Flashback Friday: Does Cholesterol Size Matter?

Flashback Friday: Does Cholesterol Size Matter?
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How do American Egg Board arguments hold up to scientific scrutiny, such as the concept that large fluffy LDL cholesterol is protective compared to small, dense LDL?

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Maria Fernandez has received nearly a half million dollars from the egg industry and writes papers like this.

She admits eggs can raise LDL, bad cholesterol, but argues that HDL, so-called good cholesterol, also rises maintaining the ratio of bad to good. This is the study she cites to support that assertion. But instead of cherry-picking this one study that she performed with Egg Board money, involving 42 people, if you look at a meta-analysis, if you look at the balance of evidence, the rise in bad with increasing cholesterol intakes is much more than the rise in good. Their meta-analysis of 17 different studies showed that dietary cholesterol increases the ratio of total to HDL-cholesterol ratio, suggesting that the favorable rise in HDL fails to compensate for the adverse rise in total and LDL-cholesterol and, therefore, that increased intake of dietary cholesterol may indeed raise the risk of coronary heart disease. The Egg Board responded by saying the increased heart disease risk associated with eating eggs needs to be put in perspective relative to other risk factors, arguing that it’s worse to be overweight than it is to eat eggs, to which the researchers replied: Be that as it may, it’s easier to cut back on egg intake than it is to permanently lose weight.

Fine, eggs increase LDL, but it’s large LDL, this concept that large fluffy LDL are not as bad as small dense LDL. And indeed large LDL only raises heart disease risk 44%, instead of 63% for the small LDL. Light large buoyant LDL still significantly increases our risk of dying from our #1 killer. This was for women, the same was found for men. Large LDL only increases risk of heart attack or death 31% instead of 44%. Bottomline, as the latest review on the subject concluded, LDL cholesterol has been clearly established as a causal agent in atherosclerosis, regardless of size. Yet check out how the egg board researcher worded it. The formation of larger LDL from eggs is considered protective against heart disease, relative to small LDL. That’s like saying getting stabbed with a knife is protective… relative to getting shot!

Health practitioners should bear in mind, that restricting dietary cholesterol puts a burden on egg intake and leads to the avoidance of a food that contains dietary components like carotenoids and choline. Now she wrote this in 2012 before the landmark 2013 study showing that choline from eggs appears to increase the risk of stroke, heart attack, and death, so she can be excused for that, but what about the carotenoids in eggs, like lutein and zeaxanthin, so important for protecting vision and reducing cholesterol oxidation. As I explored previously, the amounts of these phytonutrients in eggs are miniscule. One spoonful of spinach contains as much as nine eggs. And then compared the predictable effects on eye health: organic free-range eggs versus corn and spinach. But what about the effects of eggs on cholesterol oxidation? We’ve known for decades that LDL cholesterol is bad, but oxidized LDL is even worse. So, her logic goes, since eggs have trace amounts of these antioxidants, the implication is that eggs prevent cholesterol oxidation. But the science shows the exact opposite. Consumption of eggs increases the susceptibility of LDL cholesterol to oxidation. They found that not only does eating eggs raise LDL levels, but also increases LDL oxidizability, in addition to the oxidizability of your entire bloodstream. Was this also just published, so she couldn’t have known differently? No it was published 18 years ago, yet she still tries to insinuate that eggs would reduce oxidation.

She acknowledges receiving funding from the American Egg Board and then claims she has no conflicts of interest.

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.

Image thanks to Nikol Lohr via Flickr.

Maria Fernandez has received nearly a half million dollars from the egg industry and writes papers like this.

She admits eggs can raise LDL, bad cholesterol, but argues that HDL, so-called good cholesterol, also rises maintaining the ratio of bad to good. This is the study she cites to support that assertion. But instead of cherry-picking this one study that she performed with Egg Board money, involving 42 people, if you look at a meta-analysis, if you look at the balance of evidence, the rise in bad with increasing cholesterol intakes is much more than the rise in good. Their meta-analysis of 17 different studies showed that dietary cholesterol increases the ratio of total to HDL-cholesterol ratio, suggesting that the favorable rise in HDL fails to compensate for the adverse rise in total and LDL-cholesterol and, therefore, that increased intake of dietary cholesterol may indeed raise the risk of coronary heart disease. The Egg Board responded by saying the increased heart disease risk associated with eating eggs needs to be put in perspective relative to other risk factors, arguing that it’s worse to be overweight than it is to eat eggs, to which the researchers replied: Be that as it may, it’s easier to cut back on egg intake than it is to permanently lose weight.

Fine, eggs increase LDL, but it’s large LDL, this concept that large fluffy LDL are not as bad as small dense LDL. And indeed large LDL only raises heart disease risk 44%, instead of 63% for the small LDL. Light large buoyant LDL still significantly increases our risk of dying from our #1 killer. This was for women, the same was found for men. Large LDL only increases risk of heart attack or death 31% instead of 44%. Bottomline, as the latest review on the subject concluded, LDL cholesterol has been clearly established as a causal agent in atherosclerosis, regardless of size. Yet check out how the egg board researcher worded it. The formation of larger LDL from eggs is considered protective against heart disease, relative to small LDL. That’s like saying getting stabbed with a knife is protective… relative to getting shot!

Health practitioners should bear in mind, that restricting dietary cholesterol puts a burden on egg intake and leads to the avoidance of a food that contains dietary components like carotenoids and choline. Now she wrote this in 2012 before the landmark 2013 study showing that choline from eggs appears to increase the risk of stroke, heart attack, and death, so she can be excused for that, but what about the carotenoids in eggs, like lutein and zeaxanthin, so important for protecting vision and reducing cholesterol oxidation. As I explored previously, the amounts of these phytonutrients in eggs are miniscule. One spoonful of spinach contains as much as nine eggs. And then compared the predictable effects on eye health: organic free-range eggs versus corn and spinach. But what about the effects of eggs on cholesterol oxidation? We’ve known for decades that LDL cholesterol is bad, but oxidized LDL is even worse. So, her logic goes, since eggs have trace amounts of these antioxidants, the implication is that eggs prevent cholesterol oxidation. But the science shows the exact opposite. Consumption of eggs increases the susceptibility of LDL cholesterol to oxidation. They found that not only does eating eggs raise LDL levels, but also increases LDL oxidizability, in addition to the oxidizability of your entire bloodstream. Was this also just published, so she couldn’t have known differently? No it was published 18 years ago, yet she still tries to insinuate that eggs would reduce oxidation.

She acknowledges receiving funding from the American Egg Board and then claims she has no conflicts of interest.

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.

Image thanks to Nikol Lohr via Flickr.

Doctor's Note

This is why a site like NutritionFacts.org can be so useful, because even when a paper is published in the peer-reviewed medical literature, it can misrepresent the science. But who has time to check the primary sources? I do! If you’d like to support this work, please consider making a tax-deductible donation.

Here are some other videos in which I contrast the available science with what the egg industry asserts:

Only the meat industry may be as bold:

BOLD Indeed: Beef Lowers Cholesterol?

For more on the role of cholesterol, see:

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

121 responses to “Flashback Friday: Does Cholesterol Size Matter?

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  1. Yesterday, the leading statement in a NYT article was: “The United States surgeon general warned on Thursday that despite the well-known lethal dangers of cigarettes, too many smokers are not routinely advised by their doctors to quit.”
    https://www.nytimes.com/2020/01/23/health/surgeon-general-smoking-e-cigarettes.html

    I wonder if the same statement, substituting the phrases “animal products” for the word “cigarettes” and “meat eaters” for “smokers,” would ever be published in the NYT? If so, I wonder when?

    Probably not in my lifetime, if ever. How many years did it take for the dangers of cigarettes to be “well known?” 70 years? More?

    As a side bar, my little state suffers from the aftermath of growing shade tobacco: arsenic in the soil, now requiring remediation when found. Though arsenic containing pesticides were also used in orchards, apparently.

    1. PS: “More than 55 years after the first surgeon general’s report warned that smoking causes cancer, it remains the leading cause of preventable death and disease in the United States.“ (from the article). Though the health hazards of smoking were known well before this.

      And this is good news: “According to the Centers for Disease Control and Prevention, the rate of smoking in the United States has declined to an all-time low of 14 percent.” (ditto) Although I think at it’s hey day, the percentage of smokers was about 40%. To a non-smoker — me — it seemed much higher.

      Well, the entire article was interesting to read, and even more so when I substituted “animal products” for “cigarettes,” and “American Heart Association,” “American Diabetic Association,” etc for “American Lung Association.”

      1. Dr J,
        Regarding your quote: “More than 55 years after the first surgeon general’s report warned that smoking causes cancer, it remains the leading cause of preventable death and disease in the United States.“

        Wouldn’t it be nice to see statements like the following, X years from now:

        “More than X years after Dr Michael Greger warned that eating meat, eggs, and dairy would lead to chronic diseases, it remains the leading cause of preventable death and disease in the United States.“ :-)

        1. Clarification: I just realized my above post could be taken to wrong way! What I really wanted to point out is that even now, one could argue that a diet based on animal products could be considered the leading cause of preventable death and disease.

          Hopefully, people will take heed and change their diets now, so the news won’t be saying that a poor diet is still the leading cause of preventable death and disease X years from now!

          1. No problem. My initial understanding of your original quip was just what you intended. I thought it was cleverly stated.

            Kudos to Dr. G. for exposing these false prophets. What would Dr. Fernandez do if the cyanide manufacturers paid her to pump up the consumption of rat poison?

            I looked her up to try to figure out how she was able to garner half a mil from the egg producers. Seems she writes frequently about the subject. You kind of get the idea that each new, egg-favorable article she publishes ratchets up the compensation offered by the egg heads.

            https://chip.uconn.edu/person/maria-luz-fernandez-phd/#

              1. The ability of human beings to genuinely and sincerely believe claptrap and falsehoods should never be underestimated. Just look at the hordes of (unpaid but passionate) promoters of Atkins/low carb/keto/carnivore diets on YouTube for example. And context is everything – if you are a Bangladeshi agricultural day labourer living on white rice and a handful of lentils/chickpeas etc, then a couple of eggs a week probably is healthy. For that matter, substitutung eggs for sausage, burger, bacon and steak is probably ‘healthy’ too.

                But your general point is correct – egg industry dollars taint everything. I never knew until 5 minutes ago, for example,that the Egg Nutrition Center sponsors the USDA MyPlate.

        2. Let’s paint the full picture here. Highly processed vegetarian foods like hydrogenated plant oils, high saturated fat plant oils and other highly processed plant foods generally are probably just as bad as animal foods. They may even be worse (if we ignore the ethical and environmental issues).

        3. I was taught that the eggs and sardines were the absolute perfect foods supplying most of the nutrients I would need to me healthy. Wow! Thank you for educating me.

      2. Dr J.,

        In the documentary about cancer….

        I can’t remember the title.

        Maybe, “Healing Cancer from the Inside Out”

        Well, they talked about the Okinawans and when they smoked like chimneys and had really bad air pollution, they still weren’t dying from cancer at high rates until they added animal products to their diets.

        Dr. Greger talked about them having really poor health outcomes nowadays.

        It isn’t that they added smoking because they already smoked.

        It isn’t that they polluted their air because they already had done that, too.

        It is that they added animal products on top of their smoking and pollution.

        Yes, ideally, we try to undo all of it but health outcomes, diet may well trump smoking even if smoking is the biggest cause of preventable death.

        Smoking, plus animal products, plus creating a toxic environment, plus stress and obesity is like a Perfect Perfect Storm.

            1. gengo-gakusha,

              I had a Zojirushi rice cooker (fuzzy logic, very cute), which I liked very much, using it to cook whole grains and beans in addition to rice, but the non-stick surface in the cooking pan did concern me.

              But after using my IP for a year, with it’s nice stainless steel inner pool, and being able to cook rice as well as grains, and beans more quickly than in the rice cooker (with no need to pre-soak the beans first), and in addition soups, stews, and veggies, and incubate yogurt, slow cook, and more —- I gave my rice cooker to my neighbor. I have limited space in my kitchen. A year later, I donated my two crock pots to Goodwill. What I really want is a second IP, but I have limited space in my kitchen. So I am looking around to see what else I can give away.

              1. Dr. J, Thanks. I’ll have to try using the Instant Pot for rice and grains.

                Pretty much everything we use now in the kitchen is lead-free glass, stainless steel or wood without synthetic coatings.

                1. Gengo,

                  I agree with you about the coatings and for the most part, except for the rice cooker, I am also stainless steel, glass and wood.

                  My instant pot is more like the one wire cutter and consumer reports tested.

                  Some things overlooked and some undercookdd in the same pot and a mess all over the cabinets, plus the rics cooker doesn’t take longer at all. In 15 to 20 minutes I am eating. With the instant pot I would wait that long for it to come down naturally.

                  I did do the big pot of water on ghd stove method two days ago.

                  The di a cooker was a little less wet rice but it is because I didn’t steam it long enough at the end.

                  The logic goes back and forth. I may try microwave next.

                  My old pot really still functions well and I don’t eat rice every week but I agree with you that if I could find a better solution for grains I would.

            1. Thank, Wade. I do have an Instant Pot but need to try cooking grains and rice in it. I find the smaller rice cooker very convenient though.

              1. Gengo,

                Let me know how it goes.

                I bought more than one Instant Pot but those are what I eventually gave away.

                I don’t know if there are models made in different countries or if they switched quality.

                Consumer Reports and Wirecutter calling them out for the exact things I was struggling with tells me that I wasn’t crazy.

                Which model do people have who like theirs and when and where did you buy it?

    2. I still have to be seen by one MD who asks me about what I’m eating (but fortunately, I only have a relatively low ‘n’ and all but one visit for an infection were routine preventative visits and not disease visits). I have seen one ND and she asked a little about my diet. I thought nobody ever asked, because I am normal weight. But, even the concierge doctor my mother in law pays, hasn’t asked her once about her diet; since my MOL has multiple health issues on top of her excess weight, this is so amazingly disappointing to me. I am not even sure they test her for nutrient deficiencies (despite her frequent hand cramps)..

      However, whenever I go to a veterinarian with any of our pets (birds, cat, dogs, turtle, rats), one of the first questions is always ‘What’s her diet?” and this information is kept with the pet’s file.

      1. You make a good case against medical doctors. I am a retired physician, one who has fought obesity most of my life, despite following a good diet and marriage to a vegetarian? How much education did you have? enough to criticize others?

        1. Alan,

          That is what doctors do tend to focus on. They are the ones who are educated.

          I just do know that when my relatives go to the doctors and bring up nutrition, the doctors immediately say it doesn’t matter. I experienced the same thing as a caretaker, but my cousin has gone through it over and over again as a Diabetic and Kidney patient.

          I showed him Dr. Greger videos and even with him asking over and over again, they try to turn him away from focusing there and he said, “I have never heard any of this after 25 years of being Diabetic and years of being a kidney patient.”

          I got my brother to eat healthier while he was waiting for surgery for kidney cancer, but his doctors all stood against it and he doesn’t eat healhier now and that does frustrate the patients.

          And, no, I have ZERO education in ANY of this.

          I just watch videos every day.

          1. I am not against doctors

            And every day when I read PubMed and try to learn the science of everything, I am genuinely in awe of everything doctors have to learn.

            I just go to Forks Over Knives and see on the front page someone who reversed Kidney disease from Stage 5 and got off dialysis and I talked to my cousin about it when he was Stage 3 and his doctor sad, “No, diet won’t help. You need more animal protein. Eat 5 egg omelets and don’t eat fresh fruit and be careful with all of the plant products because of potassium and phosphorous” and Dr. McDougall and Dr. Greger were saying, “Eat less animal protein” and that people eating plant foods tested better and it is so hard for the average “patient” to figure out who to listen to.

            I have a friend whose mother just got diagnosed as Stage 3 Kidney failure and she has already blocked this out and has decided to trust her doctor and trust the medical model and she will eat 5 egg omelets and not eat as many plant foods

            1. I will also challenge whether it is okay for patients to ask questions and to challenge the answers.

              If the culture wasn’t as divided and money-oriented, then maybe “trust the expert” would be okay, but we live in a greedy Gus culture and doctors are pharmacology and medical equipment sellers and chemotherapy and surgery and even abortion and birth control are all businesses.

              We look for integrity in business and it is hard to figure out, but we do have to have skepticism and we need to try to have it be a healthy skepticism, not paranoia, if possible and trust without naivete and even though that is what we have to have, it is really, really hard to figure it out.

              1. The wider culture has created lemmings and conspiracy theorist, but there are pockets of people who are exposed to the right teaching and have the intelligence to follow it.

                (Thus says the brain-damaged culture-analyzer who has ZERO courses in cultural analysis either.)

                1. Sorry if I sound defensive with the all-cap.

                  Not meaning to be.

                  It is just that we, like lemmings, have advertisers and television personalities and flavor analysts and doctors and family members and everybody else messing with our health and I am from part of society that genuinely can’t afford modern medical.

                  I have another friend who is inches away from losing her house and perhaps inches away from sharing insulin with her spouse.

                  I watch people dying of things like Prostate cancer and he was special to me and he, probably out of generational politeness never mentioned his prostate and I never got to talk with him about whether he could have reversed it with diet and almost everybody I do try to talk with won’t listen to this message but I think, morally, I still have to mention it.

                  And, morally, I almost feel a need to challenge the 65% of the people who just follow doctors’ orders because their doctors are the ones who are the experts to take responsibility for understanding their own medical condition and I will tell them that it will be so confusing that they won’t even want to listen, and it will be fraught with people telling them to put garlic on their face and drink bleach and all sorts of crazy things and they will have to have a great big “pause and don’t do anything until they also search for warnings and scams” sign next to their computers, but they need to do it before they get old enough that it is harder for their brains to understand.

                  I am watching 90 year olds try to learn it at their age and they only learn simple things, but I watch them eating purple grapes and there is a sign on their fridge “eat purple grapes” and if that is all they learn, that is better than listening to the people telling them to do nothing at all.

                  1. The fact that it is constantly “life or death” for us and that it is so complicated that we need experts who aren’t driven by financial gain.

                    I was talking to my friend who lives in Israel yesterday and I explained immunotherapy to him and he didn’t understand the first 3 or 4 times I tried to explain it and he said, “I think you are saying that it is complicated” and my breathtakingly intelligent college-educated friend couldn’t follow the science but he immediately understood that it was complicated.

                    I had the exact same conversation with my cousin’s best friend and he was sitting in his suit stopping by with a load of groceries to help after his career job and I explained a different topic to him and he said almost the exact same sentence.

                    And that was almost the same sentence that my 90-year old uncle said before he translated the Alzheimer’s science to “eat purple grapes” and I thought it all flew over his head, but “eat purple grapes” was a good answer.

                    1. Maybe we need doctors who are more inclined to have an interest in geriatrics as a specialty?
                      They wouldn’t have to look far for patients.

            2. Deb

              Patients with end stage kidney failure have to use dialysis. Among other things, dialysis removes protein from the blood. This is why dialysis patients are advised to eat a higher protein diet.

              1. Thanks, Tom.

                I was more talking about the year and a half before he got bad enough for dialysis.

                I know of several on-line testimonials that WFPB improved kidney function and the man on the Forks Over Knives site had his doctor slowly remove him off of dialysis.

                Starting with fewer sessions per week.

                Eventually he got off.

                If that is real, people need to know.

                1. That’s amazing Deb. I have never previously heard of anyone who has reached the dialysis stage, being able to reverse the process.

        2. Alan Lasnover,

          I just learned that my brother had a heart attack 4 years ago — after eating a vegetarian diet for about 10 years (he married an animal rights activist). He was also overweight, out of shape, and on meds for high BP and cholesterol, diabetes, GERD, and I don’t know what else.

          I asked him how he gained so much weight, and he answered “I liked cheese too much?”

          Anyway, the heart attack was his wake-up call to change his lifestyle (I’d thought it was being diagnosed with T2 diabetes, but no, I misunderstood, it was his heart attack), so he changed his eating to whole plant foods — he took a course on changing his lifestyle, which included learning what to eat, how to shop for it and how to cook it. He also exercises (I don’t know when he started). He did eventually lose 70 lbs, and went off his meds, including for diabetes, high cholesterol, and GERD, and is on the lowest dose of blood pressure meds (he’s hoping to go off that one, too). For me, that’s a powerful example of how what we eat affects our health.

          Oh, and I hope you don’t mind; I do criticize doctors, at least as far as their knowledge of nutrition and it’s effects upon the health of their patients is concerned. Dr. Greger himself has said that most doctors don’t even get one nutrition course during their medical education. My daughter took one during her nursing studies — though it was an elective — so she’s ahead of most doctors as far as nutrition education is concerned. And I have a PhD in biochemistry, and spent quite a bit of time as a research scientist, so I hope that gives me sufficient “knowledge and education” for such criticism. Though I don’t think that’s necessary; this site alone equips folks who watch the videos, read the blogs, and read the books to criticize doctors’ lack of knowledge about and interest in nutrition.

          1. Dr. J
            No, your daughter is not ahead of doctors on nutrition. She was taught that meat, dairy and eggs are what people should be eating for good health. Certified nutritionists write newspaper articles, twitter feeds, appear on TV, you name it, and only rarely does one of them advocate a plant based diet. The standard western diet is what is taught as good nutrition with very few exceptions.

      2. Hi Heidi, thanks for your comment. I must admit it is not that the Drs don’t want to help and if they had time they would go into more detail analysis. I am sure if a patient asks for further help they would refer them to see a nutritionist or a dietitian to get a detailed assessment.

        1. If they had time?????
          We pay them to make the time for us!
          We trust them to have our health as a priority.
          They don’t even take our blood pressure properly.
          They operate on the same principle as the in-and-out burger chain.

          1. Hi Lucy, I hope to explain further, I mean as an empowered patient one can ask questions and initiate further investigation and putting more time for us and ask questions and referral. I was simply indicating the way I have noticed the clinics run. They allocate certain amount of time for each visit.

            1. Spring,

              That is true.

              Honestly, doctors near me are so busy that it can take months to get an appointment.

              My grandmother’s doctor had so many patients that people would only get 15 minutes with him.

              He would sometimes take longer if needed but it would cause long waiting room times.

          2. Boy, this one resonated with me. I rushed to the doctors office recently for a knee problem and they took my blood pressure immediately with no resting state. Then my doctor didn’t say a word to me but called in a prescription for Losartan Potassium. The pharmacy called me and told me to come pick up the order. I was shocked and shared my resting blood pressure with my doctor (typically ~117/~76). He said I must have white coat hypertension. I said that I’m loaded up on Ibuprofen and coffee (raises blood pressure) and had been rushing for my appointment (also raises blood pressure). Needless to say I have moved on to another care giver.

          3. Well, I sure am NOT complaining about my doctors. They are awesome! They have a ‘lifestyle first’ philosophy, and practise it themselves. My doctor just called me in fact to make sure I was ok, and if I had enough prescription meds to last until my appt next week. How nice is that?

            1. Barb,

              That is great.

              Honestly, I have walked so many people through medical issues and have never met a primary care or specialist like that and the dietitians don’t tend to be WFPB oriented either.

      3. Heidi,

        I think a video on this site points out that 1 in 6 meat eaters, as well as 1 in 3 elderly, are deficient in vitamin B12, as are many vegetarians and probably all whole plant food eaters, which deficiency is easily corrected with B12 supplements.

        But one of the symptoms of a B12 deficiency is peripheral neuropathy. Another is dementia. There are more symptoms.

        Anyway, I don’t know why doctors don’t test everyone for B12 levels. My PCP did, but my husband’s didn’t — even though she knew that he didn’t eat animal products. And is definitely elderly — or at least older (77).

        Your observation about veterinarians is interesting; in general, I like the way they run their practices far better than any medical practice I’ve visited. We switched our little old rescue mutt over to a vegan diet last year — and he’s still with us! Amazingly enough. He’s now about 16-17 yo; he’s been with us for 15 years, and he arrived as an adult dog. My daughter switched her two much younger and bigger rescue dogs to the same vegan kibble, and they are both doing well; one is doing better than on the vet prescribed diet, with a decrease in some of her allergy-like symptoms, and the vegan kibble is cheaper.

    1. Wegan, Maria apparently received research grant money from the egg board several times, but she also received $245,000 plus for researching soy and plant sterols, etc. and another grant for checking out the effect of raisins on heart disease. Personally, I loathe people who spend their days designing studies that cause horrific suffering to animals….in her case guinea pigs :( In fact, I am feeling more than a little disenchanted with the world of science. Seems to me that politics and money rile the labratories as much as anywhere else, and the journal publication editors are not exempt. Pffft!
      https://web.archive.org/web/20131126143103/http://www.canr.uconn.edu/nutsci/nutsci/hpg/mluz.html

  2. If 90% of our cholesterol is produced in the liver and not a result of our dietary intake, are we hyperfocusing on the cholesterol in certain foods? Can the 10% of the dietary cholesterol effect really have an overwhelming influence on our health?

    1. Jeffrey,

      People in parts of the world who had low cholesterol levels also had extraordinarily low rates of heart disease and when they switched diets to adding in animal products those rates changed and those rates were changed by changing diet.

      Those places used to have total cholesterol levels averaged under 150 mg/dl which is similar to people eating contemporary strictly plant-based diets.

      To quote Dr. Greger’s blog:

      According to William C. Roberts, editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in our blood. To drastically reduce LDL cholesterol levels, it appears we need to drastically reduce our intake of trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and, playing a lesser role, dietary cholesterol, found exclusively in animal-derived foods, especially eggs.

      Notice the pattern? The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating processed foods and animal products. This likely explains why populations living on traditional diets revolving around whole plant foods have largely remained free from the epidemic of heart disease.

      1. Jeffrey,

        Even if it is the liver making cholesterol, it is dietary changes that cause the epidemic of heart disease and it is only dietary changes that fix it.

        Think about it.

        What are you going to do to get your liver to produce less of it?

    2. Jeffrey

      I think the point is that lowering cholesterol (by drugs, diet, lifestyle) has been demonstrated to reduce cardiovascular events including death. It is a modifiable risk factor. Reducing cholesterol may be beneficial all other tings being equal (various cancers, chronic alcoholism, malnutrition, trauma and infectious disease also reduce cholesterol).

  3. Observational studies looking at egg consumption specifically (rather than at dietary cholesterol overall) have not found it to be associated with any form of cardiovascular disease, except maybe in diabetics. In controlled trials, whether in healthy people or in people suffering from diabetes or hyperlipidemia, egg consumption was not associated with an increase in risk markers for cardiovascular health, insulin sensitivity, or blood glucose.

    1. ‘ In controlled trials, whether in healthy people or in people suffering from diabetes or hyperlipidemia, egg consumption was not associated with an increase in risk markers for cardiovascular health, insulin sensitivity, or blood glucose.’

      I am sure that is true of egg industry funded studies. It’s been known for a long time that it’s possible to design studies that will produce a null effect in most people. The egg industry has been busily funding such studies for several decades

      Non industry funded studies that are not designed with such issues in mind show a different picture. For example, serum cholesterol is accepted as a risk factor for eg CVD. and dietary cholesterol has been conclusively shown to increase serum cholesterol. However, the dose response rate appears to be hyperbolic so people wit existing high baseline cholesterol intake show little effect from added dietary cholesterol.
      https://pdfs.semanticscholar.org/f23d/787252a77369c3c588f0cd0a3fa658d80b21.pdf

  4. Cholesterol is a fat-like substance present in all our cells. It serves many functions, such as providing the raw material for pregnenolone, from which are derived many other hormones: cortisol, DHEA, testosterone …

    Cholesterol is shuttled throughout the body by two kinds of carriers made of fat on the inside and protein on the outside: low-density lipoproteins (LDL, often called the “bad cholesterol”) and high-density lipoproteins (HDL, often called the “good cholesterol”).

    Cholesterol levels as measured by typical blood tests reflect both the cholesterol than we produce and the cholesterol that we ingest. (Most people produce more cholesterol than they ingest.)

    Cholesterol can form small crystal aggregates, found in atherosclerotic plaques. Immune cells called macrophages can take up those crystals, thus activating the NLRP3 inflammasome. Supporting this idea, other crystals such such as silica and uric acid have been shown to trigger inflammasome activation.

    Inflammasome activation triggers in turn the release of a number of pro-inflammatory cytokines, including IL-1beta and IL-18, which appear to be critical to atherosclerotic progression.

    So in a nutshell , It is mechanistically possible for cholesterol to form crystals that can trigger an inflammatory response that may promote atherosclerosis.

  5. I think the term, “No conflict of interest” is accurate when your only interest is propping up the egg industry.

    It is a bit like Bill Clinton saying, “It depends on what your definition of ‘is’ is”

    There is a whole segment of the population who have figured out how to use language that way.

    For me, the message that I am going to try to memorize this time through is:

    And indeed large LDL only raises heart disease risk 44%, instead of 63% for the small LDL. Light large buoyant LDL still significantly increases our risk of dying from our #1 killer. This was for women, the same was found for men. Large LDL only increases risk of heart attack or death 31% instead of 44%.

    1. Yeah, and most of us likely would have missed the significance of those figures too. How many people would have read 1.44 and 1.63 and just moved on without taking stock? Those tiny numbers really do mean 44% and 63% greater.

  6. Dear Dr. Greger,

    Would you be so kind to explain something about the total cholesterol to HDL ratio versus a slightly elevated LDL cholesterol concentration under fasting conditions? This all with respect to the risk of artherosclerosis.

    Best regards,
    Marcel

  7. Deb,
    You posted yesterday that you found a good steamer. Could you post the barnd name that you found? I would be intersted in getting something like that, too.

    Yesterday’s comment by Deb:

    “When I was looking at steamers, I found 2 commercial quality steamer brands selling for much cheaper than the others and in both cases it was the companies that moral decisions to not do planned obsolescence and to not do exorbitant pricing.

    That is how our company thinks and how we operate but it is harder to be that way.

    I am so happy to have resolved cleaning.”

    1. Here is one:

      https://chiefsteamer.com/?gclid=Cj0KCQiAyKrxBRDHARIsAKCzn8xQJdyI1al41OwUypJnO7aBgg_GrMEix2hwhNpzQffxd3BrBk54XAwaAgPrEALw_wcB

      The main part is not having the heating element in the water.

      They have a video in the residential side explaining the exact things they used to make their residential versus commercial steamer.

      I am on my cell so I can’t copy and paste as well.

      I think I am buying a commercial one.

      I know that having the proper tools even just for detailing my car will pay for it even with trade in value.

      I don’t mind paying for quality.

      I have already had consumer level steamers not work properly and I have had them break down, and having to use distilled water all the time was a pain.

      Both companies say you can use tap water if you don’t have a lot of minerals.

      I am going to see it as an investment in the environment.

      1. Here is another.

        https://www.myvaporclean.com/commercial-use/?gclid=Cj0KCQiAyKrxBRDHARIsAKCzn8ylbpLfiVHtLFBT1YAeN36kGO2U_S0yyuuPE24PgaMSrJjxfd6goT0aAqvzEALw_wcB

        Offers of this quality are way more expensive And some of those have plastic and some have Chinese parts.

        My friend went into auto detailing and he uses equipment like this but his cost a lot more.

        I know that it is an extravagance but I am someone who can love my $20 rice cooker and my Speed Queen washing machine even though it didn’t cost that much, but I can also love highly functioning more expensive things.

        I feel like planned obsolescence is going to increase over time and the concept of a stupid throw away society breaks my heart.

        1. Most people won’t want one that good but what I have figured out is how many things I have bought since that first steamer and that wouldn’t be hot enough for me to clean my clothes and dishes and bedding without cleaners.

          I am going for it.

            1. I am not sure if anybody else gets excited about being able to afford things that func well but that is my thing. I passionately love it when something functions well and is built to last a long time and when it is priced in a way that the monthly payments won’t cause hardship.

              1. Plus, a while back I read something about the government using so much steel for military purposes that it caused a shortage and caused prices of steel to go up.

                1. Actually, I think that was one of our vendors but government was using so much steel that the government was making it hard for anyone else to get steel for their manufacturing.

                  1. Water supply itself might be something I steam someday.

                    I say that because a few times nearby cities have had orders not to even wash hair because of something in the water supply.

                    I guess I could probably just boil it or use a Steripen but I decided to have a few ways if doing things.

                    It kills mold and bed bugs would be other things. I have had mold after extended rains. I have had people have bed bugs and steam kills them.

                    It peels wallpaper.

                    Plus if I use it I won’t need to run a humidifier in Winter and my house will be warmer.

                    1. The concept of not having to look for sales or coupons or look up toxic ingredients anymore is so exciting to me.

                      I was going to be putting in a portable pantry partly because of how much room all of the cleaning supplies take up and the steamer costs less than the pantry.

                      Plus, I did have wallpaper professionally removed from one room and I have one room that still has wallpaper and it looks nice enough right now that I may leave it but I would be anle to save hundreds of dollars just steaming it myself.

                      It seems like helping the environment and the fact I could carry it over to a poor prrson’s house and get rid of their bedbugs or disinfect their microfiber rags every once in a while.

                      I love having concepts that lower stress and save trips to the grocery store.

                  1. wow Fumbles! I am in shock! I had megoloblastic anemia years ago… severe blood loss, emergency transfusion, and I have been chasing iron through the years since. So much of what that young guy experienced rings true for me. My doctor tested me for B12 but I wonder if she said it was ok because I was not anemic at the time? Never was I told to take B12, even when I lay in the hospital so close to death. Unreal. I wonder if my b12 pills are good enough now?

      2. Deb, Thanks for the link to the steam cleaner.

        Regarding the mineral build-up from tap water in steam products, the coffee brewing machines in the past recommended running a vinegar solution through the machine every so often to remove the scale build-up. I wonder if that would also help with these steam cleaning products?

        1. That would be a good question to ask.

          They specifically said that because the heating element isn’t in the water, tap water isn’t a big deal unless you are filtering over minerals or have a softening system.

          I ended up watching videos on cleaning the refrigerator with a steam cleaner and never having to remove the shelves ever again will be a blessing. (Never having to figure out how to put them back in again will be an even bigger blessing to my brother and coworker.)

          The thing about doing it on financing is that when I do the math of all of the products I won’t be buying anymore, I think not buying the dish detergents and laundry detergents and bleach and ammonia and hydrogen peroxide and other cleaners baking soda or vinegar or essential oils or the little plink balls to refresh my drains and other things I end up buying to try to get rid of spots and stains or odors and the fact that all of those topics are so hotly debated online and I ended up trying all of them and will start giving the storage cleaning supplies to the poor people around me all makes me happy.

          I think I will not spend about $20 a month on cleaning products – but honestly, since I shop stupid sales and they sell buy 4 and get 1 free and I end up doing that ridiculous process and end up keeping things in my trunk and forgetting that they are there and finally bringing them in and looking at storage containers and then doing the Swedish Death organization process versus the Does it bring you joy? lady process. I think this will bring me joy and the fact that my coworker and his wife helped me organize when they wanted me to take in a cat, and they did the “Throw out all of these cleaning supplies” process, which didn’t happen. The supplies found their way back to the shelves after they left because the part of my mind that bought 4 and got a 5th one free didn’t find the process brought enough joy to throw everything out.

          1. Watching the joy woman who organizes by getting rid of everything, the part she doesn’t deal with was why you bought it in the first place because that represents the “problem” that needed to be solved.

            1. She has people throwing out everything they bought or giving away their outfits because they don’t bring the person joy, but those of us over a certain age can go shopping for years and look at clothing with shoddy construction or priced so high that we get sticker shock and the fact that people will throw all of it out or give it to Goodwill and they will go shopping and still not find joy is so highly likely.

              When I visited my 90-year old relatives, they still have the same clothing and furniture they had when I was a child.

              Back when American made existed and meant something.

    2. Darwin,

      For several days I have been doing the logic between those two companies.

      Looking at their accessories and comparing their cord lengths and wattage and PSI.

      I went to Bed Bath and Beyond and looked at the wattage and price of the best clothes steamer and it was 1700 watts and $300.

      I went back and forth between the mop oF one and the plumber’s helper of the other and one plumber visit being averted versus the bigger mop head making my daily life more convenient.

      I think I am going with the man who was willing to honor the warranty even if a commercial place uses one of his residential units.

      Narrowing to the two companies was still not enough.

      I am pretty sure I am doing his cheapest commercial one but my finger is still on the chess piece.

      I like both companies but he is in a relationship with his customers and won’t give me a hard time if something goes wrong.

  8. I am thankful for doctors I have used in recent years: one for severe bladder infection (SAD) that lasted for years but was cleared up in days with anti-biotics, and one for a stubborn “community acquired pneumonia” which finally was arrested and cured with proper anti-biotics and therapy. Thank you for anti-biotics. But I am also grateful for the plant-based community for their concern and information, including Dr.s McDougall, Campbell, and Greger which has cured my ‘declining kidney function”, lowered my cholesterol greatly, and given me overall much better health. It depends on what the doctors are asked to do. For nutrition, I don’t even bother to ask them any more (and don’t need to) since they always deny the need to eliminated animal products from the diet. Some are willfully aiding in destroying people’s health while others are like most people and intellectually lazy when it comes to solutions. I am 77 years old and in great health with near zero chance of a cardiac event after reading my MRI (all clear and clean). Grateful to the plant-based doctors that I’m still here while many my age have died or are deathly ill and disabled.

    1. Brian,

      Congratulations!

      Yes, I have seen dietary deniers – and not just doctors. My diabetic friends and relatives talk to me about what their dieticians told them to do and it is not WFPB they are recommending.

      I think they are more neutral about which foods to eat.

      When my cousin started listing jelly beans and soda as okay but fresh fruits and beans and vegetables we’re what he needed to avoid and he should eat 5 egg omelets, I listened to him saying, Jelly beans? Frustratedly.

      He has had at least 4 or 5 of them and they are not WFPB. None of them so far.

      1. I wonder if one of the good doctors could PLEASE VERIFY THE MAN COMING OFF DIALYSIS.

        OOPS, somehow my phone knows I am thinking in ALLCAPS.

        Can that become an n of 1 in a journal so kidney patients could hear what he did?

        Are there any doctors who could facilitate that process???

        1. It is the study concept I wanted to plant in Dr Ornish’s mind.

          But if the man did The Starch Solution or Eat To Live or Dr. Esselstyn’s diet or whatever, some of us want to know.

          Ocean Robbins mentioned someone getting off the kidney transplant list last year.

          Seems like someone needs to do a study.

  9. This is an off-topic issue but interesting enough to mention here I think ……….

    ‘Management of elevated blood pressure (BP) as a means to reduce mild cognitive impairment (MCI) and dementia is a promising area for prevention of these common, but devastating, neurologic conditions. Even before definitive clinical trial data provided evidence that BP reduction was a means for prevention, the National Academies officially recommended BP reduction as an important focus for dementia prevention.[1] When SPRINT (Systolic Blood Pressure Intervention Trial),[2] and its accompanying cognitive-focused substudy SPRINT-MIND (SPRINT Memory and Cognition in Decreased Hypertension), were completed, definitive clinical trial evidence demonstrated that aggressive BP control reduced incident MCI (hazard ratio, 0.81), as well as a combined outcome of MCI and dementia (hazard ratio, 0.85),[3] but not dementia specifically. SPRINT-MIND directly tested this question by randomizing more than 9000 individuals with hypertension to standard control (goal systolic BP <140 mm Hg) versus aggressive control (goal systolic BP <120 mm Hg). When combined with other previously conducted clinical trials, the net benefit of BP lowering on dementia reduction became significant (relative risk, 0.93 [95% CI, 0.86–1.00]).[4]'
    https://www.medscape.com/viewarticle/923660?src=wnl_edit_tpal&uac=129079FG&impID=2255394&faf=1

  10. Interstingly Dr Mercola who interviewd Dr Greger has a totally different opinion on eggs and cholesterol. Two extremely dedicated MDs, two opposing opinions. What to think?
    https://articles.mercola.com/sites/articles/archive/2018/05/21/eggs-are-good-for-your-cholesterol.aspx
    The belief that eggs are bad for your cholesterol is a myth; in fact, eating eggs doesn’t negatively impact your cholesterol at all, but they do offer crucial nutrients, including choline, and can even help you lose weight.”

    1. Luc, Besides minimizing the effect of cholesterol, It looks like Dr M is promoting eggs because of their choline content.

      Do we really want a lot choline in our bodies?

      https://nutritionfacts.org/video/eggs-choline-and-cancer/

      https://nutritionfacts.org/video/carnitine-choline-cancer-and-cholesterol-the-tmao-connection/

      If you’re concerned about a deficiency, my approach would be to get my choline tested before adding any high choline foods, especially animal products. I’m convinced that I am getting just the right amount by following Dr Greger’s Daily Dozen.

    2. Mercola is echoing the standard egg industry line and supported by dozens of conveniently designed studies. Eggs certainly don’t affect serum cholesterol levels in people whose baseline cholesterol intake is already high – which is most Americans. That’s why the egg industry has for decades been funding studies of people with existing high cholesteorl intake to prove that eggs don’t increase cholesterol levels.

      ‘When modest amounts of cholesterol are added to the daily diet, the major predictor of change in serum cholesterol is baseline dietary cholesterol. Thus,
      when one or two eggs are added to a diet that is typical for the average American (containing 400 mg/d), little change would be expected. This is precisely the study design of a number of outpatient studies in which there is little or no control of the diet, either before or after addition of eggs (3 1-34, 38, 40, 41)’
      https://pdfs.semanticscholar.org/f23d/787252a77369c3c588f0cd0a3fa658d80b21.pdf

      The egg industry as even managed to convince the US dietary guidelines people that eggs/dietary cholesterol don’t raise serum cholesterol levels despiet a century of human clinical trials showing that they do (in people eating healthy/normal diets).

  11. I went to visit my 90-year-old uncle and aunt last night and they are so preciously old school.

    My oil company changed ownership and they said, “Oh, we will help you. We are so close to our people and the husband passed away and his wife and kids took over and they are so dear to us.” and they said, “But what we have been noticing is that the McDonald’s workers don’t stay working almost at all” and they are so close to the manager and she is a sweetheart and so is everybody else. I think they are sweetheart generators.

    Anyway, I am teaching them computers and they are teaching me how to play an organ and they are keeping me updated with what is going on in the impeachment process because I find it all too stressful.

    But they are still eating their purple grapes and they are going to be adding in beets and cranberries and salad, reluctantly salad. They started eating their apples instead of doing apple juice and they are eating the peels on the red apples now. Turmeric is next.

    I have not mentioned cutting back on eggs or animal products at all yet. They have dementia and adding in is already too complicated, but they are doing better and my uncle successfully cut and paste words last night and didn’t get confused when the words disappeared. I think his brain is slowly improving.

    I love my lawyer and I love my dentist and I love my accountant and I love my electrician and my carpenter and my painter and I love my lawn care people and I love the man who does maintenance on my boiler.

    It is so amazing to me that I never found a doctor who had a sense of living within a community and being in a community relationship.

    Reading Dr. G’s very old book – which I am not plugging. It is more for people who are considering going through med school. But they are in such a different culture and I never understood that.

    1. My great-grandmother’s doctors were in a community relationship.

      My uncle’s doctor gave my uncle his private cell phone # when he got brain cancer and trigeminal neuralgia and cried for him.

      It just seems like so much has been lost on the human side of humanity and the throw-away culture threw too much away.

      1. My Selah to Dr. Greger is that maybe it wasn’t nutrition that the medical school didn’t understand.

        Maybe it was health.

        But what I also understand is that Patch Adams has spent the past several decades mostly functioning as a traveling clown trying to raise money for a clinic and he was intensely relationship-oriented but lost his wife and that is something I don’t say in judgment. I say it because who am I to even think I have any concept of how to fix things.

        I will say that I knew a medical person who was so perverted on the inside that during surgery a shoe was tossed at her.

        1. Sorry if that sounded like I was looking down on med school culture.

          When my grandmother was in the last year of her life, I was trying to be present and pay attention to what she was communicating and the doctors kept coming to me and saying “What are your goals?” and my goal was to be present and pay attention to what she was communicating and they wanted my goal to be to kill my grandmother faster and one young intern used, “This will kill her faster” while I was hanging Christmas decorations to enjoy every last drop. She was communicating that she was hungry and thirsty and was saying sentences like “I am not dead yet” and she would start laughing when I would say that when we got home I would be feeding her anything she wanted again. They were like, “She has dementia, don’t listen to her” and my culture is “She has dementia, listen to her more closely.” She was, “I am afraid of dying” and they were, “She doesn’t know what she wants.”

          My goal maybe has become to understand doctor culture so that eventually I can go through an end of life process that isn’t so totally traumatizing for my whole family that we never want to go to a doctor again.

  12. Research topic request…Pulmonary hypertension and plant-based eating. Any reduction in symptoms? My husband is 40 and on two medications for pulmonary hypertension of an unknown cause.

  13. Is MCT oil a healthy option for energy and is it healthy for the body long term?
    Is Ghee or any clarified butter an unhealthy choice for cholesterol? Or is there more good cholesterol in this kind of product?

    Thank you.

  14. Is MCT oil a healthy option for more energy and a long term healthy option for the body?
    Also, is Ghee or any clarified butter a healthy option? Concerned about cholesterol.

    1. Janaan,

      I would say no, neither MCT oil nor clarified butter are healthy options.

      First, most added oils are not healthy, especially for your arteries; there are several videos on that topic on this website. Second, clarified butter is butter from which milk solids (presumably mostly protein) have been removed, so it’s even worse, just a lot of saturated fats. Third, MCT oils are oils containing high amounts of medium chain fatty acids (eg, coconut and palm and palm kernel oils) which are saturated, and saturated oils are particularly unhealthy.

      The general message is to avoid added fats and oils, which are refined oils. Especially those high in saturated fatty acids.

    2. Janaan,

      Dr. Greger has videos on Ghee and oils.

      Neither of them contribute to health.

      When you mention MTc oil, I wonder if you are thinking Keto.

      If so, watch Dr Gregrr’s Keto series.

      The one on Diabetes is seriously important for people thinking of going Keto.

  15. Oh my freaking goodness…! scrolling through your other egg related videos linked beneath this one, I clicked on “Eggs: Who Says They Aren’t Healthy or Safe?” and I have no idea how I missed this gem. Seriously One of your BEST videos ever…. It exposes the egg industry on such a brilliantly intimate level and is maybe, somehow, despite all the hard-hitting science, THE most telling of the “healthfulness” of eggs. THIS seriously NEEDS to be put up as a flashback friday video one day soon, I hope you/your staff considers it. This is a must watch for anyone who hasn’t and it really should be plastered all over the internet.

    I also really love the style of this video… It’s moderate-paced–fast but calm and very clear and very easy to catch every word and follow without missing a word because of it.

    https://nutritionfacts.org/video/who-says-eggs-arent-healthy-or-safe/

  16. Dear Sir, please share the link for the “landmark 2013” study to which you refer. Thank you. The data appears overwhelming to me from 2013 and from the many studies since that eggs are protective for vascular health.

  17. Dr. Hooper,

    I believe the referenced work is: https://www.ncbi.nlm.nih.gov/pubmed/23614584. The key finding is the conversion of PC influencing TMAO production.

    From an empirical perspective, please see Dr. G’s newer work, https://nutritionfacts.org/video/eggs-and-breast-cancer/ or consider https://nutritionfacts.org/video/flashback-friday-who-says-eggs-arent-healthy-or-safe/ in your evaluations.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

    1. WOW! Great. Dr Kadish, I am excited to hear from you. I am lead researcher at Uchee Pines Institute, having left conventional medicine after 20 years.

      I consider plant based choline as uniformly beneficial in a vegan with the expected healthy microbiome. I see now that plant based choline is potentially detrimental to the Westerner with the “bad bacteria” (those genera of bacteria that are associated with TMAO production) with regard to certain cancers and perhaps other disease. Do you agree? Or rather is the danger of choline more a function of its form – choline compared to choline phospholipid (phosphotidylcholine)?

      Your work has changed my life. I researched at UC Davis in the 80s and Stanford and Vanderbilt in the 90s. I worked 6 months to make 1 step forward. Now, I move at the speed of light, with most of my guidance starting with your site. Thanks!

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