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“The Eskimo Myth”

As I reviewed in my video Is Fish Oil Just Snake Oil?, the revelation that fish oil appears useless in preventing heart disease—in both heart patients and those trying to prevent heart disease in the first place—leads one to wonder how this whole fish tale began.

The common mythology is that in response to anecdotal reports of a low prevalence of coronary heart disease among the Eskimo, Danish researchers Bang and Dyerberg went there and confirmed a very low incidence of heart attack. The absence of coronary artery disease would be strange in a meat-based diet with hardly any fruits and vegetables—“in other words, a diet that violates all principles of balanced and heart-healthy nutrition.” This paradox was attributed to all the seal and whale blubber, which is extremely rich in omega-3 fish fat, and the rest is history.

There’s a problem, though. It isn’t true.

As I discuss in my video Omega-3s and the Eskimo Fish Tale, the fact is Bang and Dyerberg never examined the cardiovascular status of the Eskimo; they just accepted at face value this notion that coronary atherosclerosis is almost unknown among the Eskimo, a concept that has been disproven over and over starting back in the 1930s. In fact, going back more than a thousand years, we have frozen Eskimo mummies with atherosclerosis. From 500 years ago, a woman in her early 40s had atherosclerosis in her aorta and coronary arteries. And these aren’t just isolated cases. The totality of evidence from actual clinical investigations, autopsies, and imaging techniques is that they have the same plague of coronary artery disease that non-Eskimo populations have, and the Eskimo actually have twice the fatal stroke rate and don’t live particularly long.

“Considering the dismal health status of Eskimos, it is remarkable that instead of labelling their diet as dangerous to health,” they just accepted and echoed the myth, and tried to come up with a reason to explain the false premise. The Eskimo had such dismal health that the Westernization of their diets actually lowered their rates of ischemic heart disease. You know your diet’s bad when the arrival of Twinkies improves your health.

So, why do so many researchers to this day unquestioningly parrot the myth? “Publications still referring to Bang and Dyerberg’s nutritional studies as proof that Eskimos have low prevalence of [heart disease] represent either misinterpretation of the original findings or an example of confirmation bias,” which is when people cherry-pick or slant information to confirm their preconceived notions. As the great scientist Francis Bacon put it: “Man prefers to believe what he prefers to be true.” So, we get literally thousands of articles on the alleged benefits of omega-3 fatty acids, a billion-dollar industry selling fish oil capsules, and millions of Americans taking the stuff—all based on a hypothesis that was questionable from the very beginning.

What’s this about no benefit for fish oil consumption and heart disease? See my video Is Fish Oil Just Snake Oil?.

What about fish oil for mood disorders? See Fish Consumption and Suicide. Is Fish “Brain Food” for Older Adults? Should Vegans Take DHA to Preserve Brain Function? Consumption of long-chain omega-3s (EPA and DHA) may be useful for forming and maintaining brain health, but there’s a struggle between Mercury vs. Omega-3s for Brain Development when coming from fish or fish oil, thanks to how polluted our oceans have become. In fact, this is the case even in “distilled” fish oil; see Fish Oil in Troubled Waters for more. The marine pollutants may explain the relationship between Fish and Diabetes and ALS (Lou Gehrig’s Disease): Fishing for Answers. Thankfully, there are now pollutant-free (yeast- and microalgae-derived) sources.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

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

111 responses to ““The Eskimo Myth”

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  1. I always find it amazing how people acquire their beliefs. First, as children, we acquire the folklore that is passed down from generation to generation. Some of it may be true, but a lot is questionable.

    Then we are bombarded with the indoctrination from the school system all the way through the university level. A lot of that so-called “Knowledge” is biased by vested interests running the academic systems. I must say, the one saving factor is that some universities do have some decent science and math courses.

    Then we are fed mostly propaganda from the media (TV, movies, newspapers, magazines, social media, etc.) all having an agenda to push.

    Finally, we have a handful of people like Dr Greger, who are trying to bring us real “Knowledge” based on Logic and the Scientific Method.

    It’s no wonder so many people are confused about diet and many other things these days.

    1. Have you ever read Life Extension, the website or the magazine? Yes, they’re in the supplement business. However, after each article, you’ll likely see dozens of referenced studies from what appear to be credible sources.

      1. Yes but it is the studies that they do not reference, which may cast doubt on some of their recommendtions and may be of greatest interest. Further, animal and in vitro studies do not always translate into real world effects on humans in vivo

        LEF is very good but they appear to derive the bulk of their income from selling suplements. This may consciously or unconsciousy affect the arguments and conclusions they offer. caveat emptor and all that.

    2. Agreed. I live in Monroe,CT not 10 miles from Sandy Hook and I’m telling all that it never happened. It was a CAPSTONE FEMA EXERCISE where no one died. 3-4 years and $100’s of millions to plan. It was orchestrated, like operation FAST AND FURIOUS under Obama, to destroy-disarm Americans. Watch: WE NEED TO TALK ABOUT SANDY HOOK.

      More? 911 (really was an inside job- A FALSE FLAG) Boston: DITTO (100% faked)

      Yet more? Ready to debunk EVERYTHING you have ever learned about WWI,WWII, Hitler, the Holocaust? Start here by watching (you tube) THE GREATEST STORY NEVER TOLD. History is written by the victors. What if I were to tell you the “boogieman” were really the good guys, but the … were the villains? Can your mind accept?

    3. Finally! thank you for this article and the many others.
      This is like the wine is good for you myth. And blanket statements backed up with no data or bad data continues to be re- spun on shows like Dr. Oz. No one mentions that a 5 ft 100 lb women who has one glass of wine can already be drunk. Of course she won’t die of a heart attack because she was killed on the road before age 40.

  2. I would add the condition of considered widespread as well. Reportedly they have the highest incidence per population size in the world and their calcium intake is highest as well.
    Completely confounding a myth equating calcium intake as sole determinate of bone health.

    Reminds me of a medical doc here in the states, who advocates for a meat only diet. Being on that diet for a year or so now his bloodwork….boarder line diabetic. Blood cholesterol level…don’t ask.

    1. They refer to themselves as Eskimos, because they don’t have the other word in their language, plus, nobody else would know who you were talking about at all if you use the other word, not even the ones who call themselves Eskimos, tells me that it is just a person stirring up trouble who wrote the article.

      1. And he didn’t say, “White people improved their diets.”

        He did say that their diets became more Westernized, similar to the diets all around the world.

        I don’t know what wording you would use other than, “Westernized” or how you would word it to say that their diets got better when the SAD diet infiltrated their midst.

        Dr. Greger has not shown any signs of being racist.

        1. To me, forcing another word on people who consider themselves Eskimos would be wrong.

          The people themselves get to choose what to be called.

          If they don’t even have the other word in their language, it is wrong to force a fake identity on them.

      2. They do NOT refer to themselves as “Eskimos” and YES they do have another word for themselves. They refer to themselves as Inuit, not Eskimo.

        And as for the idea that if the word “Inuit” was used in the article then no one would know who the author is referring to, a simply qualification at the beginning of the article would do, such as, “… the Inuit, formally known as Eskimos …”

        1. From the University of Alaska native language study center..
          “Although the name “Eskimo” is commonly used in Alaska to refer to all Inuit and Yupik people of the world, this name is considered derogatory in many other places because it was given by non-Inuit people and was said to mean “eater of raw meat.”
          Linguists now believe that “Eskimo” is derived from an Ojibwa word meaning “to net snowshoes.” However, the people of Canada and Greenland prefer other names. “Inuit,” meaning “people,” is used in most of Canada, and the language is called “Inuktitut” in eastern Canada although other local designations are used also. The Inuit people of Greenland refer to themselves as “Greenlanders” or “Kalaallit” in their language, which they call “Greenlandic” or “Kalaallisut.”
          Most Alaskans continue to accept the name “Eskimo,” particularly because “Inuit” refers only to the Inupiat of northern Alaska, the Inuit of Canada, and the Kalaallit of Greenland, and it is not a word in the Yupik languages of Alaska and Siberia.”

          So it roughly depends on where one lives if it is objectionalaccurate or not.

          1. I was wondering about bringing this issue of using the term “Eskimo” up as it really is secondary to the point of the blog, but important at the same time. Thank you “Mostly vegan ron in New Mexico” for an excellent and measured response to the concern. Perfect.

          2. As someone who has lived in Northern Canada, to refer to Inuit people as Eskimos is exactly like referring to Black Americans as Niggers. For a great many years, Black Americans referred to themselves as Niggers because that is what they were taught by white people was the terminology for their race. That in no way makes it okay for white people to continue to refer to them in archaic terms. And yes, I am typing the word Nigger out and not hiding behind N****r because I believe that in doing so, white people can better understand how wrong and derogatory the phrase Eskimo is. To use the excuse that the initial report referred to them as Eskimo and therefore it must be okay to keep using that term simply implies that you are too lazy and careless to correct the old terms.

            1. MA your experience is well founded in fact in Canada. However in Alaska the term is common and does not generally draw exception. The U of A does a good read on the why of that.

              In native American parlance and yes northern arctic peoples are natives, the equilivent term to N is redskin. As found in the name for the football team Washington Redskins. AS such tribes like the Dine’ in America have voted to condemn the use of the name and have not done so with their bretherns name as mentionedhere, in Alaska.

              Yes in America northern tribes of natives do consider themselves as native as any in the lower 48.
              Canada I think I agree, the preferred term would mostly be inuit.

              1. The use of the term skins is used amongst natives but it is never considered acceptable for a outside the kind to call another that, which is basically the same situation with the word use of N.

                1. I repeat this suggestion..
                  I wish all here taking exception to Dr Gregers mention, would instead draw up and lodge a complaint through email, to the Washington Redskins owner, George Snyder, for the use of the term Redskin. That is a slur equal in natives to the use of the term N of other type. If you are really concerned with this name thing.

                  1. And to repeat this also

                    from U of A. “Most Alaskans continue to accept the name “Eskimo,” particularly because “Inuit” refers only to the Inupiat of northern Alaska, the Inuit of Canada, and the Kalaallit of Greenland, and it is not a word in the Yupik languages of Alaska and Siberia.”

                    Natives all have names amongst themselves they use to identify other natives and usually groupings of peoples. Amongst the Dine’ keesanna refers to other natives that are pueblo, ginnie refers to dark peoples, belliganna refers to whites, nakai to Hispanics, and on and on(please excuse the spelling).
                    Many of the languages refers in literal translation to the meaning being of the tribes name, what they call themselves….the people. They refer to themselves in general as the people, real people, and others are often not accorded that in a linguistic fashion.

                    Point being there is much nuance to this thing of how a group is called by name. Never would one add another group into one, when talking to another of that type, as that would lessen the groups distinction.
                    A pueblo tribal member would be refered to in person, by the name of that tribe not the general term.

                    So I could see it very important to not have ones tribal group in Alaska called inuit summarily. It would diminish the standing of the tribe that one was a part of. Calling a pueblo a Navajo amongst a grouping of each others peoples could be a insult and or the inverse.

            2. Not the word you used, it was negro. Negro was descriptive, not meant to be derogatory like the word you used. I don’t know if and when Eskimo became derogatory though it may be out of favor with the native peoples.

              1. As far as I can make out, both ‘nigger’ and ‘negro’ started out as the ancient equivalent of politically correct weasel words. Nigger or niger is simply the Latin for ‘black’ and negro is Spanish for black. There is nothing offensive about them At least there wasn’t until idiots started to use them as terms of abuse. Even today, whole countries are happy to be called Niger and Nigeria. Also, scientists technically refer to some short statured groups of Austronesian peoples as Negritos. All of these words began as high falutin’ (because in a high status foreign language) descriptive terms..

                Also let’s not get too offended on their behalf about the supposed susceptibilties of aboriginal groups to whatever other group may refer to them as. A fair number of them refer to themselves as ‘real people’ or ‘the people’ pretty much implying that the rest of us are less than fully human.

                1. “The People” Tom Goth refers to the people of Australia(not you or the rest of the world.) who have lived there 60,000 years, only about 59,600 years longer than white folk. It is just the truth. I grew up there and it is just an aspect of history. Latin is a recent development compared to the language of The Indigenous peoples of Australia and we should use their term more than 58,000 years older than Latin. It is white arrogance to think the basis of English or its roots in Latin, which was not a spoken language, are somehow superior to the far older indigenous languages around the world. These people lived symbiotically with the land with the inferior modern man being a parasite killing the very earth that they depend on for sustenance.

                  1. Sorry Robert but this is no doubt politiclly correct but it doesn’t make a lot of sense. Nor is it accurate.

                    I also don’t understand why you state I was referring to the aboriginal people of Australia (especially since I wasn’t). Admittedly, I didn’t use the term Native American since it simply means anyone born in the Americas. Donald Trump is a native American. Personally, I think that aboriginal American or Amerindian are less confusing terms.

                    Over 300 aboriginal languages were spoken in Australia. Which one of them are we supposed to use to descrbe abriginal Austrlians? And if you think that any of them, were identical to that spoken 60,000 years ago, I’d have to suggest that you are probably mistaken.

                    As for the idea that all aborginal peoples lived in harmony and symbiosis with the land, I’d have to suggest that you are dreaming. The Australian megafauna wre wiped out thusands of yeears ago and it wasn’t the whities that did that..

                    I doubt that all white people are intrnsically ethically inferior to aboriginal peoples or that the latter are necessarily all saints. Or devils. We are all humans and thinking that all aboriginal peoples are better than all Westerners is just as wriong and just as racist as thinking that all Westerners are better than all aboriginal peoples.

      3. Excuse me, they do not refer to themselves as “Eskimo” The correct term is “Inuit” I know this because I am living here in the Arctic Circle (Nunavut, Canada) Just an FYI. Thanks! Aside from that, I found this article to be very interesting.

        1. Norma as the University of Alaska native language study center mentions, in Canada, yes this is objectionable.
          In Alaska it is mostly not.
          I claim no particular authority but my family most by vast majority are native. There is variance as to what tribes consider offensive. The tribe of my family is dine’ or Navajo. None will object to being called Navajo, though on all formal things, dine’ is the choice. Navajo/Dine’ are particularly concerned to being called things they do not like, and are one of the first native tribes to roundly condemn through tribal council board vote the use of the term Redskins by a football team. Many other tribes have not condemned this obvious slur.

          So it varies. I would say northern arctic areas native populations would be preferable. Inuit since all are not inuit does not apply to all.

          1. Alaskan natives have a particular response to things that is singular to them in some fashions. They for instance do not have the standard reservation system found in the lower 48, but a Alaskan unique system developed in the 60’s and put into law.

            Here is the specific reference to the term Inuit from U of A. “Most Alaskans continue to accept the name “Eskimo,” particularly because “Inuit” refers only to the Inupiat of northern Alaska, the Inuit of Canada, and the Kalaallit of Greenland, and it is not a word in the Yupik languages of Alaska and Siberia.”

            I wish all here taking exception to Dr Gregers mention, would instead draw up and lodge a complaint through email, to the Washington Redskins owner, George Snyder, for the use of the term Redskin. That is a slur equal in natives to the use of the term N of other type. If you are really concerned with this name thing.

            That it is allowed in this day and age completely baffles me.

            1. To back round a bit…it is very easy to skew any poll of natives on the hatred of the term redskin…simply ask older folk, as they are used to it, and they reflect that. The young however roundly reflect the hatred of it. So as the young are representing a larger majority in tribal politics more and more are finding offense to it. Which is why the largest tribe in America dine’ voted by tribal council to condemn its use. More and more are doing the same as time goes by.

              Mr. Snyder has seen fit to respond with personal donations to select tribes that then favor his stance and/or to select politicians who reflect his position. Tribal places are quite political as much as if not more so than general America.

              He tried the tact of support with one past, (with emphasis on past) tribal president of the Dine’/Navajo. Invited him to Washington, gave him a seat in his box to watch the game to my dim recollection. To coincide with the taking of many photos.
              That person needless to say opposed the resolution.

    1. JAMA Internal Medicine August 12/26, 2013 Volume 173, Number 15

      Discussion | The results of our analysis can be seen as the proof
      of no effectiveness of ω-3 fatty acid supplements for secondary prevention of cardiovascular disease.

    2. Greg You little naysayer you.

      Dr Greger is being very precise here. Fish oil has shown no benefit for the primary prevention of heart disease. This is not just Dr Greger’s position, it is the mainstream scientificposition also, I understand.

      “The supplemental use of n-3 fatty acids does not reduce the risk of cardiovascular morbidity and mortality in patients with multiple cardiovascular-disease risk factors[1].

      These are the conclusions of the Risk and Prevention Study Collaborative Group, a collective of Italian researchers led by Maria Carla Roncaglioni (Mario Negri Institute of Pharmacological Research, Milan, Italy). In addition to having no effect on the study’s primary end point in this group of patients with multiple cardiovascular risk factors or atherosclerotic disease, but no previous MI, the researchers did not observe any benefit on secondary end points, including death from coronary causes or sudden death from cardiac causes or major ventricular arrhythmias.

      “Our findings provide no evidence of the usefulness of n-3 fatty acids for preventing cardiovascular death or disease in this population,” write the researchers in the May 9, 2013 issue of the New England Journal of Medicine.

      Dr James Stein (University of Wisconsin, Madison), who was not affiliated with the study, said in an email to heartwire that the results are disappointing but consistent with recent studies showing no significant effect of fish-oil supplements. “Especially interesting that there was no effect even in those with low baseline intake of omega-3 fats, those not on aspirin, and those not on statins,” he commented.”

      However, where fish oil or perhaps more accurately, omega 3 oil suplementation does show a benefit is in people who already have heart disease. However, that is another matter and as Dr Greger notes, we are fortunate in having another source of omega 3 ils that is free of te pollutants common in fish and that is is environmentally sustainable – algal oils. We should also remember that Greger recommends that we should take daily vegetarian DHA/EPA supplements.

      See the AHA position on fish oil supplementation

  3. Although Bang’s and Dyerberg’s research was flawed and eskimos do have heart disease, is there any research that shows a benefit of omega-3 for heart or other health. Just because the initial research was flawed, someone may have followed up with some good research.

      1. There was a bit of a scandal a decade or more now ago, in the fish oil field. A study out of Ireland found many supplements to be grossly contaminated exceeding the Recognized as safe levels.

        The industry in response to that began to self police and clean up their act. Currently I think they all will meet generally recognized as safe levels by study. They do most always however, contain minute levels of contaminants which at those levels are not thought to be harmful.

  4. Upcoming results expected this quarter on Reduce-IT study double blind, multiyear outcome study of over 8000 people across multiple continents pairing Vascepa with statin to see effect on heart attacks, strokes, and deaths from those. Vascepa is a highly purified form of EPA, one of the omega 3 fatty acids. As Dr Greger says, “This is putting it to the test”.


      As stated on the bottle:
      Serving size 2 capsules. (60 caps in bottle)
      Omega 3 from Algal oil- 1000mg
      DHA-320 mg
      Vitamin E-17.18 IU
      Other ingredients- rice bran oil, vegetable cellulose,natural lemon flavor,natural peppermint flavor,silicon dioxide,citric acid
      This product does NOT contain animal products,derivatives or by products. It is free from GMO’s PCB’s dioxins,Mercury,PCB’s,Gluten,Yeast,Milk,Diary,Sugar and Salt.
      It has a “made in USA” “non GMO” and “V” for vegan certified logos on the bottle.

      1. I was told by an exercise physiologist who had worked with Omega-3, clinical/laboratory grade (by prescription) was the only effective form. The full retail price (no insurance) was around $200 per 100.

    2. There are now multiple sources of vegan or algae based omega 3 EPA-DHA supplements available. Spectrum sells one and so does source naturals, but there are many.

      1. I counted a total of 12 on a recent search from a internet retailer.
        A word of caution some are advertising omega 3, but what they sell is actually flax oil.
        The constituency one is usually looking for in this supplement is DHA EPA content.

        One sometimes looses the ability to make the conversion from Flax to DHA EPA as they age. It is rare that one cannot their whole life make this conversion, generally it is a age thing.
        The price range for DHA EPA algae based is generally 20-40 USD. It is much cheaper from fish oil source.

        1. I don’t personally use fish oil, not for the minute amounts of contaminants(likely they are safe) but as a moral decision as I am vegan mostly in lifestyle and diet.

          If I was not, and didn’t mind the minute contaminants, they are much cheaper than algae derived supplements. But algae derived supplements are very common now, this is not five years ago, veganism is very popular in diet.
          I would check to see the nutrients I want are in it however, EPA DHA and whatever additions one may prefer.

  5. The great failure of research is that it lumps many genotypes and different lifestyles in research treatments that may only work for a select few. When I was in my thirties living a healthful lifestyle, eating mostly whole plants, and running over 100 miles/week, my triglycerides were > 2,000 making my plasma and urine white. As you know triglycerides this high can trigger pancreatitis and heart disease. I saw a lipid specialist who trialled maximum dose statins which did little for the triglycerides and caused myopathy. Years later, I was treated with eztamibie which helped a little but the addition of fish oil of 2 grams twice/day dropped my triglycerides below 200. Each time I try to quit fish oil, my triglycerides rapidly escalate. Could it be that a very select population could benefit from fish oil. I eat an even more strict WFPBD, exercise strenuously, meditate, and do not even own a car.

      1. No I have not, but it is a good suggestion. I presently use prescription Lovaza which is a much cleaner looking oil than the motor oil appearance of over-the-counter fish oils. My Lovaza is covered by my health insurance and I have a very limited budget, but I will look into your suggestions. Thank you. Bob

  6. Dr Greger,

    You should say that the plant based diet cures everything period. Your not open to any other way of eating. So you don’t have to spend your time investing studies. What works for me is the Mediterranean diet way of eating. That does not mean it is for everyone.

    1. Dennis,

      Dr. Greger has put up videos on other diets, such as DASH diet and Mediterranean and other types.

      He has his own point of view, but I have watched enough videos to see that these topics come up.

      He is doing studies and those diets might not keep coming up in studies, but when they are relevant, he does put them in.

    2. What seems to work best for the majority of people is a whole foods plant based diet. All the docs on this side in some manner seem to agree on that, though they do differ in nuance of the thing. That is in general a scientifically found fact.
      Will other diets work for other peoples…sure.

      The oldest woman in the world for years was a French woman who lived a 120 plus and for most of her adult life smoked one cigarette a day and ate chocolate as well daily… that worked for her.

      1. She retained her cognition till the end, she was very quick witted. However she did loose her eyesight and that was the reason for her stopping the smoking several years before she became difficult and hazardous with poor eyesight.

        She did live alone for much of her time. A son had died earlier in a car crash to my recollection.
        She defied many norms.
        So you never know completely

    3. Why does he need to be “open” to anything besides what the best scientific evidence shows? That is what he does and why this site exists, and he applies what he learns in his own lifestyle. He isn’t the dietary police, you can eat whatever you want to. Letting ones taste-buds and learned preferences dictate unnecessary consumption of other sentient beings and needing someone to approve or share your opinion has nothing to do with science either, so you won’t find what you are looking for here.

      1. My personal opinion is that those who want to challenge the basic operative assumptive premesis that a Whole foods plant based diet is good for us, would be better served in their pursuit of that in the you tube comment section.

        I would guess in that format a challenge is quite the norm, and may even be a popular view at times.
        Here…why would someone want to be here if they can be on another site that favors their dietary opinion? It just makes no sense to me. Even the meat only doc, and a meat only Canadian political blogger, they have sites.
        Even if one is selling supplements, it seems you tube provides a more receptive audience to that sort of thing.

        We can disagree with Dr Greger I do often on particular issues, but the basic premesis is whole food plant based is good for us, better than in general, other diets. A challenge to that seems misplaced here.

    4. Dennis

      He doesn’t say it cures everything. You are simply misrepresenting the facts.

      Every major health authority on the planet says we should be eating more vegetables, fruits and whole grains … and mostly plants. The terminology may be different but there is little difference between Greger’s position and mainstream nutritionl recommendations.

      What differences there are relate to the amount of nimal foods that can be included in the diet and the fact that mainstream recommndations by and large assume that people do not take supplements. Therefore they do not rcommend 100% plant diets because of the risk of B12, iodine, zinc and iron etc deficiencies in people who would not eat properly planned strictly vegetarian diets or take appropriate supplements.

      My impression is that most people who say they eat Mediterranean diets are doing it iwrong. Perhaps you are different though.

    “How Not to Die” by Dr. Michael Greger: A Critical Review

    As a child, Michael Greger watched his heart-diseased grandmother return from the brink of promised death.

    Her cure was the low-fat Pritikin diet, and her Lazarusian return — a miracle to both young Greger and the entourage of doctors who’d sent her home to die — launched him on a mission to promote the healing power of foods.

    Decades later, Greger hasn’t slowed down. Now an international lecturer, doctor, and voice behind the science-parsing website Nutrition Facts, Greger recently added “bestselling author” to his résumé. His book, How Not to Die, is a 562-page user’s guide for thwarting our biggest and most preventable killers.

    His weapon of choice? The same one that saved his grandmother: a whole-food, plant-based diet.

    Like many books advocating plant-based eating, How Not to Die paints nutritional science with a broad, suspiciously uncomplicated brush. Unprocessed plant foods are good, Greger hammers home, and everything else is a blight on the dietary landscape.

    To his credit, Greger distinguishes plant-based from the less flexible terms vegan and vegetarian, and allows some freedom for humans to be human — “don’t beat yourself up if you really want to put edible bacon-flavored candles on your birthday cake,” he advises readers (page 265).

    But the science, he asserts, is clear: any foray outside the proverbial broccoli forest is for pleasure rather than for health.

    Despite its biases, How Not to Die contains treasures for members of any dietary persuasion. Its references are sprawling, its scope is vast, and its puns aren’t always bad. The book makes an exhaustive case for food as medicine and reassures readers that — far from tinfoil hat territory — being wary of the profit-driven “medical-industrial complex” is justified.

    These perks are almost enough to make up for the book’s biggest liability: its repeated misrepresentation of research to fit the plant-based ideology.

    What follows is a review of How Not to Die’s highlights and hiccups alike — with the premise that benefiting from the book’s strengths requires navigating around its weaknesses. Readers who approach the book as a starting place rather than incontrovertible truth will stand the best chance of doing both.
    Cherry-Picked Evidence

    Throughout How Not to Die, Greger distills a vast body of literature into a simple, black-and-white narrative — a feat only possible through cherry picking, one of the nutrition world’s most gainfully employed fallacies.

    Cherry picking is the act of selectively choosing or suppressing evidence to fit a predefined framework. In Greger’s case, that means presenting research when it supports plant-based eating and ignoring it (or creatively spinning it) when it doesn’t.

    In many cases, spotting Greger’s picked cherries is as simple as checking the book’s claims against their cited references. These foibles are small but frequent.

    For example, as evidence that high-oxalate vegetables aren’t a problem for kidney stones (a bold claim, given the wide acceptance of foods like rhubarb and beets as risky for stone formers), Greger cites a paper that doesn’t actually look at the effects of high-oxalate vegetables — only total vegetable intake (pages 170-171).

    Along with stating “there is some concern that greater intake of some vegetables … might increase the risk of stone formation as they are known to be rich in oxalate,” the researchers suggest the inclusion of high-oxalate veggies in participants’ diets could have diluted the positive results they found for vegetables as a whole: “It is also possible that some of the [subjects’] intake is in the form of high-oxalate containing foods which may offset some of the protective association demonstrated in this study” (1).

    In other words, Greger selected a study that not only couldn’t support his claim, but where the researchers suggested the opposite.

    Similarly, citing the EPIC-Oxford study as evidence that animal protein increases kidney stone risk, he states: “subjects who didn’t eat meat at all had a significantly lower risk of being hospitalized for kidney stones, and for those who did eat meat, the more they ate, the higher their associated risks” (page 170).

    The study actually found that, while heavy meat eaters did have the highest risk of kidney stones, people who ate small amounts of meat fared better than those who ate none at all — a hazard ratio of 0.52 for low meat eaters versus 0.69 for vegetarians (2).

    In other cases, Greger seems to redefine what “plant-based” means in order to collect more points for his dietary home team.

    For instance, he credits a reversal of diabetic vision loss to two years of plant-based eating — but the program he cites is Walter Kempner’s Rice Diet, whose foundation of white rice, refined sugar, and fruit juice hardly supports the healing power of whole plants (page 119) (3).

    Later, he again references the Rice Diet as evidence that “plant-based diets have been successful in treating chronic kidney failure” — with no caveat that the highly processed, vegetable-free diet in question is a far cry from the one Greger recommends (page 168) (4).

    In other instances, Greger cites anomalous studies whose only virtue, it seems, is that they vindicate his thesis.

    These cherry-picks are hard to spot even for the most dutiful reference checker, since the disconnect isn’t between Greger’s summary and the studies, but between the studies and reality.

    As one example: in discussing cardiovascular disease, Greger challenges the idea that omega-3 fats from fish offer disease protection, citing a 2012 meta-analysis of fish oil trials and studies advising people to load up on the ocean’s fattiest bounty (page 20) (5).

    Greger writes that the researchers “found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke” — effectively showing that fish oil is, perhaps, just snake oil (page 20).

    The catch? This meta-analysis is one of the most heavily criticized publications in the omega-3 sea — and other researchers wasted no time calling out its errors.

    In an editorial letter, one critic pointed out that among the studies included in the meta-analysis, the average omega-3 intake was 1.5 g per day — only half the amount recommended to reduce the risk of heart disease (6). Because so many studies used a clinically irrelevant dosage, the analysis might have missed the cardioprotective effects seen at higher omega-3 intakes.

    Another respondent wrote that the results “should be interpreted with caution” due to the study’s numerous shortcomings — including the use of an unnecessarily stringent cutoff for statistical significance (P < 0.0063, instead of the more common P < 0.05) (7). At more widely used P-values, the study might have deemed some of its findings significant — including a 9% reduction in cardiac death, a 13% reduction in sudden death, and an 11% reduction in heart attack associated with fish oil from food or supplements."

      1. Agree that you have pasted to much.

        The problem with the studies is they have a enormous amount of nutritional studies presented and published every month of every year.
        One may find a position to take on about each and every subject based on study…
        But what we pay for through donation Dr Greger to do is, weed through the stuff to find what seems really scientific truth, based on validity of study, and corroborative study to support it.

        If you find he is not doing so….I suggest you may care to visit sites that fit your preference.
        You may of course verse what you want here it is a free and open site but I ask why?

      2. Many sites do not allow edit functions as they enable a portal to exist… a way of entry to the system which may be favored by those who intend to utilize personal information found on the site, and/or just hack the site and render it inoperative.

    1. The grandiosely titled ‘authoritynutrition’ website was founded by a Scandinavian personal trainer with an inflated sense of his own expertise in the field of nutrition. To add insult to injury, he was another low carb saturated fat apologist.

      While things may have changed since I last looked at the website, I have no confidence in the judgement and/or opinions expressd on that site.

      You really need to assess Greger’s views against the evidence and conclusions presented in major scientific reports and consensus statements – not the personal views of people running highly dubious ‘alternative health’ websites

  8. Life is a learning process, folks. What we might (stubbornly) insist is true today we could very well eschew, say, five or ten years down the road. Happens all the time.

    In other words, go for what resonates with you now. Anything else, pass on by. You can always return to your prior way of thinking. Works for me. :-)

    1. A 2 litre tub of ice cream resonates with me right now but I still think I’ll go with what the current evidence shows rather ta my ‘druthers.

      1. Well, we’re all tempted by our egos, aren’t we! :-) And many of us do give in to our whims. But in the long run, our Higher Self eventually steers us in the right direction.

        We sometimes need to learn things the hard way; humans are a fascinating work in progress. :-)

  9. ‘There have been wide swings of the pendulum in terms of conclusions of meta-analyses[1,2,3,4] and clinical guidelines[5,6,7,8] about the role of fish oil supplements in prevention of cardiovascular disease (CVD) over recent years. A couple of months ago, the American Heart Association published a science advisory in Circulation. Here are a few clarifications and caveats about these guidelines.

    First, these guidelines do not relate directly to dietary fish. There is a clear recommendation to encourage about two servings of fish per week in the diet, preferably dark, fatty fish. Whether the benefits for CVD are due directly to the omega-3 fatty acids or from replacing red meat or other less helpful components of the diet is not known.

    The rating group of the science advisory wisely focused on randomized clinical trials of fish oil supplements in the prevention of clinical events. They concluded that there are two groups most likely to benefit: those with recent myocardial infarction or known history of coronary heart disease, and those with known reduced ejection fraction heart failure.

    The committee also concluded that there are several groups in whom fish oil supplements are not indicated and patients are not likely to benefit. These include patients without known CVD but who have diabetes or prediabetes, patients with multiple risk factors for CVD but no prior clinical events, patients with atrial fibrillation, and patients post-op from cardiac surgery. The committee was unable to make any recommendation for primary prevention because of the absence of data in large-scale, randomized clinical trials for primary prevention.’

  10. You’ve stressed that you are 100% vegetarian as opposed to “vegan.” In your mind, is there a difference between 100% vegetarian and 100% WFPB? Inquiring minds wish to know.

    (I might label myself as Mostly WFPB. We do like our labels, don’t we!)

    1. Well yes. A beer and chips diet is 100% vegetarian,so is the whisky and cigarette diet.

      And AbFab’s ciggies, Stolly (and cocaine) diet would be 100% vegetarian too.

      My point was simply that vegans actually eat a real vegetarian diet and that there is no special vegan diet as such.

  11. This site and its followers are absolutely hysterical!! I just love to visit occasionally for free entertainment. It’s like the blind leading the blind.

          1. The dude claims he likes to visit this site only “occasionally,” — and just for the jollies — but I bet he LIVES here. :-) He wants to learn new stuff, just like the rest of us.

          2. Don’t get me wrong. It’s good to have a hobby like reading scientific studies; or even following some religious group. As long as you don’t take it too seriously. All your doing is mimicking a mouse chasing his tail ; )))

  12. Where in our blood test results would we find information (indirectly, maybe) about our DHA – EPA levels? Or wouldn’t we? Should we just assume that — if we don’t eat fish — we must take a DHA-EPA supplement? Am not fond of horse pills. :-(

    1. There are various tests which can produce an estimate of your DHA/EPA levels. You should talk to your primary care physician or cardiologist.

      However, Life Extension Foundation offers these also for $99 but I presume any commercial medical pathology service can do the same.

      Dr Greger and major health authorities do not recommend DHA/EPA supplementation for primary prevention of heart disease. However, he does recommend it for brain health.

    1. Thanks…..fellas. :-)

      I’ve been doing the walnuts, but mung beans (in addition to other kinds) would be a new one. Hmmmm.

      I briefly considered Dr. Furhman’s liquid concoction, but he’s kinda pricey. If food supplies what it is we need to be healthy, I’d rather stick with food.

  13. This article is as guilty as the Eskimo study it references since it gives the impression one study proves the exact opposite. Over the years, numerous legitimate studies have researched the impact of omega 3’s, especially salmon oil, on the heart. I used to get The Harvard Heart Newsletter. About 20 years ago, one showed salmon oil helped prevent second heart attack. An offshoot of the study showed the oil also reduced incidence or eliminated irregular heartbeat. This one study alone proved that a fish oil can have a positive cardiological effect. By the way, I started taking Norwegian or wild Alaskan salmon oil after I learned of the study. It immediately reduced my incidence of afib. Neither have I had a heart attack even though 4 of my immediate family members (mother, father, sister, brother) all had one before my age and 3 died from the heart attack: mother at 44, father at 40, brother at 34.

  14. Claudia,

    Your experience and the literature are in synch, with some carviots.

    Some of the issues with fish oils are their processing, preservation and concentrations. With the various quoted journal articles you will find sustancial differences. Shopping carefully and understanding the differences is important.

    In practice I too found similar findings, especially with my Afib patients… Last week I had the opportunity to smell the contents of two competing products. One was from a large wholesale outfit and reeked of fish smell and the other was fairly neutral. Both were stored in the fridge and had similar times being opened. Clearly it’s only my nasal observation and the patients however, the difference is obvious and should be noted. Rancid products do not belong in your home and being touted as a heart healthy supplement.

    Dr. Alan Kadish Health Support volunteer for Dr. Greger

  15. Dr. Greger and others; please check out “The PEO (Parent Essential Oil) Solution. Heat destroys and mutates the structure of nutrients and oils, and even the naturally occurring oils in Fruits and Vegetables and other foods to some degree. DHA and EPA are derivatives or metabolites of alpha- linolenic acid or ALA and are made in the body on a “as needed basis” without rancidity. 95% of the PEO’s (LA and ALA) stay as PEO’s. Every cell (aprox. 60 Trillion) contains 25%-33% PEO’s and every mitochondrion (typically thousands or more per cell), contains them too. As we now know, as evolutionary biologist Bruce Lipton and others (Otto Warburg) have noted, the importance of the cell membrane to “the intelligence” of the cell. The destruction of the cell membranes through super-physiologic amounts of DHA and EPA (Derivatives) as well as rancid and denatured fats, creates havoc on the body accelerating aging and making many dis-eases worse. Interference with the movement of cellular oxygen creates a reduction in cellular oxygen throughout the body and decreases cellular respiration, phosphorylation, and all energy dependent processes. No wonder most are tired and toxic. Parent Omega -6 dominates in tissue and in organ structures as well as in Plasma and other classes of lipids, so do we really need that much derivatives of Parent Omega 3’s ie. DHA and EPA?
    Fruits and Veggies are relatively high in Parent Omega 6’s (LA) and low in Parent Omega 3’s (ALA).
    Did god make a mistake? With a wide variety of Unprocessed Vegan Raw Foods, do we really need to supplement with DHA and EPA or any Derivatives of the Parent Essential Oils? Doc: I love your work.
    Keep researches directed to the important questions that make a difference that we can apply in our daily lives. Keep it Real. Real Food/Real People Bless up!

  16. So… I have two tablespoons of flaxseeds every day. And a handful of walnuts. I thought I was doing that for the omega 3. It appears I’m wasting my time and money? Can one of you good people tell me why I should have flaxseed/walnuts every day??…

    1. A commenter above clarified but let me review knowledgeable commenter TG’s remarks that should answer your question:
      “Walnus and mung beans are high in omega 3 fat (ALA) but don’t contain DHA or EPA as such. The human body however converts ALA to DHA and EPA.”
      He cites the following NF videos which will help explain and reassure you that eating that flaxseed and those walnuts are good practices, not a waste of time or money.

  17. Nobody is saying you “should” do anything, Confused. We of the human persuasion have been given free will.

    If you scroll back up the hill you’ll see oodles of links regarding the subject. Have you read any of them?

    1. How’s that working out for you, being a contrarian. Assumption is the mother of all errors, and you make many. If you like to make assumptions I suggest when you communicate with people you perhaps assume they know things that you don’t. For you that in particular would be a good start. Good luck.

  18. Dr.Gregor, since Omege-6 and Omega-3’s seem to be a hot topic right now, can your review the book, PEO Soultion? It would be very helpful to hear your opinions, especially about the higher ratio of Omega-6 to Omega-3, as I have always heard it is the reverse that is needed. Thank you.

  19. Hi I’m a RN health support volunteer. Thanks for your great question. Omega 6 and omega 3 are a hot topic now. The standard western diet is very very high in omega 6 and low in omega 3. We need them both, but you want approximately a 1:1 ration. A high omega 6 and low omega 3 causes an inflammatory response. I’ve heard it compared to musical chairs. The omega 6 takes up all the receptors and the omega 3 cannot be used. Oils tend to have high omega 6 content. Processed foods which make up the majority of the standard western diet have a high omega 6 content from the oils.

    So the discovery of this led to a big push for omega 3 supplements and intake. As Dr. Greger has pointed out, wouldn’t it make more sense to cut out the processed foods and reduce the high amount of omega 6 rather than trying to supplement omega 3 to make up for it? Although Dr. Greger does recommend taking a seaweed based Omega 3 supplement to be sure you get enough of the long chain omega 3 fatty acid in addition to daily ground flax consumption.


  20. Dear Dr. Greger: would you please do a video on Budwig Diet (flax oil & cottage cheese) and/or reply to me? I have read that 7-time Nobel nominee Dr. Budwig had 90% success rate treating cancer using this diet. I know you are not fond of animal products like dairy, but can the Budwig diet be good for cancer patients? Thank you.
    (I also posted this following one of your videos on cheese.)

  21. Okay, a bit off subject but just read in today’s news about a study published in the American Journal of
    Clinical Nutrition that suggests a growing body of evidence indicating that full fat dairy like cheese(which I love but have learned to say no to), is showing no harm in relation to heart disease or overall mortality.
    I just wonder what you all think??

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