Flashback Friday: Optimal Cholesterol Level

Flashback Friday: Optimal Cholesterol Level
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Why don’t authorities advocate a sufficient reduction in cholesterol down to safe levels?

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No matter where we live, how old we are, or what we look like, health researchers have discovered that 90% of risk for having a first heart attack can be attributed to nine modifiable risk factors. The nine factors that are threatening our lives include smoking, too much bad cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and vegetable consumption, as well as a lack of daily exercise.

But Dr. William Clifford Roberts, Executive Director of the Baylor Heart and Vascular Institute and long-time Editor-in-Chief of the American Journal of Cardiology, is convinced that atherosclerosis has a single cause, namely cholesterol, and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we could be stressed, overweight, smoking diabetic couch potatoes, but if our cholesterol is low enough, there may just not be enough cholesterol in our bloodstream to infiltrate our artery walls and trigger the disease. Thus, the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.

It was not appreciated until recently that the average blood cholesterol level in the United States, the so-called “normal” level, was actually abnormal, accelerating the blockages in our arteries, and putting a large fraction of the normal population at risk for our #1 killer. That’s cited as one of the reasons the cholesterol controversy lasted so long–an unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level. Normal cholesterol levels may be terminal cholesterol levels

The optimal cholesterol level, the optimal “bad cholesterol” LDL level, is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that’s where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop.

That’s what we start out with at birth, that’s what our fellow primates have, that’s the level seen in populations free of the heart disease epidemic, but we can also look at all the big randomized controlled cholesterol-lowering trials. This is graphing the progression of atherosclerosis versus LDL cholesterol. More cholesterol, more atherosclerosis; but if you draw a line down through the points, you can estimate that the LDL level at which there is zero progression is down around an LDL cholesterol of 70. You can do the same with the studies preventing heart attacks. Zero coronary heart disease events might be reached down around 55, and those who’ve already had a heart attack and are trying to prevent a second one might need to push their LDL levels even lower.

Atherosclerosis is endemic in our population in part because the average person’s LDL level is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn’t recommend everyone doesn’t shoot for even just under 100, is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would financially overload the health care system. Drug usage would rise enormously. But they’re assuming drugs are the only way to get our LDL that low. But those eating really plant-based diets may hit the optimal cholesterol target without even trying. Just naturally nailing under 70.

The reason given by the federal government for not advocating what the science shows is best was that it might frustrate the public, who would have difficulty maintaining a lower level, but maybe the public’s greatest frustration would come from not being informed of the optimal diet for health.

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

Please consider volunteering to help out on the site.

Images thanks to ToM and itsokstay_calm via Flickr.

No matter where we live, how old we are, or what we look like, health researchers have discovered that 90% of risk for having a first heart attack can be attributed to nine modifiable risk factors. The nine factors that are threatening our lives include smoking, too much bad cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and vegetable consumption, as well as a lack of daily exercise.

But Dr. William Clifford Roberts, Executive Director of the Baylor Heart and Vascular Institute and long-time Editor-in-Chief of the American Journal of Cardiology, is convinced that atherosclerosis has a single cause, namely cholesterol, and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we could be stressed, overweight, smoking diabetic couch potatoes, but if our cholesterol is low enough, there may just not be enough cholesterol in our bloodstream to infiltrate our artery walls and trigger the disease. Thus, the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.

It was not appreciated until recently that the average blood cholesterol level in the United States, the so-called “normal” level, was actually abnormal, accelerating the blockages in our arteries, and putting a large fraction of the normal population at risk for our #1 killer. That’s cited as one of the reasons the cholesterol controversy lasted so long–an unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level. Normal cholesterol levels may be terminal cholesterol levels

The optimal cholesterol level, the optimal “bad cholesterol” LDL level, is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that’s where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop.

That’s what we start out with at birth, that’s what our fellow primates have, that’s the level seen in populations free of the heart disease epidemic, but we can also look at all the big randomized controlled cholesterol-lowering trials. This is graphing the progression of atherosclerosis versus LDL cholesterol. More cholesterol, more atherosclerosis; but if you draw a line down through the points, you can estimate that the LDL level at which there is zero progression is down around an LDL cholesterol of 70. You can do the same with the studies preventing heart attacks. Zero coronary heart disease events might be reached down around 55, and those who’ve already had a heart attack and are trying to prevent a second one might need to push their LDL levels even lower.

Atherosclerosis is endemic in our population in part because the average person’s LDL level is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn’t recommend everyone doesn’t shoot for even just under 100, is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would financially overload the health care system. Drug usage would rise enormously. But they’re assuming drugs are the only way to get our LDL that low. But those eating really plant-based diets may hit the optimal cholesterol target without even trying. Just naturally nailing under 70.

The reason given by the federal government for not advocating what the science shows is best was that it might frustrate the public, who would have difficulty maintaining a lower level, but maybe the public’s greatest frustration would come from not being informed of the optimal diet for health.

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

Please consider volunteering to help out on the site.

Images thanks to ToM and itsokstay_calm via Flickr.

Doctor's Note

It’s imperative for everyone to understand Dr. Rose’s sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study in Barriers to Heart Disease Prevention.

Here are a few newer cholesterol videos:

 And of course, this overview video is always a good reference: How Not to Die from Heart Disease.

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

316 responses to “Flashback Friday: Optimal Cholesterol Level

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  1. My cholesterol level is given to me in “mmol/L”. Can anyone tell me what my optimal levels should be in that measurement ? Thanks

      1. I’m confused. If the liver produces 90% of our cholesterol why are we ruminating on dietary cholesterol? If we consume more cholesterol the liver just produces less and vice versa. Don’t we need cholesterol for our cell membranes, neuronal sheaths, Vit D and sex hormone production etc? I thought the demonization of fat had been exposed as wrong. And isn’t it hard to talk about LDL and HDL without knowing their particle size? Can’t one can have an elevated LDL and it be mostly the large fluffy innocent type? And don’t 50% of people who suffer heart attack’s have normal cholesterol level? Please enlighten me!

        1. These are the typically deceptive claims made by people selling sensational ‘health’ books diet plans and various stuff on the internet …. and repeated by others who really should know better. No wonder you are confused. That is the intention I think

          First, the proportion of total cholesterol made by the body and the proportion coming from the diet depends on what you eat The fact is that diet affects our total blood cholesterol levels. The body doesn’t magically keep your blood cholesterol at a certain specific amount irrespective of your diet and lifestyle That’s why average cholesterol levels of say vegetarians and omnivores differ eg

          ‘Conclusions-—This systematic review and meta-analysis provides evidence that vegetarian diets effectively lower blood
          concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and non–high-density
          lipoprotein cholesterol. Such diets could be a useful nonpharmaceutical means of managing dyslipidemia, especially
          hypercholesterolemia. (J Am Heart Assoc. 2015;4:e002408 doi: 10.1161/JAHA.115.002408)’
          https://www.ahajournals.org/doi/pdf/10.1161/JAHA.115.002408

          Of course the body needs cholesterol. That’s why it makes cholesterol Cholesterol is not needed from the diet and high cholesterol increases the risk of many chronic diseases.

          These ridiculous claims of ‘demonisation’ of cholesterol are made by con artists and crackpots as a justification for ignoring the mountain of scientific evidence which clearly shows that high blood cholesterol is a significant risk factor for heart disease. They just dismiss all the evidence they don’t like as demonisation. Neat trick if you can get away with it huh?

          As for LDL particle size, both types are atherosclerotic The large fluffy type is only somewhat less harmful than the small type It is certainly not innocent as you have beeen told See eg

          https://nutritionfacts.org/video/does-cholesterol-size-matter/

          And yes a large proportion of people who’ve had a heart attack (myocardial infarction or MI) have normal cholesterol levels That is not all surprising because THEY’VE JUST HAD A HEART ATTACK! Heart attacks lower people’s cholesterol levels This has been known for a very long time but the self-styled cholesterol experts on the internet and YouTube – some of them, shamefully doctors – will never tell us this Bad for sales I suppose

          ‘ acute MI causes a rapid decline in serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol.’
          https://journal.chestnet.org/article/S0012-3692(16)35525-8/pdf

          We don’t know what the cholesterol levels of those heart attack patients were before they had their heart attack and were admitted to hospital – all we can be reasonably sure of is that they were significantly higher than the levels measured in hospital after their heart attack.

          1. Same thing with the alleged ‘demonisation’ of saturated fat This is just a claim by nuts and con artists to try to get people to ignore the evidence. Claim that all the scientific evidence is just ‘demonisation’ and pfft it goes away and then you can just ignore it

            Read the evidence summary on dietary fats and heart disease if you want science rather than sensational misrepresentations and wild claims
            https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510

          2. So I was lead to believe it wasn’t the total cholesterol per se but the ratio of one’s other metabolic parameters that would more accurately determine one’s level of risk. For example, a person with a chosterol level of 225 would be considered at cardiovascular risk by most physicians and “blindly” placed on stains. But if that person’s triglycerides were 50 and the HDL was 80, the triglyceride/HDL ratio is 0.6 while the cholesterol/HDL ratio is 2.7…both perfectly acceptable numbers that would not require a statin in and of itself. And that same person’s LDL was 110, I was led to believe that fraction was most likely the large fluffy “innocent “ particle size and not an independent risk factor.

            And who would ever think too low of a cholesterol level would be bad for one’s health?

            By the way and slightly off topic, why shouldn’t physicians check fasting insulin levels before or in conjunction with the more standard HGB-A1C’c or fasting glucose levels? The fasting insulin levels get out of wack long before the other horses get out of the barn. We might pick up type 2 diabetics a lot earlier.

              1. Interesting. My last labs were HDL 49, Tri 69, TC 159. Plant based but I did this after 5 days of fasting mimicking diet so I’m not sure how accurate that would be.

                My previous was HDL 31, Tri 136, TC 133, LDL 75. That was only 5 months post MI and 4 month plant based. I assume that’s why my tri was high (I was still losing a ton of weight. I’ve lost 80 pounds total).

                My thought was low HDL on a WFPB diet isn’t important since there isn’t a ton of LDL to move out of the system. I guess no one really knows.

        2. Hello Jeffrey,

          You have brought up nearly every point of confusion around the topic of cholesterol, so thank you for bringing light to that. I will go through each one and do my best to clear up the confusion.

          Yes our livers produce much of our cholesterol; however, dietary cholesterol does have an impact. It is believed by some that eating cholesterol doesn’t have much of an effect on our overall cholesterol levels is because for most of us in the western world, we already eat a lot of saturated fat and cholesterol. If you have a relatively high (or “normal”) cholesterol level, then you won’t experience a big change by eating cholesterol. However, if you have a lower cholesterol level, like that seen in plant based eaters, then adding an egg to your diet will have a significant effect. We also know that cholesterol is a cause of heart disease because those with genetically low cholesterol levels, even though they live similar lifestyles to their counterparts, do not suffer from heart disease. There’s a great nutritionfacts video on this topic which I have linked.
          https://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/
          https://www.ncbi.nlm.nih.gov/pubmed/1534437

          You are correct that cholesterol is needed for several components and processes in the body; however, like you mentioned, our livers make all we need. In studies on those with genetically low levels or people on high doses of cholesterol lowering medications have no side effects with regards to hormone production.
          https://www.ncbi.nlm.nih.gov/pubmed/26405182

          As for the demonization of fat being “debunked,” that is also largely based on falsehoods. The meat and dairy industry have tried very hard to combat the science demonstrating that heart disease is caused by their products, so there has been some research showing lack of risk. The problem is that they are riddled with design errors. Dr. Greger has done a great job of exposing their tactics in this video: https://nutritionfacts.org/video/the-saturated-fat-studies-buttering-up-the-public/

          The size of LDL particles does matter, but the large type isn’t innocent. The larger LDL particles are LESS atherogenic than the small type; however, they still cause heart disease. Advocates of animal based diets like to conflate “less harm” with “safe”, but that’s not true. This is also a topic that has been covered on this website: https://nutritionfacts.org/video/does-cholesterol-size-matter/

          And lastly, about 1/3 of heart attacks occur in those with “normal” levels; however, as demonstrated in this very video, “normal” does not mean “optimal.” Our recommendations for cholesterol levels should be lowered, but then the only people who would even have cholesterol levels that low would be those with amazing genetics or those on plant-based diets. If you want optimal levels, most people can achieve that through diet alone!

          I hope this helps your understanding,

          Matt, Health Support

      2. No success yet with cholesterol. My numbers remain high (total: 210. LDL: 140) in spite of WFPB (for almost 1 year), following DD (Daily Dozen) and sos-free (no salt, no oil, no sugar) with few exceptions.

        Added daily tweaks: amla, blueberry powder tea, an apple, 1 brazil nut.

        My weight is normal-low with a bmi of 17.
        I exercise a minimum of 60 minutes daily.

        I could do more such as following Jenkins’ Portfolio diet (thanks Mr Fumblefingers), or try the bean mush suggested here in comments by Lsteel (any reference for it?).

        I could also cut out the daily tablespoon of dry fruits and nuts; and also remove the small pleasures I allow myself: occasional wine glass monthly, 2 teaspoons of maple syrup weekly, daily small bits of dark chocolate, daily teaspoon of molasse or fig syrup with morning beans.

        Who knows if it would help to also cut out:
        – my daily glass of beet juice (made only with water and beets)
        – daily kale juice (made with water, half a walnut and a bit of lemon).
        – daily slice of Food for Life Ezekiel bread.

        But pushing further also involves cutting out healthy food.

        So I have decided to go back to Lipitor, starting at a low 5mg daily, but aware I will need 10mg and perhaps 20mg to make a significant reduction in my lipids.

        Suggestions?

        1. Hi I’m a health support volunteer. Sorry to hear about that. It is frustrating to be doing everything right and still not have the results you want. First of all, congratulations on all the healthy choices you have made. You are getting benefit even if the lipid panel isn’t showing it.

          There is nothing wrong with taking a cholesterol lowering medication. And it sounds like you have done everything. The travesty is when patients just go on medication and make no lifestyle changes. if you have done all you can, and you really sound like you have, the next step is medication. Sometimes there are genetic factors we can’t easily overcome.

          I do not think the few small things you are allowing yourself- the very modest wine, chocolate, and syrup are the problem. You do not need to cut out fruit or nuts. The research shows these are helpful and do not raise cholesterol. I don’t see anything you need to cut out. You can look at adding more cholesterol lowering food into your diet, although you already have a lot of these. See Dr. Greger’s blog (link below) for more ideas.

          Dr. Greger has a blog post addressing this I think you would like:
          https://nutritionfacts.org/questions/what-can-i-do-to-lower-my-cholesterol-it-seems-ive-tried-everything/

          Don’t give up and don’t beat yourself up. Keep up the great healthy lifestyle choices.

          NurseKelly

      3. Hi
        I have been told by a doctor (gp) that I do not get enough retinol on my wfpb diet. I told her that my A levels were great as per Chronometer. She said veg isn’t as good at retinol because of the need for conversion. She recommended red meat, butter etc. but I told her I don’t eat animals. I ended up buying ($45 ) arctic cod liver capsules from her practice. She also recommends Izabela Wentz internet and author on thyroid conditions.

        I am lifetime hypothyroid (since age 12, 60 yo now), looking to find an answer for why I regularly suffer fatigue for days on end. I chose her because she is a functional physician.

    1. If you have followed the Daily Dozen list, been strict wfpb with no salt, refined sugars, refined grains, or oils, and have reached a healthy body fat level, but still have elevated cholesterol the most likely explanation is genetic. It is easy to forget when looking at averages just how big the variation in a normal distribution is.

      Having said that, the diet I am going to outline is quite likely to lower cholesterol levels even in these cases. I recommend doing this for one month before getting a blood test (you also need to know your cholesterol before you begin).

      Continue with the Daily Dozen and strict wfpb, but get 1/3 – 50% of calories from legumes (lentils and beans excluding soy) and a minimum of 75g of fibre from legumes. The legumes should be prepared from dry, soaked for at least 6 hours, rinsed and then cooked until they breakdown to a starchy broth – there will be no cooking water to discard. This is most easily achieved with a pressure cooker (e.g. instant pot on high pressure bean setting for 30 minutes).

      You’ll want to spread this out to at least two meals if not three because the volume of food will be very high. You can add whatever wfpb food you want to the beans (e.g. curry spice combination, tomato, onion and garlic, oatmeal). Do not use canned beans, even if they are just water packed and make sure to cook the beans past where they remain intact.

      Why is this likely to work ( somewhat speculative)? By consuming the level of legumes that this entails and making sure they are sufficiently broken down before they reach your colon you are putting a massive demand on your body to produce bile salts. Thus this is acting to increase the consumption of cholesterol, rather than lower its production. If you have a genetic mutation(s) that makes you’re body insensitive to signals that it doesn’t need to produce as much cholesterol this will bypass the mutations since it will just consume the extra cholesterol.

      If after a month you see a noticeable change in otherwise stable LDL levels you can start tweaking to figure out how many beans you need to eat to reach and maintain the target cholesterol level.

      P.S.: This should lower LDL levels dramatically in those who aren’t perfectly wfpb but don’t have any significant genetic effects on cholesterol.

      P.P.S: There are almost certainly types of mutations that will keep your cholesterol high even with this extreme approach, but if you have done this in conjunction with DD and strict wfpb, your pretty much at the end of the line.

        1. @Heather: I would start with an isocaloric intake (i.e. substitute bean calories 1:1 for existing calories). However, you’re going to have a very hard time putting on weight with this much fibre and resistant starch going through your GI tract, so if you feel like eating more wfpb calories it shouldn’t be a problem at all.

          @Deb: ‘glop’, good to know the technical name for it ;)

      1. I soak 4 cups legumes overnight then cook in clean water in a 4 quart pot. They always cook down and have no water just a nice thick broth. One just has to learn not to add too much water when the beans start soaking up the water first added. I remember when a friend was cooking legumes in a pressure cooker. Bean skins got caught in the steam vent so the pressure cooker blew the contents out of the over pressure plug. What a mess!

        1. @cp yes, getting the water volume right is essential to getting the ‘goop’ mixture. Pressure cookers shouldn’t be filled more than half-way to the max fill line (including water), when cooking beans on high pressure.

      2. STATINS are toxic to the body. I’d rather have high cholesterol level then what Statins do to the body, and yes I eat lots of veggies, etc but genetically prone is my main problem.

        1. Well. the evidence shows that statins reduce the number of deaths, heart attacks, strokes and heart surgery in people who take them. But if you’d rather believ the claims of opinionated people on YouTube instead of the scientific evidence, that’s your prerogative.

        1. @John: I don’t think there is anything wrong with canned beans as long as they are packed with only water. However, for the purpose of trying to lower highly resistant high LDL they are not suitable because they do not form the thick broth / goop that comes from a mixture of resistant starch and fibre being released when beans are cooked to the point of disintegration. It is this mixture that binds bile salts so effectively and why I think it is worth trying the suggested routine if nothing else has worked.

  2. With the strictest wfpb, no breads, salt, sugar, oil, no fatty foods, no starchy foods, and with statins, I am lucky to keep LDL under 3mmol , on a good day. It just isn’t working.

    1. Barb,

      If you will, please share a sample day with us… list out every single food and drink item you consume on a typical day. This way, we could see if there’s room for improvement to get your numbers lower. It could well be that you have a LDL receptor issue going on, but could also be a few dietary changes could improve the number.

      1. Casper, I have been at this a long long time. I have compiled a portfolio diet extraordinnaire with all (all) the things Dr Greger has mentioned over the years. I had incredible opportunity to trial and retest my reaction to foods through quarterly blood testing, and no, there is no room for improvement anywhere. A lifetime of being slim, and exercising heavily probably has helped to even keep where I am. Casper, you only have to visit wfpb sites around the net to see how common this is. WFPB is good, but it isn’t nirvana

        1. Hey Barb, you mentioned that you are eating no oil or fatty foods. Where are you getting your good fats? Many boost HDL. HDL picks up excess cholesterol in your blood and takes it back to your liver where it’s broken down and removed from your body. I use avocado oil and extra virgin olive oil myself for all of my oil needs and have had great success.

          1. Jimbo, thanks for your comment. I did try it. I only have 1 tbsp flax seed now per day, (my HDL is good, I exercise) but about 2 years ago I did try to add 1 tbsp olive oil/day, a couple of walnuts, a slice or 2 of avocado a couple of times per week with disasterous results. My LDL went over 4.0 mmol However, I have seen others report good results with a similar idea. I am glad I tried it though.

          2. Jimbo: oils are not whole foods and all oils decrease flow mediated dilation which correlates highly with CVD. HDL levels are basically irrelevant in light of LDL and total cholesterol correlating highly with CVD. All available evidence clearly points to all oils increasing serum triglycerides and serum cholesterol and therefore as increasing the risk for heart attack and stroke. Dr. G covers this extensively in many videos on this site.

            1. For 40,000 + years we have been eating oil with our foods. We evolved with animal fats, etc. But NO hydrogenated oils. Our bodies need oil like olive oil, butter, coconut. I personally think the extra stress is what is really killing us anyway. Do de-stressing exercise, meditation, Yoga and have your extra virgin olive oil on you veggies and eat some organic meat=3-4 ozs a day.

              1. Yes, bugger what the scence and the evidence shows us, this is my opinion So there.

                BTW your claim that humans have been producing and consuming oil for 40,000 years sounds a tad unlikely. Do you have any evidence for that?

                However using your arguments about oil and about consuming animal fat, I have to point out that humans have been drinking alcohol for millions of years. So, our bodies must need that too? I mean booze played a part in our evolution so it’s got to be good for us,right? Perhaps we need to rethink cannibalism as well if your argument is correct in principle.

                mestors-were-drinking-alcohol-before-they-were-human
                https://www.sciencemag.org/news/2014/12/ability-consume-alcohol-may-have-shaped-primate-evolution

        2. Barb,
          Right. My wife has also not been able to get her LDL below even 100 on a 100% WFP diet: as of 2018, it’s 116, down from 156 in 2012. On virtually the same diet, my LDL has dropped from over 100 to around 83, down from 111 in 2012. On the other hand, her HDL is ok, 52, and her TRIs are very low (70s).

          1. gengo-gakusha, your wife and I are very similar in this regard. I would be happy with a 116 though! Both of you are doing great. My HDL is really good the doc says.. I would have to look it up for my last numbers. My triglycerides are ok too, lowest 0.70 to highest 1.35 mmol Everything else is good. A1c is 4.5. Anyway, that video with Dr Esselstyn that Kay referred to below is worth looking at. All the best to you !

            https://m.youtube.com/watch?v=ZTnbND_MpRA

          1. Dr Tim, as I said, I have tried it all. I have watched the videos daily since 2011. Yes, the amla and many more of Dr Greger’s diet tweeks which all add to the terrific health I currently enjoy, but did not lower my LDL. As I said more than a few times in the past, pre menopausal, my cholesterol levels were good. Jumped over 30% at post menopause. As Dr J said once, ‘we have to run faster just to stay in the same race’ .

        3. Barb:

          Have you tried cutting out all forms of added sugar? There was a report a few years ago that dietary sugar increases cholesterol. Look out for Barley malt, Honey. Molasses. so called sugar alcohols, apple juice and other fruit juices, etc etc. (Many fruits are beneficial if eaten whole, but their juices are simply sugar and water – Consumer Reports)

          1. Yes Sydney, and thanks for bringing up the subject. Good point you have made. I do not drink juices of any kind. I drink herbal tea, green tea, and a cup of filtered coffee or water. I eat whole fruits and my triglycerides are good. I did an experiment years ago and found out that my blood pressure hardly reacted to salt at all ( I dont use salt on my food as a rule) but it did go up with sugar!
            All of these questions are good, especially for the new people to wfpb eating who may not realize all of the things that might impact cholesterol levels and might appreciate a checklist of sorts.

            Let’s also not forget hypothyroidism as well since an untreated hypothyroid condition can push up cholesterol levels. And some alternative therapies have been suggested too, like accupuncture, meditation, yoga (Dr Ornish recommends a meditation program), and Marilyn Kaye suggested a Frankensence supplement.

          1. Ana45, check out the video with Dr Esselstyn https://m.youtube.com/watch?v=ZTnbND_MpRA and here what he has to say about the wide variety of cholesterol numbers he would expect to get with a sampling of people eating wfpb nutrition. He says, no one dies of numbers. They die from what they put in their mouth…. we can keep on eating the very best we can, exercising, losing excess weight, and not smoking….and meditate!

          2. Don’t forget, the key requirement often is UNPROCESSED wfpb. As an example, my dad used to eat a lot of whole wheat bread which qualifies as a wfpb but is highly processed and calorie dense. Not good. He needed statins because of it. If you’re not doing this already, eat farm to mouth with no machinery or factory in between.

    2. “With the strictest wfpb, no breads, salt, sugar, oil, no fatty foods, no starchy foods” So that leaves fruit and non starchy vegetables. So how are you getting your daily calories?

      1. Exactly my point. That’s why I keep asking people for a FULL list of daily intake. Because a lot of times people don’t realize what they’re really eating in detail.

          1. Exactly. You are clear about what you’re eating. That’s good. Yet, you’ve shared your experience and inability to get your numbers down to a “safe” range (including support from a Statin)… so then you should expect people to ask questions of you on this forum in order to obtain more details and get a crystal clear picture of your situation. Something doesn’t jibe… and like I mentioned to someone earlier…. this could be an LDL receptor issue. Maybe that’s something you’d be able to find out via genetic testing and it may very well be you have familial hypercholesterolemia. We’re all here to help with suggestions.

            1. I have high HDL low Triglycerides and despite eating a plant based diet I could not get my LDL down low enough without a statin. I even had a dietitian in the cardiology department review my fitness pal log and she said my diet was excellent. I workout 50 minutes a day. Finally a Dr ran a blood test for lipoprotein (a) and discovered mine was very high.

              1. It’s generally known that women have higher LDL scores than men as they age, so not sure if the ages of the four women here having this LDL-lowering issue are a factor. Your exercise is increasing your HDL.

                I’m also wondering if calcified plaque plays into the LDL score. I would think it wouldn’t, but if the women here having the issue had been building plaque for 40 years and some of it is calcified… could someone shed some light as to how this plays into numbers if at all?

  3. After six years on a wfpb diet, no oils, low nut consumption my total cholesterololesterol will not budge under 200. It has always been around 210 and this year it went down to 208. Very frustrating to me especially given the cholesterol breast cancer connection.

    1. Julie,

      If you will, please share a sample day with us… list out every single food and drink item you consume on a typical day. This way, we could see if there’s room for improvement to get your numbers lower. It could well be that you have a LDL receptor issue going on, but could also be a few dietary changes could improve the number.

      1. I have the same frustration! In 2011, after starting a wfpb diet, my cholesterol dropped 60 points in 3 months to 200 and hasn’t budged since! I know I have the APoe4 gene variant which makes me good at making cholesterol (I think). But if I’m not getting cholesterol in my diet, why is it still high?

        1. Again, Florence, you’d have to give a sample of what you consume in a day or two so we have a clear picture.

          I’ve come across so many people who say their extremely healthy diet is not lowering their numbers and yet once you find out the combination of foods they’re eating it all becomes clear.

          There’s a very popular YouTuber for example who eats 12 bananas a day. That’s wonderful for a healthy dose of Potassium but guess what? He posted his blood test results and not surprisingly his Triglycerides were like 130-150 or something like that. So, in my opinion he could cut back on 9-10 of those and use the 900-1300 calories to create a more synergistic, well rounded plant based diet.

          1. Casper. I also eat at least 12 bananas each day and my triglyceride level is 70. I don’t think that large amounts of fruit necessarily correlate with high triglycerides

            1. Ah nice. Cool to know!! So maybe it’s a combination of something else he’s consuming… how many total calories do you consume per day?

              1. I haven’t worked it out. Breakfast is a large smoothie with around 10-12 bananas, 2 medjool dates, beet, carrot, kale or spinach, finger lime, turmeric flaxseed, pepper. Lunch is oats with berries, banana or papaya, cacao powder, flaxseed, cinnamon and homemade oat milk. Dinner is a dish with beans or lentils eg. soup, chilli beans, dahl, pasta with lentils in the sauce, etc. sometimes steamed vegetables, always a salad with plenty of greens. We eat big servings. Occasionally I’ll have a few nuts

        2. Florence,
          >>>But if I’m not getting cholesterol in my diet, why is it still high?
          Because, unfortunately, most of the cholesterol is made by the body, not consumed (although consumption can raise it somewhat and that increase **can** increase risk significantly). A 60-point drop is tremendous! If your HDLis reasonably high and your triglycerides low, then I’d surmise that you have significantly decreased your risk of CVD.

          1. That’s true GG, and also, dietary fat may be the culprit. I can’t say it enough, what people think they’re doing and what they actually are doing could possibly be different enough to cause the stagnation.

            Or, could be genetics at play, or something else. We don’t know. Could be they truly cannot improve at all (which I find hard to believe bc there’s always room for improvement).

            Also, we don’t know also how much fiber people are getting. Some are getting 30g and others 90g a day. So that’s why, even though I’m being taken as arrogant, I’m just telling you that you cannot take anyone’s word until you sit down and see exactly what they eat daily and weekly.

            I know PB friends who go out and eat vegan dishes at restaurants and don’t really think it’s having any effect on their numbers.

      2. Casper-thank you for the suggestion. I will refrain from reporting on every bite I put into my mouth. I follow dr g’ s daily dozen, except lowering the nut amount and making sure that some of my foods are known to lower cholesterol. If I have to be worry about obscure micronutrients in my brussel sprouts than I guess I’m going to be living with my current cholesterol levels. I suspect that it is a hereditary issue the same as the breast cancer issue that we have in our family. Obvious from the numbers of incidences but not evident in DNA tests.

        1. I’m sorry to hear your family has had history of breast cancer. It’s terrible. I could relate, since many ppl in my family have had battles with heart disease, and some suffering death by heart attack. And everyone in my family throws around the phrase “it’s in our genes”, but I know it’s lifestyle and diet.

          Not saying that’s the case with your situation, and don’t know what types of BC you’ve experienced, but I wish you well.

    2. Julie,

      Have you tried adding in the specific foods which affect cholesterol?

      Look under topics and see if you are eating the foods, which help lower it.

      1. Also, make sure that you are taking a shelf-stable form of B-12.

        Not just Methyl B-12.

        Boy, I have to go back to the last time we did this topic because there is a list of things like wrong B-12 which can affect it.

        Some of us were still B-12 insufficient when we were supplementing with Methyl. If you are afraid of Cyano, you may need to use 2 or 3 other forms.

        1. Shelf-stable… that sounds like a degrading of quality, like it needs an expiration date posted on each bottle.

          Now, does Cyano also have a degrading of quality on the shelf? Do you have any idea what a reasonable shelf life might be for Cyano?

          1. Dr. Cobalt,

            I don’t know about it except that on PubMed it spoke about Cyano being more shelf stable and that Methyl was prone to degrade from time, light and heat.

            I just know that when I was using Methyl only as my supplement, it seemed to work until I went off of fortified plant milk and nutritional yeast. Then, I got so many symptoms of B-12 insufficiency, which went away when I switched away from Methyl B-12.

            I read someone sharing about how when they order bottles in the Summer, for instance, they often don’t seem to work and they were hypothesizing about hot UPS trucks. (At holidays, chocolate can often arrive melted if not packed with cold packs because of that problem.)

            1. Deb, I’ve been doing really well on methyl B12 (and I don’t eat fortified foods), but I got from a good company in the right packaging, etc. More recently I actually switched to one which contains both methyl and adeno which apparently are the two forms mostly found in nature. It’s pretty rare to find the combination in a supplement, it’s the VeganSafe B12. I keep mine in the fridge just to be safe and I seem to be doing really well on it, I think better than the pure methyl one I was taking before.
              But I still want to try the cyano for at least some of the time because it’s cheaper and I like the idea of just taking it once a week. My problem has been not being able to find a good vegan brand of cyano without too many icky fillers. Any brand suggestions to look for?

              1. The combination is more effective than Methyl alone.

                It was tested in a study and it was more likely to work in a combination.

                Methyl isn’t complete without one of the others with it is what one PubMed article said.

                I just know that it was a fail for me.

                I got tiny lesions and neuropathy came back and leg spasms and it brought my hallucinations back, plus skin problems. All the symptoms disappeared when I switched off of it and I have interacted with others who had the same problem of insufficiency using Methyl by itself. Including someone here.

                1. Cyano bested all of the rest in a single head-to-head test and was more shelf stable, but powers that be wanted Cyano to lose, so they did a test where it was M & A versus Cyano and recommended that you can take 2 or 3 of the other versions or Cyano.

                  I laughed because Dr

                  1. I laugh because half the people think Dr Greger is irresponsible recommending Cyano with cyanide, but dollars to donuts many of those same people also think he is paranoid coming against B-17 which has thousands of times more cyanide.

                    And more of those don’t know that flaxseed has 5000 times more cyanide than Cyano B12.

                    We are a fickle audience.

                    1. I wouldn’t say the whole audience, but some certainly are! It’s been my understanding that there simply haven’t been any substantial tests on methyl B12 and that they’ve all focused on cyano. In Europe, or at least in Germany, due to concerns over cyanide (they’re also more paranoid about flax there, I think they even recommend agains using it) you can mainly only get methyl B12. Dr. Greger recommended if you can only get methyl to take once a day and not once a week. That was from his interview with Vegains, or one of the interviews… there were two or three.

                      Still on the search for a good vegan cyano B12 brand with as little fillers as possible. I like this combination I’m on but I also like the option of taking once a week. Any suggestions on brands are welcome!

                    2. The EU did safety studies for cyanide and what I will say is that with all of the people who have used B-17, very few people have even been hospitalized or died from that. Nobody had ever been hospitalized from flaxseeds and so many people eat that. Nobody has ever been hospitalized from Cyano B12, but there is a campaign against it by people who sell supplements. Enough people are afraid of it that it really has affected it. As far as brands go, I am not sure offhand. I have tried different ones and also have tried a combo of hydroxy and adesonyl.

                      I don’t have preferences of what to take. I only had problems on Methyl.

                      With my brain problems I can risk homocysteine being elevated.

                    3. Oh I’m no way was I suggesting that their cyanide concerns were justified or backed up by any science. Actually in the interview, both Dr Greger and Vegains pretty much say as much. It was a good interview/interviews.
                      I actually take at least 2 tbsp of ground flax everyday as a rule and have consecutively for years.

                    4. S,

                      Good for you.

                      I regularly forget my flaxseeds.

                      If I didn’t like Mary’s Gone Crackers, I wouldn’t have had any for months. It is a big deal because I am trying to heal my brain. I am taking vegan omega 3 but I feel like I need to be careful.

                      Tonight, I accidentally skipped dinner and my brain was off and I felt fear again. That doesn’t happen often. I think the third day in a row of having my prefrontal cortex rest at 5% scared and discouraged me but it might be reversed. It might be that my brain is functioning at 5% and that manifested in anxiety.

                      I didn’t use the ICES tonight and this was my first night of not sleeping.and I had eye pain. I had lost my bottle of B-12 a few weeks ago and finally got a new bottle tonight.

                      Wondering how fast not having it can affect people. I am wondering if I lost track of time about it.

                      I have it next to me.

                      I have trouble with once a week supplements. Easy to forget.

        2. I had exactly the same problems with Methyl B12. Taking only that after going vegan in 2011 was a big mistake.

          In the first few years my body’s B12 storage was probably still sufficient so no symptoms came up, but after a few years I had nerve problems in my left leg, waves in my fingernails and low energy.
          All the Methyl B12 bottles were used within the “best before date”.

          After switching to Cyano B12 2500mg for around 6-8 weeks all the problems cleared up, nice fingernails, much more energy and no more nerve problems.
          Cyanocobalamin is not dangerous or toxic, it has less cyanide than a peach.

          I work in the textile industry (finance department) and have no relationship to any supplement companies or sellers etc.

          1. Daniel,

            You don’t have to convince me.

            There are a few of us now who have said that.

            Many people who take methyl already get enough Cyano in their diet.

            A few of us thought it worked until we stopped drinking fortified plant milk.

            The reason I say it every where is because I thought WFPB had failed and that I had gotten Diabetes back or something and I was so happy that switching B-12 got rid of all of the problems.

      2. Thank you for the input! Yes, I have checked into those foods and eat as many as I can fit. I stick pretty close to the daily dozen. I think my frustration comes from hearing so many stories of miraculous cholesterol lowering and have such little luck with it myself.

        1. I’m the same way! I am on a plant based, vegan diet with very little cheating and my LDL is still at around 143. But Joel Furhman, MD says the diet is much more important than the LDL number. People who eat write with high LDL are much safer than people who eat wrongly with a low LDL.

            1. Here’s my most recent cholesterol and A1C, etc:

              Total cholesterol: 204 (my best yet) LDL: 133 HDL: 44 Triglycerides: 130 Fasting glucose: 78 Hemoglobin 1AC: 5.2 Calcium: 8.9 Total Protein: 6.2 Blood Pressure: 110/70

            2. Total cholesterol: 203 LDL: 119 HDL: 61 Triglycerides: 113 Fasting glucose: 93 Hemoglobin 1AC: 5.8 Blood Pressure: 110/80. As. 70-year-old, I think I’m doing pretty well but would like the cholesterol numbers to be better.

        2. Julie, lowering sodium helps with heart but causes cholesterol to go up.

          Dr. Fuhrman pointed to eating salt lowers cholesterol but increases the risk of hemorrhagic stroke.

          Seems like I remember that other choices maybe potassium or magnesium might help, but I might be wrong, just pointing out that many of us go off salt and that could be the confounding factor in the cholesterol trials and why it suddenly becomes harder.

          Don’t correct with salt, but can someone help me figure out, does potassium or magnesium help?

    3. Two possibilities that I’m aware of: 1) you’re eating refined wfpb foods such as whole wheat bread or 2) you have familial hypercholesterolemia which has a prevalence of about 1 in 250 so it’s not rare. If you’d really like to test this, try eating farm to mouth for a month and then retest. Real unprocessed whole foods only. Knife and fork only. No factories or machinery. If that doesn’t work then statins might be the only answer.

      PS: When I see people say “wfpb no oil” I become concerned about what they’re eating because oil is not part of a wfpb diet to begin with so there is no need to mention it.

      Dr. Ben

    4. Hi, Julie! I can imagine how frustrating it must be to make lifestyle changes and not see the results you want. You did not mention your LDL numbers, and that might be more important than the total cholesterol, especially with regard to breast cancer risk. There are several factors that can drive higher cholesterol levels. If you drink coffee, that can influence your cholesterol in some cases. More on that here: https://nutritionfacts.org/video/does-coffee-affect-cholesterol/ There are specific plant foods that can help to lower cholesterol levels, such as oats, legumes, and amla. Sometimes when people are overweight or losing weight rapidly, this can elevate blood cholesterol levels until optimal weight is achieved. Nuts do not appear to drive cholesterol levels higher, and may even reduce them. More on that here: https://nutritionfacts.org/video/how-phytosterols-lower-cholesterol/ Genetic factors influence cholesterol levels as well, particularly in those who are not consuming any dietary cholesterol at all. In that case, the serum cholesterol level represents what the body is producing on its own. You can find everything on this site related to cholesterol here: https://nutritionfacts.org/topics/cholesterol/ I hope that helps!

  4. Is anyone familiar with this research, reported in the nytimes?

    “They found that women with LDL levels below 70 were more than twice as likely to have a hemorrhagic stroke as those with readings between 100 and 129. Under 100 is generally considered normal.

    Women with triglyceride readings below 75 had twice the risk for stroke compared with those with levels above 156. A triglyceride level below 150 is considered healthy.”

    https://www.nytimes.com/2019/04/10/well/live/very-low-cholesterol-may-increase-stroke-risk.html

    1. This report was raised in the comments on yesterday’s blog post. Here’s the response I offered………..

      These sorts of claims come up on a regular basis..

      It is important to note that this is just an associational study. It is possible low ldl levels are just a marker for long term chronic disease risk. That is, the early disease state causes lower cholesterol rather than the other way around.

      For example, in things like Alzheimer’s Disease and certain cancers, cholesterol levels can begin declining many years before a formal diagnosis of Alzheimer’s or cancer is made eg

      “RESULTS:
      Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents.
      CONCLUSION:
      A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.”
      http://jamanetwork.com/journals/jamaneurology/fullarticle/793179

      and re cancer …………..

      “Albanes and colleagues drew on an 18-year study of nearly 30,000 Finnish male smokers, the largest and longest of its kind.
      During that period, 7,545 men developed cancer. Men with total cholesterol over 7.15 millimoles per litre were 15% less likely to develop cancer compared to men with lower cholesterol.
      But, when the researchers excluded cancers that occurred in the first nine years of the study, this risk disappeared.
      “This finding supports the idea that the lower serum total cholesterol level we detected as a possible cancer risk factor may actually have been the result of undiagnosed cancers,” says Albanes.
      “The results should help dispel any lingering concerns anyone might have that having low cholesterol could cause cancer,” says Dr Eric Jacobs of the American Cancer Society.”

      The fact that people who have lowered cholesterol as a result of statin usage do not have higher stroke risk suggests that this association with stroke may also be an example of reverse causation.

      This 2009 editorial from “Circulation” offers an interesting discussion of the subject:

      ‘Establishing causality based on statistical associations from observational studies is always hazardous. In the general population, having low, usual total cholesterol and LDL-C appears to be associated with a higher risk of brain hemorrhage. In contrast, there is no evidence of a similar relationship in persons whose total cholesterol and LDL-C levels have been lowered therapeutically. This suggests no causal relationship between total cholesterol and LDL-C and bleeding risk.’
      http://circ.ahajournals.org/content/119/16/2131.full

      1. Can we find out if the stroke victims were vegans?

        Can we hypothesis that if their numbers were that low, they were either vegans or had other health factors causing the lowering of cholesterol?

      2. Thank you, Mr Fumblefingers; I knew I could count on you for a cogent response.

        From the abstract (the only part of the article I’ve read so far, and it loaded very, very slowly), the study was described as “a prospective cohort study among 27,937 women enrolled in the Women’s Health Study.” (Though skimming through the article, I did read the study cohort described as “middle-aged to elderly women.”) And, “During a mean of 19.3 years of follow-up, 137 hemorrhagic strokes occurred.”

        This does not seem like a high risk of hemorrhagic strokes: about 0.5% over almost 20 years. I wonder what other diseases or conditions the study participants suffered from, and died from, and in what proportion? And what were their LDL levels?

        1. Well, the study itself adjusted for a number of risk factors but how well, we don’t really know. They do say though that in some of their analyses, they only adjusted for age because of the small number of cases.

          The results may also have been confounded by other factors. For example, the low LDL group contained relatively fewer people who were obese/overweight than people who had higher LDL levels (as one would expect). Nevertheless, it did contain some. Was this relevant? It may be because “blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight” and sodium intake is associated with stroke risk.
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908596/

          It’s also worth noting that some other observational studies have failed to find an association between low LDL levels and stroke risk.
          https://www.ahajournals.org/doi/full/10.1161/ATVBAHA.111.234948?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
          https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.108.529537?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

          My take is that perhaps there is an association between low cholesterol and one less common type of stroke but it’s far from clear that the relationship is a causal one. Even if it were, the benefits of achieving ‘low’ LDL cholesterol levels in reducing risk for much more common types of CVD would outweigh the risks of hemorrhagic stroke.

    2. The plaque is kind of like a plaster or tape, good sometimes, bad sometimes, and LDL increases plaque. It’s like you had tape preventing a broken teacup from bursting. In this situation the tape is good, but in other situations the tape is bad, like if you were trying to drink the tea and all this tape was clogging it.
      Here’s the scientific explanation, from “The End of Heart Disease,” by Joel Furhman, M.D.:

      “There are two kinds of strokes, ischemic or embolic strokes caused by clots, and hemorrhagic strokes, typically more devastating, caused by a broken blood vessel that bleeds into brain tissue.Ischemic strokes are like heart attacks of the brain, and are related to our atherosclerosis-promoting dietary habits, but the hemorrhagic stroke can occur with little or no atherosclerosis present.In fact, hemorrhagic strokes occur more frequently in people with low cholesterol. They are much more common in Asia because of that population’s high salt consumption.The combination of high salt and low fat consumption is highly related to hemorrhagic strokes.

      For example, in Japan, hemorrhagic strokes were found to be three times more common in people with total serum cholesterol levels less than 160 mg/dl compared to those with higher levels, even though the higher levels were associated with increased risk of ischemic stroke.

      High salt consumption may be potentially more dangerous for vegans, vegetarians and those who have ‘earned’ a low cholesterol level because of their careful diets. We know that high cholesterol levels are associated with with an increased risk of coronary artery disease.But at very low cholesterol levels, the risk of hemorrhagic stroke increase as the risk of heart attack decreases.Studies have suggested that low serum cholesterol could enhance the vulnerability of small intraparenchymal cerebral arteries and lead to the development of stroke in the presence of hypertension.

      The plaque-building process that results in atherosclerosis and premature death may in some way protect the fragile blood vessels in the brain from rupture caused by years of high blood pressure. That said, there is a very simple solution to this issue, and that is to keep salt intake low, so a hemorrhagic stroke becomes almost impossible to happen.”

      1. That is so helpful and it was what I was going to bring up next.

        Which type of stroke?

        And again, for the people below 70, how many were vegan?

      2. Okay, forgive me for my lack of understanding on this….

        I get the whole salt topic and love that answer because it is so simple, but blood thinners can cause hemorrhagic strokes, right?

        Do we know whether it is the low cholesterol or is there a low cholesterol, plus, blood thinners (natural or medical) connection?

        1. You won’t need blood thinners if you follow either Dr. Greger’s or Dr.
          Furhman’s diet plan and stay totally off salt and unhealthy foods. If you watch Dr. Greger’s videos, you’ll see that a complete reversal of heart disease is possible, and people like Dr. Greger’s grandmother, who was basically told to go home and die, go on to be physically fit. (She lived 30 years more.) So it’s true that medications can be dangerous.
          Read “The End of Heart Disease,” by Joel Furhman. He points out that eating lots of producer can improve you so much that you no longer need blood thinner. He has lots of specific advise about Warfarin, etc.

          1. Thank you!

            Yes, I am not on blood thinners, but I eat a lot of garlic and turmeric and things like that.

            I am thinking more about the study with low cholesterol and strokes.

            To have cholesterol that low, I would think it was vegans dying and I understand about the salt, but I wonder if the people were on blood thinners or ate too much turmeric and garlic, etc. or were taking aspirin and eating turmeric.

            The fact that it makes low cholesterol look dangerous, it makes me wonder what else could have contributed.

            1. People can have low cholesterol for a number of reasons – genetic, healthy diet and lifestyle or disease states such as infections, trauma, chronic alcoholism, certain liver diseases and cancers for example. Even heart attacks and strokes have been shown to result in lowered cholesterol. I suspect that the proportion of all people with low cholesterol who are ‘vegan’s is very small. They may even be outnumbered by alcoholics for all we know.

              It’s also wortn remembering that in this study they measured LDL only at baseline – ie 19 years before the results were calculated.

              1. Tom,

                That is useful.

                It is hard when they are saying numbers low enough that it would be very few people who do have cholesterol that low.

                Things like cancer being a cause of low cholesterol is fascinating because we already have women afraid that they will get cancer from high cholesterol.

                It just is a topic which is harder for me to understand.

          2. Joy. Some people still need blood thinners. My partner has a fib which according to my research isn’t affected by diet. He took himself off his blood thinners 3 years ago and a few weeks later had a stroke. Now of course he’s back on eliquis and as a result of the stroke his right side has been effected and he has aphasia. He’s WFPB for 5 years. Vegan for 6

            1. Sorry to hear that.

              Has he been doing brain plasticity?

              I have been using gadgets from a man who has walked himself out of a stroke.

              Is he using either pulsed magnet or things like acupuncture or ultrasound or cold laser or electric foot massage to get new neurons to get back function?

              I watched The Brain That Changes Itself and a few TED Talks and there is a chiropractor in Boston who had a stroke where he became paralyzed and couldn’t see or speak or eat properly, but he knew how to recover from stroke and was driving and was back in practice 4 years later. He put his instruction videos of how he did it on YouTube. It is hard to find sometimes but it is worth finding. I haven’t memorized his name yet is the problem.

              I obsessively watched stroke recovery videos when a few of my relatives had strokes and because of my own brain issues.

              The gadgets I got was a Micropulse ICES and I recently got a Brain Gauge.

              1. Hi Deb. He was doing all sorts of things for a period after the stroke. Now he’s still doing speech therapy, works on building muscle strength and does Lumosity brain games. We have a copy of The Brain that Changes itself. In rehab they were using an electric gadget to stimulate nerves. His aphasia is the hardest for him. Very socially isolating

                1. Dr. Greger mentioned in one of his videos a while ago that the best brain exercise appears to be playing or learning a musical instrument.

      3. Joy,
        Great citation. The End of Heart Disease by Dr. Fuhrman is well worth reading in its entirety. So is The End of Diabetes.

      4. I would like to add to this discussion on ischemic and hemorrhagic stroke. My education is in Neurosciences and my career has been in Neurorehabilitation of adults with traumatic brain injury. I would like to add that talking about physical injury to the brain by stroke is a little more complicated than whether diet may or may not cause ischemia or hemorrhage. Approximately 18 in 100,000 may have a congenital condition known as atriovenious malformation (AVM). It is often referred to as a bomb in the brain as this condition is associated with weakened and tangled blood vessels in the brain. It is known that a weakened spot in a vein or artery may rupture (think of a bicycle inner tube tire). This is not an aneurysm situation. The condition is characterized by a tangled mass of blood vessels that do not grow and spread out into the brain as they should. AVM’s are often found when the brain is scanned for another reason but are otherwise not usually known about until a disaster occurs at rupture. AVM’s are diagnosed at scan for another condition and at autopsy. This is also experienced under the hemorrhagic stroke umbrella, however the cause is far from diet related. There are other brain conditions and anomalies that can occur that may or may not be diet related.

        1. Ruth, diet is the problem, not AVMs. 18 per 100k is 0.018% while the prevalence of stroke due to hypertension and/or atherosclerosis (due to diet) is on the order of 1000 times the prevalence of AVMs. AVMs are some of the rarest conditions known to medicine while stroke and other morbidity and mortality due to diet (not AVMs) are by far the most common conditions known to medicine. In addition, poor diet choices will increase the risk of rupture of AVMs. Lastly, having an AVM is not necessarily a problem as only 1.6%-3.4% of them result in annual mortality.

          Here is good review of the epidemiology of AVMs: https://www.sciencedirect.com/science/article/pii/S104236801100115X?via%3Dihub

  5. The video says LDL between 59-70 is optimal. But media reported research this week that said LDL below 70 raises the risk of stroke. Who is right?

    1. Adrienne,

      See Tom’s comment above.

      One of the common problems with observational studies is that cause and effect get reversed.

      Sometimes, the early disease state causes lower cholesterol rather than the other way around.

      I am waiting for a professional to examine that specific study.

      I am sure it will happen eventually.

  6. In the one year since going WFPB my LDL dropped from 112 to 66 and my triglycerides from 197 to 115. Now my doctors are all treating me weird because they can not believe that I did it without any medications. They like that I did it but it seems to puzzle them.

    1. Jimbo,

      Way to go! You are doing great!

      You might be the one who softens the doctors’ belief systems about diet and cholesterol just a little bit.

      1. Most doctors seem to not want to even discuss any lifestyle changes. From discussions and experiences with doctors I’ve had, I believe it is because they either think the patients will not bother doing any of it so it is wasting their time, or think the patient will lie and just say they are doing what they were told without actually changing the unhealthy habits. Sadly they probably are going from experience with most of their patients who think all health problems are some sort of mysterious magical thing and expect pills to fix it all.

    2. Lol, that’s awesome Jimbo. Maybe it will inspire them to look into (legitimate) nutritional science as a means of preventative medicine. Have you reccomended Dr. Greger’s book or website?

  7. Been a fan for years, with a few failed starts in veganism. Now I’ve been 100% for 8mos and my LDL is stubbornly 105. Total 178. It’s basically the same it has always been even when i was eating meat and eggs. I’ve been 50lbs overweight and yo-yo dieted forever.

    The only time I got near these optimal levels, I had tried to eat Joel Fuhrman’s way and I lost weight and got LDL to 70, total to 160. But it was unsustainable for me and also, my the lowered cholesterol was just due to the weight loss?

    Bottom line is I’m committed vegan ethically now. I eat Mostly whole plant foods but some veggie burgers pastas occasional French fries, no desserts.

    But I wonder if I could push a button and remove the excess 50lbs, if my cholesterol would drop.

    And yes I exercise and lift weights and have an active lifestyle, golfing, surfing horses etc.

    1. Have you gone to the topics of lowering cholesterol and tried the specific foods?

      Are you eating the beans and lentils?

      Have you tried Amla?

      Apples?

      I can’t remember the whole list, but there are specific foods, which help more than other foods.

      Have you tried those?

    2. The obnoxious voice of experience says… when you drop fats and oils to the bare minimum, the weight and numbers will very likely follow suit. I lost over 100 pounds, but until I got ingested fats to around 10%, the last 50 wouldn’t budge. As soon as I felt sorry for myself and got cocky about eating even whole food high fat sources, it crept back, and with it the higher #’s. It takes a while to get accustomed to the change, but like any “addiction”, allowing some just prolongs the torture, better to just bite the bullet and get it done. Now oils, especially fried stuff, actually tastes gross and I realize I can enjoy those calories a lot more with foods that fill me up. https://www.forksoverknives.com/the-calorie-density-approach-to-nutrition-and-lifelong-weight-management/#gs.5a46wc

      1. Love when the obnoxious voice of experience shows up on the pages.

        Yes, I regained 10 pounds and have just about lost them back lowering the fats again.

        I found a few no oil brands of hummus for when I don’t have time to make things and I could eat the whole container and I think it would be 500 calories. I like when my snacks aren’t going to cause me to gain pounds.

          1. DiNicolantonio who wrote that paper is a notorious promoter of saturated fat and salt consumption

            Yes elmiinate sugar from the diet But that doesn’t mean that saturated fat consumption is harmless All people like DiNicolantonio do is equivalent to pointing out that stabbing people is dangerous and then arguing that this somehow proves that shooting people isn’t

      2. Hi, Vegetater,
        I’d been eating “right” for quite a while and suddenly wanted my old favorite at my local Chinese restaurant: family style bean curd (e.g., comes with vegetables) so I ordered it. YIKES! So oily! I couldn’t remember it being so oily and yet it was the same restaurant as always. I learned my lesson!

  8. I have been eating strictly whole food plant based for a few years. The best numbers I can achieve are 176 total and 102 LDL. Should I be taking statins? I have had one bypass operation. I am 79 years old and active. Thank you!

    1. You’ve got to go with your cardiologist on this one. Statins like Crestor have powerful effects and can help. But as even dr greger and esselstyn have said, lower doses might be sufficient to get your cholesterol down without the side effects.

      Veganism isn’t a religion- you won’t be a bar person if you take statins after a heart attack! Again, dr. Esselstyn’s patients took statins.

      Just speak w your cardiologist and tell him or her that you’d like to try to the lowest dose first for a couple of weeks and see where that leaves you. According to the charts in this video, you’d want to drop LDL 30-50 points which is a lot.

      Doctor greger dislikes drug companies’ influence on dietary advice “eat burgers and take statins” mindset. But you’re eating healthy and dr greger wouldn’t begrudge you taking statins to get to optimal LDL while still eating healthy vegan diet.

      1. Sydney, – also, here is William Kim, M.D., MACC, FAHA, MASNC, FESC (vegan) cardiologist and past President of the American College of Cardiology.
        https://www.youtube.com/watch?v=uIh8GD8LgUQ at the recent Real Truth About Health gathering. Posted Dec, 2018. How Sugar Affects Cardiovascular Disease. It’s worth the 10 minute watch time. And a reminder that drinking our calories and adding refined sugars can be as devastating to our health as adding refined oil.
        For me, the more I remind myself to eat a whole food plant based diet the better my health is. Food as grown, not food as refined. Beans and greens.
        Have a great day! :-)

      2. DiNicolantonio who wrote that paper is a notorious promoter of saturated fat and salt consumption

        Yes elmiinate sugar from the diet But that doesn’t mean that saturated fat consumption is harmless All people like DiNicolantonio do is equivalent to pointing out that stabbing people is dangerous and then arguing that this somehow proves that shooting people isn’t

    2. Hi, Nancy Nowak! That is a decision that you and your cardiologist need to make together, but it might be helpful to make sure your doctor understands the power of plant-based diets. If not, it might be wise to find one who does. These resources might interest you, if you have not already seen them:
      https://nutritionfacts.org/2016/11/08/how-well-do-cholesterol-lowering-drugs-actually-work/
      https://nutritionfacts.org/video/nuts-and-bolts-of-cholesterol-lowering/
      https://nutritionfacts.org/video/avocados-lower-small-dense-ldl-cholesterol/
      https://nutritionfacts.org/video/amla-vs-drugs-for-cholesterol-inflammation-and-blood-thinning/
      I hope that helps!

  9. Dr. Esselstyn whom most of you know of, has come to the conclusion through his many years of extensive research/experience, etc that it’s not the numbers, it’s what you eat that is important. I too stay around 205 (though in 2016 it was180, 2017 – 166 and since and before then always around 205) Don’t know why it’s back up to 205 and the only reason it went down, so I believed, was 2016 I gave up eggs which were the only animal product I was using. I still don’t consume animal products, no oil, low fat. I’m trim, active, never smoked, don’t drink, vegetarian until 20 years ago when I then gave up dairy. 17 years later, eggs. He says it’s what you put in your mouth that is important and that some of us will just have higher numbers. I don’t think he’s talking about much higher than 200 though. Since my numbers were down twice, I want to figure out why. What I was doing differently besides giving up eggs.

    1. Very interesting, i haven’t seen him say that. He allows for almost no oil or fat in food which after a lifetime of meat and eggs and dairy, was very hard for me. I did get these very healthy numbers only once- after strictly following furhman Eat to Live- pretty low starches and had lots of veggies beans greens fruits very little fat. But it was so hard!

      I’m quite sure i can get to these optimal numbers and I just Have to redouble my efforts. I at Least have zero temptation to eat animal products again and that’s a big difference.

      1. Hi Kev, it was in one of his more recent youtube vids. Don’t know the date but I’m sure it won’t be very difficult to locate. Problem is, I can’t remember if he was being interviewed by another youtuber so I don’t know if that will make it more difficult to locate. If I can find it without much trouble, I’ll let you know.

      2. Hi Kev, I found it! It’s on “The Real Truth About Health” YouTube channel.
        It was published 2/8/19 and it’s titled “How Long Does It Take On a Plant Based Diet to Lower Cholesterol”

        There is also an older one (12/1/18) which includes Pam Popper, Esselstyn, Campbell and Kim Williams. Same channel, this one titled “What is the Healthiest Cholesterol Level to Prevent Disease”

        1. Kay, ty very much for posting that. I found the video, and it appears he will make a correction in future books. We are all good then! I don’t find the diet overly difficult. If you don’t buy it, you can’t eat it (re oil or processed foods).

            1. DiNicolantonio who wrote that paper is a notorious promoter of saturated fat and salt consumption

              Yes elmiinate sugar from the diet But that doesn’t mean that saturated fat consumption is harmless All people like DiNicolantonio do is equivalent to pointing out that stabbing people is dangerous and then arguing that this somehow proves that shooting people isn’t

      3. Kev – there’s a link to Dr. esselstyn’s video in one of the responses/discussion above where he talks about he is less worried about the number than about what you put in your mouth

  10. I recall in 1973, while a pre-med student, working in a hospital drawing AM bloodwork and doing the lab tests by hand after pipetting up the plasma by mouth, that when I first entered the CCU, not all, of the mostly men were not obese and unfit, with some in excellent appearing shape. Not all smoked. I was puzzled until later in my training, when I learned of lipid disorders. Though most, as Dr Greger has pointed out, is dietary, some have a larger component of genetic causes, with my own triglycerides being greater than 2,000, despite being a very long distance runner, and at my lowest weight of 158 pounds at 5’ 11”. Eventually I did switch to a WFPBD, and my triglycerides dropped to 500, about the same as statins that caused severe myopathy causing me to discontinue them. I was switched to Zetia, eztamibe, and 2 grams of prescription fish oil twice/day and eventually my triglycerides dropped to 160. My HDL rose from 24 to 40. With diet alone my LDL had already dropped from the 130’s to low 50’s. I always exercised very hard and kept my weight down. Therefore diet had a very beneficial effect on my lipid profile but only a moderate beneficial effect on my triglycrides, due to a severe genetic disorder. Similarly, aortic aneurysms have the same risk factors as heart disease but those with the genetic disorders of Marfans syndrome or fully penetrated EDS develop aortic aneurysms, or rupture and death. There are people, therfore, who do work very hard to live an ideal lifestyle but due to genetic disorders still become sick prematurely, need medications and surgeries, and often die very young. Years of caring for those with various forms of muscular dystrophy, spinal muscular atrophy, osteogenesis imperfecta, arthropryposis, cerebral palsy, and many other genetic disorders have taught me that I/we can not control everything though we may still help by improving the quality of life of others. In fact a condescending attitude by some in the vegan community has been one of the greatest barriers i have had to overcome to convince people to switch to a WFPBD. We should remain humble and not judge others without a full understanding of the problems and barriers they may face.

            1. First, his studies were observational and not randomised controlled trials.

              Second, in the 1950s and 1960s, they didn’t really have an effective modern system for measuring symptom control/progression.

              Nor did they have MRI etc or a range of modern blood tests to make a firm diagnosis of MS (and rule out other conditions that have similar symptoms).

              It also had a large drop-out rate. Reports were only provided for 146 of the original 264 patients.

              Of course, it is possible that Swank’s diet does work. We just don’t know for certain but there is no good eveidence that it does.. McDougall’s study strongly suggests that it doesn’t but there were some differences between the diet recommended by Swank and the one in McDougall’s study. The latter was completely vegetarian whereas Swank’s diet did allow fish, egg whites, pultry and low fat dairy and recommeded daily supplements.

    1. Right Robert, I am also one of those, but risk reduction is still preferable to the futility of resignation and inaction. We can get hit by a bus or struck by lightning too, there are never guarantees, we can just try to nudge the odds in our favor by seeking out knowledge and applying it where it does the most good.

    2. Robert Haile,

      Thank you for that dose of reality. But I did not realize those in the vegan community have such a large effect on the general population. Seems like a convenient excuse to me to keep from changing behavior.

    3. Robert,

      My family has the same hurdle of feeling looked down on by the vegan community, which is interesting because they don’t really interact with any, so it has to be online because I have tried to stay silent as much as possible for most of my first year+ as a vegan WFPB.

      What I know though is that the vegan community gets pummeled by the people looking down on them and that is probably why they start fighting back and end up appearing condescending.

    4. Robert Haille – THANK YOU for making that statement. Despite my 10 year WFPB, eating food-as-grown diet I still struggle with certain aspects of my blood work but hesitate to post here because of the criticism. I can see that menopause and aging may be a part of the mix. But being told I’m not “doing it” correctly gives me great pause. Thank you for your bravery.

  11. I whole heatedly support a vegetarian diet but for the right reasons. I feel you are cherry picking your research in this piece. What about all the research that indicates that cholesterol is not the cause of CVD? What about the people with low LDL that have CVD? I have been collecting the research that contradicts what you are saying and there is lots of it. Most of the research supporting the cholesterol theory is supported by researchers getting money from drug companies selling drugs such as statins. You also don’t address post menopausal women. Research indicates that a higher cholesterol is protective of CVD and all cause mortality for post menonpausal women. https://bmjopen.bmj.com/content/6/6/e010401 https://www.ncbi.nlm.nih.gov/pubmed/27071971 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750440/ https://www.ncbi.nlm.nih.gov/pubmed/21951982

    1. Oh Lord. I have no time for these rebuttals anymore. I’ll await a rebuttal from one of you with more time on your hands to get through to this individual. GL

    2. Katherine

      These claims about cholesterol that you have posted are unfortunately misleading and dangerous. They have been raised and addressed multiple times before on this site and elsewhere. Hence Casper’s exasperation. I must admit that I groaned too!

      First, statin drugs were developed AFTER (and because) high cholesterol was recognised as a significant risk factor for CVD. The cholesterol link with heart disease wasn’t just ‘invented’ to create a demand for statin drugs as internet conspiracy theories suggest.

      Secondly, people like Ravnskov (your first link) use observational studies to argue that there is an association between low cholesterol levels and mortality in (older) populations. This is correct. However, they go on to claim that this association between low cholesterol and ill-health/mortality is causal. OK. They then go on to say that low cholesterol causes ill-health and mortality. This is a 2+2=5 argument since the evidence merely shows an association not causality, and it definitely doesn’t show that A causes B as opposed to B causing A. That’s merely a convenient assumption by the people making those claims.

      What is more, and what those people never ever mention, is that a wide range of diseases and trauma cause cholesterol to decline. So, yes, if you look at cardiovascular disease patients in hospital because they’ve had a heart attack, stroke or heart surgey, you’ll find that have relatively low cholesterol levels. Of course, they do – heart attacks, strokes and surgery all cause cholesterol to decrease. So do Alzheimer’s Disease, certain cancers, liver diseases, infectious disease like eg hepatitis and even minor infections. So do burns and other injuries for that matter. Ditto for chronic alcoholism.

      it’s unfortunately normal in Western societies for (especially older) people to have high cholesterol. The older people who don’t are mainly those who have low cholesterol because of ill health (and a comparatively small number of people who have low cholesterol because they have a healthy lifestyle or because of genetics). That’s why there is an association between lower cholesterol and higher mortality/morbidity, and why higher cholesterol appears protective.

      It’s also why being overweight and having high blood pressure appear ‘protective’ in older people too. Many diseases and traumas cause weight loss and blood pressure to decline.

      As for the Ramsden article, this is also typical of the arguments of the cholesterol ‘sceptics’. It fails to adequately address the point that back in the 1960s/1970s, PUFA margerines, spreads and oils were routinely hydrogenated and therefore high in trans fats. They didn’t know about the dangers of trans fats then. Ramsden has no such excuse. Why do you think that these people have to go back 50 years to find studies that appear to support their belief that PUFAs are more dangerous than saturated fats? Because all the modern ones which distinguish between the effects of trans fats, (unhydrogenated) PUFAs and SFAs show that trans fats are the most unhealthy and SFAs are worse than PUFAs, that’s why.

      I have a pile of references for the above statements if you want but iIsuggest that you start with the European Atherosclerosis Society’s consensus statement on LDL cholesterol and heart disease and Dr Greger’s video on this same topic

      https://academic.oup.com/eurheartj/article/38/32/2459/3745109
      https://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/

    1. LoL I don’t think it’s a matter of being rude, it’s a matter of ignoring the preponderance of science supporting what Dr G expresses. If anybody is cherry-picking, it’s the individual who grabbed a bunch of journals in his rebuttal, but I have no time or interest in even clicking on any of them. Tired of these non-plant based dieters trying to push their inferior diets. It’s like… who cares? Why do we always try to help them? It’s a waste of our time.

      1. It is a bit rude, Casper. The Golden Rule always applies; it always correctly judges between right and wrong behavior. Just ask yourself how you would want someone to respond to your post, if he/she disagreed with you or thought you were tedious.

        My main objection to [anti]social media, including these forums, is that we have learned to hit and run. We have anonymity, so no one will know who we are. We can assault and run away; we say things in text that we would never say to a person’s face. In my view, that’s cowardice.

        That was rude too… but I’ve been aching to say it somewhere, sometime.

        1. Oh Lord. I’m rude now bc I said I’m not going to waste time with someone who is clearly cemented in their own dietary ideology? Read what he said to Dr G? And my response deserves a scolding? Man, society is becoming way too fragile. I’ve just learned who to waste time helping and who not to. Nothing wrong with that. And if you think I wouldn’t respond straight to their face with the same comment, you’re terrible mistaken. I call it like it is. If you can’t handle it, trash me further or ignore my posts.

          1. [And my response deserves a scolding?]

            No, I’m only asking you to consider the way you phrase your response.

            No one is saying you are not right. You may be. It’s not the content of your views that is in question. It’s the presentation.

            You don’t answer to me, so I’ll back off.

            1. I gotcha. My style is becoming the way McDougall presented himself with Douillard recently bc we are tired of people pushing ideas that are not rooted in science.

              For example, Katherine who may be a wonderful person and a pleasure to be around, like Douillard seems to be, is reaching at whatever research possible to permit herself to consume non-plant based foods.

              She starts by saying “I support a Vegetarian diet for the right reasons” … doesn’t say “a plant based vegan diet”… and not sure what the right reasons are… but that aside… sounds like Douillard: “Dr McD, I appreciate your dedication over the course of your lifetime… BUT, I think people should be eating by Seasons”. And he flips out because it’s pure silliness.

              Any one who allows some animal food, 1% or 15% generally seems to try and make some excuse for it. I really don’t care… I’m not here to be as hardcore ethical as Gary Yourofsky… that’s not my thing.

              But we’re at a point now… 100 years later where there’s ZERO evidence that any other diet aside from a Whole Plant Based diet, is better than a WPBD.

              Yet, time and again, we keep seeing the Mark Hyman’s of the word pop up and try to put their own marketing-based spin on the “best diet to follow for superior health”… yet they have Never ever repeated what Ornish and Esselstyn have accomplished to back their dietary programs.

              So when I hear “I’m a vegetarian” and heart disease has little to do with LDL (for example), I’d have to assume the person consumes Dairy and/or eggs at minimum.

              1. Casper, I watched the video of the interview of Dr McDougall by Douillard. One of the things that Dr McDougall said was that 70 or 80% of the medical “research” papers published now are funded by institutions with a vested interest in the results, Big Pharma, etc! Long gone are the days when scientific research was somewhat unbiased and done for the sole purpose of advancing knowledge. The followers of NF are attracted to this site because it certainly appears, to me at least, that Dr G chooses unbiased studies as carefully as possible to report on. So with all the biased studies out there, it’s easy to pick a few that will “refute” what Dr G reports on. And many people are genuinely confused by these biased studies. That’s where we all have to step back and realize that we humans are primates and physiologically suited to a whole plant food diet, so a study that comes up showing something to the contrary is highly suspect.

                1. Nicely said, Hal! So true. And again, even throwing away every research paper ever released… we still are the only ones who have the works of Ornish and Esselstyn to support a reversal of a number one killer in many countries. So, again, it’s laughable that all these gimmicky book-writers like “Grain Brain, Wheat Belly, Pegan, Paleo, etc” continue to offer “new” approaches that have never ever been proven to be superior to a WPBD. So, the like Dr G has repeatedly said, “ours should be the default diet”. It’s really not hard to understand.

                  And it’s all about creating excuses for allowing some animal foods in the diet out of personal desire. That’s really all it boils down to, and that’s why they do it (aside from making money off those in the dark).

                2. Hal,

                  Yes, that is right on the button.

                  It is easy to design a study making cholesterol look good.

                  If i wanted to design a pro-cholesterol study about stroke, I would just include hemorrhagic stroke and release it just using the word stroke.

          2. If I do not want to waste my time then I do not bother responding to a post or person. No one here is made responsible for answering every post or even asked to. Please keep these comment courteous.

            1. Well true. I am spending time crafting comments. But the time wasting would be trying to convince someone (with opposing views stuck on a handful of opposing research papers) that Dr G’s views are correct. The reason is, it’s very clear how deeply attached to a viewpoint one is when they craft their post attempting to poke holes in Dr G’s work. So, I see through these individuals. And I know it’s foolish of me to go diving in and reading all these opposing papers to then create a rebuttal and attempt to get through to that person. It doesn’t do anything for me. I’d much rather spend the time helping some folks like Julie, Joy, and Florence figure out where they could possibly improve their numbers. That’s much more productive. And yes, I’ve gone “unhinged” McDougall over the past couple of years because it’s tiring seeing Mark Hyman and William Davis brainwash ignorant victims by telling them good things about their bad habits and setting them up for early disease and death.

              1. Casper,

                What I am understanding is that people are coming against the data without explaining which version of WFPB they are on and whether they eat the foods Dr. Greger has highlighted.

                Are they including beans 3 meals per day?

                Are they getting enough fiber?

                Do they eat their flax and oats?

                Have they tried Amla?

                Soy?

                A handful of nuts?

                Do they eat sodium or oil or use sugar?

                How many years have they been WFPB and see they vegan or do they eat animal products?

                Do they supplement with a shelf-stable B-12?

                To be helpful to the community, those are the types of things we need to know.

                We already have one person who succeeded on Dr. Fuhrmsn’s diet, but went back up with things like French fries added back in.

                THAT is truly useful to me.

                I know beans help and that is something, Dr. Fuhrman promotes highly and so does Dr. Greger.

                Those of you who are struggling, do you eat your Daily Dozen?

                Have you tried it?

                1. For the rest of you, Casper is frustrated that people are giving generalizations that it doesn’t work without saying what they are doing?

                  Have you tried MacDougall? Have you tried Ornish? Have you tried Greger?

                  Please share which ones you have tried which you would call fails?

                    1. Reality Bites, no offense but I’ve seen you complain multiple times on the way these message boards go, complaining people were seeking “free advice” or something, so isn’t that quite hypocritical?

                2. Deb, they’ve answered some of the questions but still without a clear break down, we’d never be able to get the full story.

                  And again, it’s very possible they’re eating on the level of Dr. Greger and it’s a matter of genetics or other factors. Who knows. They seem to think there’s no room for improvement and don’t need community suggestions so it is what it is at this point.

        2. I think it’s different. In YouTube cases that certainly seems to be the case, dr cobalt. But much of the time here I think that people just get frustrated when dealing with people who argue despite evidence and repeat refuted arguments over and over when that can potentially create confusion and misinformation or advice that may be harmful. And then people are so used to dealing with some of those types here that they aaaume that’s the case for everyone who actually might just be genuinely asking or wanting to discuss something.
          I really think it’s just misunderstandings a lot of the time.

        3. Thank you Dr. Cobalt for your comment. Despite being WFPB for a decade I hesitate to comment here sometimes because of the rude responses. Manners and politneness never goes out of style.

        1. DiNicolantonio is another well-known saturated fat advocate. He’s just trying to give saturated fat a free pass by arguing that sugar is even worse.

          He’s attempted to do a simliar whitewash on sodium.
          https://www.theguardian.com/science/2017/aug/08/a-danger-to-public-health-uproar-as-scientist-urges-us-to-eat-more-salt

          In both cases, he argues dietary guidelines should relax recommendations to limit their consumption.

          None of his arguments are convincing.

  12. It seems more and more is being put forth about inflammation as a cause of atherosclerosis and a lesser focus on cholesterol. In fact, some are saying that cholesterol is not to blame and that it only tries to be a “band aid” for the inflammation and irritation by the already existing plaque in the vessels.
    It would be wonderful to hear Dr. Greger’s thoughts on this.

    1. Check out the YouTube vid by “The Real Truth About Health” titled “How Long Does It Take On a Plant Base Diet to Lower Your Cholesterol” by Esselstyn. He says to keep the endotheliah cells/lining healthy so pockets/cracks aren’t created for the cholesterol to enter and create inflammation.

      1. Dear Kayte and Karen B, thanks for your discussion on cholesterol.
        In this review below, they look at Vitamin E and K and absorption and arteriosclerosis and cholesterol. As you realize the complexity of the body and different aspects are involved in different individual in relation to cholesterol. Discrepancies between in vitro and in vivo data have been frequently observed in studies on intestinal lipid transporters, and such discrepancies have made it difficult to uncover the physiological functions of these proteins. One of the main reasons for these discrepancies is that compensation systems are working in vivo to maintain lipid homeostasis.I am including this review reference for your information.
        The membrane proteins that have the potential to transport dietary lipids such as cholesterol, vitamin E, and vitamin K1 were discussed in this review. Intestinal lipid absorption is regulated by multiple processes, including apical uptake, apical backflux, basolateral efflux with HDL, and lymphatic secretion with chylomicrons (Fig. 2). Interestingly, despite the differences in chemical structure among cholesterol, vitamin E, and vitamin K1, the membrane transport processes of these lipids are very similar. Indeed, as descried in this review, most of the intestinal cholesterol transporters also have the ability to transport vitamin E and vitamin K1. Vitamin E acts as an antioxidant, potentially preventing the occurrence of cardiovascular events2). Vitamin K inhibits the development of arteriosclerosis by activating the matrix Gla protein, which suppresses vascular calcification1, 75). Based on this data, it seems reasonable that cholesterol transporters are also involved in the intestinal absorption of these vitamins in order to prevent the harmful effects of excess cholesterol on the body.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392472/

    2. Defenders of high cholesterol and high saturated fat foodstuffs have been making this argument for years. It’s highly deceptive.and an attempt to distract attention away from the known effects of both high dietary and high blood cholesterol by posing it as an either/or argument.

      It’s not. Both are highly relevant. What is more, high blood cholesterol is itself inflammatory (so are cholesterol containing foods for that matter) eg

      ‘Hypercholesterolaemia leads to cholesterol accumulation in macrophages and other immune cells, which promotes inflammatory responses, including augmentation of Toll-like receptor (TLR) signalling, inflammasome activation, and the production of monocytes and neutrophils in the bone marrow and spleen. On a cellular level, activation of TLR signalling leads to decreased cholesterol efflux, which results in further cholesterol accumulation and the amplification of inflammatory responses. Although cholesterol accumulation through the promotion of inflammatory responses probably has beneficial effects in the response to infections, it worsens diseases that are associated with chronic metabolic inflammation, including atherosclerosis and obesity’

      http://www.nature.com/nri/journal/v15/n2/full/nri3793.html
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116370/
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623938/
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909263/

    3. Karen B – this is a subject that I’m interested in as my numbers (cholesterol, LDL, triglycerides have gone up and my HDL has gone down. All beyond the “safe” and recommended level (but not out of this world or anything). My CHOL/HDLC ratio is 5.2 which is consider to be high. And yes I eat a WFPB, food-as-grown, no refined products including bread diet and have for a decade. I have my suspicions what has caused this and I will take action and see if I get results. HOwever, what I wanted to bring up to you was that my last blood test, last Nov., I also chose to get a hs- CRP. High sensitivity C-reactive protein which measures the inflammation in one’s body. It is also thought that inflammation may be as great a cause for heart attack and ill health. With my high numbers I though it might be worth looking at this figure. To my delight, my hs-CRP level was 0.4 which indicates “Lower relative cardiovascular risk”. Ideal is below 1; 1-3 is average; 3-10 is higher relative risk. So it is interesting to me that all of my cholesterol numbers are “not ok” at this point but my hs-CRP is excellent. I’m not going to worry about this – I’m going to make some dietary-lifestyle changes and see what kind of results I get.
      My point about posting this is that there is a still a whole lot that we do not know about these numbers and how it all interrelates. Being rigid about it all, I find, is not helpful to me.

      1. Thank you Ruth for the interesting insight. How wonderful that your CRP is low!
        I wish you all the best on your journey to reduce LDL.

      2. Ruth and Karen, thanks for your helpful comments. Just wanted to add briefly that I too pestered my doctor to get my hs-crp done with my last tests, and it came back 0.35 So Ruth, like you I breathed a little easier thinking if there is no inflammation going on, we’re good. WBC was 4.5 or something close.

        1. KDB, Barb, and other women having difficulty with raised cholesterol:
          Just after I posted my paragraph above about my raised cholesterol numbers (from last Nov), my new blood results came in from my blood draw of 4 days ago. How’s that for timing?

          So here’s my situation. Last Nov, cholesterol was 234; HDL 45; Triglycerides 308; LDL 145; hs-CRP 0.4; weight 150 (5’7″). I am 65, menopause at 58. A1c 4.7; fasting glucose 84.
          Results of 4 days ago are: Cholesterol 182; HDL 46; Triglycerides 130; LDL 111; hs-CRP 0.7; weight 140; fasting glucose 92.
          So cholesterol dropped by 22%; Triglycerides by 58%; LDL 23%; with a 10 lb weight loss. I still have LDL work to do I see.

          So that’s some good news and I feel a little better.
          But here is the “bad” news. I changed only one thing in my diet and it’s something that I don’t see talked about very much. The one thing I changed was that I gave up alcohol in all forms. For the last 5 months I had 1 drink on 3 occasions with dinner and otherwise had no alcohol. For me, and for many women I know, wine is the one thing I have not changed in my diet and lifestyle after having gone WFPB, food-as-grown a decade ago. Wine, each day after work, a couple-few glasses, has always been my little daily reward. I have done this for decades and it’s something I’ve always enjoyed. But I needed to find out if this was part of the reason why my numbers were not where I wanted them to be despite being very diligent about my diet.
          I did find some information that one should have at least 48 hours of time between the last drink of alcohol and a blood test.
          https://www.emedicinehealth.com/cholesterol_tests/article_em.htm#can_i_drink_coffee_the_morning_of_the_cholesterol_test
          As well, drinking more than the moderate recommended amount (1 drink for women) can raise both cholesterol and triglyceride levels.
          So it appears to me that my evening wine drinking greatly affected my cholesterol and triglyceride numbers. I’m sharing this information here in case it’s useful to anyone else.
          Sorry if this is sad news to you :-( !! It is to me as I enjoy my wine. :-) But I intend to drink a lot more selectively and see if this continues to make a difference. Best to all –

          1. WTG Ruth! Great difference in numbers! I don’t drink, but I have been looking at another angle too, and that’s intermittant fasting can raise cholesterol ( by a lot! like over 25%) in some people. I have been reading all day but will post when I can find a clearly written article. This may be why Dr Longo does not recommend intermittant fasting for heart patients. Anyway, watching Dr Li’s video at the moment – thank you Ruth for the link, and again, terrific sleuthing on your part!

  13. Thanks. I always enjoy watching your videos.
    I just read an article recently on a study funded by NIH (published in Neuroscience News, 10April2019) with a few findings below: “those with very low LDL cholesterol were 2.2 times more likely to have a bleeding stroke” “After adjusting for other factors that could affect risk, researchers found that those with the lowest triglycerides were twice as likely to have a bleeding stroke.” It goes to say that what may protect your heart may not be protecting you from hemorrhagic stroke. They studied approximately 28,000 women of > 45 years with to LDL < 70 mg/dL. Any thoughts on these?

  14. @ Julie and Florence
    We could only make suggestions with a daily intake example. Until we see this, impossible to see why you can’t get TBC down to 150. For all we know, it could be you’re eating a wonderful PBD but overweight, and consuming too many calories overall. Could be you’re not consuming enough fiber. Could be you love coconut ice cream and have a cup every evening. I’ve met vegans like this. And despite having a pretty darn good diet, they can’t get out of that 200 range and A1C remains around 6% as well. Just saying. You’d like help… let us help you. But we need details.

    1. Casper-kind of you to offer the diet exam, it is appreciated. My reluctance is due to laziness I believe. If you eat a wfpb diet then you know how many different foods that can end up being in a day. Trust me when I tell you that I am not over weight and I am not so silly as to be eating something as fat laden as coconut ice cream and not realize it’s contents. Plenty of fiber as well. My comment was just that-a comment, not a plea for help. It is nice to know that there are still people out there willing to help strangers so thanks!

      1. Cool. I wasn’t thinking you were silly. But I never assume someone is not eating coconut ice cream. It’s common in the vegan community. I’ve done it plenty of times myself and I don’t worry about it because my TBC remains under 150. The break down could shed light on getting too much or too little of something or to find other ways to modify the numbers. Remember, McD and Fuhrman for example are on opposite spectrums of plant based nutrition. And there’s every combo in between. We don’t know the depth of your knowledge and level of detail you put into constructing a daily plan. That’s why to see a break down always helps gain clarity.

        But completely understand why you wouldn’t go so far as to post that break down. I do wish you the best health!

  15. Look at the NMR profile for detailed lipid parameters (see Youtube Lecture by Ron Krauss MD, lipid specialist)..The number of small LDL particles correlates much better with CVD. As a proxy, elevated Triglycerides with low HDL, a TG to HDL ratio greater than 2, is a better indicator. And look at indicators of metabolic syndrome or pre-diabetes – consistent fasting glucose above 90, and HbA1c > 5.5. Inflammation as measured by CRP is also a risk factor for CVD, and carries a higher hazard ration than LDL. CRP should be well below 1. Elevated blood pressure is also a major risk factor.

    Shoot for: Blood pressure < 120/80, HbA1c < 5.5, ideally <=5.0, fasting glucose <90, sdLDLp (small dense LDL particles) < 500, with total LDL particles <1000, and hsCRP<=0.5.

  16. I have tried my Brain Gauge twice and it is so fascinating.

    It has these annoying little tests, which seem to be accurate.

    It is so annoying, but I can already see it will be useful.

    Fascinatingly enough I got a better score at 2 in the morning than at 5 PM.

    But I got a perfect score on focus and at 5 pm I also got a perfect score on fatigue

    Where at 2 in the morning, I got nearly a perfect score on focus and 50% on fatigue.

    Time passing and reaction time are quite low. Not surprised at all.

    Interestingly, Temporal Order Judgment was near perfect at 2 in the morning and only 50% at 5 PM.

    My overall score dropped significantly at 5 PM.

    Tomorrow, I will try to test 10 in the morning or something.

    It is stressful for me taking the test, but I did find out that the NASA guy had also had a stroke and he wrote a book on increasing plasticity and my plasticity is much higher at 2 in the morning than it is at 5 PM, too.

    That explains why I can get so much work done around that time.

    1. I took the test at 7 in the morning and nailed brain plasticity 99% and accuracy and fatigue with only a slight drop in focus, but my time perception dropped seriously low and the temporal order judgment which was near perfect at 2 in the morning and only 50% at 5 PM dropped to 5% at 7 in the morning.

      98% at 2 in the morning and 5% at 7 in the morning!

      I don’t know how I am going to apply all of this, but it is fascinating to see that my brain is so different at different hours of the day.

  17. My doctor told me that studies show soy contains a certain protein that interferes with thyroid function. I thought the soy-bad was debunked. She says info is on Google Scholar but i cant find anything. I would not like to give it up for no reason even though just a half cup for breakfast.

    1. Kerry, your doctor is like 10 years behind the times. Search Nutrition Facts for all Soy videos. Plenty debunk that nonsense.

    2. Casper is spot on.
      As long as you have a normal thyroid and get sufficient iodine in your diet, there should be no problem.

      Cf. https://www.ncbi.nlm.nih.gov/pubmed/16571087

      “Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function. In contrast, some evidence suggests that soy foods, by inhibiting absorption, may increase the dose of thyroid hormone required by hypothyroid patients. However, hypothyroid adults need not avoid soy foods,…”

      NB. Euthyroid := having normal thyroid gland

      1. Exactly. You nailed it. Iodine is key. Same goes for Kale. Absolutely no need to avoid Kale as long as you have enough iodine. You could consume several servings and it shouldn’t be a problem. Lots of misinformation has so many thyroid patients fearing Kale.

        1. Thank you for the info Gengokakusha and Casper Gomez, will have a look at the link to ncbi. I have been hypothyroid and on thyroid replacement most of my life. Have been drinking soy for 10 years. Only way is to eliminate then test I suppose. :(

          1. I would try to go to a plant-based doctor if possible. They seem to pretty much be the only ones who solve health problems, and not create new ones.

            Dr. Klaper does Skype sessions last I checked. Your issue is much more involved than any advice I could possibly give.

          2. “I would not like to give it up for no reason”

            So smart of you, Kerry. More often people just trust this kind of advice off hand. You’re taking Dr. Greger’s recommended approach of “show me the evidence,” especially when it’s something you like and is beneficial.

            I had mild hypothyroidism, but I think it was a consequence of poor diet exacerbated by an injury to my liver (a horrible mistake made in a hospital by a horrible doctor and his team of interns). They put me on a low dose of synthroid, but after reading it can permanently make your thyroid dependent on the drug, I decided to take a natural approach. I just started eating more and more WFPB and made sure I got enough selenium (through brazil nuts) and iodine (through a small amount of kelp granules, sometimes dulse) and things seem to have corrected themselves. I approached it as a whole body situation and not just that there was something wrong with my thyroid. But mine was a mild case. I continued to eat soy and crucifers. I also made it a point to get off the medication I was taking for OCD for that and other reasons. I’m not sure if there was lithium in my medication, but I know certain antidepressants contain it and I learned that lithium used to be used to suppress thyroid function in people with hyperthyroidism. I also made sure to drink unfluoridated water as my regular water source as I’ve read that fluoride can interfere with iodine absorption, but I don’t know how relevant that is. I drink plenty of tea and don’t worry bout the fluoride, though.

            1. I also take ashwaganda herb capsules (Organic India brand) for assistance, seems to help with anxiety, too. I’m hoping Dr. Greger will come out with a video on adaptogen herbs like ashwaganda and tulsi.

    3. Yes, make sure you get your iodine.

      If your thyroid seems sluggish, a Russian study showed that light therapy helped 80% of the time.

        1. Infrared (or Low Level Laser).

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523874/

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534372/

          Here is a safety study of the Low Level Laser. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247385/

          It said that infrared has replaced it. It is easy to get an infrared therapy bulb on Amazon. Maybe $25, but you also would need a brooder lamp of the proper watts, which is $10 to $12. They even have some smaller cheaper bulbs.

    4. Kerry – this video is an hour long but it’s extremely interesting (not just soy is addressed). This is William Li, M.D. who is doing extensive research on food as medicine and what we can add to our diets to protect our health. He is pretty much the #1 guy doing this at his research institute. It’s brand new and just posted about 3 months ago. It’s worth everyone’s time to watch it. Title: How the Body Heals Itself https://www.youtube.com/watch?v=wlJEGJvI1UA
      Cheers!

    1. Incorrect. The world famous William Davis is a Cardiologist and his diet is quite different than WPBD. He has never published any work proving his diet could reverse heart disease. It means nothing speaking to a Cardiologist if he’s promoting foods that contribute to heart disease.

      1. Casper,
        This reminded me of my brother’s experience. He’s been treated by a cardio for many years for afib. For years I recommended he go on a WFPB diet without much success (but to be fair, his diet was very good for one that includes animal foods regularly). At one point, he needed an emergency stent put in, and so the cardio wanted to put him on a statin. He refused and instead went 100% WFP, dropping his LDL to ~75 quickly, at which point he asked the cardio why he had never recommended that diet. The answer was that although the cardio knew such a diet could work and used to recommend it, not once had a patient adopted it, so he gave up in frustration.

        People learn by sharing information. Learning is messy, and each person must be responsible for vetting any ideas they come across (even discussing it with their doctors), but that does not mean some arbitrary doctor is a better source of information, especially when it comes to diet. Ridiculous.

        1. Wow that’s some story and sounds exactly what the leaders say all the time, especially Dr. G, how doctors just assume people won’t follow the changes that are required to heal themselves. It’s really sad. That’s why it’s crucial to go to a vegan or plant based doctor. Because they generally take a nutritional approach.

        1. Correct. Atkins was another scam artist who made millions while alive. Made millions of people sicker. The most dangerous man in America died, and passed the torch to the new most dangerous man in America.

        2. Atkins’ “nutritional approach” was uninformed and irresponsible. Imconsideeing everything, I can’t believe they still sell his diet via the candy bars, etc.
          I still know people who take his deadly advice… thinking eating a plate of ground “beef” for dinner is the healthy choice. It’s scary. And yes I’ve tried explaining to people.

      1. Olive leaf extract is bactericidal. It may lower cholesterol but what does it do to our microbiome?
        —————————————————————————————————————————–
        Good question… one I’ve also considered when putting oregano drops in my tea each time I cold-brew a cup. My guess is that the digestive system somehow mediates these conflicts so they co-exist. But just to be on the safe-side, I take a half teaspoon of inulin daily in guava or mango juice, plus I eat a bran blueberry muffin daily as well as a semi-green banana. System-wise, everything seems to be copacetic.

  18. Great flashback friday choice! So much misinformation about cholesterol not being important.

    Plants are amazing things. My uncle ate a SAD and seemingly just from snacking on sunflower seeds (his only dietary and lifestyle addition or change), his cholesterol dropped to a point that impressed doctors and told him to keeping eating them. My cousin who is young but was having some issues, still eating a SAD had a significant drop from no other change than eating a small amount of beans everyday.

      1. Scrolling quickly, here’s a bit form that paper: “We urge dietary guidelines to shift focus away from recommendations to reduce saturated fat and towards recommendations to avoid added sugars.”

        Mr Fumblefingers has made some good posts on this site about using sugar as a means to distract from saturated fat. I wish I could locate them now.
        I find anything that says it wants to shift focus away from reducing saturated fat suspicious and something I would choose to disregard–they already got their bottom line wrong after all. If concerned about highly refined carbohydrates, why not make it a goal to recommend avoiding that along with foods high in saturated fat… Something isn’t right with that.

        1. DiNicolantonio is a well known advocate for saturated fat and sodium. He thinks that WHO and national dietary guidelines around the world that recommend stringent upper limits on saturated fat and sodium (salt) consumption should be relaxed.

          I dare say that the meat, dairy and processed foods industries would be cock-a-hoop if his advice was taken.

    1. Jayakumar, this is the “thing” people like to say now, I’m not sure where it originated from. Have you watched Dr. Greger’s other videos on cholesterol? There are a lot of great ones on cholesterol and heart disease, here’s one of them: https://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/

      The pubmed article you provided just makes no sense to me. There is so much evidence as presented throughout this site and elsewhere. What’s more alarming is in their conclusion there is a direct, strong promotion of eggs which are very unhealthy. The egg industry is also hugely corrupt (Dr. Greger has many videos on eggs and the egg industry), so that raises some suspicion in me. Although the authors report no conflicts of interest, I suspect there might be–it wouldn’t be the first time no reported conflicts of interests didn’t turn out to be true.

    2. It reads exactlly like something the Egg Nutrition Council would say eg ‘Considering that eggs are affordable and nutrient-dense food items, containing high-quality protein with minimal saturated fatty acids (1.56 gm/egg) and are rich in several micronutrients including vitamins and minerals, it would be worthwhile to include eggs in moderation as a part of a healthy eating pattern.”

      It is also misleading in several respects. First, yes the300 milligramme dietary cholesterol limit was dropped from the latest US dietary guidelines. However what the guidelines actually say is this

      ‘The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM,[24] individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.’
      https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/

      Eggs are not needed as part of a healthy eating pattern.

      Further, lots of carefully designed egg industry ‘research’ has reported that dietary cholesterol has little effect on blood cholesterol. This is true in the context of the standard American diet. However, It is easy to design studies that appear to show this since we have known for decades that

      ‘Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is modulated by baseline dietary cholesterol. The greatest response is expected when baseline dietary cholesterol is near zero, while little, if any, measurable change would be expected once baseline dietary cholesterol was > 400-500 mg/d. People desiring maximal reduction ofserum cholesterol by dietary means may have to reduce their dietary cholesterol to minimal levels (< 100-150 mg/d) to observe modest serum cholesterol reductions while persons eating a diet relatively rich in cholesterol would be ex- pected to experience little change in serum cholesterol after adding even large amounts ofcholesterol to their diet"
      http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.549.6029&rep=rep1&type=pdf

      Since the standard US diet is already high in cholesterol, it is not surprising cholesterol from eggs added to that diet has little effect. The egg industry and its supporters continually deliver studies that show this and ensure that they receive wide publicity in the media. However, they somehow overlook earlier independent research that shows blood cholesterol levels of people eating healthy diets, being significantly increased when eggs are added.

  19. Thank you for all that you do Dr Greger! It’s because of you I changed to a WFPB lifestyle nearly two years ago and it has changed my life in so many positive ways! I am very passionate about informing people of their food choices, therefore I have created a petition to label carcinogenic foods the same way we do with cigarettes. I think it’s time we can make informed decisions for ours and our families health. If everyone watching would like to have a look and sign it, I would be very grateful :) Thank you!!
    https://www.change.org/p/hon-dr-steven-miles-warning-labels-for-carcinogenic-foods

  20. My numbers are :
    “total cholesterol 4.8 mmol/L
    Triglycerides 1.0 mmol/L”
    I have no idea if these are too high.
    Anyone care to comment/interpret please?
    Many thanks

    1. Hello Lynda,

      If you are aiming for optimal levels, you want to drop your total cholesterol to 3.8mmol/L or lower. If you have not yet adopted a plant-based diet, that could be a great way to achieve optimal levels.

      I hope this helps,

      Matt, Health Support.

    1. Hello Helen,

      Soy is actually a very healthful food; however, you may want to limit soy to 5 servings per day. Too much soy can raise IGF-1 levels, which may produce negative health effects, cancelling out the benefits of soy. I have left a link to a great article by Dr. Greger on why he recommends no more than 5 servings/day.

      I hope this helps,

      Matt, Health Support

      https://nutritionfacts.org/2013/02/19/how-much-soy-is-too-much/

  21. Off-topic comment ………..

    Where I live, tree nuts are difficult to find and prohibitively expensive when they are found. Peanuts on the other hand [very weak joke alert] seem to grow on trees – they are everywhere and very cheap. So some recent news about nut consumption and diabetes was a bit disappointing (even though I don’t have diabetes personally)

    ‘For each one serving increase in total nuts per week, the risk for CVD decreased by 3% and the risk for death from CVD decreased by 6% (P linearity <.001).

    More specifically, eating higher levels of tree nuts was linked to a lower risk for CVD, CHD, death because of CVD, cancer, and all-cause death (all P trend <.001).

    These observations did not apply to peanuts. The only outcome that was significantly reduced with increasing levels of peanut consumption was all-cause death (P trend <.001).'
    https://www.medscape.org/viewarticle/911454?src=wnl_tpal_190413_mscpedu&impID=1936065

    Gee, eating peanuts only reduces the risk of death. Bugger.

      1. I remember seeing that when I was in the beginning of trying to treat my dog’s cancer.

        I was using Modified Citrus Pectin to lower Galectin 3 and he loves peanut butter and I couldn’t give it because that fought against what I was trying to do.

        Wow, that was almost 11 months ago.

        I specifically remember that peanuts scored pretty good in the killing cancer cell study, but raised G-3.

        I can’t remember if it a potential source of Aflatoxins, too, but eating peanut butter versus peanuts decreases the risk by quite a bit.

        I don’t think the aflatoxin risk is as big for the USA. Theoretically, it is being tested.

        But, yes, our food safety seems to show up in the news regularly.

        I am not worried about it. But if I had a diagnosis of cancer, I would not eat it.

        1. Deb, Dr. Greger addressed the concern over alfatoxins in peanuts/peanut butter in the comments section under one of his older videos a while ago. He explained that it was all over due to VERY poor storage in some poorer country or countries (going on memory) and that we really have nothing to worry about. The internet did an awesome job at blowing THAT one way out of proportion…

      2. Hi Hal

        I am pretty sure that most if not all foods contain some components that are harmful. But there are many many thousands of individual elements in every food. What’s important I think is the overall effect and as far as I know, peanut consumption is linked with lower cancer risk not higher eg

        .https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754291/
        https://www.ncbi.nlm.nih.gov/pubmed/29594821
        https://www.ncbi.nlm.nih.gov/pubmed/28768652

        Whether it accelerates an existing cancer is perhaps another matter and not known I think. Personally I suspect it’s unlikely but that’s just an opinion

  22. I believe that in some situations an individual has back pain. The individual consumes a NSAID (other than aspirin) for the back pain. The individual has a stroke (all NSAIDs except aspirin increases the risk for stroke and heart-attack) and possibly followed by a heart-attack and shortly dies. A friend recently died from possibly this situation. Sometimes eating perfectly and then using drugs cause deaths. Food for thought.

    1. George,

      Sorry to hear about your loss.

      I had several people around me bleed out after falls while they were on blood thinners.

      It was so strange. I had never heard of it before Dr. McDougall talked about it with the Eskimos dying of nose bleeds, but now I do know that it is such a big deal.

      In each case, the person hit their heads and even though they were able to interact, it was just announced that they were going to die.

      They didn’t give Yunnan Baiyao or the little red emergency pill which comes with it, which I believe contains dragon’s blood. It isn’t something I would necessarily trust because China was so secretive about the ingredients, but it has been used with bleeding horses and bleeding soldiers and there is enough anecdotal evidence that if it had been my relative, I would have been sneaking one in before the ambulance trip.

      It makes blood thinners such a big deal.

  23. Cholesterol has been totally over hyped by the statin companies and in fact has little to do with heart disease. A major study looked at around 1500 people admitted to hospitals for serious heart events and found half had LDL below 100. The statins were launched by using percentages to hype low absolute results. The number needed to treat for the statins and other cholesterol drugs runs anywhere from 60 to over 100. Where are all the headlines about reducing cholesterol and reduced heart disease? Where?

    Yes nutrition can help alot but just want to tell people that if you are on a statin, get off. The side effects are horrible and well documented too. If you look at morbidity which really reflects the entire effect, the results are disastrous.

    1. Kip,

      I couldn’t agree with you more however, it’s about finding the balance between what works for your body and lifestyle.

      Many of my patients have “elevated” cholesterols but no elevations of the most arteriosclerotic forms, RLP’s, Lipoprotein (a) or the other CV metabolic indices ( https://www.spectracell.com/cardiometabolicriskoverview/). And with repeat US studies show little to no plaque buildup. So no satins are no the be all end all by any means nor should chasing cholesterol numbers be the only way to change ones health index.

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

      1. Dr. Esselstyn said that if the person is really doing a perfect WFPB diet, he isn’t worried up to 200 cholesterol, but he says that he still gets concerned when the person’s cholesterol is closer to 300 even if they are perfect WFPB. Though he said that he starts with tweaking the diets.

    2. Kip

      I am sorry but I think that you have repeated the disinformation assiduously promoted by people selling sensational mass market ‘health’ books and diet plans targeting people who just want to be told by someone – preferably wearing a white coat – that their high cholesterol is OK and so is eating steak, cheese, butter and bacon. It is found all over the internet and in scores of ‘shock/horror/startling new health revelation’ type books being sold to an eager but unwitting public.

      Look for example at this statement you made/quoted

      ‘A major study looked at around 1500 people admitted to hospitals for serious heart events and found half had LDL below 100.’

      That statement may be factually correct but it deceives by omission. What it omits to tell us is that serious heart events themselves cause cholesterol to decline sharply so you’d expect people admitted to hospital with a serious heart event to have declining cholesterol levels:

      ‘Serum cholesterol concentrations drop significantly during hospitalization for an acute coronary syndrome after a few hours from admission to the coronary care unit.’
      https://www.ncbi.nlm.nih.gov/pubmed/12478816

      ‘From day 1 post-MI to day 4 post-MI, the mean (± SD) serum levels of total cholesterol (188.4 ± 52.5 vs 170.5 ± 57.2 mg/dL, respectively; p = 0.01), LDL cholesterol (120.3 ± 48.9 vs 105.9 ± 43.0 mg/dL, respectively; p = 0.009), and HDL cholesterol (45.0 ± 18.5 vs 39.3 ± 16.1 mg/dL, respectively; p < 0.001) decreased,'
      https://journal.chestnet.org/article/S0012-3692(16)35525-8/pdf

      'Both total cholesterol and low density lipoprotein cholesterol (LDL-C) levels decreased significantly (by 9%) in the 24 hours after admission and by 13% and 17% respectively on day 4.'
      https://www.ncbi.nlm.nih.gov/pubmed/26233997

      What that major study you quote and the others above don't tell us is the most important and relevant cholesterol number of all – what were the cholesterol levels of the people who suffered serious heart events BEFORE those events occurred? That is what would tell us most about cholesterol levels and risk

      As for the statin issue, all the evidence shows that they reduce adverse events like death If you consider that disastrous I would strongly disagree
      https://jamanetwork.com/journals/jama/fullarticle/2584057

      As the independent Cochrane Review concluded 'Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost-effective in primary prevention.'
      https://www.cochrane.org/CD004816/VASC_statins-primary-prevention-cardiovascular-disease

  24. My LDL is 28.2 mg/dL. You say optimal is between 50-70, but what does it imply if it is too low? How do I boost it? BTW, my HDL is 39 mg/dL. This was a recent non-fasting test result.

  25. Trina,

    Welcome to having an unusual situation. There are a number of associated disorders that should be evaluated when your cholesterol is so low. Please see more info at: (https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/lipid-disorders/hypolipidemia) and yes they use the conventional lipid numbers.

    The need for adequate cholesterol has to do with the production of many of our hormones. Low levels are typically associated with a number of problems. For a good overview see the easy to read pictorial at: (https://www.healthline.com/health/cholesterol/effects-on-body)

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

    1. Couldn’t not getting enough EFA’s play a roll in situations like these?

      (Sorry if there’s multiple posts, my comment doesn’t seem to be showing up)

  26. I’ve been a vegan for 10 years, exercise 5 days a week, eat tons of beans, flax, whole grains and vegetables and my LDL is 94, HDL 67 and total is 179. I’m very confused. I saw someone in the comments mentioned it could be genetics which is really the only thing that makes sense to me because I can’t imagine doing anything more to lower my LDL.

  27. Veganinja,

    You’re on the mark…. familiar hyperlipidemia (https://medlineplus.gov/ency/article/000392.htm) is a common disorder.

    As a note you don’t qualify in that category however, you’re correct that you can only change so much given certain gene expressions. I’d encourage you to not focus on the numbers, but rather the type of cholesterol and keep up the great life style choices you’ve made. With your ratio of HDL/LDL and the moderately lower total cholesterol you’re probably in a good area for your body.

    If you want to explore further consider the CV test by Spectracell. (https://www.spectracell.com/cardiometabolicriskoverview/)

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

  28. I despair, more fear mongering about LDL being the main driver of heart disease. First of all you have to take away lipid lowering drugs from graphs and adat on LDL and heart disease. You have no way of knowing that lower LDL played any part, perhaps the anti inflamatory qualities played a larger role.If you look at LDL outside of drug based trials the association is weak to non existent. This Israel based trial focuses more on blood pressure and HDL which is why Total/HDL ratio is a far better predictor than LDL

    1. Mark

      You are simply in denial about the facts. You have also been confused by the arguments of con artists and cranks. The HDL/LDL ratio may or may not be a better predictor That is not the point The point is that LDL levels are a modifiable risk factor The ratio isn’t.

      The reasons we know that LDL cholesterol is atherosclerotic are set out here
      https://academic.oup.com/eurheartj/article/38/32/2459/3745109

      ‘We assessed whether the association between LDL and ASCVD fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, and randomized trials of LDL-lowering therapies. In clinical studies, plasma LDL burden is usually estimated by determination of plasma LDL cholesterol level (LDL-C). Rare genetic mutations that cause reduced LDL receptor function lead to markedly higher LDL-C and a dose-dependent increase in the risk of ASCVD, whereas rare variants leading to lower LDL-C are associated with a correspondingly lower risk of ASCVD. Separate meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, and randomized trials including more than 2 million participants with over 20 million person-years of follow-up and over 150 000 cardiovascular events demonstrate a remarkably consistent dose-dependent log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C. Both the naturally randomized genetic studies and the randomized intervention trials consistently demonstrate that any mechanism of lowering plasma LDL particle concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C, provided that the achieved reduction in LDL-C is concordant with the reduction in LDL particle number and that there are no competing deleterious off-target effects.

      Conclusion
      Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.’

      1. Here si the key phrase from you study

        “provided that the achieved reduction in LDL-C is concordant with the reduction in LDL particle number”

        Evidence shows that what you would consider high LDL C but low LDL P does not lead to high rates of heart disease especially if HDL is high

        1. That’s not what it means. The key part is

          ‘Separate meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, and randomized trials including more than 2 million participants with over 20 million person-years of follow-up and over 150 000 cardiovascular events demonstrate a remarkably consistent dose-dependent log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C.’

          The phrase you quote is about the mechanism of risk reduction. It seems to state that lowering total LDL-C appears not to lower risk if LDL particle number is not also reduced.

          Do you have any evidence to support your statement that “evidence shows that what you would consider high LDL C but low LDL P does not lead to high rates of heart disease especially if HDL is high’?

          1. Here is one

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

            ” Among the 764 individuals in the bottom quartile of LDL-C, 603 (79%) had concordantly low LDL-P (25th percentile) (data not shown). The unadjusted event rate was more than double in the latter group; there were 46 events in the concordant group and 29 in the discordant group. After age and gender adjustment, event rates in these 2 groups were 65 and 85 events per 1000 person-years, respectively.”

  29. DOES
    100% grass fed cooked on low heat beef/lamb
    LOWER CHOLESTEROL?

    Okay, this is definitely anecdotal, however it IS my experience:

    At one time I was eating 2 – 2 1/2 lbs of standard roast beef each day and my Total Cholesterol was 240. Then I switched to eating a mixture of oats, olive oil and ground turkey breast snd my TC dropped to 170. Then I switched to 100% grass fed beef and my TC dropped further to 140!

    My own advice to those vegetarians who have not been able to get their LDL low enough:

    First make sure you have cut out all forms of sugar: Honey, Maple Syrup, Molasses, Malt, fruit juices, etc.

    Then try eating about two to four oz of 100% grass fed cooked on low heat beef/lamb each day for one month. Have yourself tested before resuming your current diet.

    BTW1- 100% grass fed beef/lamb fat is different from standard beef/lamb fat: It is 3x higher in Conjugated Linoleic Acid, higher in Omega 3, etc. The fat from 100% grass fed cows looks different, tastes different and cooks different than standard beef fat.

    BTW2- Those studies that show higher cancer rates in areas of the world that consume higher amounts of beef are all INVALID because none of them take into account cooking methods. Remember: the WHO did NOT say beef causes cancer. The WHO said beef cooked on high heat causes cancer.

    BTW3- There are no studies that show whether 100% grass fed beef raises or lowers cholesterol.

    BTW4- Make sure the 100% grass fed beef/lamb you eat is not too low in fat. Remember CLA is a fatty acid.

    1. This is rubbish Sydney You have made the false claim before that ‘WHO did NOT say beef causes cancer. The WHO said beef cooked on high heat causes cancer.’ and been shown that it is factually incorrect Yet here you are trotting it out again. Why do you continue to misrepresent the facts? The WHO actually said:

      ‘there were not enough data for the IARC Working Group to reach a conclusion about whether the way meat is cooked affects the risk of cancer.’
      https://www.iarc.fr/wp-content/uploads/2018/07/Monographs-QA_Vol114.pdf

      You continue to confuse your own wishful thinking with actual facts. There is no evidence that grass-fed beef or lamb is any safer than any other form of beef or lamb Cooked or uncooked, low heat or high heat Red meat has not only been assessed as probably carcinogenic but has also been linked to increased heart disease rates and higher overall mortality.

      ‘Heart failure (HF) remains a major public health issue. Red meat and dietary heme iron have been associated with an increased risk of coronary heart disease and hypertension, two major risk factors for HF. …………. We used Cox proportional hazard models to estimate hazard ratios. In a multivariable model, there was a positive and graded relation between red meat consumption and HF [hazard ratio (95% CI) of 1.0 (reference), 1.02 (0.85–1.22), 1.08 (0.90–1.30), 1.17 (0.97–1.41), and 1.24 (1.03–1.48) from the lowest to the highest quintile of red meat, respectively (p for trend 0.007)]. This association was observed for HF with (p for trend 0. 035) and without (p for trend 0.038) antecedent myocardial infarction.’
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974007/

      ‘Red meat consumption is associated with an increased risk of total, CVD and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.’
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712342/

      And remember that CLA is a trans fat and has not been shown by any good evidence to have overall health benefits. And why don’t you mention all the saturated fat, cholesterol, haem iron, IGF1, NeuG5C etc in grass fed beef and lamb while you saying that it contains CLA?

      1. Well said, Mr Fumblefingers. I didn’t read the full comment by Sydney, just a few HORRIFYING parts. What hideous, ill-informed and harmful advice. Why do people feel comfortable not only giving out serious medical advice with no evidence to back it up, but also countering existing evidence…. The arrogance just for what, their own idealism? Smh…

      1. I was trying to read the article on my phone, it was difficult to scroll through so I gave up. But that seems counterintuitive to me and goes against the collective evidence. But I couldn’t read through the whole thing, it was really hard to scroll through on my phone.

        1. This was a study by Jenkins – the inventor of the Portfolio Diet … but this study was published 10 years before his Portfolio Diet paper.

          All it showed was that a diet of leafy vegetables abd fruit delivered a greater decrease in cholesterol than a starch based diet The article is well worth a read if you can get to a computer or tablet

          1. Ah, I really misunderstood that. Thanks Tom, I’ll look it over on my computer. Sounds interesting. I can see where that would be really helpful information to some.

      1. I think the question for you is whether you were losing weight at the time because everybody’s cholesterol drops while they are losing weight and as Tom mentioned above, it also drops when they have a myriad of health problems.

        Including cancer.

        1. “Studies have found that plant-based diets lower cholesterol levels more effectively than other diets. In 2017, researchers reviewed 49 studies that compared plant-based diets with omnivorous diets to test their effects on cholesterol. Plant-based diets lowered total cholesterol, LDL, and HDL levels when compared to omnivorous diets. Low-fat, plant-based regimens typically reduce LDL levels by about 15 to 30 percent.”

      2. Exactly, people will be wondering if they can go on eating meat, etc. without harming their health or even bettering it, so it’s very dangerous when people like Sydney give out false information stated as facts.

    1. There will never be another animal that dies for me so that I may munch its flesh.
      ———————————————————————————————————–
      Very noble, but roadkill is killed accidentally so not eating that is just being wasteful. ‘-)

      1. Lonie, not so, actually! Often times wildlife eats animals who have been killed by traffic–one of the reasons it’s good to move animals out of the road if you see them hit and killed if you’re able to (and if they’re alive, help them obviously). Also sometimes animals get killed because they go into the road mourning their loved ones e.g. birds often do this, a mother raccoon won’t leave her babies as I’m sure is the case for all kinds of mother species and siblings and mates, etc. And bears and other wildlife will actually sometimes specifically look for “roadkill” because of stupid deforestation for subdivisions and mini malls so when they’re not getting shot at for digging through trash where their homes used to be, they may be looking for animals on the side of the road.

        1. Instead of me being the straight man for your comedy routine, you’ve turned things upside down and made my comedy routine into the opening for your serious monologue. ‘-)… well played.

          Side note: Wish we could post video here. I once took some mini dv tape footage of a momma raccoon and her many babies in the fork of a large tree in my front yard.

          She was nursing her brood and I set up the camera on a tripod not 10 feet away while she nursed her brood. One of her babies got right up in her face… My mind went to the baby saying to the momma “Please momma, get over them PP blues… don’t drown your babies momma… o.k., maybe you could drown brother number 3 ’cause he’s always knocking me off your teat, but please don’t drown me, your darling little daughter who loves you verrrrrry much, momma… Please, please, pleeeeeeezzzzz!

          No raccoons lately but I do have three broods of kittens. I need a family plan for neutering.

  30. He talked about going snowboarding with his eldest grandchild, so I think the one where people are calling him crazy may have had a few drinks involved and this one a week before then didn’t.

    I hate the internet.

  31. 18 months wfpbno, and my ldl is still over 100. Total fat is about 20% ( a few nuts) which is super low. Trying niacin at night. Weight normal. Crazy about exercise. I wish I could figure it out. Concerned about taking fat to 10% which would be no nuts.

  32. As I’ve mentioned previously, why would you say “no” with “wfpb”? Oil is by definition not a whole food so its not part of a wfpb diet at all. Processed foods such as smoothies or whole wheat bread can be a problem for some people as well. If you can’t lower your ldl down to 70 by eating nothing but fresh fruits and veggies (no factory, no machinery) then you could have familial hypercholesterolemia (prevalence 1 in 250)

    1. Ben, sorry but I consider myself WFPB because my diet is made up of whole plant foods, I’m not going to say I don’t eat a whole foods plant based diet because I use modest amounts of oil or salt or maple syrup here and there as a seasoning to some of my whole plant foods. No need to over police the term. Dr. Greger advises a WFPB diet without the use of oil or added salt, that’s different. He also has his dining by traffic light video, on the other hand. I think it’s fair enough to want to specify they don’t use oil as I’ve seen many others specify that, though probably better to just say that you use no added oils because all these abbreviations get to be too much with the SOS and all that… WFPBSOS (dear god). And yes, the whole-est of WFPB is just whole plant foods.

    1. Thanks Lonie.

      “After taking account of potentially influential factors, including age, cholesterol level, and any underlying conditions before treatment, patients who failed to reach a 40 per cent reduction after two years were 22 per cent more likely to develop cardiovascular disease than those who did respond well.
      Every 1 mmol/l fall in low density cholesterol was associated with a 6 per cent lower risk of stroke and mini stroke in those who failed to reach the 40 per cent target.
      But among those who responded well, this was associated with a 13 per cent lower risk of cardiovascular disease, in general, reinforcing the health benefits of reaching the 40 per cent target, say the researchers.”

      It is things like this that make me wonder about the statin haters who post here. Diet and lifestyle changes to reduce cholesterol are obviously far preferable to using statins but many people aren’t willing to make such changes. And in some people, possibly for genetic reasons, such changes don’t always deliver a large enough drop in levels to reduce risk. In such cases, statin use seems to avert many ‘adverse events’.

      1. Diet and lifestyle changes to reduce cholesterol are obviously far preferable to using statins but many people aren’t willing to make such changes.
        ——————————————————————————————————-
        Yeah, the data in the link suggests statins may or may not work, depending on the individual. And while I’ll likely never resort to statins (I consider them synthetic and try to avoid anything synthetic affecting my naturals) I know there are many who need the guidance of a medical professional to stay alive.

        In a way I am one of them but am waiting for the science of manipulating our personal genome, that is, our natural selves, to fine tune our bodies.

        In the meantime I try to compensate for any labs that are out of range… i.e. my latest labs show my cholesterol to be within range (which Dr. Greger suggests the allowable range is too high) but my LDL is high. I don’t panic and allow my VA Dr. to prescribe statins, but aim to tamp down any harm from this and other anomalies in my labs by taking natural anti-inflammatories.

        If I read something that could be helpful (from the alternative medicine community) or just intuitively feel like something is going to be helpful, I’ll try that as my first line of defense. My “medicine” cabinet has a high turnover rate… if I don’t think something is cost effective (based on newer information or progressions in my labs) I may drop it rather than re-order it.

        Some of these decisions are made after my gut makes a recommendation to my brain. They seem to work well together even though at times I second guess a decision and re-start a supplement or regimen.

        But being where I’m at in my self medicating regime has taken decades… so I completely understand the need for guidance, whether WFPB or Medico.

  33. I’m fascinated by the whole LDL thing…but what about the individual with high HDL, low Triglycerides, and an LP-PLA2 of 143, but has an LDL of 190? Individual is not ore-diabetic, has low blood pressure, is not a smoker or drug user. Doctor is pushing Repatha…but individual is scared of the side effects. What happens to individual cases like the above?

    1. Carol Paul, my labs are very similar to what you have described. My solution is to try taking olive leaf capsules.

      https://www.medicalnewstoday.com/articles/324878.php?

      I’ve been taking 2 to 3, 400 mg vegi caps of Full Spectrum Olive Leaf.

      In my case, however, I’ve experienced brief and mild dizziness when I bolt upright out of bed in the mornings. As far as I can remember, the Olive Leaf is the only new change in my regimen, so I’ll cut back to 2 caps and if the morning dizziness persists, I’ll cut back to one. The dizziness isn’t a big deal and only lasts a couple of seconds, so I can tolerate that if in fact the Olive Leaf is the cause.

  34. My LDL is 153 and has always been high. I have been Plant-based for 8 years. PBWFNO (or very very little oil) for over 3 years. I have no other risk factors. I have told my doctor to drop the subject of statins because I will never go on them. So, what do I do?

    1. Hope for the best?

      Seriously, you may just have to go the whole hog – and eat only raw or minimally processed whole plant foods. No bread, no instant oats, no oil etc. Some WFPB diets appear to be more effective at lowering cholesterol than others.

      Jenkins showed that a diet of green leafy vegetable, fruit and nuts lowered cholesterol significantly more than a starch based diet.
      https://www.researchgate.net/publication/12045973_Effect_of_a_very-high-fiber_vegetable_fruit_and_nut_diet_on_serum_lipids_and_colonic_function

  35. I am getting very confused by some of the conflicting information I have recently found on the internet and am in need of some help to sort it out.
    My background: I have been on the WFPB diet for three years now and have been able to lower my total cholesterol below 150 but have not been able to lower my LDL below the recommended 70 or even 55 for those with prior CVD so I have been checking the internet for more information from time to time and read with interest this latest blog on cholesterol. However what I didn’t find here was any mention or refutation of the serious, to me, conflicts of so-called science of the cholesterol- heart disease theory. I have read elsewhere that the cholesterol theory was a hoax, based on several research studies by medical doctors, and that statins do help, not by cholesterol reduction, but by decreasing inflammation which is the real cause of heart disease.
    One article (Atherosclerosis How Does it Happen by Jeffrey Dach MD), goes on to say the following, in part,:
    Heart Disease or clogging of the arteries of the heart is today’s number one killer in America and is the reason why 16 million Americans are taking a Statin anti-cholesterol drug. In this article we will examine the current knowledge about what causes heart disease and how to prevent and reverse heart disease without the use of drugs or surgery.Most everyone will tell you that high cholesterol and fat in the diet causes heart disease, and you will see this type of information prominently mentioned in newspaper articles and on television. However, if you actually look at the data, you will find a number of disturbing facts. Most people who enter the hospital with heart attacks have a normal cholesterol blood level. Studies of populations of people who eat mostly animal fat such as the Greenland Eskimos show virtually no heart disease. Before the 1920’s in America, we consumed plentiful amounts of eggs, butter and lard, yet heart disease was relatively rare at that time. Only after the 1920’s did Heart Disease became an epidemic in the US. At this time, processed vegetable oils (also called Trans Fats) and refined sugar products were introduced into the American diet.
    How can something as American as refined sugar which has nothing to do with fat or cholesterol cause our current epidemic of heart disease? It’s not the sugar that is the bad guy because sugar is your brain’s primary fuel. It’s the high Insulin level that high blood sugar provokes that is the bad guy. The high Insulin leads to Insulin resistance, Obesity and Diabetes, and it activates an important enzyme in the body which turns on a little switch causing chronic inflammation. If the chronic inflammation attacks the lining of the arteries, you get heart disease. If it attacks your joints, you get arthritis. Yes, cholesterol is a major part of the atherosclerotic plaque that clogs the artery along with calcium. However, cholesterol is not the cause. It is deposited in the artery wall to repair damage from the inflammation which is the real cause. Cholesterol is essential for life. It is an important substance used by the body to make hormones such as estrogen, and testosterone and it accounts for one half the dry weight of the brain. Cholesterol is present in all the cell membranes. What happens when your cholesterol is reduced too low? You get blood sugar problems, edema, mineral deficiencies, chronic inflammation, and difficulty in healing, allergies, asthma, reduced libido, infertility and various reproductive problems.
    Statin drugs work very well at reducing cholesterol measurements in the blood. They also are successful at reducing cardiac events such as heart attacks. However a critical examination of the data on the numerous medical studies again raises some disturbing questions. Firstly, none of the Statin Drug studies has ever shown a mortality benefit for women. Secondly, in the elderly over age 65, lowering the cholesterol is associated with a higher mortality. In middle aged men who have known heart disease, the benefits of a Statin anti-cholesterol drug are not related to the degree in which they lower the blood cholesterol level. Instead, the Statin Drug seems to work as a crude anti-inflammatory drug.
    REFERENCES
    Lipitor: Thief of Memory, Statin Drugs and the Misguided War on Cholesterol, by Duane Graveline, M.D.(c) 2004
    The Cholesterol Myths : Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease, by Uffe Ravnskov,MD, PhD,
    The Heart Revolution : The Extraordinary Discovery That Finally Laid the Cholesterol Myth to Rest by Kilmer McCully, M.D. (c) 2000
    Heart Frauds: Uncovering the Biggest Health Scam in History by Charles T. McGee, M.D.
    The Myth of Cholesterol: Dispelling the Fear and Creating Real Heart Health – Dugliss Paul, M.D. (c) 2005
    The Truth About the Drug Companies: How They Deceive Us and What to Do About It – Marcia Angell, M.D. (c) 2004 Random House
    Overdosed America: The Broken Promise Of American Medicine – John Abramson, M.D.(c) 2004 HarperCollins
    Jeffrey Dach MD 7450 Griffin Road, Suite 190, Davie, Fl 33314, 954-792-4663

    (C) Copyright 2013, Jeffrey Dach MD, All Rights Reserved.

    Another article by Dr. Dach, “Cholesterol Levels and Atherosclerosis: Autopsy Studies Show No Correlation”, also says the cholesterol theory is a hoax. I would like to see Dr. Greger or some of his volunteers address these conflicts because I don’t have the medical knowledge to do it.

  36. Hello Dr. Greger,

    I want to thank you for graciously allowing me to interview you for my documentary series iThrive – Rising from the Depths of Diabetes and Obesity. Many people have been inspired to adopt a plant-based diet and have reversed their own diabetes and are off the medicine. However, the power of the meat and dairy industry and media is so strong many people, as you know, are super confused around the new popularity of animal products (fat is back, keto, low carb, paleo etc).

    I am inundated with questions about the new science refuting all previous science saying high cholesterol is bad. In fact it is good and people with higher cholesterol live longer. The old science was bad and we learn new things every day. Eat your eggs and bacon cooked in butter with a cup of coffee spiked with MCT oil.

    Here is an article citing these types of studies. Would you comment or direct me to another video. I have gone through the ones recommended here.

    Cheers,
    Jon McMahon

    High Cholesterol is associated with longer life – picture of bacon and eggs thumbs up!

    https://medium.com/the-mission/higher-cholesterol-is-associated-with-longer-life-b4090f28d96e

    1. Hi, Jon! Dr. Greger is always happy to get the word out about the power of plants. You can find everything on this site related to cholesterol here: https://nutritionfacts.org/topics/cholesterol/ We know what you mean about being inundated with questions from people who have been misled. We get a lot of that here, which is why volunteers like me are needed to help address them all. I hope that helps!

      1. Thank you Christine. Do you do any freelance consulting work where I could pay you by the hour to do nutritional consulting or answer questions for my community that is focused on reversing diabetes and obesity on a WFPB diet.

  37. We’re always open minded when it comes to new, well founded, unbiased, peer-reviewed clinical research. Studies that suggest/conclude that elevating dietary and serum cholesterol will reduce the risk of disease and premature death don’t qualify and are total hogwash. Very sick people (cancer) experience a drop in their cholesterol levels due to the disease. The low cholesterol did not cause the disease. Lets not confuse association and causation. The Framingham heart study and many others may be old, but they are well founded and have never been disproven. The “preponderance of the evidence” clearly shows that elevated serum cholesterol levels and consumption of dietary cholesterol increases the risk for disease and premature death. There is no doubt whatsoever. And as far the photo inference that bacon and eggs have some health benefits, there are none. Bacon, a processed meat, has been clearly shown to be a Class I carcinogen just like cigarettes. Eggs have been clearly shown in several studies to increase the risk for premature death by ingesting as few as 1.5 eggs per week. Everyone loves to hear good news about their bad habits, so it sells, but its not factual.

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