Optimal Cholesterol Level

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

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

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

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

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

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

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

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

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

Please consider volunteering to help out on the site.

Images thanks to ToM and itsokstay_calm via Flickr.

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

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

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

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

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

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

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

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

Please consider volunteering to help out on the site.

Images thanks to ToM and itsokstay_calm via Flickr.

Doctor's Note

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

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

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

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

517 responses to “Optimal Cholesterol Level

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  1. Interestingly, in my experience, I have had a couple of patients that have had very low cholesterol levels with one having a stroke and another having multiple MI’s. They both, however, ate the SAD way. I will find one of the files I have on the carotid Ultrasound of the gentleman with the stroke and post his cholesterol levels in a follow up. I think I remember his Total cholesterol at 125 or something like that. Stay tuned. . .
    Point being in my experience it doesn’t matter what your cholesterol levels are, if you eat the SAD way you increase your risk tremendously of cardiac and vascular disease.
    Nice work Dr. G and crew!




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      1. Mac, HIPAA is violated only when patient IDENTITY is given. Otherwise the simple medical facts could be applied to anyone and, hence, anonymous.




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    1. Possible high burden of Lp(a)?? I have a gentleman with pristine lipids, 6 time ironman, ultrarunner etc.. Who is just ate up with CAD. CAC score was over 2500. His Lp(a) levels both Lp(a) mass and Lp(a) are sky high. Infact most of his LDL is Lp(a).




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      1. High carb load will drive Lp(a) and Insulin Response problems, which cause atherosclerosis problems. High endurance exercise program e.g., marathon is a driver of inflammation and is particularly troubling for the cardiovascular system with lactic acid buildup. LCHF and eliminating grain oils, among other things help.




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        1. Wrong. All long-lived healthy populations, such as the Okinawans, ate a high carb, low fat diet. Whole, plant-based carbs, like rice, beans, potatoes, and corn, are the key to health and longevity, as well as low cholesterol.




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    2. SAD diet definitely increases your risk of developing vascular diseases, yes. One of the main reasons is due to increased cholesterol. What were the serial measurements of your patients’ cholesterol over his life-time? That is very important. His most recent tc of 125 is not of much consequence, but rather the totality of cholesterol his arteries have been exposed to since childhood (in addition to hyperglycemia, htn, etc).

      This is a nice article talking about the causal exposure model: http://www.ncbi.nlm.nih.gov/pubmed/22187965




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      1. The SAD diet is a disaster but saturated fat and protein is not the problem. The biggest problem is the high carb load of the average American and the resultant epidemic of inflammation, insulin resistance and diabetes. Some other factors are the quantity of food, factory foods i.e., edible product, with high levels of Omega 6, particularly grain oils and low levels of Omega 3s, both of which are essential for life but the proportions are all wrong. Look into the low carb high fat i.e., Paleo lifestyle for solutions. https://www.youtube.com/watch?v=fuj6nxCDBZ0




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            1. It may be your recommendation, but it’s still a fad diet. I’ve eaten a whole foods, plant-based diet for over two years, and I’m doing quite well. Plenty of whole grains (gasp!), beans (gasp!), fruits, vegetables, and the occasional nuts and seeds (gasp!).

              I’m still waiting for my Wheat Belly and my Grain Brain. Instead, I’ve lost 60 pounds, and I haven’t felt this good since I was a teenager. I won’t be changing my eating habits anytime soon. If only we could meet again in ten years. It would interest me to see if you’re still eating the “Paleo” way.




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              1. Well, I’ve never been overweight but if you were overweight by 60lbs, no doubt whatever you are doing now is better than what you were doing. I’ve had three heart attacks and a couple bypass surgeries (family history), the first twenty one years ago. All before “LCHF” and reading Gary Taubes’, Why We Get Fat … book. I can tell you that carbs, particularly grains (gasp) drive insulin, will reduce HDL and change lipid size to the more dangerous small LDL and increase LPa.. Saturated animal fats drive the HDL numbers up as well as TC but lipids will be changed to larger “safer” size. I have the blood test results to prove it. Of course you can’t draw conclusions from one sample but it dovetails with evidence I’ve seen in researching this for twenty years. You’d be better off listening to the wisdom of the crowds than the medical establishment. I’m just some guy looking for a solution and I put my money where my mouth is. I had two slices of bacon, two brats, eight oz. cottage cheese, two free range eggs over easy and washed it down with a glass of whole raw milk this morning. I’m 60 years old, 6’1″ and 174lbs., same as when I was eighteen, have six pack abs and feel better than I have in years. I’ve been seriously LCHF for four years and I’d love to get together in ten years. Good luck to you. https://www.youtube.com/watch?v=E57cFhjpxgw&feature=youtu.be




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                1. I have much to say in response to your post, but I don’t have the time right now.

                  However, I will say that dairy products are excluded from the Paleo Diet, but you said you drank a glass of whole milk this morning. Your diet seems more like a “high saturated fat diet” than a “Paleo Diet.”




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                  1. Thanks for the effort, I’ve seen Dr. Greger and don’t agree. I’ve had blood tests and a vegetarian diet drives my already low HDL numbers into the ground and does not lower LDL. Inflammation e.g., tendonitis, prostatitis, back pain and other ailments have all disappeared with the elimination of grain oils and limiting sugar and bread. I hope you read the attachment, It’s pretty much what I believe. Good luck with your health, keep an open mind and I hope you find the key. http://www.biznews.com/low-carb-healthy-fat-science/2015/02/27/can-you-cure-type-2-diabetes-with-diet-dr-jay-wortman-proves-you-can/




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                    1. It’s not just about a “vegetarian diet.” Oreos, soda, and plenty of processed foods are vegetarian. Whole food, 100% plant-based, and no oil is the way to go for optimal health, heart-wise and otherwise.




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                  2. “If insulin was so universally awful, why do you think the body would produce it at all?” Well we could say the same about cholesterol. If it is so universally awful, why would Mother Nature/GOD/Evolution (take your pick) create a body whereby the liver creates cholesterol and the intestines are programmed to reabsorb it. All of ones steroid hormones have the cholesterol molecule as their backbone. This, of course, does not mean, in my book, that one eat no fruit and veggies, and instead eat globs of bacon, butter, sausages and the like. As always balance is the key, and I see no balance in the pharmaceutical rush to get everyone’s LDL down to 70 or below. That view certainly sells Statin drugs however!




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                    1. Hi Linda. Yes, of course both cholesterol and insulin are required components for a functioning human body. But, that doesn’t mean we should be consuming cholesterol, and that doesn’t mean we should have high levels of cholesterol in our blood. The research seems to indicate that having lower blood cholesterol means less CVD. In one of the big studies, nobody who had a total cholesterol under 150 had a single heart event.

                      I’ve been eating 100% whole foods, plant-based for 2 years now, and I just recently got my cholesterol levels tested:

                      Total cholesterol: 91
                      LDL: 44
                      HDL: 32
                      Triglycerides: 75

                      I’m pretty satisfied with my results here, and they were accomplished without any medications whatsoever.




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                    2. Well I am very happy to hear that you are satisfied with your cholesterol levels being that low, and you have to do what is right for you and what you believe in. As for me I would NEVER allow my cholesterol levels to get that low. Knowing what I know about the importance of cholesterol to bodily and brain functions, having a cholesterol level that low would scare the living hell out of me and cause me to take serious immediate remedial action. Of course I would never seek to get my cholesterol that low in the first place. But again, you have to do what you believe is right, and I truly wish you well with your choice.




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                    3. If you could point me to any science that indicates that low cholesterol is bad for you, I would appreciate that. I’m aware that people with familial hypocholesterolemia (extremely low cholesterol), actually have longer lifespans and much lower incidence of CVD than “normal” people. That’s pretty good evidence that low cholesterol is better.

                      The human body knows how to make all the cholesterol it needs. It doesn’t require us to eat cholesterol and saturated fat to artificially increase our blood cholesterol levels. I’m not losing any sleep over my brain function. IMO, worrying about low cholesterol levels is a classic case of looking for problems where there aren’t any.




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                    4. Eating cholesterol doesn’t raise your blood cholesterol. Even the US government has finally acknowledged that fact in the current guidelines. Eggs are allowed again.




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                    5. False. Eating eggs increases serum cholesterol. Eating saturated fat increases your cholesterol. Saturated fat is found virtually everywhere cholesterol is found in nature. The US government did not “acknowledge” that cholesterol doesn’t increase serum cholesterol. Nobody ever said that eggs are “allowed” again, whatever that means. This is just propaganda from the Cholesterol Confusionists.




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                    6. twitchyfirefly: To expand on what Ed said: “…when it came to the final/actual guidelines that
                      got released (as opposed to the preliminary floater ideas), the FDA …strengthened their warning about cholesterol.” See below for the full explanation.
                      .
                      ***************************
                      I recommend you take a look at the following article which explains how the FDA got to their initial conclusion (which later got reversed): http://blogs.bmj.com/bmj/2015/04/28/neal-d-barnard-and-angela-eakin-yes-cholesterol-matters/. Very important details. As they say, the devil is in the details.
                      .
                      And, as it turns out, when it came to the final/actual guidelines that got released (as opposed to the preliminary floater ideas), the FDA did the very opposite of removing cholesterol limits form its dietary guidelines. The FDA got forced to actually acknowledge the science. In the end, the FDA strengthened their warning about cholesterol. You can read about it here: http://www.pcrm.org/USDA And here is a quote:
                      .
                      The Guidelines state: “As recommended by the IOM, individuals should eat as little dietary cholesterol as possible … Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity. … Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry.”
                      .
                      Sometimes the truth really does win. The problem is that many websites and the media didn’t bother to report what actually happened. If I were you, I’d be darn mad that the sources I rely on for valid nutrition information did not inform me of this situation. Perhaps it is time to get some reliable sources of information. ;-)




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                    7. THEA: But that´s from 2015. Now there came up something new… from 2017.

                      Thea says:
                      FEBRUARY 1ST, 2017 AT 12:12 PM
                      twitchyfirefly: To expand on what Ed said: “…when it came to the final/actual guidelines that
                      got released (as opposed to the preliminary floater ideas), the FDA …strengthened their warning about cholesterol.” See below for the full explanation.
                      .
                      ***************************
                      I recommend you take a look at the following article which explains how the FDA got to their initial conclusion (which later got reversed): http://blogs.bmj.com/bmj/2015/04/28/neal-d-barnard-and-angela-eakin-yes-cholesterol-matters/. Very important details. As they say, the devil is in the details.
                      .
                      And, as it turns out, when it came to the final/actual guidelines that got released (as opposed to the preliminary floater ideas), the FDA did the very opposite of removing cholesterol limits form its dietary guidelines. The FDA got forced to actually acknowledge the science. In the end, the FDA strengthened their warning about cholesterol. You can read about it here: http://www.pcrm.org/USDA And here is a quote:
                      .
                      The Guidelines state: “As recommended by the IOM, individuals should eat as little dietary cholesterol as possible … Strong evidence from mostly prospective cohort studies but also randomized controlled trials has shown that eating patterns that include lower intake of dietary cholesterol are associated with reduced risk of CVD, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity. … Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry.”
                      .
                      Sometimes the truth really does win. The problem is that many websites and the media didn’t bother to report what actually happened. If I were you, I’d be darn mad that the sources I rely on for valid nutrition information did not inform me of this situation. Perhaps it is time to get some reliable sources of information. ;-)




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                2. I had a heart attack at 49. 9 years later eating Whole Food Plant Based, no oil. I am off of all medications even a daily aspirin. I weigh what I did in high school. I ran my first half marathon in January. My total cholesterol is 109. It works for me no reason to change. Besides the overwhelming research supports a WFPB diet. It is the only diet that has been proven to reverse the chronic diseases that Americans suffer from.




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                    1. What recommendations can you give to someone who has high cholesterol (213), with hereditary factors from both parents (who were both on cholesterol medication)?
                      I am not overweight and have no other risk factors. My primary doctor is pushing to put me on medication, which I do not want to do.
                      I have started the whole foods plant based diet about 6 mos ago.




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        1. I’m guessing you haven’t seen the Dr. G’s vids on “Paleo”. Regardless of whether one diet is healthier than the other. Meat diets are the least sustainable and most environmentally destructive. Why not just choose the diet that is healthiest for ourselves, our planet and the animals. A triple win yes?




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          1. All I can see between my house in Ohio and the Colorado Rockies are corn and soybean deserts, not much habitat for wildlife. Personally, I don’t think grain or grain oils are fit for human consumption. The Global warming scam is a huge grab for trillions in taxes and subsidies and will barely put a dent in CO2 or any warming trends we may see in the future. You do know that global temperatures haven’t risen in like eighteen years and that records going back 600 million years show that current CO2 levels are as low now, as any over that period of time. In fact they have been higher by a factor of twelve or fifteen. If you really want to help the wildlife and the environment, all those corn deserts need to be converted to pastures and hay fields with a diversity of grass fed animals. At least you can find wildlife in a hayfield. Try that in a GMO corn field. Please pay particular attention to Dr. Mercola’s article and read about Dr. Joseph Kraft’s research on insulin resistance, he’s done the foundational work on IR and wrote a book titled Diabetes and You, very powerful. http://www.geocraft.com/WVFossils/Carboniferous_climate.html http://www.energytomorrow.org/blog/2015/january/ethanol-and-consequence-honeybee edition http://articles.mercola.com/sites/articles/archive/2001/07/14/insulin-part-one.aspx?ShowAllComments=True&FocusOn=39257




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            1. Who do you think eats most of that corn and soy? Farmed animals.

              I agree with you about grain oils (or any type of oil). But grains? Ridiculous! Grains and legumes are the basis of the diets of the longest-lived, healthiest communities on Earth (the “Blue Zones”), where little or no meat is consumed.




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      1. It’s the standard American diet, which contains a typical amount, by American standards, of meat, dairy, and processed foods, and fewer servings than optimal of fruits, vegetables, legumes, and whole grains.




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        1. Thanks for replying! I work full time, two teenage boys in sports and a wife that also works full time and goes to school part time, so it is hard for me to always get back to my comments. I appreciate your help!




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    3. Could just be a rare statistical outlier. Or, it could be that the reading of 125 is not representative of their typical cholesterol, or that they experience large fluctuations. Also worth considering is the possibility of undetected cancer or some other such disease known to have cholesterol lowering effects.




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      1. I’ll try to find that study today and post it. The number for T Chol was their typical cholesterol number. But in my experience he is a statistical outlier. I like your thinking about the possibility of cancer. I will never know that answer because I don’t see him as a patient anymore but great thought.




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        1. You mention total cholesterol was typical for that patient, but how was the HDL/LDL ratio? A patient could have a low total cholesterol while still having a high LDL and really low HDL, which would be problematic. Obviously, you know this, I’m just clarifying my train of thought.




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          1. To your point look at the image I posted above. Pt’s HDL/LDL ratio was very low 1.8.
            Crazy stuff.
            I appreciate your input and thoughts!




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      2. Synergy, below is the follow up Carotid Duplex scan (Ultrasound) of the carotid arteries. The Red arrow on the left of the image shows the Right Carotid artery where a plaque ruptured and was the most likely cause of this patients stroke. On the right is the patients cholesterol level and it is very low: Total Cholesterol of 129 and LDL of 75. Remember goal of T. Chol: <150 and LDL: < 70.

        Interestingly as Synergy mentioned above maybe the low cholesterol was because of cancer. As you can see on the image of the Carotid scan he had a history of Throat cancer but it was removed and "in remission" as far as we knew at the time. And you can also see he stopped smoking at age 16 and pt was then 65.

        Again my point is eating the SAD diet definitely increases ones risk for SAD outcomes.

        Stay healthy my friends!
        *
        *




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          1. Patient was not on statins or any other cholesterol lowering drug. His cholesterol levels were his everyday cholesterol levels.




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    4. LDL cholesterol provides the building blocks and endothelial inflammation the wrecking ball in cardiovascular disease. The standard American diet contributes to both, and its a lot safer to stand next to even tall walls when there’s no demolition crew.




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        1. My understanding is that other stimulants of innate immune response (endotoxins, saturated fats, Neu5gc etc.) initiate endothelial inflammation and migration of monocytes into the vascular wall, which differentiate into macrophages releasing free radicals and inflammatory cytokines, and foam cells sucking up LDL and becoming plaques. Most of the oxidation of LDL is catalyzed by the macrophage free radicals, but from there OxLDL further contributes to differentiation into foam cells. Its considerably more complicated, but overall not a purely linear progression: some products later in the disease mechanism provide positive feedback to earlier steps, and is a canonical example of the pathological cycles of inappropriate innate immune response we’ve discussed elsewhere.




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            1. What I meant here is that oxidized LDL is an important part of the inflammatory feedback loops that turn our local cops on patrol (monocytes) into the foam cells that gobble passing cholesterol and become atherosclerotic plaques. However, I haven’t seen evidence that oxidized LDL is the only cause or even the primary one for these transformations. Endothelial inflammation from a variety of causes initiates the disease process, but high LDL perpetuates it.




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      1. Ischemic stroke from a ruptured plaque. See posted image above showing the Carotid duplex scan of the pt’s carotids. Check out his cholesterol as well.




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    5. Below is the follow up Carotid Duplex scan (Ultrasound) of the carotid arteries. The Red arrow on the left of the image shows the Right Carotid artery where a plaque ruptured and was the most likely cause of this patients stroke. On the right is the patients cholesterol level and it is very low: Total Cholesterol of 129 and LDL of 75. Remember goal of T. Chol: <150 and LDL: < 70.
      Interestingly as Synergy mentioned below maybe low cholesterol because of cancer. As you can see on the image of the Carotid scan he had a history of Throat cancer but it was removed and "in remission" as far as we knew at the time. And you can also see he stopped smoking at age 16 and pt is now 65.
      Again my point is eating the SAD diet definitely increases ones risk for SAD outcomes.
      Stay healthy my friends!




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        1. This is a very good point to raise, thank you. I also noticed in the video above, the vegan average was just under 70 for LDL, but the deviation was almost 30 points. I’m not sure if that is the range, or a standard deviation – my research skills are rusty. Even so, that means a significant number of vegans have LDL that is too high. I wonder what the factors are – probably too much refined fat, but perhaps sugar also plays a role.




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          1. A great way to improve your HDL/LDL ratio is exercise, and I suspect most vegans (and everyone else) are sedentary. After going 100% WFPB I added regular exercise to shift that ratio.




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    6. Very interesting. I wonder (a) how the gentleman’s cholesterol was so low on the SAD diet, and (b) why his low cholesterol levels were not cardioprotective.




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      1. We now know that if you eat the SAD diet that your HDL is dysfunctional. I learned that from Dr. Caldwell Esselstyn. Dr. Greger may have a video on that as well. It was very interesting to learn that it’s not the cholesterol level that seems to matter. IT’S THE DIET! (I’m not yelling just placing extreme emphasis on ‘It’s the FOOD.”)




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      1. If this is the case, (and I suspect you are right) I would like to know the mechanism of action. Just quite curious about this. What are the phytonutrients (or other plant nutrients) doing to the blood vessels exactly?




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      1. I am a layperson, I would think so. I think you have asked in the right place, but nobody has answered you with the research to back it up. Pretty sure a plant-based diet helps everyone who has hypercholesterolemia, whether familial or not.




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    7. Was the gentleman’s stroke hemorrhagic? If so, he could have been taking aspirin or had a dietary salicylate buildup in his system, which increases the fragility of blood vessels in the brain…




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          1. I did a long time ago. Check through the comment section here and you will see my post with the picture attached. That was back when we allowed image uploads




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    8. So what is clogging the artery if cholesterol levels are low? What is causing the high blood pressure? My father has high blood pressure and low cholesterol.




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    9. We must recall that 50% of atherosclerosis is triggered by inflammation which could even include chronic gum disease. Before medical school, I drew blood and worked in the Lab to pay for school. I was surprised to see some very healthy looking people in the Coronary Care Unit, until I learned later about the role of inflammation. Brushing your teeth, and eating anti inflammatory foods, such as turmeric and ginger, and avoiding pro-inflammatory foods such as meat reduces heart disease risk and generalized atherosclerosis.




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    10. I have lower my total cholesterol to 145 , LDL 88 , TG 136 but my HDL is too low at 30. I exercise more than 90 minutes 6-7 days a week, no alcohol, no smoking and i am only 75kg very trim 1.80 tall, i have tried everything but it will not go up, should i worry about it or it is ok to be low? I have only been on “plant based diet” for 60 days and here is my results:

      Before and after

      Total: 228 now 145
      HDL: 44 now 30
      LDL: 153 now 88
      TG: 156 now 136




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      1. George: I’m no expert, but your numbers look like they are going in the right direction. Below is some information I share with people who are concerned about their HDL. I hope this helps.

        ********************
        I am not an expert on the topic of HDL, but some of my favorite NutritionFacts forum members and some experts have had a thing or two to say on the matter. BOTTOM LINE: I synthesize the information below to mean we do not need to worry about HDL levels or HDL falling in the context of a whole plant food based diet, when LDL goes down or is already at a healthy level.
        .
        In other words, if you have high/unsafe cholesterol levels (total and LDL) overall, then also having high HDL can be protective (especially if you got that high HDL through exercise or some other healthy behavior rather than diet). But in the face of healthy LDL levels, the HDL level doesn’t seem to matter. I may be wrong about this, but see what you think.
        ************************************
        .
        First, check out the following article from heart health expert Dean Ornish. He does a great job of explaining the role of HDL and when we need to worry about it’s levels vs when we do not. http://www.huffingtonpost.com/dr-dean-ornish/cholesterol-the-good-the-_b_870655.html “A low HDL in the context of a healthy low-fat diet has a very different prognostic significance than a low HDL in someone eating a high-fat, high-cholesterol diet.”
        .
        Two of our more knowledgable forum particpants, Gatherer and Darryl, have put together for us some of the strongest evidence–a list of good studies. Gatherer wrote (from comment http://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/#comment-3098014284 ) :
        .
        “”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” https://www.statnews.com/2016/10/31/hdl-cholesterol/
        that provides an overview of the study
        “High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions”
        http://www.onlinejacc.org/content/68/19/2073 LDL and non-HDL cholesterol appear to be better indicators of health status than HDL.”
        .
        Darryl wrote (from comment: http://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/#comment-3098365137 )
        .
        “Meta-analysis of 108 randomized controlled trials effecting HDL levels (statins, fibrates, resins, niacin, n-3 fats, ACAT inhibitors, ABCA1 inthibitors, CETP inhibitors, PPAR activators, diets, bariatric surgery): No effect. (http://www.bmj.com/content/338/bmj.b92.full ) Subsequent AIM-HIGH niacin trial No effect. (http://www.nejm.org/doi/full/10.1056/NEJMoa1107579#t=abstract ) ABCA1 gene loss of function No effect (http://archneur.jamanetwork.com/article.aspx?articleid=182020 ), LCAT gene single nucleotide polymorphisms (SNPs) lowering HDL: No effect. (http://press.endocrine.org/doi/full/10.1210/jc.2011-1846 ), composite HDL effect from 20 SNPs No effect (http://www.sciencedirect.com/science/article/pii/S0140673612603122 ), 19 SNPs affecting HDL from a genome wide association study (which don’t simultaneously affect LDL) No effect. (http://eprints.gla.ac.uk/91036/1/91036.pdf )
        .
        … One reason that HDL appeared protective in epidemiology may be that a number of lifestyle factors (like exercise, or moderate alcohol intake) both increase HDL and reduce cardiovascular risk by independent mechanisms. Or perhaps only a subfraction of HDL is active, one which isn’t increased by either clinical interventions or genetic variants affecting aggregate HDL levels. It seems likely that that most dietary interventions that increase HDL would not offer the benefits calculated from a reduced LDL/HDL ratio, particularly when they also increase LDL.”
        .
        .
        WHICH MATTERS MORE, LOW LDL OR HIGH HDL?
        Moderator Rami found some great information for us. Here is what he shared with us some time ago:
        “Low LDL matters far more than raised HDL. 108 randomized trials involving nearly 300k participants at risk of cardiovascular events. HDL levels found to play no significant role in determine risk. Primary goal remains to lower LDL.
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645847/
        Genetic studies of high HDL, high LDL, and low LDL. High genetically raised HDL not protective, while high LDL is damaging. Low LDL is protective
        http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960312-2/fulltext
        http://www.ncbi.nlm.nih.gov/books/NBK174884/
        http://www.sciencedirect.com/science/article/pii/S0735109712047730
        http://www.nejm.org/doi/full/10.1056/NEJMoa054013#t=articleTop
        In this animal model study, atherosclerotic lesion growth regressed in a low LDL environment, but did not with high HDL.
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098380/
        Quote from the comment: http://nutritionfacts.org/2016/03/22/the-effects-of-dietary-cholesterol-on-blood-cholesterol/#comment-2630127562
        .
        .
        WHAT ABOUT TRYING TO INCREASE HDL?
        There are healthy ways to increase HDL (such as through exercise) and unhealthy ways to increase HDL (such as through eating saturated fat–see explanation from Ornish above). Exercise is a great idea for a bazillion reasons and may be helpful in a heart protective way if someone is having trouble getting to healthy cholesterol levels. However, in general, increasing HDL does not “…reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths.”
        .
        .
        WHAT ABOUT FALLING HDL?
        When some people switch to a WFPB diet, both their LDL and their HDL goes down. Do people need to worry about HDL going down? I thought that Dominic (a participant on this site) had a really great post on this topic. Here’s a quote I find compelling: “In populations where CAD is just about nonexistent, people have both low LDL and HDL levels. These populations follow diets that are higher in whole plant foods and lower in fat and saturated fat than the typical western diet. Studies have shown that it does not appear that low HDL levels provide any vascular risk in individuals who attain very low concentrations of LDL – through diet alone or on extensive statin therapy.3,4.” To see the full post: http://nutritionfacts.org/video/paleo-diets-may-negate-benefits-of-exercise/#comment-1849535796 This post also includes a guideline (not sure where it came from) on how to better judge your cholesterol numbers rather than worrying about HDL levels by themselves.
        .
        Dr. McDougall also has an article on the topic in one of his older newsletter articles: https://www.drmcdougall.com/misc/2003nl/sep/030900pugoodcholesterolworsens.htm The article includes these quotes:
        .
        “Worldwide (comparing people who eat different diets) those who have the lowest HDL levels (like people in rural Japan, China, and Africa) have the lowest rate of heart disease…”
        and
        “HDL cholesterol is a risk factor – not a disease. No one dies of low HDL – they die of rotten arteries.”
        and
        “When you adopt the McDougall Program, you will watch your total cholesterol fall dramatically. As it does, both LDL and HDL levels will drop, as well. And as they do, so too will your risk of heart disease. And your health will improve dramatically. Unfortunately, because HDL doesn’t go up with a healthy diet some unenlightened physicians – acting like puppets for the pharmaceutical industry – give their patients a totally undeserved hard time.”
        .
        I hope this information is helpful in allowing you to judge your own situation.




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        1. Thea

          Thank you so much for your reply, it helps a lot, I will stick to the healthy lifestyle and see how the results will be in the near future Thank you so much for your time




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  2. Dr. G, I attended two Engine2 conferences last year, one at which you spoke. I have been following Dr. Essylsten’s diet and one thing that I believe that is not stressed enough is to not eat any sugar. I just got my cholesterol checked and it jumped to 250, and this is while eating only plants, no added oil, no nuts, no avocado. But I have been putting a lot of sugar in my tea. So now I have jettisoned the sugar, and will get retested in two to three months. I am really scared, as before my first Engine2 conference a year ago, my doctor found via a Calcium CT scan I have atheresclerosis.




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      1. What’s so weird is that my cholesterol went down 100 points when I first started the diet to 228. I gave up the nuts and avocado and was really excited to get my blood results and am so discouraged (just got the new results a few days ago) that due to my genes maybe I need statins. But I read something by Dr. Essylsten recently about how sugar also needs to be jettisoned (something I’ve been ignoring) so I have stopped it. I am also now trying to eat at least one head of kale a day. My bad cholesterol this go round jumped SIGNIFICANTLY and is up to 198!! I am really scared.




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        1. In my experience and in Dr. McDougalls and Dr. Neal Barnards, in people who eat a whole food, plant based diet very low in fat (and take B12) just don’t have Heart Attacks. I have people with Total cholesterols in the 250’s and LDLs of 150 (familial hypercholesterolemia)




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          1. Thank you, HemoDynamic, M.D! That makes me feel better. My internist found that my thyroid level was low (I had skipped a few doses of my synthroid) and he thought that also had something to do with the spike in my cholesterol. I want to be heart attack proof: My dad had his first at 56 and died of a massive one at 72, my mom survived hers, my dad’s sister dropped dead of a massive one at 60.




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            1. I agree with HemoDynamic MD that stabilizing arterial disease is more about diet with some help from regular exercise and of course not smoking. We don’t have studies on persons who eat a whole food plant based diet and still have “elevated” cholesterols by today’s recommendations. In my clinical experience elevation of cholesterol can be partly due to fruit and sugar in some individuals. Remember sugar is one glucose molecule and one fructose molecule. The latter is metabolized primarily by the liver see.. http://nutritionfacts.org/video/how-much-added-sugar-is-too-much/ and http://nutritionfacts.org/video/if-fructose-is-bad-what-about-fruit/. Thyroid is another factor as your doctor pointed out. I’m not sure it is possible to be “heart attack” proof but the data is clear you can certainly lower your risk to a very small number through proper lifestyle interventions.




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              1. Dr. Forrester. In browsing your website I came across Lupus. I’ve been a bit under the weather past week and in this weakened state I pretty much have that butterfly pattern on my face now where I only had 2 stripes on my cheeks past year. History of high protein in urine, sensitive for psychosis, photosensitive, knee problems, flare ups inflamed toes & finger tips, all in all pretty likely. I’m going to contact an old friend who I squatted a building with in the study years he is a M.D., this is just becoming too ridiculously complex now, I hope he’ll have me because the next doctor who says go do something with how you plan your day is gonna have a very rough day himself.

                My question, is there something in WFPBD that might make this condition worse?
                Would blueberries and acaii be bad for me now?




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                1. Have you seen this link? http://nutritionfacts.org/2014/07/22/how-to-treat-multiple-sclerosis-with-diet/ A doctor was so sure that animal saturated fats were related to the explosion of MS in the post World War II world that he showed that they were the cause. He found that the vegan diet was effective as any treatment for MS. Lupus, Parkinsons, Fibromalygia and other neurological disorders might be related and the WFPBD could help. In World War II they used to treat emotional health with Niacin (VItamin B3 and Vitamin C). Dr. Hoffra, deceased, turned this into his profession in Psychology and had great numbers of patients in remission.. See this link http://www.altmedrev.com/publications/13/4/287.pdf Between the plant based diet and Vitamin B3 I think this site gives people hope.




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                  1. Hmmm, I’m watching the McDougall video linked by Adrien about the Swank diet, and unaware of this but after the rice diet video on this site I started giving that a try a week before Christmas. With adding 3 days before magnesium I was able to go visit my mother 175 km drive away, this move to the rice diet was after I noticed myself physically recoiling when I made eye contact with women, lovely creatures don’t get me wrong. I was so overloaded that the slightest of extra stimulation of the brain literally stunned me, that was very worrying. The magnesium had the same (side)effect as diazepam, I loathe downers in general but not taking it wasn’t an option anymore. Choline a week later made me open for input again after the sedation and the hot scalp and glowing upper spine went away.

                    Now from what I take from McDougalls presentation the low fat, I settled on 15% instead of 5%, might have been a solid contributing factor too. I did let the low fat slip a little bit again past 3 – 4 weeks, still moderate in almost all definitions but more around 20 I’d guess, 15% was pretty trying combined with the flax and 30 grams of walnuts. Had to settle on 20 – 20, and start measuring the sesame oil grams to get keep within the 15%.

                    Update: My old friend offered to take me into his practice 70 km from here, I’m much relieved already. Had a nice conversation, tinker time.




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              2. Thank you, Don Forrester MD. Dr. Essylsten told us that being exact is the key and I have not been exact when it comes to sugar, including that in fruit.




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                  1. Dr E has said that for some people they may need to limit to 3 fruit serving a day to lower the tri #… I am one of those people. Maybe because for years I was a raw foodist with a diet the contained almost all raw fruit… not what my mentor recommended… for me it was just easier to eat… So, no, Dr E does NOT recommend NOT eating fruit…




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            2. You’re doing great! Keep it up! And even if you unfortunately meet an untimely demise (it does happen to some) you are living with the highest quality of life by taking care of yourself!




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            3. Hi newsjunkie, I just wanted to share my tea experience when going vegan. I used to drink a pot of black tea with (dairy) milk every morning. When I first went vegan (apparently before I figured out how to buy non dairy milk) I immediately switched to green since it doesn’t require milk. Eventually I got sick of the green because it’s just a bit too astringent for me first thing in the morning, so I switched to white. To me the white tea with nothing added is as smooth as black tea with milk added. There’s very little astringency. Also I get a fruit/vanilla flavored blend and it actually tastes slightly sweet without any sugar. Years ago in my black tea with dairy milk days I would also add nutrasweet. Now tea with any kind of sugar/non-sugar sweetener actually tastes worse to me, and has a noticeably unpleasant aftertaste compared to plain tea. So if you can get your taste buds readjusted without the sugar, who knows maybe you’ll grow to like it better that way too. Fyi there are several varieties of white tea and I’ve found some are just as tart as green, but if you can find a nice smooth variety I think you might really enjoy it. It can look quite expensive by the pound, but it’s also much less dense than black tea. I can get about a 2 month supply for $18 at my local tea shop and I use a tablespoon per day.

              Also, if you want to go the commercial almond milk route, I personally think the blue diamond unsweetened has the least pronounced almond flavor of any I’ve tried. However, if you want to decrease fat altogether, keep in mind that almond milk, while low in calorie, is still mostly fat by caloric percentage, which might add up if you drink a large quantity of it. If you want a much lower fat milk, you might consider rice or oat milk. While they can be more expensive in the store, they are both dirt cheap if made at home. Personally I’ve found the oat milk to have a little too much oat flavor and also a gelatinous quality which I didn’t care for. However homemade rice milk I find quite dandy.




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            4. A couple years ago I stopped consuming sugar or anything sweet. The first month was challenging, after that it was quite easy. During that first month, I realized that I had developed (over many years) a habit of eating something sweet after each meal. As time went on, my taste buds changed I was able to taste sweetness in plain oats, lettuce, spinach…I’m not advocating that you avoid fruit entirely, there are certainly nutritionally dense fruits (that I now consume) in my daily smoothie. Best of luck to you.




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          2. I have been putting Westsoy unsweetened soy milk in my tea and decaf coffee, and drink about a carton a day (32 oz). Could this be a contributing factor too?




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            1. I think it might be. Wastsoy unsweetened has 5 g of fat per 8 oz serving, one of those is saturated. Esselstyn recommends non-fat soymilk or oat milk in his Prevent and Reverse Heart Disease book.




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                1. Make your own – it is SO much better! Half a cup of almond meal (Bob’s Red Mill makes a great one), packed tightly, to 2 cups of water. Blend for two minutes, then strain through a nut milk bag. Delicious!




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            2. It’s really hard giving up added sugar but worth it. The “withdrawal symptoms” and headaches lasted 8 days for me but you won’t have cravings after that. It also helped with going Whole food as you tend to eliminate the other kinds of food naturally, like refined flour for example. The immediate and long-term improvement in my health(including energy, skin , sleep and mood) was quite unexpected. Seeing a documentary about how people’s blood-flow turns “sticky” with sugar consumption was more than enough to make me give it up.




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              1. Thank you, I haven’t had sugar now for a few days and don’t miss it! Drinking tea with erythritol or nothing, and finding I prefer nothing :)




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        2. Hmmm. Interesting that your numbers went up AFTER giving up nuts and avocado. Those are heart-healthy foods, especially the nuts (1 ounce/day). Perhaps adding them back into your diet will get you back on track?




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          1. Nuts and avocado, according to Dr. Essylsten, should not be eaten by people with heart disease and should be eaten in limited quantities by others because they are not heart-healthy.




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            1. I’m familiar with Dr. Esselstyn’s position on nuts. And I respect where he’s coming from. However, if you watch Dr. Greger’s videos, you’ll see an alternative viewpoint based on the science. And you’ve got to deal with the reality that the changes you have made according to Dr. Esselstyn’s program may not be the best for you as an individual.




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          1. exactly right. My doctor said my TSH was low and wants to retest me in two to three months. I had skipped my synthroid a few times in the week before the blood test last week.




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            1. I ask because my friend went vegan two years ago, and TSH values quickly jumped massively and cholesterol raised. She’s was able to fix these problems by supplementing iodine, gradually increasing the dose and was able to get her tsh back to a normal value with a massive dose of iodine(100mg/day) and its cofactors(selenium).
              Not sure but synthyroid I guess solves the same problem but I think you can take both.

              I noticed with the vegetarian adventists study that the pesco-vegetarians women faired quite a bit better than vegan women. I this might be because women require more iodine and seafood has it.




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              1. I had a shock last week. I got my blood test back and it was TSH 5.8 LDL 177. No symptoms, well my hair is a little dry. T3 and T4 levels are within range. I assumed I was super healthy because I had been eating mostly vegan for years, then vegan for the last year. I don’t use salt, I totally stopped eating fish about a year ago, I eat seaweed but not all the time. The medical establishment says wait and see for subclinical hypothyroidism because there is no such thing as iodine deficiency in the developed world. Wait and see until you need our drugs that is. I ordered Iodoral and will take 1/2 a tablet per day for a month then go up from there. Of course it could be autoimmune so I am avoiding gluten in case there is any truth to that connection. If it turns out it was the iodine I will eventually switch to a daily serving of dulse. With flax and amla and turmeric and blueberries etc. I wonder how widespread iodine deficiency is and how many failed vegans it caused.




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                1. THeres a video here that says 80% of vegans are deficient. Although Greger is very conservative when it comes to what he says about iodine and warns about the dangers, but those dangers seem to only come from other nutrient deficiencies… mainly selenium.




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        3. We are behind you! Taking sugar out of the diet is tough. Dr G at some point recommended eryrithritol as being the best sweetener if you are having a tough time.

          Remember to supplement b12z




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    1. newsjunkie, Just a reminder that stress itself is not good for us. I learned recently that just being stressed when getting our blood drawn will alter the results (for the worse). Meditation, relaxation exercises, walking in nature–anything that relaxes you should help improve your health and cholesterol numbers.




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    2. The average American consumes 156 pounds of sugar annually. It is prevalent in processed foods, soft drinks and a common add in for coffee and tea. Sugar has an adverse effect on the body and puts us at risk for diseases such as obesity, heart disease and especially Cancer. While there are sugar substitutes, the best is to completely eliminate added sugars from our diet. Once the addiction subsides so do the cravings. You might consider adding cinnamon or cardamon to your tea.




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      1. Thank you! I have started using a great substitute called erythritol after seeing a video on this site. Is there a study that shows that too is bad for me?




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        1. newsjunkie,

          While Dr. Greger has highlighted erythritol as a safe alternative sweetener, he does address three ways that using alternative sweeteners can still contribute to weight gain here: http://nutritionfacts.org/2013/05/09/how-to-gain-weight-on-diet-soda/

          Additionally, Dr. Greger published a note of caution about using erythritol in this Q & A post: http://nutritionfacts.org/2013/05/09/how-to-gain-weight-on-diet-soda/ (http://www.ncbi.nlm.nih.gov/pubmed/22118754) that found erythritol can increase “gastrointestinal symptoms” depending on how much fructose is also consumed.

          I’m confident Dr. Greger will let us know if additional concerns are found too! Hope that helps.




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            1. newsjunkie: That reminds me of my own progression to drinking tea. When I was a kid, my only exposure to tea was in Asian restaurants and I was allowed to put in as much sugar as I wanted. I wasn’t shy. But that first, over-sweet exposure to tea turned into me liking tea naked many years later. I honestly don’t think I would enjoy tea the way I do today or be able to drink it at all if I hadn’t had the early sweet exposure.

              I’m glad you gave the sugar-free version a try. You may never like it as much as you like the sweetened kind, but you may find you can tolerate it well enough.




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        2. It is best to cut out all added sugar. Do you know what your fasting glucose level is? I eat a whole food plant-based diet hardly ever use added sugar but I consume plenty of fruits, which probably make up 70% of my diet. My glucose level is 92mg/dl in the range of 65-139mg/dl. My HDL is 51 and my LDL is 51. Cut out the added sugar and drink plenty of water.




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    3. i too have jettisoned the sugar – the very last vestige of SAD indulgence – because i’ve just learned i have extensive calcification in my coronary arteries. left anterior descending (aka the widow maker) is the worst. just shy of 60, i’ve been vegan for 12 years, LDL of 65, well with-in weight range, no smoke or alcohol, exercise daily (yoga and walk), and all the other good stuff for healthy living. most definitely hereditary. doing baby aspirin, red rice yeast and arjuna daily. dr wants to see my LDL around 40. any and all fine points of information is most beneficial – and appreciated – as i’d like to stay as holistic as possible for as long as possible.




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  3. I believe it would also be worth mentioning ApoB or LDL particle number as well. We do know that both of these are better indicators of CV risk especially when the LDLc and LDLp are discordant. Ultimately it’s the number of ApoB containing lipoproteins that’s drives CV disease and not just the cholesterol they traffic. It’s the entire Lipoprotein that penetrates the vascular wall, becomes endocytosed by the macrophage ultimately forming the foam cell etc.. Granted folks who have “normal” LDLc but yet high LDLp typically have elevated triglycerides.




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      1. Rami,

        Rob is not talking about lipoprotein size but about the number of particles that shuttle the cholesterol. He’s referring to the number of vehicles, not the size of the trucks.

        He’s talking about a subject Thomas Dayspring champions: When LDLs are busy trafficking triglycerides, the body generates more lipoproteins to compensate for the shortage of vehicles in order to get the same cholesterol transportation job done.

        Although I tend to believe Dayspring on this matter, I am suspicious of the financial interest he has in the company that makes the NMR machines needed to assay the particles.

        I also vehemently disagree with his buddy-buddy relationship with Gary Taubes/Peter Attia/Nina Teicholz (can’t the man do a minimal amount of fact checking, for goodness sakes?) and hid endorsement of Atkins/LCHF animal-based diets to counter IR/discordant dyslipidemia. That’s the diet he is personally following.




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        1. I misinterpreted his post and assumed particle number was a reference to size. Thanks for the correction. Also, this is my new profile name MacSmiley. You may know me as “Toxins”.




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      2. Ditto on what Macsmiley said. When I draw a lipid panel (Atherotech) I do focus more on LDLp. Size is not relevant once you know how many particles you have. Even a large LDL particle is plenty small to penetrate the vessel wall. An example of this would be people who have Familial Hyoercholesterolemia, they are at a very high lifetime risk of CV disease and will typically have large particle size. I also try not to get caught up fretting over HDLc. Typically it’s low due to elevated Trigs and will rise as Trigs go down. I do dislike though referring to LDL as bad and HDL as good. Cholesterol is cholesterol. It’s the vehicle that is different. Very little of your HDLc is derived from cholesterol that has been pulled from the vascular wall.




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  4. How many years does it take for LDL to base once you start on a strict plant diet? My first few months were amazing. The next two years squeezed only 10 additional points. This isn’t bringing me quite as low as I want to go (but I’m close). McDougall’s interview with Pritikin suggests that it can take up to five years.

    Are home tests for cholesterol levels effective?




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    1. Clem, Thanks for posting this as it made me go back and review the content more closely. It seems that the two videos focus on different risk factors to major life threatening events; namely hypertension vs. atherosclerosis.

      In re-watching the “Flax Seeds for Hypertension” video, the reference to SBP > 115 is this statement from Dr. Greger: “Because having a systolic blood pressure over 115—that’s the top number—may be the single most important determinant for death in the world today.” Death, per the transcript, refers to death from strokes and heart attacks: “a drop like that could cut stroke risk 46%, heart disease 29%”.

      In today’s video, the reference to cholesterol being the single cause of atherosclerosis is the opinion of, “Dr. William Clifford Roberts…. Executive Director of Baylor Heart and Vascular Institute and long-time Editor in Chief of the American Journal of Cardiology.” Further, the transcript summarizes, “thus the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.”

      So, I would say that it’s not that one is more important than the other but that elevated measurements of either SBP or cholesterol are indicators of separate risk factors to be considered in maintenance of overall health.




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  5. My numbers were 200 total, 110 LDL, 36 HDL prior to my diet change. 2 years later my numbers are 170, 90, and 53 respectively. I haven’t seen a change since the first 6 weeks of a plant based diet. I’ve gone over my diet with a microscope and can’t find anything else to change. What next? How do I hit the numbers they are suggesting?




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    1. Siberspeer, What are your triglycerides? Your HDL is 31% of total cholesterol which is awesome (up from 18%; should be above 25%). Triglyceride to HDL ratio should be below 2, so if your triglycerides are below 105, you’re good. Now LDL is only 20 points away from 70. Exercise and omega 3 supplements (vegan algae is very bioavailable) can help reduce LDL.




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      1. My triglycerides are 62. I do a tablespoon of flax meal every day for omega 3 and I don’t think I can do more cardio. But thanks for the reply.




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        1. Your lipids are better than the vast majority of folks out there. It sounds like you’re really making positive health changes. Keep up the good work, keep watching the great info that’s posted here and don’t fret over your LDL of 90. Chances are its a calculated LDLc and inaccurate anyway.




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  6. My original numbers were Total 200, LDL 110, HDL 36. After 2 months on a plant based diet they were 170, 90, and 53 respectively. That was 2 years ago and they haven’t changed. I’ve gone over my diet with a microscope and I can’t find anything else to remove. I try to be very strict but something isn’t working. My numbers are good, but they aren’t in the ranges that are suggested above. 50 to 70??? I wish. What else can I do?




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        1. Because of their recent prominence and influence in the matter. The whole “lipid hypothesis” denialism started with Uffe Ravnskov, and all his inaccuracies have been echo-chambered by Taubes/Techolz/the anti-vax Weston A Price Foundation and others. What they say certain studies suggest is often just the opposite.

          Plant Positive addresses the Honolulu and Japanese studies you bring up.

          http://plantpositive.com




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            1. This is true, though much of that is just the guideline levels are not physiologic. As Dr Greger said in the video physiologic LDLc levels are around 40 or so though for a low risk person the guidelines consider 130 to be normal. The other reason is related to what I said earlier about the particle number. You can have a low LDLc but still have a huge number of athrogenic particles trafficking that cholesterol. And then there are other factors such as Lp(a) levels.




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              1. There are many papers showing the association between stress and high LDLc/Lp(a). Shouldn’t we ask if the diet factor is not as nearly important as physical and psychological stress?




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          1. MacSmiley: I thought your first post was so helpful because you gave references to specific fact checkers. I was going to ask why you didn’t include Plant Positive. Happy to see you snuck him in here. :-) All those sources together make for some really powerful evidence.




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      1. Quote from Wikipedia:

        The lipid hypothesis was described in 1976 as the premise that
        “measures used to lower the plasma lipids in patients with
        hyperlipidemia will lead to reductions in new events of coronary heart disease”.[1] Another formulation is that “decreasing blood cholesterol… significantly reduces coronary heart disease events”;[2] this discussion is also referred to as the “cholesterol controversy”.[3] It is closely related to the saturated fat and cardiovascular disease controversy.

        http://en.wikipedia.org/wiki/Lipid_hypothesis




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      2. Quote from Wikipedia:

        The lipid hypothesis was described in 1976 as the premise that
        “measures used to lower the plasma lipids in patients with
        hyperlipidemia will lead to reductions in new events of coronary heart disease”.[1] Another formulation is that “decreasing blood cholesterol… significantly reduces coronary heart disease events”;[2] this discussion is also referred to as the “cholesterol controversy”.[3] It is closely related to the saturated fat and cardiovascular disease controversy.

        http://en.wikipedia.org/wiki/Lipid_hypothesis




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  7. I am totally puzzled. Not long ago, I attended a conference of a very trustworthy doctor, specialized in nutrition and plant based diet. He assured that the numbers for high cholesterol risk were exaggerated, and that Big Pharma has been lowering them in order to get more clients for their statins. He said that you can have 350 total cholesterol and be fine. So I stopped worrying about cholesterol. Now that I read this, and I remember my last blood test showing HDL 74.8, LDL 136 and total cholesterol 223, I wonder… how? and do I really have to worry? I eat a good, balanced, varied plant based diet. Why is my cholesterol that high? I only make little exceptions like dark chocolate every now and then, I love bread and cereals but always dark and organic. I love coconut milk as well, but surely that doesn’t give you cholesterol as there’s no cholesterol in vegetable foods? Please help!




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      1. Any doctor who speaks against bigpharma is a trustworthy doctor to me. As for Christina’s point, I wonder if the reference range for cholesterol is different in other countries.




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        1. Any doctor who speaks against bigpharma is a trustworthy doctor to me.

          Sounds ideologically dogmatic to me. Anti-Big Pharma ideology has directed people to bogus supplements and all kinds of alt-med woo, some of which can be quite harmful.

          Dr. Greger would agree that lifestyle change should be first line defense and prevention, but that drugs have their proper place and can even save lives.




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          1. Excellent point. It is interesting how “Big” has somehow become synonymous with “Bad.” If it weren’t for “Big-Pharma” we’d still be lobotomizing psychiatric patients.




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            1. “We” are chemically lobotomizing psychiatric patients? Patients “appear” to be improved…but they are subjectively zombified. They have no real interior life. Makes it easier for the nurses and orderlies? The patient is in a form of suspended animation…zombified. I think that around 40% of people in nursing homes are psychiatric patients? The other 60% probably get some of the same drugs. Makes it easier for the nurses and orderlies?




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      2. Hi Mac! Well, he is a Southamerican doctor, expert in nutrition (plant based), I can’t remember his name now, but at the conference he was presented as an expert with more than 30 years experience, everyone was saying how good he was, and everything he said (basically most things Dr Greger says), made lots of sense to me, so I was surprised to hear about the cholesterol thing, which I have heard from other Naturopathic doctors as well.




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    1. Remember that saturated fat raises cholesterol, even vegan forms. Coconut and chocolate (cocoa butter) are very high in saturated fat. Also, I’ve heard ratios are important. At 34%, your HDL is well above the recommended 25%+ of cholesterol. Triglyceride/HDL should be below 2 so if your TG’s are below 110, you’re good. Exercise and DHA/EPA (vegan source = algae oil) also help reduce LDL.




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      1. Thanks very much Julie! The thing is my HDL is just above the recommended level, and my LDL is within the safe limits, but my triglycerides are very low. Does that make sense? I excercise quite a lot, and regularly, and take a vegan DHA/EPA. Thanks again!




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    2. Cristina, there are a lot of factors that can play into your lipid numbers. Reducing saturated fat, trans fat, cholesterol, and animal products in your diet will be the best way to reduce your total cholesterol. Ideally, you want total cholesterol to be <150 mg/dL. Studies show that in populations where cholesterol is <150 mg/dL, heart disease & heart attacks are very rare.

      LDL cholesterol is an independent risk factor for cardiovascular disease. The lower your LDL the better. Ideally LDL should be <70 mg/dL, as these are the levels shown to correlate with reversal of atherosclerosis. You can reduce LDL by increasing consumption of beans, fruit, vegetables, whole grains, nuts, & seeds. Decreasing processed oils, saturated fats, trans fats, & cholesterol intake will help reduce LDL.

      HDL is your “good” cholesterol. It is involved in transporting cholesterol back to the liver, which ultimately results in less cholesterol buildup in plaques in the arteries. For every increase of 5 mg/dL in HDL, there is a decrease in risk of 11%. HDL may be increased by weight loss, quitting smoking, & increased exercise (ideally 1,500-3,000 calories burned per week).

      Triglycerides are fats that may be stored or burned for energy. High triglycerides are an independent risk factor for heart disease and can contribute to atherosclerosis. Ideally triglycerides should be maintained <90 mg/dL. Weight loss, decrease in intake of refined oils, animal fats, alcohol, sugar, and processed foods can reduce triglycerides. Exercise, fiber rich foods, fruits, and vegetables also help to reduce triglyceride level.

      Studies on children show us that the sooner we start making these types of changes the better. This Dr. Greger video explains how heart disease actually starts in childhood and that kids as young as 10 years old have fatty streaks inside their arteries. Unbelievable but true!




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      1. Tara, the amount of cholesterol that is trafficked by HDL that comes from the vascular walk is infatisimly small. Reverse cholesterol transport is a minor roll of HDL. It’s likely main purpose as far as lipids go is transportin CE to the steroidogenic organs. HDL also gives a fair amount of its cholesterol to LDL particles via CETP.




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      2. Thanks very much for your detailed explanation, Tara, much appreciated! The thing is I am vegan, and have been for many years, my LDL is low and my HDL is high, but my total cholesterol is 230. I am really not that worried, as my vegan diet is very balanced, but you can’t help getting confused when you hear respected professionals say the very opposite thing from one another. I guess I’ll just continue with my ways and eat what I like without worrying too much. Probably the stress of wondering if you are doing the righ thing is worse than anything else. :)




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    3. A plant based diet may not lower your cholesterol, but a low fat (10%)whole-food plant based diet may help. Coconut milk has a lot of saturated fat…not good for lowering cholesterol.




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      1. Thanks Joe! Still, coconut products have good press as being the only saturated fat that is good for you. I really don’t know what to believe anymore. I think I will just eat anything I please (plant based, of course) in moderation, and that will probably keep me healthier than worrying about if this or that is good or bad.




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  8. Many cardiologists also recommend LDL below 70. But what about ratios, LDL particle size and number? Cardiologists place importance on these as well. HDL should be 25%+ of total cholesterol and the triglyceride/HDL ratio should be below 2.




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  9. Not everyone who eats a plant-based diet will get their total cholesterol under 150 or their LDL below 70. At 3:37 in the video Dr. Greger refers to this study http://www.ncbi.nlm.nih.gov/pubmed/17364116 which found “Mean and standard deviation for TC were 208.09 +/- 49.09 mg/dl in the group of omnivores, and 141.06 +/- 30.56 mg/dl in the group of vegans (p < 0.001). LDL values for omnivores and vegans were respectively: 123.43 +/- 42.67 mg/dl and 69.28 +/- 29.53 mg/dl (p < 0.001)." The mean and deviation values indicate that in this study vegans had TC ranging from about 110 to 171 mg/dl, and LDL ranging from about 40 to 100 mg/dl. IMO stating that we all should have cholesterol under 150 mg/dl is like saying that we all should be less than 5'8" tall because research shows that shorter people live longer. The fact is each of us is a unique individual with a signature low cholesterol just like a signature fingerprint. Eating a plant based diet will probably get your TC as low as YOU can go, but it might not be as low as someone else's. That doesn't mean you won't have protection against atherosclerosis. All of these reports deal with means and averages, Your own mileage may vary.




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  10. My guess is the reason that they do not lower the ideal cholesterol level is because of the money that would be lost by the meat and dairy industry !!!!




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  11. I eat a whole food diet that includes meat, dairy and eggs in addition to fruits, veggies, nuts, seeds, etc. I take 10 mgs Atorvastatin/day in addition to other supplements.

    Last blood test was 9/2/2014 – I will be going for another blood test next month

    Results
    Fasting Glucose – 83 mg/dl
    hs-CRP – 0.9 mg/l
    TC – 120 mg/dl
    HDL – 54 mg/dl
    TG – 50 mg/dl
    LDL (calculated) – 56 mg/dl

    LDL-P – 1011 nmol/l
    LDL small – 184 nmol/l
    LDL medium – 164 nmol/l
    HDH large 5946 nmol/l

    ApoA1 – 138 mg/dl
    ApoB – 59 mg/dl
    ApoB/A1 ratio – 0.41

    HA1C – 5.7% of total HGB

    Homocysteine – 9.9 umol/l

    CAC – 47 (taken 2/14 – up from 30 in 12/07) so the rate of progression has slowed to a crawl) Plaque is on the LAD (the widow maker)




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    1. I shouldn’t be surprised someone would try to sell a “take a pill and eat whatever you want” solution over eating right, but I am. I think your post is an implicit acknowledgement that your diet is “eating wrong”, am I correct….or would you like to backtrack a bit? Or, maybe it’s just someone passing along information to others…in which case I would like to point out the following:

      I get the same result eating vegan, and for that I get a ton of health benefits…unlike those who take Atrovastin, which face a ton of potential harm, including:

      Cough
      difficulty with swallowing
      dizziness
      fast heartbeat
      fever
      hives
      itching
      muscle cramps, pain, stiffness, swelling, or weakness
      puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
      skin rash
      tightness in the chest
      unusual tiredness or weakness
      wheezing
      Blistering, peeling, or loosening of the skin
      chills
      dark-colored urine
      diarrhea
      joint pain
      large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
      red skin lesions, often with a purple center sore
      red, irritated eyes
      sore throat
      sores, ulcers, or white spots in the mouth or on the lips
      Headache
      hoarseness
      lower back or side pain
      pain or tenderness around the eyes and cheekbones
      painful or difficult urination
      stuffy or runny nose
      Abdominal or stomach pain
      back pain
      belching or excessive gas
      constipation
      general feeling of discomfort or illness
      heartburn, indigestion, or stomach discomfort
      lack or loss of strength
      loss of appetite
      nausea
      shivering
      sweating
      trouble sleeping
      vomiting
      Appetite increased
      black, tarry stools
      bloody nose
      bloody or cloudy urine
      blurred vision
      continuing ringing or buzzing or other unexplained noise in the ears
      difficult, burning, or painful urination
      difficulty seeing at night
      excessive muscle tone or tension
      fruit-like breath odor
      groin or scrotum pain
      inability to have or keep an erection
      increased body movements
      increased sensitivity of the eyes to light
      increased sensitivity to touch or pain
      increased thirst
      increased urination
      loss of bladder control
      loss of sexual ability, drive, or desire
      menstrual bleeding occurring earlier or lasting longer than usual
      mental depression
      nervousness
      nightmares
      pale skin
      paranoia
      pinpoint red spots on the skin
      slurred speech
      swollen or tender lymph glands in the neck, armpit, or groin
      unable to move or feel face
      unusual bleeding or bruising
      weight loss




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        1. I did not mean to imply that side-effect free equals risk-free. The drug you are so pleased with carries substantial risks…and for what….so you can continue to eat the foods that caused your disease in the first place and caused the situation in which you now have to take Atrovastin?

          Do you see any problem here?




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          1. I have more information than you could possible imagine and I choose not to follow a vegan diet/lifestyle whuich I believe is not the healthiest. If my next CT scan shows plaque regression what will you say then??




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            1. Putting aside for now the issue of whether or not I can imagine the amount of information you possess, I would welcome a comment from you in the future letting me know that a CT scan shows plaque regression. If that happens, reply to this comment and we won’t have to deal in hypotheticals. I have only seen that happen to people on diets far stricter than yours, so I would certainly have to cross that bridge when and if I came to it. For what it’s worth, I certainly hope that for you, but based on your diet I don’t think it will.




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              1. I will save this page and reply when I take it. However, there are studies that show plaque regression with ultra low LDL with statins.

                Effect of a Combined Therapeutic Approach of Intensive Lipid Management, Omega-3 Fatty Acid Supplementation, and Increased Serum 25 (OH) Vitamin D on Coronary Calcium Scores in Asymptomatic Adults

                William Davis, MD, FACC,1* Susie Rockway, PhD, CNS,2 and Mary Kwasny, ScD3

                The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS ≥50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides≤60 mg/dL; high-density lipoprotein ≥60 mg/dL; and vitamin D3 supplementation to achieve serum levels of ≥50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%–29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%–71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.

                Our findings lend support to the concept that dietary changes and the addition of omega-3 and vitamin D3 supplements to pharmacological therapy targeting LDL cholesterol 60, HDL 60, and TG 60 mg/dL may slow or reduce progression of coronary calcium scores in a substantial proportion of patients. The precise parameters that will be necessary to achieve consistent reductions in coronary calcium scoring have yet to be determined. Whether or not reductions of calcium score will also yield concomitant reduction of coronary events is a tantalizing, but unproven, prospect.




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                1. Thanks for the citation. I will check it out. And thanks also for being open to revisiting this conversation if you get some plaque regression.




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                  1. The fact that the plaque burden has only gone from 30 to 47 in 6 years plus the fact that I lowered my SFA consumption and started the statins 2 years ago leads me to believe that the progression has slowed dramatically. Arterial plaque normally progresses at a rate of 20-35% per annum so the next step should be regression. We shall see




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                    1. Based on what I know those are indeed far better than average numbers, but it sounds like your goal is reversal, which is admirable and I believe likely doable based on studies done over the past decade that to my amazement still don’t get as much attention as they should given the prevalence of heart disease in the US. But, you’ve no doubt seen them, and you’re here at nutritionfacts.org, which is a great resource. You’ve probably also run into doctors like Esselstyn and McDougall who promote diets that do the very thing you’re trying to do. I look forward to hearing how it’s going down the road.




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  12. You’ll hear no argument from me about the negative impacts of cholesterol on artery health…

    but is it true that dietary cholesterol has no significant impact on blood cholesterol, and what do you make of the government’s plan to withdraw its warning about eating high amounts of cholesterol or high cholesterol-containing foods in its official dietary guidelines?




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    1. The USDA has massive conflicts of interest. Its job is to promote U.S. agriculture industries, not public health. We’re idiots to accept dietary guidelines from the milk and meat industries.




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    2. They are being influenced by the egg industry and a couple poorly interpreted studies by david katz I believe. Hence, they’re just loosening their recommendations on dietary cholesterol intake.

      It is in fact very true that dietary cholesterol impacts blood cholesterol – but only does so substantially when blood cholesterol is not high. So if you have high cholesterol (lets say from eating meat dairy and eggs everyday) and you add 1-2 eggs on top of that unhealthy diet, you will not see a significant rise in blood cholesterol. However, if you give someone on a whole food plant based diet 1-2 eggs, you’ll see their cholesterol rise considerably. Just like if you took a 1pack a day smoker and gave him a few extra cigarettes, think it would make that much of a difference to his lungs? No, but give someone who’s never smoked before a few cigarettes a day and you’ll see significant damage pretty soon.




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    3. You raise an important question in light of the recent news that the 2015 Dietary Guidelines for Americans may drop the recommendation to limit dietary cholesterol. I wanted to expand on the points that pbdoc brought up in response to your question.

      One issue with the research on the relationship between dietary cholesterol and serum cholesterol is that many studies have not accounted for the effects of baseline dietary cholesterol. Serum cholesterol rises if you add foods high in cholesterol to a diet that was low in cholesterol to begin with. However, if you are already eating a diet high in cholesterol, adding more may not raise your serum cholesterol further. This meta-analysis illustrates the problem when baseline dietary cholesterol is not accounted for.

      As Dr. Greger discusses in this video the Institute of Medicine has not set a Tolerable Upper Limit for cholesterol (or saturated fat and trans fats for that matter) because any intake of dietary cholesterol above zero is linked to an increase in LDL (bad) cholesterol.

      One of the arguments that is being made for changing the Dietary Guidelines for cholesterol is that, compared to saturated fat, dietary cholesterol does not have as much of an effect on heart disease risk. This may be true, as this meta-analysis shows, reduction in dietary cholesterol by 200 mg per day did reduce serum cholesterol, but replacing saturated fats in the diet had a greater effect. However, saturated fat and cholesterol are often found together in the same foods, and one can argue that it may be just as useful, if not more so, to study the effect of whole foods, rather than focusing on a single nutrient.

      I think the major response of the media to the news about DGA dropping its cholesterol restriction has been, “Woo-hoo, eggs are safe to eat again!” So it may be of interest to look at some of the studies on egg consumption. The Framingham Study did not find an association between egg consumption and serum cholesterol levels, however they also note that none of their subjects actually had a low dietary cholesterol consumption. The Physician’s Health Study did not find an association between egg consumption and increased risk of heart attack or stroke but did find a significant increase in all-cause mortality with higher egg consumption and the effect was greater for those who have diabetes. Egg consumption has also been shown to increase atherosclerosis and diabetes as Dr. Greger discusses here and here.

      Hope you find the information useful!




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      1. I did find it useful – thanks. I’ll look forward to the longitudinal study of 20 vegans that measures changes in cholesterol that result from feeding ten of them eggs daily.




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  13. Personally I think, and this has no validity, that in our reductionist way of thinking that stressing the cholesterol level has taken too much importance over emphasizing a healthy diet and lifestyle.




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  14. OFF subject. Had a hair analysis. Slightly raised arsenic level. What does anyone know about the validity of hair analysis and how to lower arsenic levels? There are several videos about arsenic in food products but nothing I found that says how to reduce the levels once they are in the body. Will have my water tested again but it has never shown any before.




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      1. I’ve been WFPB for 5 years McDougall style, no processed food. No meat for 20 years before that. Last 5+ yrs have been very careful about eliminating food with toxins.




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    1. Arsenic, if present in the groundwater, clings to the outer layer of rice. The reason it’s present in some areas in dangerous amounts is due to run-off from the chicken industry. Unfortunately, in the U.S., much of the rice grown (in Arkansas and Louisiana) happens to be downstream from poultry farms. To minimize the amount of arsenic in rice, rinse it before cooking, and then cook it in lots of extra water (like cooking pasta) and drain off the water. Or buy rice grown in other parts of the world, such as India or Pakistan, where arsenic amounts are negligible.




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  15. The study referenced in the clip showed the mean LDL for vegans was 69.28, right at the cutoff for optimal LDL levels. So, It appears half of all vegans will need to be on statins in order to lower their LDL to the optimum range.

    If so many vegans on a strictly plant based diet need cholesterol lowering drugs to reach the recommended target LDL, there’s no doubt it would prove frustrating to the average person to try and lower their LDL cholesterol with diet alone. And sadly, even if the entire population went vegan, in order to bring everyone’s LDL down to the heart attack proof range, drug therapy would still be necessary for half of us. Am I missing something?




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    1. It’s much more optimistic, actually, Adam: the whole food plant based only, or vegan diet, is optimal: Dr. Greger says vegans ‘nail it’ under 70, and ends with saying that all folks deserve to know this WFPB lifestyle answer to our epidemic, so they don’t get frustrated finding out they weren’t informed of this vital true answer :)




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    2. Being vegan says nithing of exercise. I would feel comfortable assuming that most vegans could get their LDL down to an optimum level with significant exercise. Vegans can be unhealthy as crap.




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      1. I wonder if people who tend to have lower cholesterol have ancestry who lived on greater amounts of meat long ago. That would sure be interesting.




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        1. Interesting thought, who knows? The great news is you have a healthier than most cholesterol, which reduces your cancer risk too; good for you :)




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  16. Dr. Greger has shown that the vegan diet, whenever you can use it, for as long as you can use it, can reduce your heart disease and improve your life and fix heart disease risk. This video suggests only vegans, a minority in today’s society, have ideal numbers for LDL, but does again validate their lifestyle choice for heart health and suggests that they alone will never have a heart attack. Only vegans though have this benefit, in contradiction to the federal government’s assertion that eating cholesterol does not raise cholesterol, something that ironically seems to be the opposite of truth, that cholesterol eaten is jealously guarded. To lower cholesterol, this site recommends: nuts (particularly almonds), whole grains (like Cheerios), flax seed meal, kiwi, grapefruit, red yeast rice, dried apples, amla, and beans like chickpeas. Perhaps eating some of these foods can endow a partial benefit. There are some activities that can reduce heart disease risk, like eating beans, drinking tea, eating nuts, eating whole grains, taking an aspirin a day*, drinking one drink a day*, eating cocoa or dark chocolate, eating kiwi, getting 10 minutes of exercise a day, eating soy, eating citrus, eating tomatoes or juice or paste, eating leafy vegetables (spinach, broccali, or kale), eating flax seeds, and eating beets. *not highly recommended here for the healthy. This video offers specific advise on how to lower heart disease risk. http://nutritionfacts.org/video/eliminating-90-of-heart-disease-risk/




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  17. Thank you to everyone who has commented on my post. It has been so incredibly helpful and have already decided to make further changes in my diet, namely to stop my final guilty pleasure– putting Westsoy unsweetened soymilk in my tea or decaf and adding sugar or erythritol. Thanks to everyone for your suggestions, as you know it is very difficult in our society to eat a whole food, plant-based, no-oil added (and for me no sugar added) diet. Anyone know of a decent-tasting almond milk? I can’t STAND it!!




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    1. Newsjunkie: I hope it gets easier for you — are you noticing any health benefits? I find it easy at home, since it’s just what’s okay to consume, instead of all the bad choices to avoid ‘out there’. Do you like almond butter, or have whole almonds at home – and a blender? 2-3 tablespoons of either in a blender with water — whirls up to a nice almond milk you might like. Just enjoy trying each until you find what you like, or a different nut milk like hazelnut, hemp, or oat, etc. — you might like more :)




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  18. I’ve been eating WFPB/non junk food vegan for 3 1/2 years now and my LDL is 98 with triglycerides at 208. I exercise 2-3 times a week and weight only 145lbs at 6″ tall. It’s a bit frustrating to see these numbers but the hell if I’m going to start eating meat again.




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    1. I hear you editor_d — I do the WFPB non junk food vegan lifestyle too and still need lower numbers. I agree, and the science supports not going back to meat: that would certainly be the wrong direction to go, for all the preventive reasons.
      What I am going to try is daily exercising half an hour, at least, by walking nonstop outside. Want to be my cyber partner on this?




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  19. My question is: does’ high body-fat’ generally mean ‘high-cholesterol’, and therefore ‘low body-fat’ generally means ‘low cholesterol’…?

    I try to keep my body fat levels at around 10% via WFPBD and daily exercise.




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  20. Say a person stays on the standard American diet… How strongly is cholesterol level correlated with BMI or body weight? Or, do skinny people who eat SAD have similarly high cholesterol levels as heavy people?




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  21. Please need some help… and it help other like my case too…

    My total cholesterol level were 6.8 mmolL and I was told that is from my gene and there is nothing I can do much about it, so I decided to go vegan for the last 7 months … and guess what …. the Cholesterol when up to 7mmolL I WAS SHOCKED.

    Now the doctor wants to put me on Statin as I have family history of heart attacks.

    I am 42 and never smoked and I have lost 15 Kg and I am planning to lost another 5 Kg so that I will be in my optimal weight.

    Do I need to continue with the Vegan diet or should I take the Statin…

    Thanks Dr. G




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  22. A doctor at the Red Cross where I go to give blood tells me this: vi) “Cholesterol in food has no impact on cholesterol in the blood and we’ve known that all along.” Ancel Keys.

    He is in his late 70’s. and eats 3-5 raw eggs a day.

    Ancel Keys, the same man who did the brilliant Minnesota starvation experiment, spent the 1950’s trying to show that cholesterol in food was associated with cholesterol in the blood. He concluded unequivocally that there was not even an association, let alone a causation. He never deviated from this view.

    Cholesterol is only found in animal foods (it is a vital substance for every living creature). Hence the only foods that Keys could add to human diets, to test the impact of cholesterol, were animal foods. Given that he concluded that eating animal foods had no impact on blood cholesterol levels, it follows that animal foods per se have no impact on blood cholesterol levels (not that high cholesterol is a problem – quite the contrary – but that’s another story).

    There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products etc for any cholesterol that they may contain, or for any other reason.

    The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.

    Ref 1: EH Mangiapane, AM Salter, Diet, Lipoproteins and Coronary Heart Disease: A Biochemical Perspective, Nottingham University Press, (1999). (See reference 159 The Obesity Epidemic)




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    1. My total cholesterol hovered in the mid to high 200’s all my life. 40 years…until I went vegan…

      and it dropped and stayed below 150.

      That must be because animal foods have no impact on blood cholesterol.




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      1. “There is no need, whatsoever, to avoid liver, red meat, other meat, fish, eggs, dairy products etc for any cholesterol that they may contain, or for any other reason.”

        UCBAIum…I don’t buy it either, but this info is out there and being given top billing by ‘experts’.




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        1. It’s unfortunate. The USDA is tasked with promoting US agriculture in the US and throughout the world, which means it’s a business advocacy group, and there exists a revolving door between the chemical and processed food industries and USDA senior management, which means corporate managers driven by maintaining and increasing the profits of their companies and their industries are setting public policy.

          Their bunk permeates other groups like the AMA, the result is death, and that’s just for starters.

          Death is literally the cost of setting dietary guidelines not by the guidance of health promotion but by the benefit of the food and agriculture industries. And the benefit is what? What are “we” getting in return for all that death? That would be protecting the profits of some companies, so “we” aren’t really getting anything. “We” just suffer the cost of this public policy failure.

          The result is also massive human misery. I wonder if the millions of teens now obese with what we used to call “adult onset diabetes” but stopped because we’re in the midst of an epidemic of childhood-onset diabetes are happy. I wonder if the person who can’t walk a flight of stairs because of their diet-caused diabetes or heart disease or obesity is happy, or an optimally productive member of society.

          I would strongly suggest they are not, and our public policy – specifically the promotion of profits over health – is clearly to blame.

          Out of disgust, people are beginning to revolt against the tobacco company-esque tactics of processed food, chemical company, and beef, dairy, and other industry advocacy groups. GMO labeling laws, sugar warning labels, A sugar-sweetened beverage tax in my city and I’m sure in the future others, and of course the myriad dietary advocacy groups and websites like nutritonfacts.org that exist to fill the void left by a failed public policy.

          And when it’s all said and done, you know who will be the casualties? That will be the millions of people – men, women, and children – who sickened and died, or lived in misery because our government failed to do the thing a government needs to do, which is advocate for the health of its citizens and set policy accordingly. It will also be society as a whole, because untold trillions in human capital and national wealth will have been squandered as they were replaced by misery and disease.

          And the casualty will also be faith in the idea of collective self-government itself. If our government lied to us…failed to step in and give us the truth…failed to give us information to protect us and protect our health…and not only that, our government actually told us stuff they knew to be untrue because doing so led to higher profits for some, and they did so knowing it would lead to disease and death…well, I’m afraid that’s something that just can’t stand, and you can make a strong argument that our 250 year old experiment in self-government has failed.

          Dramatic, yes, but not overly so. There is in my view just one thing that could end this country as we know it. That thing is a loss of faith and distrust that results from being lied to repeatedly, covertly, and intentionally, by people looking out for their own self-interests willing to do so even if it leads to death and misery for millions of men, women, and children.

          /rant, though I could continue.




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    2. I would agree that our bodies are designed to help us survive. I believe that the balance of science over the last number of years supports that we should minimize the intake of animal products. Looking at it from a systems perspective our biological system is a “hind gut fermenting herbivore” who was a “hunted gatherer” until we invented weapons to hunt. Our food has changed substantially over the last 100 years. Given processing and the addition of chemicals to our food either directly or via the environment we need to minimize the intake of persistent organic pollutants. We can consume many things that are harmful but we don’t get sick immediately. Not only is it a matter of time but also amount (i.e. the dose makes the poison). Cholesterol is necessary for our bodies but taking in more than we need may not be the approach which leads to the best long term health.




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    3. There’s most definitely an effect of dietary cholesterol on serum cholesterol as determined in metabolic ward studes, only the effect size within “normal” dietary variation is small (100 mg add’l might be expected tor raise TC 2.2 mg/dl) compared to the effect size from other modifiable factors, like dietary saturated fats. For those of us on cholesterol free diets and with very low blood levels, dietary cholesterol is more efficiently absorbed.

      The current wave of Mendelian randomization studies, in which genetic predispositions to elevated risk markers are correlated with clinical events, offers best evidence to date that elevated LDL plays a major causal role in cardiovascular disease in humans: (1, 2, 3, 4).

      Your body isn’t actively trying to kill you, but nature seems indifferent to our fates after our reproductive years. The modern era, with increased dietary cholesterol and saturated fats (both of which increase blood levels), and decreased dietary phytosterols and intestinal worms (which formerly reduced cholesterol levels) have dramatically increased life long exposures to elevated LDL.




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        1. Metabolic ward studies are medium term (days to months) nutrition studies where all food is provided to subjects, commonly conducted with volunteer prisoners in prison hospitals. These are the most “controlled” studies in humans, but due to their high expense and some ethics concerns with incarcerated subjects, are less common than in their 1950-70s heyday.




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    4. tkramer: re: “The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.”
      Your logic escapes me. The body makes bone and cells and blood too. And too much of any of those things or when put in the wrong place will kill you. We are talking about disease, which could be thought of as a natural process going awry. For example, when a body makes say too many red blood cells or not enough of them. The fact that your body makes cholesterol is irrelevant.

      Another way to think about it: Your statement is a strawman argument when the questions are: 1) Does dietary cholestrol lead to increased cholesterol in the body? and 2) Is increased cholesterol in the body an indication of increased risk for heart disease and early death? We have clear answers to both of those questions. You can find out some of the science behind these questions and answers here on NutritionFacts. This video is one great example. But since Ancel Keys work is so important to you, I highly recommend taking a look at the videos from PlantPositive.com who directly addresses Ancel Key’s work as well as the questions being discussed. It will be an eye opener for you.

      http://plantpositive.com/display/Search?moduleId=19496100&searchQuery=ancel+keys




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  23. there is this diet call balance point diet that cut out grains ( which is a staple of all vegan diet ) and the heart turn back the clock by 30 years.

    Then, for two weeks, he played the guinea pig. He drenched everything from kale salads to steamed okra with olive oil and ate only the most low-fat proteins such as fish and egg whites. Every day, he kept his dietary intake within the above percentages and cut out all grains, starchy vegetables and saturated fat — fat originating from an animal sources — to solve his cholesterol problem.

    Cholesterol, a soft, fat-like substance both manufactured by the liver and supplied by diet, helps maintain health by circulating through the bloodstream to generate cell membranes and some hormones. But too much cholesterol can stick to vessel walls and clog blood flow enough to produce a heart attack or stroke.

    Doctors measure cholesterol in two basic ways. High-density lipoprotein, or HDL, carries cholesterol away from the arteries and is therefore dubbed “good cholesterol.” Low-density lipoprotein, or LDL, clogs arteries and is considered “bad” cholesterol. Those with unhealthy cholesterol counts ultimately aim to bring good cholesterol numbers up and bad cholesterol numbers down.

    Selby’s doctor balked at measuring his cholesterol counts after just 14 days. But the results seemed to back the Boulder man’s health hunches.

    His “bad” cholesterol LDL levels dropped from 117 mg/dl to 75 mg/dl, and the “good” cholesterol levels rose from 83 mg/dl to 106 mg/dl. The American Heart Association recommends that people at high risk for heart disease keep LDL numbers below 100 mg/dl and HDL numbers for men at 40 mg/dl and 50 mg/dl for women.

    “This has sort of been like my DaVinci code,” Selby said.

    When he shared the good bill of health with his coffee klatch at 6:30 a.m. the next day, they probed him for more information about his BalancePoint Diet.

    By this spring, 10 of them — five women and five men, ages 28 to 69 — decided to try the diet for two weeks and get their before and after cholesterol counts measured at Boulder Community Hospital. The two participants already taking statin drugs to improve their cholesterol continued taking that medication in conjunction with following the diet.

    Like Selby, they carried around olive oil and scales to accurately weigh foods to the gram. Then, they logged their food diary information into a data base. By the end of the two-week pilot trial, all reported improved cholesterol readings, Selby said. The participant reporting the most dramatic numbers dropped 81 points in the LDLs.

    On its Web site, the AHA notes that some studies show monounsaturated fats such as olive oil lowering LDL cholesterol “slightly when eaten as part of a low-saturated- fat diet.”




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  24. I was diagnosed a type 2 diabetic years ago and went vegan about 6 months ago. After my last annual check up the Simvastatin was removed from the daily pills and the Glucophage reduced by half to 500mg a day. Another check up in 3 months to see how i am doing.




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    1. Andrew: Awesome, keep up the great efforts! I wonder what lifestyle are you doing each day. Have you looked up and watched the videos about the whole food plant-based way, ground flax seeds, cinnamon, and today’s about fiber? All exceptionally stabilizing for blood sugar …




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  25. Doctors in Spain encurrage patients to eat eggs and meat when total cholesterol is under 70 ml-dl.. actually its call it hypocholesrolemia (and doc take it that way from 160 ml-dl). Knowing that the normal cholesterol should be lower, when it will be to low acording to the new studies?




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    1. the argument it is that low cholesterol level drow to depresion.. but if you check thats studies they didnt look in the leveles of Omega 3, and it may be that low fat eaters also eat low leveles of other nutrients aswell. sorry for my english!




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      1. I understand that Spanish studies showing links between low cholesterol and suicide were contradicted by a subsequent US study which actually showed a lower risk of suicide in people with low cholesterol.
        https://www.aacp.com/pdf%2F0811%2F0811ACP_deLeon.pdf

        Statin studies show no increase in suicide in people with resulting lower cholesterol. In the light of this and the US study above, it is likely that associations between low cholesterol and depression.suicide are due to confounding factors. Possible confounding factors include malnutrition, heavy drinking, heavy smoking, cancer and other chronic diseases …all of which are believed to result in low cholesterol.




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  26. Noe Marcial: I understand your English :) . I agree, they probably weren’t putting ground flax seeds on their whole plant foods every day!
    And, good ideas for more whole research. In the meantime, for your interest, see videos Can Cholesterol be Too Low? and, Don’t Forget Fiber




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  27. What if your LDL is on the high side (134) but your HDL is very high and you have a low ratio (2.6), should you be concerned if you have a total of 234?




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  28. Hey Dr G and others!

    So I 17 years old, and have recently become a vegan having watched your videos. No, not a vegan that eats vegan bags of chips but a diet with a lot of fruits and veggies. I recently found out though I was not consuming nearly enough calories per day (only 1500 generally). In any case I have started to consume a lot of brown — and now — red rice to bring up my caloric intake.

    In any case the reason I am commenting is because I am seeing mixed messages about how much cholesterol we need. I don’t think I am getting ANY from my diet and am wondering if this is a bad thing and how to get it to optimal levels?

    Beyond this if anyone could point me in the direction of a video demonstrating a meal plan almost to help me figure out what to get. I have been consuming a ton of vegetables, but never getting full and not enough calories. I also have chronic diarrhea, (with undigested food in my stool sometimes), really bad acne and other issues. These all started much before I became vegan; though I have been working at farmer’s markets and into the health food world for a while and was under the impression I was eating healthy.

    If anyone could help me out that would be amazing & very much appreciated !

    Thanks

    Jake




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      1. Hi, I have been dairy free with a a few (10 maybe) uncontrollable dairy intakes. So it has been quite a while.
        Just started consuming beans. I am curious though how much beans per week is ideal? I would really LOVE to find some sort of plant based meal plan (ie. Breakfast – rice & beans & veggies , lunch – sweet potato & beans, etc.)




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    1. Hi Jake,

      Let me say that there are a lot of variables here (physical activity, time being vegan, medications (esp. antibiotics), typical day of eating, etc), but let me try to give you some general help and let me know if it sounds good.

      It is very rare for you to not have enough cholesterol in your body. Our bodies are extremely efficient and would never let our cholesterol get so low that it could hurt us. It is just up to you to eat a well balanced diet, so along with lots of fruits and veggies make sure to throw in some whole grains, beans, legumes, etc. Here is a great resource to help you on your new journey to a plant based diet. Definitely use this as a guide for your meals.

      As for you never getting full, i would say that depending on your plate size, this is a good thing. We never really want to eat until we are “full” just eat until you are satisfied. How you eat can have a big effect on your fullness and digestive health. If you are a very fast eater you will not feel as full and you may have diarrhea and see chunks of food in your stool. This is especially true for high fiber fruits and vegetables (they need some good chewing). Practice some Mindful Eating techniques and really chew your food to see if that helps.

      At 17 years old, I say that acne is pretty common, but keep up the clean eating and living, and you might see a change. If you ever think about consuming dairy again, watch this. What we eat is a huge part of our health, but our environment also plays a huge role. Environmental toxins from our home, hygiene products, etc can have an impact on our health as well. Check out the EWG website to see which products are best to use. They give great science based guides on all of our everyday products. The idea here is that acne is an immune response, so decreasing potential autogens or pro-inflammatory chemicals can decrease acne.

      Well Jake, I threw a boat load of info at you, so let me know if you have any questions or need some further clarification. I wish I was as health conscious as you when I was 17, so I definitely admire your thirst for knowledge and health! Wish you all the best.




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      1. Thanks a lot for taking your time to respond ! I really appreciate the information and resources.

        Mainly right now I just want to make sure I am getting a balanced diet, getting all the nutrients, etc. that I need. Honestly, I haven’t taken any B12 so I am certainly deficient but plan to order some online to get it nice and cheap.

        Thanks again for the resources, it is very much appreciated and extremely helpful !




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    2. JakeN: This is one of my favorite questions! You have made a decision to make a change. Now you want to know how to do it right. Good for you!!

      I have some resources that I think you will find very helpful. First, here are Dr. Greger’s overall nutrition recommendations. It’s not quite the meal plans you are looking for, but it gives some great general advice that you will want to keep in mind, including B12:
      http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      As for how to put together meals that are good for you, check out the following graphic from PCRM, Physician’s Committee For Responsible Medicine. What I like about this graphic is it’s simplicity. It shows how you don’t have to make healthy eating be all that complicated. I would recommend adding a side cup of 1-2 ounces of nuts and seeds to the graphic. But other than that, it is really helpful.
      http://www.pcrm.org/health/diets/pplate/power-plate

      If you generally follow the PCRM guidelines, it should help eliminate your hunger issues. You need to get enough calories, and that is hard to do *only* eating such bulky foods as veggies. You want at least half of your food to come from whole starchy foods of grains and legumes. Plus, as an active teen, who may need more calories relative to your body weight compared to an adult (I think), those nuts and seeds may be especially important for you as they are calorie-dense foods.

      I can do even better than the Power Plate to address your meal plan request. How about 21 days worth of meal plans, recipes, videos, inspirational messages, and a forum where you can ask questions! 21 Day Kickstart is a free program, from PCRM, which you can sign up for in the following link. You don’t have to follow all of those recipes/plans. But it will give you a good idea of what a healthy diet looks like when it comes to the details of what to actually eat:
      http://www.pcrm.org/kickstartHome/
      (Click the green “Register Now” button.)

      I have a couple more suggestions: Check out the book, The Starch Solution. This seems to work very well for lots of people, is very healthy, and includes recipes in the back of the book.

      Get a copy of Jeff Novick’s Fast Food DVD series. Jeff does a great job of giving simple (10 mintues!), tasty, extremely healthy recipes, all in a mini cooking show format. Here’s one to get you started:
      http://www.amazon.com/Jeff-Novicks-Fast-Food-1/dp/B00466DP42/ref=sr_1_1?s=movies-tv&ie=UTF8&qid=1418772380&sr=1-1&keywords=fast+food+jeff+novick
      The burgers and fries DVD is a good one too.
      —————
      I believe that other people have addressed your cholesterol concern. Since your body makes all of the cholesterol that it needs, you don’t have to consume any in your diet. In fact, consuming cholesterol is not healthy.

      I hope this helps!




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      1. Thank you SO much for the response ! I will check out these resources and really look forward to putting all of this incredible wealth of knowledge and information to practice. I want to make sure I do it right ! After all, it is my health (which isn’t doing great— largely due to stress) which is the greatest investment I can make.

        Thanks again!




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  29. awesome-you just made all of the peeps who want to push statins extraordinarily happy. and cholesterol levels that low have been associated with many other disease-Love plant-based diets with adequate protein but this video is slanted and garbage. those levels are currently only part of the guidelines for people that have already had a cardiovascular event or have a “cardiac equivalent” like diabetes….plenty of patients who get their levels here still have heart attacks and strokes- I have seen it… simple carbs are the REAL problem…




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    1. Sure, people can get their levels down low and still have heart attacks and strokes, especially if levels over the lifetime were very high and if the diet still has factors which advance the disease process in a more acute way. LDL is a major substrate of atheromas over the long term but I don’t think that anyone would propose that it is the only thing that can cause existing plaque to rupture.

      You seem to be proposing an all-or-nothing fallacy. Just because some patients still face risk when lowering LDL through statin therapy does not mean that lowering LDL to low levels is unimportant, let alone that statins’ lipid-lowering effects aren’t valuable in the therapy of some patients. For that, you do have to look at the amount of cardiovascular risk reduction and weigh it against the risks posed by the statin. I would be among the first to say that statins have some bad effects and that a healthy diet is preferable, but for patients who do not change their diet, a statin may be prudent. Or at least, you haven’t presented evidence which would move my views further away from that position, given that your post really hasn’t presented any evidence at all.




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    2. You seem angry and you aren’t convincing. The “real” problem? As opposed to the fake one we’re focusing on here? And what are you arguing about the “association” between low cholesterol and certain diseases? I can’t imagine your point. Honestly, your post comes off as reactionary and overly simplistic.




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    3. “cholesterol levels that low have been associated with many other disease” – you aren’t aware then that many chronic diseases (including cancer) and traumatic injury cause low cholesterol? Not to mention some viruses, parasitic infections and heavy smoking and drinking? As for statins, obviously they are not an ideal solution but this meta analysis indicates net benefits and shows that there was no consequent increase in cancer or other all-cause mortality (also indicating that the observed associations between low cholesterol and “many other diseases” is probably not causal):

      “This meta-analysis included individual participant data from 22 trials of statin versus control (n=134,537; mean LDL cholesterol difference 1·08 mmol/L; median follow-up 4·8 years) and five trials of more versus less statin (n=39,612; difference 0·51 mmol/L; 5·1 years). Major vascular events were major coronary events (ie, non-fatal myocardial infarction or coronary death), strokes, or coronary revascularisations. …………..

      Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0·79, 95% CI 0·77-0·81, per 1·0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories (RR per 1·0 mmol/L reduction from lowest to highest risk: 0·62 [99% CI 0·47-0·81], 0·69 [99% CI 0·60-0·79], 0·79 [99% CI 0·74-0·85], 0·81 [99% CI 0·77-0·86], and 0·79 [99% CI 0·74-0·84]; trend p=0·04), which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0·57, 99% CI 0·36-0·89, p=0·0012, and 0·61, 99% CI 0·50-0·74, p<0·0001) and in coronary revascularisations (RR 0·52, 99% CI 0·35-0·75, and 0·63, 99% CI 0·51-0·79; both p<0·0001). For stroke, the reduction in risk in participants with 5-year risk of major vascular events lower than 10% (RR per 1·0 mmol/L LDL cholesterol reduction 0·76, 99% CI 0·61-0·95, p=0·0012) was also similar to that seen in higher risk categories (trend p=0·3). In participants without a history of vascular disease, statins reduced the risks of vascular (RR per 1·0 mmol/L LDL cholesterol reduction 0·85, 95% CI 0·77-0·95) and all-cause mortality (RR 0·91, 95% CI 0·85-0·97), and the proportional reductions were similar by baseline risk. There was no evidence that reduction of LDL cholesterol with a statin increased cancer incidence (RR per 1·0 mmol/L LDL cholesterol reduction 1·00, 95% CI 0·96-1·04), cancer mortality (RR 0·99, 95% CI 0·93-1·06), or other non-vascular mortality."
      http://www.ncbi.nlm.nih.gov/pubmed/22607822




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  30. I just wanted to add a few figures based on the current recommendations for the USA & UK.

    According to this video by Dr Greger, the latest research shows that optimal LDL cholesterol levels should be between 50mg/dl – 70mg/dl (in the UK that equates to 1.29mmol/L – 1.81mmol/L).

    The UK’s cholesterol guidelines show the desirable levels to be below:
    – 5mmol/L (193mg/dl) for Total Cholesterol.
    – 3mmol/L (116mg/dl) for LDL.

    The USA’s cholesterol guidelines show the desirable levels to be below:
    – 5.18mmol/L (200mg/dl) for Total Cholesterol.
    – 2.59mmol/L (100mg/dl) for LDL.

    Again, I thought this might be useful for others reading this to know what the current UK & USA cholesterol guidelines say are desirable levels.




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    1. Scott: What a helpful post. It does a great job of pointing out how problematic the USA and UK’s guidelines are. Those guidelines claim to be “desirable levels”, when in fact, they are way too high.

      These bad guidelines lead to confusion. They lead to people understandably making the argument: “Look at the stats show that a huge percentage of people with ‘desirable levels’ of cholesterol still get heart attacks! So, cholesterol has nothing to do with heart attacks.” Instead, what is really going on, as you point out, the official guidelines are way too high. The NutritionFacts video on this page shows where the safe levels are. Those government figures are more like “averages in our sick society” levels. That’s not helpful for people trying to figure out how to eat healthy.




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  31. 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”




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  32. The optimal cholesterol level for every individual is unique for the reasons outlined below.

    China study data suggests that it is relative: “What made this so surprising was that Chinese levels were far lower than we had expected. The average level of blood cholesterol was only 127 mg/dl, which is almost 100 points less than the American average (215 mg/dl). …Some counties had average levels as low as 94 mg/dl.”

    In the China study those that ate a lot of animal foods and had a total cholesterol 130 had heart disease because their natural baseline was closer to 90. Furthermore, Total cholesterol and LDL cholesterol are important factors but a recent studies implies that HDL cholesterol level is perhaps the most important factor. http://www.ncbi.nlm.nih.gov/pubmed/19081406

    One can surmise that the “optimal” blood level for each individual is unique and dependent on different environmental factors and ethnicity. For example, one study noted that “shorter adult leg length” was associated with higher LDL and total cholesterol. http://www.ncbi.nlm.nih.gov/pubmed/17325398

    Also of note, lipid levels vary depending on ethnicity. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721871/

    Based on the above data, personally, I have no concern with heart disease. I have been vegan since 1998 and I run about 50 to 70 miles per week. I am 5’ 11’’ and 163 pounds and have been the same weight since high school. My lipid panel checked this week was HDL 88, LDL 87, Total cholesterol 188 and TG 60. I am 38 years old and have been checking my lipid panel every year for about 15 years and it has always been excellent and I have NEVER had a total cholesterol below 150. Currently, I am not convinced that a global policy of driving everyone’s total cholesterol below 150 is prudent. I evaluate each patient’s lipids in a case by case basis and help them find their baseline.




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    1. I don’t really see what in your post points to the hypothesis that adults have widely-varying levels of critical serum cholesterol, where I mean ‘critical’ in the sense that would identify the worst levels possible that still carry minimal risk. Yes, the ‘baseline’ cholesterol under fixed developmental and pharmaceutical conditions will vary from one person to another, but what makes you conclude that this variation in this baseline level doesn’t modulate risk?

      You present a cross-sectional study showing that more people being admitted for CAD have HDL below the recommended target than those who have LDL above the recommended target for LDL. About the same numbers of people have LDL<70 as are on lipid-lowering medications, and the authors state that high LDL was associated with the non-use of lipid-lowering medications. Is there perhaps a confounding effect here, where people with low LDL tend to be unhealthy in other ways, which is why the statin bandaid was put on their still-unhealthy lifestyles?




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  33. I’ve been vegan for five years and still have an elevated cholesterol level, so apparently just following a no-cholesterol, plant-based diet is not enough. Dr. Greger, what else do you recommend as a way to lower my levels? I would like to avoid drugs. Do you ascribe to Dr. Esselstyn’s regimen? FYI, I am 56 and overweight.




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    1. Ursula2007: I think it is worth considering Esselstyn’s diet because he has been proven so successful. Sticking with whole foods and low fat (with the exception of nuts) makes sense to me.

      But I have another idea too. How about tweaking your diet to include those plant foods which have been shown to lower cholesterol? In other words, when you went vegan, you gave up foods that are bad for your health. How about now, focusing on *adding* particular foods that are likely to help with your particular concern. There are several videos on this website that lists these foods. (I can’t get a good enough search to bring up only those videos. So you have to look around.) I think that trying multiple of these foods/approaches rather than just one makes the most sense.
      http://nutritionfacts.org/?s=lower+cholesterol

      Good luck.




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    2. Thea’s advice is sound. However, you may also need to lose weight before your your cholesterol improves:

      There is an interesting article on being overweight and its effects on lipids like cholesterol. It is quite technical but it concludes:

      “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”.

      http://www.ncbi.nlm.nih.gov/pu

      It is therefore possible that your system and metabolic response to eating a healthy diet won’t result in optimal cholesterol numbers until you are in a healthy weight range




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  34. Since being a vegan the past year with increased exercise, reduced calories, legumes at every meal, my cholestrol has gone up. While my good HDL has gone up , my bad has as well (tri’s took a dive as well as BP). I’m wondering how this is possible to go from a guy who ate steak and pizza 4 to 5 nights a week, to someone eating nothing but veg’s, cooking without oil, and juice fasting for the first part of every day( actually I did the same as an ominvore ) , eating nuts, and a gluten/ soy based mok meat now and then, lost 40 lbs as well. Any advice ? I’m totally confused as to how this would be possible and was shocked when I just got my numbers. Makes me wonder if something else is wrong systemically, but blood tests didn’t indicate anything.




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    1. That is a puzzle. But it was only one test, I assume? It may just be an outlier. Also, is it possible that you were in some way stressed at the time? Stress can raise cholesterol in some individuals eg
      http://www.medicalnewstoday.com/releases/34047.php

      Another possibility is the mock meats, I gave up eating mock meats when I saw the ones I had been using, and which were advertised as suitable for vegetarians, actually contained eggs. Trans fats and sugar are other possible possible causes of raised cholesterol and may be found in some margarines in the US
      http://www.webmd.com/cholesterol-management/understanding-cholesterol-problems-basics

      Hyperthyroidism is also a possibility (as is anorexia bit I’m assuming your “reduced calories” aren’t that reduced!).
      http://cholesterol.about.com/lw/Health-Medicine/Conditions-and-diseases/Can-Diseases-Cause-High-Cholesterol.htm

      You should really discuss this with your physician.




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      1. Unfortunately my Physicians advice is to go on statins, something I became a vegan to avoid. As for the Mock meats ( beyond meat and litelife ) ,the ingredients don’t appear to be bad. And the use is a few times a week and minimal in quantity. I don’t do sweets but infrequently ) As for Hyperthyroidism wouldn’t a complete blood work up indicate that ? Lastly stress is always a given when I visit the Dr.. My old diet was super carnivore and loaded with pizza, cannot imagine how that gave me better cholestorol than eating legumes and veggies till them come out my ears. Perhaps it was a fluke , but I was expecting very low cholestorol, not higher.




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        1. I am sorry to hear that. I have a couple of thoughts:

          1. Stress, smoking, alcohol and coffee (if you don’t use paper filters) all raise cholesterol.Re coffee see thishttp://www.sciencedaily.com/releases/2007/06/070614162223.htm
          Also trans fats in margarines and some vegan/vegetarian foods raise LDL cholesterol
          The figures show that wholefood vegans have on average very low cholesterol. But not all of us are average. Perhaps you could focus on foods that actively lower LDL cholesterol like oat groats, steel-cut oats or rolled oats (old-fashioned oats)? This link might help ..
          .http://www.webmd.com/cholesterol-management/guide/cholesterol-management-food

          2. I don’t know what your weight is (or was) but this could be a factor if you are overweight. There is an interesting article on this. It is quite technical but it concludes: “diets low in saturated fat and cholesterol are less effective in the obese. The most effective way for obese people to normalize their blood lipids is to lose weight”. It is therefore possible that your system and metabolic response to diet won’t work normally unless you are in a healthy weight range
          http://www.ncbi.nlm.nih.gov/pubmed/16256004




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    2. I was on Liptor for about 10 years and my total Cholesterol was 4.5 mmol/l ( 174 mg/dl ) then I decided to change my diet and be vegan and eventually stopped the Statin.

      I was shocked to see my Cholesterol when up I have being doing the blood test every 3 months :

      6.6 mmol/l ( 255.22042 mg/dl),
      6.8 mmol/l (262.9 mg/dl)
      7mmoll (270.68 mg/dl).

      Really confused and I don’t want to take the statin again on the same time I don’t know how to lower my munbers.




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    3. I knew that smoking and alcohol can also raise cholesterol but I didn’t know that (black) coffee can do this also. Perhaps this might be a factor in your case?
      “….cafestol is the most potent dietary cholesterol-elevating agent known, said Dr. David Moore, professor of molecular and cellular biology at BCM, and Dr. Marie-Louise Ricketts, a postdoctoral student and first author of the report. Cafetiere, or French press coffee, boiled Scandinavian brew and espresso contain the highest levels of the compound, which is removed by paper filters used in most other brewing processes. Removing caffeine does not remove cafestol, however.”
      http://www.sciencedaily.com/releases/2007/06/070614162223.htm




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  35. I have scar tissue on both kidneys, because of this I have HBP, and my cholesterol is over 200. I am 129 pds and on a vegan diet with excerc
    ise 3x a week. I am seeing a ND for help trying to lower these numbers, What else is there to do, my numbers havent gone down.




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  36. Thank you for posting the article Thea it was very helpful. In the news I am reading that there is no correlation between cholesterol and negative health effects. How are they getting away with this? They are stating that Cholesterol is no longer a “nutrient of concern”.




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    1. In my lay opinion, your post exemplifies the problem with the new dietary guidelines.

      They actually aren’t saying there is no correlation between cholesterol and negative health effects. They’re saying the effect of dietary cholesterol on blood cholesterol is such that people don’t need to be concerned with dietary cholesterol…

      and the critique I’m seeing is that this leads to confusion in the public’s mind between dietary cholesterol and blood cholesterol, which we do need to be concerned about.




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    2. I think that this decision is based on a lot of recent “research” funded by eg the American Egg Board which appears to show that additional dietary cholesterol has no effect on the serum cholesterol of people eating a normal US diet. However, it has been known for many decades that the effect on serum cholesterol of additional dietary cholesterol is dependent upon baseline dietary cholesterol eg

      “Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is
      modulated by baseline dietary cholesterol. The greatest response is expected when baseline dietary cholesterol is near zero, while little, if any, measurable change would be expected once baseline dietary cholesterol was > 400-500 mg/d. People desiring maximal reduction of serum cholesterol by dietary means may have to reduce their dietary cholesterol to minimal levels (< 100-150 mg/d) to observe modest serum cholesterol reductions while persons eating a diet relatively rich in cholesterol would be expected to experience little change in serum cholesterol after adding even large amounts of cholesterol to their diet."
      http://ajcn.nutrition.org/content/55/6/1060.long

      Most Americans already consume significant amounts of cholesterol. This "old" cholesterol science has therefore allowed producers of high cholesterol foods to fund modern studies that they know beforehand will produce results that appear to show that added dietary cholesterol has little or no effect on the serum cholesterol of Americans. To be fair though, we also know that there is considerable individual variability in the response to dietary cholesterol – some people are hyperresponders while others are hyporesponders.




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  37. I am 54 and have been a vegan for over 3 years now, am not overweight, and exercise moderately and yet my cholesterol levels are still fairly high: Total 206 and LDL 123. What gives? Any ideas?




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  38. wow this one really clears up a lot of confusion out there, and yest i have watch all of plantpostives videos, which were amazing of course. HOWEVER, can anyone comment on idea that cholesterol does not cause heart disease??? the argument is that the brain is mostly made up of cholesterol and if you lower cholesterol too much, you start to have memory problems, decreased brain function,etc. : those such as dr david perlmutter (grain brain), dr. mercola, the entire weston a. price foundation, and dr. stephanie senuf. they would probably say that you can eat all the eggs you want bc cholesterol doesnt cause heart disease…in fact, heres a CNN report that says cholesterol doesnt matter! http://www.cnn.com/2015/02/19/health/dietary-guidelines/. anyway, wonder if dr g could comment or maybe do a video as a rebuttal to these theories. thx.




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  39. That’s why I don’t trust the government – it’s like a wolf in sheep’s clothing. Lecturing about lower and middle class, but caring only for super rich and Big business monopolies.




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  40. What would you say to an individual whose total cholesterol has not budged from the 280 range (HDL about 110) despite being on a rigorous whole food, plant-based SOS (no added sugar or salt and almost no added oil) diet for more than four years. I have heard of a number of cases, especially among females, of people whose cholesterol numbers don’t move despite an optimal diet and a well above average, consistent exercise regimen. The recent release of research results dealing with the issue of the amount of dietary cholesterol compared to that naturally produced by the individual is very interesting in this light.




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  41. A week or so ago, NBC news said that the gov’t was going to drop the recommendation to avoid cholesterol from its dietary recommendation. They were keeping sat fat… and sat fat and cholesterol tend to be in the same animal based foods. It has been known for quite awhile, though, that a person’s cholesterol is not a good predictor of heart disease… and that cholesterol lowering drugs don’t increase life expectancy. There is just no substitute for eating a plant based diet.




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    1. “a person’s cholesterol is not a good predictor of heart disease.”

      …that is when the average is already dangerously high. A single bullet loaded gun is a poor predictor as to who will die from a game of Russian Roulette. While an unloaded gun (low cholesterol) is an excellent predictor as to who will survive.

      Or like my father says “I’ve been eating this way all my life and I’m still alive”. Existential indeed. I expect Atkins said the same until the last.




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      1. Good comment. I have known people, like my wife, that do not eat well and have low cholesterol and low blood pressure. I hope she lives a long time, but I would feel a whole lot better if that low cholesterol was from following a plant based diet (it isn’t),




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        1. I’m kinda in the same boat. My lady is in perfect shape (perhaps too thin). I suspect she’s very healthy, but I’d like her to go (semi-) vegan for my sake. I’m tired of cooking twice and eating the ‘other option’. We have no idea our cholesterol levels.




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          1. It seems like it is usually the female of the couple eating healthy and the male eating steak and eggs. Glad to hear there are at least 2 of us.




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  42. I’ve given up dairy and need to replace the 1/2 qt of milk daily with some other form of protein for my post workout protein shakes. I’m using Whey protein now but it is still dairy. What should be the base for my protein shakes? Eating a bowl of beans after the gym doesn’t seem interesting. Age 72 and still damn healthy eating fish and plants and working out 6 days/week. Thanks in advance for help.




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    1. rhart: Good for you for doing so well. I wish I really worked out 6 days/week.

      I’m wondering why you think you need a protein shake at all? How about just a healthy shake/smoothie? If you work your way through the following article, you will get a very good idea of the needs humans have for protein, including active humans.
      http://michaelbluejay.com/veg/protein.html

      I would say that there’s doesn’t appear to be a need to add special protein to the diet. Contrary, it seems more likely that we would be wise to make sure we don’t get too much protein. Older people may have higher protein needs than younger people. But that still doesn’t mean that older people can’t over-dose.
      >> Check out the January 2004 newsletter and the article on protein overload:
      http://www.drmcdougall.com/health/education/newsletter/archives/

      Something to think about. This could free you from both your worry of needing to have protein over-rich foods and from eating that whey.




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      1. rhart: I meant to also add: If the above information doesn’t seem compelling to you and you still want a protein-ladden shake, some people like to add hemp seeds, which are supposed to be high in protein. Other people use vegan protein powders *marketed* to athletes or just for general health. Here is page that lists 7 brands of vegan protein powders:
        http://www.onegreenplanet.org/vegan-health/7-must-try-vegan-protein-powders/

        Again, I wouldn’t recommend or use them. But if someone felt that they really needed it, I would expect these products to be a whole lot healthier than whey.

        Good luck.




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      2. Wow. I read carefully the Bluejay article and learned a lot. I did not realize the level of protein in veggies. I still need extra protein to get to my 75g per pound but I’m now comfortable kicking the Whey protein and going with pea protein or tofu smoothies. Very Very helpful and informative. Thank you




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        1. rhart: Awesome. I refer people to that article all the time. You are one of the very few people who actually read it. I’m so glad you did. I found it so incredibly helpful myself. Best of luck to you.




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  43. There is a large number of heart specialists that rely on oxidized LDL measured with the VAP test, not total cholesterol. The claim in this video is way out in left field, unlike most of your vegan claims, which I can confirmed from unrelated sources. Claims like this require multiple studies, preferably, Cochrane meta-analysis. The likelihood of a single cause for heart disease is nil given the complexity of human metabolism. Too low a cholesterol number is much more of a risk factor, since vitamin D is produced from it.




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    1. “Too low a cholesterol number is much more of a risk factor, since vitamin D is produced from it.”

      I challenge you to support that, specifically with a numerical cutoff about what may be too low. Leaving aside the subtext behind your appeal to what is basically the vitamin-cure-all du-jour, what evidence is there that the body can’t regulate its cholesterol well without exogenous forcing from saturated fat and dietary cholesterol?

      There can be very important causes in complex systems. Wildfire has complex structure, but without oxygen in the air, there’s no fire. Similarly, cholesterol is a large fraction of plaque, and LDL is the vehicle which delivers most of the atherosclerotic material to the intima where macrophages respond. LDL is a rate-limiting step in much of the atherosclerotic process and we’d expect that by lowering the concentration, lower atherosclerotic progression would result and that the regressive processes would be larger in comparison, all else being equal.

      Your admission that the body is a complex system is precisely why you should be cautious in extrapolating from preferred biomarkers for distinguishing people with high risk of CVD from those with imminent risk. When the usual biomarkers are already bad, of course you may have to use something else, but that doesn’t mean that these sort-of “tie-breakers” should be used in other circumstances where the more reliable risk factors differ vastly.

      LDL less than 70mg/dl is probably good, and even if there aren’t large amounts of controlled experimental data to show this, you should consider the many other ways in which this idea is plausible. You should also consider that the most recent Cochrane meta-analysis of 5 statins for the primary prevention of CAD concludes that this treatment is indicated, and that the treatment of the hyperlipidemic patients in the studies resulted in LDL lowering of around 40mg/dl on average. http://www.ncbi.nlm.nih.gov/pubmed/23440795

      The Lifestyle Heart Trial by Ornish et al also got fairly close to LDL of 70mg/dl in the treatment group (mean 86.56mg/dl), though their sample was small. On the other hand, weight loss during one year was not exactly ideal and it looks like many of the experimental patients were still overweight at the end of 1 year. http://www.ornishspectrum.com/wp-content/uploads/Intensive-lifestyle-changes-for-reversal-of-coronary-heart-disease1.pdf




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  44. Is it possible to have too low cholesterol? My husband’s doctor told him that his was the lowest he had ever seen. My husband also has low blood pressure. He does get light headed dizzy spells regularly. We are vegan and eat a wholefood plant based diet and have done for many years. Any suggestions what would pick up his blood pressure? It is 90/55. My husband is 58 years old. He is 5’7″ and weighs around 60 kg or less.Thank you.




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  45. Beef Magazine contributors and comment section shows an impending sharpening of knives to cut off any medical information regarding cholesterol. The government itself is sending two messages. Saturated fat bad, cholesterol OK; http://beefmagazine.com/blog/3-ways-government-committee-got-it-wrong-dietary-guidelines How can anyone decipher the real truth and not get frustrated and day the heck with it? For me, what I eat isn’t just about me but most others it is.




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  46. CVD is a nutrient deficiency, which is guaranteed in the SAD. Cholesterol is just a side effect of damage caused by inflammation, it is the repair substance the body uses to patch the damage caused by inadequate vitamin C and the proper amino acids needed to maintain the large coronary arteries. Diet has very little to do with cholesterol levels, the body makes it. The brain needs it…..decrease your cholesterol with drugs and studies show you get increase suicides and violent behaviors.
    Eating a plant based diet means higher nutrients, vascular protection and your body isn’t inflamed so you need less cholesterol to patch up any damage. High cholesterol indicates hypothyroidism…….look it up




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    1. Cite reasonably high-quality research backing some of your claims. For instance, show me a study showing that treatment with statins is associated with violent behavior. Identify the “proper” amino acids which are somehow abundant in comparatively low-protein plant based diets which lower cholesterol. Show me studies where vitamin C supplementation lowers cholesterol. Explain why it is that adding egg yolks to a diet containing zero cholesterol would raise serum cholesterol. Last I checked, this wouldn’t do anything to reduce amino acid intake and it wouldn’t do anything to lower vitamin C intake, so what’s the deal, there?

      Lastly, but most importantly, what’s your credible reference for the claim that cholesterol is a repair substance. If it’s a repair substance, why is plaque jammed full of it, and why does it provoke an immune response where the macrophages ultimately die on-site and inflammation worsens?




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      1. I suggest you read the book, THE GREAT CHOLESTEROL CON, which lists the research studies I am referring to. It will answer of your questions better than I can here. And like me, make you angry for the lies. After teaching the ‘low cholesterol diet’ prescribed by physicians for over 25 years I have been enlightened to the scam. As the media and then MD awareness catches up to the facts it will be every interesting. As far as vitamin C, look up the patent Linus Pauling, 2 time noble prize winner, was granted in the 1990’s which uses Vitamin C, L-Lysine, and L-Proline to heal the arterial damage and remove the plaque within the artery…essentially resolving CAD without Big Pharma profits. (Which is why doctors don’t know as they are educated and controlled by Big Pharma (and their swat teams the FDA & CDC) BTW, cholesterol is a response to inflammation, not the other way around. A study done in the late 1970’s by a Dr. Margaret Flynn at the Univ of MO found that 3 eggs daily, did not raise cholesterol. I was her student.




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  47. The New York Times admitted last week that “there is no real evidence that eating dietary cholesterol is bad for you”. Could you please comment on this news article?




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      1. I think so…I have seen more comments like”see! Told ya so! Even they dont know !!!” I am staying WFPB….dont care what the latest is…




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  48. I agree that physicians still look at this incorrectly. I have adopted a plant based diet for about a year and have had high LDL and cholesterol levels for some time. My HDL is also high, and my physician says that due to this I am not a risk for coronary issues. I disagree. I had my lipids checked 3 months and 6 months after adopting a vegan diet, and do not eat junk food, yet my levels have only decreased minimally and remain elevated. I am concerned as to why, and my physician does not seem concerned as he feels I am not a risk. I plan to recheck again in May, but wondered if you had encountered this in others or have thoughts as to why!!




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  49. I was listening to NPR yesterday and this interviewer was discussing “no direct link between eggs and dietary cholesterol to heart disease”. Two doctors bantered back and forth discussing how “people” (presumably the public) jump to conclusions and that eggs and other high cholesterol foods have NO bearing on our heart disease risk. I almost fell over! I am interested in hearing what everyone thinks of new cholesterol recommendations.




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    1. Marjorie: Here are some great responses to these new recommendations:

      http://www.pcrm.org/nbBlog/index.php/new-dietary-guidelines-the-good-the-bad-and-the-downright-confusing/
      http://www.pcrm.org/nbBlog/index.php/cholesterol-confusion-lets-make-sense-of-it/

      Also, if you ever want to dive in deeper into the issue, Plant Positive does a good job of explaining the vast amount of evidence we have linking foods like eggs to heart disease.
      http://www.plantpositive.com




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  50. Hi, what’s your opinion on the new dietary guidelines for cholesterol. Now all of a sudden they are saying they got it all wrong and eat as much eggs butter and so on because cholesterol is all of a sudden good for you.




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  51. I wonder if you could comment on the recent FDA and earlier AHA proposals to de-prioritize or eliminate dietary cholesterol (DC) labelling? Is it really not an issue? Is there only a typical correlation between DC and high saturated fats in the same foods? What is the current understanding of the direct and indirect causes of high levels of bad cholesterol in the blood?




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      1. Thanks Thea. Very useful info. I wonder if consumption to results have been quantified/iable. A la >X mg/kg of dietary cholesterol tends to raise while <X mg/kg tends to lower blood cholesterol levels.




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        1. Alex: re: “… while < X mg/kg tends to lower blood cholesterol levels." Dr. Greger has identified foods which have been shown to lower cholesterol, but none of those foods actually have cholesterol in them. I think the best you could hope for is trying to find an X amount of dietary that at least doesn't raise cholesterol.

          re: Showing that dietary cholesterol tends to raise serum cholesterol
          I think we have a lot of evidence of this, but it does get complicated since dietary cholesterol almost always comes connected with saturated fat, animal protein, and other undesirables. Food is a package deal. So, how much of the problem of an increase in cholesterol and related increase in heart disease risk is directly related to the dietary cholesterol and how much is related to the other factors of eating animals?

          Or (what I think) how much is related to the entire animal food with all those factors working together? We do have *plenty* of evidence that eating animal products raise cholesterol. Since only animal products have cholesterol in them, telling people to avoid eating cholesterol is a no-brainer and a reasonable way to work around political injunctions against educating people on the science that links animal consumption to various diseases, including heart disease, stroke, etc. That's one reason the new guidelines are such a travesty.

          If you are interested in details of the scientific evidence we have that links dietary cholesterol to serum/blood cholesterol, I recommend checking out Plant Positive:
          http://www.PlantPositive.com

          I'm not sure which video would specifically interest you, but you might start with this one:
          http://plantpositive.com/23-cholesterol-confusion-6-die




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          1. Note: There were some weird characters in the post above that probably got sent out/included in the related e-mail for anyone who got it. I was able to fix/get rid of the characters for the post on-line here. So, if someone wants to read my reply without needing a decoder ring, come here directly to the page/site.




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            1. “weird characters in the post above”

              Yeah, my greater-than/less-than signs cannibalised the HTML. I corrected my own post with & lt ; (no spaces) but messed you up downstream. Sorry.

              Thanks again, Thea, for generously offering your time, expertise, and links. You’re fighting the good fight!”




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  52. I can’t wait to hear Dr. G respond to the removal of cholesterol as a “nutrient of concern” by the 2015 Dietary Guidlines Advisory Committee.




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  53. Ok, let’s cut to the chase. This video is 2 weeks old now, so my query may not have a wide response. What are the LDL-C numbers of the commenters to this video? Mine is 87. I’ve been vegan for 3-1/2 years. How long does it take to get below 70? Is anyone’s LDL-C lower than 70? Even here north of the 49th, Health Canada specifies a number higher than 50-70mg/dL.

    Maybe the newest member of Dr. Greger’s staff, Joseph Gonzales R.D. could comment, perhaps offering his personal LDL-C #.




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  54. @Theresa. Your page link is an advertorial for W.Gifford Jones M.D. An advertorial milady is an ad dressed up as an editorial. There’s nothing free about canadafreepress. It, like facebook and Google, are ad companies first and foremost. Hey it’s nothing personal, it’s just business. When the USDA wants to delist cholesterol and the GOP wants to desist from science in their new bill, you know that these criminal corporations will do anything to remain in the black.




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  55. I received this information from AARP this morning:

    http://www.aarp.org/health/healthy-living/info-2015/cholesterol-myths.1.html

    I believe it to be quite contrary to the information that you provide on your website.

    The article was written by what appears to be a journalist and does not have any scientific references. I would appreciate if you would comment on the article.

    I very much appreciate the work that you do.

    Best Regards,

    Don Pitts




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    1. Thanks for reporting this, Don. I think you hit the nail on the head that this is not a scientific evaluation of all of the evidence. The article does throw out some references, but again, not enough to claim saturated fats and butter is “back”. So much information on cholesterol here.




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    1. Interesting. From the conclusion I think the researchers explain “our meta-analysis showed that there is insufficient evidence from prospective epidemiologic studies to conclude that dietary saturated fat is associated with an increased risk of CHD, stroke, or CVD. However, the available data were not adequate for determining whether there are CHD or stroke associations with saturated fat in specific age and sex subgroups. Furthermore, there was insufficient statistical power for this meta-analysis to assess the effects on CVD risk of replacing specific amounts of saturated fat with either polyunsaturated fat or carbohydrate.”

      Hope that helps. Also, Dr. Esselstyn published research showing how a plant-based diet can be a way to reverse CAD. Meat can cause inflammation and saturated fat appears to have other deleterious effects such as increasing the risk of heart disease.




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  56. I’ve been vegan for about 17 years, and my LDL is about 69.5 mg/dl (measured last year at 1.8mmol/l). My GP said it was the lowest cholesterol level he’s ever seen… But if the “optimal” range is 50-70, why is mine so high?




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    1. According to Dr. John McDougall and many others, all veganism is not created equal and fat consumption, even non-animal, still matters. If you check out his website drmcdougall.com you’ll see he even recommends against eating any isolated oils (soybean, olive, coconut, etc.) or even certain high-fat plant foods many consider extremely healthy such as avocados. Maybe lowering your fat consumption would lower your LDL even further?




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  57. I am so confused here. If you look at the article on Dr. Mercola’s website today titled “Why You May be Better Off Ignoring Conventional and Low-Fat Dietary Guidelines,” I just don’t get it, and I’m trying to understand. There must be another factor for atherosclerosis related to endothelial dysfunction. I not arguing either way, I am simply completely at my wits’ end with the polar opposite presentations of endless studies on fats and cholesterol related to heart disease. Again, I suspect there has to be another variable we are missing. What explains the incredibly low heart disease rates among non-Westernized diets of, for instance, the native Eskimos who ate almost exclusively meat and saturated fat, or the the Masai people of Kenya who eat large quantities of ruminant milk and meat, and the Jamaicans who eat large amounts of saturated fat in the form of coconut oil? All three of these populations, all consuming high saturated fat diets, were relatively free of heath disease, when especially compared to the epidemic happing in America. So I am in quite a quandary here given the multitude of variables that exist (and maybe it does not matter in context to the SAD with respect to simply lowering cholesterol as the only answer here in the states???). For example, is it inflammation caused by pollutants, pesticides and herbicides; could it be conventionally grain-fed, contaminant laced feedlot raised animals and products derived therefrom; an imbalance of omega 3 and 6 fatty acids, the elimination of omega-6 fatty acids by the inclusion of saturated fats and exclusion of omega-6s; GMO’s with RoundUp, refined carbohydrates, sugars, fructose, etc., etc., etc. I’m simply trying to understand what is the underlying variable that confounds the seemingly endless research, studies, and conclusions drawn therefrom on the polar opposite sides of the spectrum.

    Does anyone else here feel whipsawed with all this?




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    1. Nutrition research is very complex, but eating food doesn’t have to be. Our site differs widely from Mercola. He sells stuff. We don’t. We like folks to make up their own mind based on the research provided. I think Dr. Greger does an amazing job offering the latest science, for free, and giving dietary suggestions.




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  58. Here’s a link to the article where I pulled some of my commentary from. Please, I am NOT trying to do dueling studies B.S. here. I simply am trying to figure out what is going on with the two polar opposite conclusions based on the studies.

    http://www.mercola.com/article/carbohydrates/scientific_evidence_low_grains.htm

    I am raising a lot of this because of my own research into Lipoprotein A. Incredibly enough, I switched to a vegan regimen recently and then read this about soy (it raises Lipoprotein A???). Can anyone see why I am genuinely struggling with this subject? Any help or advice?

    http://articles.mercola.com/sites/articles/archive/2008/01/02/soy-increases-lipoprotein.aspx




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  59. Dear Dr. Greger,

    I have been following a whole plant low-fat diet for over 2 years now with lots of fruits, berries, legumes, sweet potatoes, veggies, greens, nuts, no processed foods etc., but my cholesterol levels have not improved, e.g. total cholesterol was and still is around 220, LDL around 150, triglycerides 150-200, A1C 6.0 to 7.0 etc. I was never overweight (at 5’7″ I am 145 lb), never smoked, exercise daily. Still I had a quadruple bypass 7 years ago.

    I am completely puzzled why the diet had virtually no expected effects.
    My doctor is puzzled too, so I am planning to start to take statin drugs (Lipitor).

    Is there any hope to make diet work for me?




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    1. Hi Alex. Someone at the top of this tread has similar concerns. I think my comment to her will serve you well. Let me know if it helps?

      Thanks,
      Joseph




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    2. Hi Alex. Let me see if I can help. For those who have tried everything and still have high LDL, try focusing on the saturated fat sources (coconut oil; cocoa butter, and yes even nuts). I would also make sure you’re doing the Jenkins portfolio diet, including foods like (beans, okra, flax, etc.) and get thyroid function tested. Dr. Jenkins developed a portfolio diet for lowering cholesterol, and it does include some nuts but I would try avoiding or keeping to a single ounce a day. Weight loss is important if there is too much abdominal fat (abdominal circumference exceeds half height). So check with your doctor about these measurements. And if your diet is top-notch and LDL is still too high then try Dr. Esselstyn’s 6 servings of greens a day to keep nitric oxide flowing. If you still find it’s not coming down consider a statin. See if any of those tips help. How frustrating if doing everything right and still not having success.




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  60. I am a type 1 diabetic and also have an elevated level of lipoprotein (a). The information I have is that lipoprotein (a) may be a particularly pernicious form of cholesterol and that one’s level is determined by genetic factors and is not affected by exercise or diet (or statins). The only thing that can reduce it is niacin. My level was initially 64, but taking a dose of 3,000 mg of niaspan originally brought the level down to just below 30, in the normal range. However, in more recent years, my level has incrementally increased and is now up to the 80s, even though I am still taking 3,000 mg of niaspan daily (which is quite expensive).

    Have you seen any information in your reviews of nutritional studies that questions that lipoprotein (a) levels are not affected by diet (or exercise)? I understand that as a general matter of coronary health, if I can’t keep a normal or healthy lipoprotein (a) level, it is especially incumbent on me to do anything else to put the odds in my favor, so in that sense, eating a plant-based, whole-foods diet can be effective. I’m wondering if you have seen anything that suggests that diet might have some affect on lipoprotein (a) levels? Or perhaps, in the alternative, have you seen anything suggesting, as in the video, that if one’s LDL level is kept sufficiently low, then plaque buildup isn’t triggered, so perhaps an elevated lipoprotein (a) level isn’t such a concern?




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    1. Hi Bawaite, sorry you’re dealing with that-but so happy to hear about all of your healthy lifestyle choices. PubMed search showed of the 2015 literature showed that daily exercise and almond consumption may improve lipoprotein A levels. Dr. G. plans to make a video about lipoprotein A in the future…till then, here’s a favorite NutritionFacts.org piece about a bonus benefit of almonds.




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    2. Hi Bawaite thanks for reposting. Jen gave some hints below and I might also suggest Dr. Forrester’s comments and links on diabetes, here. See if these resources help?




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  61. Brenda Somers

    Jun 1, 4:31 PM

    I know Dr. Gregor says that the amount of sat fat in the diet should
    be Zero or as close to it as possible. I have an intake of about 7gm
    daily from the following:
    32g peanut butter (peanuts
    & some salt and I pour off the oil on top), 1/2 oz almonds, 1/2 oz
    walnuts, 1 tbsp hulled hemp seeds and 1 tbsp either sunflower seeds,
    chia seeds or pumpkin seeds. All seeds and nuts are raw and certified
    organic if possible.

    I eat a very healthy whole food plant based no oil added diabetic
    diet. Five months ago my total cholesterol was 159 & LDL 88. I’m
    trying to get cholesterol below 150 & LDL below 70 and don’t want
    the plant sources of sat fat to work against this.

    Also, I’m 69, weight 130 (have kept off a 100 lb weight loss for 15 months) and was diagnosed Type II diabetic in Nov 2010. My A1C has been 4.9-5.0 for the last 18 months.

    Thank you for your help and for such a wonderful, informative blog.




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    1. Hi Brenda,

      Thanks so much for reposting. It’s impossible to have zero saturated fats, as all foods have a bit of fat in different ratios. You are wise to keep it low, though. My go-to Dr. Greger answer (paraphrased) for those who have tried everything and still have high LD, try focusing on the saturated fat sources (coconut oil; cocoa butter, and yes even nuts and seeds). I would also make sure you’re doing the Jenkins portfolio diet, including foods like (beans, okra, flax, etc.) and get thyroid function tested. Dr. Jenkins developed a portfolio diet for lowering cholesterol, and it actually includes some nuts. Weight loss is important if there is too much abdominal fat (abdominal circumference exceeds half height). So check with your doctor about these measurements. And if your diet is top-notch and LDL is still too high then try Dr. Esselstyn’s 6 servings of greens a day to keep nitric oxide flowing. If you still find it’s not coming down consider a statin. Maybe some of our doctor’s who help reply on our site can help answer better, but I’d start there. Let us know if anything helps and do make sure to check in with your doctors about all of this.

      Best,
      Joseph




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      1. I am very familiar with Dr. Esselstyn’s research and follow his advice closely, but hadn’t previously heard of Dr. Jenkins or his portfolio diet for lowering cholesterol. I’ll give his advice a whirl – particularly by replacing other WFPB starches with oats and barley, and by taking Metamucil three times a day. Perhaps this will move my cholesterol and triglycerides in a downward direction.

        Thanks for posting this and for pointing me to it.




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