How Do We Know that Cholesterol Causes Heart Disease?

How Do We Know that Cholesterol Causes Heart Disease?
4.62 (92.41%) 58 votes

What would happen if babies were randomized at birth to a lifetime of low cholesterol levels? We already know because Mother Nature did exactly that! In this video, I introduce the concept of Mendelian randomization.


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

“It is well accepted that coronary atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before [symptoms arise]. However, the average age in cholesterol-lowering drug trials is 63, and therefore, people “had already been exposed to a lifetime of circulating LDL-[cholesterol].” So, no wonder pharmaceutical “therapies…typically [reduce] cardiovascular disease risk by [only] 20% to 30%.”

We know LDL, so-called bad cholesterol, plays “a central role…in the initiation, development, and progression” of our #1 killer. Over a hundred prospective studies involving more than a million people have demonstrated that those with higher LDL levels are at higher risk.

“It seems reasonable to assume…that if lowering [cholesterol] later in life” can help, then “keeping LDL[-C] levels low…earlier” in our lives might prevent our arteries from getting clogged in the first place. But, let’s not just assume.

“It would be [considered]…unethical to set up a controlled clinical trial in which young adults with elevated serum cholesterol levels were treated or not treated over their lifetime”—just like you couldn’t ethically set up a study in which half the kids are made to start smoking, to see if smoking really does cause lung cancer. That’s where observational studies come in. You can follow people who already smoke, and compare their disease rates to those that don’t.

It’s like 40 years ago, when the president of the American Heart Association tried to argue that we should all stop smoking—even though there were no randomized controlled trials. Look, those who smoke have a higher risk of heart attack; the more we smoke the higher the risk; and, after we stop, our risk drops. The same can be said for high cholesterol.

If you look at young men, aged 18 through 39, and follow them for up to 34 years, cholesterol levels, even when you’re young, predict long-term risk of heart disease and death. Men in their 20s and 30s who have a total cholesterol even just under 200, have a “substantially longer estimated life expectancy”—around four to nine years longer—than those over 240.

“Evidence from observational studies, however, [is] vulnerable to [so-called] confounding [factors].” Eating a diet plant-based enough to lower cholesterol below average may add years to our lives, regardless of what our cholesterol is. Ideally, we’d have “a long-term randomized controlled trial.”

And, nature may have actually set one up for us. Each of us, at conception, gets a random assortment of genes from our mother and our father, and some of those genes may affect our cholesterol levels. Just like there’s rare genetic mutations that result in unusually high cholesterol, there are rare genetic mutations that lead to unusually low cholesterol—providing an ideal system “to assess the consequences of low LDL cholesterol levels independent…of” confounding diet and lifestyle factors.

Let me show you what I mean. About 1 in 40 African Americans have a mutation that drops their LDL cholesterol from up around 130 down towards more optimal levels. Now, this group didn’t eat healthy to get there. It’s just in their genes. More than half had high blood pressure; there were lots of smokers and diabetics, yet those with genetically low LDL levels still had a “significant reduction in the incidence of [coronary heart disease]…even in the presence of [all these other] risk factors. How significant? How much less heart disease? How about 88% of heart disease gone?

The astounding finding was that the heart disease risk in these individuals was reduced by more than 80%; whereas, the same 20- to 40-point decrease in LDL from drugs only reduces risk like 30%. Makes sense, though, right? The folks with the mutation had low levels like that their whole lives; they didn’t just start taking some pill when they were 60 years old.

“The magnitude of the effect of long-term exposure to lower LDL[-cholesterol] concentrations observed in each of these studies represents threefold greater reduction in the risk of [heart disease],” compared to drug treatment “started later in life.” For you fellow research nerds out there, check out that p value. You’d have to do like a quintillion studies to get that kind of result by chance.

“Therefore, a primary prevention strategy that promotes keeping LDL[-cholesterol] levels as low as possible, beginning as early in life as possible, and sustaining those low levels of LDL[-cholesterol] throughout the whole of one’s lifetime has the potential to dramatically reduce the risk of [coronary heart disease].” And, that’s just what a healthy diet can do.

Please consider volunteering to help out on the site.

Image credit: Marty Gabel via flickr. Image has been modified.

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

“It is well accepted that coronary atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before [symptoms arise]. However, the average age in cholesterol-lowering drug trials is 63, and therefore, people “had already been exposed to a lifetime of circulating LDL-[cholesterol].” So, no wonder pharmaceutical “therapies…typically [reduce] cardiovascular disease risk by [only] 20% to 30%.”

We know LDL, so-called bad cholesterol, plays “a central role…in the initiation, development, and progression” of our #1 killer. Over a hundred prospective studies involving more than a million people have demonstrated that those with higher LDL levels are at higher risk.

“It seems reasonable to assume…that if lowering [cholesterol] later in life” can help, then “keeping LDL[-C] levels low…earlier” in our lives might prevent our arteries from getting clogged in the first place. But, let’s not just assume.

“It would be [considered]…unethical to set up a controlled clinical trial in which young adults with elevated serum cholesterol levels were treated or not treated over their lifetime”—just like you couldn’t ethically set up a study in which half the kids are made to start smoking, to see if smoking really does cause lung cancer. That’s where observational studies come in. You can follow people who already smoke, and compare their disease rates to those that don’t.

It’s like 40 years ago, when the president of the American Heart Association tried to argue that we should all stop smoking—even though there were no randomized controlled trials. Look, those who smoke have a higher risk of heart attack; the more we smoke the higher the risk; and, after we stop, our risk drops. The same can be said for high cholesterol.

If you look at young men, aged 18 through 39, and follow them for up to 34 years, cholesterol levels, even when you’re young, predict long-term risk of heart disease and death. Men in their 20s and 30s who have a total cholesterol even just under 200, have a “substantially longer estimated life expectancy”—around four to nine years longer—than those over 240.

“Evidence from observational studies, however, [is] vulnerable to [so-called] confounding [factors].” Eating a diet plant-based enough to lower cholesterol below average may add years to our lives, regardless of what our cholesterol is. Ideally, we’d have “a long-term randomized controlled trial.”

And, nature may have actually set one up for us. Each of us, at conception, gets a random assortment of genes from our mother and our father, and some of those genes may affect our cholesterol levels. Just like there’s rare genetic mutations that result in unusually high cholesterol, there are rare genetic mutations that lead to unusually low cholesterol—providing an ideal system “to assess the consequences of low LDL cholesterol levels independent…of” confounding diet and lifestyle factors.

Let me show you what I mean. About 1 in 40 African Americans have a mutation that drops their LDL cholesterol from up around 130 down towards more optimal levels. Now, this group didn’t eat healthy to get there. It’s just in their genes. More than half had high blood pressure; there were lots of smokers and diabetics, yet those with genetically low LDL levels still had a “significant reduction in the incidence of [coronary heart disease]…even in the presence of [all these other] risk factors. How significant? How much less heart disease? How about 88% of heart disease gone?

The astounding finding was that the heart disease risk in these individuals was reduced by more than 80%; whereas, the same 20- to 40-point decrease in LDL from drugs only reduces risk like 30%. Makes sense, though, right? The folks with the mutation had low levels like that their whole lives; they didn’t just start taking some pill when they were 60 years old.

“The magnitude of the effect of long-term exposure to lower LDL[-cholesterol] concentrations observed in each of these studies represents threefold greater reduction in the risk of [heart disease],” compared to drug treatment “started later in life.” For you fellow research nerds out there, check out that p value. You’d have to do like a quintillion studies to get that kind of result by chance.

“Therefore, a primary prevention strategy that promotes keeping LDL[-cholesterol] levels as low as possible, beginning as early in life as possible, and sustaining those low levels of LDL[-cholesterol] throughout the whole of one’s lifetime has the potential to dramatically reduce the risk of [coronary heart disease].” And, that’s just what a healthy diet can do.

Please consider volunteering to help out on the site.

Image credit: Marty Gabel via flickr. Image has been modified.

Doctor's Note

If you don’t know your cholesterol level, I encourage you to get it checked—maybe even starting in childhood. See my video Should All Children Have Their Cholesterol Checked? to learn more.

What if you do get tested and your doctor tells you not to worry because your cholesterol’s “normal”? Having a “normal” cholesterol level in a society where it’s normal to drop dead of a heart attack, the number-one killer of men and women, is not necessarily a good thing. See my video When Low Risk Means High Risk.

Check out Optimal Cholesterol Level and What’s the Optimal Level? to find out where you should be.

What if your doctor tells you your LDL is large and fluffy? See my video Does Cholesterol Size Matter?.

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

PS: Did anyone notice the “Kahn, J” in that landmark article? That’s none other than THE Joel Kahn, one of my favorite doctors!

348 responses to “How Do We Know that Cholesterol Causes Heart Disease?

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  1. Hello. Are you sure that your blood cholesterol level depends on your diet?
    I eat 3 eggs a day, on average, and have a low LDL level…

              1. update us WFPBR, are you a no oil vegan or what and for how long?

                have you seen any improvements since your diet change, any serious conditions that have reversed?

                1. I am a no oil, no processed food, no sugar vegan. I used to use Veganrunner as my name but after reading Vegan magazine I thought WFPB was probably more accurate. Or you can call me Gale! I am a physical therapist who encourages a WFPB diet with my patients.

                  So about 8 years ago (time flies) I decided to take my health into my own hands. I had an autoimmune disease called Acquired Attricia. And what that meant was instead of my eardrums being cellophane thin they were a quarter inch thick. Well obviously sound doesn’t conduct very well. So about eight years ago I went into the surgeons office and said, “You need to replace my eardrums again.” He said he couldn’t do that because I had this autoimmune disease and the same thing would just happen again.

                  I went home and spends days reading research articles. Anything I could find on this “very, very rare” disease. What kept coming up in all the discussion sections was the inflammatory component. People with this often had psoriasis and other skin issues. (Although I didn’t)

                  After the research I dropped all dairy and gluten. I ate only Whole Foods–veggies, fruit etc. However I was still eating small servings of organic-free range animals and fish. And my condition completely cleared up. No inflammation. But my eardrums remained too thick to conduct sound. My doctor made a deal with me. Because the inflammation was gone from the ear canal he would replace one drum again and if after six months there was no sign of thickening he would replace the other. So I now have two new drums and can hear perfectly. He was absolutely shocked! And happy. He calls me his poster child.
                  At that same time-7 or so years ago I found this website. And with everyone’s gentle encouragement I completely gave up the animal products 5 years ago.

                  I had been reading a couple of endurance running books written by vegans. Everything just came together at the same time.

                  I do have a family history of severe heart disease so once I started listening to these videos it became obvious I had no business eating meat. The most interesting thing is that I was eating Whole Foods. Nothing processed and only organic free range meats. But dropping the dairy and gluten changed everything. And dropping the meat has dropped my Thyroid medication by 25%. I feel great. And releaved to know I won’t die of a heart attack in my 50s!

                    1. Well good Thea. I forgot to add I had IBD! How could I forget that! That was bad. And it was a strange one. About 3 years ago I had biopsies done and they found a thin microscopic film on the lining of my intestines. What? So I am thinking it was something I was eating–too much turmeric? Smoothies? And it finally cleared up a couple of years ago. Very frustrating but I did have it before going vegan. Now–all good!

                      The endocrinologist said I probably did have celiacs disease but because I had been off gluten so long it would be impossible to text positive. And that the IBD would go along with the other autoimmune issues I HAD!!!

                    2. WFPBRunner: Really, how could you forget!? ;-)
                      It’s interesting to me how certain diseases go together. It makes perfect sense, but it’s not how I grew up thinking about health and lack there-of As I’m often telling people and you already know, going vegan is not a magic pill guaranteed to cure all a person’s woes. However, because so many health problems are related to the same root cause, it is just so common for people to give a whole list of ailments that disappear on the whole plant food diet. It’s fun to read these stories as it often feels like magic.

                    3. It is magic!
                      Maybe I forgot because it is such a dang embarrassing topic! I mean what if we get together at some point! Here is the best part. My gastroenterologist was my patient. OK. That is embarrassing!

                  1. that’s an incredibly compelling story, gale!

                    it’s people like you, me, thea and others on this site who “get it” and understand how a NO OIL vegan diet cures virtually everything. WE GET ALL THE FATS THAT WE NEED IN THE RIGHT PROPORTIONS IN THE BANANA OR APPLE OR RICE OR BEAN THAT WE ATE but most can’t comprehend that.

                    the no oil part is where Dr G and i differ a slight bit because of his promotion of nuts (due to studies NOT done on no fat vegans) but we can’t all agree on everything.

                    afterall, i follow Dr E to the “T” but disagree with the fruit part… in fact i’m going to cut up a canteloupe and apple and orange and raisins now just for spite!

                    let the cholesterol deniers be damned, lol. (you can probably tell by now that i’m not PC and have no patience for them which is why thea has to keep me in line every once in awhile. i get so aggravated by them because I LITERALLY HAD A MONTH OR TWO left to live [imagine the feeling of KNOWING you are a DEAD MAN WALKING, extending out quite a few years] and i just can’t argue with people who don’t WANT to learn after i have been thru this life change and am alive ONLY because of diet change. not sure if i ever told you this but my neurologist had another patient at the same time with similar symptoms but not nearly as severe. his MRA could have been placed over mine looking identical. he was also told to go home, not change his diet or anything because there wasn’t anything left for them to do so ENJOY the time you have left. that poor schmuck is 6 feet under now for about 4 years while i have completely reversed my disease, unequivocally.)

                    OH, and the IBD. i had it terrible. confirmed ULCERATIVE COLITIS on colonoscopy prior to diet change. you could clearly see the ‘smooth walled’ lower colon devoid of the ripples that should be there.

                    colonoscopy AFTER a WFPBD showed NO EVIDENCE OF DISEASE nor the lifetime of drugs that the first Gastroenterologist wanted me to be on.

                    Thea: {As I’m often telling people and you already know, going vegan is not a magic pill guaranteed to cure all a person’s woes.}

                    YES IT IS !!! :o)

                    especially since i did all of this on my own, just the internet, never even read ‘prevent and reverse heart disease’ until after i cured myself, no plant based doctor to hold my hand or anyone even agreeing with me especially when i quit statins and did the ‘dead man walking thing’ for years, i’m so glad i found you guys….


                    1. What an amazing story. And we do have a great group of commentators here.

                      I do eat nuts. But if I had heart disease I would give them up in a minute.

                      People ask me ” How can you eat like that?” I reply “because I want to hear.” That simple.

                      The fat deniers are so sure of themselves. I do believe it has to do with addiction. It must be easier to buy that grass feed story than give it up. But what I am always wondering is how they would tell me, whose father died young and his brother even younger, that it has nothing to do with animal and fat. Are they so sure of themselves they would be ok with me eating that way?

                      I am sure you are a huge motivator of people reading this comment section.

                    2. i have an MD who knows my history and refers patients to me who want to beat cancer or other disease with a vegan diet, believe it or not.

                      actually, i have a cancer clinic in utah who also refers patients to me who are ‘on the fence’ about their facility but that’s a whole nother story.

                      ‘joe’ contacted me a year or so ago about his biopsy confirmed prostate cancer which was obviously progressing because of his rising PSA #’s even though the had gone thru hypertherapy treatment in europe for this condition AND was a converted vegan. the #’s initially dropped after treatment but within months began rising.

                      when he contacted me, he had been vegan for ~6 months yet had increasing PSA #’s which means most likely cancer growth especially with his high gleason score.

                      his urologist had been insisting on him having a radical prostatectomy now for over a year. you know, just rip it out and have side effects of diarrhea, impotence, incontinence, etc.

                      by the time he contacted me, maybe 8 or 9 months ago i figured out immediately that he had added oil in his diet in the form of olive and nuts because, well, they’re heart healthy, right? that’s exactly what he thought.

                      i stopped them immediately and taught him how to read labels for hidden fats.

                      in fact, he would randomly call me from the grocery store asking about the ingredients of a product.

                      i didn’t have to do any arm twisting, he was a follower immediately because he didn’t want to be impotent and wearing a diaper for the rest of his life. (cover your ears thea)


                      he revisited his urologist last week who asked him “when are you going to let me remove that prostate because of your high gleason score”, blah blah blah.

                      he took my advice and asked for an ultrasound which was scheduled for the very next morning.

                      by 9 am he had called me more excited than a little boy on christmas day, i couldn’t shut him up.

                      after the procedure, the doc said, ‘joe’, i don’t understand it.

                      there’s nothing there, it’s completely homogenous and i see absolutely no irregularity in the prostate, no signs of cancer, i don’t know what to say.

                      ‘joe’ went from needing a radical prostatectomy on tuesday to being completely free of disease and healthy on wednesday.

                      well i know the answer, it’s no @*% $*&^%@ OIL!!!)

                      i’m sure you saw my previous links about the raw vegan who had a stroke but just in case you missed it, here it is again.

                      remember, the first ‘symptom’ of heart attack or stroke in half the patients is death, not chest pain or a tia.




                    3. {But if I had heart disease I would give them up in a minute}

                      every 10 year old autopsied in this country has heart disease, fatty streaks in the heart which are just the beginning stages.

                      IOW, we ALL have vascular disease.

                      once you have symptoms, the disease is 90% advanced and THEN it’s visible via radiology.

                      something to think about while watching those videos i posted and please, do watch them…


                    4. I did watch them. I don’t eat that many.
                      Even when I was eating meat my total cholesterol was around 150, LDL 70. Probably from the training? Or I didn’t eat that much meat, or I didn’t inherit my father heart disease but my mothers family dementia?

                      But I love your passion.

                  2. Another way to further reduce cholesterol levels is to squeeze all your meals (eating) into an 8 hour period out of 24 hours. So 16hrs fasting. Half that is sleep anyway.
                    I tried that and it worked!!
                    Apparently it works even at 10hrs
                    The key is not to eat anything during the fast period.

    1. What does this prove? Maybe you have genes that gives you lower LDL levels? The other problem eating cholesterol is that they increase your risk of getting a hearth disease regardless of their effect on your lipid cholesterol levels. It might be due to excess protein, saturated fat, lack of fiber, lack of plant nutrients or accumulated toxins so on. The optimal move you can do is to eliminate or greatly reduce the intake, or just accept the risk and hope for the best rather than being proud of eating eggs and having low (lower to what?) LDL.

      1. Thank you for your answer, Burak, I didn’t mean to offend anyone. WFPBRunner told me that my LDL was not so low anyway. Have a nice day.

        1. Thanks for your reply. That is one of the reason why these videos by Dr Greger are great as it makes us curious to dig deeper into finding optimal health through life style and diet.

    2. Even if you are genetically prone to low cholesterol levels you might not want to eat eggs given the other risks associated with them, including cancer viruses. Just search for eggs in the search box on this page and check out some of the videos. I regret ever eating them.

    3. Hi Pierre-Yves SALOMON, I’m wondering what it is about diet that lowers cholesterol, too. I did an elimination diet that eliminated sugar, dairy, alcohol, grains and legumes and included lots of meat, vegetables, fruit, eggs, nuts and seeds. After 18 days my cholesterol went down 47 points. When I went back to eating my usual manner, my cholesterol went back up. I also tried a WFPB diet and my cholesterol went down 35 points. The thing the 2 diets had in common were no sugar, no dairy and no alcohol. I’m doing the WFPB diet right now cause my doc said if the cholesterol was high again she wants me on meds and I’m not going to do that. So, yes, I’m sure diet can play a powerful part in lowering cholesterol, but eggs do not appear to be a factor.

      1. Linda, I commend you on your self experiment and your desire to avoid taking drugs. That said, you must admit that your experiment only had one subject and that more than one variable was changed in your diet (i.e., other changes besides just eggs).

        See this video for how eggs affect blood cholesterol and for how the egg industry “scientists” fudge the data.

        “How the Egg Board Designs Misleading Studies”

        Also, if you lose weight, for any reason, your blood cholesterol will go down.

      2. I agree with you in a very unscientific way as I’m not good a numbers. I had 2 great grand mothers and fathers who lived into their 90’s who came to U.S. from Europe well over 150 years ago. I even remember being with them when I was about 5-6 years old. I am now 83 but I had bypass surgery at 65 and I don’t expect to live close to 90 My father had heart disease in his early 60’s and died at 72. My mother was 92 when she passed and never had a heart issue. Bottom line, it’s all in the genetics. I have friends in 80’s still playing tennis or pickle ball and I have trouble walking. We can all help ourselves with healthy living but in the end your genes will be the difference.

        1. I think what Dr G. is saying is that the study of those with “better” genes essentially proves that lower LDL number reduces heart disease. So if someone is not born with the better genetic makeup, that person needs to take additional steps to keep the LDL low.

          I hear people tell me all the time that eating WFPB doesn’t matter because it all in the genes anyway. That is a cop out in my opinion. I look at it this way: If I am predisposed to heart disease because of my genetic makeup then I need to work harder to reverse the effects of the disease.

        2. Genes load the gun while diet/lifestyle pull the trigger.. Sure I agree some people’s genes set them up really badly in life but for most people that’s not true.. Just a lifetime of poor diet/lifestyle choices catches up with them eventually.. Most people’s biggest problem is they’ve inherited poor dietary choices/culture.. Look into epigenetics. You can switch on and off genes I think through diet/lifestyle choices..

          “Stop blaming your genes” is a great talk from Dr.Rosane Oliveira (director of UC Davis Integrative Medicine) and the talk is well worth watching.

    4. Yes, diet (but not the cholesterol from your diet) influences your cholesterol level.

      LDL cholesterol is affected by diet. Knowing which fats raise LDL cholesterol and which ones don’t is the first step in lowering your risk of heart disease and stroke. Your body naturally produces LDaL cholesterol. Eating saturated fat, and trans fat raises your blood cholesterol level even further. (source AHA)

      For most people, the amount of cholesterol eaten has only a modest impact on the amount of cholesterol circulating in the blood. For some people, though, blood cholesterol levels rise and fall very strongly in relation to the amount of cholesterol eaten. For these “responders,” avoiding cholesterol-rich foods can have a substantial effect on blood cholesterol levels. Unfortunately, at this point there is no way other than by trial and error to identify responders from non-responders to dietary cholesterol. (source Harvard HSPH)

      Note that this is one of the dogmatic reasons used to promote WFPB (not that there aren’t other valid reasons): don’t eat cholesterol because it is bad for you.

      1. “For most people” yes people that have totals between 180 and 250 the cholesterol in the diet did not seem to make a significant difference. People with totals below 150 reflect cholesterol in their diets differently so the statement that cholesterol in the diet is not important is wrong but popular.

        1. Don’t tell me that, please contact Harvard School of Public Health (the 2nd best public health school in the country), part of the university most affiliated with Nobel laureates, and tell them they have this popular, but wrong opinion.
          You have the chance to prove Harvard wrong. Not many times, and not many of us have this honorable opportunity.

          I am always astonished by how easy everyone thinks he’s entitled to have an opinion on nutrition. In fact, this is a mere feature of any ideology.

            1. Johanna, everyone should be free to have an opinion, any opinion, on anything (as an exercise of freedom of speech), but what I meant by ‘entitled’ was to have an educated, professional, science-based, academic opinion. In this sense, a very, very small % of us are entitled to have an opinion on very complex issues, like nutrition.

              I know there is a divergence of opinions on poultry and fish. And we have dr G on one side. But on the other side we don’t have only Harvard, but also World Heath Organization, American Heart Organization, HHS and USDA with their Dietary Guidelines 2015-2020, the british authorities, the australian authorities.

              So, we have dr G vs Harvard + WHO + AHA + USA + UK + AU.
              Choosing which of the 2 camps (but if on one side, there’s only dr G, can I call that a camp…?) is right is a difficult task only if you really buy these arguments that there’s a global conspiracy of the poultry industry and that everyone who disagrees with us is wrong, just like once upon a time all were wrong on smoking.
              Otherwise, the choice is so easy is not even a choice.

              1. You sound like it’s Dr. Greger against the WHO, American Heart Organization, HHS, and USDA, etc., etc., etc. However, there are a lot of doctors and nutritionists that you have not mentioned on Dr. Greger’s side. If you’re unaware of them, folks on this site could begin to list them. Also, many of the organizations you list are in bed with big ag or their institutions are supported by big ag, and therefore they are not dependable. For example, the USDA is largely influenced by big ag. Further, when it comes to nutrition, I’d rather go with the science than with opinions.

              2. Actually, the folks there at Harvard (etc) are well aware of the value of a plant based diet: but they feel that telling the truth to the public would be “to extreme” and thus people just wouldn’t follow the diet.

                So they look for ways to add meat back in, in the least dangerous way possible.

                Please tell me about this source of cholesterol that people are regularly eating that isn’t also a source of saturated or trans-fat?

    5. The p-value of 8.4 x 10^(-19) means that the chance that the findings are a random accident are almost non-existent. There is no “proof” in science, but this is about as close as you can come.

      As the video points out, there is a genetic factor. But this does not discount the importance of diet. Lets say, for argument that you are one of the rare individuals who are protected by familial hypo-cholesterolemia; does that mean that you should eat an heart-unhealthy diet? Why not receive the additional benefit of a WFPB diet, and potentially live even longer?

    6. Hi, Yes, It was actually explained quite well in the video. The good news is you are obviously very lucky to have the genes that help keep your cholesterol low. Most people don’t have these helpful genes. So just one egg a day can be nearly the full amount of cholesterol recommend.
      For me, my family are unlucky enough to have genes that give us unusually high cholesterol. so we all tried different methods, My dad went on medication but had a stroke at 49. So I became vegetarian which made only a little difference, my cholesterol was still too high. My brother went vegan (whole foods) and he dramatically dropped his cholesterol. I tried vegan but still ate a lot of junk like cake and some oily foods like chips. My cholesterol dropped a little, but not enough, so I decided to eat whole foods with plenty of veggies, legumes, seeds and fruit like my brother and finally my cholesterol came down.

      So yes diet does work for most people

        1. congratulations on your excellent results in transitioning to wfpb diet M85 ! The problem I have, (and many onthis forum have,) is that with aging sometimes comes rising cholesterol levels , especially with post menopausal women. As a meat-eating, dairy, margarine (!) and egg quaffing nonvegan , I had total cholesterol levels of 3.5 which is approx 140 . Years later, wfpb no-oil, no fatty plant foods, low dose statins, and my cholesterol refuses to budge from around 186.

          I dont know how things would be if I had been eating this way for decades. In some of the blue zones cholesterol levels and blood pressure do not rise with aging. I can only praise and encourage you to stay with the wfpb eating M85 and enjoy all the best in health.

  2. Hello, I’m a vegan and I don’t consume alcohol, how come my Alanine transaminase and Aspartate transaminase are high? 85 and 65 respectively. Thank you. Also my iron is high.

    1. I remember my mother had high transaminase numbers and we didn’t understand what it was. She’s vegan and doesn’t drink alcohol. We went to the doctor and he asked us if she was taking any concentrated herbal/plant supplements and effectively she was. She got rid of them and her numbers went back to normal. Just my personal experience…

    2. Elevated ALT and AST can be indicative of leaky liver cells and damage from any source: chronic hepatitis B or C infection, non-alcoholic fatty liver, diabetes, bile duct problems, infectious mononucleosis; and also when muscle cells are damaged, such as myopathy & congestive heart failure. High ALT & AST are also seen when herbal supplements (for example, green tea extract) are taken at doses higher than the hormetic / beneficial range. Test values 85 and 65 are above the reference range for males, but still below those seen with acute toxic or viral hepatitis or fatty liver disease. I suspect your doctor may wish to screen for hepatitis B and C.

      High iron levels can occur without high heme iron intake, most commonly with hereditary haemochromatosis.

        1. No. I’m not aware of any human case studies of adverse liver reactions to curcumin supplements. Perhaps this is due to poor bioavailability of most formulations that has called its therapeutic value into question. Oral curcumin has been used in a number of animal studies as a preconditioning / hormetic agent that reduces damage from hepatotoxins like acetomenophen.

          Here is a useful review of the case report literature on herbal liver injury, with links to cautionary tales with green tea extracts, black cohosh, chaparral, JuicePlus®, Herbalife®, Hydroxycut®, kava, pennyroyal, skullcap, etc.

            1. The case studies with green tea extract typically involve body builders and others seeking rapid weight loss megadosing on extract pills with intakes tens to hundreds of times higher than possible from drinking tea. Ordinary green tea infusions appear liver protective.

          1. Thank you Darryl. The only plant extract i take is curcumin and I couldn’t find any adverse effects of it except that it might aggravate gallstones, which I don’t have.

        2. I haven’t seen any curcumin studies but was just told literally 10 mins ago that Tumeric has to be cooked to get rid of certain enzymes. The person told me they read it in a study. I’d be interested if anyone knows about that too.

      1. Right, despite being a vegan, I have had high iron levels. Taking vitamin C supplements at meal times can be the triggering event. I no longer eat citrus fruit at meal times because of this. In fact I drink coffee at meal times to try to reduce the absorption of nonheme iron.

      2. Darryl:

        “…herbal supplements taken at doses higher than the hormetic / beneficial range…”

        Idea for a future NF video: How Much is Too Much of a Good Thing?

        This is something we don’t talk about enough around here, IMO. More of a good thing isn’t always better, and sometimes more can be harmful.

    3. With regard to your high iron level, I am wondering if you take vitamin C supplements, which increases absorption. This could be a problem for the minority of people like me who absorb iron very readily.

  3. Thank you for this video. These Mendelian studies are some of the most fascinating I’ve encountered in my 5 year journey into the health literature. I’m hoping for followup videos focusing on what the Mendelian studies say about whether other markers associated with disease incidence actually play causal roles (I’m looking at you, HDL).

  4. so is the take away from this that LDL is a more important measure that total cholesterol? I’m still hoping to understand what the most important indicators of optimal health are. I’d like to create a scorecard…

    1. absolutely BigGregerFan.

      ALL PLAQUE is made up ENTIRELY of LDL cholesterol and LDL is what burrows between the endothelial cells to build up underneath, narrowing the vessel lumen.

      if you get your LDL under 70, it stops depositing.

      if you get your LDL under 50, it begins dissolving.

      of course, if you get your LDL to under 70 or 50 then your cholesterol will follow (or vice versa)

      (those numbers are from memory but very close to accurate)


    2. BigGregerFan: Every time I have seen the recommendations for safe cholesterol, the experts I follow say that you need two measurements in place: Total below 150 and LDL below 70. Some want you to get the LDL even lower and I think one page on this site says that you need to get LDL to 55 or lower if you have already had a heart attack and want to avoid a second heart attack.
      In other words, it’s not a matter of total being more important than LDL or visa versa. From what I have seen, both are important together.

  5. Has Dr Greger ever commented on the books of Gary Taubes? He has a new one out too…The Case Against Sugar. He seems to be a low carb advocate. Just wondered if his books have any validity.

    1. Dr. Greger promotes a whole plant foods based diet. Look-up the daily dozen and you’ll find what he suggests for everyday eating. While Dr. Greger is definitely against refined or processed foods like sugar, I wouldn’t call the daily dozen a low carb diet.

    2. “Has Dr Greger ever commented on the books of Gary Taubes?”
      Not on (that I know of).

      “Just wondered if his books have any validity.”
      The short answer is, ‘No’. Taubes has a journalism degree and has huge holes in his understanding of physiology, biochemistry, and medicine. From what I’ve observed and read he is an evangelist for the low carb diet, regardless of the evidence based literature, and isn’t an objective person.

      For more opinion/discussion than you’ll ever want, see:
      On the right under Nutrition Past and Future you will see sixteen articles on Taubes.

    3. Nancy: Some time ago, Dr. Greger wrote a book called Carbophobia. It was later renamed Atkins Exposed and made available free on the internet. It should not be hard to find. The book focuses on the ideas Taubes focuses and may even specifically mention Taubes once or twice.
      For a very detailed look at the claims made by Taubes, the site Plant Positive is the go-to place. Really well researched information, looking at the actual studies Taubes uses to see if the studies back up the claims. Here is the site: Some videos are entirely dedicated to addressing Taubes, but the whole site is about addressing the paleo/atkins/low carb fad.

  6. But it didn’t take into consideration LDL molecule size. Maybe the gene affects molecule size and that is what results in the health effect. Or not… who knows?

        1. WFPBrunner: I had not seen either of these videos. I just took care of that. :-) Thanks for sharing. I don’t think I liked them as much as you, but I found some great nuggets and really appreciate you bringing them to my attention. :-) PS: I agree, this second panel/discussion is better.

    1. “But it didn’t take into consideration LDL molecule size.”
      No offense, but when you try to score a scientific point use the proper terminology, otherwise you appear to not know what you are talking about. For example, LDL is a particle not a molecule. A single LDL particle is composed of about 3000 to 6000 fat molecules.

    2. a couple of years before i was diagnosed with inoperable, progressive brain disease, i asked my doctor to do a blood test and it turned out that i was chock full of the light, fluffy LDL which just made me feel even more invincible in the prime of my life.

      a couple of years later i got the terminal diagnosis of blocked arteries in my head and there was nothing left for medicine to do for me.

      this light, fluffy LDL is nonsense and gives you a false sense of security.


      it all boils down to the fact that you need to have a cholesterol below 150 and an LDL below 50-70, period-dot.


  7. In one case, you have statins that lower cholesterol and reportedly lower heart issues (note that their benefit is expressed in more than heart attacks and deaths such as heart palpitations)

    In another case, you have a class of drugs that lowers cholesterol via a different means than statins. Yet that drug maker saw no improvement from lower cholesterol levels.

    How can one cholesterol lowering drug improve heart health and the other cholesterol lowering drug have no impact? Answer: There is more to the story than cholesterol levels. Look to molecule size and inflammation levels. Both impacted by carb intake (sugar and those things that convert easily to sugar(starch, grains))

    1. “In another case, you have a class of drugs that lowers cholesterol via a
      different means than statins. Yet that drug maker saw no improvement
      from lower cholesterol levels.”
      People here like to evaluate claims like this so we can come to our own conclusions. Can you provide any specifics? Any scientific references?

      1. Originally I saw it in their ads.

        You can read a summary of a couple studies at: and from there you can chase down the studies if you want. Bottom line for these studies is that the Cholesterol absorption inhibitor drug reduced cholesterol but did not affect outcomes. These were administered with statins. There is compelling conversation that the statin benefit is from the anti inflammatory benefit.

        If you read Zetia’s PDF it says “The effect of ZETIA on cardiovascular morbidity and mortality has not been determined. ” There are other reasons for lowering cholesterol but if it had an affect on cardiovascular morbidity or mortality you can be assured it would be published.

  8. Dr. Greger, I know of several cardiologists that would disagree about the cholesterol levels you speak about. Dr. Stephen Sinatra and Dr. Jack Wolfson to name just two.

    Thus, Alzheimer’s has reached an all time high of the sixth leading cause of death (your report) and Dementia is rising just as rapidly.

    It is correct that LDL can be a culprit but it is also sign to warn and even acts as a bandaid to heal and protect.

    Please read Dr. Sinatra’s article “7 Must Know Cholesterol Facts Your Doctor Won’t Tell You” and reconsider the levels you report and that cholesterol is vital to our brains, organs, and hormones. The doctor’s agree that diet is critical to help the cholesterol to position itself properly within the body.

    I know of at least a 50 doctors (oncologists, cardiologists, psychiatrists, chiropractors, neurologists, naturalpaths, and internal medicine) who have changed their minds about the myth that cholesterol should be lowered to such levels because of the far reaching health consequences that are growing expedientially.

    Thank you and I look forward to your visit to Aspen, CO.

    1. Dr. Greger looks at the sum of all available science, not just single articles. And the evidence-based whole plant foods based diet that he recommends actually lowers your risk for Alzheimer’s and many other modern diseases.

      1. exactly, Vege! {Our bodies naturally make all the cholesterol we need}

        and there is a vast difference between my naturally low levels of chol 102 and LDL 37 due to diet than someone with the same numbers reduced artificially by a statin.

        and guess who those studies on low cholesterol or LDL showing detrimental effects are done on?

        big, fat, sick, french fry eating, statin taking americans.

        like i keep repeating, ALL the studies are flawed and can’t be trusted because everyone in them is poisoned by excessive fatty diets.

    2. You know what, 50-60 years ago a lot of doctors said that smoking in moderation was actually safe and some recommended that their patients actually start smoking since it helped calm nerves and helped some to curb their appetite and lose weight. The science was already abundantly clear by that point that smoking was deadly. But these doctors didn’t want to hear about it, likely in part because many themselves smoked and didn’t want to be confronted with their own poor decisions. So as a result of their strong personal bias they tended to give a lot of weight to industry studies, which we now know were deliberately misleading.

      The same is true today with regard to many aspects of diet, of which the role of cholesterol is just one. Doctors like Dr. Sinatra are in deep denial about what the preponderance of the research shows and instead seize on the small, weak and often deliberately structured to mislead studies largely industry funded that when viewed from just the right biased angle seem to cast doubt on the effect of cholesterol on heart disease. And they find a large and financially lucrative audience of people who want to hear good news about their bad habits.

      1. I am so sick of this parallel between the general opinion on smoking at some point in the past and the current debates on nutrition.

        Can you imagine where we get if anyone that makes a claim that is against the current consensus will bring up the smoking argument to defend their position?!

        1. Hi George, I am a volunteer for Dr. Greger. Thanks for your feedback–I definitely understand where you’re coming from. However, I think that comparing the current nutritional crisis to the smoking crisis decades ago can be an effective tool in the toolbag of nutritional scientists, advocates, policy-makers, and educators. We first need to understand that the way we approach nutrition is a problem right now, and it’s at the cost of perhaps millions of people’s lives. Comparing modern nutrition to 1960’s and 70’s smoking, which do have many similarities indeed, helps us draw connections and potentially learn from the mistakes health professionals and policy-makers made back then. Of course, this should only be one tactic out of many used to improve the well-being of the population.

        2. Why? The animal and processed food industries aren’t just accidentally following a superficially similar agenda, the animal food and processed food industries are deliberately using the tobacco industry playbook with exactly the same goal, confuse the facts in order to keep making money at the expense of the public’s health. Most doctors are trying to do the best they can, but they get little or no training in nutrition and so are just as vulnerable to industry FUD as the general public. Plus doctors are human and liked their cigarettes then and like their meat, eggs and dairy now, and so have a large confirmation bias when it comes to which science to accept and which to reject. Some doctors like Sinatra are simply trying to milk the system by being controversial in order to sell useless or worse products, like Sinatra does with his vitamins. None of these quacks can make money if people realize they don’t need all their potions and nostrums, they just need whole plant food and omit the animal foods and highly processed foods. So I see the comparison to the Tobacco industry as particularly apt.

          1. Why? Because:

            • it is intellectually weak, academically laughable and unacceptable in a debate; when you want to convince me, a layman, of something, and I reply to you: “But, look, all the other experts disagree with you!”, if all you can say is “Hey, it’s just like the smoking controversy, they were all wrong on smoking, they all are wrong now!”, I want something a bit more sophisticated, you have 0 chances to convince me, even more, you have 99% chances to convince me the exact opposite of your claim is true.

            • if our final argument is not the available proofs, but the obscure financial interests behind different positions, we end up in a confusing situation: I don’t know… which is the analog of the tobacco industry in the current diet debate? Is it the egg industry that promotes eggs as healthy, or is it PETA or the broccoli industry that promotes eggs as unhealthy?

            • it is a false parallel, on so many aspects:
            • • you can’t compare a reasonably natural act of eating meat (looks like pre-humans were at least sporadically eating meat 2 mil years ago) with a unnatural act of inhaling (not even through nose, which has the natural role to protect your lungs of external issues) the smoke of a recently discovered burned plant
            • • the difficulty of the 2 problems (is smoking healthy? and what is a healthy diet?) is totally different (and as a proof of that, we now have 1 certain answer and 1 endless debate)
            • • you can’t compare the doctors that said smoking is fine with the nowadays nutritionists that say i-dont-know-what, because they are irrelevant; I don’t care what the doctors, nutritionists say. I do care what the researchers said about smoking, and I do care what researchers say about nutrition. And german researchers in 30s said smoking is bad, in 50s UK authorities start advising against smoking, in 60s US authorities did the same.
            • • (I am not aware of, but) even if at some point in the past, some public authorities said smoking is healthy, we are not in a similar situation now – no public authority says SAD is good
            • • it’s false that the real debate is between dr G and bloggers, nutritionists, mainstream doctors; the real debate should be between dr G and researchers, scientists; and if you take a look at what HSPH, WHO, AHA, HHS+USDA recommend, it’s pretty close to what dr G recommends, the more remarkable difference being on some animal products accepted by all this cohort of experts, but rejected by dr G

            1. your first sentence is nothing but slander, name-calling and insults so you already lost the argument.

              do you know of dr kim williams?

              thought so.

              he’s the current, PRESIDENT, AMERICAN COLLEGE OF CARDIOLOGY.

              call him up, argue his statement with him and then get back with us, ok?


              yeah, he’s an idiot too…..


              1. I didn’t say, not even suggested, that anyone was an idiot. I just said this particular argument (“They all are wrong now just like all others were wrong on smoking”) is a very weak one.

                1. maybe in your biased opinion it is but it’s an excellent analogy in my and many others’ opinion.

                  please talk with dr kim williams and get back with us.


                  (speaking from experience, a terminal, progressive, inoperable condition that medical science had no more to offer to me until i healed myself. look back several months in the comments sections if you really want to read about my journey)

                  good night.


  9. Slightly off topic, I have a question about flax seed: I had always read the recommendation for eating 2 tablespoons (TBS) of ground flax seed daily. But I notice that Dr Greger takes 1 TBS daily and that Dr Dean Ornish in his treatment of prostate cancer patients gave them 4 TBS a day. So, what is the optimal level for the average healthy person? Also, is there anything in flax seed that necessitates limiting the amount to just 1 TBS a day?

    Thanks, in advance for any info.
    Mark G,

      1. Thanks, I’ll check it out. But it makes me wonder even more why Dr Greger’s amount varies and if there is anything about flax seed that needs it to be limited. Thanks again.

        1. Dr. Greger also recommends an oz of walnuts or other nuts a day. The recommendation of one Tbs of flax meal may be simply to control the percentage of calories from fat. If weight and atherosclerosis are not issues for you, it seems likely that a couple of Tbs of flax seed would be fine

          1. Thanks for your thoughts on this, but I’m trying to get the actual reasoning and not speculate what the reason might be. So, I’m still hoping the doctor will take a moment to explain his recommendation or someone with the facts can help clarify.


            1. 50 grams equals 3.3333333333333335 tablepoons… So always stay below 3 tablespoons. No reason to ever go higher then 2, though. In fact, there is one study that found 30 grams of flax seed per day lowered testosterone in men. Then again maybe that’s not a bad thing for longevity, but for young guys wanting to build muscle maybe not the best thing. I like to do one tablespoon of flax and a few teaspoons of chia seed.

              1. Thanks for the conversion. I actually looked it up a little earlier on google and it depends a little on the substance, but it said that roughly it works out to what you said. I am thinking I’m going to stay somewhere between 1 and 2 TBS and probably closer to 1 than 2.

  10. Hello, I am a vegetarian and also eat little dairy, yet my cholesterol is still high. I also am 5’5″ and weigh 138. I am hesitant to go on statins, but maybe I need to.
    LDL = 169
    HDL = 49
    Total = 261
    CHOL/HDLC Ratio = 5.3
    Any advice?

      1. The foods you mention – namely coconut oil, avocados and olives (including high-quality EVOO) – are perfectly healthy in moderation.

        1. Moderation is fine if you want to be moderately ill. Oils are not food, they are waste products left behind after the fiber and nutrients have been processed out, high in calories but devoid of nutrition. Eat the whole food.

          1. god *&^% Vege, you beat me to it again! LOL

            “i just want to be moderately healthy and have a moderate risk of heart attack and a moderate risk of cancer and…” :o)


            1. Hi Ron, I am a volunteer for Dr. Greger. Thanks for your question! Fats from flaxseed, chia seeds, and walnuts do not cause cholesterol levels to go up. If anything they do the opposite. However, I would not use the oils extracted from these foods, as these are the chemically manipulated isolates of the foods, rather than an inclusion of the entire package that nature put together. When you just get the oil, you miss out on a majority of the phytochemicals, all of the fiber, and many other health-protective nutrients.

        2. BChristine, Dr. Greger and most other WFPB doctors disagree with your opinion on oils, all oils are dangerous for weight gain and endothelium destruction. If you are following Mercola or those like him, there will be much disagreement here.

        3. And exactly how much is “in moderation”. This sort of nebulous recommendation is worse than useless, since it allows the individual to simply assign the designation of “moderate” to the immoderate amount that they currently consume. After all 80% of people surveyed think that they are eating a healthy diet, when health statistics point to the fact that they decidedly are not. So please quantify the number of grams per day of each of these three oils that would meet your definition of “moderate” consumption.

        4. Oh, and all pure fats have very low to zero amounts of nutrients in comparison to whole plant foods. But the net effect is even worse than these foods not adding much to the total daily nutrient intake. Adding pure fats to the diet forces the removal of an equal number of calories of highly nutrient dense foods and so the total nutrient intake declines. Thus the nutrient density (amount of nutrients per calorie) of pure fats is effectively less than zero since they reduce your total nutrient intake. The same effect is true for any highly refined food such as sugars and isolated protein which still contain calories but little or no micronutrients.

        5. I realize that oils go through a process and the actual ‘whole food’ is the most optimal choice; however it’s not always “convenient” to say …open up a coconut or find a good, ripe avocado to eat if you want that flavor. As far as “moderation” goes; yes, everyones idea is different. IMO, a teaspoon or two per day is what I would call ‘moderation’.
          I follow Dr. Greger’s health website – among many others – because I am x-passionate about nutrition and health; and have been for over 15 years. I don’t always agree with everything he says, but I occasionally post about things I feel the most confident about and have done the most research on.
          That said … on the rare occasion when I do post (and always in a kind, respectful manner I might add), I get attacked (you know who you are). I made a general one-sentence comment, and it was thoroughly “dissected”, torn-apart and more-than-borderline condescending. I realize you want to communicate your “knowledge” to others, but you may want to consider doing it in a kinder, less overbearing way; esp. for those who do not regularly post – so as not to ‘intimidate’ them to the point where they don’t even WANT to post. Everyone has a right to voice their opinion, but it’s all about respect.

    1. Marcy, why don’t you do a little experiment: Ditch all dairy, refined carbs and processed foods for a month or two, then have your cholesterol levels tested again. I think you’ll find your answer.

    2. Marcy, I am not a doctor just an educated consumer of food. Your ratio is high which is a risk factor. Can you try giving up dairy and see if that changes things. And oils, if you regularly use oil, stop and reassess that.

    3. I’m a vegan with similar problems (apparently because i have an apoE4 gene allele, so cannot metabolize cholesterol very well), but when I reduced my saturated fat intake to under 10.0 grams a day, my LDL dropped like a rock. I’d suggest cutting out all dairy (the worst!), and counting the amount of saturated fat you eat in your vegetarian diet, then reducing it. Coconut oils, palm oils, macadamia nuts, etc. are all quite bad for LDL, very high in sat fat.

    4. Hi Marcy
      I don’t think anyone answered you.
      First go above to topics and watch all the videos on cholesterol.
      Limits fats saturated
      Lose weight
      Stop the animal products including dairy

      You cholesterol will drop.
      Good luck!

    5. I would suggest you pick up a copy of Dr. Esselstyn’s Prevent and Reverse Heart Disease, or check out one of his presentations on YouTube. Follow his diet guidelines for a month and recheck your lipid profile. Let us know what happens!!

    6. Hello! My name is Megan, I’m a dietetics student and a moderator for nutrition facts. Since there are so many different types of vegetarians, I’m not sure what your dietary habits are. For example, lacto-ovo-vegetarians still consume dairy and eggs, while lacto-vegetarians consume only dairy, but no eggs. I would highly recommend avoiding eggs at all costs to help with your cholesterol. Here is a link to a page with multiple videos about eggs and cholesterol: I would also recommend avoiding dairy, as there are many plant-based alternatives that do not contain the saturated fat of dairy products. Here is a link to some information on dairy products: There are also many plant foods that may have cholesterol-lowering effects. This page lists some of those foods and also has more videos about cholesterol and what foods can impact it: Sorry – that was a lot! But I hope some of this information can help you :)

  11. This does not answer the question as to what is LDL’s purpose. Dr. Linus Pauling said that LDL is like a band aid that covers cracks in the blood vessels until they are healed. But, with our diets low in Vitamin C, which helps heal the vessels, the healing may take a long time and the LDL then collects calcium and other things and before long we have plaque. He was able to clear out plaque with high doses of vitamin C and Lysine.
    It seems to me that LDL gets a bad rap. Obviously it is a participant but what is the reason behind its participation and then lets fix that. Both forms of cholesterol are necessary for many processes in the body and the liver makes most of the cholesterol.

  12. isthatasquirrel: The automated spam filter in disqul caught your post. I rescued it. I’m making a point of that because @WFPBrunner will not have seen your post, but she should this post. So, she can look at your reply.
    My reply to your post is to look at the reference WFPBrunner gave. The point is: If you want to define what “low” and “high” means based on the scientific evidence, then WFPBrunner is 100% correct. An LDL of 110 is very high if you want to avoid heart attacks.

  13. Ryan: I don’t know why we are getting so many false catches by the automated SPAM filter, but your post too got caught. I just released it. @Marcy, note that Ryan replied to you.

  14. I would be so appreciate if an informed source could offer feedback. When my hubbie switched from SAD to WFPB, total cholesterol went down 69 points in 2 months to 161. Surprisingly, a recent blood test a few years later shows it is up again to 205. LDL=119 HDL=68 Cholesterol/HDL ration=3.0. Why would a very healthy eater of a WFPB diet have these numbers and not lower. He does eat avocados and nuts regularly but as we know nuts are supposed to be protective and both offer good fats. Do we need to be concerned? Our plant-based local doctor says no and I do respect his opinion. But when I hear others eating the same way have much lower numbers, I can’t figure out why this is happening. We eat almost no oil so that is not in play as a factor. Feedback???

    1. Drjembe, your hubbie may be eating too many nuts and avocados. While these are very healthy foods, you can get too much of a good thing. Dr. Greger recommends just 1/4 cup of nuts per day and one TB of flax seeds. These are his only Daily Dozen recommendations that contribute much fat to the diet. Exercise is also important for reaching a healthy LDL level.

    2. My issue below is the exact same. When I first went vegan, and unfortunately was eating processed vegan stuff, my numbers were great. Over the past several years, I have eating better and better WFPB, but my numbers, especially LDL is increasing.

        1. cut out ALL fats and fatty plants, nuts and seeds as per Esselstyn and those #’s will drop like a rock.

          don’t fall for the avocado, nuts and seeds are good for you in moderation garbage. if they were GOOD for you you could eat as much as you want like you can bananas or cucumbers or apples or rice or ……

          they’re all fat, period.

          other than a TBS of flax, you get all the fat you need in the whole foods you eat.

          speaking from experience. chol 102, LDL 37.



    3. If I ate nuts/seeds, nut butters even infrequently, and one avocado a month, my cholesterol numbers would be higher than your husbands. I eat 1 walnut maybe 4 times per week and a tbsp od flax.. no oil, no avocados, nothing, and my numbers are comparable to your husband’s. And I exercise a great deal. I will be interested to see the responses you receive to your question.. thank you for asking.

      1. Susan, this is such a conundrum isn’t it. We expect and want to have the numbers close to heart attack proof that our plant-based doctors advocate yet when we believe we are consistently following the WFPB diet and it doesn’t happen, we are left wondering why? I wish some doctors/dieticians could reign in on why this happens. I am wondering what the heart attack proof HDL/cholesterol ratio is too. Is it 1?????????

        1. Yes it is frustrating for sure ! And, I’m getting the impression that it isnt that rare either to be eating very closely following the rules, but cholesterol remains high or slowly climbs back up. I have been reassured at different times that making every effort to keep LDL under 115 or so is good while maintaining the strict diet , exercise, meditation etc. Also , your husband’s chol/HDL ratio is great.. its what we want , 3.5 or under I was told. The best thing I ever did was to ask for a hs-Crp test (high sensitivity c reactive protein test ) and the reason is that they say this is more telling than other tests about the risk of heart attack.. I am not a health proffessional so do ask your doctor. We want a low value for that if possible under 1.0 is wonderful. Closer to or under 100 for LDL is my goal.

          1. HDL is completely overrated especially for a No Oil WFPBD.

            HDL are the cholesterol ‘garbage trucks’.

            they take away all the excess cholesterol and deposit it in your liver to be eliminated thru your bile salts.

            only meat and high fat eaters need a lot of garbage trucks to haul away the excess. that’s why us Fat Free Vegans have low levels of HDL and it’s a good thing because we don’t have any excess to remove from our systems.

            the most important thing are LDL levels, period.

            they should be below 70’s to stop disease progression and ideally below 50 if you want to actually reverse vessel disease which we all have, diagnosed or not.

            every 10 year old autopsied in this country has heart disease. fatty streaks in the heart vessels which are the beginning of the disease and i’m pretty sure that encompasses all of us :o)


            1. Yes, ty AZ Donald, we know what cholesterol “should be ” but we are talking about wfpb vegans , no oil, where the cholesterol doesnt drop to ac eptable levels, or , climbs ba k up slowly after an initial lowering. It happens, and not unfrequently. Quite well aware of what the plant doc’s have to say about it. Its frustrating.
              Continued good health and success on your progran!

              1. {He does eat avocados and nuts regularly}

                there’s your answer, he’s not a no oil/fat vegan and his omega 6:3 ratio is out of whack.

                there’s no cheating or deviation AT ALL.

                unless you’re absolutely strict, you will never accomplish your goal and torture yourself in the meantime..


                1. yes, I was speaking about myself. .. I am strict, very. Thin, athletic.. and my doctor’s wife had the same issue.. after an initial drop to LDL below 100, it started to climb back up. Cant eat bread or rice , just vegies, beans, lentils, some fruit,.. its a nightmare.

                  1. In Dr. Esselstyn’s program, some of the patients who couldn’t keep cholesterol down in the target range took a cholesterol lowering medication… Dr. Esselstyn’s program is very strict and one of his tag lines is “moderation still kills”. Unfortunately, this is one of those instances where genetics win. I am in the same boat as you. Diet can take me just so far… I am not yet on cholesterol lowering medication, gonna fight it as best I can.

                    1. hi Joan, thank you for your response to our ‘situation’.. Initially when I had heart surgery I was put on heavy statin does as part of the protocol.. It was the beginning of a five year nightmare of pain and side effects and 5 different specialists to handle the misery. It mostly ended the same month I finally threw away the statins. Now, after 19 months on wfpb, no oil, my chol is slowly climbing back up.. and I keep eliminating more foods.
                      I also try alternative therapies like accupuncture weekly to work on the liver, and meditation at least daily.. I dont take omega 3 pills because of the cost, but maybe that would help ?

                  2. I think we need to forget this slim fit diversion. You cannot outrun a bad diet not that I am saying yours is bad but I went to a funeral of a friend yesterday who was 63 and incredibly fit for his age, 6 pack stomach and the rest but he had a heart attack.

                    1. Mark, I totally agree with you, a doctor from our run club dropped dead in his tracks one day.. a regular 10km runner. I only mention it in the co text of risk factors and cholesterol levels. I have always been slim and fit so its not a consideration. I cant lose more to improve cholesterol. I am wfpb, no oil, no eating out, no manufactured processed food , nothing, nada, zip.

                    2. As you may detect I am not a big fan of this get your LDL into the basement theory but I can offer a couple of things that may well lower your LDL. First of all there is research that coffee raises cholesterol whilst green tea lowers it. I have found that the difference for me between the two is about 10%. So if my LDL is 3.0 on tea it will go up to 3.3 on coffee. Secondly Niacin will almost certainly lower your LDL. You can get the delayed flush variety which is fine. Personally I would find out what your cholesterol is made up of ie what is your ApoB to A ratio and Lp(a)

                    3. thank you Mark, I really appreciate your helpful comments. I will try your suggestions, and I will ask about the ApoB to A ratio. And I’ll request iodine test too re your post above. Terrific suggestions, ty

    4. There is nothing wrong with those numbers, you have a good Total to HDL ratio. Has your husband checked his APOB to APO A ratio and also Lp(a) readings ?. I would also check his Homocysteine levels if he is on a WHPB diet

      1. Mark, I am not aware of what the APOB to APO A ratio refers to. I don’t see those values or the homocysteine on the lab results. Our doctor who is WFPB did not test for those and since he said not to worry I guess he doesn’t think he needs to. But can you give me a brief explanation of what it means?

        1. Hi a few links for you to look at and a quote from one (LDLc is the reading your doctor gives you)

          “In an evaluation of 170 thousand Swedish individuals, the AMORIS (Apolipoprotein-related Mortality Risk)11 study showed that apo B was a better marker of cardiovascular risk than LDLc, especially in individuals with desirable levels of LDLc, regardless of sex. The apo B/apo A-I ratio was identified in this study as the single variable that was more strongly associated with increased risk of fatal myocardial infarction (MI), particularly when lipid levels were within the range of desirable values.”


          Both APO B and A tie in with the reverse transportation of cholesterol as the main problem

    5. Dear Drje,be. It IS frustrating when you seem to be doing everything right and those cholesterol numbers are higher than desirable. One thing you didn’t mention that can help is increased exercise. Has your husband spoken with your doctor about this? While it sounds like your husband has done an excellent job eliminating foods that raise cholesterol perhaps now aggressively focusing on foods that lower cholesterol will help. One of our dietitian moderators had some good advice I’ll include below. I’m glad you’re working to support your husband and encouraging him to do all he can.Joan-Nurse Educator
      “…once you have gotten rid of the things that increase your cholesterol you need to pack your diet with foods that actively lower your cholesterol. So, for example, the components of the portfolio diet for lowering cholesterol. I’ll highlight some of the diet tips found in Dr. Jenkins protocol using Dr. Greger’s videos as reference.
      1) Load up on foods high in soluble fiber. This means tons of beans (see what kind are best: canned or cooked), vegetables like okra, plenty of whole fruit, oatmeal, and flax/chia seed. Find ways to use beans. Lentil stew, dal, curries, bean burritos, bean soup. If you don’t like beans whole, like in a salad, maybe try them as a spread or as hummus?
      2) Take about 2 Tablespoons of ground flaxseed daily and 4 Brazil nuts monthly. Sprinkling ground flax on oatmeal in the morning is an easy way to get enough. Or add it to a smoothie. If you buy the flax whole just add it in the blender first, grind it, and then add the rest of your ingredients.
      3) Focus on several cups of greens daily to help keep nitric oxide flowing. Vegetables loaded with nitrates have been shown to improve heart health. Beets and arugula have tons! (See video on where other vegetables rank on nitrate levels). Yes, green smoothies count if you’re adding the right foods like berries and dark green leafy vegetables (kale, spinach, even parsley). What’s better? Raw or cooked vegetables? Well, it may depend on what veggies are cooked. Lastly, a word of caution for those going wild on greens is that overdosing on raw greens can happen.
      Dr. Greger says to get thyroid function tested, too. A low-functioning thyroid can contribute to high cholesterol so it’s good to rule that out. Weight loss is also important if there is too much abdominal fat. Is your height more than twice your waist circumference? So there are a lot of factors to consider, but if folks are practicing healthy eating and managing body weight and still find their LDL is not coming down they should definitely consider a statin. As I always say make sure to check with your doctor about all of this. It’s important to be transparent and communicate with everyone.” Joseph Gonzoles

      1. Thank you for taking the time to share your post. We do most of these things daily. He’s a skinny guy and does a lot of physical activity and we eat tons of whole food veggies every day including those above. Usually just 1 tbsp of flax seed and haven’t done the Brazil nuts. So could try doing those. Thanks again.

  15. I am a healthy 48yo man. I have followed a vegan diet for almost 4 years, I don’t smoke, I have low body fat, I exercise(lifting and cardio), I don’t eat processed foods or “sweets”, and I avoid as much oil as possible. My triglycerides are normal(100), my HDL’s are good at 68. My problem is my LDL’s have climbed to 155. I don’t know what I am doing wrong. I don’t want to go on a statin, but should I?
    Any advice would be appreciated!

    1. On the search bar above search “cholesterol”. Then take a look at “What can I do to lower my cholesterol? It seems I’ve tried everything!” That might help.

      Are you eating greens at least 3x a day? Are you eating beans daily. In your case I would include beans and lentils as frequently as possible. Eliminate any refined grains. Eat oatmeal. If you eat breads you might consider Ezekial breads. The ratio of fiber to carbs is about 5, which is the number recommended by Dr. Greger. In my opinion the strictist vegan doctor is Cauldwell Esselstyn. I’m sure he would tell you to avoid all nuts and avocado. One or two tablespoons of flax seed a day is helpful. Dr. Esselstyn recommends no smoothies and defintielly no juicing. He says the fiber in whole foods should not be disrupted by blending or grinding.

      You might need a statin such as pravastatin which lowers the production of cholesterol and zetia which prevents the absortpion of cholesterol from foodl. But before your regular doctor prescribes a medication you may wish to consult a vegan MD, who might do a better job at trying to figure of lowering youf LDLs without medication..

      There are some internet sites that can help you find a plant based health practioner where you live. Good luck and let us know your progress.

      1. Thank you Ken! I do eat greens 3 times a day, beans and lentils probably not daily. Never eat refined grains and I do love Ezekial bread. Oatmeal I have not done much and I do Vitamix smoothies with fruit, kale and flax seed every other day, so I will alter that. I am going to a cardiovascular lipid specialist in March, but I will research plant based practitioners also. Thank you again!

        1. Your welcome. I have a somewhat similar problem. I am 64 years old. In 2003 when I was 51 years old I had a stent placed in my right coronary artery due to experiencing angina when exercising. While I had heard of Dean Ornish MD was not savvy enough at that time to see if I could enroll in his program. When you cardiologist recommends you have an angiogram indicating a 90- 95% blockage in the right coronary artery and suggests a stent to alleviate symptoms it is hard to say no especially when you are unaware that a doctor such as Cauldwell Esselystyn might recommend a whole food plant based diet to try first. My father died of a heart attack in 1978 when he was 55 years old and I wanted to avoid the same fate. So at the young age of 25 I started seeing a cardiologist who recommended a low fat diet. I had a modest reduction in cholesterol, but not enough. At some point I was placed on pravastatin. I think my cholesterol dropped from 220-240 down to 180. My LDLs dropped to 80. At the time we thought these were good numbers. By the time I needed a stent in 2003, new research had just come out indicating for those that are predisposed to arteriosclerosis that the cholesterol needed to be reduced to under 150 and the LDLS needed to be reduced to between 50-70. After I had the stent the doctor continued the pravastatin but also placed me on Zetia. That reduced my lipids to under these numbers. Fast forward now to 2017. It is now more than 13 years after having a stent. The good news is that overall my health is excellent, I do not need another stent, I am able to exercise. I was in a 40 mile bike tour not too long ago. The problem as I see it is that I am still on the pravastatin and zetia, and I am somewhat angry that if I had been on a WFPB diet I may have avoided a stent, and I would not need to take these lipid medications. To make a long story short, 4 months ago in NYC I saw a WFPB cardiolgist who placed me on a WFPB diet. I was hoping my lipid level would go so low I would no longer needed the pravastatin and zetia,. so after 4 months of being on this program ( no meat, no diary, no oil, lots of greens vegetables, beans, fruit, some nuts, flax seed and a bit of avocado my cholesterol numbers are exactly the same (and that is with continuing the pravastatin and zetia. So I too am frustrated.. Perhaps I just genetically need medications to keep my lipid levels down. The WFBP based doctor says to stay on the WFPB diet because the positive benefits for ones health are are enormous. So I am continuing on the program but don’t see any reductions in my total cholesterol or LDLS. But for me there is a paradox. Perhaps the medications dropped my lipid levels to as low as they can go, and no diet will make them lower. I will consult the vegan cardiologist again. Perhaps he will recommend dropping the Zetia to see if my low lipid levels remain low without the Zetia if they do consider dropping the pravastatin. I am frankly at this point scared of stopping the medications, for fear of my arteries clogging up again. Thinking about my situation makes me think if I had your situation I would try a WFPB diet supervised by a vegan medical doctor. Perhaps that will do the trick. If it doesn’t than I would definitely consider trying the medication route. The medications are not that bad. I have no side effects. Eric Adams the Brooklyn borough president, was told he needed cholesterol mledication.. He went all the way to the Cleveland Heart Clinic to see a WFPB doctor, who put him on a strict healthy vegan diet. He is doing well and does not need medications. He did not say who he saw but I believe it is Cauldwell Esselstyn.
          In NYC i know of two WFPB physicians. Michelle Mc Macken at Belvue hospital and Robert Ostfeld at the Montefiore in the Bronx. Dr. Ostfeld is who I am seeing. His diet is patterned after Cauldwell Esselystein’s diet. He is a brilliant cardiologist and a nice guy,.

          1. Ken, thank you so much for sharing your story with us. Sounds like you are doing an amazing job of looking after your health regardless of the numbers. I have not had the same good fortune in doctors,.. I did not have a heart attack or symptoms, but had to have quadruple bypass 6 yrs ago. I reacted horribly to statins and can only take 10 mg 2 x week . This is all stressful though my doctor is reassuring.. her husband, also a doctor, keeps pushing for increase in statins. I have done the “portfolio” diet checklist on the page you referenced, but not the margarine with stanols.. i refuse! But I will make extra effort re the greens.

            At any rate, ty again for your thoughts.. I am sure that a great many people will benefit from the insights presented on this forum. ty all

          2. Ken have you watched Forks Over Knives? I am sure you have but if you haven’t it is a must see. Keep those patients in mind when you get discouraged. You are doing great. It has only been 4 months.

            1. don’t forget “FORKS OVER KNIVES EXTENDED INTERVIEWS”

              unfortunately many have never heard of that one and it’s even better.

              it’s all the long interviews with doctors that got cut out of the first FOK.

              it should still be on Netflix.

        2. I’ve been a ‘beaner’ long before I met Dr. Greger, and he has ‘Beans…3 cups a day’ at the top of his ‘Daily Dozen’ list.

          Dr. Joel Fuhrman insists on ‘G-BOMBS’ as the most appropriate diet (Greens, Beans, Onions/Garlic, Mushrooms, Berries, and Seeds).

          For the best possible disease reversal program, I adhere to Dr. Caldwell Esselstyn’s recommendations.

          1. LG King: This doesn’t take away from your main message, but I do think a detail is important to fix: Dr. Greger recommends 3 *servings* a day in his Daily Dozen. Each serving is 1/2 cup beans (or 1/4 cup hummus/bean dip or 1 cup fresh peas or sprouted lentils). 3 cups a day would be twice Dr. Greger’s recommendation.

    2. Don’t put too much stock in HDL levels. Here is a news release
      “Raising ‘good’ cholesterol doesn’t protect against heart disease after all, study finds
      that provides an overview of the study
      “High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions”

      LDL and non-HDL cholesterol appear to be better indicators of health status than HDL.

      1. The “HDL is causally protective” hypothesis is untenable after the past decade:

        Meta-analysis of 108 randomized controlled trials effecting HDL levels (statins, fibrates, resins, niacin, n-3 fats, ACAT inhibitors, ABCA1 inhibitors, CETP inhibitors, PPAR activators, diets, bariatric surgery): No effect. Subsequent AIM-HIGH niacin trial No effect. ABCA1 gene loss of function No effect, LCAT gene single nucleotide polymorphisms (SNPs) lowering HDL: No effect, composite HDL effect from 20 SNPs No effect, 19 SNPs affecting HDL from a genome wide association study (which don’t simultaneously affect LDL) No effect.

        1. Very nice references, Darryl.

          Aside (but related) – The “good cholesterol” “bad cholesterol” concept has always bothered me.

    3. I’ve read that if your total cholesterol minus HDL is 130 or lower, you’re heart attack proof. Maybe you don’t really have a problem.

    4. William, follow Dr Esselstyns book, “Prevent and Reverse Heart Disease” to a T and you will eventually have #’s like mine. basically a No Oil, No Fatty Food WFPBD.

      it took 5 years but i finally got down to chol 102 and LDL 37.


      (and my terminal disease reversed itself completely)


      1. AZ Donald, your story is downright amazing.. miraculous! Thank you for sharing your story and your wisdom with us. I just wanted to ask you about what you said here ‘it took 5 years but I finally.. etc’ So are you saying it took a few years and perhaps some diet tweaks to lower your cholesterol to your current levels? Thank you

      2. Hi AZ,
        I’m impressed with your outstanding results, and how succinct you are with your comments.

        So I’m hoping you may be able to analyze and point me in the direction of a simple solution for my problem. Being on a strict WFPB, no oil, no refined carb diet for 4 months but still continue the pravastatin 40mg and Setia 10mg that I have been on 13 years post stent in my RCA, My cholesterol is 142 and LDLS 61 and have been floating about these number for the last 13 years. .Frustrated the diet did not lower my cholesterol numbers further. They are excellent numbers but want them to drop further drop so I can consider stopping the medications..I would love my LDLS to drop below 50 if that is possible.

        Dr. Greger, seems to be saying great things about nuts and avocado. Esselstyn says otherwise for heart patients. Is there anywhere on Dr. Greger’s videos where he agrees with Esselstyn to stop avocado and nuts if you need further progress to reduce LDLS and cholesterol?

        Do you think there are any nuts (perhaps walnuts) I could have and what amount? Perhaps a 1/4-1/2 cup a day? Perhaps a half an avocado twice a week?

        The reason I mention the avocado and nut issue is that I have gotten too thin while on this diet. Yes I know I need to eat more grains, beans, and starches, but dropping the nuts and avocado will probably cause me to lose more weight.. I’m 6′ 0″ and only weigh 155 pounds. I’m getting too skinny.

        A couple of related issues. Ornish has had good results with his patients with prostate issues taking flax. I have BPH and started taking three TBS of ground flax seed daily to see if i could lesson this condition without medication. So far no change in BPH. Any recommendations?

        I thought my diet might further reduced inflammation but still have joint pain (rotator cuff and knee meniscus issues).

        Don’t be concerned about possibly giving me wrong recommendations. I am in great health but thought I would mention the issues of weight loss, BPH, Joint pain, and a bit too much short term memory loss, so you would have a bigger picture of my situation.. I’m 64 years old.

        Thanks for your thoughts and recommendations.

        1. hello susan and ken.

          i want to help you guys out and give you all of the knowledge i’ve gained that i’m salivating over it but i’m also so tired i can’t keep my eyes open.

          i’ll address both of you tomorrow and if i forget or get delayed, don’t hesitate to call me a dummy for it and remind me. wifes going to germany for a few months so it’s a little hectic.

          i seem to have trouble navigating this Disqus and only found this thread with BOTH of your comments by accident.

          i could find one of your comments on one and then i could find the other of your comments on another but not both on the same page until now. don’t hesitate to navigate me back here.

          all three of us have so much in common it’s crazy and i will help set your minds at ease, i promise.

          take care guys, everything will be fine and improve.
          will be talking with you soon.

          ps. if you’ve got the time, go back a few weeks/months on these boards and i’ve written my entire life story and given links and everything i could think of. there may be some pearls of wisdom in there to help you out in the meantime. ignore my rude posts to the cholesterol deniers who have never had their lives on the line, are only booksmart and only gotten their flawed knowledge from by authors who just want to make a buck. i’ve got no patience for them.

          standing blood orders
          paleo 53 yrs
          fatty plants
          whole rice, wheat etc
          raw as possible
          green smoothies
          indigenous weight range
          saw palmetto
          my bph
          lyme disease: thea


          1. Hi AZ,

            Hope your wife had a safe trip to Germany and you have caught up with your shut eye.

            When you are rested, and find the time, please advise me if there are any tweaks you recommend to my 4 month WFPB diet in which i have not seen results after 4 months. As I previously said my cholesterol is around 142 and LDL is around 58 but i continue to take pravastatin and zetia which I have been on for 13 years post my RCA stent. My health is very good with the meds but feel like I possibly could have avoided that stent when I was 51 if I was on a WFPB diet. I am 64 now. Father died of heart attack at age 55.

            Dr. Ostfeld who I have consulted once, who is a follower of Esselstyn, placed me on a WFBP diet of greens, beans, onions, berries, other vegetables, fruit , whole gains, no oil, no refined grains, starches, He also also routinely allows up to 1/4-1/2 cups of nuts, or 1/2 avocado, or combination of up to 1/4 cup nuts and 1/4 of an avocado daily, in addition to the TBS or two of ground flax seed. I supplement with B12, D3, coenzyme q10, and algae based omega 3 capsule..

            I like to share some additional background information. I have BPH but do not take
            medications for it. The WFPB diet according to Ornish is supposed to alleviate symptoms. So far not much change. I am concerned that after losing 10 pounds in 4 months on this diet, now at 155 pounds at 6″0″ , that stopping the avocado and nuts will make me too thin.. I guess I could try to replace that with more beans, whole grains and starchy vegetables. My mom had mixed dementia for the 6 years before she passed away at age 87, so at age 64 I am concerned about short term memory loss, but there seems to be little extra I can do to improve this other than learning a new language, a musical instrument and focusing on ball room dancing (none of which I am doing right now). I also have joint pain from rotator cuff issues and meniscus knees issues. That could be partially due to aging. I was thinking about glucosomine chondritan but it may be a placebo. With my WFPB diet I do add Turmeric, cloves, black pepper and flax to my morning oatmeal. I spend 1 1/2- 2 hrs in the gym 3 times a week. I keep meaning to increase that by doing latin or ballroom dancing once a week but we spend so much time cooking that we have little time for more exercise. I also make green smoothies daily with collards, kale, berries, mango, banana, kiwi and amla (dried Indian Gooseberry powder recommended by Dr. Greger.) Dr. Greger says everything I add is healthy but Esselstyn would dispute this and say I am disrupting fiber and should only eat these foods whole.

            Anyway my goal is to further drop my lipids so I can consider dropping the pravastatin and Zetia. Hey if I have to take those meds no problem, but I prefer to be off them..

            The one area where I have had some sucess on the WFPB diet is that it is more akaline allowing me to stop taking protonix (Gerd medication) I guess that is about it.Sorry threw a bit too much at you.

            Thanks for your recommendations!



            1. hello susan and ken!

              the three of us have more in common than you can imagine, long-short for any newbies.

              almost 6 years ago i was diagnosed with inoperable, progressive brain disease and told there was nothing more medical science could do for me except statins and plavix to possibly slow the inevitable. i specifically asked my esteemed U of A Neurologist and my personal physician about diet change and both said it would make no difference. my PCP was a vegetarian indian and you think he would have had some more insight but no, enjoy the time you have left i was told.

              regular doctors know nothing about nutrition for healing, only plant based doctors have a grasp on the idea.

              when my symptoms returned a few months later i realized that i had only a few months left if that because they were so severe. anywhere from just facial to complete left sided paralysis 10-15x/day for 3 months yet i never actually ruptured a plaque and stroked although i may have had small ones as my memory has definitely been affected. i never had one more stroke/TIA/mini stroke since the day after i made my diet change, not one from 15/day.

              i went WFPB overnight following Dr Esselstyn to a “T” with NO OIL, NO FAT, NO FATTY FOODS LIKE NUTS AVOCADO OLIVES COCONUT ETC. my only deviation is i eat a ton of fruit as i believe we evolved for 5 million years to do that and it hasn’t hindered my recovery one bit in fact, it’s helped IMO. the more raw we eat the better i feel. i didn’t even take flaxseed until my doctor twisted my arm a couple years ago because i was afraid of the fat and didn’t understand the omega 6-3 concept.

              during the first year, i was on statins and plavix which just wreaked havoc with me just like you susan. after about a year my chol got down to the 168 but my LDL wouldn’t budge from around 78-83 and i was aggravated like both of you to say the least. I WAS THE BEST PATIENT DR E COULD HAVE AND THE #’s WOULDN’T COME DOWN. I THINK AT THE TIME I DID NOT EAT MUCH FRUIT, I WAS EXTREMELY STRICT, NOT A MOLECULE OF OIL OR ANIMAL.

              after the first year i decided to stop my statins since i believed my body had no excess cholesterol to process anyway and the #’s kept going down. about 2 years in, the last year not being on statins my chol was a fantastic 131 but my important LDL was still at 78…. frustrating, but i was still alive and my MRA had shown complete reversal of my anterior cerebral artery blockages. by now the other patient my neurologist had wasn’t so lucky, he had progressed and died. i was on the right track even with an elevated LDL.

              in mid 2014, 3 years in, my chol was back up to 181 and LDL was 116. OUCH.

              by the end of 2014 my #’s finally began their final downward spiral, chol 161 and LDL 85 until now they’re chol 102 and LDL 37. they’ve been about there now for a year with virtually no fluctuation.

              somewhere in between all of this i did a little experiment. i ran the treadmill for 30 minutes per day for one month before my next lipid panel. my cholesterol dropped 30 points! i don’t remember what the LDL did but it was significant too. i would never have believed exercise had that profound effect but now i use the treadmill every day watching documentaries or dr gregers yearly lectures or whatever on the computer right in front of me. you could do that with a bike or rowing machine too. the effects of exercise on your cholesterol are tremendous and i’m talking reaching OVER 85% of your target heart rate, not the wimpy levels promoted on websites to reduce their liability. you need to be in a full sweat to get the full effects and then start the clock. we need 150 minutes of exercise per week broke up anyway you want to, that became very obvious to me. 20 minutes today, 40 minutes tomorrow, 30 minutes the next day etc but at a full sweat and adding up to at least 150 minutes / week.

              i believe as long as you are eating a no fat, WFPBD and NOT CHEATING IN THE LEAST that your body is able to repair itself no matter what the blood numbers are telling you. technically, i should not have reversed my disease in the first 20 months because my #’s weren’t that great in the beginning but i did. and then when they went up i was devastated, literally a dead man walking for about 4+ years but eventually it all worked out.

              i didn’t really do any tweaks to my diet susan, i followed “Prevent And Reverse Heart Disease” to a “T” other than halfway thru adding copious amounts of fruit and for a year or so lots of fruit smoothies, grape juice for some liquid, bananas and blueberries is about all i could fit in a blender and we each would down a full blender-full. there were some weekends that we went ‘fruitarian’ and i really miss those times. maybe it’s time we started that again, it’s like a cleanse but with nutrients and i always said i could feel the nutrients going into my veins.

              the KEY was no fat, nuts, seeds, fatty fruit etc. just whole wheat, whole pasta, brown rice, potatoes, corn, veggies, 2 cans of beans and 1-2 dry cups of rice per day, bean burritos on corn tortillas or wheat if you can find them w/o oil, oatmeal w/frozen blueberries and raisins and a big bowl of fruit or 2 per day. i’m sure you both know how to read labels for hidden fats under the ‘ingredients’ section in tiny little words.

              ken, i agree with dr. ostfeld but completely disagree about the fatty foods he ‘allows’. i absolutely believe you need to cut the nuts, seeds and avocado, there’s no doubt in my mind, it’s a must!

              Dr E now has 2 studies proving his diet works. the first had has gone on for 35 years and has a 100% success rate and the second for almost 4 years has a 99.4% success rate and i bet that one patient cheated somewhere along the line.

              the only other thing i would suggest is that you both create a green smoothie drink (i know you do ken) and have one or two per day. one important ingredient in ours is ‘amazing green grass superfood’ which i get on ebay or amazon. i make a blender of 4 smoothies, 64 oz and sweeten it with 12 dates. don’t worry about blending and disrupting the fiber, it’s only an unproven theory plus we get so much fiber on a WFPBD that i don’t even think sugar is bad for us. it’s bad for fat, french fry eating constipated americans but i don’t think it’s bad for us.

              don’t forget ken, you’ve only been doing this for 4 months and appear to be doing great. you are very active which is good but don’t forget the 150 minutes of sweating exercise per week, fit it in somehow. just being active isn’t enough, it has to be a full sweat.

              (i council one patient with prostate cancer who’s urologist has been insisting he have a radical prostatectomy for a year now. he’s been vegan for~9 months but his prostate CA was advancing when he contacted me ~6 months ago. i realized he was adding “heart healthy” olive oil to everything and eating foods with oils added. we stopped that immediately and he was impressively compliant. his PSA scores began leveling off then dropping. the other day he revisited the urologist who asked him when he was going to have the surgery because of his high gleason score. he asked for an ultrasound like i had suggested. afterwards, the doc was baffled. he said he couldn’t see anything, no nodules no irregularities no cancer no nothing, the prostate was completely homogenous and clear of disease. his initial progression after going vegan was all because of a minor mistake in his diet of added oils which he removed and now has reversed his cancer just as i have reversed my vascular disease.

              if you eat NO FAT clean like i have for 4 months, then i would start cutting the statins in half each month followed up with bloodwork. let it level out then cut them in half again. i think that once you’re body is cleansed of added dietary fat that statins are not helping anymore anyway and the side effects are horrendous, injuring you down to the DNA level. i follow a statin board full of damaged people.

              on top of that then you could stop the COQ10 which to me is just a huge pill of oil filler. all those pills filled with safflower or whatever oil all add up and the Q10 is a massive one which you could discontinue if you got off of statins but must stay on if you are on statins. statins cut off the branches to cholesterol pathways but also cut off the branches to COQ10 production hence the need to supplement.

              bottom line for both of you.

              get a doc to write you routine monthly bloodwork for CHOL/LDL along with whatever else the doc may want to follow. tell them you are making MAJOR changes (diet, exercise, exaggerate, etc) and NEED to follow the results monthly so you can determine if it’s helping or hindering. don’t worry about fluctuations too much but you will get to see a trend. just keep eating right, absolutely no cheating and exercise to the point of profuse sweating. if i had begun strenuous aerobic exercise right from the beginning i honestly believe i would have gotten my numbers down in half or maybe a third of the time it took me.

              i really didn’t want to muddy the waters with this but about 2 years in i was getting very ill and it took another 2 years to be diagnosed with lyme disease and i only beat it at a hyperthermia clinic in utah this past march. that’s another thing which i believe held me back to getting lower #’s quicker. i was actually bedriden for 2 years and it was determined by several Lyme Literate Doctors that my dad died of Lyme Disease, not the Progressive Supra Nuclear Palsy label (type of parkinsons) they gave him when they couldn’t figure out what was wrong with him.

              ken, try taking 180mg saw palmetto (standardized extract) twice a day and after a month see if your BPH improves. i’ve been on it since i was probably in my 30’s. it’s slow acting and takes a month to kick in but reduces the size of the prostate (urethral opening) just enough to make a big difference. it will be so gradual that you don’t know it until you stop taking it for a week and then you RUN to the drugstore for more. that happened to me once in my 15 year marriage. my wife ran out and just stopped putting them in my supplements for the day. after about a week i was always having to pee like if i just drank some coffee or i was nervous for a job interview. eventually i asked her and she said we ran out. RAN OUT!!!! THAT’S SOMETHING THAT WE JUST DON’T RUN OUT OF !!!! LOL that’s when you know it works is when you have no idea you aren’t taking it anymore and the symptoms return with a vengeance.

              i also understand your worry about becoming too thin but we are used to fat, plump, stocky people and think that’s healthy looking. your weight seems to be right in the area that it should be:


              and don’t forget, these indigenous peoples are probably more muscular than us couch potatoes so we could probably drop these numbers a little bit. i’m just about 3-4#’s less than the chart says. i do know that i have to eat 2 meals of rice and beans each day or i begin to start losing weight so it’s a calorie thing too but don’t eat fat calories because you want to keep on the weight. your body will drop below your ideal weight and then come back up to your ideal weight and that’s where you will stay.

              if you have a plant based doctor that you are not happy with then by all means visit another one, even call to make sure they are against nuts and seeds before making an appointment. that way you KNOW they are on the right esselstyn track.


              bottom line is do not deviate from Esselstyn with the exception of copious amounts of fruit, especially in the morning. eat your green smoothies. eat your fruit smoothies. do not listen to doctors who say nuts, seeds and avocado are ok because they are NOT.

              we’re not teenagers who can handle the extra fat, we’re sick old people and can’t afford that luxury anymore so just stop and don’t torture yourselves. fat, sugar and salt got us sick and the quicker we eliminate those with a WFPBD the quicker your cholesterol numbers will approach mine and your bodies will begin healing themselves at mach speeds.

              i wish i had added the exercise early on, i hope you guys don’t make that same mistake. the thrift stores are full of brand new cheap treadmills which were never used :o)

              bottom line (again) if you are following the diet to a T without ANY added fats and exercising then don’t worry about the numbers too much. they will deviate and fluctuate but your body knows there are no more poisons in it and the general trend should be down. it won’t happen overnight but it will happen. hopefully it will happen quicker than it did me. those numbers i told you about were at about year 5 as i’m going on year 6 in a couple months and like i said, i’m sure i could have cut that in half if i exercised right from the beginning and i mean over 85% of your target heart rate type of exercise.

              take care guys,


              1. AZ Donald, thank you so much for taking the time to share your experiences , recipes, and insights with us. For me, this is all valuable information. The diet I am doing well with I think.. rarely do I buy anything with a label, but yes, if I am checking a fat free salad dressing or something, I read nutrient info and the ingredient list as well. My cholesterol did drop almost 40 % after the first 30 days wfpb, but then went back up a bit in months following. I am due for blood tests again, but this is canada, and my doctors wont let me go in more than once a year.. i can ask again though.

                I remember WFPBRunner saying that her cholesterol rose 20 (?) points when she sat out an injury for months. I swim 1km /day every day april through october, and 2 x week in winter plus hiking 1 hr or more per day all year round. We have a treadmill, so I could have a go at running and see if it makes a difference.

                I eat oatmeal with flax in the moring, homemade soup and salad for lunch and often dinner too. Or a homemade oil free indian lentil /bean curry with greens and a bit of rice. Fruit for dessert and snacks – a lifesaver for me. home grown blackberries from the freezer topping sliced banana or melon for example. Salads can be the whole meal too, with a chopped vegie salad with chickpeas maybe, or other bean.

                Its been just over 18 mos since I started this in earnest with the wfpb, and surprisingly, the no oil part is not the hard part for me. I find I do have to think and plan what Im going to eat a few days at a time, and not let myself get too hungry. Your smoothie idea is terrific Donald, that might be perfect for after swim to fill the gap and give me a nutritional boost.

                One of the things I can identify with you Donald, is your keen research skills and willingness and discipline in applying what you learn to your way of doing things. My greatest frustration has been in years worth of doctor appointments where the teaching moment has not been for me unfortunately.. At this point, I would consider it a luxury to have a doctor diagnose a situation correctly, and make current viable recommendations. But it isnt happening. Instead, they listen, take notes, ask questions sometimes, and say “keep doing what you’re doing” . That being said, I so appreciate the feedback from you Donald, and from many here at NutritionFacts – I will try out your suggestions, and thank you for the encouragement. Best wishes

                1. i’m so glad i could be of help susan.

                  i was afraid that i was rambling too much but i would rather put out 99 mediocre thoughts than to miss one important one which might make an important change.

                  salad idea. we rotate salads in and out of our diets as our tastes change but here’s an idea instead of any salad dressing.

                  lemon juice is one but we like to top it off with lots of pickles, lots and lots of raisins and sprinkle the pickle juice over it all. it gives you the moisture you need and really gives it a great tart and sweet taste. yes, i know there’s salt in there but it’s not like a cup of salt in a pot of chili.

                  don’t fret if your blood #’s aren’t great as i truly believe your body knows that the poisons are gone (fat) and you’re healing yourself despite what readings you are getting say. my initial numbers weren’t great but my images spoke for themselves and the irreversible disease reversed. just keep plugging away despite what the results are knowing that your body IS healing itself now that the excess fat is gone.

                  canada healthcare, uggh, lol.

                  where in canada are you located?

                  i’m not sure up yonder but here we’re allowed to order our own blood tests without a physician’s prescription. maybe you could do the same or finagle a way to do it. if you’re near the border then you could possibly go to an american lab to get them drawn? just throwing out ideas. do an internet search on the topic.

                  it might behoove you to find a plant based doctor on our side, make a long weekend trip out of it and visit him/her every six months or so for guidance. if you google ‘plant based doctors list’ you will get several others but this one is very comprehensive:


                  this is an email from Sonora Quest about self ordering bloodwork:
                  Order Your Own Valley Fever Screen with My Lab ReQuest

                  Arizona law now allows you to order lab tests without a doctor’s order. Since the law’s passage, thousands of patients have ordered lab tests from our My Lab ReQuest menu.

                  We are excited to announce the addition of Valley Fever Screen to our My Lab ReQuest menu of patient ordered lab tests!

                  This test may assist in the diagnosis of Valley Fever (Coccidiodomycosis), a fungal infection found in Arizona. If you are suffering for at least two weeks with three or more of the following symptoms you should talk with your doctor, or consider ordering Valley Fever Screening on your own (if not already diagnosed with Valley Fever):
                  • fatigue/tiredness
                  • cough
                  • trouble breathing
                  • fever
                  • drenching night sweats
                  • painful bumps on the shins
                  • muscle/joint pain
                  • chest pain
                  My Lab ReQuest allows you to take control of your health and order your own lab test if you suspect you have Valley Fever.

                  Are you ready to order a Valley Fever Screen?
                  • Download and Complete our Lab Request Form
                  • Schedule an Appointment
                  While we believe the management of personal health is most effective when it involves a partnership with a health care provider, we can help you take a more active role in your health with a menu of select tests that you may request without a doctor’s order.
                  • Learn more about Valley Fever
                  • Learn about Valley Fever Awareness Week
                  • View a full list of available My Lab ReQuest tests and screenings


                  you say you have a treadmill, excellent. stick with the program, run 20-30 minutes per day until a full sweat for a month and THEN get your labs drawn.

                  i think you will be in for a pleasant surprise. watching documentaries really passes the time and you almost forget you’re exercising.

                  i’m going to try to figure out how to post my documentary list without it becoming bastardized the way the youtube videos pop up and distort the list making it almost unreadable. maybe i’ll try tonight.

                  your food sounds wonderful, i can’t even offer any suggestions. do you ship overnight?

                  since there are no restaurants we can ever go to we carry an emergency pack in our vehicle. it’s a plastic zippered thing with black beans, kidney beans, refried beans, corn and some fruit with a can opener and plastic forks. it’s great in a pinch. don’t forget to consume the liquid in the organic cans of beans or corn as it’s full of nutrients. drinking the corn juice is like drinking sugar, amazing.

                  if we know we’re going to be gone for the day we bring along some baked white or red potatoes (nuked, just eat them like an apple), bananas, dates, cheerios and a rice cooker of rice. we’re always grazing, lol.

                  thank you for the kind words susan, it means a lot.

                  take care,

                  i swear by this NJ600 NINJA blender and it’s only available online at walmart.

                  it has a USEABLE 72 oz pitcher. other’s market a 64 or 72 oz pitcher but don’t tell you that you can only use 50 oz of that or it spills over. if you wait, they go on sale all the time. it has a tree or pole of blades in the center instead of usual blenders with 4 blades on the bottom. this is a monster, i’ve used it for over a year and it’s still like new. if you go to walmart, you can see the 900 watt one they carry, it’s identical but this one is more powerful and cheaper when on sale. i fill mine to the 64 oz line with my green smoothie mix, blend and use 4 newmans own salsa jars to fill them with. perfect every time.



              2. Hi AZ,

                People say I am amazingly disciplined but I am a total rookie compared to you. My hat is off to you. But the best part is that you achieved the desired results! I especially commend you for being willing to share with those who are highly motivated the change, which I am. .

                As you already know I have most of the WFPB, no oil, no meat, no dairy, no refined carbs, almost no processed foods down. However, as you have pointed out the DEVIL IS IN THE DETAILS.

                I have now read and reread what you shared three times to ensure I absorbed it.

                Here is where I have been deficient. These are the mistakes:

                1.Store bought Abraham Humus. While there is no oil added that is misleading as they add Tahini.(Sounds healthy but it is nothing more than ground.sesame seeds). Wait didn’t Joel Fuhrman says seeds are great, part of the GBOMBS (mentioned in his book Eat to Live). But just like nuts, seeds contains lots of oil. Two tbs a day of flax seed is great due to omega threes but I
                don’t need Tahini. Serving size of Abraham “no oil” humus is 2 TBS. I’m hungry all the time and when I am hungry I cannot wait to cook up quinoa or brown rice. I have to eat immediately. So I grab my Finn Crisp Crackers (no fat, no oil, just made with whole rye flower and add the humus. Fin Crisp no oil bu 80mg salt for 2 slices. The problem Is that when hungry I can eat an entire large container of humus. Just imagine 20 crackers =800 mg of salt .Boy have I been bad!!!!!!!!!!! This is like confession! god knows how much humus is in a large container of Abraham humus. I eat humus this several times a day because it is quick!!!!! Yes I know I have to make my own. But I am sick of being in the kitchen all day! Too bad Ken, toughen up. Don’t be a cry baby you can do it!

                That is the problem with the WFPB diet. I confess (and we are retired) we spend hours and hours cooking, but when you are done with the healthy and nutritious WFPB meals, there are times you are still starving and there is no prepared WFPB meals left in the fridge or you are holding them for dinner. Too tired to cook. So I grab the Abrahmam Humus. When I finally stop I would short the Abraham humus on the NY stock exchange as they will be forced to go out of business. OK I know I have to stop this! I have two containers left. NO MORE AFTER. COLD TURKEY!

                Peanut and Almond Butter. Hungry at lunch. Two slices of Ezekial Bread toasted. Excellent! However the peanut and almond butter contains lots of fat (although Dr. Ostfeld feld discouraged the peanut butter said if I do eat these I need to pour the oil off the top which I did. 4 months ago Dr. Ostfeld said one could eat the avocado and nuts if one was not a heart patient. I guess I selectively forgot this. I thought to myself he must be wrong. I did not have a heart attack in fact no heart damage. He said I had a stent and therefore prone to atherosclerosis so I was a heart patient. Then Dr. Greger, God bless him, (and everyone tell me if I am wrong), encourages eating avocado and nuts as they are so healthy, The nuts lower the cholesterol he said. Anyway I opened The prevent and Reverse Heart Disease Cookbook by Ann and Jane Esselstyn (highly highly recommended) Anyway Dr. Cauldwell keeps adding comments: P 15 “steer clear of nuts, avocado and coconut. instead use 1 to 2 tbs of ground flax seeds I do the flax-seeds but need to stop the nuts, and avocado.(Boo Hoo!) I have to make my own humus!!!!!!!!!!!!!! (recipes for no oil humus in this cookbook. And I need to stop the nuts at breakfast that I add to my steel cut oats. Best way to cook them fast in the morning is to use my InstantPot pressure cooker, which I also use to cook my dry beans. Beans that is a whole other story. I guess I should soak them but I forget and cook them dry. I’m afraid the flatulence may be contributing to global warming! I guess I should not worry as the Donald is going to turn NY into Miami by ignoring this problem. Whoops, I zip my lips. No politics Ken. P 17″no tahini in the humus”

                Any brand of Saw Palmetto you prefer? I tend to buy my supplements (I buy very few) from Puritan Pride vitamins.

                Any recommendation for joint pain cause my tendonitis (rotator cuff) or knee pain (I think it is partially torn meniscus)

                There a few things more minor things I need to tweak Ilts.

                Morning: large bowl of steel cut oats. (with very low calorie Almond/ Cashew milk. I notice the mile has 2 g of fat per serving

                (a serving is 1 cup), but even Esselstyn thinks almond milk is okay. Hey I use the no sugar added Blue Diamond
                Breeze brand and plan to continue. I guess oat milk would be better but it is hard to find and I fear is too expensive. The real culprit is to not add nuts in spite of Dr. Greger’s advice.

                Okay the good is that we eat tons of kale and collards and watercress. We need to eat a bit more beans. We eat a lot of berries in the morning in our oatmeal. In our smoothie besides the greens is berries, KIWI, almond milk and amla.

                I could go on spouting for hours but I have to assist my wife with are marathon cooking which never stops.

                I told her we need to do a few more restrictions to which she having tantrums (not quite) but pretty upset.

                So Susan lives in Canada and I am guessing you are somewhere in the NorthEast due to the lyme disease you once caught.

                By the way make sure, if you are at least age 60, to get a shingles vaccination. I did it within a week of hitting 60. I’m 64 and still knock wood have avoided shingles

                Dinner ready, got to go.

                AZ thank you so much. Lets keep in touch!

                P.S. I’m seeing Ostfeld this Saturday and will share your advice. to which he will say that is what I told you but you didn not follow my advice. I guess I am stubborn but eventually I can change. This time I will.

                By the way what is your favorite go to cook book or quick ways of putting meals together. It still takes us forever and that is a BIG part of the problem.



                1. hi Ken, so glad to hear you have some good ideas on where to start making a few changes. It should make a big difference.. here’s hoping ! I have an oatmeal idea you might like. Its overnight oats adapted from the Oh She Glows cookbook ( i dodge all references to oils, avocado etc . In a bowl or 4 cup pyrex bowl combine 1 cup old fashioned large flake oats, 1/4 cup chia seed, 1 mashed banana, 1.5 cups almond milk or whatever plant milk you use, 1/2 tsp each of vanilla and cinnamon. mix it up with spoon, put it in the fridge overnight, and top with fresh fruit in the morning. it’s good !

                  I make use of the slow cooker often for soups and curries. when I bake a potatoe, I’ll bake several at one time for lunches. It can be labor intensive, but it gets easier when you have developed recipes you enjoy. Good luck !

                  1. Hi Susan,

                    What we do in the morning is to cook steel cooked oats in an InstantPot pressure cooker. Comes out delicious each time. We add banana, blueberries, blackberries, rasberries, strawberries, mango, kiwi. Up to now I had been adding walnuts and almonds but I am almost certain to stop that after listening to AZ, and reading recommendations from Cauldwell Esselstyn. This Saturday I will be meeting up with Robert Ostfeld, vegan cardiologist in charge of Montefiore Einstein Wellness program, in the NYC, to go over my likely diet changes; stopping nuts and making my own humus free of tahini and oil, and stopping avocado. He provides an almost all day seminar to his patients along with dietician Lauren Graf. I did this 4 months ago but he is allowing me to attend a refresher. They provide a delicious vegan lunch with the seminar. My next appointment with Dr. Ostfeld is not to March, I am hoping to sneak a few moments with Dr. Ostfeld to discuss diet changes I discussed with you and AZ and to review his ideas about lowering or stopping the pravastatin and Zetia.

                    Regarding your difficulties with statins. First of all if you can avoid them on a well balanced vegan diet that is the best. But for some of us they are quite helpful if we can tolerate them. I had pretty bad aches on Zocar years ago. The most mild statin is pravastatin which prevents the production of cholesterol by the liver. Since that was not sufficent my doctor added Zetia which prevents the absorption of cholesterol from food. With both these medications (been on for 13 years) and still on them my lipids have been great. I only mention this as I wanted to show I also had problems with statins but by tweaking the medications I have had great results with very little side effects. Still, if it is possible I would like to stop them.

                    Your diet that you described to AZ sounds ideal.

                    Not sure if you mentioned whether of not you have a vegan MD. I included the web address to a google spread sheet of vegan doctors on Lindsey Nixon’s Happy Herbivore site: There are a number of vegan medical doctors in Canada. Don’t know how close any of them are to you and don’t know patient reviews.


                    Reading over one of the problems people have with lowering cholesterol is a low functioning thyroid. It often happens to vegans as we can easily get an iodine deficiency. If this is a possibility just enter a search of iodine in search bar. Some vegans address this by adding a pinch of iodized salt to their food each day, or consuming certain sea vegetables. But one has to be careful. Dr. Greger gives the pros and cons of what he recommends..

                    If you want a telephone consultation with a vegan medical doctor, I believe Michael Klapper in California does them. When people ask Dr. Greger for a recommendation of a vegan medical doctor I recall he mentioned Michael Klapper.

                    Also a renown vegan dietician Jeff Novick, MS, RD | Facebook does telephone consultations. I believe Rip Esselstyn, vegan son of Cauldwell consulted Jeff for assistance in ensuring his cookbook advice was sound.

                    If you go onto Jeff Novicks web site he says he does telephone consultations.
                    “Fast Fixes Need help implementing the whole-food, plant-based diet and lifestyle? Questions about what to eat?

                    Confused by conflicting programs and recommendations? Fast Fixes are your solution! Many people who are
                    already on the path may need a little help in fine tuning the program to their personal situations They don’t need hours of counseling or months of coaching but a single, brief, directed session to help answer
                    their specific questions about the program. Fast Fixes are 20-minutes phone sessions with Jeff Novick to help answer a question or two about your program. If you are interested in a “fast fix” to your current diet and lifestyle, schedule a 20-minute appointment with Jeff now. 20-minute session = $65.00 (Includes 20-minute phone call and follow up email)
                    In order to maximize our time together, it is important that anyone who is interested in booking a
                    Fast Fixes appointment to have attended one of the programs &/or be familiar with the resources listed here. This is Jeff;s
                    Recommended Resources:


                    Neal Barnard, MD
                    – Dr. Neal Barnard’s Program for Reversing Diabetes
                    – Breaking the Food Seduction
                    – 21-Day Weight Loss Kickstart

                    Colin Campbell, PhD
                    – The China Study
                    – Whole

                    Caldwell Esselstyn, MD
                    – Prevent and Reverse Heart Disease

                    Matt Lederman, MD & Alona Pulde, MD
                    – Keep It Simple, Keep It Whole

                    Doug Lisle, PhD
                    – The Pleasure Trap

                    John McDougall, MD- Dr. McDougall’s Digestive Tune-Up
                    – The McDougall Quick & Easy Cookbook
                    – The McDougall Program: Twelve Days to Dynamic Health
                    – The McDougall Program for Maximum Weight Loss
                    – The New McDougall Cookbook
                    – The Starch Solution

                    DVDs Neal Barnard, MD

                    – Tackling Diabetes
                    – Kickstart Your Health

                    Caldwell Esselstyn, MD- Prevent & Reverse Heart Disease

                    Michael Klaper, MD- Digestion Made Easy

                    Douglas Lisle, PhD- The Continuum of Evil, Losing Weight Without Losing Your Mind, – The Pleasure Trap

                    John McDougall, MD- Dr. McDougall’s Total Health Solution for the 21st Century (podcast)- Dr. McDougall’s Common Sense Nutrition- McDougall Made Irresistible- Dr. McDougall Disputes Major Medical Treatments- McDougall Made Easy- McDougall’s Medicine

                    Jeff Novick, MS, RD- Lighten Up- Calorie Density- Should I Eat That?- From Oil to Nuts- Nuts & Health- Fast Food Vol 1: The Basics – Fast Food Vol 2: Burgers & Fries Fast Food Vol 3: Shopping School
                    Movies/Documentaries- Forks Over Knives- Processed People

                    Immersions and Programs The McDougall 3-Day & 10-Day Programs – Dr. Esselstyn – 5-hour intensive counseling seminar at the Cleveland Clinic Wellness Institute

                    John Abramson, MD- Overdosed America

                    H. Gilbert Welch, MD Should I Be Tested for Cancer?- Overdiagnosed: Making People Sick in the Pursuit of Health
                    – Know Your Chances: Understanding Health Statistics

                    Nortin Hadler, MD- Worried Sick: A Prescription for Health in an Overtreated America

                    Appointments are available on Tuesday of each week between the hours of 11 AM to 3 PM EST.

                    If you are interested in booking a Fast Fix, please send him an email for more information.

                    For myself I am considering a phone consultation with Jeff regarding nuts and avocados. But I’m fairly certain that Dr. Ostfeld will confirm what AZ suggested. And since I recently consulted Dr. Ostfeld it is important that he and I be on the same page regarding diet changes.

                    Wishing you good health.



                    1. hi Ken! Thank you so much for your thoughtful post jam-packed with great info. I copied it for easy reference since you have compiled an excellent resource list there, not just for me, but for readers that visit this page in years to come. I am familiar with the names you mentioned, but did not know the books/resources they have available. My reading list just got a lot longer !

                      Awesome idea about cooking with the instapot.. I do not have one yet, nor a blender like Donald mentioned. These would be great additions to the kitchen.

                      Sounds like Saturday will be a great day with Dr Ostfeld. Im sure you will come away with assurance that you are doing awesome things for you and your family’s health.
                      Thanks again, susan

                2. HOUSTON…. WE HAVE A PROBLEM !! LOL.

                  fantastic ken!

                  you’ve gotten past the first major hurdle of the vegan diet and now just have to make one more major TWEAK to get back on course.

                  remember my friend with the progressing prostate cancer until he made that final, NO OIL change to his vegan diet to stop and probably reverse course of the disease and never have to wear a diaper and be impotent for the rest of his life?

                  i firmly believe that we have evolved to only to be healthy on the fat levels in the right proportions which are in our foods: rice, fruits, potatoes, beans etc which is around 4-6% and nobody will ever sway me from that. i believe disease states begin at 8-10+% dietary fat.

                  i love how receptive and adaptive you are to the idea of cutting fat as it’s definitely THE POISON in our diet like nicotine for smokers or etoh for drinkers and none of them can heal until the poison is removed.


                  1. no more hummus.


                  “didn’t Joel Fuhrman says seeds are great”


                  FAT *IS* THE PROBLEM.

                  “hungry all the time”

                  you and me both which is why i always have fruit, dates, bananas, apples and even cheerios or grape nuts around. i literally eat all day long, it’s part of the new lifestyle that we just have to just get used to. it’s called grazing, no different than any other animal. be glad you’re retired and have the luxury of eating when you want to instead of set breaks or a lunchtime. try out the baked (nuked) red or white potatoes, they are great in a pinch and we carry them around in a towel going to town so they’re warm.

                  “OK I know I have to stop this! I have two containers left. NO MORE AFTER.”



                  it’s not worth your life for saving a few bucks, seriously. start your new “NORMAL FAT” diet NOW, not when your provisions run out. put everything that’s bad in a bag and give it to your neighbor, friend relative or better yet an enemy.

                  “This is like confession!”

                  you’re doing great, breathe in, breathe out, keep talking….

                  “But I am sick of being in the kitchen all day!”

                  my major complaint too, multiple times a day while i’m cutting up numerous fruit bowls for the 3 of us and continually making something to eat. the positive thing is that i’ve totally reversed my disease, i’m upright, breathing and pumping blood while my doctors’ other similar patient has been buried now for 4 years after taking their advice.

                  THAT MIGHT PUT IT IN PERSPECTIVE??….

                  “Peanut and Almond Butter”

                  no more, DONE, end of story.

                  don’t forget, a bowl of oatmeal with blueberries and raisins is quick, filling, tasty and easy when you want ‘something’ especially when hungry before bedtime.

                  stick with it and in two months you will cut your statins in half…

                  saw palmetto is saw palmetto as long as you get the standardized extract of 85-95% fatty acids and sterols and not the ‘leaf’ garbage. i get mine from Frys (Kroger) when they have it on sale for 2 for 1. actually, i suggested before that you get the 160mgx2 but i get the 320mg and take it once a day. i got lazy because i really like to break up my vitamins and supplements but in this case…..

                  “joint pain cause my tendonitis”

                  once you cut out ALL oils, exercise 150 mins/week and your body adjusts, your inflammation will subside. another reason to be extremely strict. if necessary take aspirin, oxycodone-oh yeah.. or whatever to get you through it but diet will take care of it eventually. an actual injury like a torn meniscus might be a different story but inflammation caused arthritis should be cured by a strict low fat diet and exercise and the reduction of inflammation it causes.

                  “Almond/ Cashew milk”

                  COMPLETELY DISAGREE!!.

                  go to water in your oatmeal, use copious fruits to flavor it and move on, you will get used to it. i even believe that true vegans like us can use sugars like maple syrup to flavor things because of our very high fiber intake but that’s a whole ‘nother story. i would have to direct you to fruitarians and raw vegans for more info. those guys/gals are incredibly healthy and i’m talking decades of that lifestyle with bloodwork to prove it.


                  “The real culprit is to not add nuts in spite of Dr. Greger’s advice.”

                  AGREED, 100%
                  i can prove it with my before and after mra pics which will be in dr crawfords upcoming book… someday, lol,

                  “are somewhere in the NorthEast”



                  RICE AND BEANS


                  NO OIL!




                  i sure hope i’ve given you some hope and optimism and if you follow my suggestions you should be off all meds very soon.

                  take care,


                  1. Hi AZ,

                    Thank you for your wonderful advice. As I said Dr. Ostfeld ,the vegan cardiologist (sought of a protegee of Dr. Esselstyn), suggested in September to stop the avocado. I was bad and asked if I can have any.. He said okay maybe twice a week. However since my cholesterol has not budged I’m sure he will want me to now stop the nuts and avocado. I stopped the oil back in September. He is allowing me along with my wife sit in on his WFPB seminar taught with nutritionist Lauren Graf, this Saturday as a refresher. While I had one consultation and sat in as a student in one seminar with him in September, my next appointment with him is not to March. I’m sure I can sneak a few moments of his time this Saturday at the seminar, to review the changes you recommend. Since he originally recommended the WFPB diet It is only right I go over any changes with him. And since Dr. Ostfeld was influenced by Dr. Esselstyn I’m nearly certain he will want me to implement all of your recommendations. A month ago I sent an email to Anne Esselstyn, wife of Dr. Esselstyn, questioning a recipe she wrote. I mentioned Dr. Ostfeld and was told that she and Dr. Cauldwell love him. I am very fortunate that Drl Ostfeld he is only 1/2 hour away. While he trained at Harvard and Yale he is self taught regarding WFPB diet. Based on his background any hospital in the country would have loved him to join their facility. He is a humble guy who felt he wanted to make a real difference in the world. So He joined Montefiore Einstein in the Bronx, hoping to improve the health of people who reallly could use excellent health care.. They were so impressed by him they allowed him along with dietician Lauren Graf to create the WFPB Montefiore Einstein wellness program. Most of the vegan doctors, who are wonderful people who have to make a living like everyone else charge quite a lot to see them. Dr. Ostfeld accepts my insurance and the seminar which takes about 4 hours and includes a wonderful WFPB lunch is FREE. AZ you have renewed my optimism for this program to work. I hope it does.

                    1. it will ken, i promise.

                      and more importantly, you could be off all statins in just a couple of months if you worked at it strictly.

                      in fact, with your numbers, you could begin weaning them right now (if you cut out fatty food). if you’re afraid to go right to half then go to 3/4 until the next bloodwork and then cut another 1/4 out etc.

                      {cholesterol is 142 and LDL is 58}

                      NO OIL!! (of any kind)

                      this includes ANY fatty plant foods.
                      fat is fat either from animal OR from plant.

                      GOOGLE SEARCH

                      1) No Oil — Not Even Olive Oil! – Caldwell Esselstyn MD
                      2) Make Yourself Heart Attack Proof – Caldwell Esselstyn MD
                      3) What Meat, Oil & Dairy Do To Your Heart! Dr Caldwell Esselstyn


                3. Do you have a health food store near you or a Whole Foods? If so, you can buy McDougall Right Foods items, as well as Engine 2 hummus, which is prepared without added fat. You can even order McDougall Right Foods items through Amazon. A good cookbook for fast, easy, tasty wfpb recipes is McDougall Quick and Easy Cookbook: Over 300 Delicious Low-Fat Recipes You Can Prepare in 15 Minutes or Less.

    5. First, congratulations on your progress in eating vegan for almost 4 years and the great numbers for all but those LDL’s. You are not alone in being frustrated by seemingly doing everything right and still not having your LDL’s where you want them. Since this is a common question, as a modertor for I’m going to simply give you what was an excellent response to this question written by one of our dietitian moderators. I hope this is helpful and encourage you to continue doing all you’re doing, even if those LDLs aren’t quite where you want them. These suggestions may help push them down a bit.
      “For those who have tried eating a whole food plant-based diet and still have high LDL, you should make sure you’re not eating plant sources of saturated fat, such as palm kernal oil, palm oil, coconut oil, and cocoa butter (found in chocolate). Of course if you were you wouldn’t be eating a whole food plant-based diet, but you’d be surprised how many people tell me they are and they’re like “Yeah, and I eat a spoonful of coconut oil a day.” I’d also cut out unfiltered coffee. Then once you have gotten rid of the things that increase your cholesterol you need to pack your diet with foods that actively lower your choleserol. So, for example, the components of the portfolio diet for lowering cholesterol. I’ll highlight some of the diet tips found in Dr. Jenkins protocol using Dr. Greger’s videos as reference.
      1) Load up on foods high in soluble fiber. This means tons of beans (see what kind are best: canned or cooked), vegetables like okra, plenty of whole fruit, oatmeal, and flax/chia seed. Find ways to use beans. Lentil stew, dal, curries, bean burritos, bean soup. If you don’t like beans whole, like in a salad, maybe try them as a spread or as hummus?
      2) Take about 2 Tablespoons of ground flaxseed daily and 4 Brazil nuts monthly. Sprinkling ground flax on oatmeal in the morning is an easy way to get enough. Or add it to a smoothie. If you buy the flax whole just add it in the blender first, grind it, and then add the rest of your ingredients.
      3) Focus on several cups of greens daily to help keep nitric oxide flowing. Vegetables loaded with nitrates have been shown to improve heart health. Beets and arugula have tons! (See video on where other vegetables rank on nitrate levels). Yes, green smoothies count if you’re adding the right foods like berries and dark green leafy vegetables (kale, spinach, even parsley). What’s better? Raw or cooked vegetables? Well, it may depend on what veggies are cooked. Lastly, a word of caution for those going wild on greens is that overdosing on raw greens can happen.
      Dr. Greger says to get thyroid function tested, too. A low-functioning thyroid can contribute to high cholesterol so it’s good to rule that out. Weight loss is also important if there is too much abdominal fat. Is your height more than twice your waist circumference? So there are a lot of factors to consider, but if folks are practicing heathy eating and managing body weight and still find their LDL is not coming down they should definitely consider a statin. As I always say make sure to check with your doctor about all of this. It’s important to be transparent and communicate with everyone.

      Joseph Gonzales, R.D.

  16. Having low LDL (70mg/dl) does not necessarily make you heart disease proof.

    In the elderly, having higher levels of total or LDL cholesterol is associated with increased survival

    This 70mg/dl threshhold does not mean you can’t die of heart disease. This paper supports lowering LDL below 70mg/dl (and statin use of course) but if you look at table 4, you will see that there ARE deaths in this range!

    I’ve also read studies where all cause mortality is the same between vegans and non-vegetarians. Just because there may be a decrease in CHD risk in the vegan group doesn’t mean that overall a vegan will have better survival rates.

    1. Blah, blah a LDL of 70 certainly lowers the risk of heart disease to an acceptable level. Please name three people that had a lifetime LDL of 70 and died of heart disease!

    2. Let’s take your evidence and compare it with what you said:
      Claim: “In the elderly, having higher levels of total or LDL cholesterol is associated with increased survival”

      Warrant: “We tested the hypothesis that patients who develop non-ST segment
      elevation myocardial infarction (NSTEMI) despite low LDL have a worse cardiovascular outcome in the long term….Thirty-six percent of patients with LDL 105 mg/dL were on lipid-lowering therapy on admission.”

      What does this study really say?:
      1) Arbitrary 105 cut off was chosen post-hoc to split the sample equally.
      2) Using 70 as a cut off reversed the findings
      3) More people were on statins in the “low” group
      4) Heart related death was NOT significantly higher

      “Whether this was a result of current therapy or a marker for worse baseline characteristics needs to be studied further.”
      Given that it isn’t heart-reasons people who end up in the hospital with lower LDL die faster, the only plausible explanation is that:

      hospital w/ lower LDL = other problems they die from.


      I really don’t have time to engage in a close and honest reading of all of your citations; but I ask that in the future, for the sake of an honest conversation, you do so yourself.

  17. The following “Conclusion” is from a 1993 article that addresses the “paradox” of France regarding their low rates of CHD and Finland regarding their high rates of CHD. It doesn’t even mention red wine as a mediator, just plant foods and vegetable oils as a positive influence in France and milk fat and protein as harmful in Finland:
    “CONCLUSIONS Over the years, France and Finland, with similar intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follows. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat were associated with increased CHD mortality, possibly through their effects on thrombosis as well as on atherosclerosis.”

  18. I appreciate the reference to genetics in this video, as genetic mutations can create a significant difference in how someone’s body might respond to various therapies. I would be curious to know that if someone genetically predisposed to low cholesterol, does that mean that if they eat a diet that promotes low ldl cholesterol, does that put them at risk for not having enough ldl cholesterol in their body? i.e. does their body require more dietary intake to deal with their genetic mutation?

    1. MikeOnRaw: Here is a quote from one of Tom Goff’s old posts:
      “The ATPIII report for the US National Cholesterol Education Program comments:
      Low LDL-cholesterol levels are well tolerated. LDL cholesterol as low as 25–60 mg/dL is physiologically sufficient.8 Animal species that do not develop atherosclerosis generally have LDL-cholesterol levels below 80 mg/dL. The LDL-cholesterol concentration in the newborn infant is approximately 30 mg/dL, indicating that such low levels are safe. Moreover, persons who have extremely low levels of LDL throughout life due to familial hypobetalipoproteinemia have documented longevity.9″”
      In other words, people with especially low LDL tend to live longer. Sounds good to me!

  19. Genetic variables are not necessarily uncorrelated with other variables, random numbers are. This does not mimic a clinical trial.

    1. Mendelian randomization studies do mimic a clinical trial, if a few assumptions hold true:

      1. The genetic variant(s) are independent of confounders (eg, an LDL-elevating allele isn’t linked to diet/lifestyle and is transmitted independently from other disease effecting alleles)
      2. The genetic variant is reliably associated with the exposure to elevated risk markers
      3. For known exposure and known confounders, the genetic variant is independent of the outcome (ie, an allele’s only influence on disease is through the marker).

      Obviously, these severely constrain what genetic variants are useful, but statistical methods to improve the validity of Mendelian studies using weaker assumptions exist.

      A good introduction:
      Mendelian randomisation and causal inference in observational epidemiology
      How the methodology has improved:
      Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression
      Consistent estimation in Mendelian randomization with some invalid instruments using a weighted median estimator

      There are now at least six major, independent Mendelian studies using different genetic variants (or ensembles of variants) that agree that LDL cholesterol is likely causal in cardiovascular disease (1, 2, 3, 4, 5, 6). In the last of these, the authors used a 2×2 factorial design to demonstrate that the reduced cardiovascular risk is log-linearly proportional to the absolute exposure to lower LDL-C, regardless of which of two genes was affected (which goes far to support assumption 3, above).

      1. One thing that still remains puzzling to me about the theory that high LDL “causes” blood vessel disease is that we never hear of anyone getting plaque buildup in their veins. Do people who have high LDL, in fact, get buildup in their veins and we just don’t hear about it. Or, if they don’t, why does the buildup only occur in the arteries?

        1. Hello! My name is Megan and I am a moderator for This was a really good question, and after doing some research on it I think I have an answer for you. The plaque deposits that occur in the arteries do not seem to occur in the veins because the veins are so much smaller and more elastic than the arteries. However, you can develop venous thromboses (clots), and high circulating LDL levels have been associated with increased risk of venous thrombosis. Here’s another NF video that might interest you that talks about the endotheluium (lining of the blood vessels) and how it may be affected by high-fat diets – I hope this helped!

          1. Thanks for your answer Megan. Your answer goes a long way in explaining the phenomena. And thanks for reminding me of the previous NF video on the endothelium. I know I have seen it before because I’ve watched all the videos for over three years now!

            According to the main article supporting that video, it appears that hydrodynamic shear stress may play a key role as to why arteries get more plaque buildup than veins. Here’s a key sentence from that research paper:
            “Perturbations, such as those that may occur at sites of inflammation or high hydrodynamic shear stress, disrupt these activities and induce Endothelial Cells to create a prothrombotic and antifibrinolytic microenvironment.”

            It’s certainly a complex subject! No wonder there’s so much confusion. Things like this always remind me of T Colin Campbell’s view of the synergistic effect of so many variables in any one “disease”. Thanks again for your help.

        2. It isn’t any cell types unique to arteries or veins, as vein segments used in bypass surgery develop plaques, while arterial segments replacing veins don’t, and indeed rapidly remodel to resemble veins. There’s also little difference in cholesterol concentration in arterial and veinous blood draws. The main theory for why atherosclerosis only effects arteries is that plaques are initated by endothelial injury, which is exacerbated by the higher blood pressures in arteries.

          Even within arteries, plaques mainly develop near branches and the insides of curves where hemodynamic shear stress (frictional force acting on the endothelial surface) is weaker. As with rivers, the junk doesn’t accumulate in rapid sections with laminar flow, but in eddies and vortices where the flow is disturbed and sometimes runs counter to the main current.

          1. Thanks so much for your reply Darryl. I kind of suspected it was the hemodynamic forces involved in the arteries which is much greater than in veins. It does appear that there are many pieces to the puzzle for sure. Thankfully, I’m able to keep my LDL low using the WFPB low SOS diet!

        3. if i remember correctly when veins are stripped from legs for heart surgery and the patient does not change their diet the veins become diseased also. it must have to do with the pressure side or suction side of the pump (heart).

        1. The first assumption’s pretty simple, as the effect size for genetic variants can be determine looking at aggregate marker levels for those with and without them. With large enough samples, one can establish this isn’t due to chance. The second assumption generally relies on the fact that genetic recombination over generations is effectively random.

          Its the third assumption that creates most issues. For example, protein-phosphatase-1’s (PP1) main known function is regulating glycogen synthesis, and gene variants are associated with T2 diabetes, but it also affects LDL levels. PP1 gene variants would be poor “instruments” for inferring a causal role for LDL in heart disease, as much of their effect is plausibly through diabetic pathology. On the other hand, when seeking a useful genetic instrument, one can exclude gene variants with associations with other suspected risk factors, or demonstrate that the effects of several genes on the marker have numerically rigorous association with disease incendence/events (as in 6 above), one which leaves little room for off-target effects.

    1. it was dr kim williams, president, american college of cardiology.
      chief of cardiology, rush university, chicago.



      1. There is a third kind of cardiologists, those like Dr. Sinatra, who has read the data, but actively refutes it since it would interfere with his ability to make a lot of money off of people who by into his distortions and untruths and so buy his books and expensive vitamins in a desperate attempt to find relief from the illness that are the result of the very thing that Dr. Sinatra is denying!

  20. haha I guess you do not get it. As the good doctor said,having average in a sick society is not necessarily a good thing. The best protection against heart attacks is proven to be LDL between 50 to 70. Doctors that keep up with science are recommending below 100 but that is really not good enough. So you like threading a needle and a discussion of one organization’s good Vs high. Personally, I agree with the previous comment, LDL of 110 is high. In English high means a level above a standard…you want to have fine degrees of high and call it good, have at it but you should not mark someone for not agreeing with you.

  21. on a related note, tmao also danger for clooging arteries. we make tmao from choline in soya beans .

    so those vegans/ vegertarian who consume high soya beans are in danger too!!

    1. lol this was commented extensively on the video regarding TMAO. In a nutshell, vegans don’t need to worry too much about TMAO. On the other hand consuming large amounts of soy beans (14 to 20 servings daily) can cause gynecomastia in some people (discussed in a video by Dr. Greger).

      1. And I’d say it would be difficult to consume 14+ servings of soy a day; not too mention boring and unappetising. So those vegans etc are safer than animal flesh and animal secretion consumers :-)

  22. I used to take a high dose of Statin drugs when I was about 100 pounds heavier. Sometimes it was hard to get my LDL below 100 even WITH a high dose of statins. My HDL was very low, despite taking these medicines. I lost about 95 pounds through some calorie control and daily bicycling and I got my LDL without drugs just below 100. Since then, while continuing to bicycle everyday, I have switched my diet to absolutely no meat and very limited dairy and eggs (remember many foods contain dairy and eggs in them) and I have also cut down on pastries and sweets. I have lost an additional 10 pounds and my latest LDL reading was 79. My HDL cholesterol was 83, triglycerides was 44 and my total cholesterol was 171. I do eat a LOT of nuts each day and it doesn’t seem to adversely affect my cholesterol levels at all. One thought I had, which goes along with this video, is that lifestyle changes towards a more plant based diet (along with exercise) can be more effective than taking drugs for lowering one’s cholesterol level. Perhaps, now that millions of people will lose their healthcare, that perhaps we can fill in the gap, by publicizing those things that will make persons healthy that they can do themselves. I think we should lobby against people losing their healthcare, but people can be healthy in many cases, despite this. And if we do gain back healthcare for all, it should be much more based on good nutrition than on popping pills for everything that ails us. Good natural treatments that are often used are psychotherapy and physical therapy. Plant based dietitians should play a major role in a good healthcare system. Not relying on pharmaceutical treatments could make the ideal system all the more better. On a similar vein, I have not seen anyone really benefit from taking psychotropic drugs in any real sense. I have really been helped a lot by psychotherapy. Psychotherapy teaches life skills. Psychotropic drugs don’t teach people any life skills whatsoever. Exercise and eating right also helps one’s mood.

    1. Doctors and hospitals make money from stroke, heart attack, etc…. Plant based diet is against their Wallet (profit). BUT insurance companies (life, disability, health) should push and give discounts to people that are vegan or veganish and charge extra for overweight and fat people. That is the way the capitalist system that is fair and balanced should operate.

      1. I think it might also be good for insurance companies to pay for programs that can help people break bad habits. It can be a combination of something like the McDougall or Ornish program along with psychotherapy and mindfulness training. Writing down everything I eat helped me to be more mindful, which in turn, helped me transition to a plant based diet.

    2. Daniel, just a lay person with similar concerns. You have made a lot of progress. Recommendation: to continue your progress please consider completely stopping dairy and eggs, pastries and sweets. I believe the best goal would be a cholesterol under 150 and LDLS between 50-70. If you can’t achieve that with a strict WFPB no oil diet then a mild statin like pravastatin and it needed another cholesterol pill named zetia would help you reach those goals. It seems that heart attacks rarely if ever occur when the lipid numbers are as low as the ones above. In my case taking pravastatin brought my cholesterol to your levels. But it was not enough for me. Unfortunately I needed a stent in my right coronary artery at the age of 51 even with numbers similar to the ones you have. My doctor added Zetia at the time of the stent which brought my lipid levels to the levels I recommended above nd 13 years later I still have not needed another stent. I am physically very active and feeling well.
      However my goal and yours is not to take medications but to follow a WFPB diet to prevent a heart attack or stroke. But for some people it appears that a WFPB diet is not enough.

      1. I never drink milk or yogurt and never eat eggs. It is mostly when I eat out at restaurants, or eat something someone else fixed that it might have some dairy or eggs as ingredients. When I prepare my own food, it is usually egg or dairy free. Probably the most problematic part of my diet is I eat some food at my work in a food service in a nursing home. They often cook the vegetables with stick margarine, which we know, has a lot of Trans fat. I usually try to cover these vegetables in paper towels to get the margarine off. I don’t eat the desserts at work anymore. Anyway, many desserts are made with animal products. That is one reason I no longer eat *milk* chocolate.

  23. Chris Masterjohn puts forward an interesting theory for heart disease namely poor reverse cholesterol transportation. In other words when your LDL receptors are functioning poorly they are unable to dock back at the liver or at cells to deposit the life needing cholesterol. This means it keeps circulating and as antioxidants in the LDL get used up it becomes prone to oxidisation. So what causes poor LDL receptor activity. One reason is Thyroid problems and interestingly Iodine is a contributor to healthy Thyroid function. I say interestingly because the Japanese have a great record of low heart disease but they consume large quantities of Iodine via sea weed, a basic stew ingredient in Japan. Also Finland had contrasting rates of heart disease from west to eat and the most significant contributor they could find was Iodine consumption difference.

    Try Miso soup and Kelp

  24. Dr Greger referred to a study of folks who had a genetic mutation which caused their lipid profile to be excellent. In turn, their death rate from cardio events was dramatically lower.
    My question– Overall, did those folks live significantly longer?

        1. I cited the study from the sources to this video.
          The study was in 3 cohorts that had “baseline serum cholesterol level measurements and no history of diabetes mellitus or myocardial infarction. ”

          Do people eventually die? yes of course.
          number 1 killer for adults is due to heart disease and question is cholesterol a factor? Cholesterol levels are a factor as evidenced by multiple studies.

          Note that even in the study:
          The cohort with genetic mutation their risk was lower by 88%, and not by 100% which means there were likely some cardiac events. This was done in a cohort that is at higher risk (African Americans):
          “These data indicate that moderate lifelong reduction in the plasma level of LDL cholesterol is associated with a substantial reduction in the incidence of coronary events, even in populations with a high prevalence of non-lipid-related cardiovascular risk factors.”

          1. Thanks Veritas: The last study you cited is closer to what I am looking for but fails to discuss all cause mortality. Of course, I am just looking at the abstract.
            Maybe someone from Nutrition Facts can be more specific.

      1. veritas: A couple months ago or so, someone was asking for an example study that shows just this type of information. Thank you! (Now, if only I can remember who was asking for it. But at least I’ll have this example when it comes up again in the future.)
        My concern with this particular study is that their cut-off for what counts as high vs low was way too high. But still, interesting results!

  25. Pierre , we get it! You want to keep eating your eggs. I have been whole food plant based for quite some time, but still have high cholesterol. My husband eats lunch meat, eggs and other garbage and has numbers like rural Chinese. We have never been tested for this genetic disposition, but we can look at family history. My husband’s family never dies. His grandma was a chain smoker and lived to be 90! My family all dies young of heart attacks, My grandpas was 42! For your lousy diet, you are not doing all that badly, but it proves nothing!

    1. {His grandma was a chain smoker and lived to be 90!}

      i bet you a thousand dollars that she had a cholesterol level below 150, that’s the key.

      if you have a cholesterol level below 150, not only are you heart attack proof (stroke proof) but you don’t develop cancer.

      emphysema yes, cancer no.



  26. I am a 52 year old male with familial Hypercholesterolemia (around 280), but otherwise fit and in good health (non-smoker). I’ve been a vegetarian for 5 years and a vegan for about 1.

    I hoped to avoid taking a statin, so did a CT Heart Scan for calcium and scored as low as possible (“0”). Cardiologist said I could avoid a statin for now.

    How is this (low calcium score) explained? Does TMAO or any other mechanism explain any of this?

    In general, what is Dr. Greger’s thought on statins for people with familial Hypercholesterolemia?

  27. Doesn’t the naturally-low-cholesterol-prevents-atherosclerosis discovery refute the TMAO thesis? The subjects in this study were not overwhelmingly health conscious — quite the contrary — so if the TMAO thesis were correct, they should have gotten atherosclerosis anyway, because they were almost certainly consuming a high TMAO diet. Yet they didn’t, so the TMAO thesis must not be correct.

    1. “Doesn’t the naturally-low-cholesterol-prevents-atherosclerosis discovery refute with the TMAO thesis?”

      No, I don’t see it that way.

      The biochemical actions of TMAO are still under study. However, a number of tentatively identified actions fall into the general category of TMAO affecting cholesterol and sterol metabolism in macrophages, liver and intestine (PMC3650111). Therefore, with lower amounts of cholesterol TMAO would have a reduced effect on atherogenesis.

      In addition, a small number of subjects in the study with genetically low cholesterol still experienced heart disease. It is possible that TMAO was involved, perhaps by its interaction with cholesterol metabolism or by stimulation of vascular inflammation (PMC4802459).

      1. I dunno. From everything I’ve seen, the TMAO thesis is weak. I mean, look, the vast majority of the low cholesterol folks didn’t get heart disease, even though they didn’t alter their diets to avoid TMAO. So that means that TMAO was not a factor.

        Suppose then that one follows a diet that lowers one’s cholesterol, but still consumes TMAO producing foods. One would then be in the same position as the people with naturally low cholesterol, and would get the same result — no atherosclerosis.

        At this point, I don’t see how one can untangle the TMAO thesis from the view that it is cholesterol itself that causes heart disease. Keep your serum LDL low and you will avoid atherosclerosis, despite consuming TMAO triggers.

        I take carnitine and choline supplements, which do not by themselves raise serum cholesterol, but are suppose to produce TMAO. Well, where is the evidence that these supplements cause heart disease independently of their failure to increase serum cholesterol? As far as I can see, there isn’t any.

    2. Hi, William Dwyer. I am Christine, a NF volunteer moderator. According to the Cleveland Heart Lab, TMAO makes it more likely that cholesterol will build up on artery walls.
      Doesn’t it stand to reason that, if there is less cholesterol in the first place, then less would be available to accumulate? If you put glue on your arm, particulates will stick to it, but if there are no particulates, then they will not stick to it, because they are not there. If you think of the TMAO as glue, and LDL as the particulates, then maybe this will make sense. In other words, I do not think that this does refute the role of TMAO in CHD. I hope that helps!

  28. Testing out the nuts is an idea. Perhaps for a month before my yearly physical I could stop eating nuts and then see what my numbers are. I do eat a set number of calories most days and would have to think of something to replace them with. Perhaps baked potatoes? I would want it to be a whole food.

  29. Sparky: Thanks for the link. The problem is with cassia, which is sold as cinnamon at American supermarkets. True cinnamon, also known as Ceylon cinnamon, has little coumarin and is safe (of course, in sensible amounts.) Reportedly, in Europe it’s illegal to sell cassia as cinnamon.

  30. you are exactly right, isthatasquirrel.

    these are AVERAGE numbers for the AVERAGE american with the AVERAGE risk of heart attack and AVERAGE risk of stroke and AVERAGE risk of cancer and currently the AVERAGE is almost 1 in 2 people and growing.

    now, if you want NO risk of those diseases then you get your numbers below:

    cholesterol: 150

    LDL: 70 (stops progression of disease)

    LDL: 50 (reverses progression of disease)

    TRIG: doesn’t matter because if you get the above numbers down, TRIG will come down.

    HDL: doesn’t matter at all unless you are eating a high fat, standard american diet and then you want it to be high.

    HDL are the garbage trucks which eliminate EXCESS CHOLESTEROL which you consumed thru your diet to the liver to be excreted in the bile. the more junk and excess cholesterol you have in your bloodstream the more garbage trucks you need, hence a higher HDL.

    if you are a No Oil Vegan then you don’t have excess cholesterol and your numbers will naturally be lower than that AVERAGE range you gave which is actually done on AVERAGELY sick americans eating the AVERAGELY sick diet with the AVERAGELY same combination of western diseases.

    you are heart attack, stroke and cancer PROOF if your numbers are:

    chol: <150
    LDL: <50-70

    and that's all that matters, the rest is just pompous fluff.

    after ~6 years on a No Oil WFPBD my numbers without meds are:

    chol: 102
    LDL: 37

    this is equivalent to the old, rural, indigenous chinese people's researched during the China Study who had no western disease eating a primarily fat free plant based diet.

    being AVERAGE isn't a good thing….


    1. what the heck is going on with Disqus?

      when i posted my reply, there were NO OTHERS and now going thru my emails and i see a ton of them.

      geez, i wish they’d get this bug worked out. i really didn’t need to waste half an hour composting this reply.


    2. Thanks for sharing this information.
      I can vouch for the scientifically-grounded claim that it is possible to become heart attack and stroke *proof*, Dr. Esselstyn has demonstrated it over, and over again with the sickest possible patients.

      However, you might want to reconsider (or else elaborate on) your “cancer-proof” claim because as much as lifestyle can greatly reduce cancer risk (~85%) there is no evidence I’m aware that ensures being cancer-proof with lifestyle modifications.

      I have good reasons to hypothesize safely that reducing the risk by very close to 100% may be achievable, with fasting protocols and chemoprevention typically. But I consider those (especially chemoprevention) to not fall under “lifestyle”and even less under “dietary” modifications.

  31. EGGZACTLY!!!

    nobody ever seems to understand that concept. the fast is to get the excess fat out of the system and try to determine the baseline.


  32. Hi, great video :)
    Just a question about cholesterol: On foods I buy at the supermarket, I can see how much “cholesterol” foods contain. I am not sure how this cholesterol is linked to HLD/LDL and if it has a direct effect on our LDL/HDL levels. Could you clarify this or point me to a video that explains this concept? Thanks.
    Also, I heard somebody claiming “Eating eggs, which are loaded with cholesterol, is fine because their cholesterol is never absorbed”. Any resource on cholesterol absorption from foods/food cholesterol effects?

    1. Hi Philippe, I am a volunteer for Dr. Greger. Thanks so much for your question–I think it is an important one. Dietary cholesterol itself is not primarily responsible for increased cholesterol levels. Saturated fat is the main culprit that is raising our cholesterol. However, in many cases, you cannot get one without the other, as they come hand in hand with naturally occurring animal products. This is in addition to the other carcinogenic and otherwise harmful compounds in meat and animal products, which is why whole plant foods, which offer the best of everything nutritionally, are recommended in unrestricted amounts. I hope this helped to answer your question!

      1. Hi Cody, thanks for your answer. It helps a lot.
        Out of curiosity though, what are the effects of dietary cholesterol alone (if one could separate if from sat and trans fat)? And, is it actually absorbed?

    2. On the topic of cholesterol in eggs not being absorbed, that is simply not the case. Your body can and does absorb cholesterol. What the egg industry funded studies do is very sneaky. They know that after eating a meal with cholesterol in it your blood cholesterol levels increase. The more you eat, the higher the rise in blood cholesterol. Then over the next 6-8 hours your body works to get rid of the extra cholesterol. At the end of this period your blood cholesterol is pretty much back down to whatever your baseline cholesterol level was. So how does the egg industry show that eggs don’t affect blood cholesterol level. First they measure your baseline cholesterol level, then they give you a meal with some cholesterol in it. THEN they have subjects fast for 12 hours and measure their cholesterol again, which we know from above will by that time pretty much be back at the baseline level. And presto, eggs don’t increase your cholesterol levels. The trouble is that with 3 egg and cheese omlette for breakfast, a sandwich with meat and cheese, and then chicken (with perhaps more cheese on it) for dinner, people are spending 18-20 hours a day at the higher postprandial cholesterol level and only a few hours at the “baseline” level, and so it is this higher level after meals that is the one that your body experiences for most of the time and thus is the more important level.

      Also important is what eggs don’t have and that is fiber. Your body is dumping cholesterol into the intestines all the time in the form of bile acids. We evolved eating around 100 grams of fiber a day. The fiber binds to the cholesterol in the bile and help prevent it from being reabsorbed. Since eggs have no fiber and displace other foods like oatmeal that does, eggs not only add to the amount of cholesterol present they also decrease the amount of fiber in the diet and so increase the cholesterol absorption rate.

  33. just like theres the healthiest vitamin c intake (200mg 335% of recommended intake) is there other nutrients that we need to be taking more of what about vitamin e

  34. In a study from the University of California 136,905 cases from 541 hospitals 75% had LDL below 130mg/dl (normal), 50% below 100mg/dl very good.
    Puzzled by this they finally concluded oxidised LDL (from rancid and smoked oils ) was the culprit. Statins cause this and type 2 diabetes as well.

    1. That isn’t really a “normal” level but an abnormally high level of LDL cholesterol. LDL should be at LEAST below 70 and ideally around 50 or lower….

  35. Studies suggest that a daily intake of 2 grams of plant sterols reduces LDL cholesterol by approximately 9 to 15 procent in those with elevated cholesterol levels. A report noted that a “raw vegan” diet provided from 500 to more then 1.200 mg of plant sterols per day in comparisment with the 150 to 450 mg of mixed diets. Perhabs supplementing with an additional 1 – 1.5 gram of plant sterols could bring vegans even closer to the optimal cholesterol levels. But plant sterols are to be supplemented with food, because they reduce cholesterol levels by preventing the adsorption of cholesterol. Now, my question is; are these plant sterols going to work with people on a plant based diet, a diet that doesn’t have much dietary cholesterol to begin with?

    1. Dietary cholesterol is just a part of the story. Your body makes all the cholesterol it needs. When it has cholesterol it wants to dispose of it sends it into our intestines in the form of bile. Our bodies evolved eating a high fiber, high phytosterol/phytostanol diet. This is important because a lot of the cholesterol in the bile acids would be a reabsorbed were it not being bound to all the fiber in the food. Also the phytosterol/stanols competed for space in the intestinal cells that absorb cholesterol so less of the excess cholesterol the body dumped into the intestines gets reabsorbed. The end result is that our bodies “plan” on a lot of the cholesterol being dumped into the intestinal tract to NOT be reabsorbed and pass out of the body. Without the fiber and plant phytosterol/stanols your endogenous cholesterol is still being made at the same rate, but now a lot of it is getting reabsorbed and your cholesterol level goes up. So the standard American diet is a double whammy with lots of dietary cholesterol to add to the load of endogenous cholesterol the body is trying to get rid of, and very little fiber or phytosterols into slow or interfere with that reabsorption. So even though those on a plant based diet aren’t getting cholesterol through their diet, we still have to help keep the reabsorption rate of our own bodies cholesterol in check if we want to keep our cholesterol to a healthy level.

      The following is a link to the first of a 5 video series that Dr. Greger did about 4 years ago on this topic.

    2. Normally about 50% of the dietary and biliary cholesterol (produced by the body) is absorbed from the digestive tract into the bloodstream but Plant stanol ester is able to effectively reduce this absorption. Reduced cholesterol absorption results in reduced blood total and LDL cholesterol levels.

      Plant stanol ester works by partly inhibiting the absorption of cholesterol from the digestive tract into the blood. Plant stanol ester partly blocks the absorption of dietary and biliary cholesterol. A measurable reduction in blood cholesterol levels can be seen already after two to three week’s daily consumption.

      To date, more than 70 clinical studies have been published to in scientific journals. These studies confirm that an intake of 1.5 to 2.4 g plant stanol reduces cholesterol levels by an average of 7-10% within two to three weeks.

  36. Lately I have been dowloading and reading the published papers from the studies of Drs Ornish and Esselstyn. It has balanced out somewhat the sweeping generalisations I read in various health oriented forums about the factors relating to ‘heart disease reversal’. I did come across this article quoting Dr Ornish re the reversal of heart disease in a patient that had cholesterol levels substantially above the 150 mark..

    1. that is an incredible find, susan, but these were the very first trials of it’s kind for ornish and there are a lot of variables which go into it so i’d have to take that one with a grain of salt.

      in 1990 I was doing a tremendous amount of stress thallium heart scans as a nuclear medicine technologist. (ironically, the same year as your article reference)

      I was 32, in tremendous shape working out 5-7 days a week at powerhouse gym in detroit, weightlifting/bodybuilding etc and was invincible in my own mind because I looked great on the outside.

      I began to read and see the images about the incredible reversals of heart disease that ornish was having with low fat diets in my journal of nuclear medicine (JNM). the images were unbelievable to those of us in the field.


      little did I know that I was setting up the groundwork for my own inoperable illness a few decades later by eating 5 high protein meals per day even waking up at 1 am to have another protein load. if time would allow, I would actually eat a first lunch at 11am and a second one when the cafeteria closed at 1:30pm.

      you see, we are able to digest a high protein meal every 2 hours minimum so I ate every 2.5-3 hours which kept your nitrogen levels high, just like steroids do. in between meals I would take fistfuls of desiccated protein liver pills from “healthy” south american cows.

      a high nitrogen level allows the body to be in a prime environment to build muscle. steroids don’t ‘make’ muscle they allow the extremely high nitrogen environment for them to build easily and the closest thing to doing that naturally is to eat a protein meal every 2-3 hours.

      back then, they repeated the studies a year later to see improvements but then the diets were not all that strict, allowing animal products and excess fat. my definition being anything fatty (animal products) or added fat even if it is kept below that 10% level. I believe disease states begin at over 8%.

      by now with more strict diets like the one i’m on, ornish has shown reversal of ischemic heart disease in just 2 weeks or less on those same nuclear medicine heart scans.

      he’s progressed a long way since those initial studies in 1989.



      1. hi Donald , this is my second reply.. the one I wrote suddenly vanished.. maybe lost in the halls of disqus. Anyway, thank you for YOUR post.. very interesting as always and its downright amazing that you lived to tell the tale. I do not doubt you are right about the 8% fat level, and about strict no animal products rule. I totally agree since my inflammation levels didnt really drop til the last bits of dairy were gone from my diet. I struggle here and there with bp and cholesterol numbers, but not with the diet. I quite enjoy it .

        I dont ever recall hearing anything from doctors about diet or nutrition at that time, or since up until this last year. Were doctors in the 90s acknowledging Dr Ornish’ success?
        I enjoy listening to Nathan Pritikin too I really admired the man’s determination and courage. He figured it out on his own.. marvelous!

  37. Hi Guys,
    i need help, it is very urgent. Please read if you have professional knowledge of heart health, especially the main valve, not the to the lungs, the other one.
    My Granddad is 91 years old, and his main valve is kind of stiff and opens only about 4 square millimeters.
    He as angina pain since summer and feels dizziness, always if he bends over to tie his shoes or grabs something from below.

    I am a big fan of Dr. Greger. As I watched his Google speech I immediately bought his ebook. Two months later the actual book was released in german, so I bought two, for my mom and aunt.

    Now my Granddad is forced/persuaded to an operation (kadiology MD husband of my cousin). The valve shall be pushed away and a new “biovalve” shall take its place.
    I had him on the Greger/Esselstyn/Ornish kind of diet for about 3 Days now, the dizziness is reduced and the.
    Mid January: LDL 151mg/dl
    Since a few weeks, he ate less and less animal stuff. Like i said, since 3 Days nothing animal like but fats, like nuts an oil,
    I kind of learned today to stop even that.
    I said to my mom, to give him only 13grams of flax seed “powder/grinded” 3grams walnut and 3grams peanuts each day. Each with the other meals. Because he needs some kind of fat to take the fat vitamins in, right?
    I think maybe the less dizziness and the less pain, from the last days is because no endotoxins are around anymore, and the valve is maybe less stiff? It can not be the dropping of the LDL can it?

    The actual question is, can anyone tell me if we can stabilize my granddads condition so that he do not have to take the risk of that operation. The OP is scheduled for Friday 17.02.2017. I have read often about arteries but never about valves.
    Is the point of no return reached with only 4 square millimeter opening and a LDL just under maybe 130mg/dl?
    If not, is it possible to drop the LDL fast and if, how?
    Please help me guys, despite my poor English skills. My grandpa is the best man I have ever known. He is kind, funny and never judges anyone. Live and let live, everyone just wants to be happy.
    The risk of this OP is surely significant, even if he would be 61 instead of 91.
    I think, I made myself somewhat clear.
    Thanks in advance, now I go back to read Dr. Esselstyns book on reversing Heart disease, which mentions no valves I’m afraid.
    Wish all of you well!
    Bye, marcus

    1. Marcus: I’m sorry to hear about your grandfather. It sounds like he has a fairly advanced case of aortic stenosis and sclerosis. I am Dr. Jon, a family physician, and a volunteer moderator for this website. I strongly suggest that you try to speak directly with Dr. Caldwell Esselstyn. You can hopefully find a phone number for him. He works at the Cleveland Clinic.

      It sounds like changing to plant-based nutrition is already helping your grandfather. You are correct that the risks of valve-replacement surgery are fairly high. If you can get his symptoms (dizziness and angina) to resolve using a plant-based diet, I would say that you should put off the surgery. But his case sounds fairly serious, and you should speak with an expert like Dr. Esselstyn. I hope this helps. Good luck!

  38. Hello friendly people here at nutritionfacts.

    I am not sure that this is the place to write my questions, if not then please teach me where to do it in the future.

    For a while I have been discussing subjects like cardio vascular diseases and the influence that our cholesterol and the intake of animal fat has got in relative to the subject.
    Pretty often I am told that I am “oldschool” in my knowledge and that anybody who really cares about nutrtition nowadays knows that neither fat og cholestorol are the problem in that matter! I truly dont get this! I am like “excuse me but which studies are you readoing?”.
    Can someone in here please help understand what this is about? I follow Gregers work and it’s not my understanding that it is what he claims? But where does all this come from then?
    Even when I was watching one of Dr. Kim Williams vids the other day I saw someone in the comments section accuse him for being oldschool after he is talking about the connection between cardio vascular diseases and cholesterol / fat.
    I am really willing to change my mind, but I still havent seen anything convincing?

    My other question is of another matter.
    I am working as a social worker. I work woth people in many different contexts like therapy, social management ect. Anyway, a holistic approach is very important to me. I do not really understand how so many people in my position can work with peoples mental condition without worrying about what they eat / drink, the nutritional value of their food choices ect. Therefore I am searching for the right place to get some more education.
    Ofcourse is a very place to start, but I would like to get some more structured teaching and some kind of a diploma.
    I live en Denmark and here the choices are only a few. And the ones we have are not having a holistic approach, also they are not really openminded to a plantbased diet.
    In my search I found this online education system from the Canadian School of Natural Nutrition:
    I even met someone who recommend it.
    Does any of you know anything about it? What do you think about their education system?
    I know it isnt an university degree in nutrition or something like that. Also it is important to say that I am not looking to be a scientist or a clinical specialst in nutrition. However it is ofcourse still important that the education is serious, reasonable science are used ect.

    I hope some of you will find the time to answer this post.

    Wish you all a nice and peaceful day.

    1. Hi, Marco Bellacci. I am Christine, a NF volunteer moderator. There have been some well-publicized recent studies seeming to show that saturated fat and cholesterol do not contribute to cardiovascular disease. Some people have latched onto these because people love to hear good news about their bad habits. On closer examination, these studies were poorly designed, because they compared groups consuming a certain amount of cholesterol and saturated fat with those consuming a bit less. They did not include a group consuming none. Some may consider it old-school, and I do not necessarily think that is a bad thing, but there is a lot of scientific evidence linking dietary cholesterol and saturated fat with cardiovascular disease. If you want to learn more about where the sources of information in the NutritionFacts videos, you can click the tab next to each video labeled “Sources Cited,” and find links to the studies used in producing that video.
      With regard to the Canadian program you mentioned, I do not know much about it. I do know that Cornell University offers an online certificate program in plant-base nutrition that is quite comprehensive. You might want to check it out. I hope that helps!

      1. Hi Christine.

        Thank you very much!
        So what you are telling me is that I can trust the the studies and science that points out cholesterol and fat as a factor even more than the other studies? That they are more credible than the studies that points out that cholesterol and fat walks free? I am asking only because I am not that good at reading studies close. Ofcourse I can (and I will) watch Gregers vids and read what is necessary, but one thing is to watch and read his material another thing is to know how reliable the studies Greger are using actally are. Please dont get me wrong. I am a BIG fan of this site but one has to be careful…

        Thank you for the advice about Cornell University. As fare as I know it is the one made by octor Campbell isnt it?
        To be honest, I have been ignoring that education. Simply because I have seen so much critic about him (The China Study). But maybe I am wrong?

        Thank you.

    2. Marco Bellacci: To address your first question, I’ll add to the reply you already got. The idea that cholesterol levels do not matter come from a set of people who are making a lot of money selling that idea. They base it on faulty research or research references which do not actually back up their claims.

      One of the terms I think “Plant Positive” came up with to describe this group is “cholesterol confusionists”. Plant Positive has done an intensive, in-depth look at the claims made by the cholesterol confusionists. He put together a really great set of videos, going over the claims and comparing to the actual science. There’s quite a bit there, but if you really want to get into it, you can learn a lot at the Plant Positive website. Maybe just starting with a few videos and seeing where it goes from there?

      Following is the website. You can see the table of contents on the right and you can search for particular topics if you are interested. Or you can start at the top and just go through it one by one. :-)

      1. Thank you very much Thea! I will sure do that!

        Do you have any opinion on the Canadian program I mentioned? Or The Campbell online education?


        1. Marco Bellacci: I can’t really say anything. I’ve never heard of the Canadian program (but that doesn’t mean anything as I’m not in the field myself). I’ve heard good things about the Campbell program, but it’s not first-hand experience.

          I do think that going through the plant positive videos would give someone quite an education! But it would not be a formal education and the focus is very limited. Still, if you get a chance to check out some of those videos, I think you will be glad that you did.

      2. Hi again Thea.

        Well that visit quickly came up with two questions…

        1. Who is behind that page? I have always been told to start by examine who is behind what I am reading but I cant seem to find out?

        2. Is it closed? I seems like the last blogpost is more than 2 years old?

        Thank you.

        1. Marco Bellacci: I can understand why you want to know who is behind the page. I’ll share what I remember reading on the Plant Positive site some years ago, though I may be misremembering something. One reason to remain anonymous is that the author wanted the work to speak for itself. He gives all references and lays out the points very clearly. The other reason is that he wants to maintain a private life. As it is, he got a lot of vitriol for that work. The people who make a living being cholesterol confusionists really, really do not like Plant Positive. He did not want to expose himself or his family to that kind of reaction personally.

          The reason I’m personally OK with not knowing who Plant Positive is is because he took no money to do any of that work. The reason to learn about someone’s background is to learn if they have a conflict of interest or a bias that affects what the person presents. I’m satisfied that Plant Positive has no conflict of interest and no agenda other than discovering the truth as he sees it. Of course, I have to take his word that he is not taking any money, but I believe him.

          Because Plant Positive is not willing to take money for doing that work, he was only able to do it a short time. That’s why you do not see any recent postings. That doesn’t mean that the information on the site isn’t still perfectly relevant and very helpful. For example, one of the points cholesterol confusionists make is to say that Ancel Keys, an old researcher, “cherry picked” data and that started scientists off on the wrong direction concerning fat and cholesterol. Plant Positive thoroughly debunks that claim. Plant Positive’s information about Ancel Keys is as relevant today as it was two years ago or 10 years ago for that mater (had the video been made earlier).

          Most of the site is made up of videos. Here is a sample Plant Positive video that I’m guessing you might appreciate as a starter: Here is an article on the site that I found to be especially good:

            1. Marco Bellacci: I was doing some research for someone else and was reminded about my conversation with you. You had expressed some concern that the person behind the Plant Positive website is anonymous. I was just reminded of a blog from Seth Yoder who covered a lot of the same ground as Plant Positive. For example, Seth covers Gary Taube’s book, Good Calories, Bad Calories. He also cover’s Nina’s Teicholz’s work . In the course of Seth’s blog posts, you can learn how to see through the cholesterol confusionist’s claims.

              It’s a lot of information which may not make as much sense if you haven’t read the books being debunked. But in case you are interested, here a blog page where you could start: This time I’m referring you to someone who is not anonymous. :-)

  39. Hello Doctor,

    I’ve read that the human body is capable of manufacturing its own cholesterol, therefore it does not require any further cholesterol through diet. But is it true that the body stops or decreases cholesterol production when cholesterol-ridden foods are eaten? I see this as a common rebuttal from people who believe meat, dairy, and eggs are not the reason for high cholesterol levels.
    Thank you.

    1. Lindsay: I’d say that the “common rebuttal” you are getting is somewhat true, somewhat false, totally misleading.

      Here’s the scoop: When you eat animal products or plant products high in saturated fat, your body starts to make more cholesterol than is healthy. This elevated cholesterol level dramatically increases our risk for disease and death.

      However, our bodies do tend to have an upper limit. So, if you are at your upper limit (which is above the healthy levels) and you eat yet even more unhealthy foods, then yes, your body will tend to compensate and keep your levels stable–at the high/unhealthy level.

      Many studies show this. If someone is at a human-normal/healthy cholesterol levels, then eating meat, dairy and eggs raises their cholesterol levels. However, if their normal diet consists of lots of meat, dairy and eggs, then adding yet more meat, dairy and eggs, is not likely to have much of an impact on the cholesterol levels. The body is already super-saturated. Does that make sense?

      Someone who only tells you half of this picture is ignorant of the science (most likely friends and family) or deliberately misleading you (the ‘experts’ who claim that cholesterol levels are not related to diet).

  40. God bless Doctor Arthur moon for helping me cure my diabetes type 2. Brethren, i have suffered diabetes for a long period of time, i have tried so many remedy, but known seems to work. But i had contact with a herbal doctor who i saw so many people testifying on how they were all cured of their various disease and viruses by this doctor. So i explained my entire problem to him, and he promised to cure me. So i gave him all benefit of doubt, and behold he prepared the herbal mixture, and he send it to me in my country. Today, i am proud to say i am diabetes free, and my sugar level has been restored to normal. So in case you are out there suffering from diabetes and other diseases or virus, i want to tell you to quickly contact: Arthur moon for your cure. Email:

  41. To reduce heart disease should we focus on lowering cholesterol and what part does saturated fat play in that equation?, should we use vegetable oil instead ?

  42. Nutrition Facts is a joy and an important focus for all our attentions. However, there might be a confusing and neglected area of concern upon which there has been extensive comment over time. In attempting to search the site for Trigycerides nothing comes up. The few notes in videos state that Trigycerides are a component of heart disease…to avoid them as well as Saturated Fat. The comments on this site have stated that although strictly vegan, avoiding all dangerous foods, eating a complete and balanced healthful diet still has people living with high Trigyceride levels. The accompanying references left by those who are investigating on their own suggests the culprit is high carb diets as well as sugar. And these are coming in the most natural and pure forms…i.e. nuts and fruit and beans and grains. For example, the referenced material suggest avoiding fruit. A clear explanation of the research accompanies the material.
    Obviously, extremely opposed to Dr. Greger’s research notes. If the good doctor has any explanation or further research which explains or advices where long time abiding Vegans adapt to these suggested Trigyceride enhancers it would be important for those concerned to get a clearer understand of the dilemma.

  43. Hi there,

    I saw this study by Grasgruber et al. (2016), “Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries.” Food Nutr Res. 2016 Sep 27;60:31694. doi: 10.3402/fnr.v60.31694. eCollection 2016.

    It was being used as a “gotcha” to say that heart disease risk was correlated with starches and alcohol and not with saturated fats. I haven’t seen any responses to it from anyone in the plant-based community, and was wondering if it might be a good one to respond to here (or maybe I missed the response?)

    Thanks! This site is amazing and I admire your work.

  44. Anyones have thoughts on this study? I’m shifting to a WFPB diet and have been reading books by Esselstyn, Caldwell, and others to get as informed as I can. I’ve seen this study on several sites which question the link between cholesterol and saturated fat that I feel has been well established. Is this study flawed?

    Apologies if this has been addressed before, but I’ve searched the comments and don’t see it. Please point me in the right direction if this is the case. Thanks!!

  45. Hi Chris and thanks for your question. It appears that this study is looking at the association of total cholesterol with ischemic heart disease whereas your question relates to the question of consumption of saturated fat and the effect on total cholesterol. Total cholesterol values are composed of the HDL, LDL and triglycerides. In general, fats are comprised of components of both saturated and unsaturated fatty acids with some sources being more predominantly of the saturated type (i.e. animal and tropical fats) and others more predominantly of the unsaturated type (i.e. most plant based sources). Ideally, we should adopt dietary strategies throughout life that will keep our LDL levels low and thereby decrease our lifetime risk of heart disease as discussed in this video: Whole food plant based – once again, the evidence is there to support this dietary pattern.

  46. For past 3-4 months I have a vegan diet, more vegetables and I don’t eat breakfast, never have (sort of intermittent fasting).

    The good: I lost additional weight:. In DEC-2016, I was down to 203 lbs, now I am 187 lbs @ 5’9″ 51 years old.
    My A1C is at an all time low 5.0, my blood pressure is 120/80, normal, I sleep a little better and have a little more energy. My testosterone has risen to 508 from 290. 100 of that gain in the past 5 months

    BUT my cholesterol is too high 209, 51 HDL, 126 LDL & 201 Triglycerides. I don’t know about particle count or size or if I should be worried because everything else is doing better.
    Worried my Dr will put me back on statins.What do I do??

  47. Hey, thanks for your question..
    Congratulations on your weight loss and improved health! Do you know what your cholesterol #s were before you started eating a vegan diet? You’re right, your #s are still high. However, try not to worry too much. It takes time for your body to clear out the extra cholesterol and this will not happen overnight. Also, remember that oils have cholesterol, and can keep your levels elevated if you are consuming it/cooking with it. Stick it eating a whole foods plant based diet with limited (or no) oil, and you will see your cholesterol continue to improve. Docs will tell you that ideal total cholesterol is less than 200 and LDL is less than 100, but optimal LDL is actually closer to 50-70. You do not need to go back on statins with those numbers— you can and will lower your cholesterol naturally. Good luck!


  48. Julia,
    Thank you for the response. My cholesterol has been all over.
    03/02/16: Total 164, 50 HDL, 99 LDL, VLDL 23 & Triglycerides 114
    01/01/16: Total 255, 39 HDL, 167 LDL, VLDL 49 & Triglycerides 245
    Not sure what diet I was doing back then but I was NOT vegan and was not on statins.
    I think on the 3/2/16 one; I was eating fish but little or no saturated animal fat.

    Can you send a link about oil and cholesterol? I thought plant oil had no cholesterol and since i am vegan, I was not eating animal fats.I do understand Omega 6 as inflammatory but did not know about the cholesterol piece.

    Do you have any information pertaining to this comment, “It takes time for your body to clear out the extra cholesterol and this will not happen overnight.” Like how long? Just surprises me that everything else is better except this.

    1. Hi this is Dr. Daniela Sozanski, PhD in Natural Medicine and Moderator with Nutritionfacts.
      Oil is not a whole food. It is extracted and many time good nutrients are left behind. Between Dr. Greger, Dr. McDonalds and Dr. Esselstyn, you will find that oil does not hold a favorite position in the diets they recommend. There is less association between vegetable oils and cholesterol increase, with one exception, the coconut oil. Check this out:; however oils are known to cause inflammation, just as you mentioned, due to high contents of arachidonic acid, which makes them less desirable for consumption, particularly in cardiovascular disease. Your 01/01/16 lipid tests also show an elevation of triglycerides… I would like to draw your attention to that too. For a vegan, the triglycerides get elevated due to either high consumption of processed sugars, be it from cane, beets, corn etc or stress. A number of recommendations would be to increase the consumption of fiber, as in legumes, green leafy veggies, oat, oat bran, nuts and seeds, a regular exercise routine, maybe yoga or meditation and to try to remove the source of stress if possible, also, to eliminate sugar and flour consumption. As far as cholesterol is going, as you are a vegan, the only dietary factor I could think of would be trans fats, which, if you do eat processed vegan foods, you may intake more than you think. In addition, amla powder, a tea spoon a day in a smoothie or with oat meal was shown to have significant effect in lowering cholesterol, also brazil nuts, 6/week, taken all at the same time (limit consumption due to high levels of selenium). Please let me know if any of these suggestions works. Thanks, Daniela

      1. Daniela, I understand: – oil lacks nutrients – cholesterol from coconut oil – Omega-6 relationship to inflammation.

        I don’t understand: – How do I keep an eye on inflammation?  Should I include some IGF-1 or other test in my next blood test to check how I am doing?
        Previously I consumed very little red meat but likely 7 to 10 servings of fish weekly with some poultry thrown in. Very few vegetables and fruits.
        I am new to plant based and it is a big change. I have totally cut out all forms of dairy and meat but like many new plant based folks; I consume a good amount of carb / snacks typically made with sunflower oil (Omega 6). I also attempt to limit eating to 6 hours while not eating during the other 18 hours (intermittent fasting). I do take a 500mg Omega 3 supplement but there is no way that can even put a dent in my Omega 3/6 ratio….I also consume a little chia and flax but very little.
        – As for Triglycerides, Yes all those carbs likely do not help but I do eat a very large amount of fiber, exercise an hour every day and I will add Amla to the mix as you recommend to see if there is an impact.
        – What are typical/popular vegan food sources containing ‘hidden’ trans fat?
        Thank you for you time. Good to know someone is listening out there!

        | | | | Omega-3 Supplement | Vegan Heart Health Dietary Supplement | DHA EPA – O…

        Ovega-3™ is a plant-based omega-3 supplement containing both DHA and EPA omega-3 fatty acids, to support heart h…



        1. Daniela,
          Maybe I should take a metal/toxin free fish oil in addition to the Ovega-3 500 MG supplement since they are much more potent?
          Also Alzheimer’s runs in family and I would certainly like to keep up with my high level of Omega 3/DHA I had in my prior diet

        2. Hi very good question: you would need to check out your homocysteine levels, homocysteine is a toxic metabolic product, normally detoxified by B12, B6, choline and folic acid, which is a marker of inflammation and cardiovascular health, and if high we do have a solution to lower it, also, c-reactive protein, which is produced by liver and also a marker of inflammation and if high we need to address the liver function and overall inflammation. I hope this helps, let me know how it goes, Daniela

          Dr. Daniela Sozanski, PhD, PScD Sandy Springs GA c: 864-380-8017 (

        3. Hi Scott, one more time an email I thought I sent to you.

          Hi Scott, very good question: you would need to check out your homocysteine levels, homocysteine is a toxic metabolic product, normally detoxified by some of the B vitamins and choline; homocysteine is a marker of inflammation and cardiovascular health, and if high, we do have a solution to lower it, also, c-reactive protein, which is produced by liver and also a marker of inflammation and if high we need to address the liver function and overall inflammation with nutrition. Daniela

          Sources of trans fats? Biscuits, store bought cakes and cookies, flaky crusts, margarine containing snacks, deep fried foods, vegan snacks made with various oils, all vegan. Please remember, vegan can mean junk food and there is a billion dollars “vegan” industry out there ready to take your money. What i am saying is whole food vegan is a different story than vegan. My hope is that vegans are generally more nutritionally aware than the rest of the population.
          Omega 3s? 3,,000 mg /day or 1,000 mg AND 2 table spoons of ground flax seed; chia can wait. You workout? I do too, need cellular oxygenation so 200 mg CoQ10/day can help.
          In addition, why such an extreme schedule. I hope you do not fast continuously. If you do, do it twice a year, but being vegan is fasting enough, unless there are undisclosed health issues. Please let me know how it goes. Best regards, Daniela

          1. – OK, I will request to add homocysteine and c-reactive protein to my next blood test. I just got my Amla powder, so I will shoot for a teaspoon a day of that. You also recommended adding 200 mg CoQ10 daily since I work out 1 hour per day to help with cellular oxidation.

            – 3 grams / day of Omega 3 seems light, maybe that would offset up to 12 grams a day of Omega 6 but I am pretty sure there is way more Omega 6 than that in my diet. 50 years of eating many carbs snacks is a big shift to 100% whole foods. I am not 100% whole foods yet and that transition is taking longer and is the most difficult piece especially when you go out to eat and / or travel. I have cut out all meat and dairy, but like many new plant based folks; the carbs tend to fill in some of the void along with the Omega 6 in those foods. Kind of why I asked about metal/toxin free Omega 3 fish oil above.

            I was getting so much protein and Omega 3 in the past from (lower contaminate) salmon 7-10 servings per week. Is that fish really that bad in the grand scheme of things? I do my best to eat protein but I was eating 100-200g /day in the past. Now getting in 50-100g daily I lost a lot of muscle and skin seems a little looser. A lot of good to vegan diet but some of these downsides I’d like to minimize.

            – As for daily intermittent fasting, I eat about the same number of calories daily (maybe slightly less since there is less early day and night time snacking) just in a smaller window of time (like 6 hours) to reduce hours of insulin release allowing fat to be burned. Tons of information is available about intermittent fasting. Dr. Gregor mentioned he would do a series on it but never did to the best of my knowledge. The main benefit supposedly is your metabolic rate does not slow like it does with a reduced calorie diet. And yes I did have a pretty high A1C of 5.8 before plant based diet + intermittent fasting. Now my A1C is down to 5.0.

            1. Swendell, hi: All you are doing seems great, except I do not understand the 12 g of Omega 6…. where does that come from; there is one thing to suspect it comes from snacks and another to know precisely the quantity. Glad you decided on CoQ10, for cellular oxygenation and ensuing many benefits. You do not need a lot of protein, 60 g/day more or less is more than sufficient. I understand that in the absence of animal foods, one tends to lean on carbohydrates…. but you can use great cut raw vegetables instead of processed carbs, with a little oil and hummus for dip.
              Fish? I am not a vegan and I do eat fish, not too much. It has to do with preference and personal values.
              Finally if indeed you do not consume any animal products, I strongly recommend that you supplement with B12 (as metylcobalamin 1mg sublingual, take 3-4 times a week, not every day, to keep the homocysteine levels down, instead of waiting 6 months to check it in a blood test.

              1. Daniela,

                1) My logic: It seems widely excepted that the ratio of Omega 3 to Omega 6 should be no more than 1:4. So if you say to take 3g of Omega 3, that would offset about 12g of Omega 6.
                2) My diet varies greatly but many vegan snacks have a lot of sunflower and canola oil and I estimate between those snacks and other foods to be about 20g/day of Omega6 with a wide Std Deviation.
                3) According to the most recently published results of the National Health and Nutrition Examination Survey (NHANES 2013-2014) average protein consumption for women ages 20 and older was 69.8 grams and for men 98.3 grams/day.
                I know this varies but I am only pointing out I am eating less than half of what I use to eat…
                4) I do take a vegan B12 supplement so I have that covered
                5) Fish: Basically seems so contaminated that the benefits may be offset by the damage from contaminates even in fish lower on food chain and/or with less contamination. Dr Gregor does not seem to be a fan of fish for this reason which is why I asked about contaminate free fish oil.
                6) I did not see a response my comment, ” – As for daily intermittent fasting, I eat about the same number of calories daily (maybe slightly less since there is less early day and night time snacking) just in a smaller window of time (like 6 hours) to reduce hours of insulin release allowing fat to be burned. Tons of information is available about intermittent fasting. Dr. Gregor mentioned he would do a series on it but never did to the best of my knowledge. The main benefit supposedly is your metabolic rate does not slow like it does with a reduced calorie diet. And yes I did have a pretty high A1C of 5.8 before plant based diet + intermittent fasting. Now my A1C is down to 5.0.”

  49. Ok, I stand corrected; I just found notes that indicate I did start taking Crestor in late JAN-2016 which explains the rapid drop.
    I think I had stopped taking Crestor 5/27/2014 before restarting in late JAN-2016
    I don’t think I had another cholesterol test between 3/2/16 and 10/27/17
    I will try to cut out more plant oils as suggested

  50. Julia, I hope I didn’t loose ya on those two questions (above)?

    1) Can you send a link about oil and cholesterol? I thought plant oil had no cholesterol and since i am vegan, I was not eating animal fats.I do understand Omega 6 as inflammatory but did not know about the cholesterol piece.

    2) Do you have any information pertaining to this comment, “It takes time for your body to clear out the extra cholesterol and this will not happen overnight.” Like how long? Just surprises me that everything else is better except this.

    Also I got my hands on another blood from 10-5-17 for insurance which shows:
    10/05/17: Total 188, 49.9 HDL, 114.9 LDL & Triglycerides 116
    but I originally posted (above) my 10-27-17 Blood test:
    10/27/17: Total 209, 51 HDL, 126 LDL & Triglycerides 201
    How can my blood work change that much in 22 days?

    1. Julia,

      Cholesterol levels can and will change daily……the numbers are driven by your diet, exercise and a host of other considerations including liver and bowel function.

      I’m curious what you had to eat before the last test on 10/27/17 with the increasing change in triglycerides. I would suspect that you had a higher than average simple carbohydrate meal the night prior and possibly closer to your blood draw time. This would reflect the changes seen, as an example.

      As to the omega 6 deal….it’s about balance between the various oils, not to the exclusion of the 6’s. For a quick overview please see: It’s a bit of an oversimplification and no you do not need to get the omega 3’s from fish oil however the overall message is on point…..balance.

      Dr. Alan Kadish moderator for Dr. Greger

      1. Both 10/05 & 10/27 were morning blood test, fasted after about 9p. No idea what I ate the day before. Next time i will track that better

        I actually said, I do understand the omega 3/6 balance but not Julia’s comment above: “Also, remember that oils have cholesterol, and can keep your levels elevated if you are consuming it/cooking with it.” because I use only plant oils as a vegan and do not understand Julia’s cholesterol reference…

        Do you have any information pertaining to this comment from Julia, “It takes time for your body to clear out the extra cholesterol and this will not happen overnight.” Like how long?

  51. Swendell,
    You are correct, plants do not have cholesterol, however, they do have small amounts of saturated fat (Coconut oil and palm oil has high levels of saturated fat). Your liver can make cholesterol from saturated fats. I would expect your lab values to continue to improve as you continue on WFPB diet and avoid coconut. Exercise will also help lower your LDL cholesterol.

  52. Please could someone address this study that showed that increased dietary cholesterol had no affect on the atherogenicity of the LDL particle.,%202004.pdf

    I believe the design of the study is flawed because by design the authors had set the upper limit for total cholesterol and triglycerides at high levels and unless I’m mistaken the study didn’t present what the participants cholesterol or triglyceride levels were before the study?

  53. Hi Steven,

    Good question.
    This study (while very, very old) showed a decrease in LDL in patients with familial hyperlipidemia when placed on a cholesterol-free vegetarian diet.

    Familial hypercholesterolemia involves defective hepatic (liver) and non-hepatic LDL receptors. Excess intake of saturated fats increases the liver’s production of VLDL and triglycerides via a molecular mechanism involving protein activators. So, avoiding saturated fat is especially important for individuals with familial HLD due to the protein activators. A high fiber, low fat diet with regular exercise is the best lifestyle to manage this condition. If you still need medications to control your LDL after adopting this lifestyle, that is OKAY. This condition commonly requires medication starting early in life. However, a healthy lifestyle is much more protective against future consequences of this condition than simply taking a statin.



  54. I have been on a vegan diet for the last 6 mos and there has been no change in my lipid profile Total C 211 HDL 30 LDL 139 Tri glycerides 273 Chol/HDL 7 and
    AIC 6 oatmeal everyday for the past 6 months. I am disheartened, might as well go back to bacon egg and cheese. My GP says it is genetic, but I know the impacts of epigenetics. Any incite would help.

  55. French fries and coke is very much vegan but is (obviously) very unhealthy; i.e. vegan can mean many things. If you list all the food/drink you consume over several days then we might be able to help. Keep in mind that if you have excess body fat, you could also have excess visceral fat and suffer from metabolic syndrome which could account for this as well.

    Dr. Ben

  56. Does fruit (and sugar) raise cholesterol? Dr Caldwell Esselstyn book, “How to Prevent Heart Disease” says it does. I know the book was written a long time ago (by science standards), so I am wondering if there is a definitive answer on this?

  57. Good question. Keep in mind there is no such thing as “outdated” or “old” evidence. There is only disproved evidence. All the evidence I’ve seen and the information I’ve seen from Dr. Esselstyn (who I have tremendous respect for) do not equate fruit and processed sugar in the slightest. Fruit consists of small amounts of manageable carbs in form of sugar that is attached to dietary fiber and antioxidants. The sugar you get from eating whole fruit is absorbed slowly and can be utilized by your body in a healthy manner. Processed sugar has no fiber and no antioxidants. In addition, it is absorbed very rapidly in a manner that cannot be metabolized by your body correctly such that a large quantity is turned into fat that increases your risk for many diseases. Fruit juice is a no-no too because the fiber has been removed and thrown away.

    Dr. Ben

  58. I’m curious about possible explanations for a dramatic rise in my husband’s LDL after he became more assiduous about eating a vegan, mostly-WF diet. He’s been vegetarian (some fish) for 25 years. We were concerned after his LDL increased from the 120/130 range to 153, so he adjusted his diet and the LDL shot up more–to 179. (The high baseline LDL appears to be genetic).

    For context, his BMI is 24.5 and his HS-CRP is 0.5; triglycerides, blood sugar, & HDL were all in the normal range. His typical daily fare is green tea, a bowl of plain oats, ~2 oz nuts/hempseeds, a cup of beans, an apple, a few dates, and a vegan dinner (usually beans or tofu with vegetables, maybe 1 t oil)…and 1-2 pints of beer. In addition to the beer, he does have a handful of other non-WF sins over the week (generally two vegan cookies, one Field Roast sausage, one meal of Amy’s Kitchen vegan black bean enchiladas, and maybe a serving of chips and salsa).

  59. My doctor isn’t concerned with my ldl but it’s unsettling to me. It’s 130 HDL 67 I’ve been a long distance runner 40 yrs and have a BMI of 17.8. 5’3” 100 lbs. I’ve been vegan for 10 yrs. mostly greens green and beet smoothies sprouted nuts and seeds Amy’s vegan dinners and fresh fruits …… doesn’t make sense

  60. Jilan,

    First, Great Work on the lifestyle….well done !

    I appreciate your feeling unsettled however…. just having the LDL number without a breakdown of your family of LDL’s may be leaving you with only a small amount of good health information. You can assess your risk using a full range of findings for the types of cholesterol, along with other indices and get a much better answer of your potential CV risk and rest easier.

    I am of the opinion that we are overly focused on the LDL and total cholesterol numbers and would suggest you look at the work at both Genova and Berkley labs. These are two of many labs that have a much more comprehensive lipid evaluation panels.

    It’s one of those “rest of the story” types of deals where getting your fractionation and other blood values will really determine where to place your focus. vs As an FYI you can do these tests without a physicians orders.

    Dr. Alan Kadish moderator for Dr. Greger

  61. Has Dr Greger ever done a video on or even mentioned Lipoprotein a? I did a search on here but came up empty. Basically it is another kind of cholesterol carrying molecule and having a high level is a strong predictor of heart disease. It is present by heredity in about 20% of those of European descent. Dr. Joel Kahn has several videos on it and I’ll link one below. In one video of Dr. Kahn’s he references a study that shows it is independent of other risk factors such as LDL levels. He also references a theory of Linus Pauling that plaques will develop in the presence of low Vitamin C blood levels. This theory has recently been confirmed by the work of Dr. Rath working with mice.

    I find it impossible to believe Dr. Greger hasn’t seen all of this research.

    Here’s the video from Dr. Kahn:

    Would love to get everyone’s take on this.

  62. Does anyone have information regarding Low LDL and HDL levels?

    Someone i know, a vegetarian who consumes cheese and the occasional dairy snack such as icecream from time to time but rarely milk or meats (Save chicken perhaps 1ce per fortnight), recetnly did blood tests and came back extremely low in both HDL (0.37 G/L i.e 0.95mmol/l) and LDL (0.74 g/l i.e 1.96 mmol/l).

    My friend uses olive oil with their salads and eats a pretty wide range of fruits and vegetables so one woudl assume that their Cholesterol levels would be normal if not high however it is quite the opposite and I am slightly concerned.
    Is there any form of action you#d advise for them to naturally increase both (dietarily or lifestyle wise).
    I will admit they do not exercise often and that can often aid but generally those who simply eat a balanced diet dont need to worry about low levels since cholesterol is found everywhere(or at least that’s what it seems like).
    Thanks for any advice!
    Very broad question but would be interesting to hear peoples views since LOW cholesterol isn’t often discussed nor measure to take

  63. Hi! I’m Dr Anderson, a cardiologist and Health Support Volunteer with

    LDL 1.96 is good, but a bit lower would be best. It’s at the upper limit of goal, and less than 1.8 is ideal for lowering risk of heart disease.

    As for the concept of too low LDL, we know from people who are born with a certain genetic abnormality who have very low LDLs (far lower than 1.96), that there are no ill health effects, and they have a very low risk of heart disease.

    An HDL of 0.95 is fine, not excessively low.

    Best to you and your friend!

  64. Hello! Could you please explain several studies where elderly people over the age of 80 with higher cholesterol were shown to have a decreased risk of mortality from heart disease, cancer and infection compared to elderly people with low cholesterol? Is it like cholesterol stops being dangerous after certain age?

  65. This question has come up before, and while it might seem to cast doubt on the need to monitor cholesterol in the elderly, the answer is not that obvious. Here is one review that clarifies;

    Here’s another explanation which should make a similar point: Jeremy Pearson, PhD, associate medical director at the British Heart Foundation, says he’s not surprised that the researchers did not find a link between high LDL cholesterol and more deaths.”As we get older”, he says, “many more things affect our health. That makes it less easy to understand how high cholesterol vs. other conditions influences our risk of dying.
    “In contrast, the evidence from large clinical trials demonstrates very clearly that lowering LDL cholesterol reduces our risk of death overall and from heart attacks and strokes, regardless of age,” he says. “There is nothing in the current paper to support the authors’ suggestions that the studies they reviewed cast doubt on the idea that LDL cholesterol is a major cause of heart disease or that guidelines on LDL reduction in the elderly need re-evaluating.”

    I hope these resources will clarify why it’s still important to monitor cholesterol throughout our life span. Keep coming back to this site for reassurance and knowledge to clarify those frequently misleading headlines.

  66. Hello! This guy from Germany claims here:
    and on several other Videos on his Chanel. More Cholesterol and animal fat= live longer. He is Talking About this study:
    Actually he adresses Dr. Greger rude and directly, discredits him and blame him for getting Paid by the Statins Industrie. And of Course Dr. Esselstyn is a liar too. Mr. Pugge says.

    I think Mr. Pugge is quite arrogant, BUT, do he has a apoint. Maybe???

    And second Question, has Dr. Greger already covered this study I mentioned above?


    1. That’s not how it works Martin Harlov.

      The lipid hypothesis is a medical theory that is now firmly established in the medical community across the globe. There is no controversy about it, it has evolved over decades in the past and the literature has a strong consensus across various kinds of research pillars.

      That is why a claim by “a guy in Germany” while citing a meta analysis from the ’60s that is just part of thousands of studies and evidence accumulated over years and years, is not even relevant. This theory is unrelated to Dr. Greger or Dr. Esselstyn, it has nothing to do with the plant based community and spans across mainstream medical science as reflected in the prescription of statins.

  67. I wonder if you have more research content about reducing LDL in Familial Hypercholesterolaemia patients. I’m 31 diagnosed at 28 after my father of 52 needed two emergency stents. I have reduced with a plantbased diet but my docs still want me to take statins for life, (they don’t believe in diet). I’m desperate for another way but keep getting lost down internet rabbit holes and nutritional info’ overload and overwhelm with no clear path to take. If anyone can point me in the direction of research, current trials or someone experienced with this gene it’d be a lifeline to me.


  68. Our brains are made up of Cholesterol and Fat. The problem with heart disease is sugar consumption. It is basic anatomy and physiology. Our bodies produce cholesterol based on the need for repair. Not sure where you got this old school bad science. ??

  69. Hi, Ashlie Villar! It is precisely because our bodies produce cholesterol that there is not need to consume it. While cholesterol is needed in the body, our livers make plenty. Too much cholesterol definitely has adverse effects. While there have been documented harms from lowering cholesterol too much with medication, no such effects have been found from a lack of cholesterol in the diet. You can find everything on this site related to cholesterol here: I hope that helps!

  70. Can the WFPB diet cause regression of coronary plaque in which calcification has occurred? Or is calcification resistant to regression? Thanks for your reply.

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