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How to Achieve Food Synergy

There are thousands of phytochemicals that will never make it onto the side of a cereal box but may play a role in reducing the risk of chronic diseases—and those are just the ones we know about. Whole plant foods have consistently been found to be protective, so it’s reasonable for scientists to try to find the “magic bullet” active ingredient that can be sold in a pill, but “[p]ills or tablets simply cannot mimic this balanced natural combination of phytochemicals present in fruits and vegetables.” When isolated out, the compound may lose its activity or behave differently. The antioxidant and anticancer activities of plant foods are thought to derive from the “additive and synergistic effects of phytochemicals in fruits and vegetables,” meaning the whole may be greater than the sum of its parts. This helps explain why a pill can’t replace the complex combination of phytochemicals present in whole plant foods.

As T. Colin Campbell has pointed out, more than a hundred trials “overwhelmingly show no long-term benefit for vitamin supplements, along with worrisome findings that certain vitamins may even increase disease occurrence for diabetes, heart disease, and cancer.” Supplementation with fish oil, for example, appears useless or, even worse, “posing increased risk for diabetes,” yet the science doesn’t seem to matter. People continue to buy them. “The public desire for quick fixes through pills…is overwhelming, especially when money can be made.”

Each plant has thousands of different phytochemicals, as well as entirely different phytonutrient profiles. So, there may be synergistic effects when eating different foods together, too. Eating beta-carotene in carrot form is more beneficial than in pill form. because of all the other compounds in the carrot that may synergize with the beta-carotene. Well, when we dip that carrot in hummus, we suddenly have the thousands of carrot compounds mixing with the thousands of chickpea compounds. So what happens if we mix different fruits with different vegetables or different beans?

As you can see in my video Food Synergy, combining foods across different categories increased the likelihood of synergy. For example, a study showed the antioxidant powers of raspberries and adzuki beans. If there were a strictly additive effect, the expected combined antioxidant power would simply be that of the raspberries plus that of the adzuki beans. However, the observed combined antioxidant power was actually greater than the sum of one plus the other.

What about cancer-fighting effects? The study was repeated, but, this time, different combinations of food were dripped on breast cancer cells growing in a petri dish. For some foods, the same synergistic effects were found. Grapes, for example, can suppress the growth of breast cancer cells about 30 percent, but onions worked even better, cutting breast cancer cell growth in half. One would assume that if we added half the grapes with half the onion, we’d get a result somewhere in the middle between the two. Instead, the researchers found that cancer cell growth was suppressed by up to 70 percent with that combination. The whole plus the whole was greater than the sum of the whole parts. Given these findings, did the researchers recommend people eat a variety of foods? Perhaps adding some raisins along with chopped red onions to our next salad? Where’s the money in that? No, the reason the researchers were investigating the different types of interactions was “to identify mixtures that hold synergistic interactions that can ultimately lead to the development of functional foods”—maybe something like grape-flavored Funyuns.

Why should we care about the antioxidant power of foods? See

If you’re not familiar with this concept of reductionism, be sure to check out some of these other videos: Industry Response to Plants Not Pills, Why Is Nutrition So Commercialized?, and Reductionism and the Deficiency Mentality.

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.

287 responses to “How to Achieve Food Synergy

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  1. People continue to buy vitamins and other useless supplements because the overwhelming reality is that they are being told by doctors, nutritionists, advertising and who knows what else. Information to the contrary is hard to find usually. You have be looking for it. Hardly anyone understands the synergy aspect of foods or has even thought of it. Most people just don’t have time. So food scientists on behalf of big Pharma for the most part are getting away with frauds on a grand scale and there’s no way to stop any of it.

    On the other hand, at least now there is information like Dr. Greger offers out there to be found as opposed to even five years ago when there was next to nothing.

    1. Kate,

      Dr. Greger recommends a Vegan Omega 3. I don’t believe that he has changed his position. The fish oil supplements often test for toxicity. The vegan versions are grown in safer ways.

    2. The ARED2 study by the US National Eye Institute found that omega 3 did not help. It was previously thought that it did.

      However, your omega 3 supplement may reduce the risk of dementia.

      You can buy the official AREDS2 vitamin supplement for your ARMD. However it is expensive. There is an unlicensed alternative supplement which has exactly the same formula but is significantly cheaper. It is called Supervision2. Both are available from and probably other online sites too.

    3. In this 2019 placebo controlled RCT, a fish oil precursor showed good results: “This study, published in the January 3, 2019, issue of the New England Journal of Medicine, included patients at high risk for cardiovascular events who were already treated with a statin and had hypertriglyceridemia. They were randomly assigned to receive either 2 g of icosapent ethyl (IE) twice daily or placebo. Icosapent ethyl is a precursor of eicosapentaenoic acid (EPA)………..During a mean of nearly 5 years of follow-up, the IE treatment group experienced a significant 25% reduction in the risk for a composite of cardiovascular death and major cardiovascular events. Rates of stroke and myocardial infarction were significantly lower in the IE group, and the hazard ratio for cardiovascular death in comparing the IE and placebo groups was 0.80 (95% confidence interval [CI], 0.66-0.98). IE was associated with a higher risk for atrial fibrillation than placebo, and it was associated with a nonsignificant increase in the risk for serious bleeding events………”. IOW, the placebo group suffered 20% more CV death. Other trials referred to by the authors of this trial showed similar results: “In the 2015 trial OMEGA-REMODEL, patients who took a proprietary n-PUFA preparation at 4 g/d for 6 months after an MI showed reductions in ventricular remodeling, fibrosis, and inflammatory markers.

      More recently, in the REDUCE-IT trial, patients with raised triglycerides and CV disease or diabetes plus 1 other CV risk factor showed a 25% reduction in the composite outcome of CV death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina over the course of 5 years while receiving icosapent ethyl at 4 g/d. The agent acts as a precursor of EPA. …………………………..

      In an analysis adjusted for age, sex, race, body mass index, smoking status, type 2 diabetes, blood pressure, lipids, lipid-lowering therapy, albuminuria, and types of PUFA, percent-EPA was inversely associated with risk for HF at a hazard ratio of 0.73 for each log-unit difference (P=.001). ……………………………The respective final adjusted hazard ratio for DHA concentration and risk for HF was 0.51 (95% CI, 0.38-0.70). Combining DHA and EPA concentrations, the hazard ratio for HF per log increase in plasma concentration was 0.54………”. Also, the FDA has recently allowed a patented prescription drug for lowering triglycerides- Vescepa – which is nothing more than purified, concentrated fish oil. So, if your doctor recommends Omega 3, he might be on to something.

  2. Great article. It makes so much sense – whole foods are a powerful source of nutrients, not the isolated properties in supplements. I plan to share this information in my online class.

      1. EPA/DHA supplementation is based on skewed studies with fish oil or commercial studies. Don’t waste your money on oil capsules that may increase your cancer risk, like vet agressive forms of prostate cancer.

        B12 at high dose (> 25mcg) like weekly doses may put you at risk with skin disorders, and high doses are also linked with an increase risk of cancer.

        High doses of vitamin D are also linked with an increase risk of cancer. Not sure that vitamin D supplementation is really useful at all.

          1. We are speaking of science and facts, not of opinions. Dr Greger’s and Furhman’s recommendations are not followed by every vegan, but they may partly explain why so many vegan failed at sustaining a plant-based diet, as reported on YouTube in the last years with the thousands of « I am no longer vegan anymore »: some of them being caused by skin disorders amongst whole plant foods eaters. High B12 intake and nuts consumption may be the culprit there.

            1. Yes and the moon may be made of green cheese, But ‘may’ is not the same as ‘is’.

              You are expressing a point of view as if it were a scientific fact. Big difference between those two concepts..

            2. ‘May partly explain’? Sounds like a pretty flimsy opinion.

              By the way, not everyone does well on a McDougall style diet and switching to a Fuhrman style diet has worked well for them. You do not seem to have a real point to make, at least one you are supporting in any objective way.

              1. Accordig to Nobel Laureate James Watson (see your very informative message below in the comments), antioxydants may increase cancer development at advanced stage.

                Dr McDougall may recommend to someone with a cancer diagnosis to only eat sweet patatoes and drink water, while Dr Furhman’s would recommend his nutritarian diet which is way more rich in antioxydants and in absorbed antioxydants because of the fat added with lots of nuts in his recommendation.

                Result: There is more chance to survive cancer with the lwo fat starch-based diet than with the “nut”-ritarian diet.

                1. Nobel Laureate James Watson say that antioxydants promote cancers in late stage, “among my most important work since the double helix”.


                  What to do in case of cancer diagnosis ?

                  1) Dr McDougall: “Eat sweet patatoes and water. That’s it!”


                  2) Dr Greger and Dr Furhman: “Eat large salads with nuts for better absorbption of the antioxydants !”




          Within the pooled cohort (N = 5038), 77 women were diagnosed with breast cancer (age-adjusted incidence: 512 cases per 100,000 person-years). Results were similar for the three analyses. First, comparing incidence rates, there was an 82% lower incidence rate of breast cancer for women with 25(OH)D concentrations ≥60 vs <20 ng/ml (Rate Ratio = 0.18, P = 0.006). Second, Kaplan-Meier curves for concentrations of <20, 20–39, 40–59 and ≥60 ng/ml were significantly different (P = 0.02), with the highest proportion breast cancer-free in the ≥60 ng/ml group (99.3%) and the lowest proportion breast cancer-free in the <20 ng/ml group (96.8%). The proportion with breast cancer was 78% lower for ≥60 vs <20 ng/ml (P = 0.02). Third, multivariate Cox regression revealed that women with 25(OH)D concentrations ≥60 ng/ml had an 80% lower risk of breast cancer than women with concentrations <20 ng/ml (HR = 0.20, P = 0.03), adjusting for age, BMI, smoking status, calcium supplement intake, and study of origin.

          Higher 25(OH)D concentrations were associated with a dose-response decrease in breast cancer risk with concentrations ≥60 ng/ml being most protective."

          1. I forgot to copy the title, and do not see how to edit, so here it is, this goes with my previous link: “Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations ≥60 vs <20 ng/ml (150 vs 50 nmol/L): Pooled analysis of two randomized trials and a prospective cohort".

            1. So, what role plays vitamin D supplementation in the context of an unhealthy diet that would explain this risk reduction ? And how this risk reduction compare to the one of a healthy diet without vitamin D supplementation ?

              1. I don’t know the answer to either question. All I know is the result of the trial, which was that those who supplemented with vitamin D had significantly lower breast cancer(BC) risk over the 4 years the study covered, and that those who achieved the very highest blood levels(>60ng/ml) of Vit D had by far the greatest reduction, including a significantly greater reduction over those who merely achieved what most would consider more than adequate levels of about 40. If you scroll down to table 2, notice that the group which had what is considered good, high levels between 40-59 had an adjusted hazard ratio(HR) for BC of .52, not too shabby on it’s own. However, those in the study that managed to achieve blood levels greater than 60 ng/ml had an additional whopping improvement in HR to .20.

                Presumably, there was a wide variety of diets among all of these women, some with “bad” diets and some with “good”. Presumably pretty well randomly distributed in both directions, but I don’t think there is any data here about the groups diets. All that is looked at is vitamin D(and the resulting blood levels achieved by this supplementation) vs placebo.
                “Methods Analyses used pooled data from two randomized clinical trials (N = 1129, N = 2196) and a prospective cohort (N = 1713) to examine a broad range of 25(OH)D concentrations. The outcome was diagnosis of breast cancer during the observation periods (median: 4.0 years). Three analyses were conducted: 1) Incidence rates were compared according to 25(OH)D concentration from <20 to ≥60 ng/ml (<50 to ≥150 nmol/L), 2) Kaplan-Meier plots were developed and 3) multivariate Cox regression was used to examine the association between 25(OH)D and breast cancer risk using multiple 25(OH)D measurements.

                Results Within the pooled cohort (N = 5038), 77 women were diagnosed with breast cancer (age-adjusted incidence: 512 cases per 100,000 person-years). Results were similar for the three analyses. First, comparing incidence rates, there was an 82% lower incidence rate of breast cancer for women with 25(OH)D concentrations ≥60 vs <20 ng/ml (Rate Ratio = 0.18, P = 0.006)……………………………..Kaplan-Meier curves for concentrations of <20, 20–39, 40–59 and ≥60 ng/ml were significantly different (P = 0.02), with the highest proportion breast cancer-free in the ≥60 ng/ml group (99.3%) and the lowest proportion breast cancer-free in the <20 ng/ml group (96.8%). The proportion with breast cancer was 78% lower for ≥60 vs <20 ng/ml (P = 0.02). Third, multivariate Cox regression revealed that women with 25(OH)D concentrations ≥60 ng/ml had an 80% lower risk of breast cancer than women with concentrations <20 ng/ml (HR = 0.20, P = 0.03), adjusting for age, BMI, smoking status, calcium supplement intake, and study of origin……………….

                Discussion In this pooled cohort, 25(OH)D concentration was significantly inversely associated with breast cancer risk. All three analyses showed that women with 25(OH)D concentrations ≥60 ng/ml had significantly lower risk of breast cancer (~80%) compared to women with concentrations 60 ng/ml had an 83% lower risk of breast cancer than women with concentrations <20 ng/ml (P<0.001) [7]. The present study replicated these findings in a much larger, population-based study, thus increasing generalizability, and it’s prospective design enabled use of 25(OH)D values before diagnosis to distinguish between cause and effect.
                The Women’s Health Initiative (WHI) trial did not find an association between assigned vitamin D treatment group and breast cancer risk [34]; however, low dosage (400 IU/day) and poor compliance (~50%) likely contributed to the lack of effect. A subsequent re-analysis of the WHI data showed a significant reduction in breast cancer risk among women not taking a vitamin D or calcium supplement before enrollment [35]…………………………………..
                Whether our findings reflect prevention of the primary tumor or treatment of early stage, undiagnosed cancer by vitamin D is not clear. Of interest, the results for women who were followed and free of breast cancer at the end of the first year revealed a stronger association between 25(OH)D concentration and breast cancer risk (HR: 0.07, P = 0.02 for ≥60 vs <20 ng/ml). There was only one case of breast cancer diagnosed after one year among those with 25(OH)D concentrations ≥60 ng/ml. This woman’s diagnosis occurred 2 months into year two. Since there is a time delay between cancer initiation and diagnosis, many undiagnosed cancers that existed at enrollment would be diagnosed during the first year. Therefore, it is possible that analyses among women free of breast cancer at one year would better assess vitamin D’s specific role in prevention rather than prevention and tumor arrest combined.

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                | | | | Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concent…

                While numerous epidemiologic studies have found an association between higher serum 25-hydroxyvitamin D [25(OH)D…



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                | | | | Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concent…

                While numerous epidemiologic studies have found an association between higher serum 25-hydroxyvitamin D [25(OH)D…



                1. “Bio-Tech Pharmacal was a commercial source of funding.”

                  Thanks Bio-Tech Pharmacal for this educational opportunity.

                  “Analyses used pooled data from two randomized clinical trials and a prospective cohort to examine a broad range of 25(OH)D concentrations.”

                  This means that the study was not about vitamin D supplementation per say, but about vitamin D concentration in the blood, and the finding was that in women aged 55 years old and older high vitamin D concentrations in the blood were associated with less breast cancer.

                  Can one conclude from this study that vitamin D supplementation lead to less breast cancer ?

                  No, because more vitamin D in the blood may be caused by less fat into the body, because vitamin D is stored into fat cells.

                  So if you have lots of vitamin D to be stored, but if you do not have much storage for it, then you will have necessarily more vitamin D into the blood.

                  High vitamin D into the blood does not indicate that you have enough vitamin D, it may rather indicate that you have too much vitamin D for what you can store. In fact, there is no optimal vitamin D concentration into the blood, because it all depends on your body fat.

                  Why those women had less bress cancer ? Simply, because they have less fat into the body, meaning that they eat less fat and/or exercise more, two markers of a decrease in breast cancer incidence.

                  Thus, this study does not show that it is vitamin D supplementation that decreases breast cancer incidence, but rather that there is a correlation between the amount of fat into the body of those women and the risk of breast cancer.

                  1. AB, you are wrong about that. This was a pooling of 2 different placebo controlled randomized clinical trials, where vitamin D3 was administered to the intervention group, with a control placebo group. Then, they looked at the blood levels that resulted. And of course, there is no way that any one ended up with blood levels as high as 40 ng/ml and even >60 ng/ml without supplementation. The average person who does not supplement is way below 30 and often well below 20 ng/ml.  Even many people supplementing with over 2000 iu per day struggle to reach 30 ng/ml. In fact, that applied to me.

                  2. Materials and methods

                    Women in the 2007 Lappe et al. cohort (hereafter termed 2007 Lappe cohort) participated in a four year, population-based, double-blind, placebo-controlled trial of vitamin D and calcium supplementation in a 9-county area in Eastern Nebraska. Participants were randomly assigned to: 1) calcium plus vitamin D3 (1400–1500 mg/day of calcium plus 1100 IU/day of vitamin D3), 2) calcium (calcium as mentioned previously plus vitamin D placebo), or 3) control (calcium and vitamin D placebos). This trial was registered at as NCT00352170.

                    In another study, women in the 2017 Lappe et al. cohort (hereafter termed 2017 Lappe cohort) participated in a four year, population-based, double-blind, placebo-controlled trial of vitamin D and calcium supplementation in a 31-county area in Eastern Nebraska. Participants were randomly assigned to: 1) intervention (1500 mg/day of calcium and 2000 IU/day of vitamin D3) or 2) control (calcium and vitamin D placebos). This trial was registered at as NCT01052051.

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                    | | | | Clinical Trial of Vitamin D3 to Reduce Cancer Risk in Postmenopausal Wom…

                    Clinical Trial of Vitamin D3 to Reduce Cancer Risk in Postmenopausal Women – Full Text View.



                    1. Let me rephrase the statement. Though the vitamin D concentration in the blood may reflect the vitamin D supplementation that was given to those women, it is also an indicator of the capacity of the body to store vitamin D, and as vitamin D is stored into the fat cell, it may be an indicator of the body fat.

                      More vitamin D into the blood relates to less capacity of storage and thus to less body fat, thus less fat intake or more exercise or both.

                      This may be the confounding factors leading to the observation that high blood concentrations of vitamin D is associated to less incidence of breast cancer, but it is not at all proven to be a cause and effect.

                      More probably, women already with less risk to develop breast cancer have in consequence higher concentration of vitamin D when supplemented. But there may also be some other factors to take into account besides body mass, like the actual rate of use of the vitamin D by the body, which may be used by the body for very different things.

        2. Thanks didn’t know this about b12 as I am vegan was taking this a daily one of 1000ug plus nutritional yeast plus vegan marmite will cut back now as have developed dry itchy skin on my back , now I think I know the reason

    1. Yes, I’d like to know the same thing. Us folk that don’t eat dairy or meat are told to supplement with B12 and dha/epa–is this a waste of money?

      1. No, B12 is not a waste of money. In fact, if you eat no animal products, it’s essential.

        Consider it the exception that proves the rule.

        1. Also, can be essential for animal food eaters, especially older ones. Don’t forget most people likely get B12 from fortified foods like breakfast cereals, i.e.through supplementation.

      2. Brendan,

        People can die from going too low in B-12. People have had their spines rot out.

        So, no B-12 is not a waste of money.

        When it comes to DHA, there is a big debate within the Whole Food Plant-Based communities.

        Humans can convert ALA to Omega 3, but we become less efficient at it as we get older and if we eat things like soy products and corn and nuts, they contain Omega 6 and causes less ALA to be converted to Omega 3 and that Omega 3/Omega 6 ratio is believed to be important.

        There are studies where they used MRI’s and found that supplementing with DHA helped to preserve the size of the brain. The brain shrunk less for those who supplemented. Other studies though didn’t show a benefit to things like cardiovascular disease and many of the doctors have said that it isn’t worth taking because at high doses men have seemed to develop Prostate cancer, but Dr. Ornish was able to reverse Prostate cancer even though his patients were taking Omega 3 supplements. The fish oil supplements themselves have toxins from the sea water. The vegan kind are grown away from the ocean and do not have the same toxicity.

        Nuts are another thing the WFPB doctors debate wildly about. There are groups like the Adventists where even in the vegan community the people who ate nuts had improved cardiovascular mortality levels compared to the people who didn’t eat enough nuts. It was dose dependent – the more days per week the people ate nuts, the better. Nuts though are higher fat and there are doctors’ like Dr. Esselstyn who have done heart studies where people thrived on very low fat. There are arguments about whether they prevent weight loss because people who eat a lot of nuts tend to have the lower BMI’s than people who don’t eat nuts, but people like Chef AJ couldn’t get to her ideal weight until she stopped eating nuts. But they do speed up your metabolism and eating 123 pistachios didn’t cause people to gain weight.

        Yes, there are a lot of videos and it is going to be you who have to think about it and decide what you want to do.

        1. Brendan,

          Tom posted a few more new studies and what I will tell you is that the debate is going to stay incredibly heated and doctors disagree incredibly, and the science is not yet finished weighing in.

          People like Dr. Fuhrman watched his Whole Food, vegan and nearly vegan mentors develop Parkinson’s and he tested their labs and their DHA was so low that it didn’t register in lab tests. He is pro-DHA and DHA is the only thing we need because DHA converts to EPA. They have tested that. That part gets confusing because they sell just DHA and just EPA and mixed.

          The studies were done in ways that has made the issue much more confusing and Tom would be able to explain that part better than I can.

          Lots of accusations have been made but I do genuinely believe both sides are sincere.

          1. The Vital study showed that people who don’t eat fish had a 40% drop in heart attacks Omega 3’s and African Americans had a 77% reduction in heart attack compared to those taking a placebo.

            Although a daily 1-gram omega-3 supplement did not significantly reduce major cardiovascular events over all, there was a 28% reduction in heart attacks and promising signals for other heart-related endpoints, she says. While the supplement didn’t seem to protect most healthy people against future heart problems, certain groups did appear to benefit, particularly people who ate less than 1.5 servings of fish a week or didn’t eat fish at all. “For these people, there was a significant 19% reduction in the primary endpoint of major cardiovascular events, with a 40% reduction in heart attacks,” says Dr. Manson.

            The supplements also appeared to benefit African American participants, who saw a 77% reduction in heart attack for those receiving the omega-3 supplement, compared with those taking the placebo, says Dr. Manson. It’s unclear why this group benefited more, and additional studies are needed to confirm the finding.

            1. Did the studies say what sort of shape these people were in to begin with? Are we talking athletes or desk jockey’s? If desk jockey’s there will be other factors involved as well such as flabby muscles, weak venal health and so on. Fish may just be the straw that broke Clyde’s back.

              1. John,

                The Prostate Cancer and Omega 3 study was not well-designed and Mayo Clinic’s article was excellent.

                It can be that estrogen is causing the issues and it is causing more ALA to be converted to Omega 3 and that already makes the Omega 3 more of a biomarker than a cause of cancer.

                The other theory being an enzyme which also raises IGF-1 and the IGF-1 being the cause of the problems is interesting to me, too, since we already know that elevated IGF-1 is a risk factor for cancer.

                1. I read that article and didn’t see anything about how the fish was prepared for eating. Raw? Steamed? Fried? Baked? Barbecued? Nothing about how much was eaten at a time either and what was eaten at the same time. The current health or age of the patient seemed to factor in. It seemed like the fish was consumed in a mono diet vacuum. Were the fish factory farmed? Fresh? Frozen? How many species? Did they have fries with that? I might have slept through that part.

            2. African Americans may be lower in vitamin D than people with lighter skins. This may explain why they get more benefit from omega 3 supplements.

              1. Tom, that is what I am thinking.

                But if people are low in both D and Omega 3, which Americans tend to be low in both, the Black community is the community that it would show up in.

                Does Omega 3 not work properly if you are deficient in D? That could confound some studies.

                There was a study mentioned by Mayo Clinic where there was a 63% risk decrease for advanced cancers having high Omega 3 for everyone and they mentioned a gene which if you have that you have a fivefold increase risk of prostate cancer if you don’t have enough Omega 3’s.


        There is another Omega 3 video.

        The thing is, if you have high blood pressure, high triglycerides, high Homocysteine, high Arachidonic Acid, or are losing brain structure, DHA is the one that helps and men don’t convert it well.

        Dr Fuhrman tested his mentors for DHA when he started seeing WFPB people developing Parkinson’s and they didn’t register at all for DHA.

        If you are on statins or eat fish they probably will not benefit you much at all.

        If you don’t eat fish they might lower your risk of heart attack and might slow your brain shrinkage.

        There will be huge debates about this for the rest of our lives but fish is getting more risky every year and the cruise ships alone pour a billion pounds of pollution into the ocean.

        Farmed fish eat ocean fish and they are so diseased already and it is hard to get rid of the heavy metals and chemicals.

    2. I live in rainy dark Seattle and I take Vitamin D. The truth is, as you age, and the farther north you live, and genetic tendencies, make it difficult to get vitamin D as a vegan. My blood level was really low, like 22 ng/ml…and now I take 5,000 IU in the summer and 10,000 in the winter to get it barely above 50. EVer since I have bene doing this I feel much better…good mood in winter, no colds or flu. Of course, your mileage may vary, and you need to monitor with blood tests to see what it takes for you as an individual to get to optimal range. Dr. Greger did a great post on this:

      1. Mims,

        I have benefits cognitively from both Omega 3 and D3 – though I hate spending money on supplements and don’t remember to take either of them all of the time. That is how I know they actually do something because I accidentally miss a few months now and then.

  3. Best article in a long while. I’ve tried to explain this to others but all I get is a “not again” look and they don’t want to ‘hear’ it. Oh well — I’m going to be handing this article out. This is the best I can do! Be well!

    (All the articles are good but this one just stands out.)

    1. Ruthie,
      Same experience, such that I don’t proselytize anymore. I have found that most people are looking for a rationalization to eat what they WANT to eat. I tried to share WFPB diet info with my cousin and the response I received was at least honest: “yes, I have heard of Dr. Fuhrman and Greger but I DON’T WANT to eat that way.” She then proceeded to ask me if I had heard of the Paleo diet which allows her to eat the meat she wants to eat. Hard lesson.

      1. This is because dr Greger and dr Furhman make it utterly complicated and in a reductionist manner, by focusing on nutriments and lists of daily foods. A simple and closer to the truth approach is the one of dr McDougall, centered around starches, vegetables and fruits, putting aside nuts and other junk plant foods.

            1. Sleep in and of itself is not a nutrition topic. I’ve always thought that a nutrition site should focus on nutrition topics,

              The idea that DHA is toxic to the brain is new to me. It’s an essential component of the brain and central nervous system, and studies seem to report either a positive or neutral effect on brain health from its consumption and highest serum/tissue ;evels.

              1. The belief that you need more DHA (or anything else) than what your body actually produces is not at all scientifically proven, and even less proven in the case of healthy eating.

                Our ancestors were not feasting on fish or algae in the african jungle or savana.

              2. Yes supplemental DHA may be toxic for the brain, like all fats, as fats may allow toxins to enter into the brain, the same way as fats allow for a better absorption of some nutriments into the guts.

                Blood-Brain Barrier:
                The blood-brain barrier is the physiologic mechanism responsible for keeping toxins, such as amino acids, hormones, ions, and urea, from altering neuronal firing of the brain. It readily allows water, oxygen, carbon dioxide, glucose, some amino acids, and substances that are highly soluble in fat (e.g., alcohol, nicotine, and anesthetic agents) to pass across the barrier.5,6 The barrier consists of fused endothelial cells on a basement membrane that is surrounded by astrocytic foot extensions.6 Substances must therefore pass through, rather than around, these cells. The blood-brain barrier is absent near the hypothalamus, pineal region, anterior third ventricle, and floor of the fourth ventricle.3

                From Hillary A. Reinhold, Michele P. West, in Acute Care Handbook for Physical Therapists (Fourth Edition), 2014

  4. Great info, makes sense.

    We are wondering what are the most beneficial food combinations and are there any tasty recipes to do this?

    1. I doubt this has been studied specifically. But if you eat your Daily Dozen, as found on Dr Greger’s free app, you’ll be getting lots of wonderful combinations. There are many online sources of great recipes that combine all kinds of healthy foods. The trick is to find the right recipe bloggers, to avoid unhealthy foods in the mix. Here are a few you can start with:;;;;

  5. My naturopath has me taking a B-12 supplement, along with vitamin D between the equinoxes, along with some magnesium to help with blood pressure. Along with this, I can’t eat much fruit, other than melons, because most of the other fruits give me acid reflux, especially oranges and apples. Have you heard of fruits causing this type of reaction in people?

    1. Yes, anything acidic can cause reflux. That’s why they call it ACID reflux!

      That can include tart fruit and juices (oranges, pineapple, grapefruit, cranberry, blueberry, strawberry), onions, tomatoes (and its sauce), soda, coffee and tea. Some lists also include chocolate, peppermint and alcohol.

      Depending on the severity of your reflux, you may be able to eat some these foods in limited quantities.

      Another recommendation from my Dr.: avoid late-night snacks of any kind.

    2. Hi Ken – Thanks for your question! It is possible that any type of fruit or vegetable can cause acid reflux symptoms but this will vary from person to person along with the severity of symptoms. It is important to listen to your body and focus on increasing intake of fruits/veggies that are best tolerated so that you can still reap their benefits.

      More importantly, make sure you are limiting/avoiding other common foods that contribute to acid reflux, including high fat foods (ex. fried foods, lots of added oils, processed meats, ultra-processed snacks), too much black pepper, peppermint, alcohol, caffeine (ex. coffee, tea, energy drinks, soda), and chocolate products. Again, this is very individualized. Also, make sure that when you are eating that you wear loose-fitting clothes and avoid laying down for a least 1-hour after a meal/snack, as this can all exacerbate reflux symptoms.

      So the bottom line is to still include multiple servings of tolerated fruits and veggies in your diet! I hope this helps!

      -Janelle RD (Registered Dietitian & Health Support Volunteer)

  6. Dr. Klapper has come out with a new recommendation to stop taking DHA supplements esp for men. What is DR Greger’s opinion on this subject? Dr. Klapper has said he has done a ‘deeper dive’ into the science and many of the studies in favor have been funded by the manufacturers. He says there is evidence to suggest prostate cancer may be associated with the supplements.
    Thanks for any thoughts on this.

    1. Elizabeth,

      My logic is still that Dr. Ornish had men on Omega 3’s when he did his study to REVERSE Prostate Cancer and he still succeeded.

      There is a study, which Tom posted on the other page where they tested for Omega 3’s and men were 40% less likely to die from Prostate Cancer.

      Also, fish oils have been tested for all sorts of toxins, so that might be a factor. Vegan Omega 3’s don’t have the toxins.

      1. Deb,
        Good point (note they were on 3 gram fish oil i.e. high dose DHA,/EPA, not ALA omega 3; the term omega 3 is ambiguous and critically so). But those patients all “had newly diagnosed low-grade to moderate-grade prostate cancers (Gleason score, less than 7) that were localized to the gland (stage T1 or T2). All the men had elevated blood PSA levels of 4 to 10 nanograms per milliliter (ng/ml)”. From Klaper’s video it seemed to me the study cited (have not read) noted negative results for advanced/aggressive cancer). ”

        They were also taking 400IU vitamin E, a no no.

        Could well be being on a healthy diet low in animal products counters effectively possible negative consequences of supplemental antioxidants like E, DHA, etc.

        I think the details are important here.

    2. Thanks for that information. For those interested:

      What occurred to me is that this is consistent with Nobel laureate James Watson’s hypothesis that antioxidants could promote late stage cancers. People roundly criticized him for that but he could well be right.

      The video linked to is a bit vague. It does not seem startling to me that exceptionally high levels of DHA in the blood might be detrimental, at least among, as he says, “a subset of men” (not sure who they are). But he also states there is no solid evidence that raising DHA when levels are low, not uncommon in vegans, at least among poor ALA converters, but gives no details. This is something that certainly bears closer scrutiny.

      1. Gengo,

        Thanks for that.

        Yes, it is more complicated for vegans.

        I was reading the Vital Study and people who supplemented who don’t eat fish had a 40% decrease in heart attacks. A 77% decrease in heart attacks for African Americans.

        When I read things like that, I don’t understand why the doctors feel the need to throw the baby out with the bathwater and make blanket statements.

        1. Dr Ornish being able to reverse Prostate Cancer while giving Omega 3’s fits more in the making sure vegans get enough category.

          People who don’t eat fish have 40% fewer heart attacks if they supplement with Omega 3’s versus what risk of Prostate Cancer and I add in the study Tom pointed out where people with more Omega 3’s were 40% less likely to die of Prostate Cancer.

          Obviously doctor’s like Dr. Klaper disagree with Harvard and the Vital Study, but 40% fewer heart attacks seems worth taking to me.

          1. I found someone on PubMed who gave the risk/benefit ratio:

            Under that model, the chances of dying from ischemic heart disease are still nearly 4.5 times greater that the risk of dying from prostate cancer.

            “The wealth of data in other prostate cancer studies point in the direction of showing protective effects of omega-3 fatty acids,” he added.

            Dr. Harris concluded that the study authors and the media alike should discipline themselves to report findings in a balanced context and should “resist the temptation to wildly extrapolate in order to grab headlines”—especially if failing to do so puts patients at risk, he said.

            1. There were a whole bunch of arguments as to why the Prostate Cancer study could data could be wrong. For instance, they didn’t differentiate between fish intake and supplementing and the range of difference between the two groups was so close that there might not have been enough difference.

              There are experts who weighed in opposition to that study.

              Dr. Harris cited extensive literature on fish intake and higher omega-3 fatty acid intake that demonstrated a lower incidence of prostate cancer incidence and death, better survival among men who already had prostate cancer, and a reduced risk of aggressive prostate cancer. Furthermore, citing World Foundation of Urology data,7 he noted that the incidence of prostate cancer is high in North America and Northern Europe (among Caucasians and African-Americans (63 and 102 per 100,000, respectively) but low in Asia. With the Japanese intake of omega-3 fatty acids at about eight-fold that of Americans and with their blood levels twice as high, one would expect a higher risk. However, the Japanese prostate cancer rate of 22.7 per 100,000 in 2008 was dramatically lower than the U.S. rates of 83.8 per 100,000.8

              The Brasky article stated that the mean percentage of total omega-3 fatty acids (EPA + DPA + DHA) was 4.66% (range, 4.56%–4.75%) in cancer patients.1

              “These omega-3 levels,” according to Dr. Harris, “were far lower than would be expected from individuals taking omega-3 supplements.”

              The Brasky paper showed significantly lower omega-3 (EPA + DPA + DHA) levels in men without prostate cancer at 4.48% (range, 4.41–4.55; P = 0.002).1 The clinical significance of that difference (from 4.48% to 4.66%) was questioned by Richard Deckelbaum, MD, Director of the Institute of Human Nutrition at Columbia University in New York City. He explained in an interview:

              I specialize in fatty acid levels, and I was surprised at how small the omega-3 fatty acid differences are, especially for EPA, DPA, and DHA. In our lab, we would not consider these small differences to be biologically significant. Because of the large number of subjects in the SELECT trial, it turned out to be statistically significant, though.

              He speculated that perhaps prostate cancer itself could cause these “very small” changes in fatty acid levels. He said, “It’s not quite clear as to where the chicken is and where the egg is.”

              1. The difference between the Japanese numbers and the American numbers could be that Japanese don’t consume American Dairy products and Americans do.

            1. That one has that Brasky’s own group had another study where there was no association between fish oil capsules and prostate cancer.

              They also mentioned an Icelandic cohort where men who took fish oil at least once per week later in life had a 57% lower risk of advanced prostate cancer.

              The VITAL study had a 49% lower risk of colorectal cancer for patients who took supplements at least 4 days per week for 3 + years. Which they said was in accord with the Physicians Health Study.

              Also supplementing decreased the risk of breast cancer.

              Either way, the Mayo Clinic agrees with the critics who said that the people in the study where the Omega 3 levels seemed to correlate with Prostate Cancer didn’t have high levels of Omega 3 at all. In fact, they intentionally were trying to have the Omega 3’s be on the modest side which they said makes it more likely that it isn’t about Omega 3.

              1. One of their theories was interesting. They said that if the men were high in estrogen for instance, the estrogen could increase the conversion of ALA to Omega 3 and they weren’t separating supplements from fish eating to know if it was supplements causing problems.

                Another theory was that hepatic delta 6-desaturase, a rate-limiting enzyme for long-chain omega-3 synthesis, is insulin inducible,and insulin increases the bioactivity of plasma IGF-1 which is a key determinant of prostate cancer risk.

                So it could be that the Omega 3’s are being caused by the factor that is also spurring the cancer.

                1. The black community in the Vital study having 70+% decreased risk of heart attack makes me wonder if there was a synergy with Vitamin D?

                  I am going to want to call racism that the black community isn’t a major focus of the discussion in a positive direction.

                  That, plus the group intentionally going low Omega 3’s. I don’t trust the anti-supplement side either and I don’t know if Big Pharma is scaremongering or if big media is so shallow in how they handle it but doctors switch sides based on studies which don’t seem to be anywhere near complete answers and they skip things like non-fish eaters can have a lower risk of heart attacks and that is a bias of some sort, but skipping the Black community results when the results are so high is close enough to real racism.

          2. Note too the study only looked at a subset of men with prostate cancer. Gender often matters. As does that subset. As does there overall diet/lifestyle. I agree about the poor baby.

              1. Gengo,

                Gender definitely matters, but the fact that it was a prostate cancer study, adding women in probably would confuse things further unless they were transgender.

                1. Are you making a joke? I would not say “confuse” things as it would of course make no sense to include people without prostates in a prostate study.

                  1. I guess I should clarify my comment about gender, given your comment, Deb.

                    Dr. Klaper made a general recommendation not to supplement, although he did emphasize men, for obvious reasons. I assume his thinking is that the association could well breast cancer. That strikes me as a completely unwarranted interpretation.

                    1. “could well breast cancer” ===> “could well apply to breast cancer”.

                      There’s more than one Fumbledingers on this website.

        2. Taking high quality supplements, targeted for that person can be very helpful. And there are also remedies that were used in the past, no longer used. It is complicated and many doctors just prefer to have the drug reps tell them what to do. Plus they are rightly afraid of lawsuits, so just do what all the others do. But many drugs do have serious or unpleasant side effects.
          Example- one patient put on anti-fungal drugs that now has liver damage.
          There are some supplements I use instead in people who have problems with the drug. Saying all supplement use should be stopped is wrong.

          1. Marilyn,

            I appreciate your input.

            It has to be so hard to be a doctor.

            Dr Greger has a very large team of people reading all of the studies, and he is also not taking patients.

            Trying to keep up with the conflicting science while managing patients and not being swindled by big pharma, insurance or your patients is way beyond a full-time job.

      2. So, according to Nobel Laureate James Watson, to give a nutritarian diet to someone with advanced cancer, and not a starch-based diet, is criminal…?

    3. Elizabeth

      I had a look all the links given by Klaper and recall looking at these a while ago when we had all the Jeff Nelson kerfuffle.

      They didn’t convince me then. They don’t convince me now.

      A problem is that these are justbobservational studies. They can’t prove cause and effect. All they do is detect an association. There is an association between being a black rapper and wearing lots of bling. But wearing lots of bling won’t turn you into a black rapper.

      A further issue is that they are only studies of blood omega 3 levels not omega 3 consumption. Whether dietary or from supplements. They also showed that blood trans fatty acid levels are associated with lower risk. That is a puzzling observation.which causes me to think that something else is going on here.

      Further, some studies of actual dietary omega 3 consumption show an even greater effect on prostate cancer mortality – but in the opposite direction – eg

      ‘Among all men, those with the highest omega-3 docosahexaenoic acid and total marine fatty acid intakes were 40% less likely to die from prostate cancer (Ptrend = 0.05 and 0.04, respectively).’

      Anyway, prostate cancer isn’t the only factor we should consider.

      ‘The top quartile of plasma PC DHA level was associated with a significant 47% reduction in the risk of developing all-cause dementia in the Framingham Heart Study.’

      While these were both quite small studies, I think that I will continue to take a supplement in the absence of more convincing evidence in the opposite direction.

      What is more, the latest very large meta-analysis of randomised controlled trials shows that taking omega 3 supplements reduces heart disease risk.

      ‘Marine omega‐3 supplementation lowers risk for myocardial infarction, CHD death, total CHD, CVD death, and total CVD, even after exclusion of REDUCE‐IT. Risk reductions appeared to be linearly related to marine omega‐3 dose.’

      As a result, the question I am asking now is not should I stop but should I up my dose of algal omega 3?

      1. I will post this study here, too.

        It was a study where they put men with prostate cancer on a low-fat diet and gave them fish oil and the result was positive, though they couldn’t prove that the positive result wasn’t just from a high carb diet.

        Here is a sample of what they found:

        we found this intervention resulted in a decrease in omega-6:omega-3 fatty acid ratios in benign and malignant prostate tissue and a decrease in malignant epithelial cell proliferation as measured by Ki-67 immunostaining. Validation of these results with proliferation as the primary outcome will support the performance of long-term dietary intervention trials with clinical progression endpoints.

        That tells me that there is nothing really to worry about for people who are on a WFPB low-fat diet.

        1. Once again, a dumb bunch of scientists who once again failed to take constipation into account and blew any relevance their study might have had right out of the water. What a waste of time and money. This is what I was talking about when we were last talking about crime in science. This is a great example of people getting money for what could have been a useful initiative that was carelessly scripted. Poorly enough to be called a fraud. Keep in mind these people are supposed to be people who have an understanding of how the intestinal tract is supposed to work. So if they know how it’s supposed to work, how could they screw up that badly unless they were criminally stupid or just criminals?

          1. I think it was John Cleese who said that the problem with some people is that they are so stupid that they have no idea how stupid they are.

            People bring this quote to my attention.all the time ……………. I have no idea why.

        2. Thanks Deb. Yes, I think Klaper has been sold a pup by Nelson.

          In this trial again, very high doses were used (5 grammes daily) which is a further reason to consider going up from the 250 mg recommended by Dr G.

      2. The study quoted by Dr Greger justifying, according to him, to push DHA supplementation to vegan does not prove that DHA is good for the brain, but that it is less detrimental for the brain than sunflower oil in overweight elder women with unhealthy lifestyle.

          1. One can not give recommendations to a whole population based on epidemiological cohort studies like this one, where many confounding factors take place.

            Only interventional studies, double-bind randomized studies, can be relevant, and no such studies exist, showing, for example, that a DHA oil in a yellow capsule may decrease the risk of dementia compared to a placebo yellow capsule filled with water, for a broad range of the population, and particularly individual with healthy habits.

            Presently, there only exists skewed or commercial interventional studies designed to inflate DHA benefits in favor of the industry that show benefit for supplementation, making another diversion for not talking to people about healthy eating habit.

            The double-bind randomized study interpreted by Dr Greger as being favorable to DHA may rather in fact reveal the actual danger for brain health of sunflower oil, which is present in most processed foods including the plant-based processed foods, and which is largely used for cooking by the global population.


            1. That’s a claim made by Jeff Nelson. I have no idea if it’s true or not.

              However there evidence that dietary DHA is either protective or has no effect. There is no convincing evidence that dietary DHA or supplements are dangerous. The prostate cancer studies that Nelson quotes are merely associational, anomalous and also purport to show that trans fats are protective. They may also be contraindicated in some specific cardiovascular conditions.

              Frankly, I’d prefer to get my information on these issues from credible health authorities rather than simply accept the claims of confrontational YouTubers like Jeff Nelson.

              1. Don’t be so obsessed with one particular youtuber. One is just talking about a fact which is talked about by many different people who don’t buy into the idea of DHA supplementation, including plant-based nutrition researchers and speakers like dr Tim Radak:

                Actually, the proposition for a randomized study with one control group with a yellow capsule filled with water versus a yellow capsule with DHA for a broad range of the population including people eating healthy would be the only way to assert that DHA supplementation has any value at all. But such study does not exist.

                it is not because you believe one thing that you make recommendation about it to a whole population. However, it is what dr Greger is doing with DHA and it is hurting if not the health of people, at leats their bank account, and many people already struggle to buy themselves quality foods, because they do not earn thousands of dollars every month like dr Greger.

                Intelligent people know that DHA supplementation is nothing but a fake promise by the supplements industry, which is diverting from the main question of healthy eating: low fat plant-based without nuts, the only way of eating proven to reverse heart disease with maximal efficiency.

                1. You don’t appear to understand the basis of Dr G’s recommendation.

                  You also have a very firm opinion on the subject. Your position on issues appears to be more about your ideology ideology than about what the scientific evidence shows.

                    1. ab,

                      I have probably watched the same video as you did and recognize so many of your points as an opinion of someone on YouTube who works with Dr. McDougall and who influenced Jeff Nelson.

                      Yes, they threw out the studies by Dr. Fuhrman and Dr. Ornish and the MRI study and the studies where patients were given DHA when they already had cancer – and it has been tested both with prostate cancer and breast cancer and both types of cancer improved when it was a low fat diet supplement with fairly high dosages of fish oil.

                      They didn’t get worse. They improved.

                      All of Dr. Ornish’s studies people improved. The other scientists that combined correcting the diet, plus giving fish oil, the patients improved.

                      I am waiting to see what happens with Dr. Ornish’s Alzheimer’s trial, but he already said that it is going to be good is all he was allowed to say.

                      He is reversing everything and he is the one using fish oil with WFPB.

                    2. Deb,Isn’t it ironic that so many studies are supposedly finding fish oil useless or even harmful, but at the same time the FDA has just approved a drug that is essentially fish oil for treatment of high triglycerides and maybe other things? Similar to the recent approval of CBD for seizure treatment, working better than any other drug they had previously, after decades of them insisting MJ had NO medical uses. Well, as long as it is an expensive prescription(30Ka year for the prescription CBD), I guess it can be claimed to be good for you, right! ;)

                    3. Deb, that Dr Ornish is able to improve some conditions by adding fish oil supplements to a low fat plant-based diet does not mean that fish oil supplement is the cause of the health improvement…

                      It is totally possible that the people in those trials would even have improved better without fish oil supplementation.

                2. You don’t appear to understand the basis of Dr G’s recommendation.

                  You also have a very firm opinion on the subject. Your position on issues appears to be more about your ideology than about what the scientific evidence shows.

  7. Food synergy, yes! But finding detailed info, not to easy. Is there a list, site, resource of beneficial food pairs (i.e. green tea and lemon, turmeric and pepper, etc.)? It’s not a frequently discussed topic. Thanks!

    1. There are indeed specific known synergy pairs and combinations, but the bigger more general picture is when you eat all (most) food groups and a wide a variety of foods within each food group, you are creating myriad of combinations. A particular combination may be useful for a particular health benefit, but for a generally healthy diet, the greater the variety the better. E.g., for vegetables, include leafy greens, the onion family, the cruciferous family, root/starchy vegetables, etc. And do the same fruit, grains, legumes, nuts/seeds. No need to over-think it.

      Sent from Mail for Windows 10

      1. Rebecca,

        Thanks so much for looking for the book and asking. On Amazon, type this in the search box, “book Billig 1, 2, 3 Eat” That should do it. The full title is 1, 2, 3, Eat: Eat like you know what you are doing.
        I hope you find the book useful.

      2. Rebecca,

        Thanks so much for looking for the book and asking. On Amazon, type this in the search box, “book Billig 1, 2, 3 Eat” That should do it. The full title is 1, 2, 3, Eat: Eat like you know what you are doing.
        I hope you find the book useful.

      1. Sure. The three principles, in short, are: 1: Eat mostly whole foods 2: Eat all the food groups each day. For exceptions such as vegetarian/vegan or food allergies, you need to be educated to determine if there are nutrients you may be missing, e.g., vitamin B-12 for vegans, and learn ways to assure your still get adequate amounts of those nutrients.
        3: Eat a variety of foods within each food group over the course of a week

        There is a chapter on each principle that explains the reason why and strategies how.

        Hope this helps.
        Steve Billig

        Sent from Mail for Windows 10

      2. Sure. The three principles, in short, are: 1: Eat mostly whole foods 2: Eat all the food groups each day. For exceptions such as vegetarian/vegan or food allergies, you need to be educated to determine if there are nutrients you may be missing, e.g., vitamin B-12 for vegans, and learn ways to assure your still get adequate amounts of those nutrients.
        3: Eat a variety of foods within each food group over the course of a week

        There is a chapter on each principle that explains the reason why and strategies how.

        Hope this helps.
        Steve Billig

        Sent from Mail for Windows 10

  8. Here’s my problem with the fish oil is useless proposition.
    I have arthritis.
    I tried many supplements to no avail.
    Then I tried fish oil supplements. Bingo! A huge improvement.
    Placebo Effect you say?
    Then riddle me this: why didn’t the Placebo Effect work for all the other things I tried?

    1. Anthony Element, I would say what my doctor says.. “whatever works” ! I think you are fortunate (as many others are too) to find that omega 3 supplements help with your arthritis pain. Many of us have to limit the amount of pain medication we use so it can be a real problem in trying to find something that is effective. Currently I am taking 1/8 tsp each of turmeric, ginger, amla, and a bit of black pepper (with a tbsp of water, and drink at once).
      I like the advice of Dr Mirkin to check each bottle of capsules for freshness. Return them if you detect stale or ‘off’ fishy odours. All the best to you!

  9. Here’s what’s confusing to me in this discussion: everyone keeps saying OMEGA-3…. But there’s also DHA. Which one are we talking about? People are seemingly using these interchangeably and they are not interchangeable to me.

    After breakfast one day, I went to and put my 1.5 C of oatmeal, some flax seed, and some berries in and had already achieved the daily requirement for Omega-3’s…..

    1. Liisa,

      You are right that there are something like 8 fatty acids which I think they put under the category Omega 3.

      But when they do studies, it is generally DHA, EPA, fish oil or they measure ALA.

      They still measure “Omega 3’s” no matter which one they are using to supplement and your nutritional site will measure Omega 3’s if you eat foods with ALA or if you take fish oil pills or algal oil pills, so in that way, they are interchangeable.

      Maybe the same way you can measure “vegetable intake” and use “I ate 7 servings of vegetables” even if it is all kale.

      1. The thing with ALA is that your body needs to convert it and as we get older we don’t convert it as easily and if we eat things with Omega 6, those compete with the conversion process and if we are deficient in some minerals or vitamins we can’t convert as well and your website can’t keep track whether your body is converting it. Just how much ALA you are eating.

        Unless you are eating fish.

          1. The risk of prostate cancer study is frustrating because they intentionally went low dose and also don’t even know if people were eating fish or supplanting or if May Clinic is right that men with high estrogen levels convert more ALA to a higher level of Omega 3’s unrelated to fish intake or supplementing.

            The other mechanism which increases the levels also increases IGF-1, but….

            Well, that gives me something to look up. We know that eating too much fish will increase IGF-1. I can look up whether supplements do.

            The reality that Japan can eat fish in moderation and have a lower risk of cancer makes everything else more important.

          1. That’s why vegan may be more at risk than omnivores for cancer risk when supplementing with DHA, because they are more efficient in the ALA conversion and thus end up with more DHA than omnivores eating fish, even sometimes before any supplementation.

            1. The prostate cancer studies used a low-fat diet and DHA fish oil and the cancer proliferation improved. The biomarkers improved with women with breast cancer who were put on DHA, too.

              Also, estrogen increases the conversion and that is what the Mayo Clinic thinks causes the DHA reading to be higher in males who had prostate cancer.

            2. Dr. Ornish reversed prostate cancer AND heart disease USING fish oil. I don’t understand that what you are saying is true at all.

              I think the Mayo Clinic’s explanation that men with higher estrogen get cancer and men with higher estrogen also convert more ALA to DHA.

            3. “Vegans’ actually have a lower risk of cancer than omnivores

              ‘The first large-scale clinical trial to examine the effects of omega-3s on the primary prevention of cancer in the general population was the newly published VITAL trial. This clinical trial examined the effects of omega-3 fish oil supplementation (1 g/day containing 460 mg EPA and 380 mg DHA) with or without 2,000 IU/day vitamin D for a median of 5.3 years [57]. The study included 25,871 men aged 50 and older and women aged 55 and older with no previous cancer, heart attacks, or strokes. Compared with placebo, the omega-3 supplement had no significant effect on cancer incidence, cancer mortality rates, or the development of breast, prostate, or colorectal cancers.’

              1. If intestinal health and cleanliness were not taken into account at the outset for all test subjects which they weren’t the studies are the usual bullshit.

              2. Yes, plant-based eaters are less at risk of developping cancer, but to give them DHA supplementation may increase their risk if DHA is linked to an increase of cancer risk, as it is suggested by some studies.

              3. Your studies on cohort of omnivores clearly are not legitimate to base any supplement recommendations upon them in the context of healthy eating.

                    1. Your ideology is the one saying that ingesting a pill of something that your body already makes naturally will make you more healthy.

                      There is nothing to support that ideology for the whole population in the context of healthy eating.

          2. That is interesting.

            I haven’t seen that yet. There are so many studies and so many articles that it might take a very, very, very long time to get to everything.

      2. Deb, I’m waiting to be more convinced to take any DHA. When I stopped taking DHA, stopped buying mini Chocolove bars, and stopped much oil in my diet, my blood work numbers were noted by my doctor for excellence, and I had never had much bad blood work anyway in my opinion, but it became noteworthy enough for my doctor to comment on it. (My cholesterol dropped from 157-158 to 132.) Since consumption of DHA was part of my particular equation, I’m waiting to become more convinced that it is necessary. It seems most people here seem to think we are in dire need of it, but I’m just not convinced.

        1. Liisa,

          I understand.

          That is fabulous that you got those results!

          If your triglycerides and Homocysteine and cholesterol and blood pressure and resting heart rate are all good then you can cross those mechanisms off the list of things DHA does.

          1. My thing is that people quote Dr Ornish’s studies and he has people use fairly high doses of fish oil or omega 3.

            He is the one whose studies are talked about both for heart disease reversal and for prostate cancer reversal.

            His voice is the one I listened to when I believed these things really could be reversed.

            1. Liisa,

              It is confusing, for sure.

              I have seen studies that said that eating ALA’s showed no benefit and that people with low estrogen don’t convert to DHA, etc.

              For me, the brain MRI’s were the most compelling.

              And Dr Ornish’s studies are why I don’t understand the hubbub.

              Plus, I will not go on things like statins no matter what and they think that statins are and other meds are why the studies fail more. The list of mechanisms seem good enough to me.

              Unless they come up with a big, bad negative mechanism that counters all the positives, I will happily not have my brain shrink as fast.

        2. Yes, Liisa, it’s a problem!

          The fact that DHA raises LDL cholesterol is not a point in favor of supplements. This was mentioned more than a few times in my searches yesterday. When I started wfpb a la Dr Greger years ago, I threw out an expensive bottle of omega 3 and my cholesterol dropped in the 90 days between blood testing. For me, it was part of the equation also.

      1. That study is one I nominate for someone who understands the science to take a crack at.

        Dr Greger, Are you considering jumping ship about Omega 3’s?

        It seems like a good webinar topic, but only if it has studies which clarify things.

        1. Okay, so fish oil doesn’t increase prostate cancer in people who eat low-fat, they improved, but it can increase IGF-1 and it could increase the bad gut bacteria as potential mechanisms for people eating higher fat diets.

          It is whether it helps or hurts or does nothing at all for the SAD eaters is the part I am having trouble understanding.

          The study where prostate cancer increased, everyone was low in Omega 3’s, even though the higher DHA group was worse than the lower DHA group.

          Deciding which Omega 3 to buy is what I am thinking about.

          Not buying DHA lowers the risk of the prostate cancer even without people changing their diets. DHA was the only one with a risk. But I think DHA was the only one with a benefit over on the brain health side and In one study almost none of the ALA converted to DHA.

          For myself, I would but DHA anyway because of the MRI studies, but what should my SAD diet, non-fish eating brother with elevated PSA do about Omega 3’s?

          Some studies non-fish eaters had enough cardiovascular benefit that I haven’t resolved it yet.

          1. I just thought of 2 things, Liisa is right that they are using “Omega 3” interchangeably and that causes me to suddenly not know if the fish oil given has DHA in it. I assume so.

            But if DHA is the risk factor, does estrogen cause people to convert ALA to DHA?

            Because the other study I saw, men in particular did not convert to DHA.

            Do any of Mayo Clinic’s mechanisms cause a conversion to DHA?

            If not, then it is either fish or supplements causing increased levels and that would be either fish-eaters or supplement takers or people who eat high IGF including fish or including supplements.

              1. What mechanism other than converting ALA to DHA does estrogen do that causes these estrogen cancers?

                Does anybody know the mechanisms?

                I probably have to look up breast cancer for it.

                If converting ALA to DHA increases estrogen dependent cancers, then both sides could be right.

                Meaning if DHA is a mechanism at all as one of the things estrogen does to increase cancer rates, then ALA conversion on top of supplements could be a factor.

                  1. You confound DHA and omega 3. Omega 3 are essential fatty acids. DHA is not. It is a byproduct of ALA produced by the organism that does not need at all to be supplemented.

    1. Deb, Thanks for posting that study. Note though that there was no effect between the control and intervention groups on IGF-1 levels, i.e. the effects found were via other pathways.

      “In summary, four to six weeks of a low-fat diet and fish oil capsules to achieve an omega-6:omega-3 fatty acid ratio of 2:1 had no effect on serum IGF-1 levels, though in secondary analyses, the intervention resulted in decreased prostate cancer proliferation and decreased prostate tissue omega-6:omega-3 ratios. These results support further studies evaluating reduction of dietary fat with fish oil supplementation on modulating prostate cancer “

  10. In any videos I have seen with Dr Ornish, he has said “at least 2 grams” fish oil. There is a warning for people with heart failure or angina.. taking omega 3 could prove to be a deadly mistake. (I hope people perusing the comment sections at NutritionFacts take NO medical advice from what is written on these pages, and instead consult their own physicians)

    1. Barb,

      Do you have a warning study?

      So far, I have just seen the studies where it lowers the rate of heart attacks in non-fish esters by 40% and lowers the rate of heart attacks over 70% in black nonfish eaters.

      I would be interested in opposing studies.

        1. Okay, thanks, I read it and I will look for Dr. Leaf’s study. Thanks for sharing it.

          I was reading that DHA and not EPA lowers blood pressure. I am trying to understand how lowering triglycerides and resting heart rate and blood pressure don’t matter. It is helpful that you gave Dr. Ornish’s words so I can look at the subset where it wouldn’t be helpful.

          1. Here’s something about Dr. Leaf,

            Experiments by Dr. Alexander Leaf and his colleagues show that omega-3 fats prevent potentially fatal rhythms by suppressing the function of hyperexcitable cells that live in scar tissue or in heart muscle that doesn’t get enough oxygen. That’s great when there’s plenty of healthy heart tissue. But what about when these hyperexcitable cells are responsible for the lion’s share of cardiac function, such as in people with severe angina or other conditions in which the heart is chronically deprived of oxygen? Stifling them with fish oil could conceivably snuff out the heartbeat, explains Dr. Leaf, emeritus professor of clinical medicine at Harvard Medical School.

              1. Well, in one study people who do not eat fish had a 40% lower rate of heart attack if they took Omega 3’s.

                They do lower blood pressure and lower triglycerides and lower Homocysteine and lower Arachadonic Acid and lower the markers of inflammation and improve endothelial function and improve resting heart rate on top of a very long list of things.

                So, is it that improving blood pressure and resting heart rate doesn’t do anything really?

                Or is it that the people in the studies mostly eat a little fish so you can’t see the benefit? Or that most of them are on statins so they can’t see the benefit that way? Or are they all SAD high saturated fats, lots of oil, lots of junk food, lots of sodium and Omega 3’s do something with the Sodium channels, maybe not enough to prevent the bad news? Or is it that they moved to pure EPA and it is DHA that actually benefits?

                Again, with all of the things it actually does do, how is it that we can make blanket statements that it never matters that people have lower triglycertides or lower blood pressure or lower Homocysteine? Are they wrong about all of that other science? Is all of it fake? Is that what we just learned?

                    1. May one repeat what one said above: low fat plant-based diets (without nuts) protect from heart disease not algae oil or fish oil.

                      Did you ever hear about Dr Esselstyn’s trial on advanced heart disease, Mr Fumblefingers ?

                      We are not talking about burgers here, though Mr Trump seems to consider them as a “goto food” in period of scarcity when he invites professional athletes:

                      He does not seem to have watched the “Game Changers” movie, and that’s why the Dream Team may have failed in the latest FIBA Basketball World Cup.

          2. I found an opposite results for heart failure, but that means that people with heart failure have to walk carefully with a doctor.

            Recently, a potential new indication of omega-3 fatty acids has been demonstrated, that is heart failure.36 In the GISSI-HF trial,65 a placebo-controlled trial of approximately 7000 patients with class II to IV heart failure, the patients were randomized to 1 g of omega-3 fatty acids (containing 850–882 mg of EPA plus DHA), rosuvastatin (10 mg), both of them, or dual placebo. This study was performed in addition to well-established current therapies, and the results showed a significant benefit of omega-3 fatty acids.65 However, the optimal dose of omega-3 fatty acids remains to be determined depending on different stages and/or aetiology of heart failure and underlying mechanisms.68

            1. Deb

              You might find it helpful to read the evidence summary in the AHA advisory on fish oil supplementation and the prevention of CVD.

              It goes without saying that Barb is correct that people shouldn’t take medical advice from (unqualified) commenters here or anywhere else. And internet advice generally should be viewed with considerable caution. TBH, I am not actually sure that the AHA scientific advisory fully confirms Dr Ornish’s and Dr Leaf’s advice on this point but then I am not a medical professional.

              That doesn’t mean to say that we shouldn’t discuss our own particular circumstances or what the science shows. I think we should but it shouldn’t be construed as advice to other people – whose personal circumstances will undoubtedly be very any case.

              1. Thanks, Tom.

                I wonder what happened in 2002 that changed the outcomes.

                Of note, the magnitude of the reduction in total mortality, shown to be attributable mostly to a reduction CHD death, was greater in the studies published before 2002 than in the more recent studies.

      1. Here is one with postmenopausal women with DHA alone or with HRT.

        DHA alone improves triglycerides and resting heart rate and I think it said cholesterol and other bio markers of heart problems.

        I am going to keep reading all of the women studies because if estrogen is involved in ALA to DHA conversion, I am already past that.

        I would feel better if the people saying not to take it explained why improving the biomarkers isn’t valuable.

        1. There are so many biomarkers affected. It lowers inflammation, lowers homocysteine, lowers resting heart rate and blood pressure and triglycerides.

          Taking DHA raises EPA.

          Taking EPA lowers DHA

          In the DHA group, serum phospholipid DHA increased by 69% and EPA increased by 29%, indicating retroconversion of DHA to EPA. In the EPA group, serum phospholipid EPA increased by 297% whereas DHA decreased by 15%, suggesting that EPA is not elongated to DHA in humans. The serum phospholipid ratio of n-3 to n-6 fatty acids increased in both groups, whereas the relative changes in n-6 fatty acids suggested possible alterations in liver desaturation activity in the DHA group.

          I am trying to figure out whether alterations in liver desaturation activity is a good thing or a bad thing.

          Either way, I am remembering that I have to look for control groups where they use corn oil, but the patients with things like cancer who were treated with DHA in studies without control groups improved in the ones I have read so far, and that wouldn’t have been a tricking people with corn oil phenomenon.

        2. Omega-3 fatty acids can ultimately increase arrhythmic thresholds, reduce blood pressure, improve arterial and endothelial function, reduce platelet aggregation, and favourably affect autonomic tone

          They decrease Arachadonic Acid

          It improves ATP Generation and mitochondrial function.

          Omega-3 fatty acids decrease the risk of thrombosis by inhibiting platelet aggregation.

          Recent studies demonstrated that omega-3 fatty acids could down-regulate the activity of the nuclear factor (NF)-κB,12 which plays a key role in the regulation of gene expression in inflammatory responses and has been implicated in the pathogenesis of CVD.13 The inhibition of NF-κB activation can be mediated by the mechanism that is related to the activation of peroxisome proliferator-activated receptor (PPAR) or the inhibition of toll-like receptors.13

          omega-3 fatty acids could not only prevent the plaque development but also contribute to the plaque stabilization.33 The randomized clinical trial demonstrated that omega-3 fatty acids supplementation substantially increases tissue levels of EPA and DHA and decreases macrophage infiltration and thickened fibrous cap in human carotid arteries

        3. Some of the studies only used 10 mg when prescription doses are often 1 gram.

          I feel like I need to hear that the people throwing it out have an understanding of the mechanisms of why It doesn’t work.

          That improving the endothelial doesn’t help or lowering Homocysteine and arachadonic acid and normalizing resting heart rate isn’t as important as they made it out to be.

            1. Barb

              That’s also pretty much what the current AHA guidelines (and Dr Greger) say – in respect of primary prevention.of heart disease. The difference is that unlike Cochrane the AHA scientific panel concluded

              ‘Taken together, the cumulative findings from RCTs suggest that omega-3 PUFA supplements may reduce CHD death, possibly through a reduction in ischemia-induced SCD, among patients with prior CHD, but the treatment does not reduce the incidence of recurrent nonfatal MI. Additionally, given that the benefit likely outweighs any risk of treatment, the majority of coauthors concluded that treatment with omega-3 PUFA supplements is reasonable for the secondary prevention of CHD death (Class IIa Recommendation); a minority of coauthors preferred a slightly lower strength of recommendation for treatment of patients with this indication (Class IIb Recommendation).’

              And the very latest very large updated meta analysis (published after Cochrane) found

              ‘What Is New?
              We updated previous meta‐analyses by adding 3 recent large randomized controlled clinical trials, increasing sample size by 64%.

              Marine omega‐3 supplementation significantly lowered risk for most cardiovascular end points, even after excluding a trial testing very high‐dose supplementation.

              Risk reductions were linearly associated with dose of marine omega‐3 supplementation.

              What Are the Clinical Implications?
              Daily marine omega‐3 supplementation is effective in lowering risk for coronary and most other cardiovascular end points, including myocardial infarction, coronary heart disease death, total coronary heart disease, cardiovascular disease death, and total cardiovascular disease; no benefits, however, were found for stroke.

              Greater cardiovascular benefits may be achieved at higher doses of marine omega‐ 3 supplementation.’

              1. In one of the articles, someone said that the newer studies had way more people who were on things like blood pressure medications. They listed 3 common meds and said that the older studies where there was more of an effect, fewer people were on things like statins.

  11. Thank you for your post Fumbles! I am seeing divergent views everywhere I go.
    Here is Dr Mirkin’s take on it, and he cites a few studies in his short article, starting with the JAMA Cardiology article about 10 large studies. It included all kinds of people, with and without heart disease, lifestyle factors, orher health issues.

    He also includes a few pointers if people insist on buying it, and also mentions that no trials so far show benefit for eating fish more than once or twice per week.

      1. gengogakusha, yes, at that link you can scroll down to see his recommendations on this topic. He and his wife eat a wfpb diet with a couple of portions of fish per week. They generally eat 2 meals per day but are very active in the tandem cycling club apparently.

          1. My thing is that he used high doses of fish oil for his reversing heart disease study and his prostate cancer study and, in the end, he is the one who is reversing the diseases.

            For me, his studies, and the other cancer studies where people improved on low-fat with Omega 3’s, should remove the whole paranoia about the issue.

            1. Deborah, Are you “our Deb”?

              I agree the concern about DHA/EPA supplementation has gotten ahead of the facts and risks throwing the baby out with the bath water.

          2. Gengo,

            If Dr Ornish succeeds at reversing Alzheimer’s with his diet, plus fish oil or vegan omega 3, then, the studies reversing all these diseases from him used it and so did the studies from Dr Fuhrman.

            None of those are being called “Omega 3 studies” but Both men clinically uses it.

            I have to look up the Adventist’s, but WFPB over-reacting to a study that wasn’t well-designed is what it looks like.

            It has to be hard to design them because people do eat fish.

            The Cochrane review talked about a study where they told the control group just to keep their Omega 3’s the same as always and that is so arbitrary. They could be eating fish every week or every day.

    1. For the Vital Study, they used Omacor which is a formula sold under various brand names. I provide the link of the study description as well as the drug description. I remember talking to doctors about this prescription years ago, and all were negative about it, but maybe because the side effects would not be worth any benefit. My triglycerides are low already … omega 3 can help folks with high triglyceride levels.

    2. Thanks Barb
      Yes, that is Dr Greger’s take and the position of the AHA also – omega 3 supplements do not prevent heart attacks. Although that position is based on older (meta-)analyses. As far as I know, neither Mirkin, Geger nor the AHA have yet reviewed their position in the light of the very large updated meta-analysis published on 30 September.

      Also, Dr Mirkin hasn’t to my knowledge considered omega 3 supplements in the context of preventing dementia and so hasn’t expressed an opinion on this point.

      The linus Pauling Institute at OSU concludes that the evidence on omega 3 supplements and Alzheimer’s and cognitive decline is mixed.

      1. Thanks Fumbles! I was looking earlier at Mirkin’s site for omega 3 / Alzheimer’s notes but only found this page which was interesting nonetheless.
        I thought it worth posting the link since Friday’s video was about our microbiome, and here we have yet another connection to very important health outcomes. Though omega 3 is not specifically mentioned, the idea of an anti inflammatory diet is, along with exercise, achieving healthy weight, etc.

  12. I was just looking at the difference between DHA and EPA on biomarkers.

    Supplementation with DHA compared with supplementation with EPA led to a greater reduction in interleukin-18 (IL-18) (-7.0% ± 2.8% compared with -0.5% ± 3.0%, respectively; P = 0.01) and a greater increase in adiponectin (3.1% ± 1.6% compared with -1.2% ± 1.7%, respectively; P < 0.001). Between DHA and EPA, changes in CRP (-7.9% ± 5.0% compared with -1.8% ± 6.5%, respectively; P = 0.25), IL-6 (-12.0% ± 7.0% compared with -13.4% ± 7.0%, respectively; P = 0.86), and tumor necrosis factor-α (-14.8% ± 5.1% compared with -7.6% ± 10.2%, respectively; P = 0.63) were NS. DHA compared with EPA led to more pronounced reductions in triglycerides (-13.3% ± 2.3% compared with -11.9% ± 2.2%, respectively; P = 0.005) and the cholesterol:HDL-cholesterol ratio (-2.5% ± 1.3% compared with 0.3% ± 1.1%, respectively; P = 0.006) and greater increases in HDL cholesterol (7.6% ± 1.4% compared with -0.7% ± 1.1%, respectively; P < 0.0001) and LDL cholesterol (6.9% ± 1.8% compared with 2.2% ± 1.6%, respectively; P = 0.04). The increase in LDL-cholesterol concentrations for DHA compared with EPA was significant in men but not in women (P-treatment × sex interaction = 0.046).

    DHA is more effective than EPA in modulating specific markers of inflammation as well as blood lipids. Additional studies are needed to determine the effect of a long-term DHA supplementation per se on cardiovascular disease risk. This trial was registered at as NCT01810003.

      1. Interesting bit from the link you posted, Barb:

        “A. The VITAL results suggest that you may not receive a benefit. You should continue to include fish in your diet instead of switching to an omega-3 fatty acid supplement. It is unlikely that all of the health benefits of fish consumption can be achieved with omega-3 supplementation. For example, people who eat fish tend to eat less red meat and less saturated fat, and some of the benefits of fish consumption are likely attributable to avoiding relatively unhealthy foods.”
        – – – – –

    1. Barb, I’m not one who’s looking forward. Fasting is okay, but only if it’s a “must” for some reason. Otherwise, my 14hour “fast” is fine with me so far.

      But I agree with this statement:

      “I would like to see a ‘What Dr Greger Eats in A Day’ video.”

      And he should do more than just recite the list. He should demonstrate…maybe throw back a few bites of something or other for the folks. Yeah, that should be…..entertaining. :-)

  13. Dr. G probably has a good point about the synergy. Still, don’t forger the benefits of vitamin D3 from supplements or sunlight, you will never get enough from food(same may go for vitamin K2). And here is a study which finds very worthwhile benefits for fish oil supplements, and also refers to several other studies which do the same. The benefit vs placebo are like 25% less heat attack/stroke, or in one study 51%: “The respective final adjusted hazard ratio for DHA concentration and risk for HF was 0.51 (95% CI, 0.38-0.70). Combining DHA and EPA concentrations, the hazard ratio for HF per log increase in plasma concentration was 0.54”. So, though you are rarely going to hear about it from your doctors, supplements have been shown to be of significant benefit, sometimes. But don’t expect many studies on something non-prescription, unless the results look bad.

      1. I don’t think the newest one I linked to, which was published in 2019, has been debunked, has it? It also referred to several other studies showing benefits, I will have a look at Dr. G’s link to see if some of thos have been debunked.


      On the other hand, should we just ignore studies like this one below?…..

      ‘Conclusion The top quartile of plasma PC DHA level was associated with a significant 47% reduction in the risk of developing all-cause dementia in the Framingham Heart Study.’

      There is no credible evidence of harm from algal DHA so wouldn’t it be the prudent option.

      1. Dr Fumblefingers: “There is no credible evidence of harm from algal DHA so wouldn’t it be the prudent option.”

        Fred Hutchinson Cancer Research Center: “The consistency of these findings suggests that these fatty acids are involved in prostate tumorigenesis and recommendations to increase long-chain omega-3 fatty acid intake, in particular through supplementation, should consider its potential risks.”

        1. That particular study has been criticised as ‘junk science’

          The criticisms include that the study ignored both other relevant scientific literature and the role that the cancer process itself plays in altering fatty acid metabolism.

          If we accept your apparent belief that the associations in that study are 1) causal and 2) high DHA promotes cancer rather than cancer promoting metabolic fatty acid changes, we are then also led to the unusual even stunning conclusion that high trans fatty acid levels protect against cancer.

          1. ‘Dr’ Fumblefingers: “That particular study has been criticised as ‘junk science’”

            Personally, I do not based my argumentation on particular studies (and even less on cohort studies prone to a myriad of cofounding factors). I base my argumentation on logics, pointing out that some studies establishes a link between DHA and some diseases, not judging if it is correlation or causation, which would need further studies, and that no serious interventional study legitimate the supplementation of DHA for brain health or health in general.

            What I am saying is that:

            1) DHA is not an essential fatty acid (while ALA and LA appears to be)
            2) Oils are not a naturally occuring food, neither fish oil nor algae oil
            3) Oils are contaminated by toxins because they are refined products (both animal derived oils and plant-based oils)
            4) Oils and fats in general increase the absorption of toxins into the organism and into the brain
            5) Only the body knows better for itself how much it needs of a particular subproduct (like DHA) that it creates by itself and into the context where it is needed.

              1. Actually, BOTH DHA and ALA consumption from food have zero benefit studies and positive studies.

                But no matter what fish is toxic and getting worse. And increases the risk of suicide and heavy metal poisoning and PCB’s and Microplastics and each year those pollution numbers go up.

                    1. Fish can make brain problems worse

                      Excessive seafood intake, which they defined as like more than three to four servings per month of fishes, like tunas or snappers, elevates mercury levels and causes cognitive dysfunction. Cognitively eating 3 to 4 servings of fish per month causes a 5% decrease in cognitive function.


                      Higher current fish consumption predicted worse cognitive performance, and greater past fish consumption in childhood predicted slowed perceptual speed and reaction time. This may be due to neurotoxic contaminants, such as mercury, in fishes. We’ve known that the developing brain is particularly sensitive to the damaging effects of mercury, but maybe the aging brain is as well…..

                      pollutants like mercury and PCBs in seafood that have been related to cognitive impairment and Alzheimer’s disease…..

                      The same cognitive functions disrupted in adults, like attention, fine motor function, and verbal memory, are similar to some of those previously reported in children exposed in the womb. And the adults exposed to mercury through fish consumption didn’t just have subtle EEG brain wave changes or something, but observable deficits in neurobehavioral performance measures—for example, poorer performance on tests of fine motor speed, and dexterity, and concentration. Some aspects of verbal learning and memory were also disrupted by mercury exposure, and the greater the mercury levels, the worse they did.

                    2. PCB’s from fish are linked to Prostate cancer.


                      Fish raises IGF-1 causing cancer to spread more.


                      PCB’s and IGF-1 are both linked to many diseases, including Diabetes and Cancer and Hepatitis and Thyroid problems.



                    3. The PCB’s from fish are linked to Parkinson’s and Alzheimer’s and Dementia



                      From Peta’s page

                      Dr. Susan L. Schantz of the University of Illinois College of Veterinary Medicine has been studying fish-eaters since 1992 and has found that people who ate 24 pounds or more of fish per year have problems with learning and memory. (On average, people around the world consume 40 pounds of fish per year.) She found that fish-eaters often have high levels of PCBs in their blood and thus have difficulty recalling information they learned just 30 minutes earlier. Says Schantz: “It had been assumed that mature adults are less susceptible [to PCBs] than are developing fetuses. This may not be the case.” Some fish-eaters in her study had high levels of lead, mercury, and DDE (formed when DDT breaks down) in their blood.30 Even low concentrations of lead can cause mental retardation and physical disability in children. Higher levels can lead to learning disabilities, behavioral problems, seizures, and even death.

                      Finally, in August 2004, scientists from Indiana University warned that industrial-strength fire retardant is showing up in salmon flesh worldwide.

                    4. Over cooked fish or blackened fish exposes people to AgEs

                      Undercooked fish exposes people to parasites and salmonella.

                1. Algae can be toxic and contaminated too. And refining algae into oil also lead to contamination. but most importantly, all oil in excess may increase the absorption of toxins into the blood stream and into the brain.

                    1. Whether it is toxin free or not, it doesn’t matter: oils help the absorption of toxins into the body and brain, and oils trigger the production of bile acids which are linked with neurodegenerative diseases. As was saying Dr Greger in another article: “we are fatty heads” and bile acids love to digest fats. They are like zombies who feed on your brain, when you are sleeping.

                    2. >>> As was saying Dr Greger in another article: “we are fatty heads” and bile acids love to digest fats. They are like zombies who feed on your brain, when you are sleeping.”

                      Could you or someone else familiar with this quote, please supply the reference. I cannot form an opinion or response without reading/listening to the context or evaluating the references.

                      I cannot see where you have supported the statement “oils trigger the production of bile acids which are linked with neurodegenerative diseases.”, let alone connected that to nut/seed eating, whose effects are known to be quite different from extracted oil ingestion and generally beneficil.

                      Your posts on this as far as I am aware (there are so many posts back and forth and limited time that I might be overlooking something) either indicate therapeutic roles for specific bile acids or address specific cases like cocaine addiction and not metabolism in normal people. As far as I can tell, neither of those support your contention that eating nuts/seeds creates excess bile acid, which then crosses the blood-brain barrier and from there gobbles up brain matter, causing dementia or other neurological disorders. If this were so, autopsies would have revealed the brain wasting effects of digestive bile acids as the root cause of Alzheimer’s or other kinds of brain diseases. I am not aware of any such evidence or treatment related to that.

                      If you have references, please supply some of them. I am always ready to learn something new

                      In any event the amount of fat in a low dose DHA/EPA supplement is de minimus. For example, the 200 mg of DHA/EPA per cap in the brand I now take (Deva vegan Omega 3 DHA/EPA) has 0.5 mg of fat (~5 calories), mostly from sunflower oil.

                      Are you telling me people should worry over that amount of fat from oil?
                      That’s the least of my nutrition concerns.

                      Keep in mind that the long-lived Okinawans, often used to support ultra low fat WFPB diets, got DHA/EPA directly from fish and pigs. This indicates that although their diets were ultra-low fat, their O6:O3 fatty acid ratios were within a healthful range. Some of the studies posted here or that I have seen (can’t quite keep track of all the posts) have focused on the role of O6:O3 ratios rather than absolute amounts of various fatty acids.
                      In my view, those advocating ultra low fat diets tend to overlook or minimize this aspect, as well as overlook the fact that people differ in their conversion rates (cf. the Linus Pauling Institute reference provided by FF). Fuhrman’s recommendation, e.g., is based on his clinical experience, which you and Jeff Nelson simply dismiss out of hand, not just on his interpretation of various studies.

                      Note further that in various studies the deleterious effects of high fat diets are really about high saturated fat diets, a crucial but seemingly almost always overlooked but critical difference.

                      I think you provide a valuable service by challenging people to reconsider their assumptions and then dig into the science to try to decide what to believe. But as I said, I think your overall model lacks essential specifics that are critical in supporting your strong claims ( basically, as I understand it: “excess” fat including from nuts ==> excess bile acid creation ==> crossing of blood-brain barrier by excess bile ==> brain matter digestion by excess bile ==> dementia). After all, the validity of your claims rests on the truth of your various premises.

                      I hope you will be able to provide solid evidence for your claims as that would be truly interesting.

                    3. I see we are running out of reply real estate on the website.

                      >>>But exogenous bile acids produced by dietary fats can leak into the bloodstream, arrive into the brain and feast onto sane part of the brains.
                      This low-grade intoxication of the brain by bile acids and other acids might be the cause of neurodegenerative diseases.

                      This is precisely what you have not supported. I note your hedges “might”, “can”, which are significant. Might not, too.

                      Even were this true, there is the crucial issue of cause and effect. The various damaging agents found in the brains of e.g. Alzheimer’s patients like excess Al, Fe, etc. could be the result of antecedently damaged blood-brain barriers, not the result of eating “excess fat”, at least ‘healthy fats’ (saturated fat is another matter as it makes cell membranes stiffer, as I recall). The issue then would be what initially damages the blood-brain barrier. (No doubt you’d claim excess bile acids from digestion.)

                    4. Endogenous bile acids produced by the brain help the brain to remodel itself and give to it its plasticity. But exogenous bile acids produced by dietary fats can leak into the bloodstream, arrive into the brain and feast onto sane part of the brains. This low-grade intoxication of the brain by bile acids and other acids might be the cause of neurodegenerative diseases. It is not DHA deficiency that causes dementia amongst vegan, but most likely a lifestyle with daily nuts and salad dressings.

                    5. The only way for DHA to be really effective (in theory) for limiting brain shrinkage would be to bypass the ingestion process and to directly inject it into the brain through cranial intervention. Not very pleasant nor desirable for everyone…

                      Because if you ingest it, the algae oil will trigger bile acids production that will further shrink the brain in an endless circle.

                      So DHA supplementation is not a solution, rather a low fat diet is a solution.

        2. Perspective from the European Food Safety Authority

          ‘Supplemental intakes of EPA and DHA combined at doses up to 5 g/day, and supplemental intakes of EPA alone up to 1.8 g/day, do not raise safety concerns for adults. Dietary recommendations for EPA and DHA based on cardiovascular risk considerations for European adults are between 250 and 500 mg/day. Supplemental intakes of DHA alone up to about 1 g/day do not raise safety concerns for the general population. ‘

          1. EFSA’s recommendations are business oriented. It is not because the biology naturally produces a molecule into the body, that this particular molecule has to be marketed as a supplement.

            This is exactly what the industry is doing with DHA, and with other bological molecules as well, but without any real scientific basis.

    2. Incidentally, while I am not a follower of Fuhrman and don’t approve of his selling supplements, I think that Nelson’s personal attack on him really is pretty unpleasant.and quite unjustified.

      The fact is that Fuhrman was simply expressing the mainstream scientific position about the need for PUFAs.

      As the World health Organization’s international expert consultation concluded in its report on ‘Fats and fatty acids in human nutrition”:

      ‘The minimum intake levels for essential fatty acids to prevent deficiency symptoms
      are estimated at a convincing level to be 2.5%E LA plus 0.5%E ALA (DACH, 2000).
      Based on epidemiological studies and randomized controlled trials of CHD events, the
      minimum recommended level of total PUFA consumption for lowering LDL and total
      cholesterol concentrations, increasing HDL cholesterol concentrations and decreasing
      the risk of CHD events is 6%E. Based on experimental studies, risk of lipid peroxidation
      may increase with high (>11%E) PUFA consumption, particularly when tocopherol intake
      is low (Elmadfa and Schwalbe, 1989). This value is only slightly different from former
      recommendations (WHO, 2003). Therefore, the resulting acceptable range for total
      PUFA (n-6 and n-3 fatty acids) is between 6 and 11%E. The adequate intake to prevent
      deficiency is 2.5–3.5%E. Thus, the recommended range (AMDR) for PUFA is 6–11%E.’

      The fact is that Fuhrman is expressing the orthodox scientific position on this issue. Nelson’s very unpleasant videos do not.

      It is entirely possible to have a civil exchange of views on this point and to debate the issue in a civilised manner. That is clearly not Nelson’s intention.

      If I didn’t think it was paranoid. I’d almost suspect him of being an agent provocateur especially since his family made its fortune from the Armour Meat Company. It’s probably just an overly passionate approach though.

    3. Wow, in this video, Dr G, who recommends DHA pills though he says in private there is no good science to support it, is showed to have a conflict of interest by receiving money from Dr Furhman (one of the main donators of who himself sells DHA pills and accuse everyone not recommending it to jeopardize the brain health of vegans… vegans being the main market of Dr Furhman for selling his supplement…

      1. Rubbish – where does he say in private that there is no good science to support it?

        You are very clearly a follower of Jeff Nelson …. misrepresenting the facts and accusing people whose position you don’t agree with of lying for money.

        1. Apparently, Dr G pointed out in a private email that if the studies in favor of the need of B12 supplementation for vegans may be noted 10 out of 10 on a range of evidence, studies on DHA would only be noted 1 out of 10.

          That is quite suspicious as there is no such nuanced public position of Dr G in, who clearly states that vegan may need to supplement DHA for brain health (since many year in his recommendations), based only on an interventional study comparing fish oil and sunflower oil in 30 elder overweight women not eating healthy and allowed to smoke about 9 cigarettes per day…

          Personally, I did not know about Jeff Nelson’s position before yesterday, and it is you who are constantly talking about him and seems to be obsessed with this person. Please do not bring me between you and Mr Nelson, as I do not have anything to do with what is between you and him, Mr Fumblefingers.

  14. Yet another criticism from the Journal of the National Cancer Institute of the claims by Brasky et al

    ‘First, the research used plasma phospholipid (PL) fatty acids as a measure of long-term intake of different fatty acids, but the literature regards plasma PL only as a measure of recent fat intakes ( 2 ). However, for the sake of our argument, let’s assume that plasma PL long-chain omega-3 fatty acids from blood taken some years ago can be used to grade risk of a disease many years later. The Brasky et al. study ( 1 ) reported levels of long-chain omega-3s that are in a very narrow range as follows: the no cancer group had mean levels of 4.48%, the low-grade cancer group had mean values of 4.66%, and the high-grade cancer group had levels of 4.71%. By way of comparison, vegetarians who consume no long-chain omega-3 have plasma PL long-chain omega-3 levels of 4.1% ( 3 ), and subjects fed a fish-rich diet for 2 weeks had plasma PL levels of 21.5% ( 4 ).

    Thus, the authors’ conclusion that a difference of 0.23% in omega-3 levels between the no cancer group and the high-grade cancer group is one that represents a biologically meaningful difference in long-chain omega-3 dietary intakes is fanciful. The statistics may give a P value implying significance, but the actual difference is so small as to be biologically irrelevant. The literature shows that this very narrow range of values is within the measurement error for these fatty acids. In fact, the authors suggest that all subjects had similar low dietary intakes. Thus, we believe the conclusions drawn substantially overstate the biological relevance of the research.’

  15. WHO recommends AGAINST supplements May of this year, including omega 3’s for the prevention of dementia. You can download the executive summary of their recommendations here

    In all of this mess, about the only thing I have come away with is the recommendation for consuming fish, and the warning to not take supplements because of rancidity, increase in cancer, raising of LDL, and because they are ineffective.

    1. Dementia, like other neurodegenerative diseases, are probably caused by oils and stomach acid reflux damaging the epithelial cells of the blood-brain barrier and leading to toxins and acid absorption into the brain, shrinking the brain because the primary role of acid is to digest fat and the brain contains lots of fat. No matter how much DHA you supplement, if bile acid is coming into the brain, it will continue to digest it from the inside.

          1. I’m confused. I thought the claim was something about bile acid(or something, can’t see the OP at the moment) eating our brains? This is all evidence of protection, isn’t it?”Neuroprotective effects of several bile acids are well documented in a wide range of neurodegenerative diseases, including AD, PD, ALS, HD, and retinal degeneration, in cellular and animal models and in human clinical trials.”

            1. Bill, you do not seem to understand how your brain works. Endogenous acids are used by the brain to remodel itself through fat “digestion” or degradation, the same way as bile acids do in the stomach.

              At night, during deep sleep, the brain “cleanses” itself through the glymphatic system by releasing cerebrospinal fluid collecting all the residues of fat degradation, as well as the toxins that go along with it.

              But if bile acids come into the brain, exogenous acids like bile acid, then that fat degradation may lead to an exogenous shrinkage of the brain and an alteration of mental functions, characteristic of neurodegenerative diseases.

              We already know that stomach acid reflux can cause ashtma, gingivitis, sinusites and potentially ocular problems too, and that bile acids can reach the blood and go into the brain. So, it is quite possible that exogenous bile acids are a cause of neurodegenerative disease.

              The brain knows how much to secrete it to remodel itself endogenously, but when this remodeling system is being altered by exogenous acids, then bile acids become detrimenatal to the brain.

              1. One means: if acids get into the blood and create acidosis, those acids, whether they are bile acids or stomach acids can enter into the brain and start digesting it, thus the neurodegenerative diseases.

          2. ab, Thanks very much for that very interesting study. Did you actually read it?

            The review discussed the role of bile acids in a variety of neurodegenerative diseases but note that in each case, the effects were positive (therapeutic)!

            From the article (note the word “neuroprotective”): “Conclusions and outlook

            Neuroprotective effects of several bile acids are well documented in a wide range of neurodegenerative diseases, including AD, PD, ALS, HD, and retinal degeneration, in cellular and animal models and in human clinical trials.”

            How does this support your model of excess stomach bile crossing the blood brain barrier and devouring the brain, causing dementia?

            Nevertheless I did learn some very interesting facts about the role of bile acid metabolism in neurodegenerative disorders and about the research on the potential treatment of neurodegenerative diseases using bile acids, for which I thank you.

    2. But people who do not eat fish have a 40% reduction of risk of heart attacks by taking Omega 3’s and many people will not do statins and other things that are part of why Omega 3 studies started failing when they used to succeed.

      1. There are things like Omega 3’s improve flow-mediated dilation, and lower blood pressure and lower Homocysteine and so many other things.

        Many people in these communities are saying that they are high in blood pressure still or high in triglycerides or high in Homocysteine and those are the types of things Omega 3’s are successful at, including the slowing the shrinkage of the brain.

      2. Deb, Good point.

        There are two distinct issues involved in these discussions.

        1. Is it better to eat fish or take a supplement?

        There are arguments on both sides and, in my view, no clear answer. (In good conscience, I could not, e.g., recommend to a friend or relative who eats oily fish in moderation per Dr.Mirkin’s recommendation that s/he would be better off taking a supplement.) Those afraid of contamination in fish (which to me is a bigger concern than possible contamination in high quality tested supplements) will supplement; those concerned about a possible increase in LDL from supplementation (not my experience) might sensibly choose fish. It’s a judgement call.

        2. For those like me who are not about to eat fish, is it wiser to take a supplement per Dr.Greger’s and Dr. Fuhrman’s recommendation or to take nothing and rely on ALA conversion. The issues for are relatively well known (possible poor conversion of ALA, possible bad omega 6: omega 3 ratios, especially among many vegans, etc.). The studies being debated do not sort out this latter question. Each option comes with potential risks and benefits. I’m going to keep supplementing. Those prostate cancer studies are not convincing to me.

        Regarding Dr.Klaper, it bothers me that he advocates not eating fish and not taking even a low algal dose supplement based on what seems to me rather shaky grounds. This could well be a disservice to some vegans. But they would not realize that for many years, perhaps decades.

    3. Thanks Barb.

      That WHO paper states that the recommendation to not take supplements only applies to people without nutrient deficiencies;

      The WHO paper on ‘Fats and fatty acids in human nutrition’ states that people should consume more than 15% of total calories as fat. It also notes

      ‘ Therefore, the resulting acceptable range for total PUFA (n-6 and n-3 fatty acids) is between 6 and 11%E. The adequate intake to prevent deficiency is 2.5–3.5%E. Thus, the recommended range (AMDR) for PUFA is 6–11%E.’

      I don’t eat fish and walnuts.flax seed/chia seed are unavailable where I live (or prohibitively expensive when they do appear). For people eating a low fat WFPB diet that is completely vegetarian, it seems to me that supplementation is essential to prevent deficiency.

      1. I agree with you Fumbles, I really do. From everything I have read (which is not everything, not by a long long shot), including Adventists, guys are better off sticking to zero animal products or close to it, and wfpb. I hear you re the difficulties in what you can buy there. I would do the same as you and get the best supplements I could afford.

        In many cases I have read about, women do not reap the full benefits of some diet/supplement tweaks that guys do. Not sure why… something to explore as a scientist in my next life I guess. I am not really thrilled with the idea of fish. (i tend to like the expensive kinds lol) The supplements raise my cholesterol if I take it daily. I do flax, a walnut or two, and greens. I am looking forward to more study results on these topics since it seems they are reporting dementia rates are starting to go down!

        Thanks for all of your posts and links (i have quite a collection saved now)… it has helped me get a clearer picture, and I’m sure it helped others too.

      2. Mr Fumblefingers, are you suggesting that people eating plant-based are nutritionally deficient ?

        First, there is no RDA for DHA, that simply does not exist. There is just a suggested “daily intake”, which is a wrong expression because DHA is first and foremost produced by the body through ALA.

        If you look at this presentation by Dr Tim Radak, even without walnuts and flax seeds, you can get all the daily intake that has been suggested, by having a reasonably diverse plant-based diet.

        In fact, if you follow Dr Greger’s daily dozen as you seem to do, even without nuts, seeds algae or fortified foods, you certainly have no issue to reach the suggested “daily intake”, just by eating normal foods.

        There is absolutely no such thing as DHA deficiency in the context of healthy eating.

        Dr Tim Radal’s slides:

      3. Mr Fumblefingers, are you suggesting that people eating plant-based are nutritionally deficient ?

        First, there is no RDA for DHA, that simply does not exist. There is just a suggested “daily intake”, which is a wrong expression because DHA is first and foremost produced by the body through ALA.

        If you look at the presentation by Dr Tim Radak (towards 50 minutes), he shows that even without walnuts and flax seeds, you can get all the daily intake that has been suggested, by having a reasonably diverse plant-based diet.

        In fact, if you follow Dr Greger’s daily dozen as you seem to do, even without nuts, seeds algae or fortified foods, you certainly have no issue to reach the suggested “daily intake”, just by eating normal foods.

        There is absolutely no such thing as DHA deficiency in the context of healthy eating.

    1. Yes, but they would do fish and oil in The Mediterranean diet and I don’t do either and DHA does lower the risk of heart attack by 40% in non-fish eaters and did slow the shrinking of the brain in elderly people and lowers risk factors like blood pressure, triglycerides, flow mediated dilation, resting heart rate, improves the function of the endothelium and I can’t control things like sleep, but I can improve the other risk factors and improving the risk factors is why I take it.

        1. In that study where everyone was on the Mediterranean Diet Fish didn’t benefit cardiovascular risk at all.

          Only vegetables and nuts did.

          Nuts cut the stroke risk in half and improved the plaque to the brain which is what they believe is linked to dementia.

          1. That might mean that most people can just eat ALA, but not everyone is good at converting and people like Jeff Nelson try to get people to not eat nuts as a way to have less competition for conversion, but in people eating Mediterranean it was the nuts that was more effective not fish.

            1. People are very good at converting ALA to DHA, but the body does not need to massively convert it, that’s why the rate is very slow, but less when you are a very young infant. Your body is more intelligent than the supplement industry.

              DHA deficiency is not a cause of neurodegenerative diseases… They are caused by exogenous acids coming into the brain and altering the normal pathways of brain remodeling via endogenous acids.

              Disruption of the bile acids profile into the brain is the cause of neurodegenerative diseases. Low-grade intoxication of the brain with exogenous bile acids lead to the onset of dementia over time, and this is caused by food poisoning with animal products, processed foods and high fat diets.

            2. It is not because there is the syllab ‘nut’ in the word “nutrition” that you should eat nuts. The etymology of the words “nut” and “nutrition” are not the same. Don’t be confused by words which sound similar but have nothing in common.

            3. Dr Furhman’s sells DHA supplements in order to avoid brain shrinkage but at the same time recommends a high fat diet with nuts and salad dressings, that will increase acid production.

              Those acids may arrive into the brain and digest sane parts of it leading to Parkinson’s disease, which is associated with a damage to a part of the brain in charge of dopamine creation.

              We already know that bile acids alter this part of the brain by diminishing dopamine creation in animal models addicted to cocaïne.

              Nuts consumption may be a cause of Parkinson’s disease in vegans.

              1. >>> Dr Furhman’s sells DHA supplements in order to avoid brain shrinkage but at the same time recommends a high fat diet with nuts and salad dressings, that will increase acid production.

                This is not accurate. Fuhrman recommends a very low dose DHA/EPA supplement (~275 mg/d) and a minimum of 15% cals fat from nuts/seeds and avocados, and absolutely no oils. 15% fat is the same as the minimum recommended by WHO. He does allow higher amounts for those who are slim/underweight or athletic ( up to ~30%). You are also apparently oblivious to the key fact that the latter group burn whatever fat is absorbed (~70-80%) derived from nuts/seeds, and benefit from the vitamins, minerals and phytonutrients provided (I know as I am one of those people, maintaining a BMI of 18.5 on a diet including probably a cup of mixed nuts and 5 TBL of ground seeds (flax, chia, sunflower and pumpkin) per day).

                You are also overlooking the fact that his recommendations, which are based on his clinical experience and judgement, are tailored to the specific needs and circumstances of those adopting his recommendations (I know b/c I read a number of his forum posts).

                Cf. for a neutral source from a non-vegan doctor who pays close attention to the science and sells no supplements:


                *How Nuts Lower Cholesterol and Triglycerides* Nuts lower cholesterol and triglycerides because they are good sources of soluble fiber which cannot be absorbed in your upper intestinal tract. The soluble fiber passes unabsorbed to your colon where bacteria ferment it to form short-chain fatty acids that are absorbed from your colon into your bloodstream. Short-chain fatty acids lower cholesterol by traveling to your liver where they prevent your liver from making cholesterol. Nuts lower triglycerides because soluble fiber is a gel that sticks to other components in foods that you eat to reduce the absorption of calories in your upper intestinal tract. All extra calories can be converted by your liver to triglycerides, so reducing calories lowers triglycerides.”

                In my view, your model of the relationships among food / nutrient intake, metabolism and health effects is overly simplistic and not generally supported by science or clinical results.

                1. The issue is that even very low doses of dietary fat trigger bile acid productions, so removing oils but eating nuts every day or salad dressings made with nuts will trigger bile acid synthesis from cholesterol in the liver, as those fats need to be processed by the body, because the body have no use for them biologically as is.

                  Those fats have to be assimilated, which require energy, and for that they have to be transformed into glucose or, if they are in excess, be stored. So cholesterol is used by the liver to transform fats into glucose by the synthesis of bile acids.

                  A part of those bile acids when released into the bloodstream via the enterohepatic circulation may then end up into the brain, as exogenous bile acid.

                  Those exogenous bile acids may disrupt cholesterol homeostasis into the brain.

                  “When bile acids are secreted into the intestine, >90% are reabsorbed into the portal system via the enterohepatic circulation and are recycled into hepatocytes (1). However, in disease states where there is a disruption of this reuptake, there is a spillover of bile acids into the circulation that can produce a variety of pathological effects. Recent research has indicated that bile acids and bile acid signaling can influence a variety of neuropathological conditions.”

                  Effects of bile acids on neurological function and disease

                  1. Thanks, I will look at that when I have more time.

                    But I noticed that the quote refers to ****reuptake disruption in disease states**** leading to spillover.

                    ” However, in disease states where there is a disruption of this reuptake, there is a spillover of bile acids into the circulation that can produce a variety of pathological effects. ”

                    That’s a very interesting point, and I have learned something new.

                    But my question, and the one I think most important, is what leads to the antecedent disease state? I am skeptical it results from eating a lot of nuts/seeds but admit I do not know.

                    1. Contrary to the author who speaks of “disease states” for the spillover, one would be tempted to say that the more bile acid is produced by the liver, so supposedly the more fat there is into the diet, the more there are bile acid molecules “spilling over” into the bloodstream.

                      Because mechanically, the liver might not be 100% efficient in reuptaking the bile acid, and is prone to be even less efficient, statistically, if there are a lot of bile acids circulating into the bloodstream…

                      So one would say that the higher in fat the diet is, the more bile acid can make its path into the brain, and any fatty food into the diet will comparatively produce more spillover into the bloodstream than any other less food with less fat in it.

                      Thus, in matter of brain health and longevity, there may be no safe intake of fat, as any intake of fat may trigger detrimental effects on the brain through the spillover of bile acids into the bloodstream.

                      But of course, there are surely other factors contributing to brain health as well ,like the quality of sleep, and the quality of one’s mind in the daytime: for example, is the mind constantly occupied, in conflict or in contradiction within itself ? Or is it rather “calm”, “still” and using thought only when necessary ?

                      Because apparently, the brain cleanses itself from fat residues and toxins via the glymphatic system only when the brain is “still” and not occupied or in contradiction (for example at night: not in dream state but in deep sleep).

                    2. You are speculating, in my view, rather wildly, without any substantial support.

                      Unless I missed something, the studies you cite suggest providing various types of bile acids as therapeutic agents for various neurological disorders resulting from genetic SNPs, liver failure, traumatic brain injury to Alzheimer’s disease, e.g.
                      — “several other neurological diseases such as stroke and ALS can be improved by bile acid supplementation” or — “certain bile acids may have the capacity to mitigate apoptosis and inflammation associated with traumatic brain injury”.

                      It is true that bile acids are important signaling molecules found in the brain and in certain disease states, found to be elevated. But that does not show that they are the culprit in any of these disorders. Rather they are presumably raised because they are therapeutic (reduce inflammation and neuronal cell apoptosis).

                      In the studies you have cited, I have not come across one instance of authors mentioning bile acids spilling over into the brain and gobbling up brain matter. If this were a concern or a finding, I’d think it would be front and center in any overview.

                      You are welcome to your own speculations with all of your hedges, but citing studies that seem to provide no support for them does nothing to persuade me to take your claims seriously.

                      I don’t really have more time to understand or debate your speculations but it has been fun to learn more about the role of bile acids as signaling molecules in the brain.

                    3. I may push the hypothesis further in saying that heart disease might be caused by that spillover of bile acids into the bloodstream, consequently to high fat meals…

                      The bile acids might be the first factor of deterioration of the epithelial cells in the arteries, triggering inflammation and altering its structure…

                      That’s why a very low fat plant-based diet (without nuts) seems to work so well in Esselstyn’s trial…

                    4. And I may push the hypothesis even further by saying that high fat meals, or nuts into the salad, because they allow a better absorption of antioxydants, is also the cause of cancer progression…

                      According to James Watson, cancer progression is due to antioxydants prevents apoptosis of cancer cells by interacting with Reactive Oxygen Species(ROS), that he calls a “force of life”.

                      So dietary fats may be the cause of neurodegenerative diseases and of heart disease by encouraging the spillover of bile acids into the bloodstream, and the cause of cancer progression via the absorption of plant antioxydants preventing the death of cancer cells…

                    5. Yes, I know about the claim of Watson, since I’m the one who posted that, but you are getting far ahead of what is established. Watson was presenting a theory, widely criticized. And even if correct, it would not necessarily hold that eating lots of whole food nonstarchy vegetables, fruit, grains, legume and nuts/seeds, as opposed to supplements, would drive such a response. All the evidence I have seen indicates the opposite. There is more to phytonutrients than antioxidant effects.

                      Don’t hold on to an overly simplistic picture. Reality often does not conform to our simple, intuition-based models, and nutrition is no exception.

                    6. No bile acid signaling occurs into the gut through secondary bile acid.

                      Once bile acids enter into the bloodstream and are not reuptaken by the liver:

                      “there is a spillover of bile acids into the circulation that can produce a variety of pathological effects”

                      as the author of the study pointed out:

                      Those pathological effects include, it seems to me: heart disease and neurological diseases.

                    7. Acid reflux clearly is not a therapeutical effect: it burns the epithelial cells and triggers quite a lot of symptoms (GERD).

                      Heart disease is the “GERD” of the vascular system via bile acid spillover into the arteries.

    1. Going back to the Mediterranean Study, there was no benefit from fish on cardiovascular issues.

      But it is a benefit if people are eating SAD.

      DHA isn’t a benefit in the age of statins, but it is a benefit for people who don’t eat fish, even in the studies who Omega 3’s failed, they succeeded at preventing heart attacks for non-fish eaters.

      1. But fish had no benefit when they tested it within the Mediterranean Diet so Omega 3’s might not either if people are eating nuts and eating the Mediterranean diet levels of vegetables.

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