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How Healthy is the Mediterranean Diet?

The heart of a traditional Mediterranean diet is mainly vegetarian—much lower in meat and dairy than a standard Western diet—and uses fruit for dessert! So, it’s no surprise that those eating that way had very low heart disease rates compared to those eating standard Western diets. My video Mediterranean Diet & Atherosclerosis gives the lowdown on the link between the fats we eat and the health of our arteries.

A landmark study has been cited to suggest that all types of fat—whether animal or vegetable—are associated with the appearance of new atherosclerotic lesions in our coronary arteries, which feed our hearts. About 100 men were given angiograms at baseline and then again two years later, looking for the development of coronary lesions, all while monitoring their diets every year. Only about 1 in 20 eating lower fat diets had new lesions, compared to about 8 in 20 on more typical American diets of around 33% or more fat. But, when the researchers drilled down, only three types of fat appeared to increase significantly the likelihood of the appearance of new lesions: lauric, oleic, and linoleic. Lauric acid is a saturated fat found in coconut oil and palm kernel oil, which can be found in such junk foods as whipped cream and candy bars. Oleic comes from the Latin word oleum, for olive oil, but that’s not where the subjects of this study were getting their oleic acid: The top sources for Americans are cake, chicken, and pork, and linoleic comes mostly from chicken. So, the study really just showed that people eating lots of junk, chicken, and pork tended to close off their coronary arteries.

To see if major sources of plant fats like olive oil or nuts help or hurt, ideally we’d do a multi-year, randomized study where we’d take thousands of people, have one-third eat more nuts, another third eat more olive oil, and the final third do essentially nothing, and then see who does better. And that’s exactly what researchers did. The PREDIMED study took thousands of people in Spain who were at high risk for heart disease and were already eating a Mediterranean-ish diet, and randomized them into three groups for a couple of years—one group with added extra virgin olive oil, a second with added nuts, and a third group that was told to cut down on fat, but actually didn’t, so basically ended up as a no-dietary-changes control group. What happened to the amount of plaque in their arteries over time?

Whereas there was significant worsening of carotid artery thickening and plaque in the no-dietary-changes control group, those in the added-nuts group showed a significant reversal in thickening and an arrest in plaque progression. There were no significant changes in the added olive oil group.

“The richness of the plant-based MedDiet [Mediterranean diet] in potentially beneficial foods, such as fruit, vegetables, legumes, nuts, cereals, and olive oil, is believed to explain its cardioprotective effects.” However, these results suggest nuts are a preferable source of fat compared to olive oil and may “delay the progression of atherosclerosis, the harbinger of future cardiovascular events” such as stroke. Adding nuts appeared to cut the risk of stroke in half.

Note, though, they were still having strokes, albeit half as many. So, the nuts appeared to be helping. However, they were still eating a diet conducive to strokes and heart attacks. All three groups had basically the same heart attack rates, the same overall death rates. That’s what Dr. Ornish, a proponent of a mostly whole foods, plant-based diet, noted when he commented on the study: “There was no significant reduction in the rates of heart attack, death from cardiovascular causes, or death from any cause,” only that stroke benefit. But, hey, that’s not nothing. A Mediterranean diet is certainly better than what most people are consuming, but a diet based on whole plant foods may be even better, since it’s shown to reverse heart disease, not contribute to it. The authors of the study replied that they didn’t wish to detract from Ornish’s work, noting that Mediterranean and plant-based diets actually share a great number of foods in common. Yes, Ornish’s diet can reverse heart disease. The major problem with the Ornish diet, argued proponents of the Mediterranean diet, is that it doesn’t taste good, so hardly anyone sticks to it.


If you’d like to learn more, I bring up the Ornish back-and-forth in my 2015 annual live review, Food as Medicine: Preventing and Treating Our Most Dreaded Diseases with Diet, and directly address the accusation that plant-based diets are marked by poor compliance for disease prevention and reversal. For a shorter overview on heart disease, check out How Not to Die from Heart Disease.

For more on the famous PREDIMED trial and the body of evidence surrounding Mediterranean diets, I’ve got a bunch of good videos for you:

What might happen to the arteries of someone who goes on a low-carb diet? You don’t want to know. (But, if you’re really curious, see: Low Carb Diets and Coronary Blood Flow.)

What we eat doesn’t only have an impact on the structure of our arteries over the long-term (i.e., the thickening and narrowing described in the video), but the function of our arteries within hours of consumption. To see what your breakfast may have done to your arteries, check out:

Note, though, the benefits of plant-based nutrition can be undermined by vitamin B12 deficiency if you don’t include a regular reliable source in your diet. See Vitamin B12 Necessary for Arterial Health.

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.


113 responses to “How Healthy is the Mediterranean Diet?

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  1. Great blog.
    On this….”The major problem with the Ornish diet, argued proponents of the Mediterranean diet, is that it doesn’t taste good, so hardly anyone sticks to it.”

    I don’t know if any have done a study on it but my guess is our basic food preference or taste for foods what we consider to taste good or bad is developed at a very young age.
    What is our chance of abstracting from than ingrained habitual tendency….I’d say the chances of most sticking to a successful diet to loose weight probably speaks to that…..very very low.

    We know what is good for us but taste in the end almost always wins out. We must nevertheless know what is good for us and not say our taste says it is healthy. Nor change the facts of the health of things to fit our dietary preference by taste.
    Which is how our national media and perhaps most of us seem to frame the thing..
    Good tasting food is a affirmation of our culture and type. Radically differing foods exist by taste. But
    most all societies consider theirs the best. IN the end I think it as this is what their dear mums and dads taught them tastes good. And we all love our good mums and dads. To eat differently is a way that may be considered, against those who first brought us food and love us dearly. We stray but not far from that thing of taste.

    1. Ron, I agree that most of our food tastes are formed in childhood and they are habits that are hard to break because our bodies have to totally re-adapt, when we makes major changes to our diet. When I became WFPB, and stopped eating all meat, fish, eggs, and dairy, it took me at least a year before I lost my desire for those unhealthy foods.

      Here’s a link to a good summary by Dr Michael Klaper of why it’s so hard to make major changes to our diets. He emphasizes that changing the content of the food stream alters a person’s entire metabolic composition:

      https://www.drcarney.com/blog/entry/but-i-must-have-animal-protein

      1. Interesting. I agree with that. Our whole bacterial life in the intestines it seems to change.
        To be clear I have had no problem disavowing meat and dairy being vegan mostly since 1990 vegetarian since 1986.

        I do supplement with creatine but it is vegan and sourced from a german process which is not contaminated, most creatine is.
        But I do like a fake ham sandwich and fake hamburgers and all the rest on occasion. Not every meal but probably at least once per day. That is my habit in action.
        Now they are making one fake hamburger with some sort of hem iron..will have to avoid that one. To replicate the taste is why. But have not seen it yet..

        Eat the wrong thing continuously and it may override everything. Macrobiotic peoples come to mind in that for me. One actually died at a relatively early age from breast cancer and most did not live all that long. We now know one of the seaweeds is grossly contaminated and really should not be consumed, I think it is arsenic. Dr Greger mentions it. Arame or Hijiki I forget which. Since the quake I will only use kelp from the atlantic. But seaweed is a mainstay in their mostly PBWH diet.
        They also did not use any electricity in cooking to prevent cancer to their opinion..

        1. “But I do like a fake ham sandwich and fake hamburgers and all the rest on occasion. Not every meal but probably at least once per day.”

          Once per day, yet? Uh-oh! One of the problems with fake stuff is that they’re loaded with sodium, fat & TVP, etc.

        1. YR
          Just checking one Lightlife what I have in my fridge at the moment…sodium per serving is 13% recommended percent. Total fat is 2% potassium 6% protein 12 grams.2 grams of sugar. That is a fake ham. Which by nutritional profile in no way represents real ham.

          I lift run am very active so a bit of sodium is Ok by my read. I will be covered in sweat in about a half hour from now when I go running and that will go on for 45 minutes or so. After that I kick and hit the heavy bag. Low salt is not my priority. If one sits in a office all day and their idea of exercise is walking to the bus that is not me. A one size fits all approach to diet to my opinion is not the way to go. I am also recovering from doing a 2 hour or so workout yesterday emphasizing dead lifts, 6 sets varying low rep max effort rep range. And a bunch of other things to include a short run and sprints. Low reps high weight are a way of stimulating the production naturally of human growth hormone. My protein requirements are also not that in the range of your typical American.

          Yeah we don’t need more protein due to increased muscle mass and activity level….the AMA for years said steroid anabolic steroids do not work in any regard to increase muscle mass. How wrong were they….100% Most all the studies back in that day were on average joes who mowed the lawn of weekends.Not elite level athletes. Steroids work to enhance recovery and training effect. You never train they have no effect. .Protein yeah your requirements and mine differ. Ever hear of people in intense exercise cramping up..you know the cure….salt they have to have it immediately. But you average ameican knows none of that.

          No offense to Dr Greger but muscle mass?? He and I are different. I live in a wild place and do wild things I need muscle. I enjoy doing things pushing things. I am running in the snow probably snowing a bit as I run at 7200 feet up and down trails in the manzanita mountains on federal forest land in about five minutes
          He is talking as he walks on his treadmill.
          We are almost like two different specie.

          As to TVP this does have vital wheat gluten and soy to derive the protein. In any event I am not gluten intolereant and have not a problem with TVP at all.Sugars are only 2Gms in this so it is low sugar by most reads. A can of soda is about 40 plus, one can with no fiber nor protein this has both.
          In any event I bet I never exceed recommended sodium intake levels despite what I sweat out. And my protein and fat levels are also certainly below most americans.
          Sugar usually a not added thing but present by content well probably below 10 gms daily.

          I know you mean well with that advise but I have done the vegan thing since 1990 and do not do it haphazardly. There was no Dr Greger around in 1990 we had to do all the homework ourselves. A creature of habit I still check all the labels to know what is what in things.
          Cheap things are made cheaply to include dietary items. I don’t buy cheap. I die I die. I live I live.This is compassion for me first performance second. I will live till I die. That means having it all strength speed endurance till the end. Not completely but better than most.
          My aim is as well probably not yours.

          1. Different strokes, as they say. My favorite foods contain one ingredient only — beans, peanut butter (nothing added), quinoa, etc. etc.

    2. What your taste buds don’t like is usually what you need. It does take time to change your taste bud preferences, but people are impatient. I never used to eat fruit but forced myself to start with a little each day, now I can’t wait for my morning bowl of fruit everyday, and not only am I loving it my body is too.

  2. On the subject of which fats are good and which fats are bad, I think coconut oil is great …
    ….for dry scaly skin! I use it all the time for dry skin on my feet, but would never put that awful stuff in my mouth!

    I use no added oils of any kind. Whole plant foods contain all the good oils that one needs and in the right proportions. I do eat a handful of nuts each day (walnuts, pecans, etc.).

    1. Just me I guess. But I go very low fat and my immune system seems to suffer. So I eat a bit of vegan no sugar chocolate every day. And some oils, not to much though. Added to fruit/leaves smoothies some say it adds to nutrient absorbtion. I do have what most would say is a very physically active lifestyle. Deadlifts last night after a short run with the dog and sprints after the run. About 2 hours with the weights chin-ups and such, though big breaks between sets. Today I will run and hit and kick the heavy bag.

      Everyones physiology if different I suppose. But I think some do say cholesterol formation(not added cholesterol but the cholesterol we make) may have a to do with immune cell formation.
      Just personal conjecture I guess. But I have also heard those with very low cholesterol such as with overprescribed statins perhaps are not very healthy at all as regards immune function.

      So heart only cancer perhaps fats. Immune as in colds flu things of that sort…is fat bad or helpful? Fat peoples of course it is bad most cough just walking around… but normal weight?
      Not saying I am sure but surely seems that way. For me at least.

      1. Nathan Pritikin the father of most of this stuff….he did in the end die of suicide but was suffering from terminal leukemia which due to pain caused that seemingly.
        Of course we don’t know his history and likely environmental exposure but he was low low fat for about 30 years or so. He was 69 when he died.

        I believe he was whole foods plant based suffering from cardiac before he began his diet..
        Not firm in this as well as we really don’t know but is there a balance to this or just no fat is good?..
        A very little in nuts and seeds I guess.

        1. hi ron, thought you might enjoy listening to these nathan pritikin files as much as I did. https://www.drmcdougall.com/health/education/podcast/nathan-pritikin/
          Nathan Pritikin had a horrible diet before the doctors diagnosed him with heart disease and he then changed his diet. His main weakness was indulging in ice cream. He speaks about it in the files. If you prefer a video, this link should help https://m.youtube.com/watch?v=qOj4rzSkqok

          One of the things I found really interesting was Nathan’s comments about Jim Fixx re his belief that if a person was fit enough, what they ate didnt matter. This is discussed in the audio as well as the video i believe. https://en.m.wikipedia.org/wiki/Jim_Fixx , the athlete who died of heart attack at the young age of 52.

          1. I believe Jim Fixx’s father dies of a heart attack at age 43. His first heart attack at age 35. I took up running in 1980. My waist measurement went from 30 to 31. I was an avid reader of Runners world. Jim Fixx was a contributor to that publication. I was an avid runner for about 8 years until I was diagnosed with a congenital lung disease.
            Jim Fixx and myself are both examples of what genes have to do with longevity. I’ve been trying to stay on a WFPB lifestyle for almost 2 years. I’ve had meat 4-5 times during this period, I’ve consumed salmon about once a month since moderating this diet. I stuck strictly to the WFPB for 5 months, my cholesterol went from 253 to 239. During this time I went from 175 to 155, I looked unhealthy.
            At 6 ft tall, I was never really overweight. This is a very difficult diet to stay on religiously. I guess I’ll Stating?

              1. Statins will reduce cholesterol but they do hazard the liver a bit. Staying within a prescribed range I guess it should be ok though.
                One of the companies gave it a go to try to actually remove present arterial plaque and it did work. But the side effects at the higher dose necessary were to detrimental to continue.
                Exercise is a strange bird at times. There is a correlation between extreme intensity cardio as in running for long duration or biking and the presence of atrial fibrillation. Someone has written a book on that.One ultra marathoner in his fifties out here in New Mexico died while on a run in the forest.. Fixx also I noted in reading one of his books after the fact, did not believe in any supplements like vitamins.

            1. @Dave Davis: You may want to get your blood tested for ” lipoprotein a” which 1 in 5 people have this factor. It makes it nearly impossible to adequately lower cholesterol through the recommended lifestyle practices (WFPB no added oil, exercise, meditation/relaxation.) We learned about this from Dr. Joel Kahn, a plant-based cardiologist. You can read about it in his book, The Whole Heart Solution, or do online searches. There are supplements one can take that are supposed to inhibit the action of lipoprotein a. (That’s lipoprotein followed by a small “a.”) Dr. Kahn told us that few cardiologists in the U.S. order this blood test. I got mine done through my local medical clinic, and I believe they sent that test out to Quest Diagnostics Lab in San Diego, CA. As a result, my husband is not taking any statins. He is following Dr. Kahn’s recommendations (based on an private consultation with him at his clinic) for using a variety of supplements that medical research has demonstrated effective for this condition. Good luck to you!

            2. Dave Davis, read Karen’s comment.
              Lp(a) can be reduced with Ginkgo Bilbao. (In the study they used Eg261, a type made in Germany, but available in US by Nature’s Way.
              It’s called Ginkgold and is manufactured in Germany.)

              Study is called: ‘Reduction of Atheroscerotic nanoplaque formation and size by Ginkgo biloba in high risk cardiovascular patients.’
              It’s available on NIH website.

              Also important to have enough B12 or your homocysteine goes up, another risk factor for heart disease.

    2. I tried coconut oil on my skin and I got a reaction. But, now I use Bragg’s apple cider vinegar on my skin and scalp after a shower and it really helps. I recommend Bragg’s apple cider vinegar for most skin problems. I have never tried it, but some people in India use a paste of Gooseberry powder on their skin problems with good results.

  3. I’m a vegetarian and have lived in Spain for over 20 years and am wondering where this ‘Mediterranean diet’ comes from. The first thing the Spanish put on their plate is a pile of MEAT. Then add a few veggies to it. They buy a lot of vegetables but they seem to appear as soups and stews. I was invited to eat with a Spanish family and they did not really know what to give me. I also refused fish, which, I am told is good for you!! The lady in our local fruit and veg shop asked me what I did with all my veg — especially the celery — I just said I eat it raw. She smiled and tapped her temple saying ‘loco’.
    Personally I don’t see a MedDiet as being full of fruits and veg – in my experience.

    1. Will
      Spain is one of the Mediterranean countries , so why are those countries so healthy ? Maybe it is the pasta Italians eat . They eat about 3 times as much as North Americans or maybe it is the milk , as they drink more of that too . Why would it be fruits and vegetables and olive oil ? Sounds fictitious too me .

      1. It sounds fake that eating lots of fruits and vegetables helps make people healthy buster? Ooooookaaaaay. Why are you on nutritionfacts again?

        1. hi Ryan
          Reading the website “pasta for all ” they state that “fish and tofu were the only individual food groups associated with a noticeable decrease in heart problems ”
          They have a lot of info there plus recipes that I like .
          Gut health should be number one concern for everyone , if you have time watch…
          https://www.youtube.com/watch?v=KORnNxnj1AU

      2. They are NOT healthy anymore. Because they have been eating Americans style processed junk for a generation.

        They were healthy despite all the olive oil because they didn’t have access to processed junk a generation ago and had to eat whole foods.

        Jeeze, WAPO just did a big article on it.

        Try google.

    2. hi Will, the origional mediterranean diet referred to a post-war dietary habits of the people from the Isle of Crete. Dr Greger links related videos above, and here is the first os a 6 part series on the topic https://nutritionfacts.org/video/why-was-heart-disease-rare-in-the-mediterranean/ The diet was a far cry from what many eat today, and would be considered austere by comparison. I believe there was an exercise factor as well – I seem to recall one of the videos mentioning that people would walk miles daily to the coastal markets and villages.

    3. What is eaten today in the Mediterranean (and Okinawa) is not the same diet as was observed by researchers in the middle of the 20th century. The original Mediterranean diet, like the traditional Okinawan diet, was a diet of poverty not one of abundance

      Ancel Keys who virtually invented the concept of the Mediterranean diet, visited Naples with his wife (Margaret Haney) and observed the very low rates of heart disease. However, he also noted that the rich people who ate lots of animal foods did die of cardiovascular disease.

      “In one month Margaret Haney collected many blood samples of the workers of a famous Neapolitan steelworks factory and she analyzed them. Comparing them with the samples of the men in Minnesota, they noticed that the cholesterol rates were greatly different. At that point they had a flash of inspiration. Probably cholesterol was the causation of heart attacks. But that was not all. They started observing what workers ate, and the first evidence was that they eat meat once a week, on Sunday evening. It was the meat of a traditional sauce for pasta, called ragout, that was, and still is, mandatory on Sunday lunch when the families gathers around the table (Moro, 2014: 25-26).
      The Keys started to take note of what common people ate: lots of vegetables, legumes, broccoli, all kinds of fruits, unrefined cereals, dairy products, but very little fish and meat. Neapolitans loved soups, minestre and minestroni, in Italian. Not the same thing as what French people usually call soups, since they were not made with cream or butter, but with vegetables, olive oil, and a bit of pasta. The Keys found bean soup, pumpkin soup, green peas soup, zucchini soup. Those who could afford pasta, would add few spoons of the so called short pasta, not long spaghetti, but small size pasta. If pasta was not available, they used rice, hard bread or the so called biscotto or fresella – a whole meal bread, cooked twice in order to make it very dry, so it may be conserved for long periods”
      https://www.sciencedirect.com/science/article/pii/S1877042816304608

      http://www.nytimes.com/2004/11/23/obituaries/dr-ancel-keys-100-promoter-of-mediterranean-diet-dies.html

      1. TG,

        Thanks for sharing that. It is fabulously interesting to hear how the whole Mediterranean Diet concept came to be and what the people were eating back then.

        The writer has captured the “aha” moment of discovery well enough that I can almost feel what it would have been like to be there. There is a simplicity in the way they were approaching food, which attracts me.

        I think the simplicity is what attracts me most to WFPB ways of eating.

        Yes, I am here everyday trying to cut through all these complex issues, but I open my refrigerator and see kale and tomatoes and carrots and pomegranate seeds and broccoli sprouts and tri-color peppers and edamame and citrus fruits and grapes and bananas and herbs and there are times I can just stand there and look at all the colors and that part isn’t all that complicated at all.

    4. Agree with you Will. Unfortunately the mediterranean diet is no more. Ive been going regularly to Malta for 30 years 4 or 5 times a year. I’ve seen the American diet overtake them, with the advent of McDonalds and PizzaHut and massive servings of meat on the plate in restaurants. Infact the Maltese women are the fattest in Europe ! It’s got very difficult to find plant based foods on the menu although a good Indian restaurant can always feed you and if you phone any of them in advance they are very accommodating.

      1. The standard american diet seems to be spreading around the planet. Except, Russian leaders are starting to change the diet of Russian military, scientists, and key essential people to a more plant based diet so that they are more competitive in the world. The people themselves still eat a lot of meat, dairy, eggs, milk, breads, and cheese. But, the leaders, movers and shakers are trying to be more competitive. This is called weaponizing food.
        Some of the elites in America are also leaning more toward a plant based diet with small amounts of meat. The Clintons eat a lot of vegetables, so I heard on a YouTube video where an insider was interviewed. Trump seems to be still wallowing in McDonald’s hamburgers. It would be interesting to find out exactly what all of the high and mighty people on the planet eat….Do they eat in order to be healthy and competitive, or do they eat for pleasure like most people do. But, once you get onto a whole plant food diet, the food slowly becomes very pleasurable. I’m at a point where I love my raw salads with NO OIL…..no salad dressing….just the raw vegetables.
        Now, I can eat like a rabbit and enjoy every bite of it.

      1. What’s wrong with considering what the evidence shows?

        Oh, what’s that? It contradicts your opinions? Good, golly gosh, we can’t have that can we?

        Let’s ditch that inconvenient evidence and just believe whatever nonsense we like then. So much more fun that way.

      1. NutritionFacts.org | curciotara (Health Support Volunteer) replied to your comment on How Healthy is the Mediterranean Diet?.Hello and thanks!

  4. Fat will not build up in the arteries if they are not inflamed. Both processed grains (ie glucose) and TMAO (from animal protein) provoke the immune system to produce such inflammation.

    And one more thing that is rarely mentioned concerning ALL substances: The Poison Is In the Dose. We use coconut oil at our house to pop corn. It probably won’t be what kills us.

  5. Everything you eat that was once alive contains fat. Every cell in your body contains fat. The brain and nervous system are at least 40% fat. Feed it.

    INFLAMMATION causes ALL chronic non-infectious disease, not fat. (Animal fat, however, contains all the hormones, immune cells, and toxins that were in the animal when it was alive. They cause inflammation.)

    1. Why should anyone believe you or other fat worshippers? You just make assertions and seldom if ever provide any supporting evidence. All you have is simplistic arguments.

      In any case, your claim about inflammation as the first or sole cause is manifestly false.

      There are all sorts of causes of noncommunicable chronic diseases not just one. Look at the evidence around viruses, bacteria, diet, stress and pollution for starters.

      In any case, inflammation appears to be the body’s response to various. It is like saying that pain is the cause of all traumatic injury. It is a mechanism not a primary cause.

      1. I really like reading your rebuttals Tom, because it prepares me to debate people in my own community who have jumped on the band wagon of the Paleo Diet.

  6. So does this study nudge the nuts closer to a green light food? Especially since a previous study showed that nuts do not lead to weight gain …

      1. Am I going crazy here? I believe Dr. Greger said linoleic fat is bad for the arteries and chicken is a main source of it. So is flaxseed, listed in many articles as the main source of linoleic acid. So, I have ben taking 2 tablespoons of flaxseed a day and all of a sudden it is bad for my health!

        Could Dr. Greger clarify, please?

        1. Both LA and ALA are essential. It’s not just the total amount that is important, it’s also the ratio. The ALA : LA ratio of flaxseed is about 4:1; for chicken it’s more like 1 ALA : 13 LA.. Makes a big difference as they compete for the same biosynthetic pathways.

          http://nutritiondata.self.com/facts/poultry-products/699/2
          http://nutritiondata.self.com/facts/nut-and-seed-products/3163/2

          Hope this helps… btw, I assume you are grinding the flaxseeds.

    1. Hi WJB! Dr. Greger has quite a few videos and articles demonstrating the many benefits of nuts, all of which you can find here! :-)

    1. My guess is Esselstyn his research was based on a low low fat diet not nuts. So he knows definitively that low low fat works to reverse heart disease but has not specificially tested a low low fat diet with nuts.

      Improving artery function is not reversing heart disease AS with beet juice this may be a temporary effect. .Possibly with those with advanced heart disease nuts may not have the same beneficial effect could be the thinking.
      Sort of like if it ain’t broke why fix it. He knows low fat works why tinker with the plan?
      Just a guess though.
      Medical treatments and recommendations may vary considering the advancement of the disease or if a disease is present at all.

      1. >>>So why does Dr Esselstyn recommend no nuts to heart patients if nut improve artery function?
        I think Ron In NM is right. Just heard a recent lecture by him (Mastering Diabetes Summit), where he said that IF one has heart disease, he is “cautious on nuts/seeds” because of some rat studies showing peanut oil is atherogenic and no other diet is known to work.

    1. Jim, neither peanut or olive oil should be heated, they get oxidized, which may be the whole problem with oils.
      I used to work in a lab that tested these oils when I was in college.
      I would never cook with them, or any polyunsaturated oil, actually, they are the worst.
      Btw, peanut oil doesn’t have a very good oil profile either. I wouldn’t use that for anything.
      Sauté your veggies in a little bit of water or vegetable juice, then you can add a high quality olive oil after they’re cooked if you still want it.
      It’s at least better than margerine or butter.

    2. I don’t use oil for cooking. Who needs it?

      However, Harvard advises

      “Cook with healthy oils. Olive, canola, soy, peanut, sunflower, corn, and other oils from plants are the best choices, since they are high in healthy unsaturated fat. If you have a dish that requires the flavor of butter, use a very small amount of butter mixed with a neutral-flavored oil, such as canola oil. And keep in mind that it’s okay to cook with extra-virgin olive oil. The healthy fats in extra-virgin olive oil are stable at temperatures used in home cooking, with the exception of deep-fat frying or stir frying. Then we’d advise using an oil that’s more stable, like peanut oil.”
      https://www.hsph.harvard.edu/nutritionsource/2012/06/21/ask-the-expert-healthy-fats/

      1. The people who wrote this article from Harvard, have obviously never seen what happens to oils when they are heated.
        Oils break down, and become oxidized when heated. That is why they are inflammatory.

        1. They clearly have considered the effects of heat on oils since they discuss this very point tin he latter part of their discussion.

          So, you are telling us that Harvard, the AHA and the CDC are wrong and you are right?

          http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/SimpleCookingandRecipes/Healthy-Cooking-Oils_UCM_445179_Article.jsp#.WnrGyKiWbIU
          https://www.cdc.gov/diabetes/prevention/pdf/postcurriculum_session2.pdf

          The oxidisation claims made about unsaturated oils by the saturated fat apologists are of very long-standing. They were discussed by Plant Positive some five or so years ago.
          http://plantpositive.com/41-pufas-oxidize/

          1. Harvard, the AHA or CDC are not promoting a Whole Food diet here. Processed oils are not whole food.
            My comment has nothing to do with saturated fat,
            And Dr. Esselstyne is correct, the peanut oil proved aterogenic to primates as well as the rabbits.

          2. Listen everyone. I used to debate Tom on some issues…but I have come to a point that I totally trust his opinions. This guy has read so much on every nutrition issue PRO and CON that you can’t help but be convinced by his logic and all of the evidence he presents. Plus, Tom has an investment in these debates. He is trying to find out what is best for his health issues also. He is only going to do what is going to help him and avoid things that might not help him. He’s not here just to waste time….he is seriously looking for health solutions.

  7. Why does Dr. Fuhrman tout a high-fat diet including coconut, olive oil, butter and lean “grass fed” beef? He also seems to be a well-respected doctor with his “Nutritarian” diet and generally follows many of the same suggestions as Dr. Greger and others regarding fruits/vegetables (GBOMBS), etc. Fuhrman tends to focus a lot on the brain needing fat (because much of it is made of fat so he says), but are those who are whole food plant based not getting enough fat for their brains? And he says that his recommendations are all backed by scientific facts/data as well. So confusing who to listen to/trust.

    1. >>Why does Dr. Fuhrman tout a high-fat diet including coconut, olive oil, butter and lean “grass fed” beef?
      Where did you get this idea? Dr. Fuhrman recommends no such thing! He is against all oils, butter, dairy, any kind of red meat, fish, poultry etc. (Perhaps you are confusing him with Hyman?).

      It is true that he thinks ultra-low (less than 15% total cals) fat diets are neurologically risky, and even allows that up to 30% fat can be healthy IF one is slim/athletic and the fat comes from whole foods, primarily seeds and nuts (some avocado, olives ok). Esselstyn (just listened to a video lecture as part of the Mastering Diabetes Summit) said he is “cautious on nuts and seeds” b/c of some study/studies on rats showing peanut oil is atherogenic, which is not very strong evidence, in my view. But he also differentiates people with heart disease and healthy people, the latter of which can eat more nuts/seeds, avocado, etc. So the lower end of Fuhrman’s recommendation is not that far off from Esselstyn’s recommendations, at least if you are not dying from heart disease and eat more nuts/seeds. But stating that one can eat 30% of cals as fat in whole food form is not and be perfectly healthy under certain conditions is not the same as “touting a high fat diet..

      Having said that, I too would like to see Dr. Greger weigh in on this.

      1. Two corrrections:
        1. He said in the video I mentioned that IF one has heart disease, he is “cautious on nuts/seeds”, so apparently not really concerned if a person has no heart disease.

        2. My last sentence should read:
        But stating that one can eat 30% of cals as fat in whole food form and be perfectly healthy under certain conditions is not the same as “touting a high fat diet..

    2. Dr Greger’s research substantiation is right there in the videos for us to see. And the thinking that led to the conclusions are as well.
      Omega 3 EPA-DHA a type of omega3 fatty acid may be found in flax and other seeds. We however loose the ability to convert what is found in the seeds to this fat type as we age. It is found chiefly in fish oil and in algae. Most meat eaters get it in fish. So as we age it may be the best thing to do to supplement with this. It is available in vegan form if one wants to avoid the impurities normally found in fish. Many fish oils are within safe recommended levels but contaminants are almost invariably present though at low levels. Algae based this may be pretty entirely avoided.

      At a younger age say under 50 normally the conversion ability is still there.
      These help to assure cognitive health as one ages. The brain tends to shrink and this it is thought may alleviate that a bit.

      Someone can say they find that or this in study. To actually show the studies and
      show how the study may be valid or not, to my view only Dr Greger does that.

      He has a video on this and one may care to search it on the site to bring it up.

      1. Ron,
        I think you meant to say that flaxseeds, etc, contain ALA, which is elongated to EPA and from there to DHA.

        Also, I don’t think all young people are efficient converters (women are generally better than me). Not to mention that the O6:O3 ratio can reduce conversion if it is too high. The issue, as I understand it, is that the consequences of overly low DHA does not make itself known for many decades, kind of like heart disease. Hence the recommendation to supplement DHA.

        1. Yeah….flaxseeds suffice for most of us to convert ALA to EPA and DHA.

          I said it backwards ;( and meant to say it correctly.
          I think age is the thing but like with conversion of betacarotenes to vit A some can never do that. But for most of us we can. till we age. Peoples vary.

          I supplement with a vegan source EPA DHA as a precaution.
          Most vegan I think past 50 should.Brains shrink past our early 20’s. But most I think retain the conversion factor. There is no epidemic of vegans with alzheimers. B-12 is more critical by my read.
          I would not personally worry before age 50 but to each their own. I take flax but the root nutrient is also available elsewhere from other source. Hemp some others I think have it a bit less concentrated.

    3. Hi Ellen
      You may want to check your source again about Dr Furhman “touting a high fat diet.” He actually doesn’t recommend oils of any kind if I am not mistaken. He is all about nutrient dense foods. Not calorie dense foods unless you are an athlete and having a hard time keeping weight on. Pick up any of his health books and he talks a lot about those topics.

      1. I meant Dr. Hyman

        Ellen Rozics NASM Certified Personal Trainer FUNctional FITness with Ellen, LLC 410-487-5095

        “Gotta do whatcha can with whatcha got!”

        1. Ellen

          Hyman is an expert on marketing and writing best-selling books but I wouldn’t take seriously everything he says on nutrition. Some of his advice – like avoiding processed foods – may well be sensible but not everything by any means.

          He is pretty good at echoing the latest dietary fads and fashions and cherry-picking a few studies to support his claims. It is the evidence that he does not mention which is the worry. For example, he does not mention that the World Health Organization has classified beef and other red meats as a group 2A carcinogen or that Harvard researchers found that dairy fat (as found in butter) consumption is associated with increased risk of cardiovascular disease
          http://www.who.int/features/qa/cancer-red-meat/en/
          https://www.hsph.harvard.edu/nutritionsource/2016/10/25/dairy-fat-cardiovascular-disease-risk/

          It is really important to fact check claims by such people and read reports on diet, nutrition and disease by real experts. These include the panels of scientific experts who authored reports on nutrition and disease for the World Health Organization, the World Cancer Research Fund and the US Dietary Guidelines Advisory Committee. Those reports are all free (unlike Hyman’s many books)
          http://www.who.int/dietphysicalactivity/publications/trs916/en/
          https://www.wcrf.org/int/research-we-fund/continuous-update-project-cup/second-expert-report
          https://ods.od.nih.gov/pubs/2015_DGAC_Scientific_Report.pdf

          I consider that Dr Greger’s statements on nutrition and health are broadly consistent with the findings in those reports, even if they differ on certain points. IMHO Dr Hyman’s aren’t consistent with the science.

          1. The Bill Clinton used to follow the advice of Dr. Esselstyn, but then Hillary convinced Bill to follow the advice of Hyman. One insider reported on YouTube that the Clintons eat a lot of vegetables. I wonder what Clint Eastwood eats. He is thin, still making movies, very functional, and I think he is in his 90’s. What about Suzanne Sommers? She has tried to jump into the nutrition game by publishing a book several years ago. On her FaceBook page she has pictures of her garden. I doubt that she is into whole plant food diet, because if she was, she would be vocal about it.
            What about Nancy Pelosi? She is think, active, functional, and moves around with more energy than people her age. She looks like she tries to improve her health. I wonder what her diet is? What about Arnold Schwartznegger?
            Now here is a guy who is totally obsessed with maintaining health. But, his focus is exercise. I don’t think he focuses that much on diet. Body builders in general think they need a lot of meat to maintain their hypertrophy of muscle tissue. He is looking more muscular now since he has returned to seriously working out with weights and machines, however, when you look at his face and eyes they seem to not glow with health. I would bet he is still eating a lot of meat, eggs, dairy, and the such.

    4. Ellen,
      Here are a few quotes from Dr. Fuhrman taken from his website
      https://www.drfuhrman.com/learn/eat-to-live-blog/19/dr-fuhrman-answers-the-top-questions-he-is-asked-most

      “Lately, very high-fat diets are in vogue, then we have the extremely low-fat crowd of plant-based enthusiasts; though usually a step in the right direction, neither can be considered ideal, because they do not expose us to sufficient longevity-promoting, anti-cancer phytochemicals and the fat extremism limits the absorption of the protective phytonutrients, when they are consumed

      Saturated fats from animal products are still linked to almost all causes of premature death. On the other hand, eating beans, nuts, and seeds (instead of butter and other high saturated-fat animal foods) is associated with a dramatic reduction in heart disease risk. Comparing fat sources, butter is not harmless and does not provide health benefits as nuts, seeds, and avocados do.

      Whole plant foods with scientifically-backed health benefits make up the vast majority of calories in the Nutritarian diet. “

      So you are right he recommends a diet higher in fat than most others (15-30% range) but he only recommends whole plant food. He discusses this in more detail in hisbook The End of Heart Disease., where he discusses issues of neurological health.

      I agree this is a confusing difference in opinion but please don’t put him in with the butter etc crowd.

      1. I meant Dr. Hyman, not Fuhrman

        Ellen Rozics NASM Certified Personal Trainer FUNctional FITness with Ellen, LLC 410-487-5095

        “Gotta do whatcha can with whatcha got!”

    5. Stop misquoting nonsense.

      LOL you have no idea what Dr Fuhrman “touts”. WHAT? You’re totally confused with him and someone else. I think, probably Dr Cousens on the oils and brain. I have no idea who you’re confused about on the animal products.

      Not only is Dr Fuhrman EXTREMELY strict about NO oils whatsoever (unless you’re a healthy underweight person and can use 1 tsp max per day), but also no animal products whatsoever. No added sodium, no added sugars or artificial sugars.

      He only allows 6 oz per week animal/fish meat in 2 oz servings for MEAT EATERS who want to try ETL.

      Sorry to inform you but Dr Greger is the closest to Dr Furman’s Nutritarian Diet but not even close since Dr Fuhrman is the one who INSISTS that one pound a day raw greens and vegs and an equally large portion of cooked greens and vegs be the goal , as it is the backbone of ETL.

      1. Yes, I posted this months ago and meant Dr. Hyman, not Fuhrman. I wrote that in the comment section that I put the wrong doc by mistake.

  8. “But he also differentiates people with heart disease and healthy people, the latter of which can eat more nuts/seeds, avocado, etc.”

    If you grew up in a ‘western’ country and are an adult, whether you know it or not…you have heart disease. Just because you may not be showing symptoms is irrelevant.

    No nuts, avocado, or oil…!

    1. By the way, the “he” in my statement was Esselstyn (not Fuhrman), which could well not have been clear. Esselstyn is not against eating nuts/seeds IF you have no demonstrably heart disease. Why? no doubt b/c he feels that those in lower risk categories can heal whatever damage they might have with an anti-inflammatory whole food plant diet that includes some nuts/seeds, particularly some flaxseeds. So, it is not irrelevant..

      Can you be healthy without eating any nuts/seeds? No doubt. But they are not equivalent to oils, and neither is avocado.

  9. There is a mystical thing about Okinawan and Chinese in the (fake) Chinese study and 7th day Adventist living long life.

    Truth is that nowadays there are more 100,000 Spaniard who live more than 100 year of age and they enjoy their life and eat albeit a balanced and diverse diet of plant foods and animal foods. They don’t have to munch sweet potato all day long like the mystical Okinawan, or eat 2% of calorie in animal food like the mystical Chinese as told in a famous novel.

    http://guardianlv.com/2013/11/spain-lives-longest-in-europe-spanish-style-mediterranean-diet-explored/

    https://www.expatica.com/es/news/country-news/OP-Spain-has-second-highest-life-expectancy-in-the-world-new-figures-show_895677.html

    https://www.huffingtonpost.com/entry/anchovies-secret-longer-life_us_570d5288e4b0836057a2a9eb

    1. Sure, Jerry, all the evidence you don’t like is “faked” or “mystical” (do you mean “mythical”

      And all those centenarian Spaniards would have been born a hundred years ago and would have been
      eating
      “The Spanish Mediterranean diet consists of fruits, vegetables, cereal grains, olive oil, seafood, nuts and wine, which are Spain’s traditional agricultural products.”

      Of course, you being you just make up your own facts and claim they ate/eat a balanced diet of plant and animal foods. It seems to me that the animal foods content was quite small from your article and plant foods predominated as they did in the Okinawan and Chinese traditional diets.
      http://guardianlv.com/2013/11/spain-lives-longest-in-europe-spanish-style-mediterranean-diet-explored/

      It is truly fascinating to observe inventing your own facts and then claiming that actual real world facts are faked and mystical. You have big problems Jerry ……………….

    2. I am not going to get in the middle of a debate about the China Study.

      I don’t look at it as mythical, unless there is some evidence that they did something like fake the dietary surveys or something, which hasn’t happened. No matter whether people agree with every single conclusion, the study did show trends within a country, and the more information we have from around the world, the bigger picture will come to light eventually.

      I understand the concept of questioning some of the conclusions, based on other cultures, like the Eskimos, but I do still highly value the study. The Eskimos are a mystery to me. Perhaps there will be an explanation someday.

      It is such a complex process understanding the genuine effects of diet on diseases which take years to come to light.

      I was thinking about the arsenic in rice from Texas projected to leading to Cancer at such low daily doses versus the reality that the Hispanic cultures outlive other groups. Perhaps the beans are powerful enough to offset the problems from the rice? Or they cook it differently? Or they buy it from California? Or they have better genetics? I say it, because it is a mystery in my mind, but it would take researchers to be interested enough to test it and that would make me happy, but for now, I appreciate Consumer Reports for having tested the rice, because it gives information, which I can make decisions with.

      Jerry, Thank you for the links about the Spanish-style Mediterranean diet.

      It was interesting reading their sample day’s eating.

        1. Thanks for the link.

          I had heard that the frozen food industry started because of how healthy they were or something like that. (it was a PBS series on how one invention led to another. A while back, so I might not be repeating the story properly.

          I value the discussion here.

          A year ago, I was trying to heal from brain issues, which, I have come to believe was from not having B12, Omega 3, D3, and I was low in Magnesium and was probably Diabetic, but spent a few years doing care taking and not going to the doctors. No sleep for years probably didn’t help.

          Back then, I did have a short phase where I tried fats, after watching Dr Amen and Grain Brain and After reading about Paleo and Keto.

          I also had Cancer symptoms and ended up watching a documentary of a group of people who got off their Diabetes meds in a few weeks going raw vegan. Dr Cousens? Maybe.

          I got tossed back and forth between Keto and plant based theories for Cancer, but all the testimonies I could find were plant based.

          So, yes, I bought coconut oil and took it for three days and it ruined my smoothies and I threw it up. Couldn’t keep it down. Tried flax seed oil and it went rancid and the experiment was over.

          Switched to ground flax seed..

          I am eating nuts now, because of Dr Greger.

          I laugh, because the first video of his that I watched was the vegans dying of Alzheimer’s and that questioning about healing the brain after it is damaged is the one question, which tempted me to the fat side.

          If Any vegan doctor can do a study where Alzheimer’s improves with their diet, theirs will be the one I end up doing.

    3. I ask forgiveness from all the people who are more sophisticated in their thinking than I am.

      I genuinely appreciate seeing the various cultures and hearing the various philosophies.

      I find that it does expose mysteries for the researchers to solve if they find it interesting.

      If any researchers come here, I just want to say, “Thank you from the bottom of my heart.”

      1. Debe, please don’t put yourself down. We aren’t all doctors or experts here. I like you am here to learn and make my diet more healthy. I have a whole variety of ailments that the is helping, but Im a newbie at all of this and value the comments of everybody that is searching for the truth.

  10. Hi, I hope Dr. Greger by himself will read this “cry for help”.
    In the earlier article “faffy meals impair arthery function” Dr. Greger mention this sources: July 23, 1955
    ANGINA PECTORIS INDUCED BY FAT INGESTION IN PATIENTS WITH CORONARY ARTERY DISEASEBALLISTOCARDIOGRAPHIC AND ELECTROCARDIOGRAPHIC FINDINGS
    Peter T. Kuo, M.D.; Claude R. Joyner Jr., M.D.
    JAMA. 1955;158(12):1008-1013. doi:10.1001/jama.1955.02960120008004
    I found this article but I have to pay for the full text :-(
    So my question is – have anyone already the full text and would share it with me, please? (may you Dr. Greger?)
    Backround of this question. I run a free blog site in German about the advantage of a WFPBLFD, because most of the Germans don’t know nutritionfacts.org and (more important) they are not able to read and understand English. So I see my task to make science available for the “normal people” ;-)
    Thank you in advance, Steffen

  11. Dr Greger, thank you for putting this out in an organized way and including the links.

    This is so relevant to the conversations people around me are having and you have given useful information to me.

  12. How often does one need to consume chicken for the lesions to show? Is this for someone who eats chicken every week? Curious as to what the consumption of chicken was.

    1. Jeff- You asked how quickly athlerscotic lesions would develop and were curious about how much chicken was eaten to cause the lesions. Unfortunately when I went to the study cited The influence of diet on the appearance of new lesions in human coronary arteries.
      (https://www.ncbi.nlm.nih.gov/pubmed/2407875/ ) there was only an indication that the plaques developed over a 2 year period when the angiograms were don. What we do know is that very little of the fat in chicken was needed to increase risk: ” Each quartile of increased consumption of total fat and polyunsaturated fat was associated with a significant increase in risk of new lesions. Increased intake of lauric, oleic, and linoleic acids significantly increased risk. ” I know you are interested in plaque build up, but perhaps this study on the hazards of chicken consumption in terms of obesity might help put things in perspective: https://nutritionfacts.org/video/Chicken-Big-Poultry-and-Obesity/ “(T)hose eating about 20 or more grams of chicken a day had a significantly greater increase in their body mass index. That’s around one chicken nugget. Or a single chicken breast once every two weeks, compared to no chicken at all.” Doesn’t appear to take much chicken to cause damage!

      1. If one chicken breast every two weeks can cause that much plaque

        build up, then what is happening with people who are vegetarian and

        eat maybe some salmon once every two weeks?

        What about those people like Jerry who claims to eat a lot of

        vegetable but also eats meat frequently?

  13. I find myself only reading comments these days for the hysterically funny and misguided comments from Jerry Lewis. Jerry Lewis had me laughing as a child as I watched his antics on screen and now I can relive those good times on this here fine site through another Jerry’s antics.
    It is indeed mystical & ridiculous how in Jerry’s mind the China Study was faked. Because if that was true – there would have been litigation by now (for we live in a society that loves to sue people for misinformation).
    But no….Jerry will peruse every newspaper article / magazine snipping / popular “news” based site to back up his beliefs – valid or not.
    Just what does he put in his Bone Broth! o.O
    What does frustrates me about our pal Jerry though – is why does he visit a Whole Foods Plant Based website daily – if he believes his way of eating is correct? Banned from his local stand up comedy club? A life long desire to prove fantasy? Just to aggravate? Whatever the reason…Jerry is indeed entitled to his opinions…but that is all they are.
    Anyways Jerry…..even if your fatty based comments clog our articles….they do produce chuckles – and laughter does promote good health. Bless.

  14. Sorry for posting too many long comments.

    My brain still isn’t 100% and I am still trying to learn science and medicine and nutrition for the first time in my life with half my brain tied behind my back, or so it seems.

    I failed the left nostril peanut butter test a few times, and had a relative pass away from early on-set Alzheimer’s and she had started around my age, so I am interested in the fats and oils and nuts debates.

    I know that I express too much right now and I shouldn’t do that unless I start my own blog.

    I will try to do better.

  15. CORRECTION: The World Health Organization did NOT say that beef was a carcinogen. What the WHO did say was Processed Beef is carcinogenic and also beef cooked at high temperatures is carcinogenic.

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