Vegan Protein Status

Vegan Protein Status
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The anti-inflammatory nature of plant-based diets may explain higher blood protein levels in vegans.


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

Last year, we learned, in a study of Buddhist nuns, that long-term vegans—vegans for up to 72 years straight—had clinically equivalent bone mineral density, despite milk-drinking women getting twice as much calcium in their daily diet.

This year, there was a 200-page review published on health indicators in people eating vegetarian long-term. What about protein status? Both vegans and meat-eaters, on average, get the recommended amount of protein in their daily diets.

Meat-eaters eat about 20% more protein a day, though. But do they achieve significantly higher levels of protein in their blood? Who has higher plasma protein levels? Three choices: vegans higher, meat-eaters higher, or both the same protein levels?

Despite 20% less protein in their daily diets, vegans actually had significantly higher plasma albumin—the predominant protein in the blood—though inflammation suppresses protein production in the liver. So this is more likely just an indicator of how much less inflammation there is in the bodies of those eating vegan.

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

Last year, we learned, in a study of Buddhist nuns, that long-term vegans—vegans for up to 72 years straight—had clinically equivalent bone mineral density, despite milk-drinking women getting twice as much calcium in their daily diet.

This year, there was a 200-page review published on health indicators in people eating vegetarian long-term. What about protein status? Both vegans and meat-eaters, on average, get the recommended amount of protein in their daily diets.

Meat-eaters eat about 20% more protein a day, though. But do they achieve significantly higher levels of protein in their blood? Who has higher plasma protein levels? Three choices: vegans higher, meat-eaters higher, or both the same protein levels?

Despite 20% less protein in their daily diets, vegans actually had significantly higher plasma albumin—the predominant protein in the blood—though inflammation suppresses protein production in the liver. So this is more likely just an indicator of how much less inflammation there is in the bodies of those eating vegan.

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Doctor's Note

For more information on plant-based diets and protein, check out these videos:
Do Vegetarians Get Enough Protein?
Do Flexitarians Live Longer?
Methionine Restriction as a Life Extension Strategy
Treating Kidney Failure Through Diet

And check out my other videos on protein

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

109 responses to “Vegan Protein Status

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    1. Hello Dr. Greger!

      I’m have been vegetarian for a long long time and vegan for the last 3. My 11 year old has been vegetarian for 3 and vegan since last June! She wants to be kind to animals. We take vitamin B12, vitamin D and Dr. Furhman’s Omega’s. Every time I get bloodwork done my protein is low. I don’t want my daughter to have low protein. Can you recommend what to feed her to prevent this please?
      Thank you!!!


      1. Cristina: How wonderful to hear that you and your family are moving toward a healthy diet. And how uplifting to hear that your daughter is motivated by kindness. The good news is that you *can* have both: a diet that is both healthy and ethical. I understand your concerns given your own situation. I have two bits that I hope will help you. First, I *highly* recommend the following article on protein: The article contains basic information about protein which everyone needs.

        Second, I’m going to share a post I put together for people who ask about how to raise vegan kids. I believe that the information you are looking for is in the resources listed in the post below. Best of luck to you and your family. I hope this helps.

        First, note the following quote from a position paper from the ADA: “It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.”
        Also note this quote from Dr. Greger’s book, How Not To Die, page 411-412: “Vitamin B12-fortified plant-based diets can offer health benefits for all stages of the life cycle. [When] Dr. Benjamin Spock, the most esteemed pediatrician of all time,…died at ninety-four, he advocated children be raised on a plant-based diet with no exposure to meat or dairy products. … ‘Children who grow up getting their nutrition from plant foods have a tremendous health advantage and are much less likely to develop health problems as the years go by.’ ”
        But having said that, there are some ‘gotchas’ when it comes to young children and whole plant food diets (just like there are gotchas with children and any diet). So, it really is worth spending some time reviewing accurate, evidence-based information on the topic. Here’s some ideas for specifics:
        PCRM is the Physician’s Committee For Responsible Medicine, headed up by Dr. Barnard. Dr. Greger has mentioned Dr. Barnard and PCRM favorably in posts and his book. Here are two articles from PCRM:
        I’ll also refer you to a site called the Vegetarian Resource Group, VRG. Their articles are usually very well researched and Dr. Greger has mentioned VRG favorably at least once. VRG has a whole section on kids on their website.
        Here’s the main page. Scroll down to the Nutrition section:
        This is one of my favorite articles on that page. which starts with babies and goes on up:
        Finally, I *highly* recommend getting a book called, Becoming Vegan, Express Edition. That book is a great over-all reference book for the whole family. It also has an entire chapter on children and what to feed. It also includes an age-based chart where you can get ideas on how much of each of the main nutrients your child needs at various ages. The authors of that book have been guest bloggers here on NutritionFacts. They are very well respected and extremely knowledgeable about nutrition science and how it applies to all ages.

        1. | Thea replied to Cristina Cadavieco on Vegan Protein StatusThea- Cristina is referring to a blood test called Total Protein, when low it may indicate a liver disorder or severe malnutrition. Vegans and vegetarians often have low levels of globulin which indicates that protein is not being digested or absorbed properly. Vegan and vegetarian diets can be unhealthy for certain individuals. Vegans die sooner than pescatarians so it can’t be such a healthy diet.

          1. Windy T.: I’m sure there are people with genetic defects who have troubles like what you are describing. However, this would be very rare. The vast majority of the science shows that people who eat a Whole Plant Food Based (WPFB) diet are the longest lived, healthiest people on the planet. Consider that one of the longest lived, healthiest populations on the planet was the traditional Okinawans. They have so many people who get to 100 years old that the community has a group party where the birthday girls and boys *march* down the street… What did these super healthy people eat? Their diet was 85% carbs, 6% fat and 9% protein. 69% of the diet was sweet potatoes. About 4% of their calories came from animal products. I’m not saying you need to exactly imitate the Okinawans to be healthy. I’m trying to drive home the point that animal products are not necessary for most humans. Neither is a diet high in protein. We have a ton of science which tells us that the Okinawans were healthy in spite of that tiny amount of animal consumption — not because of it.

            I’m not a doctor, and I know nothing about your previous vegetarian diet nor Cristina’s. What I do know is that a lot of people who describe their diet as vegetarian are not actually eating a diet of whole plant foods. They are eating too much of what amounts to plant junk foods (store-bought veggie burgers, white bread, chips, etc) or eating a diet of mainly fruit. Eating junk food or only fruit are two vegetarian diets and are two ways that a person can become protein deficient. That’s not the diet recommended on this site nor is it the diet recommended in the references I gave Cristina. Also, if you read the first link that I provided for Cristina, you can learn a lot about protein and where we get it from food.

            There is not enough data to say that pescatarians live longer than vegans. There was ONE! study that showed a slight difference in longevity between the two groups. Here it is important to note again that a diet described as “vegan” does not necessarily mean a healthy diet. It just describes a diet absent of meat, dairy and eggs. Many people who eat a vegetarian or vegan diet are doing so for ethical reason and do not eat healthy. Meanwhile, people eating fish might be more health conscious and generally eating a healthy diet except for the fish, of which they may not be having very much. The study you are talking about did not try to distinguish between healthy eating and non healthy eating. It only looked at the categories of food the people chose to eat. Bottom line is that you cannot conclude from a study like this that a WPFB diet “can’t be such a healthy diet”. Looking at the vast amount of data on this site shows how untrue that statement is.

            You make the claim that “Vegans and vegetarians often have low levels of globulin…” I personally know a lot of people who have been vegetarian and/or vegan for decades and none of them have problems with their protein levels. That’s just the people I know, but if there is significant data to back up your claim that this is a general problem/”often have”, I would be surprised. Interestingly enough, I do know one person who said her doctor diagnosed her with having a protein problem. She’s neither vegan nor vegetarian. She does eat a lot of junk…

            Getting back to the birth defect point: NutritionFacts does have a video about a boy who got sick when he went vegetarian. Turns out the boy had a birth defect. Rather solve the problem by eating meat and get all the bad stuff that comes with eating meat (plus harming the animals and planet, etc), the boy decided to take a pill for the one substance that his body couldn’t produce on his own. If I were in that situation, I’d try to find out what my specific problem was and address it similarly to that boy if it were possible. It may not be possible in some situations. I’m just saying that it is something that could be looked into if someone was motivated to do so.

            1. There are no diet studies that distinguish ”healthy” vegan/vegetarian diets from junk food vegan/vegetarian diets so one must look at the existing studies. You make up stuff according to your beliefs- the pescatarians didn’t eat very much fish, etc. Okinawans have a small gene pool as do all Japanese. There has also been more recent valid information that Okinawans never ate a mostly plant-based diet- that the so-called study that you tout was bogus. In 1960, Japanese died 6-8 years earlier than Americans. They were eating a much more traditional diet in 1960 than now and Americans were eating more meat than we do now. There has also come to light a diet study published in the BMJ- the Minnesota Coronary Experiment-the results of which were suppressed at the time- that clearly showed that the patients on the cholesterol-lowering diet that were over 65 had a significantly higher mortality rate than the group that ate meat, cheese, eggs, etc. But mere facts cannot convince you, you want to save the planet. You come from a biased state of mind. I don’t. Here’s another fact you will have a hard time wrapping your brain around. People over 65 with the highest LDL-C levels live longer than those with the lowest levels. And the ones that live the longest are eating- gasp! meat, cheese, eggs, fish and enjoying their delicious meals and extra years of longevity. Check out the Northern Manhattan studies for that data. And there’s more- will continue tomorrow. Suggestion- name your sources- the actual studies and stick to what’s in the studies- don’t make stuff up.

              1. You say “stick to the studies and don’t make stuff up,” but your entire post is nonsense with no actual citations whatsoever. We all howl with laughter when someone cites a “fact” (made up in their head) but then tries to make it our job to “look it up.” Comedy at its finest. You’re free to eat whatever garbage you want based on a few poorly designed studies with heavy selection bias, poor statistical analysis and those funded by the cattle and egg industry, but don’t expect anyone else to pay attention to your inane blather.

                Dr. Ben Moderator for

                1. Neither you nor Thea addressed the Total Protein blood test that Cristina had asked about because she was below the normal range. The info I gave about this lab test can be found on many sites and also any internist would give the same info. What I said is standard medical info and factual. I have sent a response to Thea with more info about the studies I refer to.

                  Your rude reply to me tells me more than I wanted to know about your intelligence and emotional health or lack thereof. Seems like your diet certainly isn’t giving you equanimity. Sounds like you are having health issues or are very anti-social. You give this website a bad name. I will share your snarky reply with others, many others!

                  1. Please do spread the word. Any objective individual not addicted to ingesting bird embryos and cow muscle infected with bovine leukemia virus will find the vast body of knowledge in support of a WFPB lifestyle a godsend. We’re all rolling on the floor with laughter at your citations of “any internist” and “many sites.” These must be new peer reviewed journals. Did you know the earth is flat? It sure is. You’ll find it all over the internet so it must be true. Go look it up.

                    Dr Ben

                    1. | Moderator Ben replied to your comment on Vegan Protein Status.You don’t know anything about what I eat. Low Total Protein can be because of low Globulin- one of the proteins that this test measures. High amounts of Globulin are found in animal foods and smaller amounts in plant foods. Pick yourself up off the floor and Google it because there is no info about this on your website. It’s easy info to find online and the type of info that doesn’t need citations anymore than one would need a citation to say that Spain is in Europe. You still have not answered Cristina’s question about her low plasma Total Protein test level. You are very hostile and should not be a moderator of anything nor should you be representing Dr. Greger, an intelligent and decent man.
                      Yes- I will share your responses with Dr. Greger, I’m sure he’ll be so proud of your childishly nasty responses to me.

                    2. This isn’t the kindergarten playground. This is a website devoted to critical review of the vast body of peer-reviewed published research which you don’t seem to understand in the slightest. The only saving grace to your ludicrous unsubstantiated comments is that no one is paying any attention to what you’re saying.

                      Dr. Ben

                    3. | Moderator Ben replied to your comment on Vegan Protein Status.You are paying attention to what I am saying. You are the kindergartener rolling around on the floor. I do understand what I read on your website and I have not made any unsubstantiated comments. And I doubt very much that you have a Doctorate in anything.

                    4. No one cares what you think, least of all me. I’m here to call you out for trying to pass off unsubstantiated hogwash as fact, just in case someone impressionable is reading. I’ve accomplished that.

                      Dr. Ben

                    5. | Moderator Ben replied to your comment on Vegan Protein Status.You have shown people reading the website that you have a nasty streak, and cannot tolerate info that you don’t like. Why would you protest so much if your ”facts” are true? Your outrageously rude responses put into question the information presented on the website. You show your emotional weakness and self doubts to anyone reading your insulting language to me. If you didn’t actually care what I think, your response would have been measured, moderate, mature. That’s not possible for you, you are antisocial to an extreme and lack insight into your behavior.

                    6. As I said, my goal, which I accomplished, is to dispel any notion that your comments have any merit, which they don’t.

                      Dr. Ben

                    7. | Moderator Ben replied to your comment on Vegan Protein Status.Your truly immoderate responses will stimulate others to look up the studies I cited. You will never know if you accomplished your ”goal”. I am in communication with one of your readers now -we’ve exchanged EMs and info. And there may be others in the days to come. Your behavior makes the website look like it’s in the hands of a demented person, not exactly a great endorsement of veganism.

                    8. | Moderator Ben replied to your comment on Vegan Protein Status.Really? So you have stopped rolling around on your floor? Good for you! They are on the site, not addressed to you. And I have several (5) responses to what I posted.

                    9. Still trying to pretend that you have a compelling point by sending others on wild goose chases to search for your supposed evidence that doesn’t exist. Classic.

                      Dr. Ben

                    10. | Moderator Ben replied to your comment on Vegan Protein Status.You are back on the floor again, time for your nap?

                    11. Hi Sars2000- I doubt ”Dr. Ben” ever spent even an hour in medical school and he is certainly anti-social to the extreme. This site seems to attract more than its share of cultists and crazies that act as moderators. There is certainly more accurate up-to-date medical information on other websites that don’t have moderators like ”Dr. Ben”. Be well- Windy T

              2. Windy T: sigh. I wasn’t “making stuff up” when it came to talking about how much fish the fishy people ate. I was making a point. To repeat: The point is that we don’t know anything about the healthfulness of the diet of either group. Nor do we know how much fish they ate. However, based on what we do know about the reasons people often pick for eating vegetarian or vegan and based on what we know about the reasons people often have for eating fish, I noted that we have a reasonable explanation for that one study you think is relevant. That explanation has nothing to do with your conclusion about what the study means. I’m sure you can “wrap your head” around this point. I won’t try to insult you by saying otherwise.

                One of the cross checks we can do to see if my speculation is relevant is to look at healthy populations, such as the traditional Okinawans. I did provide provide references. Did you not see the links? NutritionFacts videos include a ‘sources cited’ button which links you to the original studies. Note the following sentence from the study on the composition of the traditional Okinawan diet: “Data derived from analysis of U.S. National Archives, archived food records, 1949 and based on survey of 2279 persons.” 1949: before a lot of influence from western diets. If that doesn’t convince you, you could look at other blue zone populations. No, they were not vegan any more than the Okinawans were. But their diet was primarily a whole plant food based diet.

                I understand why you would find those studies compelling which *seem* to say that people who eat meat/fish, dairy and eggs live longer. Or that people with higher LDL cholesterol live longer. However, you have been mislead about what those studies mean. I’m sure you have heard that “association does not equal causation”. Let’s take those studies which show that people with higher LDL seem to live longer as an example. Does it mean that having high LDL is protective and helps you live longer? OR is it a question of reverse causation–where diseases cause LDL drop. In this case, we know that it is a situation of reverse causation. Ie, it is a matter of disease causing loss of LDL/cholesterol.

                To my knowledge, this is not a contested phenomenon. Even getting a heart attack can cause your cholesterol to drop! Here is a helpful quote from forum member TG: “A ton of other conditions also cause cholesterol to decline. These range from cancer, heart attacks, sepsis, infections and surgery and other trauma to malnutrition and alcoholism:
                “Low or subnormal low-density lipoprotein (LDL) levels are another characteristic of the lipoprotein pattern in chronic alcoholics.”
       So, yes, in the US and other countries with similar dietary practices,simple observational studies do find that ON AVERAGE older people with low cholesterol often have poorer health and functioning than people with high cholesterol. It is just like the saturated fat studies that don’t adequately control for other variables.

                And of course, when people get diseases like cancer, they are going to die sooner. To lay it out here: Those studies which *seem* to show that having high LDL makes you live longer–do not show that at all. The people with the lower LDL got sick and then their LDL dropped. The people who tell you that these studies mean anything else are misleading you. The people who hit the genetic lottery and didn’t get sick (just like not all people who smoke get lung cancer) live longer than the people who got sick and this in and of itself tells us nothing about the healthfulness of LDL levels.

                I have additional resources for understanding reverse causation and how the science shows that people who maintain life-long levels of human-normal levels (“low” levels based on say American averages) of cholesterol/LDL through their whole lives do better. There are some really great resource in general for debunking cholesterol denialism. It would help you understand what the science is really telling us. These resources are pretty eye opening stuff and do not require conspiracy theories about science being repressed. If you would agree to actually look into the resources I provide, I’ll dig up that information for you.

                In short, I haven’t made anything up and have examined the evidence carefully. I’m as biased about protecting human health as I am about protecting the planet. Happily, the two ethical principles have no conflict. The science is very clear on the big picture about which diet is healthy for the general human population. That diet either abstains from all meat, dairy, eggs and plant junk food or contains very little of those foods. To be complete and fair, I have acknowledged that if you have a rare birth defect that makes the situation different for you, then you would have to make accommodations accordingly. Good luck to you.

                1. For Okinawan gene pool- ”Siblings of Okinawan Centenarians Share Life-long Mortality Advantages”, Willcox BJ, Willcox DC, He Q…

                  Okinawan diet- compared to the average Japanese diet- Okinawans ate 50% more pork, higher fat and protein intakes, lower carbs and salt. Daily intake of meat- 3.17 oz.. Source- various via ”Wikipedia- see ”Okinawan Diet”. The Okinawan diet was not vegan or vegetarian. And yet it’s cited by vegans and vegetarians as ”proof” that meat shortens your life. Go figure. BTW, I was in Okinawa in 1963 and most Okinawans raised a few chickens and pigs for food, ate fish/seafood, and were not vegetarians by a long shot. Veganism and Vegetarianism cannot explain the good health and longevity of the French who eat everything and have a high sat. fat diet. Yes- only one study with pescetarians living longer than vegans. But no studies showing vegans living longer than others, and not one study on any ethnic group that has a vegan diet.

                  U.N. Demographic Yearbook 1962, pp 574-583 shows Life Expectancy at Birth for Japan, the U.S. and other nations. We Americans had higher life expectancy in 1960 than the Japanese.

                  Studies of elderly showing longevity for the highest LDL-C have taken into account that certain diseases lower LDL-C. These studies go on for many years and eliminate those with terminal disease and mortality in the first few years. Here’s one – ”Relationship Between Plasma Lipids and All-cause Mortality in Nondemented Elderly”, Schupf N, Costa R….. 2,277 aged 65 to 98 in Northern Manhattan.

                  For an analysis of many studies- BMJ- 6-6-2016- open source – ”Lack of an Association….” Ravnskov U, Diamond David M,… It addresses your hypothesis that LDL-C of sick elderly decreases before death. True, but these deaths are excluded in most of these studies during the first years. See paragraph- ”Inverse Causation” and ”Is high LDL-C Beneficial?” Both address your hypothesis. These researchers are M.D.s and are reporting their findings. They are not website ”commentators” or ”moderators”. And they aren’t trying to convince anyone to eat differently. They don’t have a dog in the fight.

                  Medscape 10/12/’17 ”Vegetarianism linked to Depression”. Interesting study. It’s occurred to me it may apply to ”Dr. Ben” after reading his snarky, insulting and aggressive over-the-top comment to me.

                  And an older study of 30 vegan mothers with cerebral atrophy in 37% of their offspring and 60% of their offspring with developmental delays. 2008, Dror and Allen- ”increased risk of hypospadias for vegan/vegetarian pregnancies”.

                  The Minnesota Coronary Experiment findings were suppressed- meaning not published at the time. This was recently published for the 1st time many years after the study was completed- published in the BMJ. And those eating the most sat. fat clearly lived longer.

                  I have no conspiracy theories about anything. Nor is anyone ”misleading” me. I have a medical education and background and understand scholarly articles. I also have no agenda and am indifferent to what anyone eats.

                  I never said all ”people” with highest LDL-C levels live the longest- only elderly people. This also corresponds to my own experience with family members- my grandmother lived to 106, my mother to 100. They both had LDL-C on the high side after the age of 65 or so- and their levels continued to rise slowly over the years. Neither had any diseases that lower LDL-C and as far as anyone knows, they died with high LDL-C levels. LDL-C is not taken post-mortem. There is recent information about cholesterol/all-cause mortality that will be difficult to fit into your ideas regarding meat-free diets and longevity. Much of your site info has been put into question by more recent studies. I have an open mind, do you?

                  1. Windy T: I do have an open mind when it comes to good data. Your post is just not convincing on multiple levels. I’m not going to try to pick it apart. I’ll just address a few points. For example, I’m not convinced you understood my point about reverse causation though. For example, you listed studies about veganism and mental health. None of the studies I looked into in the past ruled out reverse causation. (A lot of people turn to a vegan diet in order to feel better. IE: They started out already with a problem.)

                    I think it’s great that you are trying to find valid studies. But I think you give too much credit to a researcher just because she or he is an MD. Did you hear about the recent study which came out which seemed to show that eating a diet higher in fats is healthier? Carbs make people die earlier? Note how many MDs are on the team : And it turns out that their conclusions are pure baloney. Here are some reviews that point out the fatal flaws of this study:

                    You listed a similar study that you think shows that eating more saturated fat is protective. I don’t have any reason to believe that your study is any more valid than the “PURE” study.

                    I give you props for including references. You didn’t include links to the actual studies, though, so I wasn’t able to easily look up the actual studies. Even if I could, I’m not a professional like Dr. Greger and others. I’m not always able to find the flaws in those studies myself, like what was done for the PURE study I reference above. (Though sometimes I see it myself!) I’m quite confident, though, that Dr. Greger and the other experts I follow have looked at the studies you presented plus plenty of others. Dr. Greger has a method that involves looking at who funded studies and whether or not fatal flaws were involved in the studies. Dr. Greger also evaluates the body of scientific evidence. In other words, it’s never about just one study or even a handful. It is about all them and looking at what the big picture tells us. That big picture is pretty clear… There’s certainly no reason to believe that protein absorption from whole plant foods is a problem for the majority of humans.

                    I’m glad you are happy with your diet. I wish you luck with it. If you are interested in some of the science around longevity and whether people eat animals or not, NutritionFacts has a great topic page on longevity: and some videos (along with references) on the topic:
                    >> Also, the article below may interest you.

                    Some time ago, TG shared comments from Dr Mirkin’s newsletter:

                    “Do Vegetarians Live Longer?

                    Three recent large studies provide more support for a primarily plant-based diet. Two of the studies compared dietary protein from plants and animals and the third one compared dietary fats from plant or animal sources.

                    Comparing Protein Sources:
                    Researchers at Harvard monitored the records of more than 130,000 people for more than thirty years (JAMA Int Med, August 1, 2016), and found that:
                    * every three per cent increase in calories from plant protein, compared to animal protein, reduced risk of death by 10 per cent, and risk for death from heart disease by 12 percent
                    * eliminating unprocessed red meat dropped death risk by 12 per cent
                    * a 10 percent increase in animal protein was associated with a two per cent increased risk for death from all causes and an eight per cent increased risk for death from heart disease
                    * death rate rose markedly for those who smoked, drank excess alcohol, were obese or did not exercise
                    * regular eaters of red meat died earlier than those who regularly ate fish or chicken

                    Researchers from the Mayo Clinic in Arizona reviewed six studies involving more than 1.5 million people (Journal of the American Osteopathic Association, May, 2016), and found that:
                    * people who restrict red meat, fish and chicken for at least 17 years lived an average of 3.6 years longer than those who ate meat regularly
                    * eating red meat and processed meats is associated with earlier death, particularly from heart disease

                    Comparing Fat Sources:
                    Data from more than 126,000 participants followed for 32 years showed that increasing total fat intake is associated with decreasing risk of death (JAMA Intern Med, August 1, 2016;176(8):1134-1145). This may surprise you because previously researchers have associated increased dietary fat intake with increased heart attack risk. However, we now know that reducing fat intake by substituting sugars and other refined carbohydrates for fats actually increases heart attack risk. Heart attack risk appears to be increased primarily by eating too many foods and drinks with added sugars.

                    Saturated fats from animal sources and trans fats (partially hydrogenated vegetable oils) appear to increase heart attack risk, while polyunsaturated and monounsaturated fats decrease risk. The Nurses’ Health Study and the Health Professionals Follow -up Study show that replacing five percent of saturated fat calories with polyunsaturated fats reduced death rate by 27 percent, and replacing five percent of saturated fat calories with monounsaturated fats reduced the death rate by 13 percent. Both omega-3s, found in deep water fish and many plant sources such as nuts, and omega-6 polyunsaturated fats found in most plants, are considered healthful. See my recent report on The Saturated Fat Debate.

                    1. In the time it took you to write your response to me you could have looked at the studies about LDL-C and sat. fat. I gave you enough info to Google them. I was already familiar with the studies you cite. You would have to read the studies- I even made it easy for you -telling you about the 2 paragraphs which answered your hypothesis. None of the studies had sponsors in meat, egg, pharma, etc. industries. The studies were observational. I am only talking about the elderly, not people under 60 years old. I am not knocking plant foods. There are multiple studies which may indicate that dietary needs change in old age. There may be certain longevity diets for elderly that differ from diets that get individuals to age 60. There also may be a ”best” diet for each individual which may be very different for another individual. And the ”best” diet may change at different ages for an individual.

                    2. | Thea replied to your comment on Vegan Protein Status.The PURE study- I’m familiar with this and not really interested – population isn’t old enough -35-70, only went on for 7.4 years. Too many countries. Almost impossible to account for all the factors that would influence outcomes. I’ve lived in several foreign countries for 3-5 years, 2 were 3rd world (Mexico and Indonesia) so I know that life/death in 3rd world countries can turn on how far away is a doctor or hospital and if the patient has enough money and has transportation at that moment to pay for medical care. The Minnesota Experiment had an older population, all institutionalized, had to eat one of the two diets assigned to them. I’m interested in these elderly populations in controlled circumstances. The PURE study will stimulate other studies, I don’t think it was meant to be conclusive. These newer studies have outcomes that are putting into doubt conventional wisdom about various fats and carbs. Unexpected outcomes generate a lot of critics- doctors are very conventional people and don’t change their protocols until there is overwhelming evidence for many years. The PCRM. org is on the same vegan/vegetarian team that you’re on so of course they’ll tear into the PURE results.

                    3. PURE is a junk study. Were the subjects eating corn chips and coke, or broccoli and water? They’re both vegan foods, but obviously different. They have planned follow up studies to determine the source of fats and carbs, but who knows how long that will take and there is no evidence yet, which is not evidence.

                      Healthcare professionals are resistant to change opinions when we have 20 well designed studies with excellent statistical analysis showing a clear result. Then one new poorly designed study comes along that refutes all the “old” data. We don’t pay attention. Non-objective individuals with a vested interest (meat/egg/dairy lovers) in the result of the new study will embrace the new data. That’s called confirmation bias. Emphasis on “bias”.
                      Dr. G goes to great lengths to filter out this type of bias which is the reason his vids are the closest thing to the truth that you’ll find. He won’t mention the new irrelevant data because it’s irrelevant and just noise.

                      Dr. Ben

                    4. | Moderator Ben replied to your comment on Vegan Protein Status.I’m not into PURE- not interested in that population. 20 studies aren’t really that many. Try 50+ all saying the same thing- then maybe. As to diet- few physicians themselves eat any differently than the general population. My grandmother was in a study for centenarians. She kept a record of what she ate and I did read the results of that study some years ago- they did not eat or live any differently than people that died between the ages of 80 and 90. One difference in longevity was that some had a devoted relative who took good care of the ones that lived over 100.

                    5. Windy T: You completely missed the point about the PURE study. Your interest in it or not is irrelevant.

                      Also, from your response, including, “These newer studies have outcomes that are putting into doubt conventional wisdom…” says to me that you didn’t actually read the reviews of the study. (Invalid studies don’t put doubt in anything other than the competence or integrity of the researchers.) It’s responses from you like this, including dismissing both reviews which explain the fatal flaws of the PURE study simply because you don’t like the messenger, that make me doubt your claim that you are open minded or that you are able to evaluate the quality of studies. I’m not challenging you to actually read the reviews. I’m just making a point.

                      It seems like this conversation has reached an end. Again, I’m glad you feel confident in your diet. Good luck to you.

                    6. | Thea replied to your comment on Vegan Protein Status.You say PURE is invalid. What are your credentials? Those were two reviews that you agreed with. Others with more experience and education disagree with you. Have you read all the reviews about PURE- there were more than the two you read. You lack a broad view of what studies are, and how a study with unusual conclusions opens up an area that will be explored by other researchers. You may lack the knowledge to put a study such as PURE into perspective. PURE is not invalid and I’m not interested in it nor in your uneducated opinion. You lack curiosity and an ability to analyze complex material. Stay in school!

                  2. Windy T. It is a pity that your posts do not provide links or even many detailed references to sources so that the claims made there can be fact-checked. However, my understanding is that most of those claims are incorrect. This appears to be because those claims are from alternative health websites and books, and are founded on speculation and on misrepresentation of the science. I have certainly seen many if not all of them on alternative health and other fringe websites of no or doubtful credibility. The claims do not, I believe, derive from credible sources.

                    I should first mention that this site does not promote “veganism” or “vegetarianism” as such. It argues, based on the evidence, that a whole food plant based diet is demonstrably the healthiest. Such a diet may or may not include small amounts of animal foods. Greger himself and many others here identify as “vegans” but he does not argue that a whole food exclusively plant diet is shown to the healthiest. He believes it is but accepts that the evidence does not conclusively show this. In fact, he argues that if people eat a whole food exclusively plant diet, they need to take certain supplements to achieve optimum health. He has also commented on many occasions that various “vegan” and vegetarian diets are unhealthy. For example, see this video from way back in 2003.

                    I did however track down eg the Medscape article about the recent study on vegetarianism and depression you referred to. That is a perfectly good study. Unfortunately, the first sentence of the Medscape article misrepresents the findings of that study. It claims that vegetarians are at greater risk of depression. The study does not say that. The study itself merely found that the two were linked but “reverse causation and residual confounding cannot be ruled out.” The study’s findings are in fact nothing new. European studies for example have also found an association between vegetarian diets and mental health problems. Unlike this particular study and others though, one of those earlier studies actually bothered to examine both the age of adoption of a vegetarian diet and the onset of a mental health problem. It found that “The analysis of the respective ages at adoption of a vegetarian diet and onset of a mental disorder showed that the adoption of the vegetarian diet tends to follow the onset of mental disorders”. This is reverse causation and exactly what we should expect since many people appear to adopt vegetarian diets for therapeutic reasons, as a consequence of health concerns.

                    You additionally mentioned an article or letter by Ravnskov. He uses very old cherry-picked articles to support his claims which nobody except fringe groups take seriously. They are certainly contrary to the conclusions of the global scientific and medical communities – conclusions reached after extensive consideration of all the evidence eg

                    You also wrote “vegans die sooner than pescatarians so it can’t be such a healthy diet.” If you are referring the the 7th Day Adventist mortality study, both pescatarians and so-called “vegans” had significantly lower mortality risk than meat eaters at 81% and 85% respectively. They also had significantly lower mortality risk than people eating eggs and dairy. According to your own logic, therefore, you should be arguing that meat eating and consuming eggs and dairy are clearly much more unhealthy than “veganism”.

                    Those figures were for both sexes by the way. On this point, if you look at the actual data, male “vegans” actually had the lowest relative mortality risk of all sub-groups – 72% of that of male meat eaters. I am not sure why there is this difference between men and women but sex hormones and/or hormone replacement drugs for women may be factors. Nonetheless, using your own logic again, you should in fact be arguing that a “vegan” diet is tbe healthiest diet for men. Yet you don’t. However, I personally don’t agree with your logic and would not say that the evidence indisputably shows that “vegan” diets are the healthiest diets for men. Nevertheless, it does show that the claims and arguments set out in your posts are contradictory.

                    The claims about the Okinawan diet also seem to derive from fringe websites. Nobody except, well call a spade a spade, crackpots argues that the Okinawan Diet study was “bogus”. There is no evidence whatsoever for this claim. The study itself is based on official survey figures from 1949 and 1950 when Okinawans and mainland Japanese werev eating largely traditional diets. Attempts to muddy the waters by pointing to what Okinawans etc were eating at later dates when US fast food outlets and Western style eating practices were spreading possibly as a result of the large numbers of US forces there and increasing affluence, are just that. Attempts to muddy the waters. The traditional Okinawan diet was mainly plant foods and fewer than 4% of calories came from animal foods. Mainland Japanese, who also enjoyed good lonegity at that time but not as good as that of Okinawans, ate rather more animal foods at less than 7% of total calories with the extra calories coming mainly from fish (which doesn’t support the idea that eating more fish is necessarily healthy).

                    The view that a whole food plant based diet is the healthiest is not contrary to either the evidence or the scientific consensus. There have been a number of major reports on nutrition and health expert scientific panels. They pretty much all agree that we should be eating mostly plants and especially more fruits, vegetables and whole grains. They also seem to agree that people should be eating less trans fat, less saturated fat and fewer processed foods (animal and plant). The World Cancer Research Fund expert scientific report for example recommends that we should “Eat mostly foods of plant origin”,

                    The World Health Organization expert report on diet, nutrition and the prevention of chronic disease stresses the imporatnce of fruit, vegetable and whole grain consumption (including high fibre intake). It also notes that “The experience of the Republic of Korea is also notable since the community has largely maintained its traditional high-vegetable diet despite major social and economic change (17). The Republic of Korea has lower rates of chronic diseases and lower than expected level of fat intake and obesity prevalence than other industrialized countries with similar economic development (18)”

                    The World Health Organization, incidentally, subsequently determined that processed meat is carcinogenic and red meat is “probably carcinogenic” following a detailed scientific review.

                    The scientific report of the US Dietary Guidelines Advisory Committee also argues that people should be consuming more fruits, vegetabkles and whole grains. it does not recommend consuming more meat, saturated fat or cholesterol. I don’t see that any of these reports are inconsistent with the WFPB diet advocated by this site although they do appear to contradict the views you seem to hold about consuming meat etc. Also contrary to your views is the statement in the US dietary guidelines themselves that vegetarian and “vegan” diets that meet nutrient standards are healthy.

                    As for your remarks about LDL cholesterol and older people, this association has been known for a long time. It has been known for even longer – since at least 1926 – that cholesterol falls in many ill and injured people
                    From cancer to infections, from Alzheimers to alcoholism, and from heart attacks to surgery and other traumas, diseases and injuries cause cholesterol to decline. In Western countries, the number of older people who have low cholesterol because of healthy lifestles or genetic factors is I suggest likely to be very low and certainly far, far fewer than those who have low and declining cholesterol because of poor health. However despite this being known since at least 1926, neither Ravnskov nor any of the other fringe cholesterol denialists seem to mention this fact and prefer to claim instead (without any credible evidence) that low cholesterol causes disease. Here are some references showing that disease and injury induce low cholesterol(there are others but I think these are enough)

                    The Minniesota study claims are also highly misleading – they rely on reworking old data to produce the results desired by saturated fat advocates and in any case ignore the fact that, when the study took place, margarines and oils were routinely hydrogenated so the vegetable fats consumed contained significant amounts of transfats despite the oils and nargarines being described as PUFAs. Modern PUFA oils do not usually contain transfat, at least where I live in Australia. The dangers and properties of transfats weren’t understood at that time. Strangely, the revisionist authors of this study chose not to mention this fact. Harvard was quite critical of the claims in that paper

                    I would strongly urge you to read major scientific reports on diet, health and nutrition instead of relying on the wild assertions and misrepresentations found on fringe “alternative health” websites and in sensational popular books. They all-too-often represent unscientific and “counterfactual” pseudoscience. I think you will find that the information on this site is consistent with the conclusions of major scientific reviews of nutrition and health whereas the sites where you obtained the contents of your posts, are most definitely not.

                    1. | Tom Goff replied to your comment on Vegan Protein Status.Tom, My sources- Medscape, World Health Yearbook, BMJ, JAMA. Which of these are ”alternative/fringe websites”? They could not be more mainstream. Uffe Ravnskov and David M. Diamond are both respected researchers, respected by mainstream health professionals and both have multiple articles published in mainstream medical journals. Ravnskov has 73 articles published in English, in JAMA, New England Journal of Medicine, six articles in Lancet, 10 articles in BMJ, three in Circulation, others in Ann Intr Med, J Ntl Cancer and more. He speaks Danish and has 87 articles published in Danish medical journals. I wonder if you would be able to understand some of his articles, they are way above the level of videos for popular consumption that are on NutritionFacts might be considered a ”fringe/alternative website”- and is less mainstream than my sources.

                      Yes, people with mental illnesses do sometimes become vegans and vegetarians and even spokespeople for these diets. Many remain mentally unbalanced despite their change in diet- perfect example -”Dr.” Ben.

                      I was referring to the 7th Day Adventist study. I’m a woman and so am interested in effects of diets for women. The women ”vegans” had significantly higher mortality for Ischemic Heart Disease- 1.39, and Cardiovascular Disease- 1.18. The pesco diet- IHD- 0.51, CVD- 0.90. Huge difference in risk. Even the women eating meat, eggs and cheese had significantly less risk of these diseases than did the ”vegans”. So, no, I would certainly not ”argue” that meat eating is clearly more unhealthy for women than ”veganism”. It isn’t!!! Just the opposite is true. The pesco diet for women -All-cause mortality was 0.88, Semi-veg was 0.92, Lact-ovo was 0.94 and Vegan was 0.97. The vegan diet for men was by far the best and if I were a man, that’s the diet I would try out. But the vegan diet for women is far worse than the nonveg (meat, etc.) diet for heart disease- the #1 killer of women.

                      I am not ”arguing” for any particular diet for everyone. I have already said that I’m indifferent to what other people eat. Obviously there isn’t one diet that is healthiest for all people. The stats above show large differences in health outcomes for women vs men via each diet. For instance-epileptic patients whose seizures can’t be controlled with meds have high fat diets (ketogenic) that reduce or eliminate their seizures. The Predimed diet (41% fat) reduces strokes in the elderly- high fat with olive oil or nuts. There are diets for people on dialysis, diets for people with kidney stones that eliminate certain vegetables, etc. You can look this info up yourself, I’m not going to provide websites for info that’s ubiquitous.
                      The Okinawan stats were accurate and were not found on a fringe site. ”Bogus” in that Okinawans were never vegans or vegetarians- they were eating 3+ oz. meat daily even before WW2, more than mainland Japanese and lived longer. When I was growing up in the U.S. we ate about 3 oz. of meat/fish/eggs/cheese a day, if that much. My mother and father ate the same foods in the same proportion- my father died at 53- 4th heart attack, my mother at 100. My father exercised, my mother never did, neither were overweight, both were energetic.

                      I have yet to read a logical explanation for the ”French Paradox” by the vegans and vegetarians. The French eat everything, live long healthy lives, drink, smoke, do not have a small gene pool. It may turn out that meat eaters do live the longest, with less illness than vegans and vegetarians. Most of the subjects of lipids/diet/heart/mortality studies have been men, many of them diabetic obese couch potato men. I’m a non-diabetic, slim, well-exercised woman. I like the 7th Day Adventist Study because it shows that the diets have different outcomes for men and women. The vegan diet for women is worst in most of the categories than the nonvegetarian diet. I am not going to increase my risk of IHD by 39% to 88% (I’m a pescatarian) to make a cow, fish, chicken, vegan or vegetarian happier.

                      The people on this website live in the small world of Dr. Greger videos, they are apparently incapable of researching anything all by themselves. If there isn’t a Greger video, is doesn’t exist. Videos are for the illiterate and the videos on this site are less than riveting. I can read faster than the info in a video so will get my questions answered elsewhere.

                    2. Windy T. This is all standard “alternative health” fare too. The inaccuracy of some of these claims and the flaws in the logic are also pretty obvious to anyone who examines them closely..

                      You wrote “My sources- Medscape, World Health Yearbook, BMJ, JAMA. Which of these are ”alternative/fringe websites”?” First you haven’t given us most of your specific sources/links either before or now for that matter. Second, the odds are you found this stuff on crank websites and simply repeated it here. For example, if you yourself had actually checked out the Medscape article which one of your posts did refer to, it would have been been obvious that it misrepresented the findings of the actual study.

                      You also wrote “Uffe Ravnskov and David M. Diamond are both respected researchers, respected by mainstream health professionals” Sorry but this is a ridiculous claim. Ravnskov is widely regarded as a crank when it comes to cholesterol. He may be a published crank but he is still a crank nonetheless. His views are completely contrary to cholesterol guidelines around the world not to mention the massive evidence base. Even Ravnskov himself accepts that mainstream scientists regard him as a crank
                      Diamond, who has authored several papers with Ravnskov, is also regarded as having nonsensical views on cholesterol eg

                      As for arguing that the 7th Day Adventists mortality study shows that a “vegan” diet is unhealthy for women, this is false logic. Observational studies cannot account for all confounders and as Dr Greger has frequebntly pointed out, many “vegan” and vegetarian diets are in any event unhealthy. This study doesn’t say anything about whether whole food plant based diets are healthy or not. In any case, simply basing your views on a single observational study and ignoring all other evidence doesn’t seem particularly wise. In fact, basing your views solely on observational studies, no matter how many, can be misleading, Consider for example, this from Medscape (since you seem to like that site):
                      and, regarding the potential pitfalls of relying on observational studies, consider this also from Medscape
                      “There is a whimsical example by Austin and colleagues,[8] who studied the medical effects of astrological signs. They divided approximately 10 million patients into 2 sets of approximately 5 million each, and made 24 tests, using all 12 signs and 2 outcomes, for the ill effects associated with astrological sign in one set. They showed that the “significant” results were not confirmed in the other half of the data. Figure 2 gives the probability of a false claim as a function of the number of questions asked.”

                      Further, you wrote “The Okinawan stats were accurate and were not found on a fringe site. ”Bogus” in that Okinawans were never vegans or vegetarians” This is bizarre. You haven’t provided any sources for your stats or told us what period they supposedly relate to. Also, nobody described the Okininawans eating a traditional diet as “vegans” or “vegetarians”. You – or somebody – has just made that claim up. As I wrote – simply bizarre. However, it is pretty obvious that obtaining fewer than 4% of total calories from animal foods means they were eating a plant based diet. Little wonder then that militant low carbers/meat eaters/saturated fat advocates and other such alternative health types would try to dismiss the study as “bogus” even though the reason your post give for this description is patently absurd.

                      Also bizarre is the statement “I have yet to read a logical explanation for the ”French Paradox” by the vegans and vegetarians.” What on earth has the French Paradox got to do with vegans and vegetaruans? I doubt that many if any of the scientists and researchers who have identified saturated fat is a risk factor are “vegans and vegetarians”.. Are we supposed to assume that the World Health Organization expert scientific panel, the US dietary guidelines scientific advisory committee, the American Heart Association expert panel, Harvard University and lord knows how many other scientists, researchers and physicians all around the world are all vegans and vegetatians conspiring against saturated fat? This is another sign that the contents of your posts ultimately come from fringe websites, books and dubious YouTube videos. In fact of course, there are vegan and vegetarian conspiracy nuts and similar cranks who also love saturated fat – in the form of coconut oil and palm oil etc So I don’t follow the logic of your statement (even ignoring the fact that this site promotes whole food plant based diets rather than all kinds of “vegan” and vegetarian diets). It just sounds crazy to me. Sorry.

                      The French Paradox is blatantly misrepresented by many of the cranks. No credible health authority claims that saturated fat consumption is the sole risk factor for heart disease whatever the cranks may claim. Nor is cardiovascular disease solely a matter of risk factors. There are protective factors that need to be taken into account also. For example, French and other mediterranean groups may eat more fresh fruits and vegetables, or drink fewer spirits and consume fewer transfats and processed foods, than Americans and be less sedentary. Nobody is entirely sure what explains the differences. In any case, the paradox is not that saturated fat is not a risk factor in those countries because it is. The so-called paradox that it is a smaller risk factor than in eg the USA, Finland etc. Despite this, the saturated fat advocates like to imply falsely that the paradox is that saturated fat is not a risk factor at all in France/Mediterranean countries. This simply isn’t true as the famous Lyon diet heart study, which of course took place in France, amply illustrated. It showed that replacing saturated fat (butter and cream) with PUFA and MUFA margarines was associated with fewer cardiovascular events.

                      As for your final less than gracious comments, it has clearly escaped your notice that users of this site can either watch the videos or read the transcripts, whichever they prefer. Quite a few prefer the transcripts Most users of this site are also educated enough and smart enough to check out the science around nutrition and health instead of simply believing the simplistic and often obviously false claims found on many alternative health websites. This is a site devoted to nutrition facts not nutrition fictions. People are encouraged to consider the pro and con arguments before making up their mind. What is more, the sources are clearly identified so people can do their own fact-checking.

                      Your opinions on the other hand appear to be already set so, yes, you will probably be happier elsewhere. There are plenty of sites that offer counterfactual nutritional pseudoscience, conspiracy theories and wishful thinking for those who prefer that kind of thing..

                    3. Tom-OK- here are 2 links- ”Dietary Fat Guidelines have no evidence base:…” Zoe Harcombe

                      A Malhotra-2017, Rita F Redberg, Pascal Meier ”Saturated Fat Does Not Clog the Arteries…” All three are well known cardiologists, not fringe. And they cite Ravnskov and Diamond and others at the bottom of this article which you can click. All three authors treat patients. Redberg is with UCSF-Cardiology, Editor-in-Chief of JAMA Internal Medicine, Meier is Editor-in-Chief of Open Heart BMJ and Ass. Editor of Cochrane Heart Group, Malhotra is at the Univ. Hospital, Geneva- a very influential Cardiologist.

                      My own cardiologist at a large teaching hospital who is head of the Women’s heart disease division introduced me to the 7th Day Adventist study results for women a few years ago, told me to look at some articles by Ravnskov and Diamond, and more recently to the PURE study results. She is also a published researcher on women’s heart/diet issues and so has the smarts, education and experience to analyze the research of others. You discount any research that disagrees with your dated ideas yet this same research is changing well known high-level cardiologists minds, their diet advice to patients, and their practices. Dr. Greger is a GP, not a cardiologist and not a researcher. Best to keep this in mind when making choices about one’s own health.

                    4. Windy T Thanks for the links. I have come across these two before.

                      They are very well-known but they are definitely on the medical and nutritional fringesw which is why they have to cite Ravnskov and Diamond. The bulk of the scientific literature, and expert analysis, does not offer any support for their views. Malhotra is a celebrity cardiologist – as Atkins was – but his views are definitely fringe views. The UK professional guidelines make it very clear that he is out on a limb. They say for example that “The epidemiological evidence started with the Seven Countries Study, which showed that total fat, and specifically saturated fat, are both positively associated in these populations with 25 year coronary mortality.18 At the level of individuals within each population in this international study, saturated fatty acids (SFAs) were also related to coronary mortality. As consumption of saturated fatty acids increases so does LDL cholesterol. A decrease in fat intake results in a decrease in LDL and HDL cholesterol, but the overall effect on lipoproteins depends on which nutrients replace the saturated fat.19 A meta-analysis of randomised controlled trials of reducing saturated fat (using monounsaturated or polyunsaturated fats as replacement) with at least two years follow up has shown a risk reduction for cardiovascular events: 0.76 (95% CI 0.65 to 0.90).20

                      In epidemiological studies polyunsaturated fatty acids of both n-6 and n-3 classes are inversely related to risk of CHD.21–24 Linoleic acid is the principal fatty acid in the n-6 group and is mainly found in vegetable oils. Alpha-linolenic acid is the precursor of the n-3 group and the main source is certain vegetable oils: soybean, safflower, and linseed oils. A randomised controlled trial of a diet enriched with alpha-linolenic acid in high risk people has shown reductions in coronary and all cause mortality.25”

                      Malhotra also has links to the food industries via his “National Obesity Forum” which appears to receive funding by food and drug companies, and his views are roundly condemned by acknwwledged experts and credible health organisations eg the Royal Society for Public Health and government agency Public Health England

                      I understand that Malhotra now has a new diet book to sell. Also selling a diet book is Harcombe who is also very high profile but has had some of her credentials questioned in the past. Apparently she now has a PhD from the University of the West of Scotland. Either way, while high profile she is hardly a renowned researcher. She did have a paper published in the pay-to-publish Open Heart journal but a correction had to be issued because she failed to disclose a conflict of interest “Following comments from readers, and post-publication discussions within our editorial team, the authors of this paper were asked to update their competing interest statement. The potential competing interests relate to one of the authors of the article, Mrs Harcombe, who has previously published books on diet and nutrition, and is also a co-director of a company that gives dietary advice (The Harcombe Diet Co.) and co-director of a publishing company (Columbus Publishing) that publishes books on diet and nutrition.

                      At the time of submission of the manuscript, the authors did not declare these competing interests”

                      Fringe views like theirs (and Dr Atkins’ in his day) do attract a lot of public attention. The media and the public love this sort of thing – who doesn’t want to hear that butter, beef, bacon and brie are healthy? However, their views are completely contrary to the evidence set out in mmajor reports on nutrition and health. in particular they ignore evidence from clinical trials where saturated fat is replaced by healthier alternatives and cardiovascular events are reduced. Their views are also contrary to real world experiments such as Finland and Poland eg
                      “The experience of Poland is consistent with epidemiological and clinical evidence4 indicating that mortality due to coronary heart disease can be reduced by partly replacing dietary saturated fats with polyunsaturated fats while maintaining a low intake of trans fatty acids.

                      Polyunsaturated fat reduces serum concentrations of low density cholesterol,4 but this cannot account for the size and rapidity of changes in coronary mortality in Poland. A higher intake of polyunsaturated fat also improves endothelial function, reduces platelet aggregability, and reduces ventricular fibrillation.4 The net effect can therefore be appreciated only by evaluating coronary end points. Increased intakes of polyunsaturated fat also probably explain most of the major declines in coronary mortality in the United States, United Kingdom, and Australia over several decades.5”

                      However, reasons for identifying high saturated fat consumption as a risk factor are not limited to epidemiogical studies and clinical trials, A fair amount is now known about the mechanisms by which saturated fat can damage the acrdiovascular system. just two examles are
                      “A new paper, “Saturated fatty acids induce endoplasmic reticulum stress in primary cardiomyocytes,” just published in open access in “Endoplasmic Reticulum Stress in Diseases” by De Gruyter Open shows that there are striking differences in the accumulation of saturated and unsaturated fatty acids in cardiac muscle cells, and that saturated fatty acids induce the death of these cells through the ER stress. In stalking contrast, unsaturated fatty acids protect the same cells from such damage.”
                      “Consumption of a saturated fat reduces the anti-inflammatory potential of HDL and impairs arterial endothelial function. In contrast, the anti-inflammatory activity of HDL improves after consumption of polyunsaturated fat. These findings highlight novel mechanisms by which different dietary fatty acids may influence key atherogenic processes”

                      There are quite a few others. The World Health Organization, national health agencies, professional bodies everywhere and credible insttutions like Harvard identify high saturated fat consumption as a risk factor for good reasons. The fact that a very few cardiologists like Malhotra and your personal cardiologist choose to ignore this evidence is a telling commentary on them. Your cardiologist for example is definitely providing advice contrary to US cardiology guidelnes just as Malhotra is providing advice that is contary to UK cardiology guidelines. US guidelines say that concumption of saturated fat should be reduced to lower cardiovascular risk.

                      However, if you choose to prefer the advice of a small group of people like Ravnsko, Malhotra et al, that is your privilege. Personally, I am not willing to bet my health that they are right and the rest of the world is wrong, no matter how seductive their claims. Especially when the evidence they offer is so weak and opposite case is so compelling.

                      Anyway, good luck and good health to you.

                    5. The ”small group of people” are all top notch doctors and other doctors follow their advice, especially those who work alongside them. Rita Redberg, et al are not considered fringe by other doctors, and in fact, Redberg has been a ”Super Doctor”- considered an honor -voted so by other doctors, as has my own doctor. You label well-known physicians and researchers, respected by their peers as ”fringe”- this is only in your own fringe mind, no other physicians consider these doctors ”fringe” nor do they consider their various research studies ”fringe”. You can cite all the old studies that support your diet notions but prominent cardiologists are no longer practicing that way.

                      Yes, I follow the advice of my ”Super Doctor”, a Director and Co-Director of two cardiology depts. and a rehab program in a large highly rated big city U.S. hospital instead of following advice from a website by a G.P. who’s done no research of his own and most likely refers his patients with heart problems to Cardiologists, as he should.

                    6. TG: Nicely said.

                      My thoughts are: As we all know, doctors are not trained in nutrition. Just because a cardiologist thinks something about nutrition does not necessarily mean that they have a good grasp on the subject. However, if “what a cardiologist thinks” were relevant criteria, you and I could easily come up with a big list of top cardiologists who looked at the data and switched to a whole plant food based diet. We could play, “my list is bigger than yours”. ;-)

                      The criteria/data that I find most compelling when it comes to heart disease is that there has only ever been one diet proven in peer reviewed medical research to reverse heart disease – ie, open up clogged arteries : a low fat whole plant food based diet. We have before and after xrays showing the arteries clearing up. It is odd to me that anyone would want to follow the advice of people who push a diet that hasn’t been proven this way. I know you know about these studies. I’m just saying for the discussion. :-)

                      Thanks for your insight.

                    7. Windy T: Here’s one to get you started: (Here’s a quote from the video: “Dr. Kim Allan Williams became president of the American College of Cardiology. He was asked why he follows his own advice to eat a plant-based diet. “I don’t mind dying,” Dr. Williams replied. “I just don’t want it to be my [own] fault.”) I’ll let you find others on your own if you are truly interested.

                    8. | Thea replied to your comment on Vegan Protein Status.You were going to present a long list of top notch cardiologists. You’ve produced one. Vegetarians, vegans and whole plant foodarians (yes, I made this word up) are rare in the U.S. I doubt that the % of cardiologists that are vegan/vegetarian/etc. is greater than that in the general population. I and my friends and family have been to a number of prominent cardiologists over the years and not one has recommended such a diet nor have they communicated being on such a diet. I can produce a very long list of non-vegans, non-vegetarian cardiologists, where is your promised list?

                    9. Windy T: sigh again. You seemed to have missed the point. I never promised you a list. Even if I came up with a list a mile long, it would be irrelevant. Wisdom comes in understanding the second paragraph. Well, and the first too now that I think about it. I’m not going to do your work for you. I got you started. If learning the opinion of cardiologists is relevant to you, you can do your own homework. You clearly think you already know the answer. So, once again, since you know the answer as far as you are concerned, conversation over with you.

                    10. Thea- here’s a direct quote from yesterday ….”you (Tom Goff) and I (Thea) could easily come up with a big list of top cardiologists who looked at the data and switched to a whole plant food based diet”. True, you didn’t promise but you did volunteer such a list- something I had not asked you for. And you wanted Tom to assist you with your big list. Cardiologists are no more likely to be on such a diet than plumbers or cab drivers. You easily came up with one but #2 through 10 will be probably impossible.
                      Dr. Steven Levine, a cardiologist in Santa Monica, CA owns a popular restaurant called ”Wilshire” – you can google it and see what he serves there.

                    11. Windy T: When you read the whole post, you can see that I did not “volunteer” anything. And I’m done doing any work for you. So, I won’t be looking up Dr. Levine’s menu.

                      I’m not sure if you truly fail to understand the content of what I wrote or if something less savory is going on. Giving you the benefit of the doubt, I’ll put it another way for you: Does Dr. Levine include a peer reviewed published study showing before and after x-rays of arteries opening up for those people who ate a diet of his restaurant food? If not, then it looks like he is working to drum up business for himself in more ways than one. Shame.

                    12. | Thea replied to your comment on Vegan Protein Status.”Less savory” means less tasty, refers to food.-doesn’t make sense. I have never asked you to do any work for me. Obviously I am familiar with the menu of ”Wilshire”.

                    13. Windy T: I’m sorry the word “savory” was confusing to you. Here is how Merriam Webster (a respected dictionary) defines the term:

                      a :piquantly pleasant to the mind : a savory triumph
                      b :morally exemplary :edifying
                      c :pleasing to the sense of taste especially by reason of effective seasoning
                      d :pungently flavorful without sweetness

                      I hope that helps.

                      Happily, you don’t need to understand that sentence to understand the actual point of my post–the part that talks about the Dr.’s (lack of sufficient) evidence to justify his use of his credentials to sell people food. (A particularly corrupt or maybe just ignorant business, because the doctor has access to published evidence involving of a diet that does actually reverse heart disease. As I said above, a low fat diet of whole plant food is the only diet, to my knowledge, that has been proven, via before and after xrays, to open up closed arteries. If the restaurant owner has evidence of people reversing their heart disease on his restaurant food or food just like it, that would be amazing. He should get that published.)

                    14. Windy T. Sorry but these claims are fantasies. I have shown you that both the UK and US cardiology professions, through their respective national guidelines, identify saturated fat as a risk factor for heart disease. That position is based on the latest evidence as well as the huge bulk of past studies. You mentioned BMJ in a previous post. Another study in the BMJ last year concluded that:

                      “Higher dietary intakes of major SFAs are associated with an increased risk of coronary heart disease. Owing to similar associations and high correlations among individual SFAs, dietary recommendations for the prevention of coronary heart disease should continue to focus on replacing total saturated fat with more healthy sources of energy.”

                      Even more recently, In fact just a few months ago, the American Heart Association renewed its message on saturated fat:

                      “This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ˜30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality.”

                      None of this is surprising since we know that high saturated fat consumption damages the endothelium eg
                      “In this chronic study, we found that SFA impaired endothelial function and that subjects had a marked increase in TG and a fall in HDL-C on the low-fat CARB diet without an effect on FMD. PUFA and MUFA diets compared with SFA reduced P-selectin concentrations. These results lend further support that a high-SFA diet is atherogenic through its adverse effect on endothelial function and P-selectin levels.”

                      The claim that the analysis confirming that saturated fat is a risk factor is based old, outdated evidence is blatantly untrue. This is another sure sign that your views come from crank websites and individuals who deliberately misrepresent the facts. These people also ignore the evidence from experimental studies and the evidence of how saturated fats affect cardiovascular health such as that quoted above..

                      The alternative health crowd, of course, always describe any professional who agrees with their pseudoscientific opinions as a “top” this or that. It means nothing although it perfectly illustrates the hype and boldness with which their claims are made.. Yes, you can find a snall number of cardiologists and other physicians who are entirely out of step with the rest of their professions. All this shows is that there will always be a small proportion of any group who hold fringe views. How is the fact that this small group of people are cardiologists supposed to prove that they are correct when the UK and US cardiologists as a professional group say they are dead wrong? There is also a small group of cardiologists accused/found guilty of Medicare and other fraud. What does this prove? How is the existence of a small group of cardiologists who practise medicine contrary to their professional guidelines and professional ethics supposed to prove the superiority of their stance? Clearly, it can’t and doesn’t. It is like saying that the tiny number of scientists who are creationists proves that creationism must correct because those individuals are “top” scientists. Most people will understand the flaw in this logic.

                      If though, as it seems, you are seeking to argue by authority then you are backing a losing horse here because all the top cardiology experts – as evidenced by the professional guideliines – hold the opposite view. So do the expert scientific reports produced by the World Health Organization, national health authorities and professional bodies worldwide (cited previously).

                      Atkins was a cardiologist too and the incredible Donald S Miller is a heart surgeon. No doubt, they are “top” doctors also.

                      So if you want to base your diet on the advice of “super doctors”, as you call them, instead of the nutrition and health guidelines issued by real experts, then good luck to you. You’ll likely need it. People willing to consider all the evidence and the sources of health advice, will prefer to base their diet on the extensive evidence set out in the major reports on diet, health and nutrition. That evidence is compatible with the information provided on the NF website but which completely refutes the claims made by those so-called “super doctors” who chose to ignore the bulk of available evidence.

                    15. | Tom Goff replied to Tom Goff on Vegan Protein StatusI’m aware of past studies and in fact I was in a program-Ornish- and on that very low-fat diet. If you look at his earliest study- this is off the top of my head- the results of 6 patients on the Ornish program were tossed out and not counted and one Ornish patient died , the 5 women in the control group all improved as did a few others in that group that weren’t on a diet or exercise program. Since I know the ”fates” of the people in my Ornish group I don’t think heart disease is all about sat. fat. And we already know from N. Pritikin that while his arteries were clean, he committed suicide when he got leukemia for the 2nd time so his diet did not protect him from cancer or despair.
                      I think that sat. fat does not cause plaque and that there will be more studies that will show this. This is not to say that a diet devoid of veggies, fruits, grains, is healthy or that having 40%+ of calories coming from sat. fats is healthy. Everything in moderation works for most people.
                      There are very few cardiologists that recommend veganism or vegetarianism or eat that way themselves. Most rely on an array of meds for their patients and many think that Ornish’s studies and conclusions are ”not scientific”- two doctors told me this who were doctors associated with the Ornish program. So I doubt there is a long list of prominent cardiologists that are on a whole plant foods based diet or recommend it to their patients. Most advocate exercise, not smoking and having a normal weight. There are hundreds of studies on diet/disease so anyone can find some that agree with their point of view. And there will be more studies in the future.

                    16. Windy T: TG tried to reply to your Ornish post twice. For some reason, the reply disappeared. It stuck on another page though and I agreed to copy the post for you here. The following is TG’s response to your post that talks about your opinion of the Ornish program.

                      Windy T. I think that we are changing the subject here. The point was that any cardiologist who recommends a high saturated fat diet, or suggests that such a diet is harmless, is practising medicine contrary to his or her professional guidelines. Not to mention contrary to the evidence. Furthermore, a whole food plant based diet is basically what all dietary guidelines AND cardiology guidelines, via eg the DASH diet, recommend. They all advise more fruits, more vegetables and more whole grains and reduced consumption of processed foods, red meat and transfats. Few of the guidelines uses terms like vegan, vegetarian or plant based and they almost always recommend small(er) amounts of animal foods. Not always of course, the US dietary guidelines explicitly state that well-planned “vegan” and vegetarian diets are healthful. Also, the World Cancer Research Fund scientific panel’s recommendation to “Eat mostly foods of plant origin” is just another way of saying eat a plant based diet.
                      As Shakespeare put it, a rose by any other name would smell as sweet.

                      The claim that cardiologists are no longer advising against high saturated fat consumption is simply untrue as is the claim that the identification of saturated fat and cholesterol as risk factors is old, outdated information. Any cardiologist doing or saying this is ignorant of the evidence, going against professional guidelines and probably (in the US at least) vulnerable to medical malpractice suits. That is because I understand (although I am no lawyer) that failure to follow professional guidelines is sufficient grounds to demonstrate medical negligence ………….
                      “in Washington v Washington Hospital Center, a patient sued a hospital, alleging that a physician there was negligent by failing to use a certain monitor.7 Although this issue was not ultimately dispositive in the case, a Washington, DC, court upheld that the American Association of Anesthesiology’s guidelines (which recommended the use of that type of monitor) were sufficient grounds for a jury to find that the physician was negligent.”

                      Such false claims simply show that either ignorance abounds in cholesterol and saturated fat “sceptic” circles or that the cranks and crackpots have absolutely no regard for the facts and apparently will say anything if it advances their pseudoscience agenda. I am surprised that you repeat such claims here because I had assumed that you had done some actual research as opposed to just looking at fringe websites and misleading popular “health” books. The claim about outdated information is absolutely ludicrous and the exact opposite of the truth. In fact the idea that high cholesterol is both normal as we get older and harmless, was tossed into the waste bin of history 50 or so years ago once the evidence started to come in. Yet, the cholesterol and saturated fat apologists are still clinging to this ancient, disproven theory. You could usefully read Steinberg’s five-part history of the cholesterol controversy, in the Journal of Lipid Research, on this point.

                      The recent evidence also confirms that high cholesterol is a risk factor, despite the efforts of advocates using observational studies which confuse the issue by not even mentioning that disease and trauma cause cholesterol to decline. Besides epidemiological and experimental studies, and the identification of the mechanisms which show how high cholesterol damages cardiovascular health, the recent use of Mendelian randomisation techniques not only added another row of nails to close down the coffin lid of the “high cholesterol is harmless/healthy” claim, it sealed the lid shut by high tech, high temperature welding.
                      “The fundamental principle of Mendelian randomisation is that if genetic variants that either alter the level of, or imitate the biological effects of, a modifiable biomarker that is causal in disease, then these genetic variants should also be associated with disease risk to the extent predicted by the effect of the genetic variant with the biomarker.16 This can be thought of as an analogy to a RCT: when stronger doses of drugs are used that have a greater effect on a causal biomarker (eg, use of more potent statins that have a greater reduction on low density lipoprotein cholesterol (LDL-C) levels), the resultant effect on risk reduction for CHD is greater.18 Thus, use of genetic variants that have stronger effects on LDL-C should have stronger relationships with risk of CHD, and this is exactly what is seen.19”

                      The cholesterol argument is made by defenders of saturated fat because the main (but far from only) mechanism by which high saturated fat consumption damages cardiovascular health is that it raises LDL cholesterol. If they can cast doubt on the fact that high plasma LDL cholesterol is a risk factor, they think that they can also cast doubt on the fact that high dietary saturated fat is a risk factor. This is why they tie themselves in knots trying to defend the indefensible.

                      Consequently, whether or not there are “vegan” or vegetarian cardiologists is neither here nor there. Cardiologists are usually not trained in nutrition (and even lipidology seems to be a fairly small part of the training). However, there are a number including Kim Williams, Heather Shenkman, John Teeters, Joel Kahn, Jeffrey Soble and Andrew Freeman off the top of my head.

                      As for the Ornish remarks, there is no doubt that double-blinded, randomised, controlled trials are the gold standard in medical research. Few studies that do not involve a single intervention, a specific pill perhaps, can reach this standard. Ornish’s study was no exception. His study also involved multiple variables eg diet, exercise and stress management, so it is virtually impossible to disentangle the precise role of diet alone in the study results.

                      However, his studies were stronger forms of evidence than virtually everything cited by the saturated fat and cholesterol apologists. In fact, the evidence his studies delivered was strong enough to convince hard-headed money managers that operating Ornish programmes would both benefit patients and save health systems money by reducing their expenditure on adverse health events. These include Medicare, Highmark, Anthem and HMSA. Those organisations don’t spend money on an intervention unless there is good evidence that it works AND/OR it reduces future costs. That alone I think is a pretty telling indication of the strength of the Ornish evidence.

                      I am not aware that Medicare, HMOs or insurers reimburse cardiac patients who embark on saturated fat or keto interventional regimes.

                      Also the major UK NICE cost effectiveness review of cardiovascular risk management guidelines found that reducing cholesterol benefitted patients and saved the healthcare system money. The UK spends billions on statins and other drugs to lower cholesterol. They only do that because cholesterol lowering works. Far better to do it via diet though and that really means reducing or eliminating saturated fat consumption .

                    17. Also read/click on Reference 2. Nissen, Steven E ”U.S. Dietary Guidelines: an evidence-free zone.” Nissen is Chairman of Cardiovascular Medicine at the Cleveland Clinic or as you would say the ”fringe” Cleveland Clinic (!). Wikipedia has a page about him. The dietary guidelines are based on not much which may be why cardiologists have little confidence in them.
                      So odd that all the cardiologists I have mentioned, according to you- ”crackpots”, ”cholesterol apologists”, ”on fringe websites” (like the Lancet?) have risen to such high and influential positions in the best teaching hospitals, are editors of prestigious cardiology journals, have themselves published many research articles. Must be a plot!!! The PURE study was not done by ”cranks and crackpots”. The researchers did not know what the findings would be until all the data was in which took years. One of the findings of the PURE study was that those who ate the highest amount of saturated fats, lived the longest. Those who ate the most carbohydrates lived the shortest. You don’t like their results. Tough.

                    18. TG: I just got around to reading this post and am so glad I did. The stuff on Mendelian randomisation is new to me and so interesting.

                      Also, the list of papers on the history of cholesterol research is so helpful. I didn’t read the whole thing yet, but I did take a peak at the end. I got a kick out of the 10 reasons listed for there being any controversy about the role of cholesterol in heart disease. #9 is particularly relevant to this conversation:

                      “The preoccupation of cardiologists with their new and exciting diagnostic and interventional tools, and impatience with the notion of preventive cardiology.”

                      All of them are good points. That one was funny though in light of this conversation. Thanks for taking the time to write this post.

          2. If they are unhealthy its because they want to make the jump to be veg, but dont plan meals properly.

            Like for example, a person could be “vegetarian” and living off of cereal and milk, cheetos and pizza. While not having meat, THAT isnt healthy.

            Honestly if a person eats different beans, kidney beans, black beans etc. As well as different lentils, maybe quinoa, etc. Then they can certainly easily achieve their protein needs. Not to mention meat-substitutes like MorningStar is a godsend for veg eaters who dont have enough know-how yet to know which foods to prepare

      2. Cristina- Before I went on a vegetarian diet, my Total Protein level was normal- right in the mid-range. After 6 months , it had decreased, but was still normal. At the one year mark, it was lower still, just short of abnormal. 6 months after that, it was below normal. I took the same vitamins you did but I felt very weak, no stamina and no energy after being 18 months eating vegetarian. When I again began to eat fish and other animal proteins, I felt really well and my Total Protein went right back to mid-range normal. I would never again eat vegetarian, for me it wasn’t at all healthy. Some people may thrive on vegan or vegetarian, but I’m not one of them.

        1. Windy T, one problem with the so-called French Paradox, is that the French have some of the highest breast cancer rates in the world. Rank # 3 I believe. Even higher than US.
          Maybe they are mostly healthier than Americans because they do eat a lot of plant foods, and walk a lot?

          1. Marilyn- I’m going to use death rates (age standardized) for breast cancer because it’s a disease that can be ”overdiagnosed” or ”overtreated”. France’s death rate is 23.34 per 100,000, the U.S. is 19.36, less than 4 deaths difference. The highest rate- Armenia 39.96, and the lowest- Bhutan 2.12. Coronary Heart Disease deaths- France 29.97, U.S. 77.97, we have 48 more deaths than France. India with over 1/3 of the population strict vegetarians and another 1/3rd mostly vegetarian- 138.36 deaths. I’ve been to France a few times and noticed they smoke much more than we do. They have real butter, full fat cheeses, eggs, meat, rich sauces, fantastic pastries and plenty of wine. They have a diet with one of the highest saturated fat intakes in the world. Their higher breast cancer rate may be the alcohol or they may have more women with the BRCA genes. They do walk more than Americans. They live longer, and live many more years in good health than we do.
            Vegans have much higher death rates from Ischemic and Cardiovascular heart disease than those who eat the ordinary American diet. I think that we will see some major rethinking of what comprises a healthy diet in the next few years as more good studies are done.

            1. Where on Earth do you get all this stuff from? You don’t provide any sources and the Adventist 2 study suggests that you are dead wrong about mortality ie your claim “Vegans have much higher death rates from Ischemic and Cardiovascular heart disease than those who eat the ordinary American diet.” is incorrect according to that study. where vegans in fact have substantially lower mortality than omnivores.

              Other studies have found no difference or “Mortality from ischemic heart disease was 24% lower in vegetarians than in nonvegetarians (death rate ratio: 0.76; 95% CI: 0.62, 0.94; P < 0.01) …… .and 26% lower in vegans"

              Perhaps you get this stuff from crackpots like the Weston Price Foundation who have made similar claims in the past? I suspect that they are as unreliable on this matter as they are on everything else..

              1. Women vegans- we already talked about this- look at the 7th Day Adv. stats. I have never read anything from Weston Price, I gather from you he has opposite views.

          2. This whole discussion is interesting as there is a lot of data here.
            One point, it does not matter at all what ‘most’ cardiologists recommend or are advising people to do. The history of science is that the ‘herd’ is wrong many times. Think of Pasteur, Semmelweis, Kammerow, etc. When scientists suggest something not currently thought, they are first ridiculed, then usually persecuted, then finally, sometimes many years later, proven right.
            Sometimes finding the answers is difficult. I applaud Dr. Gregor for trying to do this. Will every one of these studies hold up long term, probably not. But most will, and the discussion, and the next round of studies generated will prove valuable.
            The one concern I have, is that the protocol stated for this website, to be respectful, is too often not being observed.
            This will only result in turning off many people seeking the truth.

            1. | Marilyn Kay replied to Marilyn Kay on Vegan Protein StatusI agree with you about when scientists suggest something not considered conventional wisdom, they are ridiculed and sometimes many years later they are proved right. This latest PURE study goes against the prevailing assumptions about saturated fats being a cause of heart disease. I wrote here that three well known cardiologists wrote an opinion paper saying that the PURE study is accurate- that saturated fats do not cause heart disease. Someone from this website said- among other things- that these cardiologists are ”fringe” doctors even though they hold respected positions in cardiology, treat patients, do research themselves and are held in high regard by their fellow cardiologists. It would be ”fringe” for a cardiologist to recommend a vegan/vegetarian diet- it so rarely happens. That’s pretty much the definition of ”fringe”- something way off to one side, not mainstream. It’s possible that the PURE study verified their own observations of their patients as it did my own cardiologist. There have been other opinion papers criticizing the three cardiologists for backing the results of the PURE study but I have not seen any criticisms by actual cardiologists that treat patients. My own cardiologist alerted me to the PURE study recently, and a few years ago to the Adventist 2 heart disease results for vegan/vegetarian women which were worse than even the results for non-vegetarian women. These study results apparently upset a few vegans/vegetarians here no end. I would think that if someone were getting good results from their diet that a study that runs contrary to their own experience would not faze them- different strokes for different folks. You say that it doesn’t matter what most cardiologists recommend to their patients but the researchers that conducted the PURE study are cardiologists, most in high level positions in teaching hospitals all over the world where they are also professors teaching medical students. This is what top cardiologists do- they take care of patients, they teach and they do research. This is what my own cardiologist does. Cardiologists/researchers know that not everything is already known about heart disease. They are endlessly curious and excellent observers of what works and doesn’t work with their patients. I don’t know which of these recent studies or the older studies that Dr. Greger has used in his video library will hold up over time, but I am certainly interested and looking forward to future studies that will have been stimulated by PURE and Adventist 2.

              1. Read the Pure Study. I’m not a doctor, but I have done research. I think this study compared apples to oranges, and proved absolutely nothing.

                1. Prominent cardiologists disagree with you. You are certainly entitled to your own opinion. In response to Thea, I provided a link to a Lancet article with another link -Reference 4. by SE Nissen. The PURE study also has links in References.

                  1. Windy T: I believe I already covered that the PURE study has fatal design flaws. The PURE study does not tell us anything but the following: people in poor countries who do not have access to health care and adequate nutrition die sooner than people in rich countries. As it turns out, people in poor countries don’t have the means to buy as much meat, dairy and eggs as people in right countries. That’s what the data is telling us. As Marilyn Kay kindly pointed out, you really should check into the study if you want to cite it. If you don’t feel up to evaluating the study yourself, here are good reviews that explain these fatal flaws:

                    From PCRM:
                    From Dr. Katz:

                    Well respected poster on NutritionFacts, TG, also wrote the following:
                    “…it is worth bearing in mind that McMaster University has a history of producing studies which show dairy foods in a favourable light and/or which defend saturated fat consumption. What is more, they receive grant funding from the Canadian dairy Industry (and occasionally the US Dairy Council). Dairy Farmers of Canada calls McMaster University a “partner”.

                    Consequently, I tend to look closely at the study design of anything coming out of McMaster. In this case, comparing outcomes for people across different countries eating carbs with people eating fat etc, can often end up simply comparing the mortality rates of poor people in underdeveloped countries who eat primarily cheap low quality carbs with the mortality rates of people in wealthy developed countries whose diet is generally richer in fats etc. Not controlling for such factors would be expected to produce results exonerating saturated fats or implying that they are healthful. In fact, saturated fat and cholesterol apologists have been doing this same sort of thing for years. Plant Positive discusses this misleading approach here

                    Like TG, the first two reviews above also point out the flaw of comparing two different economic groups with access to different amounts of calories and health care. What’s great about TG’s post is that he points out that this strategy has been used for *years* in order to twist the data and confuse people. Plant Positive is a great resource. If you haven’t checked out that work yet, it is worth doing.

                    The Bigger Picture: Faulty study methods have been a big problem of meta studies in general. The following commentary published in JAMA explains the why and how of it: “The misuse of meta-analysis in nutrition research.” “Controversial conclusions from meta-analyses in nutrition are of tremendous interest to the public and can influence policies on diet and health. When the results of meta-analyses are the product of faulty methods, they can be misleading and can also be exploited by economic interests seeking to counteract unflattering scientific findings about commercial products” IE: It’s good to keep that information in mind when you see headlines about research that seems to do nothing more than give you good news about foods you know are bad for you.

                    1. You say PURE has fatal design flaws, SE Nissan M.D., Chairman of Cardiovascular Medicine at the Cleveland Clinic says it does not. I will go with Dr. Nissen rather than you on this. And I will go with Dr. Rita Redberg on sat. fats not being a cause of heart disease. Both these cardiologists can be googled and readers can decide for themselves.

                    2. Windy T: re: “… can decide for themselves.” Deciding for yourself means looking at the actual study and the study’s criticisms and making an informed judgement for yourself. Judging for yourself does not mean googling someone’s credentials, a credential that does not equate to knowledge in the subject of nutrition research to begin with, and then turning over judgement to that person. Your choice of course. I’m just making the distinction.

                    3. | Thea replied to your comment on Vegan Protein Status.Readers can decide for themselves, does not necessarily mean what you say it means- ”looking at the actual study….”. You would make a fine dictator! Although you might have difficulty getting much of a following. Your motto could be- ”what can be said in 10 words, I will say in 100 words”.

                    4. The PURE study states that those with a higher consumption of sat. fats, fruits, raw vegetables, and legumes lived longest vs those with highest consumption of carbs, lowest fruits, raw vegetables, and legumes.

                    5. Windy T: No, your statement is inaccurate. The authors of PURE study provided incorrect conclusions about the data in their study. Here is what the *data* shows: people in poor countries who do not have access to health care and adequate nutrition die sooner than people in rich countries. As it turns out, people in poor countries don’t have the means to buy as much meat, dairy and eggs as people in rich countries. That’s what the data is telling us.

                      As Marilyn Kay kindly pointed out, you really should check into the study if you want to cite it. If you don’t feel up to evaluating the study yourself, here are good reviews that Explain the experimental design flaws. It is worth understanding this information:

                      From PCRM:
                      From Dr. Katz:

                    6. | Thea replied to your comment on Vegan Protein Status.This is what you say the data is telling “us”. Telling you ,not ”us”. My statement is accurate.
                      I have better things to do. Goodbye.

                    7. Windy, You, yourself, say the (Pure study shows that those eating higher amounts of saturated fats, fruits, raw vegetables, and legumes lived the longest, vs. those with highest consumption of carbohydrates, lowest fruits, raw vegetables and legumes.)

                      How then can this study ‘prove’ there is no issue with saturated fats? The study was not designed to show that.
                      Why not conclude there is benefit in eating more fruit, veggies, and legumes?
                      Why not conclude the empty calories eating cheap carbs is the problem? Could the benefit be the added food-derived fiber and vitamin C? Who knows? That’s the flaw in the study. It isn’t proving anything.

                      I think there is a rush to show that saturated fat is ok, since most people eat a lot of it anyway. And after the problem with high amounts of saturated fats was shown, many people replaced fat with empty carbs leading to obesity and metabolic syndrome. Obviously that wasn’t the answer either.

                    8. I didn’t say PURE ”proved” anything. Read the study for yourself, the study authors themselves don’t say it ”proved” anything. It showed outcomes from the data, just like every other study. The posters on this website twist the outcomes of every study that doesn’t agree with what they think every study ”should” show- which would be their point of view. This website seems to attract the mentally unstable, the paranoid, and the gullible. I’ve moved on. Goodbye.

                    9. Marilyn Kay: Unable to support her views, Windy T has resorted to name calling. I let her get away with it when she was doing it with me, but I will not let her get away with doing that to you. I will be deleting her latest post. I’m writing this so that you understand that you will not be able to find Windy’s post to reply to.

                      As for Windy: You keep saying you are moving on and saying “goodbye” and yet you keep posting. Fair warning: Going forward, I will be more strict about deleting those of your posts which break the site’s rules. If you cannot be civil, you really should move on.

                      – Part time volunteer lay moderator, Thea

                    10. That’s ok Thea, name calling is the last resort of those who have nothing valid to say.
                      I have appreciated your patience. You are kind and generous to spend so much time trying to help her, and indeed you help so many others.

                    11. In this study, people lived longest who ate less carbs and more fats, including saturated fat and more raw vegetables, fruit, and legumes. Why didn’t I conclude it was just the legumes, fruit, and veggies? Because I don’t get to ”edit” the results, that would be dishonest. I also didn’t ”conclude” anything, I just reported the outcomes of this study and gave a link so that people could read the study for themselves. There has been no ”rush” to show that saturated fat is ok. The study took over seven years, the researchers reported all the results they had at that time- SOP. You think they should have reported the saturated fat result much later than the other results- some sort of a time lag? Why? The PURE study is ongoing and I just heard a podcast at the Lancet where one of the researchers said that a further analysis of the carbs- whole grain, processed, etc. is coming so this may answer your questions. PURE findings regarding saturated fats/carbs in relation to mortality were not really new, there have been several other observational and randomized trials that had the same findings, but this is the largest.

                2. Marilyn Kay: I wasn’t able to reply to your post below. I just wanted to thank you for your support and kind words! I appreciate your comments to. :-)

    2. Hello Dr. Greger, i am on a Whole foods plant based diet for 11 months, my b12 is at highest level , but my albumin and bilirubin is a bit high.
      I am 30 and my bilirubin was allready high before i was vegan.
      Thank You, keep doing your job and spread the good info to the public.

  1. Why is it that the study referenced says that the digestibility of plant based foods is not as good as animal based foods? Where does this myth perpetuate from?

    1. Hi Toxins, You seem to be referring to the Protein Digestibility Corrected Amino Acid Score, or PDCAAS, correct? While casein (the predominant protein in milk) boast a score of 1.00 and peanuts earn a score of only 0.52,

      these numbers merely reflect the body’s ability to digest a particular protein. Note however, that a higher score doesn’t necessarily equate to a better protein. On the contrary, proteins with higher scores trigger the release of the cancer-promoting growth hormone IGF-1 more
      than plant proteins may be because the relative ratios of amino acids in
      animal proteins more closely resembles our own.

      So while plant-based foods do appear less digestible than animal-based foods, this feature conveys a virtue rather than a detriment.

  2. There is another possible explanation for the higher albumin level in
    vegans: albumin is a heterogenous class of protein, so its aminoacids sequence is not constant; it can vary to certain limits.
    It is possible that albumin serves as a sort of aminoacid buffer (store) to contain excess/waste aminoacids from vegetarian diet to avoid excess gluconeogenesis due to unbalanced aminoacid intake from vegetarian food. These molecules could break down some days later when the subject changes the protein sources profile in order to provide missing aminoacids, while other albumin molecules are build up with different excess aminoacids from the current diet. Just a speculation.
    We shouldn’t forget that the cells are provided with aminoacids as protein source, not with albumin.

  3. How much protein should a vegan consume after exercising such as lifting weights or aerobics exercises. Does eating protein it help in the recovery process?

  4. Hello, I’ve been vegan since January. Blood tests have shown my Albumin and platelet levels are low. My doctor wants me to eat meat, I don’t know what to do. I’m 25 and female.

    1. Hi Chelsey. Did you have a blood test before changing to a vegan diet with the albumin and platelets within normal range – meaning do you know that the diet is the cause of these low values? Low albumin and platelet counts can be caused by a variety of conditions- so your MD has ruled out everything else except for diet?

      If everything is healthy for you, continue to learn about your eating/nutrition, have MD monitor and maybe you can share information with MD!

      Low Albumin: So as a vegan are eating nutrient-dense plant protein? For starters check this information out:

      Low platelets: A low platelet count can be caused by diet, but this would be exceedingly rare without other more prominent signs and symptoms. Vitamin B12 and folic acid are 2 vitamins that are required for platelet production which can be deficient in some cases. You should be tested for levels of these two vitamins as a part of your work-up. Since the body stores B12 it takes years for a vegan to become B12 deficient not usually a few months as in your case-so this is puzzling. Nonetheless be sure and get your B12.

      Check for and get enough through fortified breakfast cereals, fortified soymilk, and fortified meat analogues contain a reliable source of the vitamin. Nutritional yeast, such as Red Star Vegetarian Support Formula, is also a reliable source.

      But supplementation is easy, cheap and worry free:
      For more B12:

      1. Hi JacquieRN

        Thanks for your considered reply. Unfortunately I don’t have blood tests to
        compare pre-vegan. My Cumulative Liver
        Function Test came back normal and Cumulative Electrolytes were normal too, but
        Creatine was on the low side. However my
        Vitamin D level was significantly low, but I attribute that to not getting out
        in the sun (now supplementing).

        Iron was low but I have being taking Ferro-tab which has
        bought things back to normal. FT4 was
        low in the thyroid so I now take Thyroxine.
        I’ve been treated for Major Depressive disorder and panic disorder for
        the past 11 years and have taken lots of medications in that time.

        Vitamin B12 is at 313 pg/mL and Red Cell Folate is 549 ng/mL
        (I’m from Australia.) The test says
        they’re both normal.

        Thank you for the links, I like to eat beans but will
        attempt to get more dietary protein, I’m looking at a vegan protein powder.

        I suppose I’m a bit nervous as to whether I’m doing the
        right thing, especially when most say I need to eat meat, but in my heart I
        want to be vegan.

        Thanks again

  5. Hi Doctor Greger..I have been vegan for 5 years and I seem to have a significance of hair loss. I have had my thyroid checked and iodine is in tac and folic acid in tac, I take B-12 also. I have noticed low protein levels in my blood work. I have added more higher protein foods such as seitan and tofu to my diet and I seem to feel better and be showing more hair growth again. I still consume a lot of beans and whole grains, veggies, fruit and greens in my diet.

  6. I recently started donating plasma at a local donation center here in Utah and when I told them I ate a predominantly vegan diet the nurse performing my physical exam became worried and very concerned as to whether or not I would be able to continue donating long term. I recently downloaded your Daily Dozen app have have been following it and love how simple it makes eating healthy. With all that being said, do I need to worry about my protein levels dropping or becoming “abnormal” with plasma donation?

    1. Make sure you are eating lots of nuts, legumes etc, and taking vitamins. Stay away from vitamin d supplements though because they are made from animals.

      I ways eat a peanut protein bar afterwards and take my vitamins. I’m not vegan though, but I don’t eat a lot of meats. It’s just that it takes your proteins and you vitamins and minerals floating in 90% water.

      If you drink lots of water before you will get done faster.

      Also make sure you take probiotics. Without milk you get less lactobacillus which is a friendly bacteria. Good bacteria in you gut helps you process the cellulose better.

      1. Mayz,
        There is now vitamin D3 that is vegan. My Kind from garden of life has it in a spray and also a chewable tablet. It is made from lichen and is actual D3 and not the D2 which is not very absorbable by the body. Also a good vegan probiotic is the Up4 adult 15 billion probiotic.

  7. In nephrotic syndrome during relapse what diet should be recommended?
    Can a protein diet be given when the kidneys a re spilling proteins?
    And which source of proteins is the best for the kidneys?

  8. Hi, Dr. Greger, do you have any information about whether or not vegans who do weight training/muscle mass building type exercise are benefited by eating more protein or taking vegan protein supplements? And do you have any information on the effects of vegan protein supplements? I would think there would be some negative health effects since these supplements (protein powders) do not contain whole foods, but I’m very interested to see what researchers may have found. Thank you.

  9. Hi there,
    I’m working on a little project for family that is concerned about our protein intake. I would like to make a list of all the essential amino acids, what is necessary to metabolize them (fat soluble/water soluble, binding issues, etc.) and vegan sources of amino acids. Is there a place you can recommend I begin my research? Google does not bring up any scholarly resources I can use.


  10. Does vegetarianism/veganism also affect prealbumin levels? I am 95% plant-based (eat mostly veggies, tons of beans, lots of fruits and grains and a small amount of fish or dairy once/week) and my prealbumin level came back at 11 which concerned my doctor. Would consuming more plant-based protein increase my prealbumin level? If I am otherwise healthy and all other blood markers come back normal, do I need to be concerned?

    Thank you!

    1. Leslie,

      Perhaps starting off with a quote is in order:

      Until recently, the prealbumin test was believed to be a useful marker of nutritional status and was used to help detect and diagnose protein-calorie malnutrition as well as to monitor people receiving total parenteral nutrition (TPN, getting nutrition via a solution injected into a vein). It was also used to monitor changes in nutritional status in someone undergoing hemodialysis as part of treatment for kidney disease.

      Some health practitioners continue to use the test in this manner; however, there is controversy because changes in prealbumin may actually reflect other conditions such as inflammation, infection, or trauma. As such, it has been suggested by some health professionals that the prealbumin test should no longer be used to assess nutritional status or diagnose malnutrition. However, others believe that the test can be useful in determining prognosis for people who are critically ill, hospitalized, and/or at risk of poor outcomes and can prompt nutritional and other support that may improve patient outcomes.”

      Even way back in 2005…. it was questioned as being an indicator of nutritional status in really ill folks

      Typically as a vegan/vegetarian you should, especially with your description of your diet, be getting adequate protein. I would look at the whole of your tests and then have someone do some further interpretation. You can do a quick check of your protein level intake by using the calculator. I suspect your probably going to find your fine both medically and in terms of your protein intake, but it never hurts to double check.

      I suspect your albumin levels are normal ? Did you fast prior to the blood testing or have any changes to your diet just prior to the tests ? Let your physician know the answers to these questions and have him/her check your liver function, including GGTP not just AST/ALT….. these are common tests.

      Dr. Alan Kadish moderator for Dr. Greger

  11. I also have a low platelet count on a vegen diet ive been on it for a year and my alt is elevated and my glucose is 113 but my a1c is 5.1

  12. I recently had a Urea Nitrogen, 24-Hour Urine test to check my protein. The results came back at 8 flagging it ‘LOW’. Normal should be in the 12-20 range. I have been told frequently that I am malnourished in protein. However, I have been a vegetarian since 1990, tried to go Vegan for a few months and was told I messed my gallbladder up and had to have it removed. I am now going Vegan again and feeling great! I wondered if there were different standards as it relates to the normal range for a Vegan or Vegetarian vs the normal Meat Eater. My doctor wants to see me next week Friday and I’d like to have some information on this before he tries to once again tell me it’s because I don’t eat meat. I will never eat meat again, plain and simple. I eat so many veggies and I do add tofu and other vegetarian meat alternatives, as well as beans & legumes to my diet. I feel very healthy. Your thoughts? Thank you so much.

  13. Hi Mary and thanks for the interesting question. Low protein intake is one possible cause of low urine urea nitrogen, but there are others. To verify low protein is the problem, its best to weigh your food and keep a food log for a few weeks to see how much your protein you’re actually ingesting. You can then bring these calculations to your physician and have an informed discussion as to what needs to be corrected.

    I noticed that you mentioned “vegetarian meat alternatives” which could include eggs and dairy. Dr. Greger consistently recommends avoiding animal derived foods, so it would be best to eat vegan meat alternatives. One thing to keep in mind is that these “alternatives” are often highly processed with significant amounts of sodium and added fat. Your best source of protein, as you already listed, is whole foods like beans and legumes.

    Thanks for reading!
    Dr. Ben

    1. I too had my blood tested in a study I participated in and they flagged me as having too low of BUN (5 mg/dL–their range is 8-22 mg/dL).

      I tried to do a vegan diet for a couple of months but had to stop–I started developing this awful vertigo, where just standing would make me feel woozy. I started eating meat again and the vertigo went away. However, I did stay completely off of dairy, and I make it a point to have at least 1 vegan meal per day. I’ve also lowered the amount of meat/eggs I have per serving and make sure I have an abundance of vegetables. I also eat a lot of peanut butter.

      So do you think it could be that I just have low protein in my diet as well?

      1. Without a lot of additional info I wouldn’t know. There are a lot of things that can cause vertigo. Inadequate caloric intake is one. You’d really need to keep a complete food log for awhile along with an account of your daily activities, all prior to development of the vertigo. Your best strategy would be to appoint with a doctor for exam/consult that is very familiar with WFPB lifestyle.

  14. I’m glad to see that maybe the higher blood protein levels are due to reduced inflammation, because I was afraid that maybe taking in less protein in the diet was causing the body to “eat” its muscles for protein. I realize there are a lot of vegan weightlifters, but I also noticed I’m eating a lot less when I eat a vegan diet, as opposed to the vegetarian one I’ve been following for 26 years. My blood tests from February and July show an increase in protein that doesn’t logically make sense. I didn’t want to put my theory about eating muscle out into the world and then have someone latch onto it to “prove” this diet is dangerous to your health. I know a lot of times a theory gets presented as fact, and I didn’t want to add to the misinformation. The inflammation explanation is probably correct, since I also have normal cholesterol levels that I haven’t seen in my entire adult life. Maybe “God” should have stopped talking after we were told to eat from the trees.

  15. I was on a normal diet. Although I ate very little red meat, I did eat fish and poultry. I felt well and all my labs were normal except I had very high LDL and was diagnosed with Heterozygous Familial Hypercholesterolemia. Because of this I became a vegetarian, eating only small amounts of fat-free diary and egg whites. I had under 10 grams of fat daily. This did lower my LDL, but also lowered my HDL. After 6 months, my labs showed normal LDL, very low HDL (24) and my Triglycerides were double- 180 what they’d been. I also noticed my Total Protein was lower. A year after that my Total Protein was abnormally low, my HDL was 22, my Triglycerides were 340 and my LDL was as high as it had been before starting the vegetarian diet. I felt lousy, had low energy, wondered if I had some deadly disease. I had also by then, lost 34 lbs even though my BMI at beginning of diet was only slightly overweight at 26. I realized this vegetarian diet was deteriorating my health and so I went back to eating fish and poultry and stopped counting fat grams. I had my labs done 3 months later. Everything was back to normal, I felt good again. I now take Praluent for my LDL. I am a 74 year old woman, and the vegetarian/low-fat diet was bad for my health- I would never eat that way again.

  16. I don’t understand your ”meeting utile information”- please ”spell check” and ask your question again, I’m not sure what it is you want to know. The diet I was on was the Dean Ornish Reversal diet, a very unhealthy diet for me. IMHO, there may be an ideal healthiest diet for an individual but it will not be the same for everyone. Some people thrive on a vegan diet, some become very ill. Statistically, pescatarians live the longest, vegans live the shortest, shorter than vegetarians.

  17. Good morning !

    Regarding the very useful information of the video, I would like to ask a question:
    how do we test the levels of protein status in our body ?

    And, which is the exact name of this test to mention it to my doctor, so as to prescribe it.

    Thanks in advance for your time


    1. | Giannis Kiousis commented on Vegan Protein StatusGianni, The ”Total Serum Protein Test” is a blood test which measures the amounts of albumin and globulin and the ratio of albumin to globulin in your blood- A/G Ratio. Windy T.

  18. Hi Dr. Greger,

    T1D patient here with an A1c of 5.2%

    I just recently received a metabolic panel and noticed an increase in in my Calcium levels and also my Albumin levels. Note that I recently went vegan 4 months ago. Is there any cause for concern?

    Calcium: 10.1 mg/dL (from 9.8 mg/dL 6 mo. ago)
    Protein, Total: 7.3 g/dL
    Albumin: 5.1 g/dL
    A/G Ratio: 2.3

    Thanks in advance!

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