    1. Agreed! As a dietitian, I could never properly understand what I’m counseling patients on without having the base knowledge of organic chemistry and biochemistry as a foundation.




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    2. Thank you Dr. Healy for pointing this out. As a chemist who worked in the edible oil industry, I agree completely. Studies are good, but sometimes it takes looking at how nutrients interact in the body ( biochemistry ) to get the why. To me the why is very important. Can’t imagine who would give you a thumbs down for your comments.




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  8. I’ve been following the plant-based diet for about a year now, but not strictly. I limit my meat intake to once or twice a month or less. I still eat fish from time to time, but have greatly reduced dairy. I had my cholesterol taken last week and they were: total cholesterol 127 (from 167 3 years prior), LCD 69 (from 103) and HDL to 33 from 40. My doctor seems concerned with this HDL level and wants me eating more fish in order to raise it. I already eat nuts, beans, which should help HDL and I exercise religiously (bike to work, weightlift, lot of walking, yoga). My weight hasn’t changed much for over 20 years (~160, 5’10). Do I need to be concerned about my HDL?




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    1. Thanks for your question.

      According to the National Institute of Health, HDL below 40 is a major risk factor for heart disease (see here). The 2016 Framingham Offspring Study also found that:

      “Compared with isolated low HDL-C, CVD risks were higher when low HDL-C was accompanied by LDL-C ≥100 mg/dL and TG <100 mg/dL (odds ratio 1.3 [1.0, 1.6]), TG ≥100 mg/dL and LDL-C <100 mg/dL (odds ratio 1.3 [1.1, 1.5]), or TG and LDL-C ≥100 mg/dL (odds ratio 1.6, [1.2, 2.2]), after adjustment for covariates. When low HDL-C was analyzed with higher thresholds for TG (≥150 mg/dL) and LDL-C (≥130 mg/dL), results were essentially the same. In contrast, compared with isolated low HDL-C, high HDL-C was associated with 20% to 40% lower CVD risk except when TG and LDL-C were elevated."

      I would not consume fish, read this summary to understand why.

      Apart from individual medical guidance, here is how you can increase your HDL:

      – According to this study, consuming (7.5 g per serving) of a soluble cocoa product (providing 45.3 mg flavanols per day) can have a positive effect without any weigh gain.
      This review details selected nutrients and supplements that can have an impact on HDL levels (see Table 2 & 3 for a summary).
      – 10g of almonds before breakfast could also have a beneficial effect (see here).
      – According to this review: “Diets high in omega-3 fatty acids have been shown to increase HDL-C.” But since fish should be avoided, nonaquatic food sources include walnuts, green, leafy vegetables, flaxseed oil, and certain fortified foods.

      If you smoke, quitting can help.

      Hope this answer helps




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      1. According to Dr. John McDougall HDL is not that important. It´s the total cholesterol (under 150) and LDL (under 70) that needs to be considered, to give you the best chance of avoiding heart disease. My favorite whole food plant based “wise doctors”: Dr. Greger, Dr. McDougall, Dr. Esselstyn, Dr. Bernard and PHD Colin Campbell.




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      2. Thanks for your response. I’ll cut out/reduce the fish as well. I don’t smoke. I’m a bit frustrated by the HDL because I feel like I already check nearly all the boxes on things that can raise it. I will try out the soluble cocoa. It looks like Navitas makes a good product. One of the things I don’t do is drink alcohol (or very little) any longer after advice from my cardiologist following an afib episode who said 1-2 week (also cut off caffeine). I was drinking 1-2 / day as I thought it was healthy for me! Since I pretty much cut out alcohol and started this lifestyle, I feel better than ever (btw, I was 40 after my last afib espisode, now 42).

        I did see a couple other responses that said ignore the HDL and worry about LDL. If that is the case, I’m in good shape.

        Thanks for all the links and advice. This site has changed my life.




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    2. Given your personal health description, I would not worry about HDL.

      Thea, a former NF.org moderator, wrote a comment that summarizes why HDL levels are likely not a concern for people like you.

      Go to this page.

      Thea provides links to a number of citations that should ease your concern and help you ignore your physician’s advice to eat more fish. Perhaps you can educate your doctor.




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  9. I suggest that anybody who still doesn’t know how Ansell Keys mislead the world for about 60 years until recently when his misinformation concerning cholesterol and heart disease was proved so wrong. Try looking up the Seven Countries Study for starters.




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  10. It amuses me when I hear an MD say, “always check with your doctor before starting a new diet regimen.” What a wasted recommendation. My own personal experience is in line with Dr. G’s discussion – they (MD’s) propagate non-sense and hear say based on what they pick up fro the popular media. I once asked a cardiologist what I should do to prevent heart disease. His response – “Drink a little wine.” Holy cow!




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  11. In general I agree that dietitians are the experts in nutrition as I rely on them to counsel y patients. The amount of hours of nutrition in med school is not really salient as we do a lot of extra reading in nutrition. The complicated questions are not dealt very well with dietitians. For example they do not know the heavy metal content of most foods which is extremely important. They do not seem to realize that nuts, seafood and soya are loaded with heavy metals that can cause cancer, dementia and organ failure.




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  12. A few years ago I suffered from eosinophilic pneumonia for months, and I thought I was going to die. The specialists were scratching their heads, could not come up with a proper diagnosis, and gave no medication. When I finally recovered they described as a miracle. I told my doctor that I recovered thanks to switching to a vegan diet, from a paleo style diet. Then my doctor blurted out that ‘there’s nothing wrong with meat!’ And that was the end of his ‘nutritional counseling’ of me, we haven’t discussed such matters since…




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  13. In general I agree that dietitians are the experts in nutrition as I rely on them to counsel my patients. The amount of hours of nutrition in med school is not really salient as we do a lot of extra reading in nutrition. The complicated questions are not dealt very well with dietitians. For example, they do not know the heavy metal content of most foods which is extremely important. They do not seem to realize that nuts, seafood and soya are loaded with heavy metals that can cause cancer, dementia and organ failure.




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    1. Kiyoshi Mori, M.D. – I was rather shocked to read your comment that nuts and soy are “loaded with heavy metals”. (I think we all understand the pollution problems with fish). I would be interested if you would elaborate on this information if you get a chance (i.e., where you found this info, etc.).
      Meanwhile I did a quick search on the heavy metal load in soy. I found this most interesting PubMed piece:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673422/ This piece of research explains that a variety of plants will uptake heavy metals as a result of the contamination of the soils and water they are grown in. This particular piece of research focused on a contaminated soils area near a copper mine. It showed that the further away the crops were from the mine the less heavy metal uptake the plants accumulated. Here is a quote from the research:
      <em>”Metal concentrations in plants varied with the plant species, higher levels were found in plant leaves and lower levels in grain. In particular, Thus, metal concentrations in sampled plants decreased in the order spring onion > soybean leaves > perilla leaves ≈ red pepper > corn grain ≈ jujube grain. In the same plant species, metal concentrations decreased in the order Zn > Cu > Pb > Cd due to mainly to differences in the total metal concentrations in soils and their bioavailability.”

      So I am wondering if the contamination you mention in your comments on soy and nuts are ultimately a function of the growing conditions and not of the species itself? This makes an interesting case for organically grown products. In the research mentioned above, I thought it was interesting to note that they found the heavy metal accumulation in the soybean leaf of the plant (not the bean).




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      1. It also matter if the heavy metals in different foods are bound up or easily absorbed.
        If they pass through without absorption, who cares. Like the fats in nuts that aren’t absorbed.




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    2. Dr. Mori,
      When making blanket statements such as ” They do not seem to realize that nuts, seafood and soya are loaded with heavy metals that can cause cancer, dementia and organ failure.”, please support your assertion (especially with respect to nuts and soya) with cited articles, research as an assertion does not prove itself.




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    3. Hey Doc.  A rather arrogant response.  I think nutritionists are well aware of toxins.  Perhaps the ones you worked with were not informed, but that does not speak to the entire group. (I am not a nutritionist – just a health researcher.)




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  14. We are entering an era of information (and misinformation). Science is moving forward fast, but it’s not only science. Information about things is now more accurate in youtube, internet, etc than on books or formal education. Not to say anything about current institutions.

    We are assisting to a creation of a new type of poverty.
    It’s really naive to think that conservative institutions can change. Some will, but some not, and by the time they do, science may have moved even more forward.

    Formal education is not doomed but…..yeah, it will be doomed soon. To spread the message about nutrition I would target scientist, facebook, youtube, etc. But mostly users.

    An idea, why not do a compendium of plant-based diet stories (and maybe numbers as cholesterol, TG, etc). It’s not very scientific, but well, it’s not like we can put a broccoli in a pill and do a randomized controlled trial any time soon.
    Forums need to improve. Valuable information should be easy to find, even from users (a compendium of posts with the most “likes”?). Or tagging posts as “motivation”, “information”, “lifestory”, “controversy”, etc
    Plant based whatsup groups?
    A “common ground” Greger, Esselstyn, McDougall, etc plant based book (or website)?

    I know all that takes a lot of effort (and money), but it’s the way forward. Waiting for institutions to catch up is hopeless.




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    1. Laurie, Wow! Thanks for sending this comprehensive guide for Kaiser Permanente doctors and others. It is well written, with lots of research references. I’m keeping a copy to share with anybody who shows interest in becoming healthier. This may even impress my son one day!




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  15. I asked some Pre Med students about Lifestyle and Medicine and they seemed pretty hip to plant based diets and lifestyle and said the program at Temple U included some of that. I’m sure its going to be changing, but those stats don’t sound so good.




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  16. Thanks for this article. It seems to me that the main issue is why isn’t nutrition taught in med schools. Health care is a business today. It wasn’t obviously so when I opened my first office in 1971. The role of medical schools is to teach how to
    diagnose and treat. Prevention is rarely stressed. In 1976, insurance companies did not make the desired profits on investments wanted. What did they do to solve their problem? Liability insurance premiums were increased 10-fold for everyone, even those who had never been sued. Hospitals granted privileges only to those who had insurance. Today, many
    physicians in practice have experienced a reduction in payment of claims
    and have had to employ more staff to remain open. Often many more patients are being seen each day which leaves little time to educate patients which is usually not compensated. Physicians are not the problem even if
    more nutrition information were taught in med school they may not feel they
    could spare the time. Patients with DMT2 will incur a post diagnosis average cost for the rest of their lives of $80,000. I don’t know the stats for
    cardiovascular disease. The pharmaceutical industry makes billions from
    the sales of prescriptions to treat these chronic diseases which are relatively easy to prevent and/or reverse. The obstacle isn’t, in my opinion, not teaching nutrition in med school. The country is faced with significant future health problems. One out of 3 born by or after 2000 is predicted by WHO
    and CDC to become a diabetic during their lifetimes. Alzheimer’s disease incidence is estimated to increase by millions. These diseases, as are most or all, related to food. Automation will be creating unemployment in the near future which will impact adversely on healthcare. The obstacle, as I see it, is profit. Becoming a physician is expensive now with many graduating with debts in the hundreds of thousands which adds to their need to generate income. Solutions to these problems?? Our patients are
    the biggest losers. Food stamps (SNAPS) in Michigan, I recently learned,
    are being used in a 2 groceries for the value of 1food stamp. Creativity
    is needed to help solve these issues. Food is currently in the position tobacco was when in 1964 the surgeon general announced that smoking caused lung cancer. How long did it take to deal with that?




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  17. Yes it is true that nutrition is not taught much in most medical schools, but in my mind, as a plant based doctor, not sure it would do that much good since the prevailing guidelines have not caught up with the research on plant based diet. Assuming the dietitians are also using those very same guidelines.
    Another sad factor for medics is the culture of medical training and residency. The doctors in training are a cheap workforce for the hospital, and when I trained, in a “humane” family practice residency a light week was about 80 hours but we frequently worked more than 100 hours per week (there are 168 hours in a week), including 2 or more sleepless nights, followed by a working day. 36 hours “on” was not unusual.I calculated that our real hourly wage was under minimum wage. Instead of resisting this craziness and exploitation,on the whole the medical culture seemed to buy into it. There was a kind of machismo in that doctors, REAL doctors, need not sleep or eat, as ordinary mortals do. You were supposed to be a super hero, out there, saving lives. Only very selfish and wimpy doctors would be concerned with their own health or what they themselves were eating. I mention this because I do believe that medical culture and to some degree nursing culture is very tainted by the years of enforced over doing it, in training. So that many simply continue to treat their bodies like machines, and I think that is part of the reason why many professionals who have trained and continued to live on a treadmill are very out of touch with their bodies and feelings, have not cultivated the ability to reflect, and honestly truly don’t get it. (I mean a metaphorical treadmill, not Dr G’s treadmill!) It seems that mentality may be changing with the influence of the American College of Lifestyle Medicine, PCRM and others. On the subject of medical education though, I have written a chapter on nutrition in a medical textbook coming out this year, citing key researches showing benefits of WFPBD and pointing readers in the direction of researches of Ornish, Esselstyn, Fuhrman, Kempner, Barnard etc, it will be in medical school libraries and I hope it may expose some professionals to this information at the beginning of their careers.




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  18. I often hear about the strange or outdated advice doctors will give patients about nutrition and lifestyle. We can change healthcare drastically if we educated doctors on nutrition and also when to refer a patient to a nutritionist. What we see is doctors wanting to own what they don’t know when expert counseling in this field can often reverse disease or set a foundation of health that will prevent disease. This country is also too dependent on the pharmaceutical industry. Let’s make those on the disease prevention side our heroes and get back to our original food pharmacy where most healing can occur without medical intervention. Seriously, we have been talking about this since I attended Bastyr University in the early 90s!




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  19. Unfortunately, since Big Pharma has such influence over medical schools, healthy nutrition will not be taught any time soon. People getting healthy without prescription medication is definitely not what pharmaceutical companies want – it is in their interests to keep people sick. And how terrible is that.




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  20. Hi!
    I have a question not exactly regarding this blog post, but still in the line of discussion here since Doctors just tend to blame the diet and say I’m lacking fish and meat or just prescribe medications, which I would like to avoid if possible. The situation is: I have low blood pressure (9/6) and I’ve been feeling dizzy and tired, despite my care with food and taking my B12 supplement daily. I don’t smoke, drink alcohol and only recently added coffee (1 cup) to my diet in order to help me with this issue. As I already exercise (I walk 30 min everyday, practice yoga and ocasionally pilates – HIIT makes me feel very dizzy), drink plenty of water daily, sleep 8h and eat with so much care, I wonder what I can do to increase my blood pressure for a bit. Does anybody here has dealt with this issue and maybe has some advice?
    Thank you so much and wish you all a lovely day!




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    1. Marta, I am no doctor or professional of any kind relating to medicine. I am well read in health matters.

      With that disclaimer out of the way, if I were experiencing what you are (low blood pressure) the first thing I would do is rejoice! The next thing I would do is begin taking is the amino acid taurine when I need a boost. I have read that it increases the output of your heart. One way I would do that is by stopping the coffee except on occasions and instead taking one of those energy drinks like 5 hour Energy which I know contains Taurine as well as L Phenalalanine and Tyrosine and caffeine. Personally, I would only take about 1/3 of those at a time with no more than one of them per day and not necessarily every day.

      I offer this suggestion with full knowledge that we are all individuals and an individualized approach is warranted.




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    2. Marta Lee,

      Have you checked your adrenal function? Perhaps your low blood pressure is not the problem, but low adrenal function may be. I used to feel faint for a few seconds if I stood up quickly, and was told this had to do with adrenals, not my low blood pressure. That was many years ago, and I didn’t do anything about it, but it’s gone long since. Can any of you doctors speak up here?

      There are also other causes of dizziness you may wish to explore. Inner ear inflammation is what the doctor thought caused me to be dizzy for a few days not long ago. Meniere’s disease causes dizziness.

      Just some thoughts…




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    3. As one of the moderators for NF.org, I’d like to respond to you concerns with low blood pressure. You mentioned you’re assuming doctors might just tell you to eat meat for this or prescribe medications, but I’d say you should still be working with your doctor to rule out other problems, if you haven’t already. You can make it clear how healthfully you are eating and how you’ve carefully researched so you know you are getting adequate protein upfront. As other commenters have mentioned since it appears you are eating well exercising, sleeping well, etc. checking for non-lifestyle causes in this case makes sense, although you may need to be persistent, as you are aware. Thyroid or other endocrine problems can cause hypotension.
      I think you’re aware enough to make sure you are staying well hydrated and are not experiencing any affects of medication that could be causing your symptoms. Feeling dizzy and tired for a lengthy time is certainly something to investigate, Marta Lee.so I encourage you now to consult your doctor and investigate, knowing you may receive some misleading advice about diet that you may need to ignore while you search for the cause of that low blood pressure.




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  21. Dr. Greger and readers on this blog may be interested in a new report A Deficiency of Nutrition Education and Practice in Cardiology, recently published by The American Journal of Medicine and authored by a dozen physicians and healthcare professionals in the United States and Spain. The report finds even cardiologists skimp on fruit and vegetables. And, while they overwhelmingly believe their role includes personally providing patients with at least basic nutrition information, less than a third describe their nutrition knowledge as “mostly up to date” or better. It’s based upon what is believed to be the largest survey of physicians and health care professionals – and the only such survey of cardiologists – on personal dietary habits, level of nutrition education, and attitudes and practices regarding nutrition in patient care. More details at

    http://www.gaplesinstitute.org/press-release-new-survey-finds-most-cardiologists-receive-minimal-nutrition-education/




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