Cholesterol Crystals May Tear Through Our Artery Lining

Cholesterol Crystals May Tear Through Our Artery Lining
4.75 (95%) 40 votes

Crystallization of cholesterol may be what causes atherosclerotic plaque rupture, the trigger for heart attacks


In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy as kids, but then the standard American diet, the saturated fat, trans fat, and cholesterol increase the cholesterol in our blood, which accumulates in the artery wall, triggering an inflammatory response. The fatty streak becomes an atherosclerotic plaque, which can then rupture into our artery. A blood clot forms, shutting off blood flow to a part of our heart, which can then die and kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from human autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque, so they wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point that it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open. So they made a supersaturated solution of cholesterol in a test tube to see if when it crystallized it would expand, and indeed it did–just like how water expands when it crystallizes into ice. Here’s a cholesterol crystal shooting out the top of a test tube, and when you look at the tips of the cholesterol crystals under a microscope they are sharp jagged needles. They placed a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. So they showed that as cholesterol crystallized, the peak volume can increase rapidly by up to 45% within minutes and sharp-tipped crystals can cut through and tear membranes, suggesting that the crystallization of supersaturated cholesterol in atherosclerotic plaques can induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks–acute coronary syndrome. Extensive protrusion of cholesterol crystals into the middle of the artery. What makes us think it was the crystals that actually burst the plaque?

All patients who died of acute heart attacks had perforating cholesterol crystals like this sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet or drugs can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy as kids, but then the standard American diet, the saturated fat, trans fat, and cholesterol increase the cholesterol in our blood, which accumulates in the artery wall, triggering an inflammatory response. The fatty streak becomes an atherosclerotic plaque, which can then rupture into our artery. A blood clot forms, shutting off blood flow to a part of our heart, which can then die and kill us.

What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from human autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque, so they wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point that it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open. So they made a supersaturated solution of cholesterol in a test tube to see if when it crystallized it would expand, and indeed it did–just like how water expands when it crystallizes into ice. Here’s a cholesterol crystal shooting out the top of a test tube, and when you look at the tips of the cholesterol crystals under a microscope they are sharp jagged needles. They placed a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. So they showed that as cholesterol crystallized, the peak volume can increase rapidly by up to 45% within minutes and sharp-tipped crystals can cut through and tear membranes, suggesting that the crystallization of supersaturated cholesterol in atherosclerotic plaques can induce the rupture that kills us.

A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks–acute coronary syndrome. Extensive protrusion of cholesterol crystals into the middle of the artery. What makes us think it was the crystals that actually burst the plaque?

All patients who died of acute heart attacks had perforating cholesterol crystals like this sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet or drugs can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Doctor's Note

Isn’t that extraordinary? Makes you really not want to be building up cholesterol in your arteries. I have a feeling, given the powerful visual, that this might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.

Arterial Acne is video I mentioned on inflamed pockets of pus. Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Switching from red meat to white won’t do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol

Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See Does Cholesterol Size Matter?

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

155 responses to “Cholesterol Crystals May Tear Through Our Artery Lining

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  1. What I want to know is if you can get supersaturation of cholesterol if you have high LDL due to an iodine deficiency? (With vegan diet)

        1. I was wondering if you had any updated info on that mouth wash. Good/bad? Your opinion means a great deal to us and am very appreciative of your continued work!

      1. Thanks, Wegan. Very interesting. I’m thinking about trying this product but first would like to find some independent research or commentary on original research. How long have you used it and what results have you seen?

        1. I sent them an email asking about that we’ll see if they reply. I thought it could be a good way to supplement iodine. Maybe they’ll continue for the study a year. TSH levels can take a year to normalize with iodine supplemention from what I have read. Something about nis transporters being made.

          1. One would think that this would be a blockbuster result. One the other hand, their special gingivitis formula may not be needed for cholesterol dissolving effects – not much money in iodized salt.

      2. I would suggest that killing oral bacteria kills the good along with the bad. A better approach would be to encourage growth of the good and deny the bad. This is best achieved through a whole plant based diet while cleaning & rinsing with green tea. I have been using green tea for sometime now and my last trip to the dentist resulted in no cavities and no gingivitis. My mouth tastes better too.

        1. Another option is an oral probiotic….such as….

          I chew 1/2 tab before bed.

          “a special strain of S. salivarius called BLIS K12, which was developed
          by BLIS Technologies of New Zealand. BLIS K12 is a naturally-occurring
          beneficial bacteria that only lives within the oral cavity and is proven
          to promote good oral health, support natural immune system defense
          functions (key for seasonal wellness support) and protect against the
          proliferation of bacteria that can cause bad breath. BLIS K12 has been
          involved with several clinical studies and been included in over 30
          published scientific papers. The theory behind BLIS K12 oral probiotic
          formula is that when taken regularly, it can help support upper
          respiratory health and the health of the throat and the oral cavity

          1. As a dentist, I find Oral Probiotics an interesting concept. Especially in patients high in Strep Mutans counts.
            Or the periodontal groups of gram negatives.
            However, without immaculate plaque control including tounge debridement, and removal of sub gingival tartar deposits. Ive never seen significant change. Makes sense, you have to significantly decrease the existing colony number for the new guys to stand a chance.
            Lets face it.. If we could easily replace our oral bacteria , periodontal disease would not be the number one cause of tooth loss.
            Diet has a great effect. +1 Lawrence. But would not revert perio alone, without removal of hard deposits.
            Also.. re-colonisation from other family members is inevitable, unless their diet changes too.
            Perio runs in families….. Not all the heredatory Interleukin deficiency’s ;-)

    1. I have not heard of iodine deficiency leading to high LDL’s, until I saw this study “Iodine treatment in children with subclinical hypothyroidism due to chronic iodine deficiency decreases thyrotropin and C-peptide concentrations and improves the lipid profile”. If you want to browse around for more research here are 31 more studies that may be relevant. Of course, Dr. Greger discusses optimal level of cholesterol here, and I wrote more on the importance of iodine here. Thanks, Wegan.

      1. I have had very low thyroid for most of my life until finally diagnosed and given the right treatment for T3 in my 50’s. I have a 50% blockage in one artery, which concerns me. I refuse to take lipitor, which has huge side effects, and is evidently only effective in a low percentage of cases. I immediately started a vegan diet, with occasional salmon 1-2x month. What I wonder is…does taking Trio-L-thyroinine improve the lipid profile, or is it only iodine that does that?

        1. Hi Leslie. I am not sure. I would assume if you are taking medication for low iodine that if the levels (T3 and T4) were to be stabilized, than lipid profiles would improve. Please ask your doctor to be certain. I think when you say “Trio-L-thyroinine ” you are referring to triiodothyronine (T3), which is composed of iodine. Therefore, if taking a medication or a supplement to boost T3 (and T4, which is also important for thyroid health) you’d be essentially taking iodine.

      2. I was eating a daily wakame salad, but have subsequently fallen out of the habit. Sounds as if I should get back into that habit because I do not use any added salt, iodized or otherwise.

        1. I think that’s a good call, Joe! Remember some iodine is found in coastal veggies, but to rely on that as a source would be unadvisable I feel. Not sure if you’ve seen this, but I wrote a post about iodine. Best regards!

          1. I did read it, thank you very much. I eat a lot of raw and cooked cruciferous vegetables so getting adequate iodine intake seems particularly important.
            The mineral content of whole plant foods are so dependent on the soils in which they are grown which is another good reason to source organically grown produce. Heathy soils produced more nutritious food.

          2. The more I read about wakame as a whole food source of iodine, the more I like it. Omega-3, contains EPA and stimulates the liver to produce DHA. Animal (rat) studies indicate that it may improve fat metabolism, and promote weight loss. Reduction in LDL. Sources:
            New Zealand wakame is the cleanest according to the following, avoide the Chinese:

    2. Having high cholesterol is bad and yes I suppose it would also occur if LDL is high. Very important to consider how to modify the diet and reduce LDL cholesterol or consider a medication.

  2. Excellent video, makes me want to redouble efforts to check amount of saturated fat and cholestrol in packages products I consume. Wonder what the Atkins bacon gorging folks have to say to this.

  3. Oh, happy Monday — another horrifying video. I hope that lots of beans and veggies will do something about the unknowing decades I spent scarfing down trans fats in margarine and who knows where else. I really love my Earth Balance, but I suppose it’s not much better for me than any other margarine. I will have a hard time giving it up. :(

    1. It was hard to give up butter. Then it was hard to give up margarine. Then it was hard to give up Earth Balance. But it turned out to all be a matter of habit. Now the thought of eating any of the above makes me sick. No fiber. No carbs. Worst of the fats. Terrible after taste. No desire whatsoever. Anyone for Spry?

      1. I hope I can follow your example. I never heard of Spry, but it probably has connotations like the ones Crisco has for me. Blech. :P

          1. Coconut oil is one of the few vegetable oils high in saturated fat. See what Dr. Greger says on this site. You don’t need oil to have incredibly tasty and satisfying food. The reason we cook with oil is because we are creatures of habit. Lots of websites on oil-free sautéing and roasting of veggies.

        1. According to the label Smart Balance contains 10g of fat, no trans fats, 2.5g of which is saturated. Is it bad for you? it depends on how much you use. Considering there is very little nutrition coming from a tablespoon of smart balance, there probably are better sources of fat than butter substitutes. But you have to do what you feel comfortable doing. For my potatoes I tend to make a nice no fat gravy to use rather than butter.

        2. Its not difficult to be a sick fat vegan. Being vegan is great for the animals but WFPB completes the journey by being great for the #1 animal, yourself.

          1. I understand. I’m barely a vegetarian. Not interested in cheese but my family loves butter flavoring. I thought I was doing good with the vegan butter flavored stuff.

            1. I think small changes are important, as they can lead to larger ones. When transitioning to healthier foods it’s nice to have some items like trans-fat free oils and “plant-based butter” to help the transition. Of course these are not health foods, but it may be super important as to what you se it on? a small dab on a piece of whole grain toast with fresh fruit is far better than bacon and eggs with white toast and regular butter. So I think it’s important to put everything into context and realize overall diet is most important. Keep up the good work! I see some great comments here and I hope they are all helpful.

              1. Thanks for the encouragement. I struggle with sweet breads and candy. Addicted. It has been 24 hrs since my last sweet thing. My doc says too many carbs turn into fat that affects everything in a bad way. This video makes me think I should get back on the statins till I get my eating much better.

                1. Important to make the distinction between processed carbs and whole food carbs, HUGE difference. Some doctors think our diet should be at least 75% complex carbs. We have a lot of enzymes to digest the starches in carbs, unlike most animals, so this makes good sense. Not to mention that’s how I finally lost a ton and got rid of diabetes!

        3. All processed foods have the potential to harm you. Avoiding them is one of the pillars of the Whole Plant Food Based Diet. Hanging on to old habits with substitutes just maintains the desires for fat, sweet and salty foods.

    2. I still have margarine that I use from time to time, it pretty much has the same saturated fat (1.5g for 10g) compared to extra virgin olive oil (1.5g for 10ml) so it’s not a lot. We should aim for 0 but with these numbers are quite low!

      1. Not to be nit-picky, but I think it is impossible to aim for zero. Fat is a package deal and you’ll always get a bit of mono, poly, and saturated fats with any fatty foods. Shoot, even non-fatty foods like beans will still have a little bit of fat. Still, I think minimizing saturated fat is key, as you noted. We surely do not need much at all!

        1. I was using a light dairy-free spread (mono saturated 1.1, Trans 0.03), should I stop?
          would spreading organic peanut butter be better?
          ( I try to have oats with fruit and almond milk every second day instead of toast ).

        2. Joseph, if one is otherwise healthy, I guess using a dab or two as a treat is okay, but I agree, eliminating it completely is often a whole lot easier than trying to limit it. Kind of like every ex smoker I know who relented and “just had a drag or two”, almost inevitably started smoking again! If you take spreads out of your fridge, you will definitely learn to do without, but having them there is too much of a temptation to use…too often. Well, I should speak for myself, but….

    3. I don’t think Earth Balance has any trans fats, but surly it is still fatty :( Perhaps try cutting back and using a small amount, or using something like a nut butter (which although fatty at least you obtain more nutrients rather than straight fat). I try to think about other condiments I already like such as mustards, vinegars, herbs and spices and go heavy on those. Spreading 1/4 of an avocado on toast, etc. I am sure others have better ideas. I will say butter or margarine without the trans fats are better than those with, as trans fats are damaging to the arteries.

    4. Maybe don’t look at it from the perspective of giving it up completely forever and ever, but keep it in its place as a delicious but objectively harmful food to be eaten only once in a while. I remember when I heard Dr. McDougall describe our modern diets as eating like it’s a holiday feast, or like kings and queens for every meal, it really made an impact on me. The idea that it’s just not natural to be eating “indulgent” foods on a constant basis really resonated with me. After I decided to cut out refined oils (including earth balance, tortilla chips, baked goods, etc) I was really astonished by how much more sensitive my taste buds became and by the total disappearance of cravings, even though I didn’t think I was eating very much of these foods to begin with. For me, eating 100% WFPB most of the time works so much better than mostly WFPB all the time. Does that make sense? :) It doesn’t take much refined oils if eaten on a regular basis to keep the taste buds desensitized and keep the cravings for such foods alive. I know it’s kind of hard to believe that when you “deprive” yourself of these kinds of foods, you can actually end up enjoying food more. But it’s true! Try cutting it out as a temporary experiment, just give yourself a few weeks, and see what happens to your cravings and how much you enjoy it when you try it again. You might be surprised.

      1. I agree — this is what’s been happening to me and it’s pretty great. Converting to WFPB, no oil, minimum refined sugars has been much so easier to sustain that I ever expected. I’m so happy about it.

        1. This is certainly “food for thought.” I actually find salt the hardest thing to cut back on, but this sounds like it’s worth a try. I’ll report back if I manage to do this….

          1. You will discover that you really were just using food as a vehicle for salt – not really enjoying the food itself. So many good websites on how to spice food without salt. See, for instance - –

          2. I’ve heard a couple times before among SOS-free dieters that salt is the hardest to give up. Full disclosure: I eat salt! Not eating refined sugars and oils is so easy, the longer you go without eating them, the more the cravings disappear to nothing. That never really happened to me with salt when I tried decreasing it in the past. I read an interesting article a while back about this Russian family living alone in the Siberian wilderness for about 40 years. Pretty messed up story. They were unaware that WWII ever happened. The dad was a religious nut. The daughters developed their own gibberish language. When they were found by scientists in the 70s, they refused to move back to civilization, thought TV was of the devil, refused modern medical treatment… But the one thing the dad said he still missed after all that time: salt.

            With the more recent research coming out about sodium, I don’t really care to decrease my intake as much as possible like I used to. Without any attempts at restriction, I get between 1500 – 2000 mg and I’m fine with that. I guess since salt doesn’t really affect the quality of the rest of my diet, I don’t really care about it for that reason either. If anything, salt only increases my cravings for veggies, beans, and grains.

            That said, if you do want to decrease or eliminate it, I find lemon and lime juice, vinegar, and garlic all decrease the need for salt.

      2. Since going 100% WFPB no SOS I realize that my previous food habits actually prevented me from discovering a vast world of flavors and textures. Coating the inside of one’s mouth with a slimy film of oil does to food what a condom does to sex :-) I now experience the magic of spices as opposed to the boredom and predictability of condiments (condoments?)

    5. My family got off Earth Balance because it (and other vegan margarine) is so processed. Now that we have avoided it for awhile, we notice that vegan margarine tastes really fake!

  4. RE: Iodine deficiency. Have nodules in my thyroid (vegetarian for 20 years). My doctor thinks I should to nothing so far as it is due to hormonal changes. I decided to experiment. Have a fantastic pharmacist; trying to improve my condition holistically. Starting today I am rubbing ONE drop (not more!) anywhere on your body, or in a glass of water, room-temperature. Continue for 3 weeks, stop the 4th, and then repeat. Will have another ultrasound of my Thyroid in six months. Only then I will know if any positive changes occurred.

      1. Apparently the iodine evaporates quickly once the box is opened and it only contains potassium iodide for the thyroid and not the kind the rest of the body uses. There is a school of thought that the RDA is way too low and that the danger of supplementation is overblown. has information about it.

      2. According to Dr. David Brownstein, it is to be avoided. He says only about 10% of the iodine in iodized salt is bioavailable, and that the product contains undesirable contaminants as well. Recommended Himalayan Pink salt instead.

  5. Iodine is known as Lugols Solution. Another holistic method is via pure Fulvic Acid (should not contain any Humic Acid). If Lugols Solution is not successful I will try Fulvic Acid (comes from the USA).

  6. Another great video Dr G! So glad I gave up animal foods high in cholesterol and saturated fat… Low-fat is where it’s at!

  7. This is amazing. It also reminds me of my past (decades ago) perceptions about atherosclerosis. I used to think of plaque buildup as rock candy caused by supersaturated cholesterol in the blood stream. Now I see the process is much more complicated, involving the immune response, but I find it interesting that rock candy-ish crystals are evidently involved in the actual myocardial infarction.

    BTW does Dr. Greger have any plans to cover the difference in heart attacks between men and women?

    pS. What happened to the image upload icon in Disqus?

    1. I’ll ask if he does, but can you let me know in what context you’d like to understand their differences? I did come across some literature “Gender Differences in Left Ventricular Function Following Percutaneous Coronary Intervention for First Anterior Wall ST-Segment Elevation Myocardial Infarction”. I see hundreds of studies on this topic so perhaps Dr. Greger will discuss this in further detail.

      And hold tight on your question about Disqus I’ll find out. Thanks, MacSmiley.

      1. I have a graphic I wanted to use for context, but the little picture frame upload icon does not appear in the comment boxes today. *TECH ISSUE?*

        The context is in this TEDTalk: difference in the way plaque is laid, different symptoms in a cardiac event, how the female pattern of MI differed from the male pattern seen in today’s video, etc.

        1. Great, thanks for clarifying! I’ll get back to you for sure. I’ve sent a request to our tech support and hope to get an answer soon.

        2. I know what happened. We decided to allow site users to continue to post links to images and videos, however, because sometimes the image of a youtube video is larger than Dr. Greger’s video itself, we felt it takes away from the actual video of the day. Therefore, you cannot upload images like before. Sorry about that. Hopefully you can still copy and paste a link to the image and I (and others) can view it that way. I realize this is an extra step, but hopefully folks are not too dismayed by the new policy.

          1. When I click on a link it would be nice for it to take me to another window. Now done with the new link and clicking on back arrow it does not take me back to where I was in the comments. Discques has to reload. Irritating.

            1. Can you double click the mouse and have it open in a new tab? Thanks, jj. Sorry I too get frustrated when I click a link and it goes away from the page I was on.

          2. Image can not be linked to since it is a screen print from the video. The problem with image URL linking is that the source is not always available forever. My comments in Flickr uses that system and they’re full of blank “Image not available” spots.

            BTW I do not experience on my iPhone the video/image size issues to which you refer.

            1. I see. Thanks for letting me know. Perhaps different views on computer screen vs phone is the case? If you have a better suggestion let us know we hate to limit our users ability to post information.

          3. Joseph, I’m thinking there must be something in your code and/or Disqus’s code which is causing this problem. I would suggest your webmaster collaborate with Disqus to find and eliminate the problem so that we can resume our postings. Graphics are so useful in scientific dialog, as you know.

    1. Wow very good find! I wonder the same thing, and it looks like it might. Not sure that is a solid reason to start drinking booze (as clearly there are many risks), but when we hear of moderate alcohol consumption benefiting heart disease perhaps this is a mechanism involved? Thanks for that find!

    2. I would doubt that for one reason. The crystals are encased and protected from the bloodstream inside the plaque until it ruptures. Unless blood somehow infiltrates the plaque?

  8. This is a very convincing video! I am just curious what this says about statins? Are they helpful with this or not at all helpful in preventing the rupture?

    1. I am not sure about statins and prevention of ruptures. I would think they have some effect of lowering rupture risk since their main job is lowering cholesterol. However there are reasons to be weary of taking statins, as Dr. Greger mentions.

    2. From what I’ve read, statins have a totally separate function, independent of lowering cholesterol, of stabilizing plaques and lowering the risk of ruptures. Even with some of the new blockbuster monoclonal drugs coming on the market in a few years, the thought is that people will still want to use statins. The trick is to eat WFPB no SOS while you are still young so you don’t get plaques in the first place! Damage control is no fun.

  9. Is there a way to determine the cholesterol source (our own, or animal ) within the arterial walls? Or is it the same after digestion and processing?

      1. According to the DGAC for 2015, the estimate is that for most ppl, “only” 20% of serum cholesterol can be attributed to absorption from food in the digestive tract. There must be a basis for such an estimate.

        Thus the decision not to include guidelines on dietary cholesterol at all. I believe that advice to be misguided. The DGAC are trying to encourage consumption of seafood even if it’s high in cholesterol, as part of the Mediterranean diet pattern. Unfortunately this message is confusing the public, especially as it is being co-opted by Atkins /WAPF/Paleo/LCHFrs like Taubes and his poster child Teicholz.

    1. I don’t think so. Measuring serum cholesterol is the only way to my knowledge and It wouldn’t tell us if the cholesterol was from animals or produced on their own. Come to think of it, I don’t know of any test that distinguishes between eaten cholesterol and human-produced cholesterol.

  10. Frightening. Sudden death due to a supersaturated solution of cholesterol in arterial plaque pustules which means people who are on the edge are just one polish sausage or slice of pizza away from the morgue.

  11. Wow! Thanks for this video. I may have to re-think my disbelief in the cholesterol theory. I’m soliciting comments on the following:

    I was taught back in the 1980’s that the Xanthine Oxidase (XO) Theory was also under discussion, along with two other theories, at the time the government settled on the Cholesterol Theory. My prof said only half jokingly that at that time the dairy lobby was stronger than the pork or beef lobbies or else the truth would’ve prevailed back then and we would have seen very different advice about how to prevent heart disease. He also said that XO occurs naturally in cow’s milk in a form that is safe for us to consume IF the milk has not been homogenized; that homogenizing the milk breaks the molecule into pieces that the liver cannot process, so it kicks it out into the blood stream; that the sharp hooks created on the XO pieces by the mechanical homogenization process eventually pierce the arterial walls and create injury and inflammation.; that at the bottom of most arterial plaques one may find these broken pieces of XO actually hooked into the arterial wall. He theorized that the subsequent buildup of cholesterol over these damaged areas was caused by the body trying to bandage the injury. I see where this theory could explain the cause of the relatively slow buildup of arterial plaque, the kind around which the body creates its own collateral circulation. But could XO have a role in this new theory of crystallizing cholesterol?

    Also, I’ve read that the negative impact of the LDL depends on the particle size and whether or not it is oxidized. How does this fit into the crystallized cholesterol theory?

    About the Iodine mouth rinse, just as a matter of curiosity, does anyone out there remember that Edgar Cayce the “Sleeping Prophet” way back in the 1930’s recommended the use of “Atomidine” which he described as “atomic iodine”? I think he advised using it for the thyroid. It used to be sold by the Heritage Store in Virginia Beach VA.

    While we’re on the subject of Iodine deficiency, I recently view an 11 part documentary at that included an interview with Dr. David Brownstein who wrote the book “Iodinde:Why You Need It, Why You Can’t Live Without It.” He said that our diets contain too much Bromide (from wheat flour) and too much Fluoride (from tap water, fluoridated toothpaste) and that these two can interfere with Iodine absorption, resulting in a deficiency. He recommends 12 – 25 mg/day of Iodine, more if you have cancer, and advised we use Lugol solution or tablets. As for the iodized salt issue, he recommended avoiding it because only 10% of the iodine in iodized salt is bioavailable, and it is accompanied by undesirable contaminants. He says sea salt is questionable because of contamination also, and recommended Himalayan Pink salt.

  12. “Normal adults typically synthesize about 1 g (1,000 mg) cholesterol per day and the total body content is about 35g.

    Typical daily additional dietary intake, in the United States and similar cultures is about 200–300 mg. The body compensates for cholesterol intake by reducing the amount synthesized. This occurs by reduction of synthesis of cholesterol, reutilization of the existing cholesterol and excretion of excess cholesterol by the liver via the bile into the digestive tract.

    Typically about 50% of the excreted cholesterol is reabsorbed by the small intestinesback into the bloodstream for reuse.”

    SO – even if my dietary cholesterol is ZERO I will still produce 1,000 mgs per day.

    Crystals anyone??

    1. Hi Charles,
      Just curious. You are obviously a devout animal eater. Do you get other useful information from this sight that helps with your health?

      1. Actually I get useful information from many sites – including this one. I believe that man is an omnivore by nature so my diet does include meat, dairy and eggs. I also eat fruit, veggies, nuts, seeds, etc. My main problem is with people on either extreme sides of the diet paradigm – from vegans, fruitarians to VLCHF, ZC.

        Moderation is the key – the best diet lies in the middle.

        My question still remains – if the liver produces appx 1,000 mgs of cholesterol per day and the production by the liver goes down in relation to consumption what would cause crystals to form?

        If it’s inflammation then if the markers of inflammation are low would dietary cholesterol be that much of a problem?

        1. Hi Charles, are you aware of the effects of saturated fat consumption on endogenous cholesterol production? That would be my first line of investigation in your inquiry. Going from say, Okinawans to SAD eaters, how much variation is there in this 1000 mg/day figure? Same with the 50% reabsorption figure. It would be nice to know fiber intake, phytosterol intake, etc associated with that.

          In general I’m not quite clear on your question itself – if you are genuinely concerned only with dietary cholesterol, or if the effects of dietary and serum cholesterol are being conflated.

          1. Studies by Ancel Keys show no effect of dietary cholesterol on serum cholesterol.
            Question – what causes cholesterol crystals to form? Is it dietary cholesterol, saturated fat intake, systemic inflammation?
            If markers of inflammation are low will cholesterol crystals still form?

            Cholesterol Crystals Activate the NLRP3 Inflammasome in Human Macrophages: A Novel Link between Cholesterol Metabolism and Inflammation

            “Chronic inflammation of the arterial wall is a key element in the pathogenesis of atherosclerosis, yet the factors that trigger and sustain the inflammation remain elusive. Inflammasomes are cytoplasmic caspase-1-activating protein complexes that promote maturation and secretion of the proinflammatory cytokines interleukin(IL)-1β and IL-18. The most intensively studied inflammasome, NLRP3 inflammasome, is activated by diverse substances, including crystalline and particulate materials. As cholesterol crystals are abundant in atherosclerotic lesions, and IL-1β has been linked to atherogenesis, we explored the possibility that cholesterol crystals promote inflammation by activating the inflammasome pathway.”

            Why cholesterol damages arteries: Cholesterol crystals lead to life-threatening inflammation in blood vessel walls

            “In addition to crystallized cholesterol, atherosclerotic plaques always contain large quantities of immune cells but, surprisingly, no bacteria or viruses. It was previously unclear just how the body’s own defence forces are called into action. Even animals that are kept in an absolutely sterile environment can suffer from “clogging” or “furring” of the arteries when their food contains high levels of cholesterol. The same relationship is found in humans.”

            “The higher the blood cholesterol level, the greater the risk of atherosclerosis and the greater the likelihood of suffering a heart attack. “We have known this for a long time,” points out Professor Dr. Eicke Latz from Bonn University, “but nobody understood exactly why.”

            “Professor Latz has been exploring this question in collaboration with Dr Peter Düwell from LMU Munich, Professor Veit Hornung, also from Bonn University, and research colleagues based in the US. The researchers have succeeded for the first time in identifying the molecular trigger for inflammation in large blood vessels. “We’ve found that, given a certain type of nutrition, cholesterol crystals are deposited in the arterial walls after a relatively short time,” says Dr Düwell. “These crystals are then taken up by the immune system’s scavenger cells.” This becomes the starting signal for a catastrophic chain reaction. The unhealthy food results in the accumulation of cholesterol crystals that activate an “inflammasome” complex within the scavenger cells. One of the functions of this multi-protein complex is to induce the release of inflammatory mediators. The mediators then attract more and more immune cells to the site where the problem is occurring. The growing invasion ultimately destabilizes the vessel walls — with potentially life-threatening consequences.”

        2. I don’t follow the logic of the phrase “moderation is the key”. If it is true that meat, dairy and eggs are deleterious and do not add any nutritional value over that of a whole food plant-based diet, why is “moderation” defined as a good “balance” between unhealthy an healthy food?
          Humans are fortunate to be an “omnivore-capable” – allowing the species to survive in almost any region of the world. But in our culture, we don’t need that capability in order to thrive. I have a spare and jack in my trunk but I don’t make a habit of changing my tires just because I can.
          Crystals form in supersaturated conditions where molecules concentrate. It appears that there is a mechanism to cause this concentration to happen when an artery wall is insulted by a cholesterol particle. Low LDL is directly correlated to lack of plaques – regions of concentrated cholesterol.

        Dare to Be 100: Cholesterol Again and Again
        Walter M. Bortz II, M.D.
        Clinical Professor of Medicine at Stanford University

        “The human body contains about 150 grams of cholesterol. Its presence is critical to many body functions including sex hormone production. Population studies reveal extensive variability in blood levels as low as 77 in the Bantu to as high as 280 and above in Western populations. Ancel Keys studied the serum levels in Japanese persons living in Japan, Hawaii, and the mainland U.S. He concluded that the closer the diet comes to the American average the higher is the blood level. (1) Stress also raises the level. Accountants at tax time and students at exam time have high levels.”

        “But it is the dietary factors that keep resurfacing. Years ago when I was in my cholesterol experimental era I wrote a paper called “THE PATHOGENESIS OF HYPERCHOLESTEROLEMIA” in the Annals of Internal Medicine (2). It included studies that declare that the level in our blood depends not so much on the amount of cholesterol in the diet. Of much greater significance is the amount that is made by the liver. Whereas all body tissues contain the enzymatic machinery to manufacture cholesterol it is the liver that is the main source, about 1 gram per day. This makes much sense since the liver makes the bile that is essential to assist in the amount of fat that is absorbed. Bile is a byproduct of cholesterol metabolism, so it follows naturally that the more fat we eat the more bile we need, and therefore make more cholesterol. It is not the cholesterol in the diet that is responsible for high levels in the blood but rather the amount of fat in the diet.”

        “In fact the human intestine has a limited capacity to absorb dietary cholesterol. It is the dietary fat content not the cholesterol that is the switch, but tales keep coming”
        Human Atherosclerosis and the Diet
        By ANCEL KEYS, PH.D.

        “In summary, then, we may remark that direct evidence on the effect of the diet on human atherosclerosis is very little and is likely to remain unsatisfactory for a long time. But such evidence as there is, plus valid inferences from indirect evidence, suggests that a substantial measure of control of the development of atherosclerosis in man may be achieved by control of the intake of calories and of all kinds of fats, with no special attention to the cholesterol intake. This means: (1) avoidance of obesity, with restriction of the body weight to about that considered standard for height at age 25; (2) avoidance of periodic gorging and even temporary large calorie excesses; (3) restriction of all fats to the point where the total extractable fats in the diet are not over about 25 to 30 per cent of the total calories; (4) disregard of cholesterol intake except, possibly, for a restriction to an intake less than 1 Gm. per week.”

        Cross-sectional surveys in Minnesota on young men – no relationship between dietary cholesterol and the total serum cholesterol concentration

        Two surveys on Island of Sardinia – failed to show any difference in the serum cholesterol concentrations of men of the same age, physical activity, relative body weight, and dietary pattern, but differing markedly in cholesterol intake

        Careful study during 4 years with 33 men whose diets consistently very low in cholesterol – serum cholesterol values did not differ from 35 men on very high cholesterol diet

        Comparisons made of 23 men before and after they doubled their cholesterol intake and of 41 men who halved their intake – failed to show any response in serum cholesterol level in 4-12 months

        Detailed study of the complete dietary intakes of 119 Minnesota businessman – failed to show any significant increase in serum cholesterol with increasing dietary cholesterol intake

        4 completely controlled experiments on men – addition or removal of 500-600mg of cholesterol a day had no effect on serum cholesterol

        Completely controlled experiment on 5 physically active men – changing from a diet of 500 mg cholesterol to 0 mg of cholesterol had no effect on serum cholesterol

        In completely controlled experiment in 13 men – no significant effect in changing cholesterol from 374 mg/day to 1369 mg/day, or from 1369mg/day to 374 mg/day on serum cholesterol.

        The foregoing evidence is definitive, we think, in showing that variations in the intake of cholesterol over the whole range of natural diets do not influence the serum level of physically normal adult men so long as other elements in the diet are constant.

        They conclude that “in adult men, the serum cholesterol is essentially independent of the cholesterol intake.”

        I’m in no way a cholesterel denier BUT is it the cholesterol, the amount of saturated fat, inflammation, or a combination of all three??

        1. Thanks for the interesting references. I don’t think anyone denies the liver’s primary role in cholesterol levels. The new PCSK-9 inhibiter drugs coming on the market rely on the fundamental role of the liver in the cholesterol cycle. However, you did not address Dr. Greger’s contention that I referenced. Dr. Greger’s point is not regarding homeostasis baseline levels of cholesterol but transient. A stopped clock is right twice a day. If we only measure cholesterol when it is guaranteed to be at the fasting value, we will get fasting results. If it is true that CHD is, in part, a statistical process determined by the number of cholesterol “collisions” with arterial walls as well as the effectiveness of those collisions due to particle size, then doesn’t it make sense that bathing arteries in elevated cholesterol levels for a significant part of the day would have a meaningful impact? Dr. Greger makes the compelling case to avoid eggs.

            1. I would believe your chances of having CVD are greatly reduced. Don’t think those good numbers would impact risk of metabolic syndrome, cancer, etc.

    2. I just logged onto and entered a fairly typical day in the life omnivorous menu of bacon and eggs in the morning, a club sandwich with coleslaw for lunch and a dinner of either a beef steak OR three pieces of chicken, skin on, accompanied with salad and broccoli resulting in:
      2600 kCals, 185 grams total fat, 60 grams saturated fat, 5.5 grams trans fats, 15 grams of fiber and over 800 mg of cholesterol.
      The above is well within the standard deviation for an average adult American.
      Your dietary cholesterol intake estimates are quit low.

        1. Alrighty then. I invite your to eat what you normally eat; log your dietary intake for a week; and get back to us with your average cholesterol intake. I guess you can game the results by avoiding foods high cholesterol, but then you’ll only be cheating yourself.
          It is telling that the American Heart Associations daily RDI for cholesterol is less than 300. If the average Americans routinely consumed less than the recommended rate, why do you suppose that they would feel the need to publish an upper limit guideline?

  13. While its pretty sad to see how they use animals for testing, this very interesting article demonstrates how eating a typical Western diet can cause plaques to become more unstable. They feed mice a standard Western diet for up to 6 months to “induce” arterial sclerotic plaques. They then using special nano-particle markers to determine how easy it is for particles to enter the plaques – that is, how permeable they are to particles. Finally they damage the artery with a laser to see if the more permeable plaques rupture more easily. The fatty diet is directly related to increased permeability and rupture. The good news is that when they take the mice off the Western diet, they become less susceptible to rupture. I think Mickey is trying to tell us something.

  14. Scary video!

    The Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC) has dropped cholesterol from their list of “nutrients of concern”, I think because they don’t consider dietary cholesterol to be a proven factor in raising cholesterol levels. This seems unfortunate, especially considering that a conclusion statement from their own USDA Nutrition Evidence Library states, “Moderate evidence from epidemiologic studies relates dietary cholesterol intake to clinical cardiovascular disease (CVD) end-points” and “…among individuals with type 2 diabetes, increased dietary cholesterol intake is associated with CVD risk.”
    The purpose of the DGAC report is to provide a framework for the 2015 Dietary Guidelines for Americans.

    Public comment period for the DGAC extends through May 8, 2015. Joseph, do you happen to know if Dr. Greger or PCRM has commented?
    For accessing the report and submitting comments:

  15. WOW! This is HUGE especially now since the dietary guidelines are considering dropping the cholesterol warning! (Or did they already?) This video is going to get shared like crazy, I am gonna do something I rarely do…forward it to everyone I know and even post on FB…(so everyone can ignore it like they always do, but hey, worth a try! LOL) I was wondering since viewing this then, in regards to cholesterol lowing meds…I eat low fat and no animal products (intentionally anyway) but my cholesterol still tends to be higher than I would like, (familial apparently) but I hated taking statins before I changed my diet. What would be my best option to further lower my numbers, or is it still an issue if I’m not ingesting it?

    1. They haven’t dropped them yet. Yes, please share away for those interested. Hmmm, I am not sure about lowering numbers further if you tend to run high. Perhaps focussing on boost HDL and finding a good ratio is warranted? Keep up the good work and thanks for your support and many comments, Charzie.

    1. Hi Edegar. You sure can download them now. Check here for more info and click the “download” hyperlink from that blog. Hope that helps. Thanks for your support.

  16. This discussion is interesting, because the Russian folkways knows a similar technic. They flush there mouth in the morning with a tablespoonful of sunflower oil and chew them as long the oil feels like water in the mount (about 7 or 8 minutes) and then they spoke it out. It’s also well-known as oil-chewing.
    The nature medicine people claims that this technic pull out toxins – may it has the same effect of the LDL – Cholesterol?
    It’s only a idea but it came in my mind, when I read the articles beneath… (sorry for my bad English ;-) )

    1. No apologies necessary I understand you just fine :-) Dr. Greger mentions many foods that can help lower cholesterol please take a look at the last paragraph and click the links. Let me know if these help? Thanks, Steffen!

  17. Vegan diets certainly do not need to be iodide deficient, and I personally have not known anyone who suffered from an iodine deficiency. But I seem to be constantly crushed by someone suffering from stroke, peripheral arterial disease, congestive heart failure, valve replacement surgery, by-pass, diabetic and metabolic syndrome neuropathy, angina, vascular dementia and heart attack.

    Many of the vegans and near vegans on a plant-based diet will include some seaweed in say miso soup, or eat vegetarian sushi- the seaweed provides a natural source of iodine. They can also include some iodized salt in their diet. Say blend a bit of iodized salt to their regular salt, in say a 1:8 or 1:6 ratio so as not to overconsume iodine.

    Also, daily B-12, legumes, flax seeds with occasional nuts sprinkled on salad or apple, helps plant-based eaters get their B-vitamins, zinc, B-12 and Omega-3’s. Bok choy, collard greens and sesame seeds are great calcium sources as is sweet potato. It may be wise to test for DHA/EPA, but really informed plant-eaters are less at risk for deficiencies than their omnivores: typically deficient in fiber, vit.C, calcium, folate etc…

  18. I am new to this forum, but have been following Dr. Gregor for about a year since seeing his videos first on This is my first question and I hope it provides a good interaction among all those interested.

    Are there studies available indicating lifespan differences between populations with the lowest cholesterol versus those with higher cholesterol? I am very interested in this question. If there are earlier posts relevant to my question, please provide links.

    Also, I admittedly have been flummoxed by the contrasting information on versus other sites, such as Dr. Mercola’s website, regarding coconut oil related to lifespan and morbidity. I am coming around to the part about the oil, i.e., use sparingly, if at all. But what about eating coconuts as a fresh, whole food?

    I am sincerely looking for help in understanding my two above questions. Feedback would be much appreciated and I hope to foster some good information that is also helpful to others!

    1. Welcome! I am new as well, but have been following Dr. Greger’s work for maybe 8 years now. I can remember a good friend mention his name in 2000! Glad you enjoy the site let me see if I can help. I don’t know Dr. Mercola, but his website differs than ours, as he sells stuff. Some of it may help I am not certain. The only supplements recommended here by Dr. Greger can be found in Dr. Greger’s Optimal Nutrition Recommendations. This video on optimal cholesterol levels will help answer your question, as well as videos on longevity here and here. I hope they help. Let me know if you have further questions just post them to any blog or video!


      1. Thank you Joseph. I will look at the resources you provided. Much appreciated. Did my links come through for the articles I was referencing?
        Also, probably a really stupid question, but how do folks here keep track of their comments and the responses without having to scroll through multiple pages searching? Is there an easier way for us to track our discussions? Thanks so much again!

        1. I think Disqus will notify you when someone responds to your comment. I am pretty sure whatever way you use to post comments and questions (FB, Discus, NF site) you should be notified. If this problem remains let me know I’ll ask our tech team.

  19. I did not mind giving up butter. when I tasted it after 6 months of giving it up , it tasted like shampoo.
    Same with sugar. It tastes strange now. Salt is hard to reduce, but I think we can substitute it with spices and citrus etc.
    Just discovered that sulfur dioxide is often injected into meat , so I won’t be missing it that much either.

    1. A couple times in the recent past we’ve had people bring in butter rich baked goods to the office, and I can’t even describe how bad they smelled to me. It’s incredibly fascinating to me that non-vegans (including myself in the past) think butter is appealing. The best way I can describe how it smells to me now is a rich yet musty bodily fluid. And it was so overpowering relative to the other ingredients. Funny how much our senses change over time.

      1. Yes it is that odd sweet but unappealing smell, hard to describe. I am pretty sure that I can also smell and taste the flavorings and additives in processed food. I never used to notice but now there is a distinct and unpleasant/synthetic taste. Sometimes I buy these things once in a while, believing that I miss them but end up giving them away. Hopefully the new sense of smell and taste will keep putting me off unhealthy food !

  20. Woman 73 years old, eating only plant based over 2 years, still has cholesterol around 200. Can this still clog the arteries? Thanks.

  21. Thank you to the excellent team that works for our health every day. I highly depend on this site for reliable nutrition information. Can you give any information on the role of a different kind of crystal- oxalate crystals and their possible role in lichen sclerosis? I have read about oxalate crystals and their role in kidney stones but my question has to do with possible link to lichen sclerosis and oxalate effect on this disease and other areas of the body that may be affected by high oxalate intake. Most of the sites which suggest this link are not professional but anecdotal. Any current research on this?
    Thank you.

    1. Thanks for your kind words, Christine. Sorry but I could not find anything on lichen sclerosis and oxalate intake. If anything pops up I’ll be sure to notify you.

  22. As highlighted by CNN ( ), the 2015 DGAC report is dropping the recommendation that “cholesterol intake be limited to no more than 300 mg/day”, because “available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol”. I searched and couldn’t find any comment on this but I see that Dr Greger testified at the hearing and was wondering whether he now agrees with this change in recommendations. Also someone sighted a meta study that appears to support this:change, although I can’t tell whether the Egg lobby had anything to do with it:

    1. Hi Daniel, this change in recommendations is problematic on many levels:

      1) Dietary cholesterol does impact serum cholesterol in those with healthy cholesterol levels. However most Americans have cholesterol levels that are too high to begin with. This doesn’t mean dietary cholesterol is good or neutral, it means the population at large is sick and in urgent need of nutritional intervention. NF volunteer Rami explains the role of baseline cholesterol levels in the effects of dietary cholesterol well in a comment from another video:

      2) They fail to mention that the available evidence clearly shows that saturated fat raises serum cholesterol levels. So the general public hears that cholesterol is a-ok, so they start eating more eggs and meat, which also happen to be high in saturated fat, which itself will increase their serum cholesterol. In addition, the presence of dietary cholesterol is known to potentiate the serum cholesterol raising effects of saturated fat even further. So while even a vegan eating a high saturated fat diet may see undesirable increases in cholesterol, for a non-vegan whose saturated fat in the form of animal foods is usually inherently paired with dietary cholesterol as well, the effect will be even more dramatic.

      Using language like cholesterol, saturated fat, lean meat, etc is a really great way to keep people ignorant about the meaningful changes they should be making in their diet to improve their health. When the government first sought to develop nutritional recommendations, the original language would have been to decrease meat. The meat industry didn’t like this so “eat less meat” became “eat more lean meat” (see ). Now we have the confusing messages of cholesterol and saturated fat. No one puts saturated fat and cholesterol on a plate. They put meat eggs and cheese on their plate. Telling the public to eat less meat, cheese, and eggs would be the a more realistic and truthful way to get the relevant and necessary messages across to the public, however this doesn’t sit well with certain industries acting as government stakeholders.

      If you haven’t already, I highly recommend Plant Positive’s treatment on “cholesterol confusionism”. His videos are based on comprehensive review of peer-reviewed literature as here on Nutrition Facts, but go much deeper into these topics. You can see an introduction to cholesterol confusionism here:

      And the beginning of an in-depth series that will most likely answer any question you have in regards to cholesterol here:

  23. Looking for help!
    It has been 4 years since I started my plant based journey…and about 6 months since I finally weaned myself from all processed oil, coffee, and alcohol. I try to eat at least 4 Brazil nuts a week and I eat a tablespoon of ground flax a day. I’ve lost about 40 pounds but am still overweight. I walk 1-2 miles about 5 days a week and try to stay moving most of the day. When I started this my Cholesterol was 236 (HDL-77 LDL-143) Now my Cholesterol is 231 (HDL-55 LDL-183)
    This is pretty frustrating – any thoughts on how can I turn this around?

    1. My go-to Dr. Greger answer (paraphrased) for those who have tried everything and still have high LD, try focusing on the saturated fat sources (coconut oil; cocoa butter, and yes even nuts and seeds). I would also make sure you’re doing the Jenkins portfolio diet, including foods like (beans, okra, flax, etc.) and get thyroid function tested. Dr. Jenkins developed a portfolio diet for lowering cholesterol, and it actually includes some nuts. Weight loss is important if there is too much abdominal fat (abdominal circumference exceeds half height). So check with your doctor about these measurements. And if your diet is top-notch and LDL is still too high then try Dr. Esselstyn’s 6 servings of greens a day to keep nitric oxide flowing. If you still find it’s not coming down consider a statin. Maybe some of our doctor’s who help reply on our site can help answer better, but I’d start there. Let us know if anything helps and do make sure to check in with your doctors about all of this.

      1. Thank you..I will take a look at the Jenkins first. I do eat beans, greens, and flax…and while I don’t eat processed oil – I do eat nuts.

      2. I did not see your reply until this morning and the link to Dr. Jenkins Portfolio is no longer good…when I googled info on it it sounded like the recommendations were to move someone from a SAD diet to a more healthy one. I am way beyond that in that I do not need or want meat/butter substitutes. If this is not what you thought you were referring me to – could I get a new link?

      1. The article shows the increase in cholesterol after a saturated fat meal but doesn’t address the issue as to whether plaque in our blood vessels can be decreased or even eliminated. I’m wondering if any studies suggest the reversal of cholesterol plaque with a whole plant based diet.

        1. John Chartrand: I believe Esselstyn’s studies were all about literally opening up blocked arteries. I’m pretty sure Dr. Greger has at least one video about those studies. But this video is what I was able to find right away:

          Note this quote: “We know plant-based diets can reverse heart disease, dissolving plaque away, opening up arteries, in some cases without drugs…”
          I don’t think Dr. Greger links to these studies in that particular video. But if you look around, I think you will find what you are looking for. Check out this topic page, which has links to the videos that talk about reversing heart disease:

    1. Yes – get Caldwell Esselstyn, M.D.’s book Prevent and Reverse Heart Disease. He took patients with no more medical options, told to go home to die, and reversed their atherosclerosis heart disease. Shows pictures of unclogging of coronary arteries via angiogram in his book. Twenty years later patients are still alive. Also, the work of Dean Ornish, M.D. He did the same thing. His heart disease reversal program is so well documented and proven that Medicare pays for anyone on their insurance to attend his heart disease reversal program. Dr. Ornish is also reversing/stopping early stage prostate cancer in men.

    1. John Chartrand: Weston Price died in 1948. It’s my understanding that the people who took over his foundation have really twisted his views and taken a whole lot of science out of context (to put it mildly). For more information, check out this video:

      Here are other videos from Plant Positive which mention Weston Price.

    2. John Chartrand: I wanted to say more in my original reply, but I couldn’t find what I was looking for here on NutritionFacts. I had thought that Dr. Greger covered this, but I couldn’t find it. Happily, I have found an article that addresses the more specific point I wanted to make: Dr. Weston Price himself generally promoted vegetarian diets. It is the people who have run the “foundation” after Price’s death that have twisted what he said (as well as the science). Here’s an article covering this:

      Here are some quotes:
      “…Price discovered many native cultures that were extremely healthy while eating lacto-vegetarian or pisco-vegan diets. Describing one lacto-vegetarian people, for example, he called them, “The most physically perfect people in northern India… the people are very tall and are free of tooth decay.” Yet the foundation that operates under his name is strikingly hostile to vegetarians.” …

      “In 1934, Price wrote a moving letter to his nieces and nephews, instructing them in the diet he hoped they would eat. “The basic foods should be the entire grains such as whole wheat, rye or oats, whole wheat and rye breads, wheat and oat cereals, oat-cake, dairy products, including milk and cheese, which should be used liberally, and marine foods.” Yet the Weston A. Price Foundation aggressively promotes the consumption of beef, pork and other high-fat meats, while condemning people who base their diets on whole grains.

      One last example of the discrepancy between Price’s actual work and those who today purport to represent it: Price never once mentioned the word “cholesterol,” yet the foundation presuming to forward his work has declared war on the idea that high cholesterol levels are associated with higher rates of heart disease. “The truth is that cholesterol is your best friend,” they write. “There is no greater risk of heart disease at cholesterol levels of 300 than 180.” They might as well say there is no greater risk of lung cancer for heavy smokers…”

  24. hi, my father has varicose veins and very high blood pressure but he has low cholesterol levels. he works a lot and hard but eats unhealthy. how is that with his diet he has low cholesterol?

  25. Dr. Greger, would you do a video on vitamin K2 MK7. I have read much about it and clinical studies show it is a vital component for D3/Calcium as a transport. Without K2
    and a shortage of it calcium can end up in the soft tissues esp., with higher amounts of D3. Studies show that K2 can even have the ability to reverse calcified plaque in the
    arteries and also prevent this from happening. There are few foods that have K2 and kale is not one of them, it has K1 in abundance. K4 can convert into K2 in the gut via
    bacteria, but studies show that reaction produce very little K2.

      1. Good article. I’ve read just about everything out there on this Vitamin. Yes I realize eating animal products higher in K2 such as grass fed/grass finished beef and cows butter.

        Is not a viable option. Wrong thing to do to get K2. I have recently, become a vegetarian at 64. No animal products at all eggs, and dairy, and processed foods with

        Such products in them. Tough thing to do in the western world. Whole new way of living, cooking, preparing, planning. I take 105 mcg of K2 every other day with

        A meal that is higher in fats as it’s a fat soluble vitamin. I figure it can’t hurt.

  26. This video is a few years old now, but I have a question for Dr. Greger about it. How is it that cholesterol gets UNDER the endothelial lining? The cells that make up the EL are negatively charged, while cholesterol molecules are positively charged– so if the laws of physics are correct then cholesterol should be repelled away from the EL. The only way I can think of where cholesterol could get under the EL is if the EL is somehow damaged and there are “holes” or lesions in it where some cholesterol molecules may attach, and, over time, this process could result in a buildup. But the video makes it sound as though cholesterol penetrates through a healthy endothelial lining. Please explain. Thank you!

  27. Hi I’m a Health Support Volunteer. Thanks for your great question. Sounds like you are looking for a more in depth explanation. This is something Dr. Esselstyn, a pioneer in the plant based nutrition world, has talked and written extensively on. He describes the endothelium as forming a cap over plaques that have formed. He explains the typical Western diet oxidizes the HDL cholesterol which produces enzymes that erode the endothelium and thins it so the plaque is more likely to rupture. This video is a longer explanation. About 13 minutes in is where he explains most of that:

    Hope that helps.

  28. I have a question for Dr Greger.

    I am reading and enjoying ‘How not to Die’. I had a heart attack one year ago and have two stents, I follow a plant based diet almost all of the time and exercise regularly also with the use of a rebounder.

    I have reduced medication gradually to minimal and now after one year I am no longer required to take the prescribed blood thinner, most patients would now I believe, be put on a daily aspirin, however after reading in his book, page 283, that one teaspoonful of cumin per day would be the same as an aspirin that is what I have decided to take, I also use other spices regularly.

    What would Dr Greger think about this? Would he be able to put me in contact with any plant based Doctor in Scotland?

    I am a fit 73 year old and not overweight.

    1. Hello Heather,

      I’m sorry to hear about your heart attack, but am very glad to see that you’re taking charge of your health and making lifestyle changes. When making decisions about medications, we at believe that they need to be discussed with a physician so they can do the proper monitoring and follow-up checks with you. If you would like to find a plant-based doctor near you, I have left links below to 2 websites which list doctors who follow the lifestyle. I hope you are able to find one near you.
      You stated that you eat a plant based diet “almost all of the time,” which is great, but for those battling clinical heart disease and undertaking Dr. Ornish’s or Dr. Esselstyn’s programs for reversing heart disease, best results were obtained with those sticking to a strictly whole foods plant based diet. I just want to make that clear so you understand that there is potential for you to be doing even better!

      I hope you find this helpful,

      Matt, Health Support Volunteer

  29. .

    This information, if passed along discreetly to relatives and friends, can save lives.

    Imagine watching this video for the first time, ever, and viewing the shark’s teeth of cholesterol crystals emerge from a test tube in about three minutes.
    If only three minutes is required for crystals in vitro, crystal formation even in vivo gives us very little notice.

    Granted, some may debate the actual amount of cholesterol required to produce the first crystal. However, that seems entirely beside the point, since most cholesterol addicts do not know how to say “NO!” to their own cholesterol-laden “comfort” foods. They continue to abuse the margin of their own safety, and deliberately silence the alarms.

    Put differently, how to explain to such people that comfort food can kill them. For cholesterol addicts, the only question is when, not if, such a problem will occur.

    1. another form of natural selection: the survival of the most knowledgeable and disciplined over the fitted ignorant

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