Flashback Friday: Eliminating 90% of Heart Disease Risk

Flashback Friday: Eliminating 90% of Heart Disease Risk
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Preventing and treating chronic diseases such as heart disease, diabetes, and stroke with diet and lifestyle changes is not just safer but may be dramatically more effective.

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

Medical myths and dogmas die hard. Researchers creating a new body of knowledge for prevention and control of heart disease had to disprove and displace a bunch of doozies, like we used to think that heart disease was just an inevitable consequence of aging, or that cholesterol and blood pressure just naturally go up as we age. All these are now bygone notions, refuted by massive data.  But other long-standing myths and dogmas about our #1 killer epidemic persist.  For example, this notion that major risk factors, like cholesterol, account for a minority of risk and that many people have heart attacks with no risk factors; so, it’s just kind of a crap shoot – not much you can do about it.

There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. This means, of course, that most persons with atherosclerosis acquire it by what they put in their mouth.

The INTERHEART study showed that for men and women, old and young, and in all areas of the world, 9 potentially modifiable factors like diet, exercise, and smoking, accounted for >90% of the proportion of the risk of having a heart attack. And this has been confirmed in prospective studies.

Follow men over time and those making healthy lifestyle choices are associated with a 90% drop in risk. Same with women, 92% of the risk gone. Same with diabetes—91% of cases could be contributed to bad habits and behaviors. And the same healthy lifestyle, which includes not smoking, eating a healthy diet, exercising, and maintaining an optimal body weight, may reduce the risk of multiple chronic diseases—not just heart disease and diabetes but stroke as well. Up to 80% of strokes avoidable with simple lifestyle changes.

How does this all compare to drugs? Why change our diet, lose weight, and start exercising if we can just pop some pills? Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills typically only reduce cardiovascular disease risk not by 90% but only by 20% to 30%. So, even on drugs, 70 to 80% of heart attacks still occur.

One of the great things about this study, the Harvard Health Professionals Follow-Up, is that they also looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol and blood pressure lowering drugs may be able to get a further 78% drop in risk by eating and living healthfully. So, the choice isn’t diet or drugs. Cardiovascular medications should be used as an adjunct to, not just a replacement for, healthy lifestyle practices.

It takes time for new science to trickle down into mainstream medical practice. The practice of cardiology and medicine in general may correspond, on average, to what was being published 10 or 20 years before. So, it’s important to know if our doctors are still stuck back practicing 20th century medicine.

Please consider volunteering to help out on the site.

Images thanks to KWMoore via flickr.

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

Medical myths and dogmas die hard. Researchers creating a new body of knowledge for prevention and control of heart disease had to disprove and displace a bunch of doozies, like we used to think that heart disease was just an inevitable consequence of aging, or that cholesterol and blood pressure just naturally go up as we age. All these are now bygone notions, refuted by massive data.  But other long-standing myths and dogmas about our #1 killer epidemic persist.  For example, this notion that major risk factors, like cholesterol, account for a minority of risk and that many people have heart attacks with no risk factors; so, it’s just kind of a crap shoot – not much you can do about it.

There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. This means, of course, that most persons with atherosclerosis acquire it by what they put in their mouth.

The INTERHEART study showed that for men and women, old and young, and in all areas of the world, 9 potentially modifiable factors like diet, exercise, and smoking, accounted for >90% of the proportion of the risk of having a heart attack. And this has been confirmed in prospective studies.

Follow men over time and those making healthy lifestyle choices are associated with a 90% drop in risk. Same with women, 92% of the risk gone. Same with diabetes—91% of cases could be contributed to bad habits and behaviors. And the same healthy lifestyle, which includes not smoking, eating a healthy diet, exercising, and maintaining an optimal body weight, may reduce the risk of multiple chronic diseases—not just heart disease and diabetes but stroke as well. Up to 80% of strokes avoidable with simple lifestyle changes.

How does this all compare to drugs? Why change our diet, lose weight, and start exercising if we can just pop some pills? Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills typically only reduce cardiovascular disease risk not by 90% but only by 20% to 30%. So, even on drugs, 70 to 80% of heart attacks still occur.

One of the great things about this study, the Harvard Health Professionals Follow-Up, is that they also looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol and blood pressure lowering drugs may be able to get a further 78% drop in risk by eating and living healthfully. So, the choice isn’t diet or drugs. Cardiovascular medications should be used as an adjunct to, not just a replacement for, healthy lifestyle practices.

It takes time for new science to trickle down into mainstream medical practice. The practice of cardiology and medicine in general may correspond, on average, to what was being published 10 or 20 years before. So, it’s important to know if our doctors are still stuck back practicing 20th century medicine.

Please consider volunteering to help out on the site.

Images thanks to KWMoore via flickr.

Doctor's Note

Chronic disease, then—the leading cause of death and disability—may be a choice. See for example, Cavities & Coronaries: Our Choice. What do you choose?

Why reduce a preventable disease just 90%? How about 99.9%? See One in a Thousand: Ending the Heart Disease Epidemic.

More from the field of lifestyle medicine; check out my previous Flashback Friday video The Best Kept Secret in Medicine. And for a summary on the #1 killer of men and women, check out How Not to Die from Heart Disease.

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

186 responses to “Flashback Friday: Eliminating 90% of Heart Disease Risk

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  1. In a course given to high school students at a local college about health and lifestyle near me , the students were told about the importance of whole foods . However they were provided snacks each study session of the once a week 12 week course , The snacks were chips , cheese , choc ,milk and apple slices .
    For their graduation meal was pizza ,loaded with cheese ,multiple meats , and some veggies . They also had sushi and typical Chinese food .
    What scares me is these 22 high school students now feel educated in the matters of healthy eating .

    1. Well, at least the apple slices and veggies are whole foods…

      Over Thanksgiving, I got into a spirited conversation with my brother, who is board certified medical doctor, about diet and health, over the benefits of eating a balanced diet. To his way of thinking, a balanced diet means the inclusion of animal products in one’s diet. He doesn’t believe that cholesterol has anything to do with heart disease, but he is rail thin because he practices intermittent fasting (IF) which is in itself is probably a healthy practice regardless of what foods are consumed. (TBD) waiting one Dr. Greger’s videos on IF.

      The funny thing is that when one looks into his larder and freezer, it is chocked full of processed convenience foods which probably says more about his wife’s preferences than my bother’s beliefs, but the fact remains that most people perceive that a whole foods plant based (WFPB), a.k.a vegan, diet is inferior to one which contains animal products because it is restricting a whole category of foods, and is therefore inferior and less balanced than one which includes them.

      That’s the message we get from childhood. Eat a balanced diet.
      I, for one, am seriously deficient in gummy bears, snack cakes, cheese and beef steak.

        1. There are a lot of doctors doing the Intermittent Fasting and cholesterol doesn’t matter concept.

          Intermittent Fasting has some good and bad data. There are studies where they have caused Diabetes with alternating day intermittent fasting.

          Fasting is interesting to me as a topic now though because it got rid of my dog’s infections and I ended up with a whole new dog after 2 weeks of water fasting, but I understand that the part I don’t know yet will be if there are drawbacks. That question will come over the next few weeks and months.

          1. Hi Deb – 27 Week,
            He’s doing something like the Fast Five diet where you delay eating your first meal until later in the day, and then eat ad libitum over a five hour period which pretty much means you eat one large meal, around 1300-1600 calories and then fast for 19 hours. I’ve tried it before, and I felt really good on the diet.

            The reason that I gave it up was that I found myself eating less fruit because it’s so bulky that I had difficulties making it to the next feeding period if I ate a significant quantity of fruit. I thought that this was a mistake because fruit is so healthy so I now eat two meals a day. My first meal of the day is a fruit meal and the second is a savory meal.

            The TrueNorth Health Center has used water fasting to help people overcome some chronic health condition such as diabetes so I find it interesting that there are studies showing alternate day fasting actually causing diabetes.

            Would you be able to share those studies with the community?

              1. I felt horrible doing intermittent fasting… Everything was timed and overly calculated and needlessly stressful, then in order to get enough nutrition in I’d have to overeat when I was allowed to eat within the certain time frame I could eat, by the time I could have my next meal (I ate twice), I didn’t even want to eat cause I wasn’t hungry. Then, I’d get really hungry that night but couldn’t eat. I didn’t notice any specific health benefits and it seemed like I was overwhelming my digestive tract eating that much at once. I feel much butter just listening to my body and eating when I’m hungry. I like to not eat past 8 just because I like to have that period of fasting a few hours before bed and just drink tea or whatever, but I don’t freak out about it if I do.

                Looking forward to the videos on fasting, here. If there’s anything extraordinary about fasting with no or minimal risk for like a 1-3 day fast, I’d be willing to try it. If not, I’m good. I hated the way I felt fasting 24 hours (and a little more), not necessarily over the hunger but just my mood, fogginess, and head achey. But if anything amazing happened on a day or few day fast I’d deal with it and try it out.

                1. In my case, after many years of no eating between my 3 squares a day, I figure if it ain’t broke, don’t fix it. I’ve no health complaints whatsoever, so don’t think I need any major detoxing job at this time. When I do, am sure the ol’ bod will let me know.

                  I’m always finished with an evening meal by 6:45 PM, and don’t have anything to eat again until around 8 a.m. Not a bad “window,” am thinking. I went a couple of days with no food back in the day, but have no interest in taking it up again, just for sport. Not unless push comes to shove for some reason.

                  I’ve noticed that many of the all-meat eating carnie advocates are into occasional fasting. Yeah well, maybe they have stuff to clean out all right. :-)

          1. A ‘fat free diet’ tells us nothing about what you were actually eating Processed foods are often advertised as fat free yet are full of unhealthy ingredients like added sugars and refined carbohydrates.

            Fats are just one part of the equation; Many things can raise your cholesterol levels from weight gain and drinking coffee to smoking and failing to exercise, High added sugar levels in no-fat and low-fat foods and drinks can also raise cholesterol eg

            “Recently, Stanhope and colleagues showed that consuming beverages containing 10%, 17.5%, or 25% of energy requirements from HFCS produced significant linear dose-response increases in postprandial triglycerides, fasting LDL cholesterol and 24-hour mean uric acid concentrations in a 2-week parallel-arm, nonrandomized double blinded intervention study (11). Raben et al. found that a sucrose-rich diet consumed for 10 weeks resulted in significant elevations of postprandial glycemia, insulinemia, and lipidemia ”
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592517/

            High consumption of trans fats and saturated fats will increase your risk of early death And probably cancer heart disease and diabetes That is how fat-free diets are good for you. Eating foods that are just as bad as or worse than trans fats and saturated fats won’t iprove your health. However replacing the calories from those fats with calories from healthy foods like vegetables fruits and whole grains will benefit your health. Stopping taking arsenic won’t protect you from being poisoned if you start taking strychnine instead and that’s the problem with most no-fat and low-fat diets. they just substiture one set of toxic ingredients for another.

          2. Well, considering we need essential fatty acids and some amount of fat with certain foods to absorb fat soluble nutrients, a completely (not accounting for trace amounts in lettuce and such) fat free diet is NOT good for you and is deficient. Dr. Greger recommends nuts and seeds for a reason. There’s other healthy whole food sources of fat as well, obviously avocados come to mind.

        1. That’s great to hear! I also know he’ll be coming out with a series of fasting videos here. He said in one youtube interview that it won’t be before March of this coming year, if I’m remembering correctly. So I’m hoping they come out in March, lol.

      1. Joe Caner, I could never practice intermittent fasting; I think I am somewhat hypoglycemic. I have to eat fairly soon after getting up in the morning, and if I go too long without food, I get dizzy, sweaty, and feel faint. So I basically eat throughout the day, small portions. 3 regular meals, just spread out. I could never do fasting blood tests — and I’m thrilled that the evidence now suggests that these are not necessary, and that in fact blood tests from your life of normal eating may be more informative.

        But your description of your brother’s larder as “chock full of processed convenience foods” reminds me of a co-worker who once told me that I probably thought she was healthy because she was thin — but that I would be wrong, because she ate a high proportion of junk food and rarely exercised or exerted herself. I didn’t doubt her assessment. Slender people can be unhealthy.

        1. Dr. J, If that’s the way IF made me feel, I wouldn’t do it either.
          You’re right. Diabetics test their blood glucose levels all the time in a non fasting state, and thin does not necessarily mean that one is healthy.
          I’m concerned for my brother health and that he is thickening his vascular system with plaques.

      2. Strictly speaking the advice to eat a balanced diet is absolutely correct.

        An entirely vegetarian diet is deficient in B12 and possibly (if not planned well) other nutients like iodine, zinc, selenium etc It may not be as true now as in centuries gone past because we now have a range of fortified foods available However let us remember that Dr Greger counsels us to take B12, DHA/EPA etc suppleents if we eat an entirely vegetraian WFPB diet

        So I don’t see that the concept of ‘a balanced diet’ is wrong The real question is what should be the actual balance of nutrients in this balanced diet? In a whole food plant based diet like the traditional Okinawan Diet animal foods provided about 3% of total calories I would argue that the optimal balanced diet is the WFPB diet And that today this optimal balanced diet – unlike in previous centuries – can be completely vegetarian because of the widespread availability of of fortified foods and suppleents.

        Perhaps you could refer your brother to the US dietary guidelines which state, regarding the Healthy Vegetarian Eating Pattern, that vegetarian (including so-called vegan) diets can be healthful if well-planned (the Academy of Nutrition and Dietetics has been saying the same thing for years of course) This is scientific orthodoxy ….

        “This Pattern can be vegan if all dairy choices are comprised of fortified soy beverages (soymilk) or other plant-based dairy substitutes. Note that vegetarian adaptations of the USDA Food Patterns were included in the 2010 Dietary Guidelines. However, those adaptations did not modify the underlying structure of the Patterns, but substituted the same amounts of plant foods for animal foods in each food group. In contrast, the current Healthy Vegetarian Pattern includes changes in food group composition and amounts, based on assessing the food choices of vegetarians. The Pattern is similar in meeting nutrient standards to the Healthy U.S.-Style Pattern, but somewhat higher in calcium and fiber and lower in vitamin D due to differences in the foods included.

        To follow this Pattern, identify the appropriate calorie level, choose a variety of foods in each group and subgroup over time in recommended amounts, and limit choices that are not in nutrient-dense forms so that the overall calorie limit is not exceeded.”
        https://health.gov/dietaryguidelines/2015/guidelines/appendix-5/

        1. Agreed Mr Fumblefingers.
          A balanced diet is important regardless of what dietary pattern one follows. A WFPB diet can be a balanced diet, and if one is avoiding animal foods, one must take their B12 supplements, and pay special attention to ensure that they are getting adequate zinc, iodine, selenium and vitamin E.

          What convinced me that a WFPB diet was superior was the work of doctors Caldwell Esselstyn and Dean Ornish. Any diet that can reverse coronary vascular disease (CVD) is the diet that I want to be eating. It’s worth the vigilance required to ensure one is getting these micronutrients for the payoff of clearing out one’s vascular system, and a oil free, WFPB diet is the only diet that has been clinically proven to provide those benefits.

          That’s good enough for me.

        2. Mr. Fumblefingers, I tend to avoid processed foods. I thought that was what is meant by whole foods: Unprocessed foods. And fortified foods are processed foods.

          For example, I make my own soy milk — to avoid all those additives of most commercial soy milks — which I also don’t filter, so I can eat the whole soybean. I use commercial soy milk, made from water and soy beans only, to make soy yogurt (my home made doesn’t work well for yogurt, though it’s great on cereal and in baking) — to avoid all those additives of commercial soy yogurts.

          I do take a vitamin B12 supplement, as well as vitamin D one, but I don’t know if my diet is “well planned.” I try to eat a variety of foods, loosely following Dr. Greger’s daily dozen, eating a “rainbow” of produce, etc. Veggies and fruit, beans and whole grains, nuts and sees in moderation. Every day. And I don’t worry about deficiencies. I’d be more worried if I ate processed fortified foods — because I would guess that these are missing a lot more nutrients than the few added back as “fortifications.”

          Plus, all this “planning” sounds like too much work– it’s very off-putting to me. Similar to calorie counting, which I could never do. Now, menu planning, choosing nutritious recipes, making delicious dishes: much more up my alley. I LOVE my food.

          1. Dr J

            That sounds very reasonable and I must admit that I try to do the same thing although cooking bores e and y wife becoes offended if I even try. nevertheless, living in the Philippines there is a limited availability of access to eg nuts seeds and berries. And things like tempeh, soy beans and even tofu are like hens’ teeth. They can be found with some effort (although I have never come across tempeh or soy beans) but the prices are astronomical and I stick with peanuts grapes and kidney/white/mung beans I take a vegetarian multi to try to cover some possible resulting dietary weaknesses. I know that my diet is not optimal because I occasionally get cold sores – say once a year or so – suggesting a lysine deficiency.

            As for the planning well that’s advice that the US Dietary Guidelines and AND offer It sounds sensible to me even though I don’t follow it myself. However, I might now try signing up for cronometer since my chance of finding a good plant-based dietitian here in the Philippines is probably vanishingly small. It sounds like a good Xmas present to myself. In your case, you have no concerns about possible iodine or selenium deficiencies?

              1. My laptop keyboard has a similar illness!! I lose n, m, j, and other letters (I copy and paste — very laborious!), but then, suddenly, there are a machine gun of mmmmm…

                Living in the Phillipines sounds very exotic. The food must be very different there.

                I’ve never worried about iodine or selenium. I probably get too much iodine, since I nibble on kelp. I also use sea salt when baking bread (whole grain sourdough — I grind my own grains). As for selenium, I cut Brazil nuts into little pieces and add them to my mixed nuts, I eat oatmeal several times a week, sunflower seeds almost daily, lots of beans, etc. I try to eat organic food whenever possible. I cook from home — oh, and my favorite kitchen appliance is my electric pressure cooker (mine is an Instant Pot), which I’ve had now for a year and a half. It’s changed the way I eat! Many more beans and whole grains. Soups, stews, veggies, all so easy to cook! And fast.

                1. ps: actually, I nibble on dulse not kelp. (I got my seaweeds all mixed up.) Kelp is also kombu, which some cooks recommend using when cooking beans — but having tried it, I prefer the flavor of cooking beans with bay leaves instead. I also have nori and wakame in the cupboard…I should figure out how to prepare them to eat.

  2. Hello gr Greger! Need your advice. My son have not been growing for a very long time (only 163cm, 15 years old). Growth zones are open. IGF-1 levels are low, but in normal range (270). Is it possible to fix that without using synthetic HGH?

      1. Lucy, hopefully one of the volunteers (Dr. G. is way too busy, one ‘spects) will show up to answer your question. Or at least try to.

        Maybe you could give a little more info about him. Like, what HAS he been eating all these years? How old was he when you first started to notice he seemed to stop growing? If he seems happy and has no complaints, maybe you don’t need to “fix it.” He might have inherited some genes from not-very-tall ancestors. You say he’s 15. Has his voice, etc. changed yet?

        One must also assume you’ve had him checked out by various med doctors.

      1. Not sure if it would help, but muscle tissue produces its own IGF-1 in response to strength training.

        Looked it up and Dr. Fuhrman gave this recommendation for people trying to build muscle:

        “I recommend high-protein plant foods such as sunflower seeds, hemp seeds and Mediterranean pine nuts. These same foods can be incorporated into post-workout meals, along with generous amounts of green vegetables, beans and intact whole grains (such as oats, quinoa and wild rice) that are rich in micronutrients as well as protein. If you wish to use plant protein powders, hemp, pea, and pumpkin proteins are better choices than soy protein, since their amino acid profiles are not as close to that of animal protein.”

  3. Dr. Thomas Levy, MD (cardiologist for over 30 years) wrote a book entitled Stop America’s #1 Killer. This book references 650 studies published in peer-reviewed medical / science journals which prove that atherosclerosis (plaque in arteries) is caused by multiple, nutritional deficiencies. On Page 253 Dr. Levy states, “The following supplement regimen is recommended for optimizing the ability of the artery to regenerate itself and reverse any existing atherosclerosis. The typical diet does not even come close to supplying enough of these essential vitamins, minerals and nutrients.” As a person with a family history of heart disease, I have been taking these nutrients for 10 years. At 64 years of age my arteries are “clean a whistle” (quote from my doctor). I am on a mission to spread the good news. Email me (rayellis@reagan.com) and I will send you Dr. Levy’s list of nutrients and their proper, daily doses.

    1. Ray Ellis, how strange; I see that you have posted this same comment under at least one other video here at NutritionFacts.org as well as at multiple other health-related sites. Do these dates sound familiar: May 30, 2017; Feb 13, 2018; Mar 1, 2018; Apr 25, 2018. I just did a google search: “”Stop America’s #1 Killer” Thomas Levy Ray Ellis” — check it out. A lot more entries for this comment. What is your schtick, Ray Ellis?

      1. Dr J, I thought commercial enterprises were not allowed to post on here which was a nice distinguishing feature of this site. Ray here has posted numerous times, always soliciting.

          1. Just now read Dr. J’s comment: “I just did a google search: “”Stop America’s #1 Killer” Thomas Levy Ray Ellis” — check it out. A lot more entries for this comment. What is your schtick, Ray Ellis?”

            – – – —

            So, Thomas Levy Ray Ellis are one and the same?

    2. Dr Atkins was also a cardiologist of any years experience He too wrote books about diet pushing his own pseudoscientific claims on the subject

      He was also dead wrong but made a fortune selling books, various ‘nutritional’ products and diet plans Dr Levy though appears to limit himself to selling books that would not be described, I think, as sober, responsible and balanced assessents of the evidence.

      He has not only written the book referenced by ‘Ray Ellis’ above he has written books ‘proving’ that
      1 oral infections are responsible for most chronic diseases
      2 root canal treatments cause most chronic diseases
      3 regular intake of calcium and dairy causes all known chronic diseases
      4 high levels of vitamin C prevent and reverse ost chronic diseases and can reverse toxin and radiation damage

      Caveat emptor

  4. Not a huge fan of these Flashback Fridays.

    Can’t people just go back and watch the old videos? New material comes out slowly enough on this site as it is.

    1. Hello Glennis. The reason is this site is operated by a lot of volunteers. These people do this not out of personal interest but out of their wish to help others, and it may be in their free time that they find time to update the site.

    2. Thank you mjglennis for your comment. Sometime we need to go back to old material and re read them and because our own perception has changed we get to see and understand the old information in a different way and opens up new understanding even new questions and answers will come up. That is how I look at it and that helps me learn. I hope that is useful.

      1. mjglennis,

        I understand your point, but I also understand that some of us who are relative newbies wander onto a site like this knowing absolutely nothing and the “meat” of the site is buried down deep within most of the topics. (Yes, I still haven’t found another word than “meat” and I know that it is the totally wrong word, but it culturally is what people say.)

  5. How do people respond to being told they have bad habits? Don’t people identify themselves with their habits? If so, then it would mean that in order to save themselves, they would have to become someone else. But the ideological landscape of diets keeps growing, which adds uncertainty. It seems that new self made dieticians find an economical niche in which to survive and gain popularity and novelty. Butter is back and eggs are good again. All it takes is to make a story convincing and milk cash of the novelty. This is perhaps a negative aspect of the digital democratization of information, where bad is the same as good as long as it has a good presentation.

    1. Panchito,

      You have a point about this:

      “This is perhaps a negative aspect of the digital democratization of information, where bad is the same as good as long as it has a good presentation.”

      But my Keto friends would say the exact same thing and feel like everybody is picking on butter because they don’t know any better and their biggest fear would be that people like you would control the information.

      Just saying.

      I am the only one of the groups of my high school or college friends or family members or church friends or co-workers who believe that this sounded like the best logic.

      1. You are wrong I am right. That is what everybody says. However, if you show how people gets hooked on adopting an opinion, then they lower the defenses and may pop out. Or you can just wait for the long term effects but they may get quiet and not come out.

        1. You are right that when people lower their defenses, that is when they are apt to listen and to even change, but I find that only happens when people are humble enough and actually care and stop trying to win through manipulation and stop acting better than them. Pride is the biggest enemy to the process, I think. I say that from experience.

          Listening is the absolute quickest way to get people to change.

          1. They used to talk about how people find the people who listen to them the most fascinating and I have found that to be true. Maybe because it is so rare that it becomes fascinating to experience it at all.

            I watched an interview between someone and Dr. Barnard and he is so disciplined at being a good listener that the entire video became fascinating because the interviewer was looking at his cell phone and scrolling through whatever was on it and he didn’t look at Dr. Barnard even once and Dr. Barnard stayed totally present and didn’t break eye-contact with someone who wasn’t looking at him, but if that man ever stopped scrolling and looked up, he would have met eyes with someone who was listening to him and he was not returning the favor at all and that became so obvious the whole interview.

          2. Well, if they are holding the keto flag and they see you coming with the WPF flag, then they become defensive. It is about tribalism and you are a rival. When religions started, their numbers branched many times. Diets are not religions but they may branch even more.

            Why did people resisted Copernicus? Aside from religion, it takes a lot of effort to re schematize the internal connections and confront uncertainty but little effort to go along with the past and resist.

            1. Panchito,

              You are right about diets and religions.

              The USA has a lot of states which started with church splits, and even beyond religion, the same thing happened in government.

              I look at the modern political climate and reactionary is the biggest description which I can think of.

              Back to diet, have you watched a debate between any of your favorite WFPB doctors?

              I have and they have plenty of things they disagree on.

              In Dr Gregers audience, WFPB and Vegan followers are often not going to see eye to eye.

              There have been a lot of clashes in these boards.
              I still miss Ron. He would be chiming in.

              Panchito, I appreciate that you think deeply about these things.

                1. YR,

                  Wondering how old you are? That isn’t a sarcastic remark, I genuinely wonder.

                  A few of my workers have your type of sense of humor and I have been wondering if it is generational or cultural.

                  1. They are contemporaries and have the same look stylistically even, so it might be culture.

                    Do you have a culture you would call yourself?

                    1. Nor was I being sarcastic when I said I hoped you found a new buddy. Do I belong to a “culture?” Not even sure what you mean by that.

                      But truly, you’re always saying how much you miss NM Ron. And I’m sincere when I say I hope you find somebody to take his place. Are you of the culture that has suspicions about everybody?

                    2. YR,

                      I am not suspicious of you. I genuinely have a few people with the same sense of humor you have. I was just curious.

                    3. YR,

                      I am not needing people here really. I miss Ron’s passion and his love of the topic. I learned a lot from interacting with him. I like it that there have been deeper discussions.

              1. But Deb, what flag are you waving these days? You talk about listening to people to ‘get them to change”, but change to what? wfpb? I thought you said you were backing away from fruit and veggies these days? It’s none of my business, and maybe that’s closer to my point… but I honestly think just leading by example, even at tough family/friends holiday occasions is the best thing to do.
                Who cares what docs are saying what if we are munching on chips in the sidelines? What if we just dropped all the labels and ate as well as we can ?

                1. Barb,

                  The people around me have cancer and diabetes and heart problems and are on dialysis and have back problems and thyroid problems and I don’t have any of it anymore. I am not WFPB because I, like them, were raised without eating fruits or vegetables and never developed a taste for them, but getting off the animal products and oils really have gotten rid of my diabetes symptoms and my cancer symptoms and my thyroid problem symptoms and my skin issues. I don’t lecture them at all or even talk about it unless they bring things up. I just visit them at the hospital and take their phone calls, but they are strong Keto and I do think I may lose my whole family and my friends and my coworkers and I don’t know if you are in that type of a situation or not. I have been having relatives die in their 90’s and 60’s and at 50 and at 40 and have stood in funeral lines where 20 year olds have lost their mothers or father. Two of my relatives who died had 5 children. I do not lecture any of them and I do not argue with them. Not one sentence. I tear up.

                  1. My cousin got admitted to the hospital again tonight.

                    Every few weeks for him and my best friend.

                    My brother’s cat scan was denied by insurance for some odd reason.

                    But my elderly worker doesn’t really have blood clots and he got 3 hugs today.

                  2. Deb, you bring to mind so many things for me with your posts! Just want to emphasize, I am not critical.. in fact, you inspire me! And I am so glad you have reaped benefit from the changes you have made and you feel so much better.. that’s more important than anything else!
                    On another note, I am involved in community projects, and in food distribution. I spent some time reading labels, and ended up so disgusted with north american food companies for what they are selling. One major soup company puts sugar in their vegetable soup. Sugar in beans of course.. 23 grams per cup of maple baked beans !! It’s almost inescapable.. do you know they add sugar to canned peas and carrots ? why would they do that? And this is going to folks who are depending on our judgement :(

                    1. Barb,

                      Yes, they add sugar and salt for the American clients trying to get them to eat them.

                      I buy boxed beans or dry.

                      I eat a lot of beans and lentils for dinner. I eat oatmeal with flaxseeds and chia for breakfast.

                      Lunch is where I often have transition foods.

                      Honestly, I think I am more like Dr. Barnard at that point where he just got rid of oil and animal products and white and wheat flour and sugar I pretty much don’t do any of those.

                      But I am not WFPB and if I was, it would probably be adding in a sweet potato for lunch or something to cook in the microwave at work.

                    2. I have been earning the right to speak. It has taken over a year to have that happen.

                      What is also happening is that my relationships with the people are getting warmer and more affectionate and they are sharing things like when they don’t think they can change their diets at all and I am just trying to learn to be sensitive to people and it has helped.

                      My co-worker is highly anti-starch and grain, but we came together on oil and dairy and it was a bonding moment again and we are taking the workers out for dinner and it gets to be a place which is accommodating for vegan and things for other dietary types. Honestly, I love my workers. I love the Starbucks workers and grocery store workers, too, and one of the Starbucks workers said it to me. I got a free green tea latte and the words “I love you” at a Starbucks visit this week and no, it isn’t a romantic sentence to me right now. I just am overcome with emotion for all of them.

                    3. Barb,

                      I don’t wave any flag. What I know is that I used to be an insensitive person about things. People’s lives are at stake and any hint of lecturing or flag waving pushes them farther away from Vegan and WFPB. They hated vegans long before I almost became one, because vegans look down on people. That is not me saying it. That is what they feel like when interacting with the culture. They have their own doctors who are so dear to them and online, Dr. Berg and Dr. Fung and Dr. Longo and Dr. Seyfried and Dr. Amen and Dr. Bredesen all are greatly loved and they are more Keto oriented. I am enjoying watching their videos and going back and forth between their videos and Dr. Greger and McDougall and Barnard and Fuhrman and T. Colin Campbell and Esselstyn.

                      I couldn’t go Keto even if I wanted to, but I am learning science at a much greater level by watching things from both perspectives and I can help the people around me do Keto in a safer way if they are trying to use it for treating Cancer.

                  3. Deb, what you mentioned resonated with me. Mom died of a host of things a couple months ago: cancer, diabetes, obesity, stroke to name a few. Her brothers/sisters (my aunts/uncles), my younger brother, cousins, have similar health problems due to mainly what they put in their mouths, high cholesterol, fatty foods, meat, processed foods, dairy, butter, etc, all the “traditional southern” dishes. Grandma died of cancer. But I did notice that my great grandparents were different. They ate lard, meat, but they also ate a lot of vegetables, fruit, roots, and they grew everything on their farms- nothing processed. They didn’t sit around watching TV, they worked hard on the farm everyday. They lived healthily up into their 90’s. They were thin and in good shape and no disabilities. I have been working on making some lifestyle changes, but it has been difficult getting off the animal products like meat, although I’m trying. I work in the healthcare field and see a lot of illness and disease that could possibly be lessened like obesity, chronic inflammation, diabetes, heart disease, stroke. All these diseases seem to feed off one another. When mom died it hit me hard that I need to make a lifestyle change due to the way I saw her suffer over the last few months of her life. I think walking and walk speaks louder than anything we could ever say to help people change and that is my aim, not only for myself but to set a good example for my family and others I care about.

              1. There is a fundamental context. Meat eaters were raised on a context where meat is normal. They assume it is supposed to be like that since that is how they were raised and possible survival knowledge (from brain imprinting). But a converted vegan has to break the social food imprinting.

    2. Panchito,

      Agree with your comment. May I suggest an interesting group that has “cracked” the negative approach and is moving in the right direction to give people a much different approach to diet and all the hype ? Their firm is called Oasis of Change…..(www.oasisofchange.com)

      I’ve watched this couple “do their thing” a number of times and found their approach to be both novel, engaging and fun…..and yes delicious. Their recent work with children is both commendable and perhaps a new paradigm to teach kids food skills and not the dogma of big Ag or the limits of a recipe.

      I understand that they will be offering digital content shortly and expanding their message based on free form cooking, using WFPB ingredients in novel ways to maximize good nutrition. Should be both entertaining and tasty.

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

  6. Off topic, I was trying to understand the benefit of short-term water fasting on removing the T-cells which protect cancer. Longo said that it can happen in as few as 2 days and that it is related to the enzyme, heme oxygenase or HO-1, inside the T cells mitochondria.

    Here are the sentences:

    “In the mouse study, scientists saw another significant effect of the diet: the “T regulatory” cells which protect the cancer cells were expelled. The scientists traced this effect to a weakened enzyme, heme oxygenase or HO-1, inside the T regulatory cells’ mitochondria.

    Prior research has indicated that HO-1 levels are often elevated in tumors and is linked to several cancers.

    “While it’s more of a mechanism to keep the T cells away, in some ways the heme oxygenase tricks the immune system into thinking that the bad cells should not be killed,” Longo said. “By removing heme oxygenase, these T regulatory cells are also taken from the site of the cancer.”

    It caused me to look up heme iron on this site again and I got confused.

    I will put these two sentences:

    “Heme iron from animal foods, however, is readily absorbed and not well regulated by the body. Once ingested and absorbed, the body has no mechanism to remove excess iron.”

    Oh, I already think I understand it better.

    “A whole food plant-based diet may naturally control iron in the body. Phytates found in plants are a powerful natural inhibitor of the iron-associated production of hydroxyl free radicals. Dietary phytates found in plant foods (particularly beans, legumes and whole grains) appear to inactivate iron in a process called iron chelation.”

    Are the T-cells protecting the cancer cells somehow because of heme iron? Is that why the enzymes are elevated? If so, then, how do they know that it isn’t related to IGF-1 rather than the enzyme? (Since both come from animal products.)

    “Specifically, heme iron has been linked to metabolic syndrome, coronary heart disease, atherosclerosis, stroke, type 2 diabetes, Alzheimer’s disease, Parkinson’s disease, arthritis, cancer and other serious medical conditions.”

  7. So is it:

    Eating animal products increases heme and heme increases heme oxygenase and that tricks the immune system into protecting Cancer.

    Can you just not eat foods with heme iron and get the same effect as water fasting?

    What mechanism does it use to trick the immune system and why would it do that?

    Is it more afraid of iron than Cancer or something?

    1. The animal products would already contribute the IGF-1 and Methionine and would use up the enzymes for digesting the fibrin to digest the animal proteins.

      It is too far ovER my head and my cell phone is random caps now. ER is a fascinating caps choice the day my cousin went to the ER.

      1. I found that Heme oxygenase is linked to Heme, but also to things like heavy metals and inflammatory cytokines. So, if we want our immune systems to fight the cancer in our bodies, we should stay away from animal products for Heme and because they are a source of heavy metals and inflammation.

        “One such stress-response protein is heme oxygenase-1, HO-1. Since the identification of HO-1 in 1968, many of the studies involving this enzyme were understandably focused on the regulation and function of HO-1 in heme metabolism. This emphasis is self-evident as HO-1 catalyzes the first and rate-limiting step in heme degradation. Interestingly, however, evidence accumulated over the past 25 years demonstrates that HO-1 is induced not only by the substrate heme but also by a variety of non-heme inducers such as heavy metals, endotoxin, heat shock, inflammatory cytokines, and prostaglandins. The chemical diversity of HO-1 inducers led to the speculation that HO-1, besides its role in heme degradation, may also play a vital function in maintaining cellular homeostasis. Further support for this hypothesis was provided by Tyrrell and colleagues who showed in 1989 that HO-1 is also highly induced by a variety of agents causing oxidative stress. Subsequently, many investigators have focused their attention on the function and regulation of HO-1 in various in vitro and in vivo models of oxidant-mediated cellular and tissue injury. The magnitude of HO-1 induction after oxidative stress and the wide distribution of this enzyme in systemic tissues coupled with the intriguing biological activities of the catalytic byproducts, carbon monoxide, iron, and bilirubin, makes HO-1 a highly attractive and interesting candidate stress-response protein which may play key role(s) in mediating protection against oxidant-mediated lung injury.”

  8. Hi
    I just watched Dr.G’s video on Nettle tea & Rooibos,when its difficult for me to get greens in my diet I use nettle powder,is this really dangerous or do the people who grow/pick them have to be careful so as not to poison their customers?
    I’m wondering what’s the risk of continuing buying & consuming this product.
    Also should one avoid drinking Rooibos tea with meals because it reduces iron absorption or is this just with green/black tea?
    Does Rooibos tea have the equivalent of “caffeine” found in green tea?
    Thanks!

    1. Rooibos is caffeine free. It also does not contain tannins Tannins one of the nutrients that are believed to inhibit iron absorption (but only one) That said, drinking Rooibos tea appears to slightly inhibit iron absorption
      https://www.ncbi.nlm.nih.gov/pubmed/462276

      Coffee and tea both significantly inhibit iron absorption from food but on the oher hand vitamin C (found in fruits and vegetabls) increases iron absorption so I persoanlly don’t worry about it If you are concerned about this type of thing you should be aware that calcium in foods also inhibits iron absorption.

      I don’t know how reliable this site below is but it appears to contain a useful overview of what is currently known:
      http://www.irondisorders.org/diet

    2. “Mr Fumblefingers” gave you some good information on tea (below) but I thought I’d also suggest you check out the following:
      https://nutritionfacts.org/2013/09/05/latest-science-on-rooibos-nettle-tea/ which states “Nettle tea is safe as long as you 1) don’t drink too much, 2) don’t mistake it for deadly nightshade if you forage it, and 3) don’t put the leaves in your mouth fresh–they don’t call them stinging nettles for nothing! ”
      This should give you some reassurance when enjoying your Nettle tea.

  9. I firmly believe in the power of lifestyle changes but I had a disappointing experience. In 2010 I attended one of Dr. McDougall’s 10 day live in programs and I was hooked! For the entire year spring 2010-spring 2011 I ate only whole natural plant based meals, without one particle of animal AND with absolutely no added fats. I do not drink hardly at all and do not smoke, and I exercised regularly. During this time I lost almost 55 pounds which I did need to lose. OKAY, so, after the year I had my cholesterol panel drawn. Needless to say I expected great results. Not really. My total was down from over 200 to 185 but was not the 150 I had been led to believe would be mine. Also, LDLs were in low 100s and HDL had dropped to low 50’s. I was stumped and so was my doctor. SO, despite still trying to live a healthy lifestyle, I am now on statins. Sad face.

    1. Statins really?
      Those numbers don’t seem to qualify for the need for statins. I am surprised that your doctor would suggest that and that you would agree.

    2. Anne Sampson, congratulations on changing your lifestyle — and your weight loss.

      Dr. Kim Williams, past president of the American Cardiology Association (who recommends a vegan diet to his patients, and is himself vegan), says that switching to plant based eating (hopefully whole foods as well) will reduce cholesterol levels, but the amount of reduction will vary from person to person: “It seems that the response to dietary cholesterol and other changes in diet are all genetically determined and quite variable,” he said. “One person might go from 170 to 150 by going to a plant-based diet. Another person might go from 170 to 90.” (https://well.blogs.nytimes.com/2014/08/06/advice-from-a-vegan-cardiologist/)

      But I agree with Tree of Life, who wonders why you are on statins. Perhaps you are at high risk of cardiovascular disease? Statins do not help most patients. If you are at low risk of CVD, they don’t help any patient: “No statistically significant mortality benefit; 1 in 217 avoided a nonfatal heart attack (myocardial infarction); 1 in 313 avoided a nonfatal stroke;” but they do cause harm: “1 in 21 experienced pain from muscle damage; 1 in 204 developed diabetes mellitus” (http://www.thennt.com/nnt/statins-persons-low-risk-cardiovascular-disease/). However, for patients with known heart disease, they do seem to help some patients who take statins for 5 years: “1 in 83 were helped (life saved); 1 in 39 were helped (preventing non-fatal heart attack); 1 in 125 were helped (preventing stroke);” albeit with some harmed: “1 in 50 were harmed (develop diabetes*); 1 in 10 were harmed (muscle damage)” (http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/).

      Hopefully, your doctor discussed all this with you. It might also take a while. My brother changed his lifestyle, to eating plant based whole foods and exercising, and eventually went off all his meds, including a statin, but I don’t know how long that took, though I think it was longer than a year. I’ll ask him.

      So I hope you are continuing with the healthier lifestyle you adopted several years ago. I wish you all the best!

      1. Anne Sampson, my brother just told me that he slowly lost weight starting 14 years ago, after gradually changing to a vegetarian diet, but that his PCP still prescribed a statin for him. He then switched to vegan (really, plant based whole foods eating) about 3 years ago, after taking a CHIP program (https://www.chiphealth.com), and then he switched to a cardiologist and PCP who both supported plant based diets — and went off his statin about a year after that, after encouraging blood test results.

        Well, that’s anecdotal. And there are some people for whom eating a plant based whole foods diet is not enough to lower cholesterol levels. I think even the title says that about 90% of heart disease could be prevented by lifestyle changes — which means that 10% can’t be prevented by such changes. In which case statins could be life saving.

        But plant based whole foods eating is healthier for all sorts of reasons, so I hope you don’t give it up. Who knows, maybe you’re preventing other conditions. And you are reducing your footprint on our very distressed planet.

        To your continued good health!!

      2. Anne

        I would be very cautious about all these reports of statins causing muscle pain including those on the NNT site The NNT site ignores (and we have to ask why?) studies showing that when patients take a mock statin they experience just as much muscle pain as patients taking real statins This is thought to be the nocebo effect in action – the anti statin crowd are so noisy and so ubiquitous that now virtually everybody ‘knows’ that statins cause muscle pain and therefore any people duly experience such pain Whereas in fact people not taking statins but who think they are experience just as much muscle pain as those who are. .See for example
        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31075-9/fulltext

        In the light of this, I would seriously ask if the NNT people have an agenda regarding statins as opposed to being dispassionate analysts of the data Consequently I am extremely cuatious about their other analyses also The UK governent heavily subsidises approved statin and other prescription drugs It therefore has a strong financial interest in reducing costs by taking such drugs off the approved list. It did a major review a few years ago and found that for approved target groups statins were cost effective – that is the benefits outweighed the side effects. I’d suggest that you read that report before taking any decision about continuing or discontinuing statin use. It is a much more credible source of information than the websites such as NNT

        With all the disinformation flying around about cholesterol and statins, the American Heart Association issued a scientific advisory only a week ago to try to counter these misunderstandings (and in some cases downright false claims). Again it would be helpful to you to read this I think
        https://www.ahajournals.org/doi/10.1161/ATV.0000000000000073

        That said, statins are not without risks. I experienced liver damage following statin use twenty years ago which resolved when I stopped taking statins In a way that was a good thing because it led me to discovering the benefits of a WFPB diet However even with weight loss. exercise, smoking cessation and a healthy diet some people can’t achieve low cholesterol levels for genetic reasons In such circumstances statins may be helpful. But as Dr J says, sometimes it takes more than a year for our endocrine system to adapt to a healthy lifestyle and diet and ‘reset’ itself.

    3. Well Anne Sampson, welcome to the club, and I mean that sincerely. I have written about my frustrations with high cholesterol levels in spite of diet perfection wfpb, for some years on here. I was hoping Dr Greger would address this. Tom (Mr Fumblefingers, a frequent commenter ) often comes up with helpful info about rising cholesterol in the face of declining estrogen levels, or hereditary links etc. I am on statins also, have no choice, and get tested frequently re liver enzymes. Same with my husband. We are NOT only ones eating wfpb who have yet to reach the elusive desired levels. I was told by cardiologist that if we keep ldl under 100mg or close to it, and hs-CrP under 1 we are doing well. Dont let people make you feel bad for doing great, and following doctor’s suggestions. Esselstyn, McDougall, Ornish ALL have patients on statins when they cant get cholesterol low enough. Mine is still too high. My husband’s is better. All the best to you!

        1. no S, since being on here for some years reading the comment section thoroughly when this topic is discussed, I am one of many women who struggle with this. More info can be found at the Heart Association websites. Researched like crazy, did the portfolio diet thing, plus, plus, ad nauseum. Still high. Triglycerides good, HDL was good but declined with wfpb, LDL stll too high. Some women have been wfpb over 10 years, and same result. As a meat eater my cholesterol WAS under 160.

          1. That’s so odd to me. I really do hope you get a response from Dr. Greger on this or someone from his team. But you’ve stuck to WFPB, correct? So it must have been positively impacting your health overall for you to have decided to do so, no?

            1. Also, can you talk about the Portfolio Diet?

              So you were eating 50 grams of nuts and 50 grams of soy and 25 grams of soluble fiber and 2 grams of plant sterols?

              Are you still doing it?

    4. Anne,

      Which B-12 supplememt are you using?

      I looked it up when someone on the McDoufall site asked about it and B-12 being low contributes.

      I will look it up again because there were a few things but pretty sure B-12 was one.

      More than one of us were insufficient supplementing with Merhyl B-12.

      It isn’t shelf stable and degrades with light or heat.

    5. Anne,

      Dr. Greger talks about eating the foods which pull cholesterol out of your system. Things like nuts and soy every day.

      He recommended The Portfolio Diet Dr. David Jenkins for people who are WFPB and genuinely not eating coconut oil or vegan processed foods.

      1. Some of the other ones were avocado.

        And plant foods with B-Vitamins and antioxidants.

        A 2016 study published in the journal Nutrients showed that an antioxidant-rich diet raised HDL levels in relation to triglycerides. High antioxidant foods include dark chocolate, berries, beets, purple cabbage, red grapes, kale, spinach, red bell peppers, and other deeply colored fruits and vegetables.

        Niacin (vitamin B3) is believed to block cholesterol production in the body.

        Seaweed is one of the top vegan sources, but peas and potatoes are next on the list, including sweet potatoes, followed by butternut squash, okra, corn, parsnip, winter squash and pumpkins, all provide between 1 and 4 milligrams of niacin.

        Also, you want enough fats and that is where seeds come in. Flaxseed

        Make sure your homocysteine levels aren’t off. (B-12 and Folate are things you need) Are you on a shelf stable B12? Do you eat enough foods with folate?

          1. Also, dehydration and electrolyte imbalances can affect Cholesterol.

            Dehydration causes cholesterol to increase.

            Look at meds and supplements.

            Potassium pills decrease the absorption of B-12 and that increases Homocysteine and both are related to bad levels of cholesterol.

            1. Remember things like cayenne and garlic and mint and spices like turmeric, ginger, Rosemary and cloves can help by helping with inflammation.

        1. I have to add here that I experienced the same liver damage with Niacin (B3) supplements that I did with statins Supplements can be very powerful drugs even if they don’t require a prescription

            1. Tom,

              I was watching Dr Gregers videos on fish oil not having any benefit at all. Unless I messed it up, there wasn’t benefit from Omega 3 from fish or DHA and EPA,

              What rationale is there for the vegan omega 3?

              I know you are a fish eater related to the mortality studies. Did the people who eat fish once per week getting Diabetes concern you?

              I am not thinking about fish for myself, but my dog likes the fish snacks. He is doing really well. He is totally new dog since the water fast.

              It is easier to get him to eat fish, but I know the PCBs and other heavy metals concern me and if I am understanding heme oxygenase causing the t-cells to protect Cancer heavy metals would cause that to happen.

              But I know my dog looks excellent but he is still miserable about food and still doesn’t want supplements and he needs to keep getting B-12.

              I don’t know what I will decide to do with him, but he is still alive.

              1. “I know you are a fish eater related to the mortality studies. Did the people who eat fish once per week getting Diabetes concern you? ”
                – – – – – –

                Deb, were you addressing that to Fumbles? I don’t think he eats fish, but I think Lonie says he does. Sardines, or something. (?) (I myself have fish once a week or so.)

              2. Deb

                I don’t eat fish but have mentoned previously that if I did eat animal foods it would probably be a couple of small servings of ocean oily fish low on the food chain. Fish can provide B12, selenium, iodine and a number of other nutrients not commonly found in most (completely) vegetarian diets as well as being good sources of DHA/EPA. That may be why in the 7th Day Adventists nortality studies ‘pesco-vegetarians’ had an even lower mortality risk than total vegetarians. Whether it is truly beneficial or not isn’t clear There have been no randomised controlled trials looking at this. Fish may just be ‘less bad’ than meat, eggs, dairy and refined carbohydrates This alone could explain the apparent benefits of fish consumption.

                ‘ Meta-analyses also generally cannot capture the potential effects of food substitution in the diet.65 An individual’s risk of CHD would be substantially lowered if he or she increased seafood consumption to 2 meals per week by substituting seafood for processed meat, but the estimated risk reduction may be substantially less (or not at all) if the 2 seafood meals per week were substituted for healthy vegetarian meals. In a recent analysis of 2 large US cohorts, substitution of 3% of total protein calories in processed meat with 3% of total protein calories from seafood was associated with 31% lower risk of cardiovascular mortality.66 Future individual studies and systematic reviews should consider using substitution models as a more precise method to estimate risks and benefits of seafood consumption in relation to specific alternatives.’
                https://www.ahajournals.org/doi/10.1161/CIR.0000000000000574

                The ain reason for taking vegetarian DHA/EPS is brain health. See
                https://nutritionfacts.org/video/should-vegans-take-dha-to-preserve-brain-function/

                As for the fish and increased diabetes risk issue
                https://nutritionfacts.org/2015/07/23/why-would-eatingthi-fish-increase-diabetes-risk/
                this might be a concern but there could well be confounding factors at work.. Fish is often fried, battered or grilled instead of being poached or steamed Also it is frequently served with chips (fries in American) or creamy fish sauces. These alone could account for increased diabetes risk. Then there are the types of fish eaten Some are more likely to be problematic than others

                I suspect that if you choose your fish wisely, use healthy cooking methods and limit portion sizes and number of portions (per week) there will be little or no increased diabetes risk. Having said that I choose not to eat fish for ethical and environental reasons relying on supplements to provide needed nutrients instead.

                1. Mr. Fumblefingers, do you know if the generic term “seafood” includes sea plant food? I’ve discovered that I like sea kelp! I eat it as a substitute for potato chips (to which I was, sadly, addicted — and they’re vegan…sigh…). Small servings, every so often. I also add kelp flakes to some soups. I’ve never looked into the health benefits of kelp and other seaweed; maybe I will. I wonder if there’s a video about sea plant foods?…

                  1. I think seafood refers to fish and shellfish rather than se plant food

                    Anyway you have naswered y earlier question about whether you were concrned about iodine and selenium deficiencies If you are eating kelp then you won’t have any problems in those regards (although equally excess iodine can cause problems)

                    Dr G has a number of videos on seaweed and sea plants – just enter ‘seaweed’ and ‘kelp’ in the search box above

    6. Cholesterol is regulated by the liver but it also depends on a second mechanism. A diet with some phytosterols (olive oil, flax seeds, walnuts, etc) will mechanically lower LDL levels. If you have a big meal with phytosterols and bitter foods t(ex. over extracted black coffee) to stimulate the liver, then phytosterols will block cholesterol from being reabsorbed in the small intestine. That is how excess cholesterol and toxins and drugs are naturally removed from the body. Fiber (volume) also helps.

  10. DrJ, thanks for that suggestion to be patient for changes. I was in need of that. We often hear anecdotal stories of such dramatic turnarounds that we become impatient for immediate results.

    Lida

    1. Tree of Life, I am always amazed by folks who claim to have quick results in response to changing their lifestyle.

      About 20 years ago, I was vegetarian but overweight (there are a lot of junk vegetarian and vegan foods!); I started practicing portion control and making healthier choices (e.g.: a banana with my morning coffee instead of a pastry! etc), and slowly lost about 25 pounds over 18 months. The same thing happened to my husband: When he started eating my vegetarian cooking after we met almost 11 years ago, he lost about 35 pounds — but also over about 18 months. That would be much too slow for some impatient folks I know, who despair if they don’t quickly lose weight on a “diet.”

      Then, when we both switched to plant based whole foods (after discovering this site), we each lost more weight, much to our surprise: I lost about 5 pounds, and my husband lost about another 15.

      We love our food, and we eat till we’re full. We keep on incorporating small changes: More beans!! More greens! etc. It’s been fun.

          1. I predict you will be right.

            And I predict kids of today will grow up with hunched-over backs and arthritic fingers. All they do is peck away at their little smart-dumb phones. And text, text, text.

  11. Can someone please help! I remember seeing a video here where Dr. Greger explains that indeed high cholesterol IS correlated with heart disease and explains why there became the misconception that it wasn’t. I cannot find this video for the life of me and I really need it. I am surrounded by people who are believing that cholesterol has nothing to do with heart disease and it doesn’t matter or the less extreme among them who believe that “they” really don’t KNOW what cholesterol levels mean. I so need to locate this video to get all the brilliant information because I don’t remember it enough to use. So gain, if anyone can help me locate this video, I will be grateful!!

        1. Thanks, YR. This video is definitely helpful! I’ll save it for reference and will add it to the arsenal.

          The specific one I’m looking for, I remember it addressing how the myth that cholesterol doesn’t matter or how the controversy of does or doesn’t cholesterol matter, got started and why it’s clearly untrue. It was such a brilliant video but I can’t seem to find it.

          1. S & YR, Here are two videos that may be the ones you are looking for. They are both about saturated fat and cholesterol and address the techniques used by unscrupulous researchers to show that it’s OK to eat butter again! The second video explains the details of how these researches can use statistical techniques to get the result they want without falsifying data, thus concluding that there is no correlation between saturated fat and heart disease.

            https://nutritionfacts.org/video/the-saturated-fat-studies-buttering-up-the-public/

            https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/

            Hope this helps.

            1. Thanks so much WFPB-Hal! I’m extremely tired right now so I just quickly browsed through the transcript and need to watch tomorrow, but I believe the second video may have been the one I was thinking of! I’ll watch them both tomorrow.

              1. Thanks so much Tom! Will check them out tomorrow. Sometimes a highlighted point will be mixed in a video off topic and it can be hard to find later, I need to make it a better habit to save links when I know I’m going to need to reference it. I’ll go through the videos tomorrow. I’m sure what I’m remembering is in there somewhere along with lots of other valuable information. And thanks for the link to PlantPositive. I probably just need to take notes on this stuff so I’m ready when these people start talking about cholesterol not mattering.

              1. Tom, Deb, and Hal, thanks so much for all your help! This info is brilliant. It’s hard to decipher at this point which one was THE one I was thinking of because a couple of them could have had the point in it that struck me a year or so ago because really they all have brilliant info pertaining to cholesterol and falsified studies/false claims. And I love the extra links, Tom. Very helpful. I think what I’m going to do is watch and read all these again and take notes and basically just create a little personalized presentation for those mentally exhausting moments I’m confronted with “turns out, cholesterol doesn’t even matter!” I will be properly prepared next time and will actually make it a point to show some of the people I care about who have been convinced by the notion that “‘they’ don’t really know if cholesterol matters.”

  12. Searching on YouTube i get other theories for atherosclerosis. A few have to do with the liver no longer recognising the lipoproteins. Glycation of cholesterol lipoproteins makes them unrecognisable by the liver. This can happen if there’s too much blood sugar in the bloodstream? They don’t get recycled but float around the bloodstream and stick to arterial walls. Macrophages come to clean them up and in the process plaques from on the walls. Endotoxins from dead gut microflora leak into the bloodstream and have a similar effect. Free radicals can oxidise the cholesterol lipoproteins. Small dense lipoproteins are the ones responsible for forming plaques and not being recycled by the liver.

    Another thing i came across is something related to the LDL receptor sites in the liver and the importance of having enough to recycle or clear the used up cholesterol in the blood. Some factors are responsible for their number.

    Atherosclerosis depends on factors that oxidise cholesterol. High circulating blood sugar, chronic gut inflammation, metabolism and liver function all play a role in plaque formation. How much circulating LDL cholesterol does a human need to supply the cholesterol required for cells that won’t make their own cholesterol? How does the overall health of a human affect their cholesterol requirements? I’m speculating that sick, elderly, inflamed, stressed people would have more requirements for repair than healthy people and so would require more blood cholesterol.

    Which factors are most responsible for atherosclerosis? Probably insulin resistance or hyperinsulinemia. I think a whole food plant based diet with no more than about 350-500kJ of animal protein for an average person’s 8700kJ daily energy requirement would be desirable. It’s not vegan but it’s really low in animal foods. Allicin (in allium family, garlic, onions, etc) and DMB (found in balsamic vinegar, red wine, evoos and grape seed oils) can inhibit TMAO production. Yeah vegan with supplements is best but omega-3 supplements are unregulated and have got things like aldehydes in them. Iodised salt is not as good as fish, and seaweed and soy just seem wrong, like they’re not foods meant to be eaten by humans. I wonder if long chain omega-3s are absolutely necessary in the diet anyway. Agriculture could be more thoughtful about growing produce with enough minerals so that we don’t need to think about minerals like iodine.

  13. Deb,
    It gives me a headache wading through all the posts so I hope you find this even though it’s out of order. Re the portfolio diet: What we have to remember is that diets like the Portfolio and the Dash diet were not designed with peeps like us in mind. David Jenkins had said that no one put these foods together before.. well, yes they did. Just not on the McDonald’s menu maybe! Dr Greger’s Daily Dozen is a big step up from either diet. If I ate the Dash diet now, my blood pressure would go up!
    Things I could not tolerate on the portfolio was eating margarine for plant sterols (grosse!) , nuts (not allowed by Esselstyn) , more than 21 gr soy protein, and psyllium. The psyllium is laughable since I get approx 4 grams fiber per 100 cal.. so minimum 60 grams/day. I eat 1 walnut and 1 tbsp flax/day and I eat anywhere from 11 to 14 servings fruits and veg per day. I wont bore you with all this. I did put together my own portfolio diet from Dr Greger’s videos, but all of this does not address the low estrogen which is causing the cholesterol to rise. (see above post for link) The eco atkins is what i do best on (eliminating grains) but I hate it. I post a link , below.

    https://nutritionfacts.org/video/how-to-treat-high-blood-pressure-with-diet/

    https://nutritionfacts.org/video/plant-based-atkins-diet/

    https://www.ncbi.nlm.nih.gov/pubmed/19506174

    1. * I really enjoy reading all the comments very much. It’s trying to post that sometimes ends up being a headache. Sometimes when I am flipping back and forth between tabs to copy/paste links in the post my comment box will close taking my reply, links and all, with it!

    2. I wish that the Low-Carb Plant-Based in that study was compared to a High-Carb Plant-Based diet, not to Lacto-Ovo Vegetarians.

      It feels dishonest to blame carbs when people are eating dairy and eggs versus Plant-Based.

      1. Looking at the eco-Atkins study, they used things like soy and nuts and avocado, which are all known for lowering cholesterol.

        They were eating a whole lot of transition food and had good results, perhaps because of the soy and nuts and avocado.

        “vegan version of the Atkins diet. How is that possible? Well, lots of mock meats, seitan, soy burgers, veggie bacon, veggie cold cuts, veggie sausage, tofu, lot of nuts, avocado”

        I suspect that using the things like soy and nuts and avocado to lower it, that after that, people could stop eating those without going up because the whole point is getting it out of your system.

        1. And, no, I am not saying that transition foods are better than whole food plant based. Just that soy seriously helps some things and that Dr. Barnard was another who allowed transition foods in his study and had marvellous results with Diabetes.

          1. I am doing a lot of soy and a handful of nuts and 1 tablespoon of flaxseed. Also, for most of the year, I ate a super-food wrap with kale and broccoli and cauliflower and red cabbage and microgreens and broccoli sprouts and carrots and tri-color peppers and tri-color tomatoes and pomegranate seeds and I use avocado on that for moisture. Sometimes I would add dandelion greens and crunchy sprouts.

            Being post-menopausal, I feel like soy helped quite a bit.

            I didn’t have even one symptom of menopause. Nothing at all. That was very nice.

        2. Barb,

          Did you do the high soy and nuts back then and it didn’t work?

          I am maybe not saying it for you, but looking at Tom’s liver damage from statins, in my mind, I don’t put high soy and nuts and avocado versus Dr Gregers diet, I put it versus statins.

          1. There are substantial benefits for people taking baby aspirin, statins, and beta blockers for secondary prevention. This is not the best link, but it shows the survival benefit in the first year..

            https://www.sciencedirect.com/science/article/pii/S0890509613000083

            This protocol is virtually non-negotiable for both my husband and myself. The diet (to the doctors and cardiologists) is waved off with “oh that’s nice”. That reaction might partly be because we are both lean, fit, non-diabetic, well-muscled for our ages. Blood work is taken to monitor liver and kidney functions. Liver enzyme changes can be seen in advance. I answered your questions in previous posts but let me recap briefly.

            1. David Jenkins portfolio diet is not designed for high risk patients. He is addressing people who have modifiable risk factors still to deal with. The link I supplied in above post for the eco atkins trial was David Jenkins’ team too. http://stmichaelshospitalresearch.ca/researchers/david-jenkins/2

            2. My cholesterol levels went sky high post menopause with the decline of estrogen. Prior to menopause my total cholesterol was good

            3. Dr Greger’s diet is superb if a person really gives a solid effort in eating from all 11 categories.
            I can not eat oils, nuts, avocado, anything high fat or with flour, as in pasta, without my cholesterol going up further. Soy is high fat, and in high amounts can pose risks as per Dr Greger. 3 servings/day is enough. 21 gm protein from soy is beneficial according to Jenkins interview I read.

            4. Diet, exercise, and statins is not enough to lower my cholesterol to acceptable levels. Estrogen replacement is not recommended for heart disease protection. We did consider water fasting at home here, but Dr Longo was saying fasting over 12 hrs is not safe for heart patients.. not sure why.

            5. Re: Ann’s plight, above. The thing that bothers me most over the years is the broad statements made by all the plant docs about how the rainbow ends in wfpb land, and blood pressure, diabetes, heart disease, auto immune will just vanish. It isn’t necessarily the case.

            6. Eat your fruit and veggies, exercise in any which way you can daily. Go to your doctor, ask for copies of all your blood tests, every time. Knowing your numbers eg., BP, cholesterol, hs-CRP, WBC, GFR, is a good place to start. Hope this helps Deb

            1. What is the survival benefit compared against, taking nothing I presume.
              What would be interesting is having this group up against radical lifestyle and diet changes. I know which one my money would be on. There is plenty of evidence that shows diet/lifestyle beats med’s to a pulp even this web site has highlighted this. By all means swallow the propoganda but throw the kitchen sink at this as well with diet and lifestyle

              1. mark

                What you say is true for most people However some people have genetically high cholesterol levels that can’t be reduced sufficiently by dietary and lifestyle interventions There are dozens of gene mutations which affect people’s cholesterol levels Diet and lifestyle are not the only factors which affect cholesterol levels Some people also have to take statins or other cholesterol lowering drugs as well That is Barb’s point I believe

                ‘Mendelian randomization studies have consistently demonstrated that variants in over 50 genes that are associated with lower LDL-C levels (but not with other potential predictors or intermediates for ASCVD) are also associated with a correspondingly lower risk of CHD,20,27–30’
                https://academic.oup.com/eurheartj/article/38/32/2459/3745109

            2. Thanks for sharing, Barb.

              I did read the paragraphs above and did understand them. I didn’t need you to justify what you were doing, I just had gotten confused whether you have ever done the high soy and handful of nuts, but I am hearing you say that you are high risk and I am not trying to come against what you are doing.

              I don’t know my cholesterol number. I can order labs on it, but haven’t.

              A1C and blood glucose, you can get the test kit at Walmart, and I have more than one blood pressure machine.

              I have always been low blood pressure. We have a BP machine at work because my co-worker’s BP went up over 200 and so did my sister-in-law’s. But I have gotten older and 120 is now considered pre-hypertension, and so I am now pre-hypertension, but I am still early in my 100% vegan 99% of the time walk. (Yes, that is the diet end and emotionally/morally. My sneakers and the honey in my cabinet already make me need to re-write the daily sentence to a lower percent vegan, and cause me to need to lower the emotional and moral score, but it is hard to be accurate about this whole thing.)

  14. If cholesterol is such a dominant factor in reducing heart disease, so dominant that most doctors will look and treat only this factor, why is it that with statins, a drug that will crush your cholesterol levels, you only get 20 to 30% reduction. Diet and lifestyle give you around 90%. Could it be that cholesterol lowering is a not factor with any health mileage. Reducing inflamation and mitrochondrial malfunction is the root cause

      1. YR, That’s an interesting website …. thanks for sharing the link … I had never come across it before. The response to CA250 is very well written. Scientific theories are always changing because that’s the nature of the scientific method. When new evidence is discovered, if it doesn’t fit with the current theory, then the theory must be modified. A good example of changing theories is from the field on physics, where Einstein refined the work of Isaac Newton. It turns out that Newton’s theories weren’t completely “wrong”, but a better more refined theory was given by Einstein to explain new observations. In fact, in most space launches to the moon, Mars, etc., Newton’s theory is still used and works just fine!

        The problem with scientific theories about nutrition is that there are so many vested interests involved, that the so called factual discoveries they come up with are biased! A good example of research study bias is the one about saturated fat not being related to CHD, as explained in the following video:

        https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/

        If all the studies were done “objectively”, my guess is that they would all lead to an optimal human diet that is similar to the one recommended on this NF website. Dr G is doing a great job of exposing many of the biased studies!

        1. WFPB-Hal, Thank you for the link (which was also provided previously; thank you all). I’d not seen it earlier (I found this website about 2 years ago).

          It raises a question in my mind: If everyone’s cholesterol set point is different (as in the quote below), then why is there a single “cut-off” point at which statins are recommended? Especially if our biology is the same. If this is true: “Follow men over time and those making healthy lifestyle choices are associated with a 90% drop in risk. Same with women, 92% of the risk gone….Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills typically only reduce cardiovascular disease risk not by 90% but only by 20% to 30%. So, even on drugs, 70 to 80% of heart attacks still occur.” (today’s Flashback video) Then could it be that lifestyle alone is important in preventing heart disease — no matter what the cholesterol level is in that healthy lifestyle? Except for perhaps those with unusually high levels of cholesterol (which is genetic, I think).

          “everyone’s [cholesterol level] setpoint is different. Two people eating the same diet, the same amount of saturated fat, the same number of chicken nuggets a day can have very different cholesterol levels. One person can eat 10 chicken nuggets a day and have an LDL cholesterol of 90; another person eating 10 a day could start out with an LDL of 120. It depends on your genes. But while our genetics may be different, our biology is the same, meaning the rise and drop in cholesterol is the same for everyone. So if both folks cut out the nuggets, the 90 might drop to 85, whereas the 120 would be expected to drop to 115. Wherever we start, we can lower our cholesterol by eating less saturated fat, but if I just know what your saturated fat intake is—how many nuggets you eat–I can’t tell you what your starting cholesterol is. All I can say with certainty is that if you eat less [saturated fat], your cholesterol will likely improve.” (https://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/)

          1. Dr J, you raise a very good question: ” If everyone’s cholesterol set point is different (as in the quote below), then why is there a single “cut-off” point at which statins are recommended?”

            I’m certainly not an expert in this field, but in previous NF videos, the statistics show that “we can estimate that the LDL level at which there is zero atherosclerotic progression is around 70…. and that appears to be the threshold above which atherosclerosis and heart attacks develop.

            https://nutritionfacts.org/2016/12/13/whats-the-optimal-cholesterol-level/

            So the conclusion seems to be, even if one has an optimal WFPB diet and the reason one’s cholesterol is high is due to bad genes, then lowering it to the 70 level would be beneficial.

            The question then becomes: do the long term side effects of lowering LDL with pharmaceuticals outweigh the benefits of having a lower risk for CHD? To me, that seems like an individual choice that one has to make. And the human body is so complex, it’s hard to imagine that anyone has a clear definite answer to that question :-(

            1. That question has been studied extensively over the years and the data clearly show that for appropriate target groups the answer is unabiguously ‘yes’

              There also isn’t a single cut-off point at which statins are recommended The risk calculators are uch ore sophisticated than that and vary fro country to country and eve in the US there are specialist risk calculators for people with endocrine disorders heart disease particular ethnicities etc

            1. As does advice regarding appropriate BP readings. We’re now advised to get ours down to 40/30 or some such ridiculous number.

              Impossible? Well, then swallow these little pills 3x a day. :-(

              1. You write these things as though that advice is merely an opinion as opposed to the conclusion from rigorous assessents of the evidence And all the guidelines say use diet and lifestyle to reduce cholesterol and BP and only use pills when those fail or the patient is unwilling to comply

                Internet marketers and cranks routinely isrepresent the facts in this way but i’d suggest that we here should cleave to the facts and not siply repeat istaken alternative health prejudices

                We are supposed to take our tinfoil hats off before entering this website

                1. “We are supposed to take our tinfoil hats off before entering this website”
                  – – – – –

                  Aye aye sir. Message heard loud and clear.

                  Can’t be done though. Where Tinnie goes, I go. Trying to make sense of the schmaltz you throw at people from your flea-bitten keyboard hurts the eyes anyway.

                  1. All part of the service ma’am.

                    We do appear to live in different space-time continuums though. In my reality, for example, people writing books purporting to reveal the thoughts of channelled supernatural entities are laughing all the way to the bank In yours, they are apparently the noble self-sacrificing vehicles for the wisdom of a higher power

    1. mark

      Your depiction of the issue is mistaken Doctors focus on LDL cholesterol lowering because it is an approach that has been proven time after time to lower rates of death and adverse events in populations Other approaches like raising HDL or using anti inflammatory drugs have not been as successful in reducing total adverse events eg
      https://www.amjmed.com/article/S0002-9343(06)00270-1/pdf

      In any case it is a false comparison because cholesterol itself causes inflammation It is not a question of either/or as in it’s either cholesterol or it’s inflammation That’s the false dichotomy presented by internet marketers to try to get us to buy their books/pills/diet plans or whatever Believing the quacks and anti cholesterol nuts who infest the internet and rejecting the scientific evidence offered in the lengthy analyses of the evidence by panels of leading scientists is not a choice that I personally would make but certainly many people do it seems

  15. You are kidding, right Mark Littlewood? Diet and cookbooks, education, health resort, equipment, food, supplement, alternative therapies, exercise fascilities, online groups, support, apps, medical trials/education/monitoring, yoga everything, clothing, etc etc Mega billion dollar business each year in usa alone.

    https://www.sfia.org/press/3_U.S.-Sports-Industry:-Nearly-a-$70-Billion-Business

    https://www.prnewswire.com/news-releases/us-weight-loss-market-worth-66-billion-300573968.html

    https://www.thegoodbody.com/yoga-statistics/

    https://brandongaille.com/36-health-and-wellness-industry-statistics-and-trends/

    https://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197

  16. When you remove sections from above that are not connected with disease prevention/correction directly you are left with a miniscule industry compared to drugs. Try and persuade a drug company to invest in Yoga

    1. Mark, you came in late and don’t seem to be following. Deb and I were having an ongoing discussion about particular points which you have missed. The industries surrounding wellnessbare huge. If you are not familiar with Dean Ornish and his lifestyles research , then here https://www.ornish.com/undo-it/ It ALL (including yoga, meditation and other relaxation interventions) has to do with disease prevention.
      I have been enjoying this website and a vegan wfpb diet for years now, and my husband for the last few years. Have a nice evening

        1. Quite possibly it isn’t though. Where is your evidence that it is?

          Also serum fibrinogen is a predictive marker for a variety of conditions including complicated appendicitis, cancer, trauma and infections. Just as pain is a marker for a number of health conditions. However treating pain symptoms will not in itself address the course and cause of disease Will treating serum fibrinogen levels address the course and cause of disease? I suspect not

          ‘CONCLUSIONS:
          Genotypes that produce lifelong differences in fibrinogen concentrations do not materially influence coronary disease incidence. As these genotype-dependent differences in fibrinogen were allocated randomly at conception (Mendelian randomization), this association is not likely to be confounded by other factors. Consequently, these genetic results provide strong evidence that long-term differences in fibrinogen concentrations are not a major determinant of coronary disease risk.’
          https://www.ncbi.nlm.nih.gov/pubmed/16870675

      1. Also in Japan sat fat consumption has risen by 400% in the last 50 years , average cholesterol levels have gone from3.9 to 5.1 mmol and yet CHD rates have fallen 60%. If Cholesterol and sat fat were such strong drivers you would certainly not expect to see a fall.

        1. Mark, that is really interesting about Japan. I was watching a documentary recently on the changing food environment in Japan. The vending machine business is huge! The narrator of the video was showing what, if any, healthy food is available at the convenience stores if you don’t eat animal foods. So, re your statistics, what if it’s a particular demographic picking up sat fat filled foods from the market shelves? eg young people drawn to westernized junk food? It will be interesting to see the rates of heart disease etc in another 20 to 30 years. Just a thought.

        2. Not true There are other factors at work which observational studies like this do not control for. Differences in smoking rates and consumption of traditional Jaanese foods high in sodium occurred over the same time frame The Japanese were apparently also early adopters of statin drugs Observational studies like yours are notoriously subject to confrounding by extraneous variableslike these – which is why the saturated fat and cholesterol sceptics rely entirely on anoalous observational studies like Japan France and PURE to make their case

          However well-conducted experiental studies control for most of these factors and they show that replacing SFA with PUFA and lowering LDL cholesterol reduces adverse cardiovascular events

        3. Japanese researchers report that

          “The decline in CHD mortality is attributable to large declines in blood pressure levels and the prevalence of smoking, which may have offset the potentially adverse effects of increased total cholesterol levels during the past decades. High total cholesterol would need a longer incubation period to maximize the effect on CHD risk.54,55”
          http://circ.ahajournals.org/content/118/25/2725

  17. Well, my cousin had another heart attack. I think it is his second in 2 or 3 months. His stroke was a few years ago, but heart attacks seem to be frequent.

    He looked pretty good, but said that he was so tired and they wouldn’t let him sleep even a wink.

    This is the second time in a few months that he went into the hospital for an infection and had a heart attack during the time there.

      1. I am so sorry Deb. You are such an amazing support, for your cousin, and friends/family that you have mentioned here. Sounds like they are watching him very closely. Will keep him in our thoughts and prayers.

        1. He has had two heart attacks or more since he went on dialysis.

          I looked it up and found a reason.

          https://www.eurekalert.org/pub_releases/2013-05/foas-msw053013.php

          Patients with advanced kidney disease who are undergoing hemodialysis are known to be highly susceptible to heart attacks and other cardiovascular complications, and now scientists likely know why. New research findings published in the Journal of Leukocyte Biology show that uremic toxins, which are not removed by hemodialysis, increase heart attack risk. The same scientists also have found what can reduce this risk: an oral adsorbent called “AST-120.”

          Are there any whole food adsorbents?

          He was frustrated with the food situation at the hospital. They wouldn’t let him eat a slice of bread because he can’t have carbs with his diabetes. There was a whole list of things they wouldn’t let him eat because of phosphorous or potassium.

          He said to them that they needed to get a new chef and have food items, which someone with kidney problems, heart problems, and diabetes can eat, but it is genuinely hard.

          1. Another article said:

            Nutritional and environmental factors as well as the residual renal function may influence the concentration of uremic toxins in the body fluids.

            So…… which nutritional factors affect the concentration of uremic toxins?????

            Is it going to be animal products, which they are pumping him full of every meal? Eggs and chicken and dairy, perhaps?

              1. Wait!

                Is it Modified Citrus Pectin and the edible clay and activated charcoal and I am going to wonder about milk thistle and rice (I say rice because they can use it to clean up soil. Yes, totally uneducated guesses)

  18. Although this site focuses on nutrition not specific medical conditions, I was able to find two credible sources which will provide more information on small brain aneurisms: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet and
    https://www.medpagetoday.com/criticalcare/strokes/65784/ This latter article is not as scholarly, but cites solid research studies, so I’m including it
    I hope you find these helpful and reassuring, although specific information on a specific brain aneurysm would be best discussed with the doctor (neurosurgeon?) reviewing the specific case. Still this will provide some background information so you can more effectively work with the specialist involved.
    Recognize that type, risk factors, and other variables besides size also affect the danger of a specific aneurysm.
    Hope this is helpful to you.

    1. Hi Elaine,

      I am a volunteer for Dr. Greger. Thank you so much for your question. Your confusion about diet and heart health is widespread, as there is much information out there on the topic(s), as well as some information we don’t quite know yet.

      To start, Dr. Diamond’s presentation starts with several case reports and books published by a doctor or 2 during the 1800’s and 1900’s. This evidence should essentially be ignored, as it offers no scientific rigidity for his claim.

      He then discusses the effects of a ketogenic diet on cardiovascular disease risk factors. but fails to acknowledge that weight loss is one of the most important aspects for improving cardiovascular disease risk factors, and these patients lost quite a bit of weight. He then states that a review of the literature says that reducing carbohydrates is beneficial for individuals with Type 2 Diabetes. However, treating type 2 diabetes and preventing cardiovascular disease are not the same thing. The review article he showed also described the results from epidemiologic studies, rather than looking at highly controlled clinical trials, which quite clearly show that replacing saturated fat with nearly any other type of energy source improves blood lipid levels.

      The data he points to regarding butter and margarine is ridiculous. Margerines used to contain higher levels of trans fats, which they no longer do. Eating more margarine when they contained these trans fats could have contributed to a rise in heart disease. However, that data that he listed is merely correlation, with no roots in causation whatsoever. He suggests that because Ancel Keys was perhaps not the most credible heart disease scientist, that that is the reason why what he was saying is not true, when in fact, many scientists and papers published support the decrease of saturated fat for improving heart disease risk.

      Overall, anybody can pick and choose studies to support their work. The scientific rigor of the studies often picked by Dr. Diamond was rarely described. When we look at highly controlled studies, we see clear risk increases for those eating higher saturated fats. When we look at the populations that eat large amounts of carbohydrates in the form of whole plant foods, disease risks are among the lowest in the world and lifespans among the highest. If carbohydrates were the enemy, then those populations would have high rates of cardiovascular disease, which is not the case.

      Lastly, if carbohydrates were so damaging to cardiovascular disease, why have Dr. Dean Ornish and Dr. Caldwell Esselstyn, as well as Dr. Pritikin consistently shown disease regression and reversal in patients with diets high in carbohydrate? Carbohydrate quality must be factored in. Simply claiming that carbohydrates are bad or are good is missing a big piece of the picture.

      I hope this isn’t too long-winded of an explanation! It’s a very controversial topic!

      1. I think you will find that low carbers are really talking about simple carbs and not plant based carbs, anything that produces rapid blood sugar rises like pasta and obviously cakes and buns etc. As for correlation and causation I think you would struggle to pin lower so called risk factors like LDL cholesterol as causative. Even with a statin trial you cannot pin even the small benefits they offer to lowering LDL.

        I think everyone would benefits from low simple carbs, lots of plants and healthy fats and small amounts of protein from plant sources

  19. Your LDL cholesterol levels are a pretty poor indicator of Heart Disease risk. This paper is about how Machine Learning was used to evaluate the various risk factors for heart disease.
    An approach was taken with a 10 year project tracking people with 48 factors. Four different algorithms were employed on the data. The data was split into 75% to find out what the relationships were within the data, usually called ‘training’ the model in machine learning parlance. The remaining 25% was used to test how well the model could predict cardio events such as heart attacks. The results were pretty good, out performing conventional risk assessors.

    LDL was way down the list of risk factors when put in sequence of risk. Here were some of the top ones of which some you cannot control but others you can. Notice how high Total and HDL are which is another endorsement for the belief that Total/HDL ratio is a better predictor then LDL

    Age*
    Ethnicitya: South Asian
    Female*
    SESb: 2nd Townsend quintile
    Smoking*
    Ethnicitya: Black/Afro-Caribbean
    SESb: 3rd Townsend quintile
    SESb: 4th Townsend quintile
    HDL cholesterol*
    Oral corticosteroid prescribed
    HbA1c missing
    Total cholesterol*
    COPD
    Systolic blood pressure*
    Ethnicitya: Other/Mixed
    SESb: 5th Townsend quintile (most deprived)
    Atrial fibrillation
    Triglycerides
    Family history of CHD < 60 years

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