Vegetarians and Stroke Risk Factors—Animal Protein?

Vegetarians and Stroke Risk Factors—Animal Protein?
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Might animal protein-induced increases in the cancer-promoting grown hormone IGF-1 help promote brain artery integrity?


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.

In 2014, a study on dietary protein intake and stroke risk found that greater intake was associated with lower stroke risk, and furthermore it was the animal protein that appeared to be particularly protective. Might that help explain why vegetarians were recently found to have a higher stroke rate than meat-eaters?

Animal protein consumption increases the levels of a cancer-promoting growth hormone in the body known as IGF-1, insulin-like growth factor one, which can accelerate the progression of precancerous changes to invasive cancer. High blood concentrations are associated with an increased risk of breast, prostate, colorectal, and lung cancers, potentially explaining the association between dairy milk and prostate cancer risk, for example. But there are also IGF-1 receptors on blood vessels; so, maybe IGF-1 promotes cancer but also brain artery integrity.

People who have strokes appear to have lower blood levels of IGF-1, but it could just be a consequence of the stroke rather than the cause. There weren’t any prospective studies over time —until 2017, and indeed higher IGF-1 levels were linked to lower risk of stroke, but is it cause and effect? In mice the answer appears to be yes, and in a petri dish IGF-1 appears to boost production of elastin, a stretchy protein that helps keep our arteries elastic. Higher levels are associated with less artery stiffness, but acromegaly patients, like Andre the giant, those with excessive levels of growth hormones like IGF-1 do not appear to have lower stroke rates, and a more recent study of dietary protein intake and risk of stroke, looking at a dozen studies of more than a half million people, compared to only 7 studies with a quarter million in the previous analysis, found NO association between dietary protein intake and the risk of stroke. In fact, if anything dietary plant protein intake may actually decrease the risk of stroke.

However, those with high blood pressure who have low IGF-1 levels do appear to be at increased risk of developing atherosclerosis, thickening of the artery walls leading up to the brain, but no such association was found in people with normal blood pressure. So, there may be a cautionary lesson for vegans here. Yes, a whole food plant-based diet to down-regulate IGF-1 activity may slow the human aging process, not to mention reducing the risk of some of the common cancers that plaque the Western world. But, perhaps, the ‘take-home’ message should be that people who undertake to down-regulate IGF-1 activity by cutting down on animal protein intake as a pro-longevity measure should take particular care to control their blood pressure to preserve their cerebrovascular health, the health of their arteries in their brain. In particular, they should keep salt intake relatively low while ensuring an ample intake of potassium to keep their blood pressures down. So, that means avoiding processed foods and avoiding added salt, and in terms of potassium-rich foods, beans, sweet potatoes, and dark green leafy vegetables.

So, might this explain the higher stroke risk found among vegetarians? No. Why? Because dairy and egg whites are animal proteins too. Only vegans have lower IGF-1 levels in both men and women; so, low IGF-1 levels can’t explain why higher rates of stroke were found in vegetarians. So, what is it already? I think the best explanation for the mystery is something called homocysteine, which I’ll cover, next.

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Motion graphics by Avocado Video

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.

In 2014, a study on dietary protein intake and stroke risk found that greater intake was associated with lower stroke risk, and furthermore it was the animal protein that appeared to be particularly protective. Might that help explain why vegetarians were recently found to have a higher stroke rate than meat-eaters?

Animal protein consumption increases the levels of a cancer-promoting growth hormone in the body known as IGF-1, insulin-like growth factor one, which can accelerate the progression of precancerous changes to invasive cancer. High blood concentrations are associated with an increased risk of breast, prostate, colorectal, and lung cancers, potentially explaining the association between dairy milk and prostate cancer risk, for example. But there are also IGF-1 receptors on blood vessels; so, maybe IGF-1 promotes cancer but also brain artery integrity.

People who have strokes appear to have lower blood levels of IGF-1, but it could just be a consequence of the stroke rather than the cause. There weren’t any prospective studies over time —until 2017, and indeed higher IGF-1 levels were linked to lower risk of stroke, but is it cause and effect? In mice the answer appears to be yes, and in a petri dish IGF-1 appears to boost production of elastin, a stretchy protein that helps keep our arteries elastic. Higher levels are associated with less artery stiffness, but acromegaly patients, like Andre the giant, those with excessive levels of growth hormones like IGF-1 do not appear to have lower stroke rates, and a more recent study of dietary protein intake and risk of stroke, looking at a dozen studies of more than a half million people, compared to only 7 studies with a quarter million in the previous analysis, found NO association between dietary protein intake and the risk of stroke. In fact, if anything dietary plant protein intake may actually decrease the risk of stroke.

However, those with high blood pressure who have low IGF-1 levels do appear to be at increased risk of developing atherosclerosis, thickening of the artery walls leading up to the brain, but no such association was found in people with normal blood pressure. So, there may be a cautionary lesson for vegans here. Yes, a whole food plant-based diet to down-regulate IGF-1 activity may slow the human aging process, not to mention reducing the risk of some of the common cancers that plaque the Western world. But, perhaps, the ‘take-home’ message should be that people who undertake to down-regulate IGF-1 activity by cutting down on animal protein intake as a pro-longevity measure should take particular care to control their blood pressure to preserve their cerebrovascular health, the health of their arteries in their brain. In particular, they should keep salt intake relatively low while ensuring an ample intake of potassium to keep their blood pressures down. So, that means avoiding processed foods and avoiding added salt, and in terms of potassium-rich foods, beans, sweet potatoes, and dark green leafy vegetables.

So, might this explain the higher stroke risk found among vegetarians? No. Why? Because dairy and egg whites are animal proteins too. Only vegans have lower IGF-1 levels in both men and women; so, low IGF-1 levels can’t explain why higher rates of stroke were found in vegetarians. So, what is it already? I think the best explanation for the mystery is something called homocysteine, which I’ll cover, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

If you’re not familiar with IGF-1, a good primer is Animal Protein Compared to Cigarette Smoking or How Not to Die from Cancer.

How can we lower our blood pressures beyond just eating a plant-based diet? Check out the chapter of hypertension in my book How Not to Die at your local public library.

This is the 8th in a 12-part series on vegetarian stroke risk. If you missed any of the previous videos, check out:

Coming up we turn to what I think is actually going on:

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225 responses to “Vegetarians and Stroke Risk Factors—Animal Protein?

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  1. I called homocysteine when this started. Can we get back to one video one topic? Anyone using the search for a topic in the future is going to be mighty disappointed when they realize the answering videos do not answer the question but say ‘tune in again’.

    1. Reality. but future we’s can watch them all in a row! :)

      I only wish the previous video-next video were on a playlist that auto advanced so we simply find a multi-topic, then press play and off it goes through all the successive vids. I guarantee some would hang out here binge watching instead of netflix lol

      1. jazzBass,

        You can go to YouTube and I think it does work that way because it is separated by topic and tends to automatically load the next video.

        1. Thanks Deb, yep youtube works that way. I meant for all vids here, such that we could hang here and it would auto advance, say, from any starting point, then on to the next video in succession, even if we’ve started from 2016 for instance. Just auto play all vids in succession from wherever one were to start randomly was the gist.

    2. “Anyone using the search for a topic in the future is going to be mighty disappointed when they realize the answering videos do not answer the question but say ‘tune in again’.”

      Agreed! I started following Dr. Gregor in 2013. I much preferred the 2 to 3-minute videos that got the point across. They helped me enormously. People that want more in-depth information can buy the books (as I have also done).

    3. Its well known that too much igf1 is bad, but too little is also bad. Too much igf1 promotes cancer, but too little igf1 causes muscle atrophy, and old people withtoo low igf1 level die earlier, the human body is all about balance.

  2. Homocysteine was a likely suspect. B-12 willl keep it in check. A question I’ve asked myself is, “How do I know I need to supplement with B-12?” Should I get tested? My conclusion is, skip the test and do blanket coverage with dirt cheap B-12. Okay, a yearly check-up would be good also.

    1. I guess true, its not that expensive, B 12… I posed the question earlier regarding my discovery that Dr. G’s daily dozen includes 2 servings of Nutritional Yeast. My brand, Braggs, has 470% of the stuff per serving! (I recently bought it in bulk, but with no idea about its B-12 fortification, I need to ask…)

      SO that said, perhaps its enough in the Braggs fortified yeast, to not additionally take B12 supplements?

      Now… Does B-12 in excess cause problems? Some say yes, Dr. G says you just pee it out, with no mention of the associated problems some here have raised.

      SO vegan it is, green leafies as a base, + get your B-12 = lower heart disease AND lower stroke.

      Easy peasy.

      1. Reason I mention the question of B12 overage, is that apparently we must be on top of whether what we take, we use fully in terms of bioavailability.

        Which could mean we take more than just a typical supplement in order to finally use what we really need to do the job.

      2. You will end starving yourself if you base your diet on leafy greens or even green vegetables because these does not contains enough calories, need to base the diet on starchy foods and/or calories dense fruits.

        1. Julot, well what I meant when I said “base”, for me, is that its as important – or critical for its antioxidant power as the other components of diet. In fact I’ve heard Dr. G say instead of a bowl of grains with a little leafy veggies, that he recommends a bowl of leafy veggies with a little grains. (and beans, peas seeds etc..)

          Its actually too easy for me to get enough grains, since I love oatmeal, and the next few meals need only the equivalent of a half cup of brown rice..

          Which brings me to a question. As I looked just now to double check what daily dozen says is a serving of grains, I realized he doesn’t mention rice. at all.

          Are we to avoid rice?

          1. Hi jazzBass,
            not to avoid, but I think to minimize due to its arsenic content.
            You can find more here:
            and here:

            quick copy-pasta below:
            And, the same thing here. “The many health benefits of rice consumption outweigh any potential risk”—as if brown rice was the only whole grain on the planet. Can’t you get the whole grain benefits without the risks by eating oatmeal instead, or barley, or quinoa? Or, is there some unique benefit to rice, such that we really should try to keep rice in our diet?
            Switching out a third of a serving of white rice a day for brown rice might lower diabetes risk 16%, but switching out that same white rice for whole grains in general, like oats or barley, might work even better! So, other grains have like 10 times less arsenic and are associated with even lower disease risk.

            1. @Gus:
              Interesting. So not avoid, just… we can do better…Which is why daily dozen has zero rice…

              Wait I just recalled DR G said somewhere that there are regions where the rice hasnt the arsenic content as it does in , say, Arkansas or texas or cali, for instance.

              Anyone recall same?

              He also said (I think) that india has lowest rice arsenic. (I think he did anyway, see above question)

              SO I went out and bought 20lb jasmin rice from India, just finished it out. Plenty of other grains eaten though: quinoa, soughum, freakeh, bourghoul, and always groats for breakfast.

              1. @jazzBass oh, I haven’t noticed that the daily dozen had 0 rice… thanks

                For the safest places from where to buy rice, I remember DrG mentioned that but I cannot find the video.


                1. Dr Greger also has a video that cooking rice in a lot of water, similar to pasta lowers arsenic.

                  It works pretty well never dries out that way.

                    1. jazzBass,

                      You wrote: “Are we to avoid rice?”

                      I do.

                      But I used to eat a lot growing up. And a lot of “healthy” brown rice as an adult.

                      I do not really like the thought of the cumulative toxic load.

                      No level of arsenic is efficacious for health.

                      After the Consumer Reports exposé on arsenic in rice – I bought a couple of grain cookbooks (completely unnecessary) and went off to the food co-op and hit the bulk organic grain bins – and started a few months of experimentin’ . . .

                      Turns out – you can cook any grain out there and eat it just like rice.

                      Some require a little more water, some a little less. Some you cook a little longer, some a little less.

                      Not that much different than cooking white rice vs. brown rice.

                      The following all work: oat groats, millet, hulled barley, rye berries. Wheat berries work just fine as well, but I get wheat in bread – so why bother?

                      Millet is the lightest – good for accompanying lighter fare. Say – white fish. Something you would serve a white wine with.

                      Hulled barley the heartiest – good for accompanying a hefty dish of hearty beans. Highest in soluble fiber. Highest in protein. A heavy duty red wine would be fine – aircraft carrier christening worthy.

                      Oats – in between. Just right everyday. One of the healthiest grains!

                      Rye – for when you want to punish yourself. What an idiot you are! Make sure you hit yourself in the head with a 2 X 4 between each bite.

                      I am not really a very big fan of rye berries. Perhaps our Russian contingent can get behind rye, however.

                      Different grains for different folks, that’s what I always say.

                      These grains have two to three times the protein of rice, and you don’t have to concern yourself with the extra dose of arsenic from what we once thought was the “healthier” brown rice. I have come to prefer these grains over rice, and I was once a big, big fan of rice – we preferred rice to potatoes (raised in the American South – Mother could cook! – Southern Fried Chicken, real chicken gravy, and lotsa Uncle Ben’s converted rice!).

                      The work on arsenic and rice has been done by Consumer Reports. Check it out, yourself, if you like:

                      Note that rice arsenic is also a big issue for the low gluten crowd – their low gluten bread and cookies typically substitute rice flower for wheat flour. If you are into low gluten baked goods, you may wish to peruse the labels very carefully, indeed.


                      How did all this happen?

                      The cause of all this is that rice in the US is now grown in areas of Louisiana and other Southern states that used to host King Cotton. As I am sure you are aware, cotton is one of the most pesticide-driven crops on the planet: cotton covers ~3% of the world’s cropland, but utilizes ~25% of the world’s pesticide.

                      That is why “organic cotton” is not nearly as silly as it sounds.

                      Why all the pesticides?

                      The Boll Weevil.

                      Here is the current family safe Bowlderized version (I learned the original version as a lesson in Southern English dialects and I do not believe that any harm was done – but we live in an era of different sensibilities):

                      Note the reference to “Paris Green” – which you, of course, may know as copper(II) acetate triarsenite or as copper(II) acetoarsenite – the most common pesticide in the U.S. 1880s onward for quite a while. It is still used on cotton.

                      I hope you find that reassuring.

                      The arsenic laid down in the soil year by year never goes away – and we are not talking about minuscule trace arsenic, either. There is so much arsenic in the involved soil that rice cannot grow – or could not until an arsenic resistant version was bred.

                      That is the rice that most Americans eat when they eat rice today.

                      I know these things because my Grandfather grew cotton. His Negro tenant farmer was housed in a small house – with a nice porch – looking out to a breathtaking view of the adjacent cotton fields.

                      White cotton bolls hanging down as far as a child could see in the slack heavy Southern heat.

                      The house had a well.

                      He and his wife never did have children.

                      He and the Missus used to laugh as we chased the chickens around the yard surrounding their chicken coop in the dust of the Southern summer.

                      Very nice folks.

                      I think about them sometimes. And about what it all means.


                      Bon appétit –


                    2. Rice is one of the daily dozen. The dozen includes whole grains. Brown/black/purple/violet rices are whole grains.

                  1. Good one, my wife cooks it that way, im always amazed. She just boils it down, no lid until towards the end of process and water evaporates to a perfect rice. its sort of magical really. I tried it, and got pudding. lol.

            1. jb, please check the video description area for links to studies about excess b12 levels. I got my levels tested and my doctor had me take no b12 supplements for 10 months or so. I was getting some b12 in soy milk. I now take a teenie piece of a low dose pill every other day and my levels tested great this time. Everyone is different so get tested.

              1. Barb,

                Could you direct me to your source for lower dose Vitamin B12?

                I used to get the 50mcg sublingual tablets from Freeda Vitamins – they were the lowest dose that I could find.

                Freeda Vitamins used to have an excellent reputation in the Vegetarian community. But over the last year, they seem to have fallen apart.

                I do not know if they have gone under new management – or it they have gone bankrupt – or what is going on – but whatever is happening at Freeda Vitamins is not inspiring my confidence.

                Referrals to other sources of lower dose Vitamin B12 would be much appreciated.

                Thank you,


                1. Vivamus, I am going to buy more this week so I’ll let you know what I find. Often the large drug store chains and grocery stores have house brands in 1000, 500 or 100 mcg strengths. I have learned to read labels carefully though because just when you find something on sale, they end up being the methyl version. This happened to me recently. I have taken 1000 mcg tablets and cut them up into bits before and just take a piece every other day or so.

                    1. Barb,

                      Just did a quick Internet search for lower dose Cyancobalamin.

                      If you have any comments on the chemistry set ingredients (Croscarmellose Sodium?), I am most interested:

                      MASON NATURAL, B12 50 mcg
                      “No there is no gelatin in this product. The ingredients read: Cyanocobalamin, Dicalcium Phosphate, Cellulose, Croscarmelosa Sodium, Stearic Acid, Silca, Magnesium Stearate, Camine #40.”

                      The above product is apparently scored for cutting in half. “Manufactured in the United States for: Mason Vitamins, Inc. Miami Lakes, FL 33014. This product is a Consumer Lab top pick.” I cannot confirm – I do not have a Consumer Lab subscription. Never heard of the company.

                      This is a tablet to be swallowed – not a sublingual. On the bright side – no sugars or artificial flavor typical of sublingual B12. I have also read one study indicating that sublingual vs. regular swallowed pill makes no difference in absorption.

                      Because of the lower dosage, I favor the thought of this tablet.

                      RDA of B12 is 2.4 mcg. 2.8 mcg if lactating.

                      We should be covered either way. ;-)


                      Nature’s Blend Vitamin B12 100 mcg Tablets
                      “Vitamin B12 (as Cyanocobalamin) 100 mcg; Calcium Phosphate; Microcrystalline Cellulose; Magnesium Stearate; Croscarmellose Sodium; Silica”


                      Possibly of interest:

                      High-dose compared with low-dose vitamin B-12 supplement use is not associated with higher vitamin B-12 status in children, adolescents, and older adults

                      Best regards,


                  1. OMG I’ve perhaps been taking too much… but Dr G recommended the spray, and said don’t worry we will pee any excess out anyway…

                    A little confused.

                    I stopped taking the sublingual because someone mentioned you can get too much and I realized I was also doing daily dozen nutritional yeast @ 2 servings a day as recommended, but it has each serving 470% DV.

                    SO to be clear Im taking 2 servings in fortified yeast, probably soy milk daily but not too much of it, other soy product maybe some tofu lunch, plus the sublingual spray is Vegan B12 mist non gmo by Givol @5000mcg daily. (Apparently 83,333% of DV)

                    So to be clear what are the downsides of excess B12 and should we watch where we get it from?

                    I know Dr G mentioned cyano and methyl differences somewhere, but I cant find it.

            2. He says no and in the weBinar says a sentence something like ”If only they would put it to the test.” and said ”They already have” and showed a whole bunch of studies.

              The sentences aren’t his. They are my paraphrase and when the series comes along you can find out if my brain is extra broken today or accurate.

          1. Dr Greger covers it in the B12 webinar.

            Part of the reason it became confusing as an issue is that there were studies where they tested B12 levels -which also become elevated eating meat and IGF-1 causes tumors to increase in size.

        1. It is certainly correct that a number of studies have found that cancer is associated with high B12 levels . Just as other studies have found cancer is associated with being underweight and having lower cholesterol levels. Simplistic associations like these aren’t reliable evidence of causality. Sometimes X causes Y and sometimes Y causes X. Some other times there is a third unidentified variable which causes both X and Y.

          However, it is probable that some cancers themselves may lead to weight loss and affect cholesterol and B12 metabolism in ways that we don’t fully understand. As one study comments:

          ‘It is not entirely understood how the underlying cancer can cause high plasma B12 levels. Circulating B12 is exclusively bound to either haptocorrin or transcobalamin. The cancer may affect B12 metabolism by affecting the levels of these B12-binding proteins that in turn give rise to elevated plasma B12 levels (1). These protein alterations may involve inflammation cells that can produce either haptocorrin (30) or transcobalamin (31), and the potential underlying inflammation may also explain why high plasma B12 is associated with higher mortality risk and risk of venous thromboembolism among cancer patients (32, 33). These results are in concurrence with our previous finding that haptocorrin is elevated in cancer patients with high plasma B12 (2), and earlier reports showing that malignant proliferating leukocytes in patients with chronic myeloid leukemia (10). We were unable to include data on tumor size, lymph node involvement, or distant metastasis. These factors may also be important in the assessment of why and how elevated B12 is associated with cancer. Ultimately, it remains unresolved why high plasma B12 is associated with only some types of cancers and whether different protein alterations can be found in specific cancer types or stages of cancer.’

          You may be better advised to be guided by an MD rather than an ND. Naturopathy is arguably a pseudoscience.

        2. Hi, Eileen! There have been some recent studies suggesting that high blood levels of vitamin B12 may be associated with increased risk of some cancers. Vitamin B12 deficiency, on the other hand, can result in permanent neurological damage, among other things. The key is to get enough, but not too much vitamin B12. You can find everything on this site related to vitamin B12 here: I hope that helps!

          1. @Christine, Im almost positive I saw Dr. G mention excess of B12 is just peed out and you cant get too much… Did I misremember that?

      3. JB,
        Red Star nutritional yeast flakes has 1000% B-12. I eat it and take a suppliment. I’m over 60, so I do not worry about getting too much.

    1. They didn’t have a vegan subgroup.

      I found an interesting sentence in the link.

      A recent Mendelian randomization analysis and the Vitamins to Prevent Stroke (VITATOPS) trial both found that lowering of homocysteine is associated with only the small vessel subtype of ischemic stroke—which accounts for 37.7% of ischemic and 27.9% of overall stroke in Taiwan

    1. Cathy sorry to hear about the stroke, truly.

      SO its ok if you don’t want to answer, but since you seem to be faithfully following the prescribed diet I just wondered a few things:

      Have you made sure that the diet is balanced, and all other supplementals taken in proper amounts?
      Are you the type that one might consider having a runners body? Or like so many people, carrying some extra pounds, and not exercising much if at all?

      I’m thinking exercise has something to do with all this stroke business but I’m not sure yet…

      I do appreciate the personal nature of this inquiry so please don’t feel the need to respond at all, and I do hope your health improved since then and you are doing great!

    2. Hey Cathy, sorry to hear that.

      Friendly reminder that NO DIET guarantees 100% risk-free health.
      WFPB diets LOWER the risks for those nasty things that we can face down the road (or right now) but they do not make us super heroes.

      Sometimes when I get the flu or go under the weather colleagues ask me: “how come are you sick if you are eating plants like crazy?” but then I remind them that eating plants is LOWERING the risks, and not making me somehow disease-free.

      The moral of my story is: do not give up please! I think you are doing a great favor to your future self.


    3. Thank you for sharing. I’m a little disturbed. I was pretty confident I was headed down the right path now. This caused me to pause.

      1. Hi Jack,
        I’d recommend you to pause and think about what you are doing.
        I am pretty confident you are on the right path.

        However, you may just need to fine-tune expectations (expectations are a killer of so many things).
        Following a whole food plant based diet lowers RISKS a lot, but it does not make it 0, or risk free.


      2. Jack,

        Watch the rest of the series and then go back to a book like How Not To DIe.

        Or watch Forks Over Knives

        Eating You Alive

        The Game Changers


        Whole Food Plant Basedis as good as it gets.

    4. Hi Cathy,

      I went off plant based diet recently . A few months ago I had really bad chest pains went to the er. I found out that I have myocardial infarction Hugh cholesterols
      High CRP and borderline diabetic. This diet is not sustainable.

      1. Hi Margaret, sorry to hear your recent visit to ER.
        Maybe what you mean instead of
        “This diet is not sustainable” would be more in the lines of:
        “This diet did not work for me”

        Yes, being a bit picky about the wording here.

          1. Margaret,

            Curious which version of Whole Food Plant Based you were eating?

            The diabetes part surprises me. Most people, even Type 1 Diabetics improve considerably in that area.

            Were you eating refined carbs or sugar or using oil?

            Honestly curious.

            1. Hi deb, absolutely not no sugar no oil. Just fruit avocado some nuts. I did no oil at all. In my opinion that was a big mistake. And I don’t do to many Grains some Quinoa , buckwheat no gluten no corn. I was very surprised that my cholesterol was through the roof. The small particle . That’s to scary for me. I do recognize that a lot of people who are already diabetic and start this diet do fantastic. I just don’t think I was getting enough nutrients . I’m monitoring my blood work . I don’t want to go through that again. I have low blood pressure my BMI is a 23 so I could not believe the numbers I was seeing. All I can say is adding some animal protein in helped.

              1. I’m eating salmon and sardines four times a week . Still eating leafy greens some fruit and a lot of good olive oil. I make sure I get a good amount of cardio workouts in and some strength training. To be honest when I went to the ER I thought it was self inflicted I was so stressed out about this pandemic . Now I don’t get caught up in all of the negative driven news . Stress also does a number on our health. So I was very surprised when my cardiologist who is a plant based doctor and a big admirer of dr. Gregor told me to go on fish oil as well. The whole plant based diet is awesome but sometimes it’s just not enough for certain people. I happen to be one of them. I eat a lean piece of beef once a month as well.

                  1. Hi Noel, I have done those tweaks and many many more. They don’t do a thing for me. The only way I can lower ldl is while losing weight…. and I am not overweight. If I go from 120 to 100 lbs say, my cholesterol will dip twmporarily. Even if I stayed at the low weight, my cholesterol would very gradually creep back to former levels. Menopause was a major factor. Grains are another.

      2. >>> Hugh cholesterols. High CRP and borderline diabetic. This diet is not sustainable.

        I am sorry your diet has not worked out for you but please do not overgeneralize.

        My experience has been quite different, as has my older brother’s. I have been on a 100% WFP diet for years and before that on one or another hyphenated vegetarian diet since college, more than 50 years altogether. At 73, my blood work is excellent (and better than when I was a vegetarian and had high. cholesterol) with low hs-crp (below 1), reasonably low normal homocysteine, low total cholesterol (~135), low LDL (~75), low A1c, etc. No diagnosed lifestyle- related chronic disease, on no meds. My older brother needed a stent about 3 years ago. . After that he went WPFB (salmon a few times per week) and dropped his cholesterol in about teo weeks to roughly the same levels as mine. No statins prescribed. No further problems in several years. Cardiologist says he is doing fine.

        On the other hand, my prediabetic, very slim and athletic wife cannot eat all the whole grains or other whole food carbs I can because they spike her postprandial blood sugar. So she eats a very small amount of grains and fruit but lots of beans/legumes for carbs as well as a lot of nuts keeping her carb calorie ratio far below mine. We know several other cases like hers (all women, all slim and athletic, all over 50). Her diet is still WFPB. Since she shifted her carb source to beans/legumes, her postprandial spikes have much improved. Exercising 30 minutes after a meal as an additional measure keeps her blood from spiking over 130.

        Individuals will vary in their experience. So one needs to know how their body reacts to different types of food. Most people can do very well on WFPB diet.

        1. I agree with you. The whole plant based diet is great. It helps a lot but sometimes yiu just need a little animal protein mixed in.

    5. Cathy, Have you ever had your lipoprotein (a) levels checked? That could explain your stroke despite good diet. Many primary care doctors just order standard lipid panels that do not include this value. It is genetically elevated in up to 25% of Americans, and is a contributor to strokes, MIs, hypertension, aortic calcification, atherosclerosis, etc. I recently found out this runs in my family and has mine checked….levels are typically undetectable in folks without a LPA gene mutation…mine was 175 nmol/L. I am considered very high risk for CVD, despite a lifetime of never smoking, low triglycerides, low homocysteine, low total cholesterol, no T2DM or HBP, lots of WFPB eating and exercise. My carotid intima medial thickness shows I have the arteries of an 80 yo (i’m 59). I began seeing an integrative cardiologist who recommended doubling down on WFPB diet, try adding high intensity interval training, sitting less, meditating more and start red yeast rice to get my LDL below 70 (its 100 now). I consider myself lucky…some folks with mutations in this gene have lp (a) levels into the 600, 700s…and have strokes as teenagers…it is a spectrum. search the archives, Dr. Greger has several videos on Lp (a). Dr. Joel Kahn has good information too:

      1. Wow man always learning here! Ok I saw “red Rice” and thought: “Zaterans! Ha cha cha!”, but later figured it must be somehting else. Indeed it is.

        SO Then while I wa researching the history of fermented red rice, Koji, I saw that it has similar components to prescribed statins! Ok now things lining up. Now I see too that either the drug companies got into the FDA’s pants, or they simply decided to “protect” the consumer by banning the stuff so that you cant get it unless you are buying it in the form of a prescribed drug.

        Now…ok…it is convenient for drug companies, but too I’m in full acknowledgement, that we should make sure to get our opioids from a guy in a white lab coat, whom we pay, and drug companies “incentivize”, rather than from drinking a poppy smoothie for instance..

        Was a really interesting read though I should be doing something more productive.

        Here is a quick entry from wikipedia, and yes I know about wikiproblems but it I did see it after reading the same thing elsewhere but it can be vetted further I am sure.

        In this case it was case history which seems less likely to be false info..:

        The US Food and Drug Administration (FDA) position is that red yeast rice products that contain monacolin K are identical to a prescription drug and, thus, subject to regulation as a drug. In 1998, the FDA initiated action to ban a product (Cholestin) containing red yeast rice extract. The U.S. District Court in Utah ruled in favor of allowing the product to be sold without restriction. This decision was reversed on appeal to the U.S. Court of Appeals in 2001.[6] In 2007, the FDA sent Warning Letters to two dietary supplement companies. One was making a monacolin content claim about its RYR product and the other was not, but the FDA noted that both products contained monacolins. Both products were withdrawn.[16] In a press release the FDA “…is warning consumers to not buy or eat red yeast rice products… may contain an unauthorized drug that could be harmful to health.” The rationale for “harmful to health” was that consumers might not understand that the dangers of monacolin-containing red yeast rice are the same as those of prescription statin drugs.[16]

        A products analysis report from 2010 tested 12 products commercially available in the U.S. and reported that per 600 mg capsule, total monacolins content ranged from 0.31 to 11.15 mg.[17] A 2017 study tested 28 brands of red yeast rice supplements purchased from U.S. retailers, stating “the quantity of monacolin K varied from none to prescription strength”.[18] Many of these avoid FDA regulation by not having any appreciable monacolin content. Their labels and websites say no more than “fermented according to traditional Asian methods” or “similar to that used in culinary applications”. The labeling on these products often says nothing about cholesterol lowering. If products do not contain lovastatin, do not claim to contain lovastatin, and do not make a claim to lower cholesterol, they are not subject to FDA action. Two reviews confirm that the monacolin content of red yeast rice dietary supplements can vary over a wide range, with some containing negligible monacolins.[19][20]

    6. Cathy,

      So sorry to hear about your commitment to a WFPB diet and your resulting stroke. A question I have for you would be:

      during your 16 years were you able to maintain a body fat of 11-12%, a visceral fat reading below 12, and a blood pressure reading of 110/70, coupled with regular daily (vigorous) exercise…?

      1. Cathy,

        Dan Beautner pointed out that one of the things the inhabitants of the Blue Zones had in common were that they all were ‘sweating’ between 5 – 10 hours per week. That averages out to be a good 1-hour+ per day.

        While I subscribe to the WFPB philosophy, it is my belief that it is only part of the equation.

      2. Body fat of 11-12% might be fine for athletic men but is very, very lean for women. 10-13% is considered “essential” while 14-20% is considered “athletic”.

  3. Yes, Fumbles, that study came to mind right away, as did the pescatarians in the Adventist study.

    For me, things are starting to make sense, and why the pescatarian women had less than half the heart disease
    risk of the vegan women, and little less than half the risk of omnivors.

    Looks like for me, a little fish it is. Been eating “food as grown” since the 80’s, following dr greger 11 years now, done the tweaks.

    I would like to see a study on pescatarians and vegan wfpb and hormone levels. And microbiome comparisons. That would be really interesting.

    1. Can you explain your reasoning further (because those Taiwanese ‘vegetarians’ ate neither meat NOR fish)?. Taiwanese fish eaters may have had twice the stroke risk of non-fish eaters.

      ‘Vegetarian status was defined by avoidance of meat and fish in face to face confirmation by trained interviewers and in the FFQ in cohort 1. As for cohort 2, the diet section includes a question inquiring whether the participant was a vegetarian or a nonvegetarian. Participants who identified themselves as vegetarians in this question and reported consuming no meat and fish in the FFQ were classified as vegetarians; those who self-identified as nonvegetarians or reported any consumption of meat or fish within the previous year (in the FFQ ) were classified as nonvegetarians.’

      1. Fumbles, again, I find it so interesting… not that I understand what is going on. When I first read about the taiwanese study, the first thing that caught my attention was they didn’t eat onions or garlic. I had just stopped my trial of daily 1/8 tsp of garlic powder as per Dr Greger video because of (dangerous) bleeding issues. With wfpb my blood is thin enough I guess.

        As for the classification of the nonvegetarians, that is a fairly loose definition isn’t it? In the past year? So a person could have veggies and rice all year, then splurge with holiday prawns, and suddenly you are nonvegetarian. hmmm

        I don’t know what the answer is Fumbles but for me, my cholesterol was lower with a bit of animal product, my inflammation markers always very low, and I suspect it has to do with estrogen – but I’m no scientist. I am willing to be my own guinea pig though :)

        1. Thanks Barb.

          I am thoroughly befuddled on this issue. The only conclusion I have come to is that there is probably such an interplay here between risk factors and protective factors that seeking a single factor explanation is a fool’s errand…… unless it is within a very specific and tightly defined context.

          As you know, I don’t eat fish for ethical reasons but it may be a good source of B12, selenium, iodine, zinc, pre-formed DHA/EPA etc which are otherwise hard to obtain even in well planned ‘vegan’ diets. Wild caught oily fish certainly seem a much safer option than meat and (full-fat) dairy.

          On the other hand, in the Taiwanese study, they did define anybody who had eaten fish/seafood within the last 12 months as a non-vegetarian so failure to consume fish didn’t appear to be a risk factor for stroke (which is a relief for me).

          1. Fumbles, also, just wanted to mention that I was surprised how healthy both cohorts were ! I was checking out the descriptions in one of the charts on your link – overall lower weights, very little kidney disease, high bp, diagnosed heart disease, diabetes etc for a large group of 50 + year olds. They are all doing a few things right.

            1. Yes but it was a bit surprising to me that both groups obtained around about a third of total calories from fat though. I’d expected a greater difference between the vegetarians and non-vegetarians.

    1. Barb,


      What are you eating in the pescatarian realm?


      Corrections are welcome:

      Seafood – I go with the minimum that I recollect seeing in studies as being optimally beneficial.

      That way – maximum benefit / minimal pollution exposure.

      Avoiding the usual high mercury suspects, of course.

      Also avoiding B12 as methylcobalamin currently. I read some materials concerned about the methyl group in methylcobalamin affecting mercury from seafood and converting the mercury to more toxic forms. Dunno if this has stood the test of time – but until I know more, I will stick with cyanocobalamin (much, much less than 2000 mcg).

      The studies I have looked at – and discussions with fishing industry types – ~3 oz of wild caught cold water fatty fish twice a week from the least polluted waters available seems optimal.

      Lowest on food chain should be among the least polluted.

      Lowest = Sardines < Pacific anchovies < Alaskan pink salmon < Mackerel.

      My experience:

      Sardines – pretty foul. Often from warmer and more polluted waters. OK for camping trips in Communist countries in the good old days when the only alternatives were sausage that the cat won't eat and you are not yet accustomed to completely Vegetarian fare. Good memories of people and places – it's the food we try to forget . . .

      Pacific anchovies – none, yet. One of these days I have to find some . . .

      Alaskan Pink Salmon – a staple, here. They have ~ 2 year life cycle. None is farmed salmon by state law – so all is wild caught. Less polluted overall than "Pacific Salmon" or "Wild Caught Salmon."

      Other Alaskan salmon – red and king and such – have life spans of 3-5 years, and thereby longer time to accumulate pollutants.

      Note bene: "Atlantic" salmon is all farmed – wild Atlantic salmon is 99% fished out. Atlantic salmon typically runs 15-25 X higher in regards to various pollutants than Alaskan salmon. The color of farmed Atlantic salmon is from additives chosen out of a book of colors. This is what you will find when you are eating a "healthy" salmon meal in restaurants. I haven't eaten restaurant salmon in years (decades?) – if I want to eat unhealthy food in a restaurant, by golly, I will eat honestly unhealthy food in a restaurant.

      I did note some large bargain Alaskan Salmon in a grocery store freezer section – then looked on the label, "Packed in China." Uh-huh.

      I passed.

      Mackerel – the forgotten cold water fatty fish. I have never had any, but I was looking into trying 'em. Live as long as 18 years. Long time to accumulate toxins. I decided to stick with Alaskan pink salmon (2 years). Anyway – I now seem to identify with long lived fish – if I am going to eat something, I'll eat those whippersnapper youngsters!

      I switched from fish to oysters recently due to zinc and iron deficiency – and low normal copper. Oysters are super high in zinc, and also contain high iron and copper – but far lower omega-3s than cold water fatty fish. Zinc deficiency symptoms subsided in a week – the body figured it all out all by itself, without the known dangers of pill supplementation. Pollution – I figured it would be very high in oysters, due to bottom bay filter feeding – but it is much lower than I expected. Apparently because they are at the bottom of the oceanic food chain, instead of being a little higher than fish. Who knew? I do ~ 2.6 oz two times a week – one can over two days.

      I completely avoid continental U.S. fish. Checking with our state natural resources advisories – all sorts of advice for women and children not to eat – men are always sacrificed in these advisories. We don't exist. I wonder, sometimes, why men do not live as long as women? For pollution dietary advice, I consider women and children to be the canaries in the mine – if they shouldn't eat it, I won't, either.


      Bon Appétit –


      1. Vivamus, I have a wide variety of fish available here, and thought about oysters recently. I haven’t had them in decades. I do read labels carefully too, and have the same reaction re “packed in china”. I can’t help wondering if small fish fry are sold to china to be grown and processed.
        We have Alaskan pinks offered here, and I used to really enjoy smaller coho (very expensive).

        Thanks for you comments. all very helpful!

      2. Vivamus,

        Why do people always seem to assume that seafood = sea animals? Fish, bivalve mollusks, lobster, crabs, shrimp, octopus, squid, etc.

        I eat seafood — but only seaweed!!

        So I would love to see that distinction: sea animals vs seaweed or sea plants. And they don’t contain any cholesterol, as far as I know.

        1. “Why do people always seem to assume that seafood = sea animals? Fish, bivalve mollusks, lobster, crabs, shrimp, octopus, squid, etc.”

          Probably because seaweed has not really been part of the mainstream American diet.

          In language – useage follows useage.

          That is why Eskimos (Native Northern Americans? First People?) are said to have many different words for many different types of snow.

          I just call snow “snow.”

          This might frustrate an Eskimo to no end – if he let it.

      3. Mmmmm, fish!

        Swimming fish, shell fish, lobsters clams mussels.

        Man, you take a piece of salmon, and put a little dill and lemon and you wrap it up and put it right on a hot charcoal heap a few minutes, OMG, that is something. Or Maybe monkfish or shark or swordfish, those are really something. Flounder is so delicate and delicious. Sea Urchin!

        Hey do we have any other reasons not to eat fish besides they are carcinogenic, contain mercury, are the source of worms and bacterial diseases, and whose industry vessels often transport drugs and human modern slave traffic, while horribly underpaying the workers?

        Well there is this I suppose, uh oh…:

        I did a quick bit of research to see if the info was refuted, but I don’t see anything, so maybe I missed it.

        I actually hope I did miss something because I’m feeling for the little guys – and then for humanity because there is likely an avalanche of ecofuckedness to follow… if this is true….

        Ok… I’ll skip the tuna…. Darn!

        1. The concept of fish in the ocean being extinct in 28 years is devastating

          I remember Dr McDougall talking about how he had snorkled at the great barrier reef to look for sharks decades ago and went back decades later and there weren’t any sharks anymore.

        2. jazzBass,

          So – you’re encouraging us to grab everything we can before it’s gone?

          Hmmm . . .

          I guess some will be preserved – in zoos.



          And, of course – on people’s walls.

          Don’t worry.

          People won’t miss what they have never known.

          Things just keep gettin’ better an’ better –


  4. It is interesting to me how well this topic fits with the person who asked why Hong Kong eats the most meat and has the highest life expectancy topic from yesterday.

    Their younger people not doing nearly as well as their elderly already tells me that adding more meat isn’t what got them longevity but now I have to fold this information into my thought processes to try to figure out if it may have helped a little before it started seriously hurting the younger generation.

    Meaning, did it help the elderly somehow?

  5. I do like eating a a whole plant based diet but it’s not sustainable. I’ve been eating this way for a few years only to wind up in the er with severely bad chest pains
    Eating this way caused me myocardial infarction High CRP . And to top it off I’m borderline diabetic. So I added meat back into my diet and my numbers went down a lot. What’s up with that. I don’t believe there’s one perfect diet for everyone. Oh and if anyone does have a heart condition and you don’t add in good fats this will definitely cause . My diet was very low fat . Not good for me.

    1. I strongly doubt a WFPB diet caused a heart attack, high CRP or borderline diabetes. By what possible mechanism could this occur?

      Also, why do such diets reduce the risk of MIs, high CRP and diabetes in published scientific studies but apparently do the opposite in your case? Very puzzling indeed.

      This talk of ‘good fats’ is very cryptic though. What is your idea of ‘good fats’?

      1. Mr fumbles

        You doubt it . That’s your issue that you would doubt it. Plant based diet is praised as such a great diet meanwhile people are having strokes. Suit your self
        If you blood work is great on this diet that’s fantastic . For me unfortunately it did I not work. Oh and my cholesterol was through the roof. Fruits and veggies are great but they didn’t agree with my chemistry. I followed dr. Gregor recommendations and have his cookbook. I no that this may sound crazy the a plant based diet low in fat would cause this. But the reality is it did. Enough said.

        1. Fair enough but I have always found scientific studies more convincing than people’s opinions.

          People on plant based diets apparently have half the rate of strokes of people eating meat.

          My particular problem is trying to understand why you believe that a low fat plant based diet actually caused your problem. Is that a formal medical diagnosis or just your opinion? It certainly doesn’t appear to be one of the recognised risk factors.

    2. Margaret, sorry to hear!

      Question, prior to the change to WFPB, were you in perfect health, weight, blood tests showing cholesterol perfect and doing 30-90 minutes of exercise a day for decades?

      Its ok if the question is too personal, just curious about the factors surrounding your experience, beyond your observed perceptions.

      (For instance, I was on Keto for 3 years, and avid burger guy for entire life, though I exercised a lot, and honestly I’ve felt weird aches pains, energy etc… since I became totally WFPB, super low added sugar/fat/salt. I attribute my situation though, to the damage Id done previously, but I cant know yet)

      Is it possible our bodies go through an unknown period of “detox” where they need a year or so to switch to even a super healthy diet, during which we experience all these problems, only to come out the other side as a picture of health?

      Additionally Ive noticed enhanced sensitivity to the things I consumed regularly before. A beer, a burger, a cupcake, appear to give me the real sense that Ive eaten something foreign, whereas before it was just something I ate that day etc…

  6. Hi jazz,

    Yes Ive been working out for years . I’ve did p90x are do cardio weights and followed a very sensible low sodium diet with lots of fruit and veggies . Beans all of the good stuff . Very low on fat. From what I read is that you need more healthy fats in your diet. I was only doing some avocado some chia seeds flax. I though for sure I had a the best diet , but unfortunately I was very surprised to see those elevated numbers. I love eating this way and I still keep to most of it but I did need to make some changers. It. certainly effects everyone different. I read that if you want to keep your heart healthy it needs much more fats then the whole plant based diet is recommending. I only can go by my experience and my blood work. I have a plant based cardiologist and he recommended that I supplement with fish . To each your own. Get your blood work drawn so you can see we’re your out before something horrific happens. Be well

    1. Margaret,
      >> Get your blood work drawn so you can see we’re your out before something horrific happens.

      Good advice!

      Personally I have never bought into the ultra low fat claim unless one is trying to manage or reverse heart disease. Dr. Fuhrman in his WFPB book The End of Heart Disease recommended against ultra low fat diets and recommends 15-30% of calories from nuts, seeds, avocado (no oils). Even T. Colin Campbell thinks nuts are healthful.

      1. Lots to think about there.

        Here is Campbell’s position on nuts

        Dr Greger’s blog and video on this general topic may also be worth revisiting

        I tend to avoid fatty foods myself but even oatmeal is 14% fat and wholemeal bread is 12% while tofu is 50+% fat (as a % of total calories) and raw soybeans are about 40%., Consequently, I don’t worry about going out of my way to eat concentrated sources of fat. ….. other than the 250mg of marine omega 3’s recommended by Dr G. It seems unnecessary to me.

        There do also seem to be benefits from low fat diets if this healthline article is to be believed

        Given that the human body synthesises pretty much all the fats it needs (ie except ALA and LA), I’m reluctant to embrace nuts and EVOO especially given their high saturated fat contents. The low fat Esselstyn diet didn’t seem to cause significant problems for his patients.either. Given that everybody in Western countries probably has CVD to some degree, I’m half inclined to think that the Esselstyn approach might in fact be the most prudent (but I’m also half inclined to think that a WFPB diet containing oily fish might be the healthiest too).

        That’s why it would really be helpful (to me at least) to see a long term study of the Esselstyn diet vs a higher fat WFPB diet containing some animal foods …. but I can’t see that ever being done.

    2. Margaret, AH maybe thats it? I am making sure to get enough fat, but only from nuts, seeds and avocado. I eat half an avocado for each non-breakfasat meal and I use tahini in dressings for fat, and I eat nut butters with the oatmeal. I do think not enough fats will cause cells to get..”sticky” causing all sorts of problems. just 2 cents here of course.

        1. What was your BMI? You didnt mention it.
          Some very toxic compounds can wreck the body like heavy metals toxicity or others very toxic chemicals (see the movie dark waters), mercury amalgams and else…

        2. ‘You need A good quality olive oil.’

          Can you provide some evidence for this belief please?

          I ask because higher intake of monounsaturated fats like olive oil appears to be associated with increased stroke risk.

          ‘The intake of saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) both in men and women with stroke were significantly higher than controls (P = 0.04 and P = 0.03 for men and P = 0.05 and P = 0.02 for women, respectively).’

      1. Jazz Bass,

        Always go back to the doctors when changing diet.

        Ornish reversed heart disease so much that someone no longer needed a heart transplant.

        If you are doing nuts and seeds and avocado you already get enough fat.

        The Mediterranean Diet was improved upon when olive oil was switched with walnuts.

        There was a 25% decrease in strokes just replacing olive oil with walnuts.

        Dr Greger has a video on it.

        1. Deb, Im there at the docs more now than when I was on Keto! lol,

          That said Im testing everything I can, things are looking good except super low vitamin D.

          But still i can tell something is off… I wont attribute it to this diet, but who knows, and Id like to get to the bottom of things for sure, just to know.

    3. Margaret, also, what about alcohol consumption? I notice this the most. Now, even a drink gives me hangovers terribly the next day…

      1. Yes you need to find low alcohol that doesn’t cause that hang over effect. Look for dry farm wines. I have it a once or twice a week. No headaches that’s all of the chemicals in it Buy organic only .

      2. jazzBass,

        Now this is interesting.

        Have you mentioned this to your physicians?

        If not – you might wish to.

        All the best –


        1. Yes Ive done so, but so far nothing conclusive…. Im back again tomorrow and will go over some things and see what he wants to do. LIkely some more blood tests I guess…

  7. jazzBass,

    You wrote: ” Ive noticed enhanced sensitivity to the things I consumed regularly before. A beer, a burger, a cupcake, appear to give me the real sense that Ive eaten something foreign, whereas before it was just something I ate that day etc…”

    This sort of thing is common.

    My best guess is that we are not just feeding ourselves – we are feeding our microbiome.

    And that with major dietary changes – we have each shifted and changed our microbiomes toward healthier directions.

    Such that you microbiome no longer recognizes a hamburger, french fries and a coke.

    But if go back to that for a few weeks – your appetite for them will go right back where you started.

    Just a guess – no experimental double blind study to back it up.

    But it feels right.


    All the best –


    1. *ALERT some imagry in this post may be unsuitable for the WFPB consumer:

      @viv, Agree with your belief. I experienced this before. One hamburger, and I was toast like 25 years ago when I was a vegetarian, then I wasnt.

      Mmmmm. Whoa! My memories actually have taste: just daydreamt a piping hot Char broiled delicious medium rare burger nice and thick with hunk of melted cheddar cheese, and lettuce tomato and fresh red onion set up on a seeded brioche oversized bun to catch all the juices, topped with some grey poupon.

      1. jazzBass,

        Following your carefully crafted example – I just tried out some memories of once mouth-watering favorite Standard American Diet foods – hot, wet and smelly good stuff – particularly those with stronger smells – BBQ ribs, shish kebab, smokey bacon (once, along with butter, my favorite cooking spice), tamales, – and the steaks and bacon cheeseburgers – and meatball subs – and such.

        Nuthin’ much seems to happen. Except memories of family and friends I shared those times with. Get togethers. Celebrations. Work lunches. Good people. Thank you.

        But right now – my mouth is watering at the thought of asparagus and mushrooms and onions and split cherry tomatoes slow oven roasted at 250 degrees with a teaspoon of olive oil permeated with oregano and fresh pressed garlic – to be served on a bed of whole wheat pasta, also tossed with a tsp of extra virgin olive oil heated with oregano and fresh pressed garlic.

        Not unprocessed whole grain – but everything else there is fairly optimal.

        A variety of fruit and nuts / seeds before and after – with a sublingual 50 mcg tablet of Vegan Vitamin B12 included somewhere along the way (only because I couldn’t find anything smaller).

        Your tale of food inspires me to go make dinner now.

        Eating well takes time.

        Bon appétit –



        Slow food:

        1. Yes Viv, I eat that way every day. I have a garden and many herbs. Today I did roasted sunchokes (fast roasted ala julia child style) cut into long sections and tossed in chopped garlic, rosemary, EVO, and a hint of nutmeg, then onto the parchment paper and in the oven for 20 or so.

          Meanwhile I prepared my version of hummous (I know the right way since my wife is :Palestinian), but I have this penchant for improvisation of course, so I have found through the years that asian and mediteranean cuisines can match up nicely.

          SO I did a thai basil, blackbean and chickpea, miso humous.
          Just puse to chop the garlic, thai basil, black beans, chickpeas, then add tahini, lemon juce, miso, vegan sour cream, apple cider vinegar.

          Pulse, pulse, pulse for integration…then…Process it. 3 minutes super creamy.

          Put in bowl, and put EVO on top so it pools slightly on sides, then sprinkle with a touch of sumac for both color and taste.

          Good with toasted Ezekiel sprouted bread.

          Then there’s the salad! first I cut the leaves diagonally, tossing with black cumin, then I……..

          Gotta go, I’m hangry now.

  8. Margaret,

    I am rootin’ for ya!

    You wrote: “I do like eating a a whole plant based diet but it’s not sustainable.”

    My experience with a largely Vegan, healthy WFPB diet, as well.

    May I ask what fish you are now eating – how much when, etc.?


    Thank you,


    1. Im eating wild caught salmon three to four times a week . I also add in sardines. I’m looking into adding more fish but for right now this is what I’m doing. I started this right after that bad episode that I had. I also take fish oil capsules. There made from sardines and anchovies . I eat about 3 – 4 ounces . Wild caught salmon is delicious and it’s great for you heart and your brain. You can also add in anchovies with lentil pasta. I’m gluten free so lentil pasta from the whole food 365 brand is very good . I’ve made anchovies and sardines over pasta and it tastes amazing. I incorporate much more real olive oil and a few ounces of red or white wine. Organic grapes only. If your interested in the sardine or the anchovies recipes let me no. I love it. Just adding in more variety to my diet. I personally feel like I’m missing out on other nutrients . Oh I eat a very lean piece of steak or chop meat once a month and I throw in some eggs in there as well. I can go overboard with red meat but I’m staying in control and that’s why I only have it once a month. For my height and weight I stick with no more then four ounces . I hope this helps you . I still eat beans and some tempeh with lots of greens and some fruits. Right now this is working and I’m happy with it. My blood Work tells me I’m on the right track. That is key . I will keep checking my blood work every three months just to make sure I’m on the right track.

      1. Margaret,

        Hey – leave some for the rest of us!

        Thank you – this helps.

        The anchovies – are these the highly salted anchovies that one typically sees in supermarkets, or some other sort?

        I am interested in getting anchovies – but I am low-salt.

        I have never seen encountered low-salt anchovies.

        If you have any sources for low-salt anchovies – an apparent contradiction in concepts – please let me know.

        Thanks, again –



        Oh – a note on “wild caught” salmon.

        The Great Lakes have been stocked with salmon. Believe it or not. The Great Lakes salmon are highly polluted. Lotsa advisories against women and children eating them.

        They are only “Wild Caught.”

        I saw a Great Lakes commercial fishing boat at the docks one day and I stopped to ask them what local restaurant they sold their fish to.

        So I could avoid the restaurant (I did not mention that).

        They stated that they did not sell locally – just to the East Coast.

        Since then, I have discarded the previous good feelings I had over the word “Wild Caught.”

        “Wild Caught” can mean wild caught highly polluted Great Lakes fish.

        I now go for Alaskan seafood – which is much, much less polluted – to the extent that I can, instead.

        1. No there all salted . I’m low sodium as well. But I found a jar at Whole Foods that is just anchovies with sea salt . Just rinse them. That’s what I do. I actually take out what I will be using and put them in a bowl with purified water and let them soak a bit and the rinse them again. It works well . If you feel that they still taste salty don’t add any additional salt. I find that it worked out good. I’m not a fan of salt food. I only use a quarter of a teaspoon . Enjoy.

      2. Lol you even add alcohol beverages, organic or not (which are sprayed just like conventionnal anyways)it is cellular poison, this make no sense and wont help your vascular health for sure, will you also add cigarette and processed meat to be sure to ingest every harmful compounds that most people is consuming which doesnt seems to protect them from cardiovascular problems?

  9. Hi, I have a question regarding muscle cramps on a vegan diet and am hoping someone can help me. Personally, I follow a varied vegan diet and have never experienced negative outcomes even if I occasionally eat vegan junkfood like burgers. I have helped a couple of my friends go vegan, but one of my friends who I’ve recently swayed on trying reverted back to eating eggs and fish because very soon into eliminating them from his diet (like 2 weeks) he started experiencing severe muscle cramps. He works out a lot and was monitoring everything with cronometer like I advised him to, sticking to predominantly healthy foods (gym guys, you know how it is). The cramps got worse and more painful as time went by and after a month of trying veganism he started eating fish and eggs again and his symptoms went away. I have done some research but can’t find anything conclusive and I was hoping maybe somebody here knows what was wrong?
    He was eating enough in terms of calories and drank two protein shakes per day, and he ate healthy foods such as tempeh and tofu, sweet potato etc. If you have any idea what might have been the case please let me know! :)
    Ps. Dr Greger thank you, you are the reason I went vegan in the first place!

    1. Jana,

      I’ve no idea exactly what your friend was eating, but one of the emphases here is WHOLE plant foods. That means not processed. “Protein shakes” sound like a highly processed food to me. Or was your friend drinking smoothies that he made himself, from fruits and veggies? Also, many folks who eat vegan eat a lot of processed food — and that’s not whole food and it’s not healthy food. And a lot of vegans don’t eat a variety of foods, or eat too much of one type of food, such as eating a lot of greens and not eating whole grains or legumes (beans, chickpeas, lentils, and split peas) etc. Finally, eating whole plant food usually involves quite a bit of food prep and cooking at home.

      I like to use Dr. Greger’s app The Daily Dozen for guidance; it describes how many servings of different food groups is recommended per day. For example, 3 servings of beans, 2 of greens, 1 of cruciferous veggies, etc. It includes definitions of what a serving size is, describes the kinds of food in each group, and has links to information and videos about these different food groups. The app is free, and is available for iPhones and other smartphones.

      Oh, and I have no idea what a “chronometer” is. But it doesn’t sound helpful to me. Like you, I’ve never experienced the problems you describe for your friend, nor has my husband or my brother. And my brother was in bad shape, overweight, and had a heart attack 4 years ago — after being a vegetarian for about 10 years. He changed his eating to whole plant foods, as well as started exercising more, and lost 70 lbs and went off all his meds *for high cholesterol, T2 diabetes, etc) except for high BP, which he now takes at the lowest dose. He is very conscientious about what he eats, after taking a program at

      1. Jana,

        I’ve had the leg cramps – very specific.

        Waking – out of the blue – to cramping pain in the lower leg – usually just one leg or the other – with the back of the calf in total contraction and the foot frozen in extended tiptoe.

        Have to jump out of bed hurriedly – inspired by pain – and walk it off – the foot slowly flattening out over several steps.

        The initial cramp is so powerful that it resists my entire weight on the tip toe initially.

        Mild residual pain after that. Walking more helps work out the pain.

        Then back to sleep.

        I had kinda forgotten about it until you brought it up.

        I have no idea what brought it on or what has driven it away.

        Haven’t had it for a while – currently WFPB diet, variety, moderation, beans, whole grains, vegetables, fruit, nuts, seeds, avocado, minimal extra virgin olive oil, ~2.6 oz of oysters 2X a week, B12 – solar noonday sun Vitamin D when the sun shines – mild intermittent exercise thoughout the day.

        It may have been occurring back when I was eating a much more Vegan diet – I do not recollect having them since going on the oysters – but I cannot swear that that is the cause.

        You are sleepy headed when all this happens – so the thought of it fades away quickly – like dreams.

        Question – are the gentleman’s cramps similar to mine, or something entirely different?


        “He was eating enough in terms of calories and drank two protein shakes per day”

        Unfortunately, body builders are surrounded by a culture emphasizing a marked overconsumption of protein.

        These shakes are usually from animal protein – specifically whey (dairy).

        This may be renal toxic over time.

        You friend may be better off eliminating protein supplementation entirely – he probably does not need any more than ~11% protein (by calorie). And that is probably far better via whole foods, not magic manufactured formulae.

        The traditional Okinawan diet came in at 9% protein – and they are/were among the longest lived people on the planet.

        Current U.S.Guidelines run ~11%.

        Chronmeter may be helpful in this regard:

        There is plenty on protein requirements and on renal toxicity in the Vegan literature – Dr. Greger, John A. McDougall and others offer plenty of information along these lines.

        It might be helpful for you to review some of this and send along to him what you think might be helpful.

        But you may not have much luck on this in dealing with body builders.

        It’s their culture.


        All the best –


    2. Hi, Jana! I am not aware of any reason for a vegan diet to cause muscle cramps that would be relieved by eating eggs and fish. It is possible that his salt intake could have been lower on the plant-based diet, along with sweat losses and excessive hydration during exercise, which could have resulted in exercise-associated hyponatremia and resulting muscle cramps. Although there is no way to know, I wonder if the protein shakes could have contributed to the problem in some way. There could even be a psychological effect at work. I know a man who tried a plant-based diet for gout for 2 weeks, and then abandoned it, convinced that it had made him anemic as a result of iron deficiency. Unless he had significant bleeding during that time, this is highly unlikely. My point is that sometimes people attribute problems to a plant-based diet that may not in fact be caused by it. I wish I had a better answer for you, but I don’t have enough information to tell you more.

  10. ‘high blood concentrations are ‘associated’ with”….in other words, not hard science. don’t post anything about ‘associations’, they mean nothing.

  11. i no longer support dr greger because he ignores the new revelations surrounding saturated fat and is a major proponent of associative correlations and not hard science. he is a book seller with an ethical opposition to meat eating, not anything based on science. i’m going low carb, high fat and feel much better.

      1. Deb, I’m curious, when you say “I have had people suddenly drop dead on that diet.”, are you saying you are a medical doctor?

        Do you make decisions in the healthcare of the public? Volunteer at a hospital? Are you a nurse of some sort?

    1. I doubt that you ever did ‘support’ Dr Greger. We get low carb/keto/Atkins people coming here on a regular basis making such claims. It’s SOP for you people.

      There are no ‘revelations’ surrounding saturated fat just oft-repeated foolish claims based on carefully designed association studies This tactic has been used for years and is regularly exposed for what it is – poor science – but the food industry and its ‘researchers’ keep producing such studies because the resulting media publicity is invaluable.

      Good luck with your low carb diet by the way

      ‘This study prospectively examined the relationship between low carbohydrate diets, all-cause death, and deaths from coronary heart disease, cerebrovascular disease (including stroke), and cancer in a nationally representative sample of 24,825 participants of the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. Compared to participants with the highest carbohydrate consumption, those with the lowest intake had a 32% higher risk of all-cause death over an average 6.4-year follow-up. In addition, risk of death from coronary heart disease, cerebrovascular disease, and cancer increased by 51%, 50%, and 35%, respectively.

      The results were confirmed in a meta-analysis of seven prospective cohort studies with 447,506 participants and an average follow-up of 15.6 years, which found 15%, 13%, and 8% increased risks in total cardiovascular and cancer mortalities with low (compared with high) carbohydrate diets (see figure for total mortality).’

      1. Tom,

        Thank you for continuing to post that study.

        Yesterday, someone was asking about why Hong Kong ate the most meat and had the highest longevity and I started researching and when I went disease by disease the results were the elderly (who were nutritionally deficient in meat in one study) had stable diabetes levels. The young people had disturbing diabetes levels. The people born in 1900 had low breast cancer levels, the people born after 1960 had ridiculously high breast cancer levels. Same thing with stroke.

        The youth of Hong Kong have been told that their mortality went up when their meat consumption went up but it may well be that their flu vaccines switched from 3% to 50% or that their medical care is free and high tech and they are using AI robots to diagnose people before they even leave home. so that the doctors aren’t overloaded. Or that they don’t drive or that they don’t own guns and rarely go to prison and rarely get murdered and don’t smoke and can’t afford to drink, etc.

        I found so many reasons that the elderly are still alive but if the mortality levels were related to the meat and fish, then the young people and middle-aged people should be benefitting and there was an age-pattern. The younger people were not going to have longevity. They just wouldn’t find out until they were 40 or 50.

        1. I forgot that they had the best infant survival rates and the absolute lowest murder rates.

          Without even having a single dietary factor involved they could become a pseudo-Blue Zone until you started to look at the disease rate of the young people.

          1. Yes, they have an excellent health and social services system in HK also.

            I suspect the answer is the lag effect – the longevity now is the result of past dietary practices not the recent high meat diets – but it would be hard to prove. Meat consumption is also a marker of wealth and economic development which can have a significant influence on mortality.

            It’s fascinating that low carbers like this one will damn all ‘associative correlations’ but all too often they will then trot out ‘associative correlations’ like the HK meat/mortality one to justify their dietary choices.

    2. @ttlvsh hey the buffet is mostly veggies here, but I do know a steak place that’s open.

      Now about those major revelations. What you got?

      1. Dan,

        Thank you for posting this.

        I haven’t bothered with a recipe book for a long time. Just throw things together, for the most part.

        Let’s see – what do I have . . .

        I occasionally refer to my index cards.

        I particularly make it a habit to avoid recipes coming from the health care field – Ornish’s are notorious.

        But this – this looks interesting.

        Real food. Real cultures. All standing the test of time.

        First recipe book that I have been tempted by in a long, long time.

        Thanks again,


        1. V,
          I’m not a recipe cooker either. An influential book I read in my gradeschool library may have been titled, “The Big Road.” In it a young boy escapes endless work on a depression era farm and starts hobo hopping trains and living in hobo camps, something many people did back in the day. Anyway, these people tended to eat out of a collective cook pot containing scraps of what people brought.
          For decades I’ve done a large stock pot stew every week or two. I put it in serving containers in the freezer. My stew always has beans and greens and veggies and all things good I can think of to toss in. I am not shy about eating food out of cans either.

    1. i watch dr. greger videos and keto videos. opposite ends of the spectrum. blue zoners and all the other long lived people are also much more active, eat alot less and rarely eat sugar. is it minimal animal protein or other factors that contribute to long life? we did not evolve by avoiding meat, just the opposite. for every presentation extolling the value of veganism i find one just as convincing extolling low carb. low carb does not mean no plant food. even 20 grams of carbohydrate a day means 5 to 6 cups of leafy greens and cruciferous veggies. 5 cups of cooked broccoli is alot of broccoli! what i take away from all my investigating is: eat less, stay active, avoid processed food, very little or no sugar at all, and do intermittent fasting, its all about insulin.

      1. This site doesn’t promote veganism. There are plenty of very unhealthy so-called vegan diets. This site promotes whole food plant based diets which may or may not include a small proportion of animal foods.

        As for low carb diets, they are associated with a significantly increased risk of death. So they probably aren’t a good idea.

        And eating lots of vegetables is probably a good idea but may not protect you if you have a lot of unhealthy foods in your diet

        ‘Background: High red meat consumption is associated with a shorter survival and higher risk of cardiovascular disease (CVD), cancer, and all-cause mortality. Fruit and vegetable (FV) consumption is associated with a longer survival and lower mortality risk. Whether high FV consumption can counterbalance the negative impact of high red meat consumption is unknown…………………………..
        Results: Compared with participants in the lowest quintile of total red meat consumption, those in the highest quintile had a 21% increased risk of all-cause mortality (HR: 1.21; 95% CI: 1.13, 1.29), a 29% increased risk of CVD mortality (HR: 1.29; 95% CI: 1.14, 1.46), and no increase in the risk of cancer mortality (HR: 1.00; 95% CI: 0.88, 1.43). Results were remarkably similar across amounts of FV consumption, and no interaction between red meat and FV consumption was detected.’

        1. So… I have never heard Dr Greger promote consumption of animal foods.

          Though i have heard him pooh poo crappy vegan diets such as donuts and beer.

          Can anyone share a link with Dr Greger suggesting eating meat – even some, is good?
          (not meaning his few mentions of its just “ok” in the sense of falling off the wagon or a one off special occasion where you’ve declined birthday cake 20 times this year already so: “dang it I’m going to have a piece of cake” etc)

          1. Jazz Bass,

            He has done videos on handling and cooking meat and has said to people if they found a study where it increased longevity he would look at it.

            He jas said that if fish wasn’t so polluted that it might be healthy.

            He does lean vegan but most of these doctors lean vegan but say that once you get down to 5% calories from animal products the difference between the diets is more slight.

            Dr Ornish believes vegan is best but he allows a small amount of animal products on his diet.

            Honestly, many doctors use the 5% number.

          2. I’m pretty sure that Greger is a vegan himself and therefore wouldn’t promote animal foods consumption.

            In fact, he implies that no animal foods at all is optimal but doesn’t actually make that statement explicitly. For example, he writes

            ‘The greater the proportion of plant foods, the lower the rates of hypertension, and the same with excess body fat. The only dietary group not on average overweight were those eating diets composed exclusively of plant foods, but again there was the same incremental drop with fewer and fewer animal products. This suggests that it’s not black and white, not all or nothing; any steps we can make along this spectrum of eating healthier may accrue significant benefits.’

            So, plant based diets with a little animal food good but plant based diets with no animal foods better?

      2. Hi, tom! In answer to your question about whether it is minimal animal protein or other factors that contribute to long life, the answer is both. You might be interested in these videos, in case you have not already seen them:
        I hope that helps!

        1. @ Christine,

          I’m sorry but I just followed all your links and there isn’t one word in there which I can find, suggesting animals consumption is as powerful as plants at creating longevity and health, further, each of your links showed reasons to substitute animal with plants in or consumption.

          I could have missed something, but I am asking you formally to be specific regarding this assertion that eating some animal foods is proven to help you be healthy and live longer.

          Please advise.

          1. jazzBass,

            You are looking for the impossible.

            I went to PubMed to look for even one study that said that adding meat in was healthier and there aren’t any.

            Eating meat does increase height in children, but we already know that height is not a health advantage from Dr. Greger’s videos.

            Even in children, eating meat has been studied to be pro-inflammatory.


            The fact that Dr. Greger is using studies, you can’t ask him to say things that are not found in a study someplace.

                1. it’s an interesting conundrum because being taller appears to be associated with less heart disease. At least in Western countries.

                  In Asia though, those Okinawans on traditional diets and the famously long lived Japanese on traditional diets were also well-known for being short. Even today in China it was found that ‘Hainan centenarians were short in stature and underweight. ;

  12. Wow, Dr Greger, you’re taking us back to the theme of that old (first?) video of you in a classroom, discussing homocysteine/B12 and Omega3s… I remember watching it in early 2014… Always interesting. Good memories.

  13. My father still is bed-bound and not eating but his fever broke today.

    He tried to stand up when I delivered his wife ’s meds but he honestly couldn’t.

    It is amazing that he was playing tennis and swimming and walking a few weeks ago and now he is too weak to stand for one minute.

  14. I imagine that Dr. Greger will be covering some of these points in the next video. Note that the C677T MTHFR polymorphism comes into play, as would the gene variant for low conversion of folic acid to folate. I have both and take this to mean that I should focus on food sources of folate rather than foods supplemented with folic acid, and should test regularly for homocysteine levels, something that doctors never suggest.

    Quest Diagnostics: High homocysteine levels in the blood can damage the lining of the arteries and may make blood clot more easily than it should.

    PCRM: Folate deficiency typically manifests as megaloblastic anemia. However, inadequate intakes can lead to elevated serum homocysteine…. Serum folate is also influenced by genetic polymorphisms affecting the function of an enzyme, 5,10‐methylenetetrahydrofolate reductase (MTHFR), that converts one form of folate to the main form of folate found in the blood. People with two copies the C677T MTHFR polymorphism, for instance, have reduced enzyme function, lower serum folate and higher homocysteine levels.[5] Folate, derived from the word “foliage,” is found in significant amounts in dark green vegetables, as well as legumes. Folic acid, the oxidized form of folate, is also added to by law to all enriched grain products in the U.S.

    Results: Plasma folate was statistically significantly associated with risk of hemorrhagic stroke in an inverse linear manner, both in univariate analysis and after adjustment for conventional risk factors including hypertension (odds ratio [OR] for highest versus lowest quartile 0.21 (95% confidence interval [CI], 0.06 to 0.71; P for trend=0.008)). Risk estimates were attenuated by inclusion of homocysteine in the model (OR, 0.34; 95% CI, 0.08 to 1.40; P for trend=0.088).  ttps://

    We found that dietary intake of vitamin B-6 and folate were associated with a reduced risk of stroke, and this inverse association remained significant in studies with >10 y of follow-up periods and among participants without a pre-existing stroke event. … In contrast, we found no significant association between dietary vitamin B-12 intake and the risk of stroke.  

  15. Note that B6 is the one B vitamin that you can overdo with supplements, From

    Good sources of vitamin B6
    Vitamin B6 is found in a wide variety of foods, including :pork,poultry, such as chicken or turkey, some fish, peanuts, soya beans, wheatgerm, oats, bananas, milk, some fortified breakfast cereals.
    How much vitamin B6 do I need?
    The amount of vitamin B6 adults (aged 19 to 64) need is about:1.4mg a day for men, 1.2mg a day for women. You should be able to get all the vitamin B6 you need from your daily diet. The bacteria that live naturally in your bowel are also able to make vitamin B6.
    What happens if I take too much vitamin B6?
    When taking a supplement, it’s important not to take too much. Taking 200mg or more a day of vitamin B6 [LK2] can lead to a loss of feeling in the arms and legs known as peripheral neuropathy. This will usually improve once you stop taking the supplements. But in a few cases when people have taken large amounts of vitamin B6, particularly for more than a few months, the effect can be permanent.The effect of taking vitamin B6 at doses between 10 and 200 mg is unclear. So there’s not enough evidence to say how long these doses could be taken for safely.

    Folate and folic acid
    Folate is a B vitamin found in many foods. The manmade form of folate is called folic acid. Folate is also known as folacin and vitamin B9. Folate helps:the body form healthy red blood cells, reduce the risk of birth defects called neural tube defects, such as spina bifida, in unborn babies. A lack of folate could lead to folate deficiency anaemia.
    Good sources of folate
    Folate is found in small amounts in many foods. Good sources include:broccoli, brussels sprouts, leafy green vegetables, such as cabbage, kale, spring greens, and spinach, peas, chickpeas and kidney beans, liver (but avoid this during pregnancy), breakfast cereals fortified with folic acid.
    How much folate do I need?
    Adults need 200 micrograms of folate a day. There are no long-term stores in the body, so you need to eat folate-containing foods frequently. Most people should be able to get the amount of folate they need by eating a varied and balanced diet.

  16. Hi,

    I know this is not the proper way to post the question, but I couldn’t find the related subject.

    I try not to connect proteins with carbohydrates in one meal due to different ways of digestion of those two. I’m aware of the case that carbohydrates are digested in an alkaline enviroment and protein in acid, therefore mixing them might cause digesting problems, inflammations, and leaving leftovers of food in digestive system.
    I have your book with recipies and it’s hard not to notice, that you advise meals prepared against this principle.
    Could you relate to this issue?

    1. Hi, Jakub Rajewski! That topic is not covered here on NutritionFacts because it is not supported by evidence. Some of the healthiest foods on the planet, such as beans, include significant amounts of protein and carbohydrate combined. We eat food, not proteins, carbohydrates, and fats, and most whole plant foods include some combination of these macronutrients. While there is evidence that eating animal-derived protein and fat with refined carbohydrate foods such as white bread (typical cheeseburger on a bun, for example) may exaggerate spikes in blood sugar, insulin, and triglycerides, this has nothing to do with carbohydrates being digested in an alkaline environment, and proteins being digested in an acid environment. Whole plant foods do not have this effect. You might be interested in these videos in case you have not already seen them:
      I hope that helps!

    2. Christine has already answered you but I tried to look it up on PubMed and they had a study where combining proteins and carbohydrates improved

      When proteins are combined with carbohydrate after exercise, there is the activation of hypertrophic signaling molecules in skeletal muscles and there are increases in the rate of glycogen synthesis.

      In a few studies, that improved exercise performance the next day.

  17. JazzBass, I am posting here because the question you asked about animal foods was buried deep in multiple conversations, above.

    If you read the 4th paragraph in today’s video carefully, you will see Dr G discussing lower levels of IGF and stroke. He then talks about research suggesting that lower levels (animal foods cause rise in IGF) could be causative especially for those with higher blood pressure… yes this can happen with people following wfpb and exercise too.

    He warns about this connection, and that is why I am adding small amounts of fish to the menu.

    1. I must be misreading it, because it seems to point to NOT eating it, rather than eating it…. Let me go to the videotape….back soon

    2. @ barb,
      Ok that took 30 seconds. 4th paragraph copy/pasted below.

      So are you reading this to say that rather than down-regulating your blood pressure, you choose to eat animal?

      It is amazing though and goes to Margarets original post. She ate animal and got “better”, but perhaps it could have gone another way.

      I read this to say: “Down-regulate and maintain proper BP, and plants is the way to go to avoid all its harmful attributes.”

      What am I missing here?

      However, those with high blood pressure who have low IGF-1 levels do appear to be at increased risk of developing atherosclerosis, thickening of the artery walls leading up to the brain, but no such association was found in people with normal blood pressure. So, there may be a cautionary lesson for vegans here. Yes, a whole food plant-based diet to down-regulate IGF-1 activity may slow the human aging process, not to mention reducing the risk of some of the common cancers that plaque the Western world. But, perhaps, the ‘take-home’ message should be that people who undertake to down-regulate IGF-1 activity by cutting down on animal protein intake as a pro-longevity measure should take particular care to control their blood pressure to preserve their cerebrovascular health, the health of their arteries in their brain. In particular, they should keep salt intake relatively low while ensuring an ample intake of potassium to keep their blood pressures down. So, that means avoiding processed foods and avoiding added salt, and in terms of potassium-rich foods, beans, sweet potatoes, and dark green leafy vegetables.

      So, might this explain the higher stroke risk found among vegetarians? No.

      1. Dr Greger is saying that there is a link between higher IGF1 and fewer strokes. Yes, he is suggesting to treat the high blood pressure rather than eat animal products, BUT there are those of us long long time wfpb (plus all the tweaks) who have blood pressure higher than their doctors would like to see it. This poses a real risk for stroke, especially when their is familial high bp and stroke history. Yes I believe it explains part of it, but I am mulling over the taiwanese study too … different situation there maybe.
        Yes, I am seeking the protective effective of modest fish consumption in my case rather than adding two or more additional bp medications to what I am already taking. Two small servings per week is what the AHA recommends, and what the neurologist suggested.

        The pescatarian Adventist women had half the risk of vegan and omnivor women but I believe this is through another mechanism… that consuming fish not only raises IGF1 but also estrogen (I have to check that). Estrogen is protective of heart disease in women.

  18. As to the pollution question, you may find this article interesting. Over 90% of the pcb’s we ingest come from meat, dairy and veg, ie non seafood sources. They also illustrate the risk by saying if 100,000 people ate farmed fish for 70 years it might result in 24 cases of cancer, but many thousands of cases of heart disease etc would be prevented.

    1. Interesting, I suppose factory farming water animals for slaughter is fairly progressive and not fraught with potential bacterial mishaps?

      Isn’t the same true for insects-for-food farming, which uses .1% of the water?

      1. I wouldn’t feed farm fish to my dogs or cat. Disgusting… and I hope eco groups continue to apply pressure to the industry.

        Harvard used the farm fish to illustrate the risk.

        1. Yes, so we have three choices.

          1. Contribute to the destruction of the oceans ecosystems by depleting the exponentially decreasing numbers sea animals by eating them.
          2. Eat farmed fish fraught with its various and sundry destructive and harmful issues
          3. Don’t eat fish.

          I do love to eat fish so Im torn, but it seems the choice is clear, albeit a tough one.

          1. If I was a guy, or I had sustained low blood pressure, or I did not have family history of strokes/heart disease, or I had not already put in years of diet tweaks, I would probably stick to pure vegetarian. However, #1. my life is on the line here and #2. I am beginning to see what a complex question it is.

            1. Barb,

              You wrote: “I am beginning to see what a complex question it is.”

              Ahhh . . . it is so good to see someone who has seen the light.

              And, yes – make no mistake – your life does depend on it

              If you ever take an introductory course in ecology – early in the course they will likely give example after example of excellent, well-intentioned linear two dimensional ideas that went terribly awry. A leads to B – without considering C, D, and E. These illustrations teach how everything is interconnected in multiple dimensions. And how one change leads to other changes which then lead to other changes that are entirely unpredictable.

              The Law of Unintended Effects.

              So it is in human systems.

              Dr. Greger does his best to break health issues down into simple, easily digested bite-sized pieces which then can be broadly applied. A leads to B.

              And that can help us – but it is not determinative.

              It is just one piece at a time in a constantly changing complex puzzle.

              Dr. Greger helps us examine the leaves and the bark of the trees – but too often, the understanding of the forest is lost.

              The more one experiences the complexities of human health – and the more one sees the extraordinary extent of human variation – and the more one participates in the well-intentioned changes in science over time, sometimes with terrible negative consequences – the more humble one becomes in handing out health advice.

              Unfortunately that humility – the humility of hard experience – is not a core value of this web site.


              All the best –


          2. jazzBass,

            As I understand it, the The Seventh Day Adventists predicted the end of the world (or variations thereof) in 1844. October 22, if you prefer precision in these matters. I am not sure of the time of day. But you have to ask yourself – does the time of day that the world ends really matter? Oh, yes – where – where were we? Yes, yes – the world did not end. Proof – we are here. You and I. The Adventists lost ~90% of their followers – only true believers remained. Makes you wonder about who stayed. F ound new leadership – who then rewrote – excuse me – “reinterpreted” – their history. No problem. Wonderful people. Love ’em to death.

            The Jehovah’s Witnesses predicted end-of the world (or variations) circa 1878, 1914, and 1918. It hasn’t gone particularly well for them – please be nice and ask them all about it next time they show up knockin’ at your door.

            Professor Paul R. Ehrlich of Stanford University (Biology – author of The Population Bomb) predicted widespread famine – I recollect watching him being very seriously and respectfully interviewed by Johnny Carson in the 1970s – Carson had devoted an unheard of serious show to showcase Ehrlich. To a direct question from Mr. Carson, Erlich stated that humanity had eight years before overwhelming disaster. We were all shocked.

            Elrich was in error.

            I grew up waiting for the nuclear bombs to fall. Plague to hit. Famine to destroy.

            We seem to be weathering this century’s plague pretty darn well.

            A friend worries about race war. Totalitarianism. Right-wing conspiracies.

            Ho-hum – we all still seem to still keep muddlin’ through.

            I encourage you to take predictions of impending doom of life in the ocean seriously – as seriously as we should take all the other many worries – but no more seriously. And to acknowledge the limitations of such predictions.

            And I will bet you – one bottle of Amontillado – that fish will still be swimmin’ in the sea in 2048.

            I look forward to collecting.


            All the best –


            (aka “Vivamus”)


            The Cask of Amontillado
            Edgar Allan Poe

        2. Barb,

          You wrote: “I wouldn’t feed farm fish to my dogs or cat.”

          Interesting. Hmmmm . . .

          You and I share a view on wonderfulness of farmed fish. Not a very inviting idea.


          But I have not had carnivorous/omnivorous pets for a long time. And that was before I was aware of such issues.

          During that simpler, happy time – such is the kindness of memory – we just fed our dogs “dog food” and fed our cats “cat food” and we humans just ate “food.”

          You know – bacon, eggs and buttered toast for breakfast – hamburger, fries and a coke for lunch – chicken or steak or shrimp for dinner – that sort of thing.

          Now – in the current era – when we are all much more aware of diet and lifestyle – to what extent do you extend that awareness to pets?

          Is the dog food or cat food organic? Alaskan? Vegetarian? Vegan? Locally sourced? Whatever?

          Do you make sure that the cat walks briskly 30-90 minutes a day?

          Where do you apply all this knowledge to pets – and where do you sit back and relax on all this?



          1. Vivamus, thank you for your comments – all of them! You reminded me of Dr Klaper’s saying that we can never do ‘one’ thing and that any action we take can set in motion a cascade of unforseen events. I am not hasty in health decisions for myself, and I do take good advice from amazing doctors. I am thankful for their support.

            As for the animals, my joy in life…. they are aging very well, all in terrific condition. Fit, slim, and want to play. Food is not their motivator (though they enjoy our mealtimes) but play and activity is. I feed the dogs halo vegan dry dog food with other things like salmon, or the slow cooker barley, carrots, and steak stew I make for a topper for example. . The cat likes to hunt – too much – but she insists. A good cat chow or bit of the dog’s toppings for dessert and she’s fine.

            1. Vivamus, I came across this link I had bookmarked some time ago. Thought you might enjoy perusing through this collection of recipes.

              Re your question about when do I apply the knowledge etc? Mostly when I shop, whether it is for food for me, or for the pets…. actually, before I shop, in the brief planning stage according to seasonal sales. Then its relax and have fun starting with being met at door, tails wagging, heads snooping into bags, the cat hiding in a brown paper bag. LOL we don’t worry about much around here.

              1. Barb,

                Thank you for the recipe referral.

                Looks grate! ;-)


                It sounds like your pets have chosen their Mistress well.

                All the best –


            1. After the mass-die-offs, they have “breeding failures” in the birds—they said that they had an unprecedented 22 breeding failures where a colony produces zero chicks—in the region during and after the die-off.

              When I watched the snowshoe rabbit documentary, they said that when the predators become so voracious, the rabbits stop having kits.

              I wonder if it is health-related or what sentient beings tend to do during wartime.

              1. Awww, I have been reading and the farmed fish don’t know what to do.

                They display inferior courting behavior out in nature.

                Their timing is poor.

                The male salmon need to release their sperm just as the female deposits her eggs in a shallow nest of river gravel she digs but the farmed fish make mistakes.

  19. I’ve been following Dr Greger for three and a half years now and felt that I was strong and armed against most diseases, preaching the word etc… now I find that I’m hypertensive, far from the expected 110/60. I can tick all the boxes for his recommendations, even did the Prolon fast twice.. big mistake BP went up to 170/90.. too much salt in the Prolon diet, up to 4.7g per day!
    I’m not on any medications, never have been. With this video and the mention of low Igf1 I’m wondering if I should start eating a bit of fish..soften up those arteries. After all these years and the work that I’ve put into becoming plant based I’m at a loss.

    1. Sabrina, I would highly recommend you have this talk with your family physician. He/she may offer some valuable insights to encourage you on your current path, or into recommending some diet changes. She can assess your risk level, check your inflammation markers,
      and guide you to your goals. It’s what I did… and I had blood pressure rise after becoming wfpb vegan again years ago. Very frustrating. Dont own salt, oil, etc. the whole 9 yards. Anyway, see what your doctor says and maybe investigate the bp further. All the best to you.

    2. I’d second Barb’s advice.

      Ruling out heart, kidney and thyroid abnormalities would probably be prudent given your very healthy diet.

      1. Sabrina,


        I share your pain. I have not been able to reach my target blood pressure – 90/60 – despite decades of trying.

        Despite trying ‘most of the tricks out there.

        But I’ll keep pluggin’ away.

        Annual – or more often as the need arises – medical examinations are sometimes felt to be unnecessary – even conterproductive by some.

        But I find it a good practice – to look at the latest labs to titrate one’s efforts.

        To deal with issues as they arise.

        To uncover unanticipated surprises.

        And to get another set of eyes involved – a set that is more objective than mine own.

        This has has been most helpful. Time and time again.


        Take care –



        . . . no man ought to be his own physician, for fear of having a fool for his patient.

        William Grant

    3. As the other’s have already said, visiting your doctor is a basic requirement as high blood pressure is nothing to “watch”. That said, many of my patients think they are eating the optimal unprocessed plant based diet but they are not. Be careful “playing” with blood pressure, but under the guidance of your doctor, you might be very surprised what happens to your blood pressure when you eat nothing but unprocessed fresh fruit all day, every day, for a week. Sodium is hidden in many commonly eaten “healthy” foods and is usually the cause of high blood pressure. There is no significant sodium in fresh fruit.

  20. My father finally agreed to go to urgent care today and they immediately sent him to the ER. We can’t go in, so it will take several hours before we find out anything. Usually 6 to 12.

  21. Since  high blood pressure is the single most important risk factor for stroke, and is a major risk factor for heart disease, and a WFPB diet is advised for hypertension, it is puzzling why some people here have assumed that this diet is contributing to their high blood pressure or CVD and thus conclude that animal protein or more fat is what they need to solve their health issues.  The damage to their blood vessels has likely been going on for some time, perhaps long before their adoption of a WFPB diet.  

    Mayo Clinic: As a result of high blood pressure, you may develop damaged and narrowed arteries. High blood pressure can damage the cells of your arteries’ inner lining. When fats from your diet enter your bloodstream, they can collect in the damaged arteries. Eventually, your artery walls become less elastic, limiting blood flow throughout your body.

    There is much to rule out as possible causes of high blood pressure before jumping to the conclusion that a lowfat, high fiber plant based diet devoid of animal foods and processed carbs is the culprit. Questions to ask yourself:

    Have you had a calcium score test and carotid artery ultrasound to rule out atherosclerosis? This is a problem that builds up over time, likely long before you joined the WFPB bandwagon, and requires a diet like the one advised by Ornish and Esselstyn for reversal; you likely will be prescribed medication as well. Over time, high blood pressure can damage the arteries, making them more vulnerable to the narrowing and plaque buildup associated with atherosclerosis.   Most ischemic strokes are caused by atherosclerosis.  

    Is your diet sufficiently low in saturated fat and cholesterol to control cholesterol levels and prevent further plaque buildup in the arteries?

    Is your diet sufficiently high in potassium and very low in sodium? Most people consume a diet very deficient in potassium and far higher in sodium than advisable. Those with high blood pressure should get less than 1,500 milligrams  of sodium per day.

    Have you done a sleep study to rule out sleep apnea? The sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure. Having obstructive sleep apnea increases your risk of high blood pressure.  

    Do you avoid high glycemic load meals to prevent spikes in blood sugar? Long term, when glucose builds up in your bloodstream, this causes damage to organs, nerves, and blood vessels. Glycemic load is a function of both glycemic index of the food item and portion control.

    Is your weight low enough to prevent high triglycerides, insulin resistance and borderline diabetes?  Two of my doctors suggest a BMI of 22. Few people in this country are that thin.
    Do you avoid alcoholic beverages? Drinking too much alcohol can raise your blood pressure.

    Do you smoke? You should not.  Nicotine raises your blood pressure and heart rate, narrows your arteries and hardens their walls, and makes your blood more likely to clot.  

    Do you consume a lot of caffeinated, diuretic beverages like coffee? Both chronic dehydration and caffeine are implicated in high blood pressure. High blood pressure is common in people who are chronically dehydrated. When the body’s cells lack water, the brain sends a signal to the pituitary gland to secrete vasopressin, a chemical that causes constriction of the blood vessels. This causes blood pressure to increase. In a 2002 study, caffeine quickly increased the stiffness of the large arteries in people with high blood pressure.

    Do you exercise sufficiently?  Although 30 minutes a day is commonly recommended as a minimum, you should exercise more if your weight is not ideal. My cardiologist suggests a minimum of 90 minutes.

    Have you taken steps to reduce stress? Stress is a strong risk factor for stroke, and causes a temporary increase in blood pressure.

    Is your CRP in the normal range? Inflammation is associated with elevated blood pressure. Having high blood pressure may be especially dangerous for women with high levels of C-reactive protein. A 2003 study showed that when both blood pressure and CRP levels are elevated, the risk of heart attack and stroke may be as much as eight times higher.

    1. Thanks for your input Barb and Caroline.. however there is nothing in it that I don’t already know. I don’t smoke, use no oils or fats, no sugar, no added salt, had two glasses of wine on Sunday which was exceptional, use decaffeinated filtered Coffee and herbal teas .. regular Hibiscus, excercise: now that has been frustrating of late, I tripped on a lousy footpath in Paris last January and broke my upper arm(humerus) but still continued my jogging 5 to 10 km two or three times a week the other days I would cycle 40 or more minutes, I have a very large garden and stairs at home and a pool ( swim continually 30 to 45 minutes) my arm healed well and at 7 months I have full movement and no pain.. however I now have knee problems.. fractured meniscus, first left now right so that has slowed me down a bit. Before COVID I also worked out at the gym.
      My husband is a Doctor. My blood tests are all good. I’ve seen two different cardiologists who are not diet savvy, WFPB is unknown and not practiced here in France. The two stress tests that I did were more than good. I’m 63yrs old and resting heart rate 55. I support L214 and sea shepherd. I’ve read The China Study, How not to Die, How not to Diet, Prevent and Reverse Heart Disease, The Plant Based Solution, The no Meat Athlete,Idiot’s Guide Plant Based Nutrition. I’ve watched Forks over Knives, What the Health, Cowspiracy, Food Choices, The Game Changers, Earthlings, Dominion and more..of course this hypertension stresses me but I am not sure what to do now. That’s why I’m thinking that maybe low IGF levels might have something to do with it. Getting back to stress.. I’ve just started with Sam Harris’ Waking up app. Potassium: dark leafy greens , grow them in my garden, some nuts, dates, banana, coconut Water, beans etc. I would say all that Dr G recommends. Even got the dog on vegan kibble!
      Thanks for your replies

        1. Sabrina,

          Well – I see that you know what you are doing.

          Got me beat.


          Now we have to go to the reserves – you are stretchin’ the mind.

          The following each have only a few percent likelihood of success – but may be better than nothing.

          You are probably already far ahead of me – you certainly have been so far – but here goes.

          Consider white coat hypertension.

          I am susceptible.


          There are specific protocols for obtaining blood pressure properly. These protocols are almost universally violated in health care settings.

          For example – the nurse may be asking you questions proximate to taking your BP – without the requisite five minutes of relaxed quiet prior. The room may have a distracting loud ticking clock on the wall. Nasty bright lights. You are supposed to be relaxing. The nurse may take your BP with the cuff over your blouse. Wrong size cuff. Your bladder may not be empty. Etc., etc, etc.

          I routinely get 20-30 points lower taking my own BP at home following proper protocols than the nurses do violating those protocols in the health care setting.

          And I am very relaxed – or think I am – in health care settings.

          That is my briar patch.

          What to do? No guarantees. The following is my experience:

          I bought an automated blood pressure cuff. Omron seems to be one of the better brands out there – ~$60 U.S. – Omron cuffs have sensors so they do not overinflate initially like most home models do. No need for a lot of bells and whistles – a fairly basic model should be fine.

          I validate it by bringing it in and testing it against the health care system machine(s). It matches within a few points.

          My lowest readings run in the relaxed quiet time of the evening well after dinner prior to getting ready for bed.

          The whole day has wound down – and so has my blood pressure.

          Five minutes of near total body relaxation sitting in a supportive straight chair. Good posture, elbow on table, feet flat on floor. Quiet – no distractions. Subdued lighting. Computer screen turned off.

          Pre-position cuff on arm and machine. Close eyes. Visualize with eyes closed: relax entire body step by step, zone by zone, toes to top of skull – over five minutes or so.

          When very relaxed – lightly push the button to take BP.

          I find that lower readings beget even lower readings – because the anxiety about higher readings recedes further and further over time.

          If this works for you – consider similar relaxation techniques throughout the day.

          You may be able to use your sphygmomanometer to train your body.

          It might work, it might not.

          It might be worth trying.


          Consider also – a telephone consult with Dr. John A. McDougall.

          Just give him a call.

          You might also try contacting the Ornish people.

          And I would go ahead and do a web search for “Plant Based Doctors” (without the quotation marks) in your neck of the world. I see one plant-based M.D in France in all of 20 seconds of searching in English. Plus one dietitian. Searching in French may give you a better result. No guarantees as to quality – be careful! Check them out first. But this might be useful.

          A wise and knowing plant-based Physician, if you can find one, might make all the difference for you.


          I do not see anything on weight. None of my business, of course – I am not asking. But weight does seem to be a major player.

          I shoot for a BMI of ~21. Waist/hip ratio of <.95 for males, <.85 for females.


          Na (Sodium, not salt) – I shoot for 500 mg – 1200 mg / day.

          You may wish to first clear this with your Physician.


          Time for sleep –


          1. Thanks Vivamus. No thyroid problems on testing. BMI 22.3 stable for 3.5 years. Plant based doctor..already phoned around and his secretary told me that he no longer lived in France and has been replaced by someone else, this said, she seemed ignorant of the fact that the plant based dr was just that.. no idea! Salt intake is very low, I read all labels .. not that there is much that is packaged in my diet.. except for that unfortunate Prolon 5 day fast that I did. About 3 years ago I was able to contact Dr Caldwell B. Esselstyn for someone else’s problem and he wrote back! Great man!
            I have a medical digital BP machine and take my measures 3 consecutive times in the morning in bed and same again in the evening.
            I trained as a registered nurse and then as a midwife.
            Dr John McDougall, yes, The Starch Solution, read that too. He has a good website with his traffic light system. I listened to him and wife Mary when they were showing how they had prepared for the COVID lockdown.
            Signing off now, have a headache.
            Thanks for suggestions. Keep safe.

            1. Sabrina,

              Excellent. You know exactly what you are doing and you are likely in good hands.

              Let us segue this discussion onto the next day’s discussion board so it does not get lost in the shuffle.

              I still see directions to take this – understanding that yours is a case that ‘most everything has already been tried – but there may still a few things left to do –

              We’ll wait for that H/A to subside.

              You take it nice and easy –


      1. Aside from the running, we could be twins lol. And because of covid the pool is closed here :(

        I did go on a small amount of synthroid last year and it made a difference in how I feel, but not my bp. I do have white coat syn., but heart rate is 49 most often. I would do a 3 day bp monitor but I really hate them and here they charge $50 for it. For myself, I will keep up the great food, exercise, meditation, and consider the fish question. All the best to you Sabrina!

        1. Im confused. No dietary reason, or no overweight condition, and lots of regular exercise, and one can still have high blood pressure?


      2. Sabrina, here are some suggestions for steps to identify where your health problems lie. This is what I did, due to a family history of heart attacks, aneurysm, stroke, heart failure, multiple forms of cancer, both type 1 and type 2 diabetes, RA and autoimmune thyroid disease.

        First, test with one of the big genealogy companies like MyHeritage, Ancestry, or 23andme. Download the raw data file and upload to They will identify for you the health implications of your gene variants as well as give you an idea of how common these variants are in the general population, and their opinion of how significant each one is to your health. These gene variants are not a death sentence, but they do allow you to see the risks that you need to manage. Second, take the full battery of ClevelandHeart tests relating to advanced heart testing and inflammation. Quest Diagnostics does this testing here in the US. If you have a great health insurance plan and can convince the doctor that they are medically necessary for your lifestyle change program, the cost may be covered completely, as it was for me. Full cost is around $50 for each test, or perhaps less if your insurance company has negotiated a good deal with Quest. Third, get a calcium test score. This is not covered by insurance and costs around $200. Fourth, get a carotid artery scan. Fifth, read the books by Ornish and Esselstyn about their programs for reversing heart disease. The two programs are very similar. Sixth, take a look at the chart for advanced glycation endproducts in food. You get AGE either through eating the foods high in protein and fat that are higher on the scale, or by not managing your blood sugar properly. For the latter issue, look at the tables for glycemic index and glycemic load. For AGE in foods look at Table 1 at

        Finally, see if there are items you may have overlooked relating to hypertension risk, like sleep apnea, weight loss, 90 minutes of daily walking.

        I second the recommendation of an Omron upper arm blood pressure monitor. The basic no frills model is $33 US at Walmart. If you want more bells and whistles, they have more expensive models as well. Carefully read the instructions and perhaps watch a few youtube videos to be sure you are doing this correctly. I get the same reading as at the doctor’s office.

        I am unsure about the benefits of much-hyped hibiscus tea. It is very acidic, like meat, so it could have the same effect in weakening bones. “One study found the pH of hibiscus tea to be 2.5, much lower (more acidic) than tea, somewhere between orange juice and lemon juice.” You might try chamomile, mint, or fennel with a pH of ‎6-7 instead. Healthline: “Scientists found that yerba mate and brewed teas, including black tea, lemongrass tea, chamomile tea and green tea, had the highest pH values. Therefore, these tea varieties can be considered alkaline and are unlikely to damage the tooth enamel.”

        For those worried about omega-3 levels, take the OmegaCheck blood test at Quest. Ornish and Esselsytn diets tell you to consume 3T ground flaxseed and 1T chia seed daily. Spinach, flaxseed and mangoes are higher in omega 3 than omega 6. You may need to cut back on omega 6 in the diet depending on the OmegaCheck result. “Consumption of vegetable oils containing high omega-6 fatty acids should be reduced as they inhibit the conversion of ALA to EPA and DHA.” There is a caveat with respect to supplements: The U.S. Food and Drug Administration recommends consuming no more than 3 g/day of EPA and DHA combined, including up to 2 g/day from dietary supplements. Higher doses are sometimes used to lower triglycerides, but anyone taking omega-3s for this purpose should be under the care of a healthcare provider because these doses could cause bleeding problems and possibly affect immune function. My hematologist cautions against anything that might contribute to internal bleeding, such as too much fish oil or daily low dose aspirin. For me he does not recommend aspirin therapy in spite of the family history and gene variants for hereditary thrombophelia. Cleveland Clinic points out that flaxseed has other beneficial nutrients not found in fish oil supplements: “In addition to being the best plant source for the essential fatty acids, flaxseed is also an excellent source of soluble (viscous) and insoluble fibers, lignans (a phytoestrogen found to help protect against certain cancers), high quality protein and potassium. Because of the soluble fiber component in flaxseed, various researchers have also found that flax can modestly reduce both total and LDL (bad) cholesterol values.”

        1. Caroline, thanks for the reply. As already stated, don’t use oils or other fats nor do I take any drugs, aspirin not needed on a good WFPB diet.
          Fasting glycemic level is fine.
          I’m using Flaxseed meal 1tbs as Dr G and Dr Esselstyn recommend (in his book 1to2 tbs of either flaxseed OR chia meal. Also algae EPH DHA.
          My LDL Is low.
 have videos on acid/ base balance go to
          Alcaline diets, Animal Protein & Calcium Loss and you can brush up on how the body neutralises acid without harming the skeleton, just as well! otherwise we’d be just a lump of jelly!
          While you’re on it check out the videos on Hibiscus tea.. I don’t brush my teeth straight after drinking it of course. However, despite it’s formidable qualities, I find no remarkable effect on my blood pressure for which I use it.

  22. DHA,
    I went grocery shopping this afternoon. I looked for DHA but did not see any. I’m on the fence about it anyway, but do get walnuts every day. Some DHA comes from an algal source. ALS is thought to possiby come from eatting blue green algae. Just sayin’.

    1. Dam,

      1) Many males and post menopausal women don’t convert ALA to DHA.

      2) If you eat certain foods like nuts which have many studies of health benefits but they can throw off the Omega 3 to 6 ratio.

      3) The brain keeping it’s structure is the only reason to take it so far.

      I take it now for my brain and it gives me peace of mind.

  23. Here is a great article for those who complain that ALA conversion is inadequate:

    Is EFA Conversion Sufficient?
    When fish and eggs are eliminated from the diet, few direct sources of highly unsaturated omega-3 fatty acids remain. Therefore, vegetarians predominately rely on the conversion of the essential fatty acid (EFA) alpha-linolenic acid (ALA) from plants to supply EPA and DHA.

    Unfortunately, this process is commonly inefficient, as enzymes necessary for this conversion are easily disrupted. Conversion can be slowed by genetics, age, and health status. In addition, poorly designed diets can impair the conversion process. High intakes of omega-6 fatty acids can have a profound effect on omega-3 fatty acid conversion, reducing it by as much as 40% to 50%.2 Too much fat, especially trans fatty acids and saturated fats, and cholesterol can inhibit conversion. Fasting and protein deficiency can decrease the activity of conversion enzymes, as can too much glucose or alcohol. Deficiencies of vitamins B3 and B6, magnesium, and zinc can also inhibit the process, as they are necessary cofactors for delta-6-desaturase activity. Conversion enzymes may not function as well in people with diabetes, metabolic syndrome, hypertension, or certain metabolic disorders and in those who inherit a limited ability to produce these enzymes (a possibility in populations where fish has been a major component of the diet for many generations).3

    While the conversion of linoleic acid (LA) to arachidonic acid (AA) is usually efficient, the conversion of ALA to EPA and DHA tends to be less efficient. It’s commonly estimated that 5% to 10% of ALA is converted to EPA, but less than 2% to 5% of it is converted to DHA.1

    There is evidence that the conversion is significantly better in young women than in men.4,5 One study found that young women converted 21% of ALA to EPA, 9% to DHA, and 6% to an intermediary highly unsaturated fat called docosapentaenoic acid (DPA).4 This totals a remarkable 36% of ALA that was converted to highly unsaturated fatty acids. In men, the conversion was 8% for EPA, 0% for DHA, and 8% for DPA, bringing the total conversion to 16%.5 The high conversion rates reported in young women are most likely nature’s way of preparing for the increased needs of pregnancy and lactation, as DHA is necessary in the formation and development of the brain, nervous system, and retina of a fetus/newborn.

    Although conversion is slow and incomplete, it appears to be sufficient to meet the needs of most healthy people if ALA intake is sufficient. For vegetarians who consume few if any direct sources of EPA and DHA, a ratio of omega-6 to omega-3 fatty acids ranging from 2:1 to 4:1 has been suggested as being optimal to ensure maximum conversion of ALA to EPA and DHA.1,6,7 More recent research suggests that optimal conversion is achieved with a ratio of 1:1, although this is significantly more difficult to achieve.8

    The obvious question is whether the conversion process provides adequate EPA and DHA for optimal health or just enough to avoid deficiency. Scientists do not have conclusive evidence that vegetarians’ health status would be improved with more direct sources of highly unsaturated fatty acids. However, incorporating direct sources of EPA and DHA may be worth considering, particularly for those with increased needs (eg, pregnant and lactating women) and those who are at greater risk of poor conversion (eg, people with diabetes or hypertension, those with neurological disorders, premature infants, older adults).

    While it’s not common, it is possible to over consume omega-3 fatty acids. If a person minimizes omega-6 fatty acids and uses large amounts of omega-3–rich oils such as flaxseed oil, the resulting ratio of omega-6 to omega-3 could be less than 1:2, which could result in an insufficient conversion of LA to AA. In extreme cases, it could lead to omega-6 deficiency, characterized by skin problems, dry eyes, dry hair, poor wound healing, and increased susceptibility to infection.

  24. Please address:

    Studies show that CoQ10 helps increase levels of beneficial hormones that decline with age, such as insulin-like growth factor,51 and decrease compounds associated with inflammation, such as C-reactive protein

    Studies show that CoQ10 helps increase levels of beneficial hormones that decline with age, such as insulin-like growth factor,51 and decrease compounds associated with inflammation, such as C-reactive protein

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