Image Credit: Chaval Brasil / Wikimedia Commons. This image has been modified.

The Risks and Benefits of Taking Low-Dose Aspirin

Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory painkiller in the form of willow tree bark extract, which Hippocrates used to “treat fever and to alleviate pain during childbirth.” It became trademarked as a drug named Aspirin™ in 1899 and, to this day, “remains the most commonly used drug in the world.” One reason for its on-going popularity, despite the availability of better painkillers now, is that aspirin also acts as a blood thinner. Millions of people take aspirin on a daily basis to treat or prevent heart disease, which I explore in my video, Should We All Take Aspirin to Prevent Heart Disease?.

It all started in 1953 with the publication of the landmark study “Length of life and cause of death in rheumatoid arthritis” in the New England Journal of Medicine. The paper began with the sentence: “It has often been said that the way to live a long life is to acquire rheumatism.” The researchers found fewer deaths than expected from accidents, which could be explained by the fact that people with rheumatoid arthritis likely aren’t skiing or engaging in other potentially risky activity, but they also found significantly fewer deaths from heart attacks. Why would this be? Perhaps all the aspirin the subjects were taking for their joints was thinning their blood and preventing clots from forming in their coronary arteries in their heart. To find out, in the 1960s, there were calls to study whether aspirin would help those at risk for blood clots, and we got our wish in the 1970s: studies suggesting regular aspirin intake protects against heart attacks.

Today, the official recommendation is that low-dose aspirin is recommended for all patients with heart disease, but, in the general population (that is, for those without a known history of heart disease or stroke) daily aspirin is only recommended “when the potential cardiovascular [heart] disease benefit outweigh the risk of gastrointestinal bleeding.”

The bleeding complications associated with aspirin use may be considered an underestimated hazard in clinical medical practice. For those who have already had a heart attack, the risk-benefit analysis is clear. If we took 10,000 patients, daily low-dose aspirin use would be expected to prevent approximately 250 “major vascular events,” such as heart attacks, strokes, or, the most major event of all, death. However, that same aspirin “would be expected to cause approximately 40 major extracranial bleeding events,” meaning bleeding so severe you have to be hospitalized. Thus, the net benefit of aspirin for secondary prevention—for example, preventing your second heart attack—“would substantially exceed the bleeding hazard. For every 6 major vascular events prevented, approximately 1 major bleeding event would occur; therefore, the value of aspirin for secondary prevention is not disputed.”

If we instead took 10,000 patients who hadn’t ever had a heart attack or stroke and tried to use aspirin to prevent clots in the first place, that is, for so-called primary prevention, daily low-dose aspirin would only “be expected to prevent 7 major vascular events and cause 1 hemorrhagic stroke [bleeding within the brain] and 3 major extracranial bleeding events.” So, the benefits are approximately only 2 to 1, which is a little too close for comfort. This is why the new European guidelines do not recommend aspirin for the general population, especially given the additional risk of aspirin causing smaller bleeds within the brain as well.

If only there were a safe, simple solution free of side effects…and there is! Drs. Ornish and Esselstyn proved that even advanced, crippling heart disease could not only be prevented and treated, but also reversed, with a plant-based diet centered around grains, beans, vegetables, and fruits, with nuts and seeds treated as condiments, and without oils, dairy, or meat (including poultry and fish).

Long-time director of the longest-running epidemiological study in the world, the famous Framingham Heart Study, “Dr. William Castelli was asked what he would do to reverse the CAD [coronary artery disease] epidemic if he were omnipotent. His answer: ‘Have the public eat the diet of the rural Chinese as described by Dr. T. Colin Campbell…’” In other words, “‘If Americans adopted a vegetarian diet, the whole thing would disappear,’ Castelli says of the heart disease epidemic.”

Dr. Esselstyn clarified that we’re not just talking about vegetarianism. “This new paradigm” of heart disease reversal means “exclusively plant-based nutrition.”

Did you know preventing heart disease and stroke aren’t the only benefits of an aspirin a day? A daily aspirin may also decrease the risk of certain cancers. In that case, should we take an aspirin a day after all? See Should We All Take Aspirin to Prevent Cancer? and Plants with Aspirin Aspirations.

For more on preventing, arresting, and reversing heart disease, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live 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.

216 responses to “The Risks and Benefits of Taking Low-Dose Aspirin

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  1. As much as I am enthusiastic about wfpb eating, I wince every time someone uses the word “reversal”. I know what plants can do, and I wouldn’t call it reversal. In the link below, T Colin Campbell responds on the show “second opinion” to interviewer’s questions about recovery from heart disease. A gentleman with artery blockages took on the wfpb lifestyle, and started running… running marathons eventually. Point is, said the interviewers, the blockages remain. T Colin Campbell concedes this fact, and says that it’s how we define ‘reversal’.

    From my doctor’s perspective, assuming a healthy lifestyle and maintaining a trim weight is square one. In addition, prescribed aspirin, lipitor, and bp meds can have substantial benefits for secondary prevention. But we take a day at a time, and leave proclaiming miracles and sensational words like ‘reversal’ to internet medicine.

    1. Barb,

      My brother was diagnosed with T2 diabetes about 15+ years ago when he was overweight and out of shape. Long story short, he changed his lifestyle, starting eating plant based food (eventually whole plant foods, low sugar, oil, and salt), and started exercising, and he gradually lost weight and eventually went off all his meds, including for T2 diabetes.

      I asked him once if he was still considered a diabetic, since he hasn’t taken his med for a few years now (the dose was decreased over the years), and he replied “Yes.” I guess his diabetes is in remission? Because I considered it reversed. But my cancer is in remission; I don’t think it ever gets reversed.

      I think that WPF eating can slow, stop, or even reverse some diseases or conditions. But not always, and not in every person. It may depend on what exactly a person eats. Or an individual may have other underlying causes.

      And, as is pointed out in “How Not to Diet,” even folks with a “trim weight” can have abdominal or visceral fat, which is apparently worse for their health. And how exactly is a “healthy lifestyle” defined? Especially a healthy diet? Because I know people who claim to eat a “healthy diet,” but their weight suggests otherwise

        1. Barb,

          Dr Ornish being able to have someone no longer need a heart transplant is pretty sensational to me.

          Also, the plaque going away over time so that there are no longer blockages also is pretty sensational.

            1. Dr J.

              There are pretty sensational statistics and we can just use those.

              With Diabetes, over 90% of the people can reverse it with a WFPB diet if they are within 4 years of their diagnosis.

              You can tell them to take a C-Peptide test and they can know whether they have a 90% success rate potential or a 50% success rate potential or whether they are only 5% likely to succeed with diet.

              But there are people in that 5% category who have succeeded and having hope is the only reason people do a process like this.

              1. As far as “Is it reversed” goes….

                If his pancreas beta cells are producing insulin and he can eat carbs without taking medicine, then that is different from Keto which manages blood sugar by having you not eat carbs.

                Keto is NOT a reversal.

                The pancreas doesn’t function normally by going on it.

                For many, many people who had Diabetes, the fat comes out of the pancreas and the pancreas functions normally so I do consider that a real reversal versus a management of symptoms.

                For the blocked arteries it is directionally reversing the condition. Not just stopping the progression. Eventually, they can scan you and the blockages are gone and that is a genuine reversal.

                Yes, it is the diet over time and if you go back to artery-clogging foods, it will come back, but the scans will get better and better over time if you really do Dr Esselstyn’s process and better and better means a reversal.

              2. Deb,

                Actually, I became a vegetarian almost 50 years ago for environmental and sustainability reasons. More recently, I’ve added health and animal and industry worker welfare reasons, as well as greenhouse gas emissions. I also moved to WPF eating, dropping the dairy products and eggs. (As the cook in the household, I dragged my husband along with me — but he’s all the better for it. And my brother and I exchange food tips and recipes.)

                But to me, it stands to reason if diseases/conditions are called “lifestyle” diseases/conditions, because a high percentage of them are caused or exacerbated by lifestyle, then changing lifestyle to a healthier one, such as WPF eating and exercising, could reverse or alleviate a high percentage of the same disease/conditions.

              1. Gengo,

                Yes, I agree.

                Real angiograms are better, but the whole point was that it wasn’t a slowing in progression. It is a regression. And people plural in these studies have experienced reversals.

                Yes, the studies were small.

                Yes, whole generations may die before there are enough WFPB studies for people to even have heard of it.

                1. I don’t even know one person who has heard about it at all ever even on the internet and especially not from their doctors.

                  I have 2 relatives in their advanced age and their sons are people who are very interested in science and one of them did medical research, but none of them have ever heard about WFPB and the 2 relatives are struggling to eat because they didn’t like Meals on Wheels all that much and all of the food delivery and aides are all meat all the time. One of them has a blocked artery which has started contributing to dementia. So, can I make them meals and unblock the artery, which will be scanned again next year? Or is it all a bunch of bunk and there is nothing at all people can do? The thing is, cooking for them will be a lot, lot, lot of work and mentally, it wouldn’t be worth it unless it would actually help them because there are plenty of meat dinners at the grocery store, which can be delivered. There just aren’t any WFPB meals. I do believe in WFPB and do suspect it might help, but it does take a real strong belief to do the work.

                  1. Deb,

                    Knowing about WPFD doesn’t mean that anybody will change.

                    I think I’ve said this before: My brother had a friend with T2 diabetes, and my brother, during a visit (or maybe even more than one), discussed WPFD with him — and his friend wanted nothing to do with it. Not even with my brother standing before him as an example, having lost weight and gone off all his meds, including for T2 diabetes. And, sometime later, his friend had a foot amputated. They were both depressed by that.

                    The future FIL of my niece also had a foot amputated due to T2 diabetes — caused not doubt by a terrible diet. I asked her if he might be interested in lifestyle changes, and she said Nope. They wanna eat what they wanna eat. She and her fiancé are changing their diet, though, moving toward WPF eating; fingers crossed.

                    And the husband of a friend has T2 diabetes — and while she is vegan, he won’t consider it. Though he doesn’t eat a lot of animal products or processed food, he won’t give up what he does eat. And he won’t eat fruit, because he thinks it’s too high sugar. Though he does eat bread, quite a bit, I think. I’ve even sent her links from this website to share with him — to no avail. And both his wife and I are scientists — but he doesn’t accept the information about WPF eating we pass on to him.

                    So, it’s not necessarily not knowing about what to eat. I have no idea what motivates people to change their lifestyle.

                    1. Friedrich Schiller: “Mit der Dummheit kämpfen Götter selbst vergebens.”,

                      (“Against stupidity the gods themselves contend in vain”)

                    2. Dr J

                      Only 1 to 2% succeed at changing even when they are sincerely trying is what Dr Lisle said and he has walked alongside of people for a very long time both with True North and McDougall.

                      Most of the people who are succeeding don’t understand that it is close to impossible for most people.

                      That is what the medical doctors point out.

                      How hard it is to succeed is different from having them tell people that ther benefits of success aren’t real.

    2. Others wince everytime they see the words “plant-based” rather than the word “reversal”.

      Personally, the main “reversal” that I’m currently interested in is the one of vitamin B12 deficiency in healthy plant-based eaters, via a diet rich in young leafy greens (that are rich in cobalt). I am waiting for a randomized clinical trial about it.

      Young leafy greens are shown to be the richest source of cobalt in foods, even higher than meat, muscle, kidney, dairies, etc, and cobalt is key for the production of vitamin B12 by bacteria.

      “Cobalt, like other trace elements, tends to be concentrated in young actively growing parts of plants, with green leafy material often having the highest concentrations. Concentrations tend to be lower in stems, roots, tubers, and cereal grains and also tend to diminish as maturity is reached.”

      Dietary cobalt deficiency might be a marker of vitamin B12 deficiency in otherwise healthy plant-based eaters, because their diet is generally deficient in young leafy greens rich in cobalt that our ancestors were most likely eating every day.

      1. Yes but it is also worth reading Jack Norris on this point. Bottom line though is that it is prudent for people eating a completely vegetarian diet to take B12 supplements and/or eat B12 fortified foods.

        In fact, the NIH say that everybody over 50 – including meat eaters – should take a B12 supplement and/or eat B12 fortified foods.

        1. The only problem with that is that it doesn’t tell people what to eat, and if effectively eating an adequate amount of young leafy greens naturally rich in cobalt may favor endogenous vitamin B12 production, it would be a strong indicator that the natural human diet should contain young leafy greens.

          Neither meat eaters nor plant-based eaters eat young leaves nowadays, and when they do they might be deficient in cobalt (because of the way they are produced). Perhaps the normal and healthiest way for our body to have B12 is from our microbiome, and not from preformed B12 from supplementation or animal products.

          Unless it has been put to the test, one can not know.

            1. Mr Fumblefingers,

              It might be the origin of the expression “plant-based”: a diet based on plants to which one adds vitamin B12, which is not plant-based.

              But to err on the side of caution also implies to evaluate the risks and benefits of taking vitamin B12 supplementation, even at low doses, like for aspirin.

              In studying iranian villagers eating mainly whole wheat, tea and sugar, and not presenting any sign of B12 deficiency, Halsted et al established that “vitamin B12 deficiency caused only by a deficient diet must be very rare”.

              They did not evaluate the cobalt content of the soils or of the wheat in those villages.

              So there is a need for more research on this topic in order to better prevent B12 deficiency and its consequences. It is not sufficient to conclude that vegan and meat eaters above 50 should take a pill and to close the issue as if there is nothing more to learn about it.

              In 2008, Dr Carmel show that B12 deficiency in elderly was exaggerated too and that some of the symptoms including neuropathy could also be caused by alcohol consumption.

              High doses of B12 supplementation are already shown to have negative effects in some studies, like increasing the risk of skin disorders and increasing some cancer risks. But still today, one can hear doctors and people saying that there is no upper limit to B12 supplementation and that all is fine with it, which is not really the case.

              The supplement industry mainly sell high doses of vitamin B12, so eating “plant-based” and to be on the caution side is already difficult because of the lack of low dose B12 supplements and the exaggerated price of those supplements in some countries too.

              1. In the case of the Iranian villagers, we don’t know what kind of water they drank. If it was unchlorinated stream or well water, it is possible that the villagers were getting B12 from that source. Clearly, that example would not then be relevant to people in urban environments drinking treated water.

                More research may be necessary as you say but simply assuming that B12 supplementation is unnecessary appears not to be supported by any convincing/evidence.

                Certainly Jack Norris doesn’t seem to agree with you on this point. Nor do the US National Institutes of Health. Nor does Dr Greger.

                Low dose B12 is available in multivitamins. Also many commercial foods eg soymilks are fortified with low dose B12.

                1. “Low dose B12 is available in multivitamins.”

                  Perhaps, but also multivitamins are shown to be the context of interactions that transform cobalamin (vitamin B12) to analogs and some of them can even be harmful:

                  “We conclude that CN-cobalamin can be converted to potentially harmful cobalamin analogues by multivitamin-mineral interactions and that these interactions may be responsible for the presence of cobalamin analogues in animal chows and animal and human blood and tissues.”

                  Presence and formation of cobalamin analogues in multivitamin-mineral pills.

              2. ‘Evidence from the Framingham Offspring Study suggests that the prevalence of vitamin B12 deficiency in young adults might be greater than previously assumed [15]. This study found that the percentage of participants in three age groups (26–49 years, 50–64 years, and 65 years and older) with deficient blood levels of vitamin B12 was similar. The study also found that individuals who took a supplement containing vitamin B12 or consumed fortified cereal more than four times per week were much less likely to have a vitamin B12 deficiency.

                Individuals who have trouble absorbing vitamin B12 from foods, as well as vegetarians who consume no animal foods, might benefit from vitamin B12-fortified foods, oral vitamin B12 supplements, or vitamin B12 injections [29].’

                1. It is obvious that if one takes a vitamin B12 supplement, vitamin B12 deficiency will be decreased statistically, but is the underlying problem solved ?

                  Taking a vitamin is a symptomatic approach that doesn’t tell us about the underlying mechanism of vitamin B12 deficiency. And if one doesn’t deal with the cause, then the symptomatic approach may create its own problems long term.

                  So generalizing vitamin B12 supplementation for all human beings as promoted by some people is not a wise approach to the problem of vitamin B12 deficiency, which may be linked to other confounding nutritional factors, like cobalt deficiency, alcohol consumption, other factors or even multifactorial causes with multifactorial consequences.

                  For example, if cobalt deficiency is the cause, it might also have some other unknown consequences than mere vitamin B12 deficiency, related to the microbiome activity.

                  The way one deals with vitamin B12 deficiency, either symptomatically through supplementation or through finding a deeper cause to it, may lead to very different nutritional approaches and solutions to the problem. That’s why one thinks that more studies are needed on this topic.

                  Meantime, one may use some low dose B12 to be on the err side of caution as you said, but it may have its own side-effects too, and we do not know much about the interactions that may occur with multivitamins.

                    1. Where there is choice, there is lack of clarity and confusion.

                      Dr Greger does not seem to help to clarify the topic in his videos, as for example, he claimed that more than 50% of tested British vegan are deficient, with as he said in the video “a screwed up biochemistry”.


                      But if you actually read the study, it is stated that: “Of the 65 vegan men with repeat measures of serum vitamin B12 taken approximately 6 years later, 34% were considered biochemically vitamin B12 deficient (serum vitamin B12 < 118 pmol/l) and 8% were categorised as deplete (118 to 150 pmol/l) "

                      Moreover "Among the 22 men who had serum vitamin B12 concentrations below 118 pmol/l, 82% had concentrations of holoTC that would indicate vitamin B12 deficiency (< 35 pmol/l) but only 32% had a combination of a MMA greater than 0.75 μmol/l and tHcy greater than 15 μmol/l that would identify men who were likely to have a vitamin B12 deficiency."

                      So even if people have low serum levels, only a subset of those people actually present a vitamin B12 deficiency.

                      32% of 34% is not equal to more than 50%… It is actually 7 persons out of 22 for a total of 65 men tested over six years, that is: only 11%. And if one considers that those 22 vegan were not supplementing, only 32% of them had a clinically relevant vitamin B12 deficiency.

                      So to give vitamin B12 supplementation to all plant-based eaters seems to be like giving aspirin to all the population when only a subset of the population would actually benefit from it.

                      Some vegan may promote a way of plant-based eating that favors vitamin B12 deficiency and a subset of them may need to supplement.

                      But it might be more reasonnable to promote a way of plant-based eating that does not favor vitamin B12 deficiency if such way of eating exists, and to only supplement the subset of the population that may actually really benefit from the supplementation.

                  1. The cause of B12 deficiency is either not enough B12 in the diet, or inability to absorb it :

                    The older one gets the less ability to absorb vitamin B12. There is no evidence that the microbiome in humans can create enough B12 to sustain health. We are not Cattle and do not have a stomach, but with four distinct compartments made up of Rumen, Reticulum, Omasum and Abomasum.with a much different variety of gut bugs. There is a good reason Dr. Greger and other tell WFPB diets to be supplemented with B12.

                    1. Dr Ralph Carmel disputed in 2008 the idea that elder people had statistically greater rate of malabsorption (1).

                      He showed that it was the arbitrary redefinition of the statistic cut point by the researchers that was responsible for such high rate, and even called this redefinition “tinkering with normality”:

                      “Despite the doubtful premise, the major loss of specificity, and the large, usually unrewarding clinical workload this portended (Table 4), many laboratories adopted the revised criterion.”

                      Dr Greger uses rare single case studies as an argumentation about vitamin B12 supplementation for everyone, but even in epidemiological studies on vegan (most of whom were not supplementing), half of people do not present low B12 serum levels and amongst those who present low B12 serum levels, only a minority present clinically relevant vitamin B12 deficiency.

                      There are other possible explanations to vitamin B12 deficiency. One of them being cobalt deficiency into the diet.

                      If one eats a diet that is deficient in cobalt but not in dietary vitamin B12, like the diet of omnivores or the diet of most vegan supplementing with cobalamin, it may promote the growth of bacteria that feeds on dietary vitamin B12 and which transform it into vitamin B12 analogs.

                      That may explain why 98% of vitamin B12 found in human feces are analogs of cobalamin (2). Most of the dietary vitamin B12 is transformed into cobalamin analogs by bacteria that do not produce B12.

                      Thus, the combination of cobalt deficiency plus the intake of dietary vitamin B12 creates the condition for teh growth of bacteria feeding on B12 over the growth of bacteria that actually produce endogenous vitamin B12 that our body needs.

                      (1) Carmel, How I treat cobalamin (vitamin B12) deficiency

                      (2) Allen et al, Identification and quantitation of cobalamin and cobalamin analogues in human feces.

                    2. That said, even if older people would actually have a greater rate of cobalamin malabsorption in the absence of other factors like a lack of normally functioning intrinsic factor, it could also be caused by an overgrowth of bacteria feeding on dietary vitamin B12.

                      And an overgrowth of bacteria creating cobalamin analogues could also have other health consequences as some B12 analogues can potentially be harmful, as pointed out by some studies.

                      Taht may be why high doses vitamin B12 have been shown to increase cancer risk in some people. As a significant proportion of it might be transformed into potentially carcinogenic B12 analogues that may also end up into the bloodstream.

                    3. Yes it could be a cause of overgrowth of bacteria feeding on dietary B12 (SIBO), but there is still a risk of B12 in the elderly regardless.  SIBO and other gut infections would only constitute a small portion of the elderly population.  And I am not buying the B12 causing cancer issue either except in people with problems such as SIBO.
                      Then there is the issue of too much folate masking a B12 deficiency.  A whole other ball game.  Plant only diets are high in folate and low or non-existent in B12.
                      We will just have to agree to disagree.

                    4. Linda,

                      The risk pertaining to older people may be more related to a life-long intake of dietary vitamin B12 and of cobalt deficient foods that may have suppressed the growth of bacteria producing vitamin B12, amongst some other possible factors.

                      The B12-induced increase risk of cancer has been observed for lung cancer (1), like other B vitamins and also beta-carotene supplementation.

                      Some B12 analogues have been shown in animal models in vivo to prevent cobalamin to enter into the cells and to create an internal deficiency though B12 status might be adequate (2).

                      Also, vitamin C and some minerals like copper have been shown to interact with vitamin B12 and to transform it in non bioactive analogues (3).

                      Plant diets are high in vitamin C and minerals, so it may be a limiting factor for dietary B12 intake to take into account too.

                      (1) Fanidi et al, Is high vitamin B12 status a cause of lung cancer?

                      (2) Mutti et al, 4-ethylphenyl-cobalamin impairs tissue uptake of vitamin B12 and causes vitamin B12 deficiency in mice.

                      (3) Herbet et al, Destruction of vitamin B12 by ascorbic acid.

                    5. Ab, That first reference is especially interesting to me as it’s the first study I’ve seen making such a connection. I happen to be one of those who tends to have very high circulating B12 levels, no doubt thanks to genetics. That’s why I’ve never bought the claim you cannot absorb too much (Fuhrman, by the way, recognizes that). Thanks for posting that url.

              3. It’s not a smart idea to base a decision about B12 supplementation even in part on one 1960 article on some Iranian villagers. Note that Norris points out in the article Fumbles cited “Halstead et al. (8 ) reported that some Iranian villagers with very little animal product intake (dairy once a week, meat once a month) had normal B12 levels.. They also speculated that because they *****lived among their farm animals and their living areas were littered with feces, they picked up enough B12 through contamination****.”.

                1. gengogakusha,

                  No, iranian villagers did not live with their animals on a ground littered with feces. That is a somewhat gross misrepresentation of iranian culture by Norris, even amongst iranian poorest population.

                  Animals had their own place, and human had their own place like in Europe or elsewhere. They did not live litteraly with the animals. The study say that “animals are driven into the village compound at night”, so animals do not live into people’s house and they might have their own place into the village.

                  Researchers explained that they “have not seen any megaloblastic anemia caused by dietary deficiency” and that there was no significant difference in blood serum levesl between the group subsisting on a very low animal intake and the group who regularly eat animals foods.

                  They made three hypothesis:
                  1) the low dietary cobalamin intake (0,5 – 1 mcg) was sufficient
                  2) their microbiome actually produced vitamin B12
                  3) ingestion of a certain quantity of animal manure through close contact with it

                  The third one does not seem to me to be the most plausible.

                  1. >>> The third one does not seem to me to be the most plausible.

                    I’m no expert on sanitation in any agrarian population back in the 1950s or earlier but I did spend summers on two farms in the 50 s and 69s in Pennsylvania where animals had their own areas, including cows, pigs and chickens. There was no particular concern about bacteria contamination, including drinking unpasteurized milk. It seems quite plausible to me that there was sufficient bacteria around to account for the results observed.

                    1. Bacteria contamination is quite a different concept than manure ingestion.

                      In “bacteria contamination”, it implies that bacteria producing B12 are absorbed either through water or other means, and that is more a part of the second hypothesis made by the researchers, that:

                      2) their microbiome actually produced vitamin B12

                      Such hypothesis is somehow confirmed by another study they quote and which states that penicillin (an antibiotic) given orally to people with megaloblastic anemia on inadequate diets in Africa enhanced their condition (1).

                      So in this case, megaloblastic anemia, as a consequence of vitamin B12 deficiency, might have been caused by the overgrowth of bacteria feeding on vitamin B12 and competing with bacteria that actually produce vitamin B12, in the context of an inadequate diet already poor in B12.

                      (1) Foy et al, Penicillin in megaloblastic anaemias of Africans; effect of serum-vitamin B12 levels and absorption of radioactive vitamin B12.

          1. ab,
            Endogenous B12 production where?

            According to the following 2015 overview, you’re going to wait a long time for that study. It is not logically impossible but then most things aren’t.


            “Although the intestinal flora of humans is able to synthesize vitamin B12, humans are not able to absorb it since the location of synthesis (the colon) is too distal from the location of absorption (the small intestine).”

            1. 言語学者,

              The study you pointed out seems to be incomplete in its overview (perhaps made by pro-omnivores as shown by its title ?)

              Indeed, in 1980, two groups of organisms in the small intestine have been shown to produce significant amounts of vitamin B12.

              “In man, physiological amounts of vitamin B12 (cyanocobalamin) are absorbed by the intrinsic factor mediated mechanism exclusively in the ileum. Human faeces contain appreciable quantities of vitamin B12 or vitamin B12-like material presumably produced by bacteria in the colon, but this is unavailable to the non-coprophagic individual. However, the human small intestine also often harbours a considerable microflora and this is even more extensive in apparently healthy southern Indian subjects. We now show that at least two groups of organisms in the small bowel, Pseudomonas and Klebsiella sp., may synthesise significant amounts of the vitamin.”

              Albert et al., Vitamin B12 synthesis by human small intestinal bacteria.

              1. >>> The study you pointed out seems to be incomplete in its overview (perhaps made by pro-omnivores as shown by its title ?) Possibly. Warrants further investigation.

      1. No Lisa, it isn’t. That silly picture is flogged at every talk (that wasn’t one of the patients from his trial either) . Watch the video I posted in my first comment with Colin Campbell to understand my point. Then read this article by Dr McDougall carefully. He himself has old clogged arteries from his errant past. He refused to go to hospital because he knew that they would want to do something about them. New, low density deposits may resolve some, or shrink as they harden or stabilize. This is not reversal. This is not a cure. The person still has heart disease. Dr McDougall still has heart disease. We are not doing anyone any favors by allowing them to think major blockages are going to disappear. (I am not arguing against wfpb Liisa. On the contrary, unlike other commenters, I have been doing this for years. Also, I have undergone numerous scans, angiograms, mibi, neurological scans, blood testing every 6 mos for decades.)

        I think we do a better service to others by simply eating the daily dozen as perfectly as we can, exercising, obtaining good medical care when appropriate, and being good examples to others rather than feeding internet (and bookseller’s) sensationalism. Lead by example in other words.

        1. Barb, That was an interesting video. I have no stake in this but it does seem to me that “cure” and “reversal” are too strong as they are based only on being symptom free with improved risk profile. Having an 80% blockage after several years as in the case of the patient in the video seems clearly not to be a case of reversal or cure. On the other hand, requiring there to be no evidence of plaque to warrant the term “reversal”
          would seem too stringent. If the 80% plaque had reduced to, say, 65% (below 75%, so no longer considered significant), I wonder what the cardiologists would have said.

          I happened to notice that Dr. Mirkin refers to an anti-inflammatory diet (his term for a WFPB diet) as a “heart attack preventing diet” in order to “help prevent or reduce plaque formation”. That seems to be a reasonable but not as exciting way to describe what diet/lifestyle can do.

          Incidentally, given what Dr. Mirkin says in the article below about older, competitive endurance athletes and the fact that the patient interviewed was one, it seems to me some of his recovery could be attributed to his very intense exercise program.

          1. Gengo gakusha, thank you for hearing me! Now allow me to share a couple of thoughts on what ISN’T said around all these issues. As someone who has led a very active life, and who has had treatment, my view of the marathoner in the video was this. Do you know how much courage it takes to get out there and run with heart disease? I do. It can be very very scary, even months/years into the ‘program’.
            I have never had a heart attack, but almost complete blockage of the LAD, along with 4 other arteries. I hike, run, swim, spin class. My whole diet plan is not around veganisn, but anti inflammatory foods. There is another website for athletes written by a cardiologist which I found helpful years ago. (i will find the link) I learned of Dr Mirkin through your posts I believe, and his site has been very helpful and encouraging. I don’t have a coach gengo. I can’t afford the cardiac rehab. It’s over $350. My doctors support my efforts by offering the testing when I make a case for it. And Dr Mirkin’s view of “preventing or reducing plaque formation” is an excellent goal, wisely worded. The other thing that exercisers have is corollary blood supply. That’s what gets me up off the couch and doing what I do. Thanks gengo.

    3. not sure what to do, am on Eliquis for a-fib and an ultrasound shows moderate blockage in one of my carotid arteries. Cardiologist says to lower Eliquis and add baby aspirin but after reading this I am so afraid of brain bleed :( Already stopped all oil and saturated fat foods (am already vegan),

      1. Emily,

        The Eliquis can be a good choice for the a-fib issue. Even though your carotid is moderately obstructed there is a risk/benefit issue that I cannot address however you might consider review of Dr. Greger’s video using the veggie format vs an aspirin.

        To be clear, please consider the input from your health care provider, but ask them to provide you with additional information and not just make a recommendation, without some reference work.

        As a thought see and share this article: Then take a look at the updated consensus views (2016) for the a limitation of aspirin and NOAC combinations:

        As to your diet, a big Congrats…. Think of your dietary approach as melting an ice cube (the obstruction). Over time the obstruction will potentially resolve as seen time and again by many physicians and patients. Stay the dietary course and check in with a provider who is up on the current state of the art and get enough information to feel comfortable with your medical options.

        Dr. Alan Kadish moderator for Dr. Greger

    4. Barb

      I don’t think that reversal is a ‘sensational’ term or exaggerates the effect..

      After all, if say you have built up 70% arterial blockage over 60 years of life but then after 5 years of WFPB eating you are measured as having only 50% blockage, you have clearly experienced a reversal of your plaque build-up even though a blockage remains..

      Reversal doesn’t mean either ‘cure’, ‘removal’ or ‘elimination’ – it just means reversal.

    5. From my doctor’s perspective, assuming a healthy lifestyle and maintaining a trim weight is square one. In addition, prescribed aspirin…
      Aspirin is a product of addiction… that is, many doctors are addicted to prescribing it. I think D R Greger has made the case for it not being totally safe.

    1. Aren’t blood thinners antagonist of vitamin K ? Vitamin K is fat-soluble, so eating a low-fat diet (without oil and nuts) might also act in the sense of a blood thinner, by reducing extra vitamin K absorption.

      And too many vitamin K is also paired with fat in the blood, which may favors blood clotting in the first place.

  2. Dr. Esselstyn clarified that we’re not just talking about vegetarianism. “This new paradigm” of heart disease reversal means “exclusively plant-based nutrition.”

    This doesn’t clarify anything.

    The old US food pyramids had exclusively plant foods at their base so they were literally recommending “exclusively plant-based nutrition.”

    If Esselstyn instead means ‘exclusively plant nutrition’ why didn’t he say so?

    1. If one may point out, don’t make it too much complicated.

      “This truth is simple and is, therefore, easy to explain. You must eat to live. But the choice of what you eat is yours. There is an individual, specific diet that best supports the health, function, and longevity of each and every animal. The proper diet for human beings is based on starches. The more rice, corn, potatoes, sweet potatoes, and beans you eat, the trimmer and healthier you will be—and with those same food choices you will help save the Planet Earth too.”

      John Mc Dougall

      Dr John McDougall talked about “purely plant-based” and only for seven days in one study…

      You may notice that the old US Food pyramid was also “purely plant-based”… but this is not what Dr John McDougall recommends and not just for seven days. He recommends a life-long diet “made of starches, vegetables, and fruits – no animal products of any kind and no added oils” as Jeff Novick pointed out to me by email this afternoon.

      1. What’s complicated about the difference between ‘plant nutrition’ vs ‘plant-based nutrition’?

        That they are two different concepts seems obvious and pretty simple to me.

        1. “That they are two different concepts seems obvious and pretty simple to me.”

          Are you saying that all the so-called “plant-based” doctors are beating around the bush, are hiding something, or trying to make a diversion ?

          1. No, it is probably just poor English language skills.

            Perhaps though it is also convenient to fudge the difference between those who say we must eat exclusively plants and those who say small amounts if animal food are OK and, in the case of people who can’t ot won’t take supplements, beneficial

          1. No but I can read and write English reasonably well.

            The point I am trying to make (badly) is that ‘plant-based’ does not mean ‘exclusively plant’

            The ‘base’ is the bottom support on which something stands Like the base of the old US food pyramid – it is not the entire pyramid (or diet).

        2. ‘Plant-based nutrition’ means that the nutrition is made of plant, while ‘plant nutrition’ means the nutrition of plants themselves.

          But apparently, some doctors try to use the expression “plant-based” as a synonym of omnivore nutrition, which it is not…

          1. ‘Plant-based nutrition’ means that the nutrition is made of plant………’

            No it doesn’t. It means nutrition based on plant consumption. “Based on’ does not mean
            ‘exclusively consisting of’ . Not in any dictionary I have heard of, anyway. Asserting that it does is simply Alice in Wonderland stuff

            “When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

            Little wonder most people refuse to take plant based diet arguments seriously when its proponents can’t even accurately articulate their own case…

            1. Perhaps “plant-based doctors” are believing inwardly that human beings are naturally omnivore ? And that plant eating is a ” new thing” ?

              1. Perhaps like Greger they believe that each and every step towards a exclusively whole plant food diet is beneficial. And that half a loaf of bread is better than none.

                Or perhaps they base their advice on the assumption that people don’t supplement (virtually all dietary guidelines around the world do this) and that to deliver adequate amounts of B12, D, DHA/EPA. iodine etc, some amount of animal foods is necessary to avoid nutrient deficiencies. Even the US dietary guidelines, which do recognise that a 100% vegetarian diet is healthful, state that such a diet needs to include ‘fortified’ ,foods.

                1. In what you describe, there seems to be also the assumption that plant-eaters should have the same nutrients ratio as if they were eating meat and animal products… But that may not be true.

                  For example, the protein content of foods is measured based on their nitrogen content. But in plants, there is a significant proportion of nitrogen that is bound to fiber, and thus not absorbable.

                  So the nitrogen content of plant foods does not represent accurately their amino acid content like it may be the case for meat.

                  But on the other hand, plant foods and fibers are a source of nutrients for bacteria that may also produce amino acids that may be absorbed by our body.

                  The microbiome is like one hidden organism into our organism and very little is known about how it really behaves and what proportion and kind of nutrients it delivers to our body.

                  The symptoms of some nutrient deficiencies might also be caused by an impaired or altered microbiome depending on what we may eat.

      2. Disclaimer: I am not in anyway linked or associated with the McDougall Program. Just pointing it out as information.

        As for my own current understanding of what may be good nutrition, one would say that it is a diet based on:
        1) starch as shown by the duplication of amylase gene in human and domesticated animals,
        2) young leafy greens (for cobalt and endogenous vitamin B12 production, but most likely needing B12 supplementation because of hydroponics, cobalt deficiency in agricultural soils and plants, and lack of young leafy greens rich in cobalt in the groceries,
        3) fruits as shown by “the allometric relationship between the area of the absorptive mucosa of the digestive tract and functional body size” (cf: Hladik et al, The human adaptations to meat eating: a reappraisal)

        1. If someone is even questioning Dr. Esselstyn’s dietary recommendation for a strict WFPB diet then they’ve never read anything he wrote or heard him speak. Dr. McDougall does a great job laying out the simplicity of this perfect diet in his book “The Starch Solution”.

          1. I am questioning the belief that a ‘whole food plant based’ diet means exactly the same thing as a ‘whole food plant” diet. The latter necessarily consists exclusively of plants. The former does not necessarily consist exclusively of plants. It is BASED on plants … and we just need to look at a dictionary to see what the word ‘base’ means.

    2. That is interesting, Tom.

      Yes, he didn’t use the word vegan.

      Exclusively sounds pretty close to meaning vegan.

      I don’t know if he left a loophole for occasional fish or something.

      1. Deb,
        I would guess he avoids the word ‘vegan’ because it really implies or
        arguably should imply, an ethical, and so not purely, nutritional lifestyle, and might even have negative connotations for some.

        “(Exclusively) whole food plant diet” is pretty clearly what he intends. This is a clear contrast to Ornish.

        1. Thanks, Gengo.

          Yes, vegan has political and ethical connotations which many people find threatening. Plant-Based doesn’t have the negative baggage.

          Dr. Ornish has moved toward vegan and his last few studies have been vegan. His belief systems about what the best diet to eat would be is vegan, but it is easier to get people to do the diet when he allows some meat.

            1. Isn’t low fat dairy equal to high protein dairy… ? Why would Dr Ornish recommend a high protein animal product ? That does not make any sense.

              1. To directly guess at an answer your question, I’d say he is more concerned about the amount of fat, esp. sat fat, than protein. If so, that’s a direct contrast with T. Colin Campbell.

                Some hated it when differences are pointed out among WFPB docs but I find it interesting.

                1. I think that what may matter the most for disease prevention is to eat foods that don’t trigger high bile acids flow and production, because mechanically some part of it may end up into the bloodstream.

                  We know that fats are increasing bile acids production, but also apparently proteins, as pointed out in animal models:

                  1. Ab30, Some bile acids entering the blood stream is not a problem. There are many bile acid receptors in the body, in particular in the CNS and brain, i.e.
                    bile acids play an important physiological role in limited amounts. On the other hand, excess bile acid getting into general circulation and causing problems seems limited to disease states, primarily liver failure.
                    In normal people, bile acid production is carefully controlled and self-limiting via a negative feedback loop. ~95% is eliminated and almost all the other ~5% is recycled. Of course, if excess bile acid were to get into circulation, they could well cause a variety of serious problems. But that would seem to be an uncommon occurrence linked to specific disease states. Before I would buy into this view, I’d want to see better, more direct support for it than the rat study you cited. Keep working on it.

           “Concluding Remarks

                    In this review we discussed three different pathways via which bile acids could signal to the CNS. In the direct pathway (Figure 3A ), bile acids reach the brain via the systemic circulation. In the brain, the machinery for bile acid signaling is present, i.e., receptors able to bind bile acids and transporters to transport bile acids into neurons (Tables 1 –3 ).
                    However, it remains uncertain whether this pathway is substantial under normal physiological circumstances. More research is required to determine whether the postprandial increase in plasma bile acids is also translated into increased bile acid levels in the brain and whether these amounts are sufficient to activate bile acid receptors expressed in the brain.
                    Considering the current information, we believe that this pathway does not exert a prominent route for bile acid signaling to the CNS.

                    The indirect pathway mediated by FXR-FGF15/19 (Figure 3B ) could exert an effect via the CNS through the presence of FGFRs in the brain. FGF15/19 signaling in the brain is associated with energy and glucose homeostasis. However, it is questionable whether the postprandial increase of plasma FGF15/19 is sufficient for substantial signaling in the CNS. We believe that under normal physiological circumstances the peripheral mediated consequences of FGF15/19 signaling exceed the effects that are possibly mediated via the CNS.

                    The indirect pathway mediated by TGR5-GLP-1 (Figure 3C ) can signal to the CNS via two routes, through the systemic circulation and via the vagal nerve. The latter route is the most significant signaling route, because postprandial GLP-1 levels are high in the lamina propria of the intestine and hepatic portal vein, where vagal nerve terminals are present. The vagal nerve signals to the brainstem and subsequently to other brain regions. Via this pathway bile acids could influence glucose and energy homeostasis, among other things. Currently this seems to be the only noteworthy signaling route to the CNS initiated by bile acids under normal physiological circumstances. However, the exact implications of bile acids for this signaling route and their contribution to the whole-body postprandial response remains an interesting subject for future research.

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                    More 7 of 65 [image: Print all] [image: In new window] ab30 replied to your comment on The Risks and Benefits of Taking Low-Dose Aspirin.
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                    Ab30 replied to your comment on The Risks and Benefits of Taking Low-Dose Aspirin

                    1. gengogakusha,

                      You should first bear in mind that the brain is thought to produce its own endogenous bile acids (BA), ar at least, some intermediates (1).

                      BA are synthetized from cholesterol, they are cholesterol metabolites. And as the brain produces its own cholesterol, it is not surprising that some BA compounds are endogenous to the brain and may have some neurological functions within the brain.

                      The fact that some BA compounds and liver receptors (LXR) were found into the brain has led some researchers to think that there is a gut-brain connection mediated by digestive BA, but the brain BA are mainly intermediate compounds and most likely endogenous to the brain (1), while the gut-brain connection is most likely dépendent on secondary compounds triggered by digestive BA, like fibroblast growth factors (2), but not digestive BA themselves.

                      The cerebrospinal fluid (CSF) which is activated during deep sleep is thought to be a cleaning mechanism for the brain, allowing it to get rid of toxins and to repair itself at night.

                      Ogundare et al showed that in the CSF, the main identified intermediate BA does not activate the liver receptors (LXR) of the brain and is a by-product of another BA intermediate that is itself a LXR ligand (3). That means that there may be an overpresence of LXR ligands BA into the brain and that the brain first deactivates those BA and then recycles them via the CSF. That overpresence of BA compounds may come from exogenous liver activity as digestive BA crossing the blood-brain barrier.

                      Digestive BA are meant to be reuptaken by the liver through the enterohepatic circulation and should not ideallly enter into the general circulation in healthy people, because they have a toxicity potential for the body when released in important quantity into the bloodsteam.

                      In case of liver failure, digestive BA may enter into the brain via the blood-brain barrier, after spilling over into the bloodstream via the enterohepatic circulation, and those exogenous BA may interfer with brain function and potentially create neurological disorders, like hepathic encephalopathy (4).

                      But in absence of liver failure, digestive BA may also favor the development of some more common neurological disorder like dementia, Parkison’s disease, Alzheimer’s disease, in the context of a BA promoting diet like the western diet (5).

                      Indeed, while endogenous brain BA intermediates may play a role for the neuroplasticity of the brain, digestive BA, as far as they are concerned, can create brain inflammation and impair neuroplasticity, as shown by a disregulated digestive BA synthesis caused by a western diet (5).

                      The digestive bile acids profile of vegetarian has been established to be lower than the one of omnivore (6), so one can infer that there is also less BA spillover in plant-based eaters and that may explain why a whole foods plant-based diet decrease the risk of diseases induced by high postprandrial (post meal) BA serum levels.

                      High bile acids serum levels are associated with endothelial injury in animal models (7), while decreased bile acids excretion is also associated with CAD in human (8,9). This strongly suggests a potential role of digestive BA in the development of atherosclerosis, CAD and other circulatory diseases, including cerebrovascular diseases.

                      High BA levels and BA toxicity may also increase cancer risk, as it has been shown for colon, osoephagus and intestine (10,11,12), so high BA serum levels might also increase cancer risk in other parts of the body as well, through the general circulation, by favoring the creation of preliminary neoplasms, because it has been established by BA are not only cancer promotors but also carcinogenic by themselves (13).

                      So it is not difficult to understand that high bile acids serum level after meals as promoted by the Western Diet rich in fats and proteins may play a role in the development of circulatory, metabolic, oncologic and neurologic diseases.

                      (1) Quinn et al, Bile acid in the brain ? A role for bile acids in the CNS

                      (2) Liu et al, A gut-brain axis regulating glucose metabolism mediated by bile acids and competitive fibroblast growth factor actions at the hypothalamus.

                      (3) Ogundare et al, Cerebrospinal Fluid Steroidomics: Are Bioactive Bile Acids Present in Brain?

                      (4) Xie et al, Dysregulated bile acid signaling contributes to the neurological impairment in murine models of acute and chronic liver failure

                      (5) Jena et al, Dysregulated bile acid synthesis and dysbiosis are implicated in Western diet-induced systemic inflammation, microglial activation, and reduced neuroplasticity.

                      (6) Hepner et al, Altered bile acid metabolism in vegetarians

                      (7) Parl et al, Endothelial injury. Association with elevations of serum bile acid and cholesterol concentration in biliary-obstructed rats.

                      (8) Charac, The association of bile acid excretion and atherosclerotic coronary artery disease

                      (9) Charac et al, The Role of Bile Acid Excretion in Atherosclerotic Coronary Artery Disease

                      (10) Nguyen et al, Role of bile acids in colon carcinogenesis

                      (11) Kühn et al, Prediagnostic Plasma Bile Acid Levels and Colon Cancer Risk: A Prospective Study

                      (12) Phelan et al, Rethinking the bile acid/gut microbiome axis in cancer

                      (13) Bernstein et al, Bile Acids: Promoters or Carcinogens in Colon Cancer?

                    2. Also bile acids promote intracellular uptake of calcium in endothelial cells (1), and thus in consequence, the calcification of tissues, which is also related to heart disease and major cardiac events. That may be why the endothelium releases nitric oxyde (a mediator of vasodilation) in order to counteract the calcification-induced stiffness of the arteries.

                      (1) Nakajima et al. Bile acids increase intracellular Ca2+ and nitric oxide production in vascular endothelial cells. Br. J. Pharmacol. 2000 ; 130: 1457-67

                2. Gengo,

                  It is good that there are different ways of doing it.

                  Dr Lisle said that only 1 to 2% of people succeeds at remaining Whole Food Plant-Based all their lives.

                  I find that being able to switch types of Whole Food Plant Based emphasis has made me more successful.

                  Right now, I have been eating more mashed potatoes and I hadn’t had them in 3 years. Next year, it might be grains, but other people are afraid of grains and some are afraid of beans and some are afraid of nightshades.

                  Variety of approaches helps more people succeed.

                    1. gengogakusha: “Yes, being too rigid risks making “perfection the enemy of the good”.”

                      The rigidity of vessels and arteries caused by the calcification of tissues induced by high bile acids serum levels promoted by the Western diet might also be the cause of bleeding that is favored by the blood-thinning ability of aspirin.

              2. The US dietary guidelines also recommend low fat dairy. The saturated fat in dairy is seen as the primary problem.with dairy foods

                Perhaps Ornish allowed low fat dairy because it is a source of B12 and because he is not a ‘vegan’. He also allowed egg whites, fish oil etc. Whether or not he is ‘vegan’ now I have no idea.

  3. Aspirin is acetylsalicylic acid, not the salicylic acid found in willow bark, and ubiquitous at low concentrations in other plant foods. And its the acetyl- part that’s responsible for the irreversible acetylation of cyclooxygenase, preventing thromboxane A2 synthesis and blood clotting, both systemically and in stomach ulcers.

    The salicylate part has some remarkable properties, activating AMPK, recapitulating features of caloric restriction, and extending lifespan in model organisms. While there’s been very interesting research demonstrating benefits of prescription salsalate (a long half-life salicylate dimer) in diabetes treatment, I wouldn’t discount the possibility that other salicylates (not aspirin) will be viewed similarly to metformin in prevention of age-related chronic disease, and to some extent, aging.

  4. On a related topic, since aspirin is an NSAID (and as pointed out by a previous commenter, Marilyn Kaye I believe):

    ““One of the most serious adverse reactions to NSAIDs, that is little appreciated, is that as a class of compounds they cause the breakdown of articular cartilage, thereby accelerating OA [osteoarthritis], the very disease for which they are most commonly prescribed…

    massive NSAID use in osteoarthritic patients since their introduction over the past forty years is one of the main causes of the rapid rise in the need for hip and knee replacements, both now and in the future.”

    The cynic in me chortles: WIN WIN!! Prescribe NSAIDs now to earn $30+ billions, then replace joints in the future to earn lots more!!

    But I also wonder: Would taking a low dose of aspirin every day adversely affect the joints of those taking it? Is this a known side effect?

    1. Dr. J – Thanks for the link.
      I wonder also about the dose and frequency of aspirin usage that adversely accelerate the articular cartilage breakdown in osteoarthritis. And if it is only in osteoarthritis or in all people.
      To help at all I have to take willow bark 3x daily and it makes me dizzy. Acetaminophen helps body aches but it takes 325mg aspirin for a headache. Studies are helpful but often leave so many questions unanswered.

  5. I’d like to see Dr. Gregor start funding some research to back up his constant claim for benefits of Vegan.
    I can recall exactly one “study” showing one patient who reversed his heart disease–Ornish–and Esylten’s claims. other than that,there’s nothing that I have been informed of. if u r going to claim Vegan reverses heart disease do u need to define “compared to what” and under what crcumstances instead of making the bald assertion considered highly dubious by many.

    1. Personally, high-dose aspirin (500mg) is very efficient for my occasional headaches. But maybe I would not need it if I simply was not staying late at night in front of a computer screen, as I noticed a correlation between this particular behavior and headache apparition the next day.

    2. You must not have read “Prevent and Reverse Heart Disease” by Caldwell B Esselstyn or “Dr Dean Ornish’s Program for Reversing Heart Disease” and any number of books and articles by other Dr.’s, including many cardiologists. There are definitely many more and not just ONE person who reversed heart disease by eating a plant based diet.

    3. fb0252, no I think you confound the cases study. Ornish was not a heart disease reversal. Ornish reversed depression with “Vegan”, and it is not Esselstyn who reversed Ornish’s depression. He reversed it by himself by doing “Vegan” when he was young.

    4. fb0252, I get it, in fact it was Dr Gregor’s grandma who reversed heart disease. But it was the Pritikin’s program that she followed. That is explained somewhere on the website, you may find it there. I wonder why Dr Gregor’s grandma did not win the Medecine Nobel Prize for that.

        1. I was just being a little bit facetious in my previous messages to fb0252.

          The main thing in all those trials is that patients adopting a low fat diet made of whole plant foods actually have a very low rate of further cardiac event when they stick to the diet and so their life expectancy is increased.

          This is a good sign that the disease is “in control” by eating that way, even for people with severe and advanced heart disease.

          As there isa very low rate of cardiac events, one can say that patients are in “remission” and that it is a simple and effective therapy, more effective in fact than drugs and surgery.

    5. You sound very confused I can’t recall many occasions when Greger has even used the word ‘vegan’ . He advocates whole food plant based diets.

      Nor is there any special diet exclusive to vegans. Vegans eat a completely vegetarian diet However, many people who eat a completely vegetarian diet are not vegans.

      And there’s a big difference between offering opinions and making assertions, and reporting the results of scientific You also don’t seem to have any understanding of how expensive and how difficult it is to undertake the sort of studies you are talking about.

      1. The thing is that whole foods plant based is not enough specific for medical treatment of heart disease.

        Because the best results are from a diet that is strictly made of non fatty whole plants (Esseltyn):

        “Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%, significantly less than reported by other studies of plant-based nutrition therapy.”

        (Esselstyn, A way to reverse CAD ?)

        However, it has been pointed out that Dr Greger used to think that with nuts, people would have made even better. But it is not at all proven in anyway iwithin the scientific litterature, and nuts are not recommended by Dr Esselstyn for people with heart disease.

        1. Yes but Esselstyn’s recommendations relate specifically to people with heart disease. Greger’s conclusions and recommendations – unless otherwise stated – are generic public health guidance and not targeted at any specific patient group.

          1. Perhaps, but Dr Greger also pointed out that all individuals above thirteen years old has already some signs of atherosclerosis and that what matters for most individuals (the general public) is not to prevent heart disease, but to reverse the one most of us already have…

            So, in order to err on the side of caution, Dr Greger’s should add a side-note about nuts:

            “Not for people above 13 years old”.

            1. ‘During 5,063,439 person-years of follow-up, we documented 14,136 incident cardiovascular disease cases, including 8,390 coronary heart disease cases and 5,910 stroke cases. Total nut consumption was inversely associated with total cardiovascular disease and coronary heart disease after adjustment for cardiovascular risk factors. The pooled multivariable hazard ratios for cardiovascular disease and coronary heart disease among participants who consumed one serving of nuts (28 g) five or more times per week, compared to the reference category (never or almost never), were 0.86 [95% confidence interval (CI), 0.79–0.93, P trend 0.0002] and 0.80 [95% CI, 0.72–0.89, P trend <0.001], respectively. Consumption of peanuts and tree nuts (two or more times/week) and walnuts (one or more times/week), was associated with a 13%-19% lower risk of total cardiovascular disease and 15–23% lower risk of coronary heart disease.'

            2. There is some evidence though that it may in fact be beneficial

              ‘Nineteen studies were included in the analyses. The results revealed an inverse association between total nut consumption (comparing highest vs lowest categories) and CVD incidence (RR, 0.85; 95%CI, 0.800.91; I2, 0%), CVD mortality (RR, 0.77; 95%CI, 0.72–0.82; I2, 3%), coronary heart disease (CHD) incidence (RR, 0.82; 95%CI, 0.69–0.96; I2, 74%), CHD mortality (RR, 0.76; 95%CI, 0.67–0.86; I2, 46%), stroke mortality (RR, 0.83; 95%CI, 0.75–0.93; I2, 0%), and atrial fibrillation (RR, 0.85; 95%CI, 0.73–0.99; I2, 0%). No association was observed with stroke incidence and heart failure. The certainty of the evidence ranged from moderate to very low.’

              1. Epidemiological associations are not a proof of concept.

                Interventional studies show that there are more heart diseases or cardiac events in people eating nuts than in people not eating them, as pointed out by Dr Esselstyn.

                People eating nuts just get heart diseases more slowly than people eating oils and animal fats, and as he explained: “slowing the rate of heart disease is not the goal”


                1. “Epidemiological associations are not a proof of concept.’

                  I never suggested that they were,. I simply posted those study extracts because your posts suggested (without offering any evidence whatsoever) that nut consumption increases CVD risk.

                  Also, I am not aware of any ‘Interventional studies show(ing) that there are more heart diseases or cardiac events in people eating nuts than in people not eating them’. It would be interesting if you could find one and post it.

                  As far as interventional trials are concerned, my understanding is in fact that nut consumption actually lowers CVD risk factors;

                  1. Nut consumption may decrease risk of CVD compared to olive oil, but not compared to a diet like in Esselstyn’s trial.

                    No study with Esselstyn’s diet baseline with added nuts has ever been done to corroborate such claim.

                    The only studies that claim that nuts are healthy, in the context of a plant-based diet, are based on cardiovascular markers and not on actual life expectancy and recurrence of cardiac events, like Dr Furhman’s study (1). The survey of mere cardiovascular markers is not the same than the survey of actual cardiac events and of life expectancy as in Esselstyn’s trial.

                    In a spanish randomized controlled study (2), all groups: 1) mediteranean diet with olive oil, 2) mediterranean diet with nuts and 3) animal-based low fat diet (eating more than 3 servings a day of low fat high protein dairy and fish) had significantly more cardiac events than in Esselstyn’s control group.

                    CVD risks factors are not necessarily causal factors. Nutrients may not play a direct role in CVD, but rather an indirect role, via the promotion or not of bile acids secretions and of high bile acids serum levels after meals.

                    Those bile acids favor the creation of plaques, because they promote the uptake of calcium within endothelial cells (3).

                    Calcium buildup is what doctors measure when they do a heart scan which is in fact a “coronary calcium scan” (4).

                    As fats promote bile acids secretion and thus plaque formation, fatty plants like nuts may also promote plaque formation and atherosclerosis.

                    (1) Furhman et al, Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases

                    (2) Estruch et al, Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, 2013

                    (3) Nakajima et al, Bile acids increase intracellular Ca2+ concentration and nitric oxide production in vascular endothelial cells

                    (4) Mayo Clinic: Heart scan (coronary calcium scan)

                    1. ‘Nut consumption may decrease risk of CVD compared to olive oil, but not compared to a diet like in Esselstyn’s trial.’

                      No such study has ever been conducted so that assertion is speculation on your part. Esselstyn’s study and PREDIMED are chalk and cheese. They simply can’t be compared in that way.

                      You dismiss the studies I post here on the grounds that further research is needed and no direct comparison studies have ever been done. These are valid points but they apply with equal or greater force to your statements. That doesn’t stop you presenting your beliefs as hard facts though. You are trying to have your cake and eat it here.

                      observational studies show that people eating nuts have lower CVD risk than people who don’t eat nuts and clinical trials show that nut consumption improves CVD risk factors. I am not aware of any studies that show that nut consumption increases CVD hard endpoints or worsens risk factors.

                  2. Esselstyn’s trial is the gold standard trial for nutrition and heart disease.

                    Unlike Ornish’s trials, it is only based on nutrition factors, and it offers the best results so far amongst all other plant-based nutrition therapy trials with only one stroke and a 0.6% resurgence of cardiac events in people maintaining the diet.

                    So it is the de facto standard that can also be used as a control group for any study looking at nutrition and heart disease, because even in a group with the worst possible conditions (only individuals with severe and advanced heart diseases), the results are remarkable and have been demonstrated on hundred of people, so that one can scale that control group to match any other study.

                    Therefore, the burden of proof belongs not to Esselstyn’s trial but to people claiming that nuts are healthy for people with heart diseases, whereas our current understanding of heart disease show that fatty foods are most likely aggravating the disease, because they trigger more bile acids secretion.

                    It is not because nuts are a whole foods that they may not also promote heart diseases in people with high risks of cardiac events, or the development of the disease.

                    Adding nuts to an already heart disease promoting diet might even make things worse.

                    1. >>> because they trigger more bile acids secretion.

                      Nothing has shown this. Cf. my other reply. This is just your speculation.

                    2. gengogakusha, it is well known that eating fatty foods increase bile secretion and bile flow as bile is needed for the digestion of fats. Nuts are fatty foods, and though fiber allows the excretion of bile acids, the majority of bile acids is reuptaken via the enterohepatic circulation.

                      In a recent german study, it is stated:

                      “With higher ‘nuts and seeds’ consumption, fecal total cholesterol concentration significantly decreased” (1)

                      That fecal total cholesterol concentration decreases may imply that bile acids increase as bile acids are synthetized from cholesterol.

                      (1) Mitry et al, Associations between usual food intake and faecal sterols and bile acids: results from the Cooperative Health Research in the Augsburg Region (KORA FF4) study.

                    3. Ab,
                      A reply to your other note that allows no more replies:

                      >>>it is well known that eating fatty foods increase bile secretion and bile flow as bile is needed for the digestion of fats. Nuts are fatty foods,

                      Never disputed the above. You are interpreting my quote from you out of ***your*** context, so I guess I clipped too much.

                      >>> “whereas our current understanding of heart disease show that fatty foods are most likely aggravating the disease, ***because*** they trigger more bile acids secretion.”

                      Where are the studies or experts that claim it’s bile acids from fat metabolism “aggravating the disease”? Note more over, that when fatty foods are referred to, it usually turns out what is meant are fats from animal foods, fried foods or extracted oils, not PUFA/MUFA/omegas from nuts/seeds, and the connection is usually either affects on cholesterol or inflammation. I have never seen one instance of bile acids mentioned in this connection. I’d be very interested to see that gap in my knowledge filled.

                      Back to nuts, I am left wondering what intervention trials Esselstyn (and then you) were referring to.

                      >>> and though fiber allows the excretion of bile acids the majority of bile acids is reuptaken via the enterohepatic circulation.

                      Ok, but only a small amount (< 10%) reaches systemic circulation and they appear to play a useful role:

                      "Only a small portion (< 10%) of the total bile acid pool reaches the systemic circulation. … These feeding-induced changes indicate that circulating bile acids could provide a postprandial signal, transmitting information about the arrival of nutrients and the subsequent availability of energy (Thomas et al., 2008a)"

                      It seems to me that the role of bile acids in metabolism and human health/disease is not such a straightforward issue.

                    4. gengogakusha,

                      We should not confound signaling and monitoring. As I pointed out in another comment, it is shown that some signaling to the brain is done by molecules that are triggered by bile acids secretion (like fibroblast growth factors) but not by bile acids themselves.

                      Digestive bile acids are carcinogenic and the brain produce its endogenous intermediate compounds of bile acids that have a useful role in the brain. They are not to be confounded with digestive bile acids that are meant to be reuptaken by the liver.

                      When digestive bile acids enter into the bloodstream, they have a high toxicity potential and are linked to cancers and heart disease through various mechanisms. It is very straightforward.


  6. As a person with chronic kidney disease, I have been told to avoid NSAIDs, presumably because they interfere in some way with kidney function. My docs unfortunately don’t seem to think I need to know more than just to .avoid them. Any clues from the doctors on this page?

  7. How about aspirin for preventing PE (pulmonary embolism)? I got a PE following scoliosis surgery, and now I need revision surgery. I asked the surgeon if I could take aspirin BID prophylactically, and he agreed, but I’m still nervous about it (also nervous about NOT taking it). I’m a 51 yo woman, vegan for 31 years and whole-food vegan for 10 years, thin, active, otherwise healthy. Also, any thoughts about why I got the PE in the first place, considering my healthy weight, diet, and exercise?

    1. Well, if you got it following surgery, then the surgery itself may have been responsible. Or at least prolonged rest following surgery.

      My understanding is that PE is commonly caused by deep vein thrombosis (DVT). The DVT blood clots can move from the legs to the lung arteries and block them. In fact the two conditions together are often called venous thromboembolism.(VTE).

      One risk factor for DVT is prolonged bed rest or sitting for long periods of time. Consequently, passengers on long haul international flights are vulnerable to DVT which is why many airlines now give guidance to passengers on exercises they can do reduce the risk of DVT.

      Please note that I am not a doctor or clinician of any kind.

      1. Hi Mr Fumblefingers. Thanks for your reply. We never knew for sure where the blood clot originated. Could’ve been from the legs or surgery site. They had those intermittent pneumatic compression devices on my legs, so that should’ve prevented DVT, but who knows.. . .

      1. Might it be that a western diet in childhood cause scoliosis ?

        The western diet triggers more bile acids secretion and increases bile acids serum levels, while lowering the blood pH after meals.

        As a result the body buffers the blood acidity by releasing some calcium from the bones, and the bile acids, as a result, favor the uptake of calcium within endothelial cells, contributing to stiffness of the arteries and the building-up of plaques and atherosclerosis lesions.

        If the calcium that is released from the bone is released from one side of the spine, it may explain why a curvature appears while the spine grows up during childhood…

        An imbalance in the bone composition on one side of the spine might explain the development of scoliosis in childhood.

      2. Hi ab. The scoliosis was diagnosed at age 13. It’s called “idiopathic” (of unknown origin) scolosis. Then it progressively got worse, so bad that I opted to have the surgery.

        1. The reason why the scoliosis aggravates can also be due to reduced blood flow consecutive of plaque buildup. So that spine at that location may have a reduced intake of nutrients.

          1) loss of calcium leading to plaques
          2) loss of incoming calcium and nutrients resulting from the plaques

          1. Hello again. I suppose that could be the case, but I’ve been vegan over 30 years (since age 21 ). I’m thin and have low cholesterol, etc., so I’d be surprised if I have plaque buildup in my vasculature.

            1. As pointed out by Dr Greger, in the US, “by age 10, nearly all kids have fatty streaks in their arteries” (1), which is the first sign of atherosclerosis induced by the Western Diet.

              Thus, children might not yet have plaques in their main arteries, but early signs of plaques.

              The bones are fed by so-called “nutrient arteries” (2) and veins, and peripheral arteries on the side. Some of them are very tiny. So it might be possible that their flow might be reduced or that some of them may even be blocked in some children eating a western diet, and that may be the cause of scoliosis.

              If some of those tiny nutrient arteries are blocked, the bone does not receive enough nutrient and when the child grows up, the spine may develop unevenly and unbalanced where those arteries are not well functioning.

              So, first, high bile acids serum levels after meals may trigger some release of minerals (like calcium) from the bones, or just takes away some dietary calcium, which then participate to the buildup of plaques in the tiny nutrient arteries of the spine, which then might be blocked or have reduced flow locally.

              Then at those locations, the spine may have incorrect nutrient supply as a consequence, which triggers the development of scoliosis.

              As vegetables fats and complete proteins may trigger more bile acids production and secretion during meals, they also may be a cause of an aggravation of scoliosis.

              For example high protein shakes after exercises could have potentially contributed furthermore to the reduction in the flow of some already deficient spine arteries even if you ate a whole foods plant diet otherwise.

              (1) Heart Disease Starts in Childhood

              (2) Nutrient artery schema

              1. One meant: vegetable oils and complete proteins.

                The scoliosis surgery might have released into the blood circulation some already existing plaque from the spine nutrient arteries (at the origin of scoliosis) and then that plaque might have ended up into a pulmonary artery causing the apparition of pulmonary embolism symptoms…

              2. Very interesting! I’ll buy that. I certainly grew up eating a very unhealthy southern diet, high in meat, dairy, and fried foods.

                In February I’m going back in for scoliosis revision surgery. As a preventative measure, I was planning on taking 240 mg of aspirin twice a day three days prior to and a month following the surgery. I suggested this to the surgeon and he agreed. What do you think about that?

                Interesting, too, about protein shakes. I do take a little supplemental protein, about 15 mg per day, because my protein levels are low without it. Otherwise, I eat almost exclusively fruits, veggies, beans, nuts, and seeds, with very little processed foods.

                1. I am neither a doctor nor a nutritionist, but I would stop eating nuts, processed foods and supplemental proteins at least one month before the surgery. You might eat a little bit of ground flax seeds, but it might be safer to avoid fatty foods and artificially complete plant proteins like protein powders, as a preventative measure.

  8. Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory painkiller in the form of willow tree bark extract, which Hippocrates used to “treat fever and to alleviate pain during childbirth.”
    Almost every comment I’ve read has said “Oh, aspirin is dangerous so let’s all eat WFPB instead!”

    (Light bulb comes on in head) Wait a Minute!!!

    There is a simpler solution for those in a hurry… just substitute willow tree bark extract in place of the aspirin!!

    Full disclosure… I’ve been doing this for ~ the past 5+ years, maybe longer… especially after learning that White Willow Bark keeps one’s platelets under better control.

    That is, if an artery is damaged, the body sends platelets to the damage to be the finger in the dike. Problem arises when too many platelets are sent to do the job and there is a build up for cholesterol to snag onto and begin closing up the artery.

    White Willow Bark sends the right amount of platelets to heal the damage, without sending too many to cause a buildup.

  9. For 22 years my mother began takin coated enteric aspirin starting at age 50 following replacing major leg arteries with dacron. At age 72, she had developed carotid blockage and had a procedure to remove the blockage.The following day she had a major hemorrhage in the brain. For five long years she suffered rehabilitation before she died. A year after she almost got her driving permit back, but then began to loose some abilities. Then for the next 4 years there was a multitude of relapses that the doctors could not explain. It was only in the last year a doctor told us she was having small brain hemorrhages one after the other. So the aspirin was doing the damage. That was in 1998 until 2003.

    1. Quebec City,

      Yeah, It is heart attack and ischemic stroke versus problems like your mother had.

      Last year, I had a whole bunch of people who were on blood thinners who died from simple falls. One after another.

      They weren’t on aspirin. They were on things prescribed by doctors.

      I did have one relative who took aspirin who did end up having to go out of it because of internal bleeding.

      I think that is why he is talking about that only people with heart disease should be considering the math.

      1. “Last year, I had a whole bunch of people who were on blood thinners who died from simple falls. One after another.”
        – – – –

        Wow! “The whole bunch” died the very same way? Like dominoes?

        Why do I find this…….?

        1. They didn’t die on the same day.

          One friend’s father slipped on ice and hit his head. One friend’s aunt fell in her place and hit her head. One friend who was in his early 50’s who worked with the homeless fell and hit his head. Etc. Not the same day, but blood thinners create a situation where people can die from nose bleeds. Dr. McDougall said that the Inuit often die of nosebleeds or after low speed crashes because of how thin their blood is. I had never even heard of it before last year and suddenly, after I heard Dr. McDougall’s talk, I started hearing about it and it probably always happened, but I never heard it before.

            1. The interesting part to me is that when my grandmother’s generation talked about losing relatives, it was either heart attack or cancer.

              I know more people who died from bleeding on the brain after falls than either of those.

          1. I didn’t say “the same day,” I said the same “way.” You said they all died from falls as a result of taking blood thinners. Which is indeed believable.

            People die from taking a high dose of blood pressure pills too. One guy in my building said he got really dizzy and fell on the street. The ambulance showed up and he was rushed to the ER. Turns out his BP dose was waaaay too high.

            1. Deb, I should not have said “like dominoes.” I was more astonished that you knew so many people who died from falls. Yup, we gotta be careful where we place our feet as we age. :-(

                  1. Hehe

                    Been there, done that.

                    Strangely, I found that my feet became bigger in my 60s – went from a size 9 to a size 11 (UK). Osteoarthritis I think. So sticking my feet in my mouth is even more uncomfortable now.

            2. YR,

              Yeah, and I guess that is what this blog is about.

              People used to die more of heart attacks.

              Now, they are on meds to prevent things like that.

              I remember watching videos on “Death by Doctor prescriptions” and it was pretty high on the list of how people die.

              The category I am thinking might be put under “accidents” in the medical field, but it did stop me from taking low-dose aspirin and every now and then I weigh that decision.

              Every now and then I take one at night.

              The whole stroke and heart attack coming while we sleep or in the morning sometimes wins the logic. But my logic sways back and forth.

              My logic about whether to try to get my 90-year old relatives WFPB and whether it will reverse their dementia, which just started really this past year versus just let them eat what they want in their last years on earth are 2 competing logic thoughts which are out in the culture.

              When my grandmother was in her last year, I had one doctor say, “When people are dying, give them whatever they want” and I had a room full of medical people with crossed arms angry with me for trying to do that, because “starve a life end” is another logic they go by.

  10. If we give up eating farm animals and instead eat VEGANS, will it make the world a better place? I see these comments about women “dragging their husbands into veganism” and I just wonder who these men are that change their whole dietary lifestyle simply on the whim of another. Then I begin to wonder…are they even MEN at all?
    I’m truly am sick and tired of vegans looking down their noses at others simply because they’re unhappy with their own diets enough to think that others should SHARE in their collective misery. I ea meat at EVERY meal and just got a head-to-toe check up from my MD. Guess what…I’M IN PERFECT HEALTH! While my triglycerides are a little ‘elevated’ the rest of me is just fine. As a matter of fact, my doctor asked me what kind of training regimen I was on and he about ‘dropped one in his pants’ when I told him I sit behind a computer all day long (it’s my job). I walk MAYBE three times a week but usually find a reason NOT to. I’m 52y/o and my resting heart rate is 58, BP is 135/85, O2 sat is 100, and my calculated 10-year risk of heart related illness is 6.0%. I’ve been eating meat at every meal for well over a decade now and I must say, it’s DELICIOUS!
    You carnivorous people out there whose ‘significant others’ feel the need to castigate or belittle you by telling you what to eat and what NOT to eat really need to stand up for yourselves. Enjoy your beef, pork, and chicken! You won’t regret it! Remember: BEEF! It’s what’s for dinner!

    1. Michaelimus,

      You might find the film “Game Changer,” available on Netflix, of interest. I especially liked the strongest man in the world — he is a heart swoon!

      And I was joking about dragging my husband along with me; he will eat whatever I cook, because its far better than anything he would make for himself. And he is doing very well, healthier than he was when I met him 12 years ago when he was starting to take drugs for high cholesterol — but not any more. He’s lost 50 pounds, and looks great! Does the yard work, the shoveling (even chops the ice from the walks!), AND washes the dishes!!

      And 52 is young. I have a stepson almost that age.

      Oh, and who is belittling whom?

    2. We don’t care what you eat. Well, I don’t anyway. And many of us here are not vegans.

      If you want to risk premature death and ill health, it’s your business. Some of us though are interested in what to eat to reduce the risk of ill health. Some wives apparently care enough for their husbands to want them to eat a healthy diet. In some cases though, especially if they have good health and life insurance, they might be happy for their husbands to keep on eating unhealthy foods

      Good for you that you are in seemingly good health but it’s all about risk not absolute certainty. 5 out of 6 people who play Russian Roulette don’t blow their brains out …. but that doesn’t prove that Russian Roulette is risk-free. The fact that you appear to be in good health now doesn’t prove that your diet is healthy either.

      I don’t know about eating vegans in place of farm animals making the world a better place. Eating idiots might though ……….. call it Soylent Green perhaps?

    3. Hi, I wonder whether you have considered that you might be a bit paranoid? If you’re content with yourself, why the need to worry about people who eat a wfb diet? Your avatar and remark about “men” suggest a certain insecurity in you, though, which would probably be best analysed than advertised. Also, a job that has you sitting for long periods is, according to a range of easily available research out there, very bad for your health in the long term. BTW I’m surprised your doctor didn’t tell you that your BP is in fact elevated. You should try a standing desk and having a decent walk every day, and dissipate any spleen with some kind endorphins… Stand up for your health!

    4. “Milk and meat can’t be beat!” is what my husband has said for some years now. He had a similar life to you at age 52. I wish you luck. My husband has dementia now.

        1. No, I did not cook for him. He cooked for himself. My children and I were vegan/vegetarian. I cook for him now and I bring him to a large WFPB-NO potluck in our city. He does not cook for himself anymore so he’s eating a lot of vegan or WFPB things nowadays except for the bowls of vanilla ice cream he dishes out for himself after dinner and supper. On a more serious note, I believe his arteries are clogged which probably caused the dementia–and it wasn’t from eating coconuts and avocados!

        2. Yes, there are many paths to dementia, with a combinatorial effect, no doubt.

          Although e.g. obesity is on the rise and its projected half the US population will be obese by 2030 and, shudder at the thought, ~25% severely obese), indicating horrible diets and lifestyles:

          surprisingly, the rate of dementia is declining, speculated to be possibly due to a reduced lifetime exposure to lead.

          Is there a link between lifetime lead exposure and dementia?

        3. YR

          I think that you are confusing ‘nutritional deficiencies’ with ALL diet related risk factors. They are only one potential subset of dietary risk factors.

          Excess dietary saturated fat. heme iron etc are not ‘deficiencies.but may play a role in increasing dementia risk, for example.

    5. You are right Michaelimus Wardimus, beef is not bad for you, don’t listen to vegans who improvise themselves as nutrition experts and who tell to everyone that animal fats and animal proteins are bad for you…

      What is bad for you is not the beef, but what your body produces in order to digest it.

      Indeed, when you eat beef, your body increases its bile acid production in order to digest all the fats and proteins of animal products as well as the other vegetable oils or dairies in your meal.

      While your liver does normally a good job to reuptake those bile acids, when the body increases its bile acids secretion, more of them end up in the general circulation and even croos the blood-brain barrier and enter into your brain.

      Bile acids are potent carcinogens and can damage the endothelial cells into the body.

      Also, if you do not eat enough fiber, you excrete less bile acids, so more of them also end up into the bloodstream.

      That your triglycerides are a bit elevated indicates that you eat a high fat diet and that is no wonder because you eat meat at every meal.

      Don’t worry about the triglyceries, it is not what is measured at fasting time by the bloodcheck that is worrying, but rather what has not been measured, at postprandrial time (the bile acids serum level after the meals).

      1. It’s hardly only ‘vegans’ who say avoiding red meat might be the healthiest choice. Implying that it is, is a deceptive statement. Highly convenient no doubt but deceptive.

        There are quite a few organizations and individuals (from the World Health Organization downwards) who point out that mortality risk appears to go up as red meat consumption goes up, based on a plethora of studies and known mechanisms of action.

        1. Well, it is not exactly read meat that causes cancer, but bile acids that are secreted when eating red meat or any other high protein or high fat food.

          “The evidence reviewed here indicates that, in humans, bile acids are likely to be implicated in the aetiology of a number of different important cancers in terms of morbidity and mortality, such as cancer of the colon, oesophagus, stomach, pancreas, gall bladder and cancer of the breast.”

          Costerelli, 2009, Bile acids as possible human carcinogens: new tricks from an old dog

          The role of bile acids in colon cancer is pretty well established now by many studies like:

          Weisburger et al, 1983, Bile acids, but not neutral sterols, are tumor promoters in the colon in man and in rodents

          Bernstein et al, 2011, Bile Acids: Promoters or Carcinogens in Colon Cancer?

          Nguyen et al, 2018, Role of bile acids in colon carcinogenesis


          1. That is your belief. The WHO’s International Agency for Research on Cancer concluded that red meat is a Group 2A carcinogen.

            But it’s just not cancer risk that is the issue. Red meat consumption appears to be a risk factor for CVD ……. and indeed premature mortality generally. Certainly the American Heart Association for example recommends limiting red meat consumption

            And high red meat consumption appears to be linked with increased mortality in many studies eg


            Suggesting that it is only so-called vegans who ring alarm bells over red meat consumption is completely false.

            1. I do not have any belief, personally. The reason why red meat is associated with cancer and CVD is clearly identified in the scientific litterature: Bile Acids (BA).

              Bile acids are a potent carcinogen and an initiator of atherosclerotic lesions and plaque build-up via precise mechanisms.

              The belief that animal proteins are carcinogenic because they are from animals comes from T. Colin Campbell. But in the very experiences he made on rats with casein, bile acids are most probably the culprit and not animal proteins per se.

              This is even demonstrated by another TC Campbell’s study showing that when one increases the “quality” of plant proteins with the deficient amino acids, plant proteins are also associated with cancer foci development:

              “These results suggest that one can inhibit the development of foci either by decreasing the quantity of protein intake and holding the quality of the protein constant or by decreasing the quality and holding the quantity constant.”(1)

              So complete proteins, whether they are from animals or from plants, like fats, are associated with cancer development because they trigger more bile acids secretion, which in turn favor cancer development.

              This is confirmed in vivo with low protein diets fed to rats: the low protein diet has a lower bile acids profile and reduced bile flow than the high protein content of the Western diet:

              “Animals fed a 8% protein diet (LP) for 4, 8 and 12 wk had a significantly lower bile flow and a lower biliary bile acid and protein secretion rate compared with rats fed a 26% protein (normal) diet (NP).”

              (1) Schulsinger et al, Effect of dietary protein quality on development of aflatoxin B1-induced hepatic preneoplastic lesions.

              (2) Villalon et al, Effect of a low protein diet on bile flow and composition in rats.

              1. GI cancer aside (I don’t disagree), as far as I recall your only evidence that BAs cause heart disease has been based on those (either rats or people) with sufficient liver disease that the normal BA reuptake system failed, resulting in dangerous levels of BAs getting into general circulation. You also mistakenly cited an article by Esselstyn as supporting your BA/CVD connection but in fact in that article he only linked excess BAs to colon cancer. You’d think he would have mentioned the BA connection, if in fact there were any evidence for it.

                No one doubts, I’d guess, that excess BAs are carcinogenic as shown in studies on various types of ****GI*** cancers or that in people without functioning livers, excess BAs can get into circulation and cause a variety of problems, causing or contributing to non-GI cancers or heart disease, but from that special case, as far as I can tell, you have jumped to the unjustified general conclusion that it is excess BAs in general circulation that are the cause of various diseases from dementia to all kinds of cancer and CVD. It seems to me that no amount of contrary evidence or even the opinion of experts like Esselstyn could possibly change your mind.

                1. Red meat is associated with colon cancer and that’s why it has been classified by WHO as a probable carcinogen. But I never quoted Esselstyn for BA/CVD or colon cancer.

                  The bile acids causation mechanism for colon cancer has been established for example by Bernstein et al. with deoxycholic acid (DOC) in vivo (1).

                  But as pointed out in a comment above from Costerelli’s article, bile acids are associated with many types of cancers including breast cancer, which is not a GI cancer per se…

                  Dr Greger has even written a blog article about the topic in 2016:

                  “Carcinogenic bile acids are found concentrated in the fluid of breast cysts at up to a hundred times the level found in the bloodstream. By radioactively tagging bile acids, researchers were able to show that intestinal bile acids rapidly gain access to the breast, where they can exert an estrogen-like cancer-promoting effect on breast tumor cells. This would explain why we see 50% higher bile acid levels in the bloodstream of newly diagnosed breast cancer victims. These findings support the concept of a relationship between intestinally-derived bile acids and risk of breast cancer. ”


                  In the case of CVD, I’m going to answer in your other message.

                  “Based on the finding that DOC induces genomic instability in cultured cells, we investigated whether DOC, at a high physiologic level, could be a colon carcinogen. Addition of 0.2% DOC for 8-10 months to the diet of wild-type mice resulted in fecal levels of DOC in mice comparable to fecal levels of DOC for humans eating a high fat diet. This level of colon DOC induced colonic tumors in 94% of the mice, including 56% with cancers [26]. This indicates that the bile acid DOC is a carcinogen, not merely a promoter. Furthermore, these results suggest that, in humans, the association of colon cancer with a high fat diet is mediated by persistent exposure to high physiologic levels of bile acids, especially DOC.”

                  Bernstein et al, Bile Acids: Promoters or Carcinogens in Colon Cancer?

                    1. I discover the link that you mention at the moment.

                      It does not explicitely state that bile acids are a cause of cancer, as it has been showed by other studies, but there Esselstyn points out an association with bile excretion which is higher with high fat diets, adn the fact that bile acids are cancer promoters.

                      Some other studies make the link between bile acids with CVD though, and Esselstyn seems to have missed it.

                  1. Ab,
                    Thanks for the link to the Dr. Greger video. That’s quite interesting about breast cancer, and I had missed that. But it makes me wonder whether the real problem is lack of fiber and perhaps high saturated fat intake and not bile acids per se.

                    To shift the focus away from bile acids per se, my real interest is in the effects of a very high fiber (50-100 g/d) whole food plant diet with 25-35% calories from nuts/seeds and some avocado. Also such a diet would have the various protective factors identified in nuts and produced by nut metabolism. This kind of diet seems to me quite distinct from one that is high in animal foods and low in fiber, which strikes me as the kind of diet the video is based on.

                    I am unaware of studies on such a diet. So the jury is out.

                    Some people, like my skinny pre-diabetic, athletic wife and other people we know, cannot eat a high starch, McDougall style WF diet without spiking blood sugar very high, even at times into the diabetic level. Not that this is quite a different pattern from those with T2D from obesity who have fat in muscles, liver and pancreas. The only dietary remedy I have found for a skinny (BMI 19 or less), athletic prediabetic is a very high fiber, high(er) fat WFP diet (~ 50% C, 35% F, 15% plant protein), which results in only very mild (within normal levels) production of ketones. In my wife’s case, e.g. this plus exercise after eating keeps her blood sugar from spiking at one hour over 140 at peak and usually keeps it below 120, with perfectly normal fasting blood sugar levels. Between meals her blood sugar will typically be ~90-100.

                    So my real question, still unanswered and likely unanswerable at this
                    point given the lack of studies, is whether that specific type of diet changes the equation.

                    Note finally that although only observational, the longest lived Adventists were nut eaters. Moreover, other blue zone areas (Sardinia, Icaria) have diets high in fat, so in terms of longevity at the population level, fat as a percent of calories per se does not seem to be a significant determinant. This is not inconsistent with the fact that very low fat diets like the Okinawan diet can be very healthy or that such diets are the only known way to manage heart disease a la Esselstyn and Ornish. Their results show sufficiency for mitigating heart disease but not necessity of eating such a diet to be healthy and long lived.

                    Thanks for the multiple interactions.

                    1. I am not a doctor, but some diabetic people eating a healthy plant-based might still benefit from insulin in some cases.

                      Not all diabetic people can get rid of their insulin medication, or they may need more time than others to do so.

                      If eating a high fat diet may limit the need for insulin for those people, it may come with its own long term trade-off.

                      The way the blood sugar goes up after meals may vary from person to person, but the fasting blood sugar level may be what matters the most.

                      And if fasting blood sugar level is too high for someone already eating healthy, it may be indicative of some issue.

                    2. ab, >>> If eating a high fat diet may limit the need for insulin for those people, it may come with its own long term trade-off.

                      Yes, of course. Estimating risks vs. benefits is a part of life, including often diet. What I object to is the view that when it comes to diet, one size suits all. There is simply too much phenotypic variation for this to be true.

                      General prescriptions based on population models or on simplified models of disease are bound to err in serious ways in a number of cases (Nb: although the number of people in any special case might be relatively small, there are a great number of special cases). In my view not enough attention is paid to phenotypic variation. This is also true when it comes to individual sugar metabolism (cf. below).

                      >>> And if fasting blood sugar level is too high for someone already eating healthy, it may be indicative of some issue.

                      Yes, this is true, and those should be looked into and dealt with. Slim pre-diabetics are obviously distinct from overweight T2 diabetics or overweight pre-diabetics, who can often reverse their blood sugar handling problems by pulling out enough fat from muscles, liver and pancreas through sufficient weight loss. Slim pre-diabetics with normal fasting BSLs have some sort of insulin production problem, but still can produce enough insulin to bring levels back to normal, the rate depending on individual characteristics. But it turns out that many who think their BS handling is normal are mistaken, and it can take decades before that becomes apparent (cf.below). I personally know three slim,health conscious, and athletic prediabetics all of whom happen to be peri- or postmenopausal women (perhaps not an accident).

                      >>>>The way the blood sugar goes up after meals may vary from person to person, but the fasting blood sugar level may be what matters the most.

                      Abnormally high fasting BSLs are of course very bad; they indicate there have been serious BS handling problems for a long time. But abnormal fasting BSL is not the “canary in the mine”. Serious damage can occur long before that happens, which is why many doctors are starting to use the HbA1c test more routinely in older people. This test provides an estimate of the average BSL over 3 months. However, it still provides insufficient information as it ignores frequent short term spikes, which can be independently damaging, increasing not only the risk of full fledged diabetes but also over time CVD from inflammatory processes. Around 35-70% of the prediabetics will progress to full fledged diabetes, so it is key to catch it early.

                      It turns out that even non-prediabetic nondiabetics have widely varying glucose responses to various kinds of foods, thanks to phenotypic variation that has gone largely unrecognized until now,and this could speel trouble over decades. The research reported on below supports the notion of tailoring diets to significant individual variation in blood sugar responses to various foods. Another study (not handy) has shown that responses can vary significantly depending on specific foods like tomato!

                      Some researchers and even clinicians on the leading edge of diagnosis and treatment are starting to recommend continuous BSL monitoring:


                      Glucotypes reveal new patterns of glucose dysregulation

                      Current diagnostics for both diabetes and prediabetes rely on either HbA1c or single-time-point measurements of blood glucose concentration; as such, they cannot describe the nuances of glycemic patterns. Accumulating evidence suggests that not only do these measures miss a substantial portion of glucose elevations into the prediabetic and diabetic range [12 ] but also that glycemic variability, or postprandial glucose peaks, may be a metric of even greater importance than current measures of hyperglycemia such as HbA1c or single-time-point measurements when it comes to predicting cardiovascular risk [13 –15 ].
                      Indeed, postprandial hyperglycemia induces oxidative stress, hypercoagulability, endothelial dysfunction, and inflammation [16 –19 ].
                      These studies indicate that identification of glycemic variability should be an important consideration in risk stratification and possibly in guiding interventions, including diet, designed to minimize glycemic variability [20 ].

                      A comprehensive metric of glycemic variability should encompass not only the magnitude of fluctuations but also the rate of change, relative glucose concentration, and frequency of fluctuations.

                    3. gengo-gakusha,

                      It is true that individual phenotypes may play a role. But as pointed out by some of my previous comments, in my view, not enough attention is given to bile acids, and this is also true when it comes to individual glucose metabolism.

                      Researchers have shown in vivo that glucose metabolism is associated with a gut-brain axis that is mediated by “fibroblast growth factors” (1).

                      The secretion of fibroblast growth factors in the intestine is stimulated by bile acids, particularly taurocholic acid, but not lithocholic acid.

                      Those compounds stimulate a pathway in the hypothalamus related to appetite (Agouti-related peptide AgRP/NPY), while antagonist peptides of those compounds developped by the researchers appears to reduce blood glucose without inducing hypoglycemia.

                      Taurocholic acid comes from the the conjugation of cholic acid (the main bile acid) with taurine. So animal foods, naturally rich in taurine, seem to increase appetite by releasing fibroblast growth factors.

                      Antagonist of those compounds however seem to reduce blood glucose and regulate glucose metabolism.

                      It may confirm the link existing between animal foods consumption (high taurine foods) and diabete, and shows that the autonomous nervous system seems to be involved too in the regulation of glucose metabolism.

                      (1) Liu et al, A gut-brain axis regulating glucose metabolism mediated by bile acids and competitive fibroblast growth factor actions at the hypothalamus.

        2. I mean, vegans also promote “Impossible burgers” that are even higher in saturated fat than red meat.

          Those “impossible burgers” surely trigger as much bile acids secretion than red meat, and thus may be equally carcinogenic…

          1. Impossible burgers are unhealthy. Some people may promote them as ethically superior alternatives to conventional burgers but so what? That doesn’t make red meat or processed meat into health foods.

    6. Michaelimus Wardimus,

      When you are sick and tired, remember: STARCH! It’s what’s for dinner!

      And MAYBE three times a week, find a reason NOT to EAT beef, and enjoy your pasta, potatoes and bread.

      It’s DELICIOUS! You won’t regret it! And then, you will enjoy starch at EVERY meal!


  11. I’ve had a two-vessel bypass, a heart attack, and most recently a stroke. Those events occurred during the past 23 years when I was prescribed an aspirin daily. After my stroke this summer, my doc at the VA said aspirin is no longer being prescribed for these conditions. Now I’m taking clopidogrel, another blood thinner.

    Wondering if the daily aspirin contributed to these events in my life, and why they weren’t avoided by the aspirin?

  12. I will say that you might need to look at a lot of research and that eating WFPB and doing other things like staying hydrated particularly at night might be things to look at.

    This is another study comparing aspirin to it and it wasn’t a good result, but there is one more study where aspirin caused more major bleeding episodes, so the science goes back and forth.

  13. The sports radio announcer just said, “By the way, don’t ever go into the doctor’s office and say that you have been looking things up on the internet and think they are wrong. Whatever you do, don’t ever do that.”

    I agree.

    Don’t mention PubMed or any internet doctor ever.

    Be careful out there.

    1. Laughing.

      YR, I already feel cold enough.

      I don’t need no stinking iceberg lettuce.

      I just bought my watercress, kale, spinach and arugula.

      Does Whole Foods even sell iceberg lettuce???

      That is a good question.

      I also bought pomegranate seeds. I had the thought, these are so much easier for me to eat than blueberries. Maybe they are better than boycotting fruit for the next few months.

      I had another thought that it worked. I ate salad from March until November and I started wanting hot foods in the hot food season and I only eat salad once in a while now.

      I feel like I am nutritionally lacking greens now, but it has only been maybe 3 or 4 weeks without them.

      1. Dunno how you can do it, Deb. I luuuuuv raw salads and fruits of all kinds. The crunch balances off whatever else is in the meal.

        I’m one of those rare birds who, in restaurants, likes to eat the salad along with the rest of the entree. Others gulp the salad first and then the rest of the meal, but to me that would be boring. A little of this and then a little of that. I call myself The Casserole Kid. Hah!

  14. I ended up buying things like whole mushrooms and onions for my stew.

    So much preparation to do, but if I am going to cook for people to try to heal their dementia, I guess I got to do a good job.

  15. Maybe cancer might be also considered in this topic.

    A cancer doctor recommends aspirin to help prevent cancer, does Plavix do that?

    The “math” for high risk people is pretty complicated already because aspirin prevents a certain amount of heart attacks and strokes, plus a certain amount of cancer, but can cause bleeds.

    Possibly more bleeds than Plavix, though one study showed the opposite. Plavix might cause slightly fewer heart attacks and strokes and slightly fewer bleeds in some studies, but it caused an increase in mortality and mortality would be weighted worse than a bleeding episode.

    So, does the Plavix help prevent cancer?

    If I went to doctors, I would be such a terrible patient and my doctor would have to be in the ten percent of doctors who could do the statistical math.

    1. There has to be a way of cycling it to have a more optimal heart attack to bleeding ratio.

      I have to look up strokes again.

      There are times of year when they happen more often, right, so taking them during those months maybe?

      Or every other day.

  16. I went to Starbucks today and it was a long, long line and one of my sweet young men saw me and he made my drink and met me at the end of the line and thanked me for being one of their nicest customers. They know how to drag someone back in.

  17. I also was brilliantly inspired for food for my 90-year old relatives who have started with dementia.

    I started showing them the Alzheimer’s videos and kale and blueberries and turmeric and purple grapes don’t require cooking at all and if I just buy baby kale, it doesn’t need chopping and that should make it not precut, right?

      1. I am going to say it.

        I went off the salads and cruciferous and berries for a month and it did negatively impact my brain.

        The videos reminded me why I was eating it everyday to begin with.

  18. Okay, aspirin lowers the risk of

    Heart attack, stroke, cancer and Alzheimer’s


    It raises the risk of bleeding.

    Seems like that changes the math, except for people with high cholesterol.

  19. I am just catching up on the aspirin research and I just realized that Dr. Greger is probably posting this because of the newest guidelines versus the newest study from New Zealand.

    USA latest guidelines recommends against using aspirin unless people have known cardiac risk factors.

    On the other hand, New Zealand just did a study published in 2019, where it helped people who didn’t know that they had risk factors.

    “The researchers concluded that the benefits of aspirin outweigh the harms of bleeding, if you compared the risk of death from one bleeding event compared to the risk of hospitalization or death from a cardiac event. At least 12.1% of men and 2.5% of women without a history of heart problems got a net benefit from five years of aspirin treatment, the study found. The percent benefit increased even more if you compared the risk for two bleeding events to two cardiovascular events.”

    Maybe, I would like the guidelines to be multi-level based maybe on factors like diet and obesity and exercise level and age.

    Well, it seems to me, if members of this audience are WFPB-no oil, vegans who are younger and who are not overweight might need to be more careful about taking it, where people who eat animal products and use oil, might want to use it. Others might want to use it during the Winter or on the holidays when risk for heart attack and stroke goes up. It also goes up in the morning and on Mondays.

    So Sunday night might be a good aspirin day.

    When researchers looked at the days of the week, most heart attacks occurred on Mondays and the least on Saturdays. In fact, the risk of getting a heart attack was 11 per cent higher on Monday than on any other day from Tuesday to Friday.

    I am still working it out, but, since it is Sunday night and it is Winter and it is close to Christmas, I am going to go over and take a low-dose aspirin.

  20. It would seem like it would be a good idea to have a process like that.

    Maybe take one if you have to do snow removal.

    Take one if it is a really cold time period.

    Take one after your Superbowl party.

    I haven’t settled on the “rules” yet, but it is going to be something like that.

  21. Heart attacks and strokes increase 5% on almost every holiday, particularly in Winter.

    January is when they peak.

    The number of deaths from cardiac issues is higher on Dec. 25 than on any other day of the year, second highest on Dec. 26, and third highest on Jan. 1 – so this is the right week to bring up this topic. Take your aspirin during the holidays!

    Be careful to bundle up and not drink alcohol if you are at risk and try to decrease the stress a little. Hard to do, but necessary.

    Actually, I have had 2 relatives who have had the Christmas Day night in the hospital with heart attacks, so I really am not kidding.

    Well, I just read that the Monday and morning thing about sudden cardiac death is how things used to be but now in the modern world of constant stress, they aren’t linked to Monday morning anymore.

    That is based on a newer study. So if your most stressed out day is Saturday, there isn’t a magical Saturday circadian rhythm fewer heart attacks thing going on.

  22. Clock time change increases the risk for 2 days.

    So, I guess I am going to do

    Holidays, Sunday nights, the month of January and February and 2 days at Spring forward.

    Then, if work gets particularly stressful.

    I can schedule it with Siri.

  23. What I wonder though is whether I could just take serrapeptase or nattokinase maybe once a month.

    Does that thin the blood?

    It dissolves blood clots.

  24. It says it takes 5 hours to dissolve blood clots with Natto.

    I am wondering how long it takes to form another one.

    I sometimes have to do snow removal processes. It seems like maybe more than aspirin would be a good idea before that.

  25. Are there any marg majors in the audience?

    The statistics Dr Greger gives are overall, but the risk of heart attack and stroke increases and decreases throughout the year.

    Maybe Summer vacation would be skip it, unless you are flying or drinking a lot or running with bulls?

  26. Flu was another risk factor for heart attacks and strokes.

    Looks like a big flu year.

    I contacted my friends and told them that they might want to take naps and take aspirin at night on Christmas and drink water before bed.

    1. As suggested in the article, the best way to prevent cardiac events on Christmas for people at risk, is to eat a low fat meal made of whole plant foods.

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