Best Foods to Reduce Stroke Risk

Best Foods to Reduce Stroke Risk
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What are the protective components of dietary patterns and foods associated with lower risk of cerebrovascular disease (stroke)?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Stroke remains one of the most devastating of all neurological diseases, killing about five million people a year worldwide, and is “the leading cause of permanent disability” in the United States. But, the good news is that about 80% of stroke risk may be due to basic lifestyle factors: primarily, improving your diet, stopping smoking, and getting regular exercise.

The best way to stop smoking, evidently, is to have a heart attack. If you die, you automatically stop smoking—unless you’re incinerated, I guess. And, if you live, repeated “strong advice” from your doctor may persuade up to two-thirds to quit: “Never smoke again in any form as long as you live.” Yes, it’s very addictive. “Yes, [it’s] very difficult. It doesn’t matter; it has to be done. If you are walking along the lakeshore and one of your grandchildren is drowning, [it’s not a matter of] will power; it just has to be done.” It’s like a healthy diet. Some things just have to be done—”getting up at night to feed a baby” can be difficult, too. But, it’s not a matter of willpower; some things in life just have to be done.

For stroke prevention, that means a more plant-based diet, like a traditional Mediterranean diet centered around “whole grains, fruits, vegetables, lentils, beans, and nuts.” A vegetarian or vegan diet may also work, but must be accompanied by a regular, reliable source of vitamin B12—meaning B12-fortified foods or supplements. “Unfortunately, recommending taking B12 supplements may meet opposition among vegetarians, because misconceptions regarding this nutrient are prevalent. Many individuals still hold on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans. Future studies with vegetarians should focus on identifying ways of convincing vegetarians to routinely take vitamin B12 supplements in order to prevent a deficiency.” The research is clear on that. Now, we just need research on how we can convince vegetarians to actually take their B12 to prevent a deficiency.

What is it about plant-based diets? Previously, I talked about the role of fiber—potentially about a 1% drop in risk for every one gram of fiber per day. Or, maybe even a tad more: a 12% drop associated with every extra ten grams a day. In fact, fiber from, like, whole grains is associated with not only lower chance of dying from heart attack and stroke, but also cancer, diabetes, and respiratory diseases, and lower risk of dying even from infections or other causes. In other words, lower risk of dying prematurely from all causes put together.

Why? Perhaps because of “the anti-inflammatory effects of…fiber,” which could explain how it could help across the board. Or, maybe they’re eating fewer pro-inflammatory foods. Those who eat more whole plant foods, where fiber is found, may be eating less processed and animal foods. In fact, the study immediately preceding this one, this meta-analysis of fiber, was a meta-analysis on meat. They looked at red meat and processed meat, and found about a 10% increased risk of stroke associated with each three-and-a-half-ounce daily portion. So, that’s about the size of a deck of cards, or about 10% increased risk for every half-deck of processed meat.

Perhaps, it’s because of the heme iron (the blood and muscle iron in meat), perhaps because of “its pro-oxidative properties”—whereas, no association was found between nonheme iron and stroke (the type of iron that predominates in plants). Or, perhaps, because of some of the toxic pollutants, like PCBs, that can build up in animal fats. We’ve known that, like, living next to a toxic waste dump might increase stroke risk. But, only recently have we realized that dietary exposure, even at so-called safe levels, may increase stroke risk. As much as eight or nine times the odds of stroke for those with the highest levels of these pollutants in their bloodstream.

Please consider volunteering to help out on the site.

Image credit: Neil Conway via flickr. Image has been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Stroke remains one of the most devastating of all neurological diseases, killing about five million people a year worldwide, and is “the leading cause of permanent disability” in the United States. But, the good news is that about 80% of stroke risk may be due to basic lifestyle factors: primarily, improving your diet, stopping smoking, and getting regular exercise.

The best way to stop smoking, evidently, is to have a heart attack. If you die, you automatically stop smoking—unless you’re incinerated, I guess. And, if you live, repeated “strong advice” from your doctor may persuade up to two-thirds to quit: “Never smoke again in any form as long as you live.” Yes, it’s very addictive. “Yes, [it’s] very difficult. It doesn’t matter; it has to be done. If you are walking along the lakeshore and one of your grandchildren is drowning, [it’s not a matter of] will power; it just has to be done.” It’s like a healthy diet. Some things just have to be done—”getting up at night to feed a baby” can be difficult, too. But, it’s not a matter of willpower; some things in life just have to be done.

For stroke prevention, that means a more plant-based diet, like a traditional Mediterranean diet centered around “whole grains, fruits, vegetables, lentils, beans, and nuts.” A vegetarian or vegan diet may also work, but must be accompanied by a regular, reliable source of vitamin B12—meaning B12-fortified foods or supplements. “Unfortunately, recommending taking B12 supplements may meet opposition among vegetarians, because misconceptions regarding this nutrient are prevalent. Many individuals still hold on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans. Future studies with vegetarians should focus on identifying ways of convincing vegetarians to routinely take vitamin B12 supplements in order to prevent a deficiency.” The research is clear on that. Now, we just need research on how we can convince vegetarians to actually take their B12 to prevent a deficiency.

What is it about plant-based diets? Previously, I talked about the role of fiber—potentially about a 1% drop in risk for every one gram of fiber per day. Or, maybe even a tad more: a 12% drop associated with every extra ten grams a day. In fact, fiber from, like, whole grains is associated with not only lower chance of dying from heart attack and stroke, but also cancer, diabetes, and respiratory diseases, and lower risk of dying even from infections or other causes. In other words, lower risk of dying prematurely from all causes put together.

Why? Perhaps because of “the anti-inflammatory effects of…fiber,” which could explain how it could help across the board. Or, maybe they’re eating fewer pro-inflammatory foods. Those who eat more whole plant foods, where fiber is found, may be eating less processed and animal foods. In fact, the study immediately preceding this one, this meta-analysis of fiber, was a meta-analysis on meat. They looked at red meat and processed meat, and found about a 10% increased risk of stroke associated with each three-and-a-half-ounce daily portion. So, that’s about the size of a deck of cards, or about 10% increased risk for every half-deck of processed meat.

Perhaps, it’s because of the heme iron (the blood and muscle iron in meat), perhaps because of “its pro-oxidative properties”—whereas, no association was found between nonheme iron and stroke (the type of iron that predominates in plants). Or, perhaps, because of some of the toxic pollutants, like PCBs, that can build up in animal fats. We’ve known that, like, living next to a toxic waste dump might increase stroke risk. But, only recently have we realized that dietary exposure, even at so-called safe levels, may increase stroke risk. As much as eight or nine times the odds of stroke for those with the highest levels of these pollutants in their bloodstream.

Please consider volunteering to help out on the site.

Image credit: Neil Conway via flickr. Image has been modified.

Doctor's Note

I love that some-things-just-have-to-be-done sentiment. After all, what we regularly eat every day is, indeed, a matter of life and death.

More on how to reduce stroke risk with diet in these videos:

What does vitamin B12 have to do with stroke? Watch Vitamin B12 Necessary for Arterial Health.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

167 responses to “Best Foods to Reduce Stroke Risk

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  1. How sick does the nation have to get in order to begin to rise above the nonsense?

    So happy I made the break. Broke from the herd. (I was always nearer the fringe than most!).

    1. I guess when the general population get’s sick and tired of being sick and tired they will do something. Like you alluded to, most are sheep..
      This always worked for me.
      “Two roads diverged in a wood and I – I took the one less traveled by, and that has made all the difference”. Robt Frost…

      m

      1. I think one of the under-reported plant-based benefits is what we (wife and myself) found we when recently became vegan (we were mistaken about the healthiness of eating chicken and fish (only)). Now that we are plant-based only, the diversity of what we get from the plant world is, simply, astonishing. We never would have had such an array of plant-based nutrients. Yes, we would eat a huge head of broccoli every night (or kale, or chard, etc.) but that was about it (along with our whole grain). Now each meal consists of multiple whole grains (e.g. buckwheat AND lentils), various leafy greans, beans, a myriad of vegetables, and a variety of fruits (not including juicing of bell pepper, celery root, cucumber, and 6 other fruits and vegetables). Eating a plant-based diet implicitly forces a vastly improved level of diversity of incoming nutrients which clearly has substantial benefits.

        1. do you have a good tip for reducing gas from consuming lentils?… I LOVE them but uncomfortable. I googled around but thought here would be a good place to inquire.
          I like using the dried, but would assume canned would be easier on the digestion but dried are so affordable.

          1. “good tip for reducing gas from consuming lentils?.”

            I’ve soaked them and then thrown out the water… Cook with kombu sea weed or try Beano while slowly letting your body get use to the legumes. YMMV Hope it helps…

            m

            1. I used kombu for the first time last night and it seems to have worked! It also dissolved into the cooking liquid and you can’t even taste it : )

            2. I doubt soaking lentils has any impact on gas. Of course,beans should be soaked for at least 24 hours. Even intact grains which are superior to whole grains are not nutritionally high on the totem pole. If weight is a problem it is much better to focus on leafy greens and legumes while consuming a variety of other vegetables and fruits.

            3. People who use kombu with their beans should be cognizant of the iodine content. In one gram of kombu there is, on average, 2.5 milligrams (2,500 micrograms) of iodine.
              http://www.jfda-online.com/article/S1021-9498(14)00015-5/abstract
              If you add 1 gram of kombu to your beans and eat 40% of what you cook you will be at the WHO upper limit for daily iodine (1000 micrograms/day).

              Now, there are a lot of variables. Some kombu tested for iodine is higher, some lower. For the beneficial effect on beans I believe you can use very little kombu, and that is the point of this comment. I am not trying to scare people.

              Dr Greger on iodine and seaweed:
              http://nutritionfacts.org/video/too-much-iodine-can-be-as-bad-as-too-little/
              http://nutritionfacts.org/video/avoiding-iodine-deficiency-2/

              1. Gatherer: I appreciate your point, but I wonder if this caution really applies to the situation we are talking about??? What I mean is: When I put kombu in to cook with my beans, I throw the kombu out along with the cooking water when the beans are done. I’m sure some iodine gets into the cooking liquid. And from there, it would not be hard to believe that some of the iodine in the liquid soaks into the beans. My thought though, is that probably only a fraction of the iodine from the original kombu gets into the beans themselves. Do we have any reason to believe that all that iodine actually soaks into the beans?
                .
                Eden cooks their beans in kombu and if according to the Eden company, they think the iodine is greatly in the cooking liquid. http://nutritionfacts.org/2012/07/05/do-eden-beans-have-too-much-iodine/#comment-604835119 (Though I’m not sure they 100% know.)
                .
                Another thought: How much iodine we get from the kombu might be a bigger question if someone is making aquafaba. (http://www.aquafaba.com/ ) But even then, I wonder how much of the iodine transfers from the kombu into the liquid (since the kombu itself is thrown out)? I don’t know. It’s an honest question.
                .
                What do you think?

                1. Yes, the iodine in beans with kombu shouldn’t normally a problem. My comment was directed to someone who might use too much kombu in a certain way too often.

                  When I cook (bake) my beans I use near the minimal amount of water to complete the cooking process. In fact I add hot water during the cooking process as needed, keeping the beans just covered. After all, there are spices and chopped veggies in my cooking broth as well as bean protein and starches!! (lol) The beans just taste better if they aren’t diluted with too much water. Accordingly, I don’t throw out that water/broth, it is consumed with the beans. In addition, I figured that a WFPB cook would just naturally eat the seaweed. It didn’t occur to me that any of the iodine would be tossed down the drain.

                  I was also concerned that someone reading about kombu and beans may use a whole sheet of kombu to treat the beans. That could be over 50,000 micrograms of iodine. I haven’t cooked beans with kombu so I don’t know how little you can get by with, but one web site I read suggested you could treat one pound of beans with a postage stamp size of kombu. That certainly wouldn’t be a problem. I’m pretty sure a company like Eden has it titrated down toward the smallest amount of kombu necessary, since kombu isn’t cheap.

                  I haven’t used kombu, but tonight I did cook beans with pineapple juice because my GF likes Hawaiian music. Actually, half that story is true. Tonight’s recipe was pretty tasty for no added sugar or fat BBQ beans.
                  https://www.forksoverknives.com/recipes/bbq-beans-greens/

                  Regarding how much iodine ends up in the cooking water, or as you say “aquafaba”, elemental iodine is only slightly water soluble, but iodide and iodate salts are soluble. My guess is that during the long cooking process in an aqueous medium, much of the iodine from kombu ends up in the aquafaba. Most kombu is from the species Laminaria japonica and 99% of the iodine is in a water soluble form.
                  https://www.researchgate.net/publication/222904902_Determination_of_chemical_species_of_iodine_in_some_seaweeds_I

                  1. Gatherer: Thanks for the clarification. That is super helpful. Also, a big thanks for the info about iodine salts and water solubility. Good to know!!

            1. I’ve used a lot of simethicone as a wildlife rehabber (orphaned animals frequently get bloated when they don’t have mother’s milk) and it isn’t very effective. It acts as a surfactant which just breaks small bubbles into larger ones helping to move through the digestive tract more easily. It doesn’t address the cause of the issue.

            1. That’s not my experience, Blair. I’ve been waiting for more than a year and yet, I still rip and snort and sometimes have to run to the restroom for loose stools.

              1. I’ll chime in here and report that when I went plant based (and I will never go back) I swear I could have a balloon – and I don’t mean a party balloon. I mean a travel balloon with a basket on it that carries people. Omg it was bad. And it didn’t clear up “in a couple of weeks” as is the common advice. For me, it was about 2 years. But I stuck with it and now I can eat beans all the time with no problems beyond what’s normal. So my suggestion is to stay the course and maybe use Beano and/or over the counter simethecone to get you through the adjustment period. Your body will adjust I believe. Have faith!! :-)

                1. And since your gut microbes constantly adapt to what you feed them it is important to eat beans regularly. How often? I don’t know, it probably depends on the individual, but I would guess at least several times a week.

          2. Canned beans/lentils are minimally cooked, which can produce gas. I used dried beans, cook them in a pressure cooker for about 35 mins so they are well cooked. I eat them every day on my salad, in my soups etc. and they no longer produce gas (most of the time). Make sure your lentils/beans are well cooked!

            1. I purchased an instant pot well over a year ago and am terrified to use it. The manual has frightened me away. I know all it takes it just DOING but there it sits, in closet, as I eye it warily…..

              1. Chia, It’s time for you to make friends with your Instant Pot! They are wonderful! I love, love, love mine because I can set it and forget it, come back later, and not have to worry about being in the kitchen monitoring it while it’s cooking. And it’s QUIET, unlike the old stovetop pressure cookers I’ve used over the years for canning. Last night I made soy yogurt in mine and today I’m cooking black beans for later.

                Have you watched any of the Youtube videos by Chef AJ, Jill Nussinow, Jill McKeever, or any of the other bloggers who have cookbooks and videos on using the IP for whole foods plant based eating? They would help, and show you how easy the IP is to use. Google to the rescue here! The books that came with the pot aren’t much help, except for the charts showing how long to cook things.

                I have a friend who was terrified to use hers, but wanted to. She didn’t even really cook at all. I showed her a few things about using it and now she loves cooking! We’re talking about a 67-year-old woman who had never really cooked! She didn’t even have pots and pans!

                1. you are so sweet.. hee hee, but that can’t change my terror. Need an intervention or a friend to come over and MAKE me use it and teach me…. your friend sounds pretty amazing to go from doing nothing to using it though!….
                  I will you tube about it, good idea..but I can see I need outside help to really show me hands on.
                  thank you for your advice. I know it is frustrating reading about someone scared to do something when you know it is SO simple.

          3. Hi chia. I have a slightly different perspective on that. Some flatulence is normal and no problem. I assume you mean that it becomes too frequent, too noisy, or malodorous (all of which of course can lead to an awkward look around the room to imply someone else is to blame.)
            I don’t do anything special with my lentils or any other legume other than looking for the best spices and other stuff to go with them. For me the key is the quantity. When I changed my diet I found that flatulence was a function of speed of transit through the alimentary canal. If I get flatulence I’m getting too little fiber and I mean all fiber but especially legumes. However, when I do get noticeable flatulence it is much less malodorous do to the lack of rotting animal in the gut and it means the colon is full and a trip to the men’s room is due.

            1. lol… well it isn’t THAT bad ..seems to take 5-6 hours after eating. Took a beano yesterday and it did seem to help, but not completely . I cook the lentils well, don’t consume moe that half cup to maybe 3/4…I do like the regularity.
              MS has so much dietary conflicting info. Some say NO legumes, some say YES.. I think the fact that it keeps one regular has SO many health benefits compared to the lectin fears. I just don’t know what to do anymore that I throw my hands up in the air. *sigh*…

          4. Hi there – Although on a plant based diet, I wouldn’t normally suffer from gas. Any time I find I’m getting too much gas from lentils, beans or greens, I know my guts have got out of kilter, usually caused by eating too much yeasty food, eg marmite or vegan cheeses. Taking a strong probiotic with 20 billion live bacilli for a day or two, maybe three, seems to cure it completely. Ditto with indigestion – I hadn’t had it for years but had eaten some out of date bagels. Cured the bout that had lasted for 10 days with four days of probiotics. Who knows how long it would have lasted without them. Hope this helps someone.

          5. Having been a vegan all my life and enjoying Indian foods I may be able offer a few tips. You can reduce gas from foods by adding chopped or grated fresh ginger root while cooking the beans. You can added whole mustard seeds after sautéing them in a teaspoonful of oil. Be careful because the seeds crackle and bounce! The third grandma trick is to add Asafoetida ( an Indian spice) and stir it in as you are finishing cooking, a minute or two before taking it off the stove. Try these and share your experience.

      2. That line probably includes most of us who have made the switch.

        I find myself wondering why our adult children think we’re a bit batty to eat this way, even though my husband had already had angioplasty (before the days of stenting) and one carotid reamed out before I met him, in the mid ’90s, then, shortly after we married in 2000, he had angioplasty with a stent which clogged in four months, followed by a triple bypass. Then, in 2011 tests showed he had one carotid 100% blocked and the other 80%. I have no doubt he would have had a heart attack or stroke long before now if we had kept eating as he did when we met, and continued doing for several more years. That’s when we discovered Dr Esselstyn, bought his DVD and began eating sanely.

        I realize that, while I’ve been learning about real, solid nutrition from the doctors who know, and don’t just try to sell books, they get all their nutrition info from TV, magazines and newspapers which receive the bulk of their advertising support from Big Food and Big Pharma. They haven’t a clue how corrupt the medical system is. They think it’s normal for their kids to be sick half the winter and for them to take statins starting in their 50s. They’re offended if we try to talk with them, preferring to hear good news about their bad habits from sources that are lying to them every day. I have resigned myself to knowing their health will deteriorate further once they hit their late middle age years, and it will be their problem to deal with. If they want to know what to do, we’re here to share good information with them. If not, well, we’ve tried…

        1. It doesn’t matter what they think. I just went to a wedding and brought a bag with my food in it and ordered plain lettuce and put sweet potatoes on top and hummus. Everyone commented and stared but I smiled and said this is how I’ve been eating. And that was all. (Actually – they don’t really want to know because they know there’s something wrong with the way they are eating and they don’t want to change). Most of them are in their 60’s or 70’s and are on regular medications, have had cancer or heart problems etc. Watching those that you love stick to bad eating habits is a very difficult thing indeed.

          1. Why it matters is in your last sentence. It’s sad to watch loved ones digging their graves with their knives and forks, especially when the grandkids are learning such bad habits and developing strong taste preferences for junk. And of course there is always the hope that one day they will be asking for help in becoming healthier. But most probably won’t.

          2. vfran, I couldn’t help but chuckle at that image. I almost did as well a few years ago when at a training meeting in Iowa. For dinner they took us to a steak house. I just asked what sides they had and indeed they were good ones. Almost any veggie. At that place we were to get a large skillet and fill it with the flesh we wanted and whatever else. then we took it to the grill and left it there the appropriate time. I came to the window, skipped the flesh and when they ask what sides I wanted, I said, “all of them.” When I sat down the others at my table all looked rather astonished and remarked how good it looked.
            Interestingly, I thought I was picking up on the fact that they were a bit embarrassed at how unhealthy their food was when I had no problem getting an alternative that looked much better than what they had. It also did not hurt that I was the only one at the table with a normal belt size.

      3. Yeah, but it hurts a little to watch your friends and family get sick and die before their times. That’s the HUGEST suck.

        So I try to only pester gently. I made some waves the other night after dinner out at the Mexican joint. And this is where I can “blend” in because I yet eat some animal junk. Folks can see that I’m not a total weirdo.

        (No, I’m not calling 100%’ers “weirdos”, more power to you, and B12 rules.)

        1. I know several people that were overweight and did not eat like I do but still lived to 87 years old. I am not interested in trying to force my friends or relatives to change. If they ask I explain to them and the rest is up to them if they do not want cds or books from me.
          The only think that bothers me is some people think it is ok to smoke in public and think it is odd if I move,put on the fan or leave. If you have the right to smoke I have the right not to smoke and that includes second and third hand smoke!

          1. Selfish as it may seem, I’d simply rather not have watch a close relative or friend die of completely preventable causes. It has happened, and it will happen again-over and over I’m afraid.

            I’m not forcing anything but information. Information is power. GOOD information is the BEST thing to base our lifestyle choices on. I’m helping Dr. G get the word out so more folks can begin to RECOVER from their un-informed lifestyle choices AS HAVE I, because it’s not so hard they think it is.

            A satellite may drop out of the sky and kill me today, but that’s the same for everyone walking around this planet.

          2. Richard, where do you live? Smoking almost anywhere indoors, certainly restaurants and even bars, has been illegal in Washington State for several years. It’s illegal to smoke within 25′ of the doors, too.

            When my dad had to have a kidney removed, back in the dark ages of the 1950s, it was in a small town hospital that was a converted old Victorian mansion. There wasn’t even a recovery room and everybody smoked, even doctors. As he was coming out of the anesthesia, and suffering nausea from whatever, someone walked by smoking. He associated the nausea with the smoke and never smoked another cigarette!

      4. Mitch, I appreciate the sentiment, but you’re abusing Frost. It’s the most misread poem in American poetry. He’s not actually praising nonconformity. Read closer…and you’ll see there’s a powerful irony driving the poem. What the speaker says and what the poem means are not the same.

    2. never sick enough.

      How often have you seen or known people that are obese, can’t hardly walk, eat horrible diets, complain about their health all the time and yet not make the easiest change that there is to make?

      For a country the size of the USA, the answer would be many tens of millions of people and yet….here we are today.

      People can even have problems KNOWN to come from a poor diet and won’t change anything. They’d rather complain about all the medication that they have to take.

      1. So true and I know too many of them! Despite everything, they think because their doctor never mentioned the plant based diet I keep promoting with it’s obvious benefits, I got lucky and their doctors know best! Lost limbs, strokes, loss of vision, heart attacks, surgeries, nothing seems to alter the path of destruction! “We are all going to die of something and I’d rather enjoy my life” is what I always hear. Talk about a disconnect!

      2. No small part of this is the fact that our doctors, our medical professionals can be just as ignorant now as they were when they were all smoking. The other NOT SMALL part of this is the constant bombardment of selling and availability of CHEAP garbage foods.

        Just over 10 years ago I was married and we’d get Tuesday night burgers from Sonic for the whole family for like five bucks. And we never ate it all.

        We must have some hope, as disheartening as it is when we make the discovery, get excited, feel great, and cannot get anyone to listen. So much for word of mouth. But I do remain optimistic, it is my nature. The other nature is not pleasant.

        1. I do not think everyone in the medical field is ignorant despite the lack of adequate nutrition training. Many, if not most, are in a career that provides them a living and fighting with people that do not want to change is not only frustrating but in the short run if people complied their earnings would decrease.

          1. You are exactly right, everyone in the medical field is not ignorant. There are a few, just like there are a few folks who are not Medical Doctors but understand that plants reign supreme. Extreme minorities both are.

            It will be a long long time before the majority of them or US begin to fully understand how significant nutrition truly is.

      3. The government, medical field and even health insurance companies are not properly motivating good lifestyles so people are not fully paying financially for their choices. Certainly the poor live the way they prefer without considering non-existent financial penalties…

    3. Food preference and food addiction will be keeping the Western Diet popular world-wide long after we are gone. At this time about 28% of the worldwide population is at least overweight. However, in the US the number is 67% of the population, so you can see what the world is tending to move to. I have no idea how long the US will be able to afford satisfactory health care but luckily for many others in the world their country spends very little on health care and many do not live past 65 which also helps their SS system if they have one.
      I have lived abroad for about 25 years since I was 22 and my current status is the last eleven years in the Philippines. Most people would rather get sick and die young rather than eat the way I do. Even the switch from white rice to either brown or black is beyond 95% of the population here so you can just imagine where sweet potatoes are going to go in populatity.

  2. Speaking of B12, I use red star nutritional yeast….it has high amounts of B12 but I now notice it is fortified with many other B vitamins, and in high doses. Is this safe to be ingesting synthetic folic acid, B6, niacin, b5, and other synthetic B’s as result of using red star nutritional yeast? And I am also finding out that most if not all nutritional yeast used in vegan products is using fortified nutritional yeast. It seams to me that all these synthetic B’s might not be so good for us. I know you use nutritional yeast, Dr. G, so wondering your thoughts on this one. Thank you.

    1. I recently tried nutritional yeast and found out I’m in the group for which it causes mind-bogglingly large intestinal “distress” :) :(. Too bad because I really enjoyed the flavor :(.

      1. kevbo: I’m not an expert, but I had a thought for you: What if it is like legumes and you just need to work up a tolerance? Ie, so start *very* small and slooooowly work your way up? Just a thought.

              1. I don’t see anything wrong with Beano, especially if it helps you eat more beans. After a while you may be able to stop using Beano. That was my experience.

              2. Beano is simply the enzyme that is missing for those of us who find beans gaseous. I used it effectively back when it was a liquid you dripped onto your first bite of beans, but since it’s now a capsule it hasn’t worked for me.

          1. Back in the ’60s Adelle Davis liked using nutritional yeast, or brewers’ yeast in those days. She suggested starting with only 1/4 teaspoon a day and increase by maybe that much daily until things improve.

    2. B vitamins are water soluble, so you will just urinate out the excess. Folic acid can increase cancer risk, though, but that’s in much larger amounts then you would get from nutritional yeast. The dose makes the poison. Nutritional yeast is safe, IMO.

    3. Hi, Hillary in Tibet. I am Christine, a NF volunteer moderator. You might be interested in this video (and the accompanying notes) if you have not already seen it: http://nutritionfacts.org/video/daily-source-of-vitamin-b12/
      If you are concerned about synthetic vitamins added to your nutritional yeast, you might consider just taking a daily or weekly vitamin B12 supplement. If you are concerned about synthetic vitamins in processed foods, maybe it would be good to focus on whole plant foods instead of these products. I hope that helps!

  3. Could somebody help me. I’m intolerant of gluten and beans (……. and YES I am intolerant of these. I get very bad stomache issues and really painful acne which is almost like cysts). I really don’t eat much meat at the moment, mainly veg, potatoes and rice. I take a B12 supplement. I’m worried about the lack of fibre and wholegrains in my diet. Is it possible to be healthy without grains and beans on a meat free diet? Any comments would be really gratefully appreciated!

    1. Hi cloggs
      There are a lot of other grains without gluten. If you are eating plenty of veggies and fruit you are eating plenty of fiber. Don’t worry.

      Stay away from dairy.

      1. Thanks so much for your reply. I don’t eat dairy either because of the acne thing. Since removing gluten, dairy and beans, my skin has really cleared up. I am getting the usual comments from well meaning friends and family re protein and iron. I suffer with reynaud’s as well and have low blood pressure. I’m still a little worried about becoming 100% PB. Do you think I can get enough protein and iron (and convince others I am too!)?

        1. @WFPBRunner: Cloggs’ reply above got caught in the automated SPAM filter. I’m posting, because he/she is asking you a question. I wanted to make sure you saw it.

        2. Cloggs: In addition to whatever great response WFPBrunner will have for you, I thought I would mention that some people report that they are able to slowly bring back in foods (like gluten grains and beans) that they had previously removed — after stabilizing on a whole plant food diet for a while. Just something to keep in mind that might be a possibility for you.

          1. Thanks. I will bear it in mind. I do find I can sometimes eat a small amount but for some reason I feel worst with wholemeal wheat than white which is really annoying. I will give it a while on PB and try again. Thanks for your advice.

        3. If you are concerned about the amount of protein, iron or any of a dozen other vitamins and minerals, I highly recommend logging every thing you eat into cronometer.com or other similar websites. There is a smartphone and tablet apps that lets you capture what you eat as you eat it, which I find much easier than trying to write it all on a piece of paper and then entering it when I get back to my computer. And I find it actually easier, not to mention far more accurate to weigh each item with a digital kitchen scale that has a “tare” function to rezero the scale after adding each item. The website taps into several large nutritional databases and will tell you the nutrient breakdown for individual foods (just click on them to highlight them) or for the sum of all the foods in the list (just click on the title line to deselect an individual item and see the totals of all foods again). If you are interested in seeing the levels of each of the essential amino acids in addition to the amount of total protein, just make sure each food item has values listed for amino acid levels. Some commercially prepared foods in their database only give total protein with no data for the amounts of the specific amino acids. If you include any of these foods the totals for the daily amino acids will be lower than they actually were. There really is no need to worry, but it might be reassuring to see that you have no trouble meeting your daily recommended amount of all of the essential amino acids even when eating all those “low quality” plant protein. Good luck!

        4. Hi Cloggs. I am a plant based doctor and one of the NF Moderators. It wasn’t clear to me if you have been tested for celiac disease. If you have celiac disease you really need to avoid all gluten, exclude it completely from you diet. If you don’t, the intestine will remain in flamed and cause difficulty digesting pretty much anything, and also difficulty in absorbing nutrients from your food. It would be wise to check your vitamin D levels. Another question, have you always had food intolerances (beans etc) or did they dievelop at a particular moment, for example after an infection or other illness, or a course of antibiotics. This may have affected the bacteria that live in your gut and do a lot of the digesting for us. This is likely to gradually improve if you continue to eat foods which themselves feed the good bacteria (basically foods with fibre) but some practitioners would suggest using probiotics which you can buy. Would be great if you could find a sympathetic health care provider. Also if/when the Raynaud’s is cured, it would be wonderful if your doctor could write a letter about it (and how you did it) to the professional medical journals. The more doctors hear about the benefits from dietary change, the more they will be able to help others. I hope that is helpful!

        5. Absolutely! I am gluten-free and have no deficiencies. Just eat a variety of Whole Foods. There are some wonderful suggestions in response to your question.

          Animal products are junk foods. Not plants.

        6. There is no plant food that won’t supply you with all the protein you need, and in far better quality than the polluted recycled protein gotten from eating animals. Our bodies seem to utilize the nutrients from plants far more effectively. Animal based proteins contribute to a slew of problems, including heme iron from animals which can build up in tissues and cause damage, unlike plants. You avoid many issues by eating plants to get your protein the same way as the food animals do, (not just grass, but you get the idea :) and receive only benefits! Cutting out all animal products and processed foods including oils, will confer more benefits than you can imagine, and shift your microbiome to a much healthier state, often reversing overt diseases and even sensitivities over time. http://nutritionfacts.org/topics/meat/

      2. Wheat, barley, rye and triticale (a hybrid of wheat and rye) are the grains to stay away from if you’re gluten intolerant. Other whole grains or seeds such as millet, quinoa, teff, montina, buckwheat, cornmeal, sorghum, amaranth, whole grain rice (brown, black, red),wild rice, Job’s tears, popcorn and possibly oats (if processed with equipment not used with wheat) are probably fine. Also, yams, squash, pumpkins and sweet potatoes are good sources of high quality nutrition that many people overlook.

    2. ” Is it possible to be healthy without grains and beans on a meat free diet?” I think the question should be “Is it possible to be healthy eating meat?” Vegetables, brown rice and potatoes are probably the best foods on the face of the earth. Indulge.

        1. Or send then here: http://www.spudfit.com/about-spud-fit for an extreme wake up! Andrew Taylor ate ONLY plain potatoes (mostly regular but some sweet) for an entire year to rid himself of his food addictions, and not only succeeded but ended up losing 120 lbs and improved his health dramatically in many ways! Yes, it was an extreme case, but if plain, oft maligned, potatoes alone can improve health, imagine what a varied whole food plant based diet can do! (Which by the way is what he is doing now, also with great success!)

      1. Also it’s the best health insurance you can buy!! I can’t predict the future but eating WFPB diet will help me stay out of the hospital..
        m

    3. Clogs: You wrote “beans”. Does that include lentils and peas? If not, lentils and peas are as nutritious as beans. If I remember right, peas have more fiber than beans do. Also, Lentils and peas are much easier to cook than beans are.

      1. Now you come to mention it I seem OK with lentils (my Mum does a mean curry with them!). I’ll try them over the next week and see. I’m fine with peas and had no idea about the fibre content – really interesting. This site, and those who contribute comments, are great.

    4. Do you know why you don’t tolerate beans? Is it the phytohaemagglutnin (a lectin) that is present in especially high amounts in red kidney beans? If so here is a list of beans that are supposedly low in lectin content. (I grabbed this off a random internet site so take that for what it is worth.)
      Rice bean (Phaseolus calcaratus)
      Cowpea (Vigna sinensis)
      Broad beans (Vicia faba)
      Lupin seeds (Lupinus angustifolius)
      Great Northern beans (Phaseolus vulgaris)
      Pinto III cultivar (Phaseolus vulgaris)

      Phytohaemagglutnin is destroyed by high heat so make sure you are fully cooking your beans at a temperature sufficient to boil (well, simmer) the cooking water. Don’t use a slow cooker, at least not on low heat only. I like to bake my dry beans in the oven at 325 F (163 C), usually without presoaking. I only bother to presoak the types of beans resistant to cooking (e.g., chickpeas).

    5. Hi, Cloggs. I am Christine, a NF volunteer moderator. Yes, it is possible to be healthy without gluten, although it is not necessary to eliminate all grains if gluten is an issue for you. You mention that you eat rice, a gluten-free grain. Others include millet, sorghum, buckwheat (I know, it has the word “wheat” in its name, but it is not wheat at all, and does not include gluten), and gluten-free oats (oats do not inherently include gluten, but are often contaminated with it through processing on shared equipment also used to process wheat). Quinoa is also a good choice, if you are able to tolerate it. You may need to focus on gut healing and restoring balance to your intestinal microflora. This may be, at least partly, responsible for your intolerances. If you tolerate seeds these may be good to add to your diet as well. Once your gut is healed, try re-introducing small amounts of pureed beans to see if you are able to tolerate them. I hope that helps!

  4. This link https://www.ncbi.nlm.nih.gov/pubmed/24167723 is from the sources cited section above under the video. The short abstract is worth a read – the risk of stroke rises dramatically with increasing age, and although people can lower their risk up to 80 % by ‘getting it right’, researchers say ‘getting it right ‘ is a tall order. Lifestyle factors top the list.

      1. Yes indeed WFPBRunner! Looks like the average NutritionFacts devotee stands in good stead with lower risk of stroke. Not sure how exercise fits in, but must impact maintaining healthy weight, blood pressure, cholesterol levels etc. Would be interesting to have a study on NF fans.. I’d volunteer !

    1. Eating plant-based removes any benefit from eating aspirin. Your body makes the same stuff, but it’s all used up eating inflammatory animal parts and pieces and excretions and embryos.

      I used to eat NSAIDS/aspirin regularly. I don’t have to anymore. The aches and pains went away when I stopped eating animals every single meal.

      Now I just need NSAIDS when I get overhung. 8-P

        1. Worry is wasted and unhealthy emotion. Can induce stress hormones. Just another reason to switch off the “news”. I’ve consumed a pound or two of ibuprofen since the 200mg size “went public”(OTC) some years ago. And I can yet remember where I was and the chair in which I was sitting and the pain I was in when the first 400mg dose kicked in. It was amazing.

          Acetaminophen never helped my headaches. I wasn’t sure it was totally ineffective until Ibuprofen.

          So now I only take ibuprofen, aspirin, or that blue stuff. All 4 or 10 times that I might need to in a year. I used to take that many doses per month, easy.

          And I’ve no worries of stroke or heart attack. They may yet happen, but I can also worry about a satellite crashing through my roof as well.

          Relax. and have some veggies.

    2. I used to take tons of ibuprofen for headaches/pain… but then I stopped. Honestly what I did was just learn to live with the pain like it was tinnitus, only notice if I focus on it.

      But, November 2016 I finally got a medical marijuana card and a low dose (2mg-5mg) helps pretty well. Helps with back pain too.

  5. The American population will NEVER adopt healthy eating and life styles because they are constantly brainwashed on a daily basis by Big Pharma, Big Agriculture, and Big Business to consume their products. People are sheep and easily manipulated to do whatever their masters want them to do.

  6. I am loving lentils but eternal confused. I have MS, and am doing quite well except for the persistent numbness in hands and feet..plus icy…. but if that is all I have to contend with, I am GRATEFUL!.

    Here is where confusion sets in. I refused ALL drugs, neurologist rolls eyes at me but there is NO way!.. Anyways, the SWANK diet is vegetarian and low”saturated” fat and Dr. Terry Wahls diet, the MS doctor, healed her aggressive form with paleo type diet, higher fat..NO legumes. I have TWO contradicting theories

    Without being able to MRI myself frequently, besides how I feel, I have NO clue if any diet helps or harms. The stress of worrying about every bite is not healthy either.

    Without having $$$ to go seek naturopathic help, online is my only assistance, certainly NOT mainstream Doctors which my medical would pay for….so you could certainly understand how difficult it is for me….

    1. chia: I can understand your confusion. It really is tough to figure these things out. Some time ago, a forum participant named b00mer posted two comments on this topic. I find her perspective to be really helpful. Also, keep in mind, the Swank Diet is based on scientific studies. The Terry Wahl diet is based on one person’s experience and we don’t really know what she ate…
      .
      Good luck!
      .
      ********************************
      Dr. Wahl’s diet as listed below, is incredibly nutrient dense *despite* the inclusion of animal foods.
      .
      From my limited reading (I have not read her book), she seems to emphasize omega-3s, which is perhaps why she is endorsing “grass-fed” meat or certain fish. Why she doesn’t use plant-based sources for omega-3s is unclear. Perhaps because she was already inclined towards eating a paleo diet (during which she continued to decline) before starting the vegetable-heavy nutrient dense regime described below (as a result of which she improved). Perhaps this paleo inclination has resulted in an aversion to flax or chia seeds, or perhaps she feels she requires long chain omega-3s, though she could of course consume this in the form of algae.
      .
      I suspect that being off all grains and potatoes, she requires something calorically dense to simply survive and function, and has found that in low micronutrient but high calorie animal foods.
      .
      In any case, with all of the veggies she eats per day, the room left for animal foods is scant. I can’t imagine her eating a large amount of animal foods on top of all of those veggies.
      .
      So on one hand, we have multiple, highly reproducible studies showing a high plant food low saturated fat diet works for MS. On the other hand, we have an n=1 anecdotal tale about someone who eats an obviously high plant food diet and has also corrected her MS. Depending on the amount of animal foods she consumes, there may or may not be very much significant disagreement here. It would be interesting to know her saturated fat intake. Perhaps it is lower than people are inferring from her dietary description, or perhaps it is higher than those on the Swank diet, but her 9 cups of veggies per day are also higher than those on the Swank diet, and are providing a therapeutic effect to mitigate the effect of the fats.
      .
      ___________________________
      .
      Dr. Wahl’s diet:
      > 3 cups of cruciferous and dark greens
      > 3 cups intensely coloured: 1 cup red vegetables / fruit, 1 cup blue black vegetables / fruits, 1 cup yellow/orange vegetable / fruits
      > 3 cups others including: 1 cup mushrooms / onion family (for organic sulphur), and seaweed for iodine and trace minerals.
      > Include spices and herbs.
      > Omega 3 rich foods, green leaves and animals fed green leaves, wild fish and seafood. And you could add fish oil.
      > Eat organ meats once per week
      > Regular bone broth
      > Fermented foods or a probiotic
      .
      ———————————–
      .
      and a follow up post from b00mer:
      .
      Thanks Thea. I had Jeff Novick’s quotation in my mind as well. Funny how people love to pick out the single least significant and least healthful food out of an overall healthy diet to glorify e.g. olive oil or goat cheese with the mediterraneans, fish with the Japanese, etc.
      .
      I could only stand to watch about half of the video as it was achingly unscientific, but the word I heard a million times was micronutrients micronutrients micronutrients. What exactly does micronutrient intake have to do with eating meat? Not much, unless you’re trying to minimize it.
      .
      She also flippantly mentions “the essential fats are important too”, specifically mentioning saturated fat, which of course is nonessential. And in the same breath attempts to relate it to plasma membrane fluidity, which is inversely related to saturated fat composition.
      .
      It is astounding that someone that displays ignorance about such extremely basic biochem and nutrition principles is given a platform to speak about diet and health. Of course, if her message of micronutrients and essential FAs is getting cleverly construed to => eat meat and saturated fat and be healthy, well, I’m sure she’ll sell a lot of books.

      1. oh you are a DOLL!.. thank you for taking the time. Well then I suppose I am on the right track. Good point, that Wahls is just one person..sometimes it takes someone else to point out the obvious .

        The swank also promotes some fats, as in flax and olive, but I DO love ground flax and chia, a tbsp each in my morning smoothie. It also wants some seafood consumed..and is HEAVY on non fat dairy, I don’t like that. I suppose I just have to create my own based on this diet and do my best. I don’t want to spend the rest of my life, am 52 now, worried about it so much that it makes eating scary and worrisome. sigh…..the swank diet also has NO legumes and modest lean meat..
        sigh..

        so many opinions and contradictory info… paralysis by analysis.

        guess I need someone to talk to… lol…

        1. Email Dr McDougall with your questions. He was mentored by Dr Swank and took on the MS patients after Swank retired. He will usually email you back the same day with all kinds of links to pertinent articles on his website. It’s free, too!

        2. If I were you, I would download Dr. Gregor’s free Daily Dozen phone app and follow that diet. Just include a good algae based DHA/EPA supplement. I like this one: http://opti3omega.com/ …. Any inclusion of animal foods is just going to slow down your progress.

          1. thanks!.. will check it out. The swank diet encourages oily fish as does Wahls .. what a pain in the butt that I have always eaten so well, (or so I thought), and now I have to buckle down to the finest minutia of analyzing things due to autoimmune issues. The bone broth eating plan is another thing that is raved about for healing gut. Most people would just keep doing what they’re doing and take drugs the doctors hand out but I could NEVER ..UNLESS, there was something that DID heal. All these drugs do is mask symptoms and harm organs!..arghhh…..

        3. Hi, chia, I have MS and Raynaud’s, too. I’m doing well on the WFPB diet, including tons of beans and barley. I still have attacks but they clear up very quickly. My neurologist considers me non-progressive at this point. I used to be much worse.

    2. My dad has MS, but he won’t change a thing about his diet. In my research the Swank diet is THE one to pursue. They have a great support group on FB. Cheers.

      1. Thanks Wade. I’m a personal trainer…don’t drink, don’t smoke..no caffeine…at least for the past 20 years…and still, this…lol…I have to laugh, what else can I do?…funny how it seems perfectionists get MSat a statistically higher rate..

        I am really doing my best with nutrition especially since not ever having taken one drug..and refusing any!… smoothie for breakfast with kale, parsley, blueberries, flax, chia..almond milk…pea protein powder..hunk of ginger, turmeric.

        Almonds and a pear later…

        Dinner was just half can salmon and whipped yams…. while not a complete vegetarian…compared to average, I’m pretty damn vigilant and proud of putting good things in my body.

        Always a work in progress.

        1. My newest culinary delight is fresh oyster mushrooms I harvested yesterday. First time for such, and now I know what to look for. I’m mostly WFPB, maybe never fully-but it’s so different over here. I don’t think 100% could change things much. Cheers!

  7. SO confusing. For every advocate of “plant based diet” I can find a GURU advocating supplements (Dr. Wallach who dissected thousands) claiming all is healthy as long as we get the 90 essential nutrients and avoid things like oils (which get oxidized) and grains which cause inflammation… Go to you tube and do your research.. So confusing.

    1. Jim, the sad truth is lots of money is made on supplements, books, products, and sickness in general, and there are paid and conflicting studies for everything to add to the confusion. Like Dr Greger says… I don’t care about opinions or beliefs, I want to know the consensus of the best available science….and that’s why we all come here! No conflicts of interest, no profits from products, just pure nutrition facts!

    2. Grains are good.

      Maybe read the studies upon which your “mystifcation” is based, find out who has pecuniary interests in what. Also, YouTube isn’t a great source for veracity. It’s a slop-fest of garbage, entertainment, sales, and some good videos here and there-if you know how to find them. Youtube is no “source” for research, but it could lead you to some real scientific findings and/or some better sources.

      Odds aren’t good though.

    1. And he was male. A German. Caucasian. Had a funny mustache. Commissioned Volkswagens…so what is the significance and what associations should I make with this info…they are all evil?

      1. Not at all. Read: The Bad War: The truth never taught about WWII or watch the series. I’m sorry I can’t give you a paragraph reply to what is a 6 hour mini course. Do your homework sunshine. EVERYTHING we have been taught is a lie.

        1. Jim Bean: I agree with Vege-tater. Even if it were true that Hitler was a vegetarian at some point, it seems like a completely irrelevant point to this page or even this website.
          .
          Note: The website Truth or Fiction has this to say on the topic:
          “Hitler preferred a vegetarian diet, but was not a pure vegetarian.
          It started when his doctor once put him on a vegetarian menu but Hitler is described by his biographers as liking a variety of meats including sausages.”
          .
          If you can’t explain what your comment has to do with this website, I’m tempted to mark it as SPAM or delete it as inappropriate. However, I’m giving you a chance to explain yourself first. I almost never take the time to do that…

          1. Aren’t I the lucky one. You are going to give me the opportunity to explain myself? You arrogant- self bloated buffoon. Hitler hated to see anything killed. I gave the source: THE GREATEST STORY NEVER TOLD (free on you tube) Watch it learn and get over yourself. You are no authority on anything. Your sources are as reliable as Schindler’s List ( a book of fiction).

        2. I know, but war is not a specific topic I am likely to pursue because it is insane, twisted, and we are constantly immersed in the madness. A more general historical doc that covers it though I found very enlightening to share is this 3 1/2 hour historical doc you can google…”Everything is a Rich Man’s Trick”. by a British historian Not the history we were taught for sure.

      2. Don’t forget the missing ummm….He was one 1 shy of a bunch. you know, he was a cryptorchid. And he had what looks to me like Parkinsons in some of the old films…or maybe he’d just checked on the weather in Kursk.

        1. Dang, like my bro? Sadly, even though they tried to locate it surgically when he was a kid, he died from cancer that originated in those cells. He said it was his revenge against all the people that teased him about it over the years! The definition of gallows humor?

          1. Sorry Char. Its a tough universe. I think (hope?) we give life meaning when we impose our caring, our genteelness and civility with grace and courage upon the apparent indifference of the Infinite. Gallows humor included.

  8. You can also contact his office and they will respond with an answer. You can find his contact information on his webpage. I have, twice, received a response from Dr. McDougall, . . so if I were you I would read everything on his site and perhaps contact them if needed. They are ALL about getting people help.
    They also have a research leg that they accept donations for funding. They also have a program for training doctors.

    1. That’s a great sentiment, but I’m pretty sure those petitions are a waste of time. And yes I’ve participated in more than one. And no, nothing changed.

      1. Political apathy is not the solution to our problem. We must put our best foot forward and give it all we’ve got. This isn’t about sentiment or feelings, this is about life or death. Negativity or positivity is irrelevant also, it is time for truth to reign.

        P.S. Also, your hasty generalization that because one petition failed and therefore others will fail also is a logical fallacy (https://owl.english.purdue.edu/owl/resource/588/04/).

        1. I know logic, I never indicated the number of petitions I participated in. Despite my BA in Political Science and many years of activism on multiple levels of politics, I no longer play. It’s a complete waste of energy/emotion. When nothing changes in 40 years, it’s time to find another drum to bang. Power to those who oppose, I’m not against your right to think as you do. Best of luck.

    2. Great idea! Something tells me that Trump is going to be more pro-animal agriculture and fast-food industry than any President to date, but maybe you’re right and he will be unpredictable–we can hope! I just signed!

  9. Hi, I have a question regarding autoimmune thyroditis. I’ve been following a plant based diet since coming across Dr Greger and have experiences some improvements in digestion and weight loss. However I have been feeling very low, anxious and fatigue and most recent blood tests however have confirmed that I am suffering from autoimmune thyroidits and now I have been researching the best diet to reduce my antibodies and improve my symptoms. Everything points towards the AIP diet and the importance of consuming Fish and Meat Protein. I can not find any research on thyroid autoimmune disease on this website and was wondering whether you please could provide me with any knowledge or advice. Thank you so much!

  10. At the beginning it said 28% reduction from exercise, 36% from not smoking and 44% from diet choices. Does this stack? What I mean is that if I don’t smoke plus diet changes does that mean I have an 80% chance of not dying from Stroke? Or is it a case of it makes at 44% and if I smoke I just lower the odds to say 8%? So of it maxes at 44% and I don’t exercise I have a it drops to 16% reduction? How does that work? Or is it a case of 44% plus exercise decreases the odds slightly more? so not smoking plus diet adds up to 58% reduction? How does the reduction work?

    1. So your question is really one about how to interpret the statistics in the paper. This is the original full text study that is cited by Dr. Greger: http://circ.ahajournals.org/content/118/9/947

      You are asking about the additive effects of different combinations of risk factors. You can’t simply add up the stats they got for each individual risk factor, as you theorized, because it’s all about statistical modeling. So you have to plug in exactly what you want calculated into a formula (“statistical model”) to get the specific data you are seeking.

      There are 2 things to keep in mind: 1) These stats are all statistical calculations and there are many different mathematical models that are used to plug in the different risk factors or prevention factors, and what model they used is also going to affect the results and how you interpret the stats. 2) These numbers are not exact. Another study may get slightly different numbers. There is always some error involved in these sorts of estimates of risk. So don’t get TOO nitpicky about exact numbers.

      But you can look to see if there are specific statistical analyses performed by the researchers to find out the results you want to know.

      This is the full text of the study. If you’re not trained in statistics and interpreting research, it might be a bunch of gobbldeygook! http://circ.ahajournals.org/content/118/9/947. According to the study, Women with all 5 low-risk factors had a 79% reduced risk of total stroke (RR =0.21) and an 81% reduced risk of ischemic storke (RR=0.19). Men who did all 5 behaviors had a 69% reduced risk of total stroke and an 80% reduced risk of ischemic stroke. They report: “Women and men who were adherent to all 5 low-risk factors had an ≈80% lower risk of ischemic stroke compared with women and men who had no low-risk factors.”

      By the way, the reason risk reduction is not 100% if you did all 5 preventive behaviors is because you can’t possibly say that someone has a 100% chance of not getting a stroke because there may be OTHER reasons why they could have a stroke that may not be affected by these behaviors, or there might be a totally different preventive behavior that was not accounted for in this study.

      BUT your question is not what the risk is with all 5, but what about just TWO behaviors: not smoking and good diet. We have to look at the stats they reported to try to find out. IN Table 1, the researchers reported the risk depending on each individual risk factors, so these analyses give results for the effects of only ONE risk factor.

      In the Figure in the study, they show a graph that shows the incremental increase in reduced risk per lifestyle factor. It does not specifically say which are combined, the graphs just give an estimate or the number of behaviors that are practiced–from 1 to 5 low risk behaviors. So, in theory, the stats they give could be for any combination of two factors.

      In Table 3, they DO look at different specific combinations, of 3, 4 or 5 factors, but they do NOT give the data for only 2 specific factors. (It is likely that they DID calculate 2, but when publishing in a journal there is limited space. So if they did it, they didn’t have space for it.)

      So we don’t have the EXACT data you want, but we can get an idea by going back to the Figure. In the Figure, women who did all 5 behaviors had a 79% reduced risk of stroke, and men a 69% reduced risk. Women who did TWO of the behaviors had a 59% reduced risk, and men had a 53% reduced risk. So it looks like it’s ~ 50% to 60% reduced risk. Again, that stat might very slightly depending upon which combination of two risk factors it really is, but this is sort of an averaging. (

      Hope that clarifies things a bit! – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬‬‬‬‬‬‬‬

    2. Hi, Stephen Lucker Kelly. I am Christine, a NF volunteer moderator. You raise an interesting question. Although I do not know the exact numbers for combinations of risk factors and, by extension, eliminating them, they probably do not “stack,” as you say, so that exercising, not smoking, and ideal diet choices would reduce risk by 28+36+44=108%, because that is not mathematically possible. Even if we do not know precisely how much, each thing we do to improve our health is additive in terms of further reducing our risk of stroke and other serious illnesses. I hope that helps!

  11. Can anybody refute any of these articles, or studies?

    Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease
    http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract

    New Scientific Analysis Confirms Saturated Fats Have No Link to Heart Disease
    http://articles.mercola.com/sites/articles/archive/2015/08/31/saturated-fats-heart-disease.aspx

    Do Saturated Fats and Trans Fats Cause Type-2 Diabetes?
    http://www.westonaprice.org/know-your-fats/do-saturated-fats-and-trans-fats-cause-type-2-diabetes/

    The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort.
    https://www.ncbi.nlm.nih.gov/pubmed/26791181

    The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy
    https://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/

    1. walterbyrd: I’d say this whole website is a refutation of those articles. I know you are looking for a different type of answer. I hope someone will give you the answer you are looking for, but I think my answer helps to put things into perspective. You are always going to be able to find one more person on the internet who spouts this type of information. Those pages are not supported by the body of scientific information, and it is kind of exhausting to try to refute each person, page by internet page. (Though I do hope someone will try for the links you are interested in!) I think it is best to just stick to reputable sources of information.
      .
      I can see that you listed specific studies also. Someone else would have to take a crack at those. Usually the studies are not well done or do not represent the body of evidence, but I have not looked at these particular studies.
      .
      Note: The Plant Positive site does a great job of going through cholesterol confusionist points, checking sources, and doing that specific refuting you are talking about. Here are some videos that deal with Kresser and the Weston Price Foundation. You might want to check these out?
      http://plantpositive.com/display/Search?searchQuery=weston+price&moduleId=19496100&moduleFilter=&categoryFilter=&startAt=0 (On the left of this page is a list of videos on the site that mention Weston Price, but you can just start with the first video.)
      http://plantpositive.com/22-cholesterol-confusion-5-cho
      http://plantpositive.com/blog/2012/3/26/vegan-propaganda.html
      .
      Following are insightful comments from forum participants about Mercola. The point I’m making by addressing these sources in this way (by checking their general credibility) is that there aren’t any reputable sources of information that interpret the science in the way represented by your links.
      .
      Overview from Tom Goff: “Mercola is not an MD. He is an osteopath (DO).
      He is also a believer in homeopathy, that diets high in saturated fat and cholesterol are harmless, and apparently that all vaccines are harmful. He also has a number of other strange beliefs which appear to run counter to known facts. For example, he states that large LDL particles are not harmful!. Of course, as is well known, he makes a lot of money selling a wide range of pills and potions. He has, I understand, been the subject of a number of FDA orders to stop making illegal claims about products sold through his website.
      I would be extremely wary of any recommendations made by Dr Mercola, especially if they cannot be substantiated by peer reviewed studies published in credible journals.” Check out: http://www.quackwatch.org/11Ind/mercola.html
      Comments from other participants:
      http://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/#comment-1777032840
      http://nutritionfacts.org/video/does-coconut-oil-cure-alzheimers/#comment-1409184372
      http://nutritionfacts.org/video/egg-cholesterol-in-the-diet/#comment-1754124343
      http://nutritionfacts.org/video/food-as-medicine/#comment-2173922266

    2. Siri-Tarino lead study – One of the most misleading studies in recent memory. Second Thea’s recommendation to see Plant Positive’s rebut of the study.

      Mercola – Quack with potions to sell. Quality of advice is on the Dr. Oz level of pandering.

      Weston A. Price – non-scientific hacks with an agenda that Plant Positive completely evicerates with peer reviewed science

      Netherlands Cohort – Look at the initial thing that replaced saturated fats, animal protein and the last carbohydrates. In order for saturated fats to go down while animal protein went up means that they were eating more chicken, fish, low fat dairy and possibly eggs and less beef and pork. Animal protein has a number of strikes against, primarily that it stimulates the increased production of IGF-1 and mTOR. If the egg consumption went up, then dietary cholesterol went up too, which does have an effect. Also chicken and fish still have plenty of cholesterol. An since 90+% of carbohydrates come from refined sugar and refined grains which come with their own set up problems. Basically it sounds like the people in this study replaced one set of unhealthy foods for another set of unhealthy foods. As such it can say very little about the actual absolute impact on CVD risk from saturated fat, just the relative risk between two groups eating unhealthy diets.

      What is know beyond question because it can be directly observed in metabolic ward studies is that saturated fat increases cholesterol in a dose dependent manner. And there are so many studies that show that no other variable other than cholesterol is required to explain the rates of CVD. So the only thing to be learned from this study is don’t replace your bad foods with other bad foods.

      Kresser – A paleo hack with books to sell who is extremely careful which science he uses to try to back up his wishful thinking about diet. Also see the Plant Positive videos if you are actually interested in the deceptive practices these folks use.

  12. Once again Heme iron comes up. With Plant Based burgers now available with isolated plant heme iron being a main ingredient, do we have to have the same health concerns with those burgers as any other animal meat due to their use of heme iron from plants?

    1. hi Mike, I was just reading the last paragraph of the transcript and it seems to answer your question. Heme iron is fro blood and muscle (animal), whereas nonheme iron is from plants.. Dr Greger says there is no association between nonheme iron from plants and stroke. Supplements are available with nonheme iron… I did have to take them for a while with no negative effects.

    2. That is a very good question. I think the answer is that we don’t know yet. We have no research on some of these new vegan products, and certainly not the latest meat analogs. My educated guess is that they might be marginally healthier simply because they have a plant base and so, presumably, fiber and nutrients associated with the plant ingredients. And by omitting many of the other adverse ingredients in animals foods, someone’s health is bound to be a bit better. BUT, it’s unclear, how much.

      We know that good health depends on keeping the ‘bad’ stuff out and taking in the ‘good’ stuff that nourishes us, in. So, even a junk food vegan diet is bound to be slightly healthier, depending upon which health outcome you are talking about, simply because you are keeping some of the ‘bad’ stuff out. If you are failing to nourish yourself adequately on a junk food vegan diet as opposed to a whole food, plant-based diet, you are likely going to be in worse shape, though.

      But let’s not fool ourselves about some of our new vegan products: All of these new burgers are quite processed, which of course SUGGESTS that they will not be as healthful as, say, beans and quinoa. But we can’t say either way for sure because we simply don’t have the research. One of the new burgers claims to be completely identical, so perhaps that one will prove to have the same adverse effects of meat, but then, who knows. It will be interesting to see that research.

      One thing, rather than dismiss these products entirely, let’s keep in mind that they may be good transition foods. We are all evolving and most people didn’t start off eating 100% perfectly when they switched to a vegan diet. If vegan donuts and vegan burgers help omni’s realize that they can move away from animal foods, perhaps that’s a good thing. – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬‬‬‬‬‬‬‬

      1. I’m not sure. Beyond Meat claims that the big difference in their vegan burgers that allows it to cook and taste similar to beef is the heme iron the pull out of plants. How plant heme iron differs from animal heme iron I’m not sure. Thus the question. My guess is based on Dr. Heaner’s post is that no one has researched plant heme iron affects on health because no one before bothered to dig enough up to use it in food before.

        1. Wow, right you are! They are actually using leghemoglobin from legume root nodules. Technically the heme is from the bacteria that live in the root nodules but hey, bacteria are vegetables, right?

          Thanks for following up, I find this very interesting

  13. I usually hit the transcript link and read these. Just want you to know the link is broken on this particular video — when I hit “view transcript” it gave me a box to share on Twitter instead.

    1. Hi @peggyh1951:disqus – is it working for you now? I just tested it, and it went to the transcript, so it may have been a temporary glitch. Please let me know if it’s still sending you to Twitter, though!

  14. WFPB means “whole food, plant-based,” a term coined by Dr. T. Colin Campbell around 1989, It is the diet that is recommend by the plant-based doctors to cure disease. It is strict: no animal foods, all whole plant foods–which means no processed foods–and that includes oil and added sugars. So it’s all vegan, and very healthy whole-food vegan (as opposed to junk food vegan.) Oil has been shown to be inflammatory, even though it is a ‘good’ fat. Also, keep in mind that many plant foods contain Omega 3s, and not just seeds, greens, too and others. Also, you can buy an algae based DHA/EPA supplement if you think Omega 3s might be needed.

  15. I have watched every video you have (great work) and wanted to propose two questions I would love to see addressed.

    First, you allude to the fact that long-chain DHAs may be beneficial for brain health (though overstated for heart health) and suggest algae-derived Omega 3 instead of fish oil due to toxicity factors. Algae-derived Omega-3 comes in the form of an oil; however, it seems as though you and Dr. McDougall suggest people avoid all oils as a general policy. Is it your opinion that the benefits of such supplementation may outweigh the negatives associated with the oil intake?

    Second: you talk about the benefits of taking piperine with turmeric to increase bioavailability. I’ve heard from quite a few sources that Meriva (http://www.meriva.info/en/) is an even better catalyst for Turmeric absorption. I was wondering if your team has seen any research on Meriva or compared it to piperine. I couldn’t find anything on your site. Thanks!

    1. Matt Canning: For your first question, I would note that the oil in the algae DHA supplements is a very small amount. People usually use much more than that with cooking oil. Also note that a big difference is that cooking oils are typically heavy in omega 6 or saturated fat. Also, as one of the NutritionFacts videos shows, cooking oils are often bad by the time we get them: http://nutritionfacts.org/video/the-true-shelf-life-of-cooking-oils/
      .
      Your second question was very interesting. I forwarded it onto our medical moderators for them to take a crack at it or pass onto Dr. Greger.

      1. Thanks Thea! I appreciate it very much, and thanks for the insight on the oil. I’ll do some research to determine the best algae-sourced supplement. Or maybe I’ll just start drinking pool water ; )

        1. Matt Canning: re: looking for best algae supplement. According to one of our very knowledgeable participants on this site, the algae supplements in America are all made at the same plant or two. So, you might as well pick the one that best meets your needs for convenience, form (pill or liquid), etc. Good luck.

  16. Flour has been processed and the three important parts of the grain are not together….or intact. Intact grains contain 100% of the original kernel, which includes the bran, germ, and endosperm. All three of these kernel layers must be intact—hence the term “intact grains.”

    Probable best to have your blood tested for iron and/or donate blood a couple of times a year.

  17. Relatively speaking, it isn’t that far at all! Three or four hours…but we rarely go that way any more when we visit my cousin on Quadra Island. From here it’s easier to go through Port Angeles.

  18. chia: I’m often the same way. Sometimes I just have to force myself to do something the first time. For myself, after I’ve done it, I can’t imagine what all the fuss was about. I had a similar block about making my own rejuvalac (a home made probiotic that makes great vegan nut cheeses) for the first time some years ago. Now it seems so easy…
    .
    I agree with Rebecca that this one (the Instant Pot or some other electric pressure cooker) is well worth getting over that kind of block. It can open up a great deal of helpful cooking options. There are so many safety features built into these modern pressure cookers that I no longer worry in the slightest about my safety.
    .
    The biggest thing to remember is a tip that Lorna Sass put into her vegan pressure cooker cookbook (Great Vegetarian Cooking Under Pressure). I think just about every single recipe in that book reminds us to, “Remove the lid, tilting it away from you to allow excess steam to escape.” I read that so many times, it’s second nature for me now. It’s no big deal to do and no different than what we should to removing the lid off any hot pot containing liquid. (Great recipes by the way…)
    .
    Good luck.

  19. How do you get vegetarians and vegans to take B12? Well, I learned that I needed to switch from SAD to WFPB from Dr. Greger. And when I saw the video(s) about the importance of B12 supplementation for vegans, I started taking them. For some people, the “psychology” of getting them to do what is best for them is just very simply explaining what that is, and pointing to the studies that have proven it. For us there was not much special “psychology” involved. This is best; this is what I will do. The end. If I want to pass an exam, I have to study. If I want to be a wonderful musician, I have to practice. If I want money, I have to work. Nothing is free. You can’t spend without earning. You can’t live without eating. Everything has a consequence – good or bad – choose wisely. Thank you Dr. Greger for giving us the info we needed to make an informed decision about what goes in our mouth.

  20. We have research that shows some beneficial aspects of some oils (the ‘good’ fats), especially when compared to animal fats. We also have some research that suggests some beneficial nutrients in animal foods, but we have studies showing adverse effects as well. If we go by the ‘whole foods’ paradigm, we know that oils are processed. It takes ~100 small green olives to make 1 tablespoon of oil. You could probably eat 20 or 30 olives, but probably NOT 100…Not sure how many coconuts it takes for 1 Tb of oil, but no doubt, more than one! So we know that we are losing much of the nutrients from the processed form of the food—and getting 100% fat. PERHAPS oils have some therapeutic effect in some instances, but like a drug, they may also have deleterious side effects–such as increasing inflammation. Perhaps it’s safer to just stay away as much as we can—and when we cook at home at least, it’s entirely doable.

  21. I have been reading “How Not to Die” and have a question. All questions need to be tied to a video, so I selected this video to ask a question. This question pertains to cruciferous vegetables but also applies to fruits and vegetables. The book states: “The formation of sulforaphane in cruciferous vegetables is like a chemical reaction. It requires the mixing of precursor compound with an enzyme called myrosinase, which is inactivated by cooking”….
    I use a blender and blend raw broccoli, brussel sprouts and other fruits and vegetables into smoothies. Does one receive all the benefits of raw broccoli, brussel sprouts and other fruits and vegetables when these foods are in a smoothie?

    1. HI brown1pe. I’m a volunteer moderator and Registered Dietitian who helps answer questions for Dr. G. I love your question and I have an interesting bit of science to share with you. To get the maximum amount of sulforaphane from your cruciferous vegetables and still keep them raw, you want to blanch them first in boiling water for 20-30 seconds and then plunge into cold water. You can do this ahead of time and refrigerate until you’re ready to use them in your smoothie. Dr. Jefferey’s, a food researcher explains this in her interview with Karen Collins, RD with the AICR. You can view the 5 min video on YouTube here: https://www.youtube.com/watch?v=cb6vMPtJ0Vw
      To summarize, what happens is that the myrosinase enzyme, naturally present in cruciferous veggies, sets the sulforaphane free by releasing it from the sugar molecule (also naturally present in the cruciferous veggie). In raw form we get only about 12% of the sulforaphane, but when we blanch it we get significantly more. Hope this helps!

  22. Question — A friend who has been eating more or less plant-based for about two decades, is concerned about her C-reactive Protein, which has been as high as 9. (It should not be over 3.) Her doctors are unconcerned but CRP is a marker for inflammation and possibly risk for stroke or heart disease. She was advised to eat fish twice a week and the CRP dropped to .5. Can anyone give us more information or a better solution?

  23. C reactive protein is indeed a marker of systemic inflammation and could flag risk of cardiovascular disease and other health conditions. The reduction in CRP following fish consumption is probably related to the omega 3 fatty acids abundant in certain types of fish, like salmon or mackerel, and known to reduce inflammation.
    There are however excellent plant alternatives to fish consumption, such as flax seeds. In addition to high content of omega fatty acids, flax seeds also have a high content of lignans, shown to protect against growth and proliferation of certain cancers. Please visit https://nutritionfacts.org/topics/flax-seeds/ for a collection of articles on this topic.
    One other choice is turmeric known for its protective effect against both cancer and inflammation, please see https://nutritionfacts.org/topics/turmeric/.
    I hope this helps. Have a great day.

    1. Thank you for the information. Interestingly, I have been putting flax seed and turmeric on my morning oatmeal for years. I will pass this on.

      1. Thank you.

        These are to prevent stroke, but is there anything specific to people over 65 who have already suffered a stroke ?

        Joe M.

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