Low-Fat or Whole Food?

Low-Fat or Whole Food?
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Which type of plant-based diet has been shown to maximize cholesterol reduction?

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

A plant-based diet is best—but what kind of plant-based diet? A review last year looked at all the randomized controlled trials to date. Using a meat-eating group as the control, it compared people eating like a Mediterranean-style diet that minimizes meat, versus a meat-free diet, versus a meat-, dairy- and egg-free diet.

You can’t really directly compare all the studies, because they were all on slightly different diets, for different durations, studying different populations of people. But in general, people cutting out most meat cut out a quarter of their risk. Those cutting out all meat cut their risk of our #1 killer in half, and those who eliminated dairy and eggs did even better still.

But, there are two popular styles of vegan diets—there are those pushing very low fat versus those that encourage high-fat whole food sources, like nuts. Which one works better?

A whole-foods vegan diet chock full ‘o nuts may wipe out as much as 80% of our risk of falling victim to the #1 killer.

Please consider volunteering to help out on the site.

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.

A plant-based diet is best—but what kind of plant-based diet? A review last year looked at all the randomized controlled trials to date. Using a meat-eating group as the control, it compared people eating like a Mediterranean-style diet that minimizes meat, versus a meat-free diet, versus a meat-, dairy- and egg-free diet.

You can’t really directly compare all the studies, because they were all on slightly different diets, for different durations, studying different populations of people. But in general, people cutting out most meat cut out a quarter of their risk. Those cutting out all meat cut their risk of our #1 killer in half, and those who eliminated dairy and eggs did even better still.

But, there are two popular styles of vegan diets—there are those pushing very low fat versus those that encourage high-fat whole food sources, like nuts. Which one works better?

A whole-foods vegan diet chock full ‘o nuts may wipe out as much as 80% of our risk of falling victim to the #1 killer.

Please consider volunteering to help out on the site.

Doctor's Note

Check out these videos on meat and cardiovascular disease:
Flax Seeds for Hypertension
How to Prevent a Stroke
Why Was Heart Disease Rare in the Mediterranean?
Cholesterol Crystals May Tear Though Our Artery Lining

And check out my other videos on cholesterol

For more context, also see my associated blog posts: Soy milk: shake it up! and Stool Size & Breast Cancer Risk.

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

47 responses to “Low-Fat or Whole Food?

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  1. The citation provided does not appear to match this presentation, and it sounds as if more than one article is cited. Is there a citation for the low-fat vs. whole foods vegan diet?
    Thank you.

    1. You are my savior! Thank you so much for pointing that out. You deserve a prize for finding the first error on the site! In fact if you want to email me your mailing address I’ll send you a copy of my new DVD as a token of my gratitude. I have corrected the citation source (thanks to you!). A group of my interns uploaded the source citations and one of them must have made a mistake. Please help me root out any other errors on the site (and I’ll send you even more free stuff :).

  2. I’m also curious about the low-fat vegan diet vs. the whole food vegan diet that included nuts. How low was the low-fat diet?
    Thank you.

    1. That is such a great question. Too often “low-fat” diets are anything but! In this systematic review, though, some of the diets really did dip down into the 10% of calories from fat range, which is low-fat by pretty much anyone’s standards.

    1. Hi Shaadoe,
      What is “low fat”? Many a confusing conclusions from faulty clinical studies have caused many well-meaning dieters to lose faith in low-fat studies. The American Heart Association says 25-30% fat is low enough, but is it? In comes Dr. T. Colin Campbell’s to the rescue with his immensely important book: “The China Study”. His findings from rural China showed that only when dietary fat was reduced from 24% to 6% was there a clear association seen with lower breast cancer risk. But the reduction must not only be of dietary fat “but more importantly of animal-based food.” Judging from his” plant fat/ breast cancer death” chart, we may become heart-attack and breast-cancer proof with a 10-12% fat vegan diet which includes a handful of nuts/day. Get the book; there’s more goodies!

  3. great questions……looking forward to more discussion. I ate an Esslestyn diet for a couple of years, and never did manage to get my cholesterol under 150. I briefly managed to get under 150 on a Fuhrman diet, but still have not been successful long term. Would REALLY like to know how to be successful with this. Perhaps stress plays a role in keeping cholesterol high? Looking for answers……

    1. Hello working at it,
      If you are eating whole foods plant based and avoiding all animal products and processed foods while focusing on the most nutrient dense of those foods than your cholesterol should drop since your not taking in any outside sources of cholesterol. Cholesterol can only be produced by animals. Also, exercising at least an hour a day and eating ONLY when your hungry will significantly aid in lowering cholesterol levels and stress. http://nutritionfacts.org/videos/halving-heart-attack-risk/ Maybe do some rock climbing at a gym near by? I hate working out with the weights so all I do is rock climb, its great fun and it works your body hard!

    2. We produce cholesterol whether we eat animals or not. Cholesterol that we produce is very important for many functions. Each person produces the amount your body needs. If you are not taking in dietary cholesterol, than you shouldn’t worry about it. There is a reason why your body produces 150 and that’s healthy for you. Statins lower your body’s natural cholesterol, cholesterol that your body needs, recognizes and has a purpose. Perhaps the damage statins do is because the body is now not producing the cholesterol needed for neurological functions, muscle contractions, etc. Cholesterol is not the problem if your body produces it. The cholesterol we take in is the problem.

  4. Thank you, Toxins, for your suggestions on ways to lower cholesterol! Yes, am fanatical about eating only whole unprocessed plant foods. Sometimes too many fruits, and Dr. McDougall says this can raise cholesterol….I do like sweet things (like dates!). Sometimes “stress eating” is an issue, and could always get more exercise. When I was younger I LOVED to rock climb; it’s definitely a good way to focus energy, especially when on the sharp end of the rope.

  5. Do you have any outlines to eating a wholefoods vegan diet? i have been doing the lowfat mcdoughall diet and weight watchers simple filling technie?? Maybe some websites to give me a new durection in weightloss??

      1. I would agree that the McDougall diet is a great way to go. However the devil is always in the details. Two resources that I recommend for those looking to loose weight is Jeff Novick’s DVD, Calorie Density, which can be ordered off his website, http://www.JeffNovick.com. Jeff ties Calorie Density(much more important than calories) to exercise which is very important to understand. By adding more low calorie dense foods like vegetables and some fruits you will have more success at “fat” loss. I would also recommend John McDougall’s newsletter article, The Fat Vegan, it can be found in his December 2008 issue available on his website. Those resources should give you some ideas on how to proceed. Best wishes.

  6. For a clear understanding and how to immplement a plant based diet with good fats check out Dr Fuhrman’s nutritarian diet

  7. Hi Dr. Gregor. I would love for you to address the claims of the “cholesterol myth” crowd and those researchers who say having high cholesterol is healthy. They cite studies such as this: http://www.ncbi.nlm.nih.gov/pubmed/21951982

    Another website I read said here are at least 11 studies showing that high cholesterol is not associate with coronary heart disease, 11 more studies show high cholesterol didn’t predict likelihood of death.

    I think it’s important that you address these research studies, which conflicts with what we are being told as vegans. Thank you!

    1. It is very well established that cholesterol is lined with heart disease. From the national academy of science, “Given the capability of all tissues to synthesize sufficient
      cholesterol for their metabolic and structural needs, there is no
      evidence for a biological requirement for dietary cholesterol.”…”a tolerable upper intake has not been set for cholesterol because any incremental increase in cholesterol increases [cardiovascular disease] risk”

      I highly recommend this video, and very rarely do i ever link to youtube.
      http://www.youtube.com/watch?v=6bSdnQ1MKGo

      As well as some of these nutritionfacts videos.

      http://nutritionfacts.org/index.php?s=cholesterol

  8. Doctors such as John McDougall MD, Caldwell Esselstyn, Dean Ornish, T. Colin Campbell, and Neal D. Barnard all recommend a low fat vegan diet (between 10-12% fat) and also have significant research on that. Can you please address this? I’m now very concerned about which path is most beneficial. Thank you for your help and all that you do!

    1. I have the same question and concerns. Dr G hasn’t been very clear on his stance relating to a low-fat diet. After 2 years eating WFPB, the only way I was able to get my cholesterol under 225 was by cutting out plant sources of saturated fat and getting my total fat down to 10% of calories.

  9. I eat nonfat plain fortified yogurt as a partial means of getting the 1500mg calcium recommended after an osteoporosis diagnosis. I know that Dr. Greger recommends zero dairy, but I just don’t know any other means of getting sufficient calcium. All of the high calcium foods seem to be fortified. Which is the greater problem- nonfat dairy or undertreated osteoporosis?

    1. Dr. Margaret: I’m sorry it took me so long to reply and so sorry to hear about your osteoporosis diagnosis. I’m not a doctor, but I have carefully read a book called, “Building Bone Vitality: A Revolutionary Diet Plan To Prevent Bone Loss and Reverse Osteoporosis” by Dr. Amy Lanou and Michael Castleman.

      It is an excellent book. They reviewed over 1,200 studies and make a compelling case on what type of diet (and exercise!) will help prevent bone loss and possibly reverse osteoporosis. Following their plan is very do-able on a healthy plant based diet. They explain exactly how to do it, including providing some meal plans and a few recipes to give you the idea of how to proceed. This way the osteoporosis is *not* under-treated. It is just treated appropriately.

      Calcium is just one element to consider when dealing with bone health. Throwing massive amounts of calcium at a bone problem without considering 16 other vital bone related nutrients, AND without considering their proportions, AND not addressing the “bone bullies” (substances which take away from bone health – a term I picked up from the excellent reference book for nutrients: Becoming Vegan – Express Edition by RDs Brenda Davis and Vesanto Melina) is not likely to help the bone problem. My understanding is that only upping calcium is very likely to hurt the problem.

      Bottom line is that I *highly* recommend that you read that book. Also, if you want to use fortified foods to get to 1,500mg calcium a day, I recommend using a non-dairy yogurt. You would have to read the labels, but those non-dairy yogurts typically have just as much calcium as the dairy counter-parts – and if you get the right brand, are just as tasty. (The book explains why non-diary is better than dairy – better than I could.) Best of luck to you.

  10. Hi, I’d just like to mention that Dr Campbell in his latest Whole addresses these questions, quote: “relax”. As long as you eat whole, vegan foods, you’ll be all right. It helps me to relax, I was actually getting paranoid about eating a couple of nuts and fat content in edamame…

  11. I am a massive fan of Nutritionfacts.org, and Dr. Greger. I cannnot say enough good things about the quality of information provided at this site. THANK YOU!!!. One question though- I don’t understand the conclusions of this video. I realize that at this point this is now an older video, but even by 2010 Dr. Esselstyn had published his first clinical study. Since then his 2014 study showed amazing results arresting and even reversing heart disease with a low fat, whole food, ‘no nuts’ diet. Esselstyn is staunchly anti-nuts and yet has the most impressive clinical studies on heart disease management (and reversal) published. It seems to me that Esselstyn’s results are even more impressive than Ornish’s, and Ornish has done a lot for heart disease reversal and awareness. Esselstyn has achieved these amazing cardiac results by looking at all dietary fats, even those from whole food sources.

    1. Everyone has their own take on the research and the doctors you mention are paving the way for heart disease prevention! ​They are doing amazing, life-saving work. Still, the research on nuts seems to be positive. Here is a great video by Dr. Greger that explains the research between nut intake and body weight. Make sure to checkout the bottom of the video’s “Doctors Note” to see more links and info. Lastly, a follow-up to that video is solving the mystery of the missing calories, which may also help.​

  12. So a balanced diet of whole “real” foods wins, 80/10/10 is so stupid IMO. Nuts and seeds are fantastic, especially flax and chia and almonds.

  13. I would like to know what % of fat is ok. I am always like 15%, some days a bit less, some days a bit more. I don’t eat nuts everyday because of their price so I wonder if I should add more seeds the days I don’t have nuts. Is 15% (35g) of 2000 calories ok?

  14. I wish, but no. Dr. Ornish and Esselstyn have only shown reversal of atherosclerosis with a very low fat diet. In the case of this video, the apparent increase in risk with the low fat vegan group is likely due to increased ingestion of process carbs. Keep in mind that a low fat vegan diet could include nothing but coke, pepsi and wonder bread with strawberry jam; all foods with no fat, but massive amounts of processed sugar that wreck havoc with your lipids and would clog the arteries of a large segment of the population. Don’t forget that processed fructose is transformed into fat by your liver that increases the risk for metabolic syndrome and diabetes that then increase the risk for heart disease.

    Dr. Ben

  15. I would love to know how to keep fat so low on this diet. My usual breakfast is
    1/2 cup blueberries
    1/2 cup raspberries
    1/2 cup oats
    1/4 cup soy milk
    4 grams Walnuts
    1 1/2 tbsp flaxseed meal
    1 tsp psyllium
    This gives me 51% carbs,
    33% fat and 25% protein.
    At a maintenance level of 1850 calories a day, I cant get it below 15% fat even if I eat only fruit and veg for the trst of the day.
    Please help.
    PS. After a couple of months without meat, dairy, eggs, blood pressure has dropped from 135 to 115.

  16. Hello John, and thank you for your question,
    I am a family doctor with a private practice in lifestyle medicine, and also a Health Support Volunteer for this website. First of all, congratulations on your plant based diet, which has already done great things for your blood pressure.

    Secondly, if you really want to be on a very-low-fat diet, there are certainly cookbooks out there to help you achieve that: see Dr. Joel Fuhrman’s Eat To Live cookbooks, and Rip Esselstyn’s Engine 2 cookbooks.

    However, not everyone needs to be on a very low fat diet. If you have known coronary artery disease (CAD), or if you have multiple risk factors for CAD, then you want a diet proven to lead to reversal of CAD, which is a plant-based very low fat diet. Dr. Caldwell Esselstyn encourages his patients (who almost all have significant CAD) to eat virtually zero refined oil of any kind, and even to eat only small amounts of nuts and seeds.

    Dr. G has done a video about how even extra virgin olive oil can impair artery function: https://nutritionfacts.org/video/olive-oil-and-artery-function/.

    But there are some fats which are healthy and indeed essential: “essential fatty acids”. Without these, humans develop various deficiency symptoms. Dr. G. has done various videos over the years looking at this issue:
    1) https://nutritionfacts.org/video/extra-virgin-olive-oil/ — old (2007), but discusses good vs. bad fat
    2) https://nutritionfacts.org/video/forego-fat-free-dressings/ — about role of fat in absorbing nutrients
    3) https://nutritionfacts.org/video/should-we-take-dha-supplements-to-boost-brain-function/ — nice summary about essential fats
    4) https://nutritionfacts.org/video/should-vegans-take-dha-to-preserve-brain-function/ — shows how DHA and EPA are essential for long-term preservation of brain function.

    My wife has very low cholesterol, and she has found that her skin definitely is healthier (not so dry) if she eats some plant oils — either as nuts and seeds, or else small amounts of flaxseed, canola and olive oils.

    You don’t mention whether or not you have CAD or high cholesterol or diabetes or hypertension or strong family history of CAD, so it’s difficult to know how to advise you. But your current diet might be just fine for you.

    I hope this helps.
    Dr. Jon
    PhysicianAssistedWellness.com
    Health Support Volunteer for NutritionFacts.org

    1. Thank you for your response, it is much appreciated, I will certainly check out all the links. I do not have CAD, or any other diagnosed medical problems, I am 172cm, weigh around 145 lbs, 69 years old and on no medications and active. My cholesterol and blood pressure were slowly starting to rise and I wanted to bring them both down without drugs, and that is how I came across the plant based diet. I had alteady been slowly reducing meat, but have now been meat, dairy and egg free for some time and eat almost no refined food. I exercise almost every day and enjoy long bush walks here in Australia as often as I can and I would like to remain active and mobile, my aim is to remain that way for as long as I can.
      Thanks again for all the help I have received from this site.
      Regards
      John

    2. Thanks for your detailed response. Dr G hasn’t been very clear on his stance about low-fat diets. Even the video didn’t include what percent of calories came from fat in the low fat or whole food diets.

      I’ve had high cholesterol since my early 30s and a family history of heart disease. After eating wfpb for two years, my total cholesterol was still at 225. So I tried Dr Esselstyns low fat diet for one month and my cholesterol dropped to 188. That’s the first time it’s been under 200 since I was on a statin and then it only got down to 196.

      I wish Dr G would take a more firm stance on how much fat is ok, especially for people like me with high cholesterol and a strong family history of heart disease.

  17. Hi,

    is there any difference in the benefits of nuts compare to nut butter?
    of course the nut butters have to be made wholly from nuts.

    Thank you,
    Arif

  18. Hi, ARIF. That depends on the nut butter. If it is made by simply grinding nuts, without adding anything, then the benefits should be about the same, although grinding anything makes it more readily digestible than eating it whole. If food is chewed well, it is being ground in the mouth anyway. Adding oils, sugar, salt, or other substances to nut butter will affect the nutritional value. Assuming, as you say, that the nut butter is made wholly of nuts, it should not be different from eating the nuts themselves. I hope that helps!

  19. I wish it was made more clear what’s being compared here. I see that low fat vegan diet is being compared against a whole vegan diet. However, does anyone know if the low fat vegan diet was just whole or processed low fat vegan foods? Maybe both?

    It’s only a fair comparison when whole low fat vegan diets is compared against whole high fat vegan diets.

  20. You make very good points. This was a meta-analysis of studies using a variety of different methods and diets. You can’t compare the studies precisely, as Dr G points out. The common finding among all the reviewed studies in this analysis was that there was a comparison of plant-based diets of varied types to those including animal products. All variations of plant-based diets had association with or led to significantly lowered cholesterol levels compared to animal-product-containing diets. There wasn’t a direct comparison of low fat versus high fat vegan diets. The Portfolio Diet (used in several of the analyzed studies) advises plant based foods then includes plant sterols (specific plant fats) and nuts, and is associated with a substantial decrease in cholesterol levels. None of the diets analyzed encouraged vegan junk food, but all foods were not supplied, so it would be very hard to know.

    It would be great to have a trial comparing a “junk food vegan” diet to a whole food, plant based diet for a month, then cross the people over to the other group for another months then assess their cholesterol levels.

    Dr Anderson, Health Support Volunteer

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