Vegetarians and Stroke Risk Factors—Omega 3s?

Vegetarians and Stroke Risk Factors—Omega 3s?
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Does eating fish or taking fish oil supplements reduce stroke risk?

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

In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. Lower risk of heart disease, and lower risk of cardiovascular disease overall, but higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the case. What about long-chain omega 3s, the fish fats like EPA and DHA, found, not surprisingly, in markedly lower levels in vegetarians and vegans? About 30% lower in vegetarians, and more than half as low in vegans.

But according to the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date, there is no benefit for stroke, combing 28 randomized controlled trials. In fact, there was evidence that taking fish oil didn’t help with heart disease or overall mortality. either. This may be because on one hand, the omega 3s may be helping, but the mercury in fish may be making things worse. That’s the constant challenge among public health professionals, balancing the benefits with the contaminant risks.

For example, dietary exposure to PCBs may be associated with increased risk of stroke. In this study, for instance, neither fish nor intake of PCBs was related to stroke risk. However, at the same fish intake, dietary PCBs were associated with an increased risk of stroke; so, the PCB pollutants may be masking the fish benefit. Thus, if we had a time machine and could go back before the industrial revolution and find fish in an unpolluted state, it might protect against stroke. But looking at the data, if fish really was protective, then we might expect the pescatarians, those who eat fish, but no other meat, to be down here or something, since they would have the fish benefit without the meat risk. But no, they’re stuck out here. So, it doesn’t seem to be the omega 3s, either. Let’s take a closer look at what the vegetarians were actually eating.

When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are basically two types of vegetarians: those that do it for their health, and those that do it for ethical reasons, like global warming, or animals. And they tend to eat different diets. For example, health vegans tend to eat more fruit and less sweets. You don’t tend to see those doing it for health chowing down on vegan doughnuts.

In the United States, the primary motivations for meat reduction are health and cost. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns. But in the UK, where this stroke study was done, the #1 reason given for becoming vegetarian or vegan is ethics.

We know plant-based diets that emphasize higher intakes of plant foods and lower intakes of animal foods are associated with a lower risk of incident cardiovascular disease, a lower risk of dying from all causes put together––but that’s only for healthy plant foods. Eating lots of Wonder Bread, soda, and apple pie isn’t going to do you many favors. For all types of plant-based diets, it’s crucial that the choice of plant foods is given careful consideration. We should be choosing whole grains over refined grains, whole fruits, avoiding trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out, next.

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Video production by Glass Entertainment

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

In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. Lower risk of heart disease, and lower risk of cardiovascular disease overall, but higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the case. What about long-chain omega 3s, the fish fats like EPA and DHA, found, not surprisingly, in markedly lower levels in vegetarians and vegans? About 30% lower in vegetarians, and more than half as low in vegans.

But according to the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date, there is no benefit for stroke, combing 28 randomized controlled trials. In fact, there was evidence that taking fish oil didn’t help with heart disease or overall mortality. either. This may be because on one hand, the omega 3s may be helping, but the mercury in fish may be making things worse. That’s the constant challenge among public health professionals, balancing the benefits with the contaminant risks.

For example, dietary exposure to PCBs may be associated with increased risk of stroke. In this study, for instance, neither fish nor intake of PCBs was related to stroke risk. However, at the same fish intake, dietary PCBs were associated with an increased risk of stroke; so, the PCB pollutants may be masking the fish benefit. Thus, if we had a time machine and could go back before the industrial revolution and find fish in an unpolluted state, it might protect against stroke. But looking at the data, if fish really was protective, then we might expect the pescatarians, those who eat fish, but no other meat, to be down here or something, since they would have the fish benefit without the meat risk. But no, they’re stuck out here. So, it doesn’t seem to be the omega 3s, either. Let’s take a closer look at what the vegetarians were actually eating.

When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are basically two types of vegetarians: those that do it for their health, and those that do it for ethical reasons, like global warming, or animals. And they tend to eat different diets. For example, health vegans tend to eat more fruit and less sweets. You don’t tend to see those doing it for health chowing down on vegan doughnuts.

In the United States, the primary motivations for meat reduction are health and cost. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns. But in the UK, where this stroke study was done, the #1 reason given for becoming vegetarian or vegan is ethics.

We know plant-based diets that emphasize higher intakes of plant foods and lower intakes of animal foods are associated with a lower risk of incident cardiovascular disease, a lower risk of dying from all causes put together––but that’s only for healthy plant foods. Eating lots of Wonder Bread, soda, and apple pie isn’t going to do you many favors. For all types of plant-based diets, it’s crucial that the choice of plant foods is given careful consideration. We should be choosing whole grains over refined grains, whole fruits, avoiding trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

Okay, another strikeout trying to explain the increased risk. Could it be that the vegetarians were eating particularly unhealthy diets? Labels like vegetarian or vegan just tell me what you don’t eat, but there’s lots of unhealthy vegetarian foods––like French fries and potato chips and soda pop. That’s why, as a physician, I prefer the term whole food plant-based nutrition. That tells me what you do eat—oh, you actually eat vegetables, a diet centered around the healthiest foods out there. But is that what’s going on? We’ll find out in my next video:

If you missed the first four, you can catch up here:

Surprised about the fishy oil findings? You wouldn’t be if you’ve been following the science. See, for example, Is Fish Oil Just Snake Oil? and Omega 3s and the Eskimo Fish Tale.

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

173 responses to “Vegetarians and Stroke Risk Factors—Omega 3s?

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  1. Whoa, technical difficulties with the focus … This is a first.

    Hope we don’t have the rest of the series out of focus. I suppose Monday will answer that.

    1. Okay, nevermind it was my processor/memory lagging as super hoggy website was opening while the video was playing. Is fine now. I said it was a first! Forget I said anything. I would delete or have added this to the original post if that were possible, but we have that “permanent ink” sort of comments section that defies editing or error correction in any form.

  2. I just wanted to comment for the first time and say that I appreciate all the videos on this site. I try to share them with anyone I can.

    I really appreciate the new video format although it doesn’t really matter. It looks modern and slick with high production values.

    The information is easy to access and it’s nice to see the doctor in person.

  3. There is substantial benefit for women including fish in their diet according to the Adventist health studies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/?report=classic (benefit re heart attack/heart disease) Men do not seem to reap the same benefits and appear to fare better with a vegetarian lifestyle.

    Gender differences in response to foods/ lifestyle choices do come up in the studies from time to time, and I wish Dr Greger would tackle this as a topic at some point.

    https://www.hsph.harvard.edu/nutritionsource/fish/#9 Harvard discusses the risk of contamination in fish in this article.

    1. Hi Barb, Can you give me a reference within the citation of the Adventist study where the recommend that pesco-vegetarian has substantial benefits? I am just not finding it. thank you.

      1. hi Greg, sure, look on Table 4. (scroll down).
        I can’t copy/paste, my apologies.

        Also, to further the discussion on the differences between men and women in these health topics, there is
        a difference also with stroke. I did see numbers suggesting many more women than men suffer stroke, but have not located a reference as yet. https://www.stroke.org/en/about-stroke/stroke-risk-factors/women-have-a-higher-risk-of-stroke This is a good short article summarizing risk factors for stroke and also, the signs for stroke which may be very different for women than for men (same with heart attacks… symptoms can be very different and subtle for women) .
        Worth the quick read.

        1. Fumbles, I had this analysis bookmarked long ago for some reason. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073139/?report=classic It’s looking at the Adventist mortality study as well as AHS 1 and AHS2.

          In the paragraph “5. Conclusions”, they mention that in general the protective effects of vegetarian diets are stronger for men than women.
          I find this gender difference in the effect of diet interesting is all I am saying. I have noticed this in other studies, but I’m not going to dig them out atm.

          1. Yes and women in Western societies have an average 5 year mortality advantage over males. I have seen it speculated that oestrogen may be a key protective factor here. That might also be why males seem to benefit more from diet than females – they don’t already have that basic level of protection afforded by female sex.

            An interesting observation on table 4 though is that one of the biggest apparent risk factors for premature mortality was male sex. On average the males had a 4.1% mortality risk but females had only a 3.2% risk…. that’s a 28% greater relative risk of mortality among men compared to women.

            However, speculating about causality on the basis of simple statistical associations is fraught with problems.

            it’s undoubtedly a very complex subject and having all our ducks lined up in a row is key ….. ie are observed associations backed up experimental studies and known/credible mechanisms of action?

    2. You could actually argue that men derived even more benefit from fish than did women.

      Compared to female meat eaters (‘non-vegetarians’), female pescatarians had only 88%.of the all-cause mortality risk. However, compared to male meat eaters, male pescatarians had only 73% of the mortality risk. Admittedly male ‘vegans’ did even better at 72% but that is neck-and-neck really.. Female ‘vegans’ though had only 97% risk reduction compared to female meat eaters. A disappointing result.

      All that said, it was only an observational study and the possibility of uncontrolled confounding variables can’t be excluded.

      What I draw from that study is that if you are going to include animal food in a WFPB diet, then it should be fish rather than dairy or eggs …… and definitely not meat.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/?report=classic

        1. Fumbles, yes, and many people object to fish on ethical grounds. Perfectly understandable.

          The only part of this that interests me is the Ischemic Heart Disease, and Cardiovascular Disease categories for women. Increase in risk for vegans, reduced risk for pescatarians. And that was what I asked my cardiologist, neurologist and family doctor about. Any woman who is faced with heart disease/stroke risk should get a discussion going with her own doctors.

          1. Yes, it’s a tricky one. Fish will provide B12, iodine, selenium, zinc etc which are otherwise in short supply in totally vegetarian diets. The AHA continues to recommend 2 servings of oily fish per week.
            https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

            I don’t eat fish for ethical reasons but if I was making dietary decisions based purely on health grounds I personally would opt for a WFPB diet that includes two or three servings of oily fish per week

            1. That’s Dr Mirkin’s choice too, Fumbles. WFPB plus a couple of small servings of fish. He also applies some of the priciples Dr Greger spoke about in his diet series videos such as, eating earlier in the day, two meals per day, plus alternate day ‘almost fasting’ with restricted calories. Even with all their exercise they found that they just can’t eat 3 meals or eat between meals without gaining weight.

            2. @Fumbles here is another recommendation from AHA under the topic of “Healthy Living”.

              https://recipes.heart.org/en/collections/ingredients/beef

              Delicious!!

              Funding for this organization from big Pharma and Medical Device firms in the double digit millions:
              https://www.heart.org/en/about-us/statements-and-policies/2007-2008-support-from-pharmaceutical-companies-and-device-manufacturers

              Funding from Big Beef
              https://www.progressivecattle.com/news/industry-news/beef-and-heart-health-a-healthy-partnership

              —————————————-

              To be clear, just for me, for me, when I find something like this, my own trust in the organization goes away. I do believe we have enough evidence and info on what beef does to the planet and to the body and to various social structures and cultures.

              I do believe we have enough info on the power and wealth of pharmaceutical and medical device companies, and how it is they manufacture consent, how they control our healthcare in insidious ways – as shown on a tiny scale, above.

              I’ll just say to some others here, that this may help explain my similar feelings about NYT, WAPO, WHO, FBI, CIA, FOX, MSNBC, NPR etc… (In whom or about which I have found countless instances of similar contrary information in the face of knowledge and fact, to the deference of power or money.

              This is so-called tin-foil hat thinking to many, of course, but similar information proving numerous nefarious activities, willful omissions, and or planted information to the benefit of benefactors alone, can be found easily. This information will not be available from the sources above, but rather must be researched, and then evidence must be vetted, of course.

              Not that anyone asked, but for me, seeing a link to an organization that has been shown (to me) as being less than ethical, and or beholden to corporate pressures in the form of funding, or security state coercion, it does just give me pause.

              I realize that the particular information may be at times be valuable, but the taint is too great to trust, again, in my own opinion. To be sure, it is important that they get it right sometimes to bolster general validity of the messenger.

              This is not meant to be an attack or derision, just my feelings on how we gather and accept information, and the hope that all of us can make sure to be as informed beyond our organizational trust.

              They are organizations with pressures and interests and can fall short of honest activities no matter the bright erstwhile faces shown.

              Thanks to all for consideration of this share.

              1. Thanks JB. I agree that financial conflicts of industry are rife in this area.

                Nor do I regard being wary of financial conflicts of interest is tinfoil hat thinking. It’s entirely rational. It’s the beliefs in vast worldwide conspiracies involving every health authority on the planet from China to the US, and academia, that reminds me of tinfoil hat thinking.

                Your views about the AHA are fair enough but I note that the AHA don’t recommend beef twice a week or receive funding from the fish industry.

                However, we’ve noted here before how the AHA and its equivalent in Australia make pots of money by selling the official ‘heart healthy’ big red tick logo to pretty much any company willing to pay enough to have it on its product(s). That was probably three years ago now.

        2. Tom,

          So, what would you hypothesize the difference is versus the chart in the video where pescetarians had much more coronary heart disease than vegetarians per 1000 people over 10 years? Versus those specific results for the Adventists?

          For me, the Adventists could simply have not been supplementing B12, for instance.

          Or the women could have not been eating nuts.

          1. Very hard to say Deb.

            You could speculate that baked, boiled, steamed and poached herrings, pilchards,sardines etc will have much different cardiovascular effects than fried, battered, grilled, BBQ’d, smoked cod, shark, swordfish etc

      1. What comes to me is the documentary that I watched of a man who wanted to prove Pescetarian was better for the heart and he started eating wild-caught fish every day for a year and at the end of the year he got his lab work done and it was not good and he was so disappointed.

        Occasional fish might be different, but daily fish made his labs worse and it was all wild-caught.

        1. Occasional fish might not have the same level of toxins entering the body.

          But in this study, the heart disease was much worse for the fish eaters and the stroke risk was only slightly better.

      2. Tom,

        I am going to challenge you because if the vegans and vegetarians were eating processed meats with sodium, sugar, and added fats 3 to 4 times per week, and some were eating it more than that.

        Well, maybe it wasn’t the fish giving the benefit.

        Maybe it was the GMO soy and sodium, sugar, and fat from the processed faux meats hiding the potential extra benefit of WFPB.

        It is pretty amazing that the vegans and vegetarians did as well as they did with that much processed food. If I remember right, they ate a lot of bread, too, which again has a lot of sodium.

        1. Deb

          I have no idea what particular foods the Seventh Day Adventists were actually eating. Nor do you.

          The paper simply analysed outcomes on the basis of ‘dietary patterns’ not individual foods.

    3. Barb,

      What I do remember was that the Adventist women were eating a whole lot of faux meat products. Multiple per week.

      Not sure if that is a confounding factor. Meaning the fish eaters may have been eating plant-foods when they weren’t eating fish, where the vegetarian community was eating multiple processed vegan products per week.

        1. I also remember being surprised at 5 slices of bread per day.

          It was so long ago but bread is one of the biggest sources of sodium there is.

          1. One of the last subjects before Ron left was that he lived near the Adventists and they are processed food and bread and he used his logic that some of Dr Greger’s logic might have been wrong but my logic said, ”The vegan women might have done something wrong that caused the pescetarians to look better.”

            Now, on this side, the sodium in faux meat and in Ezekiel bread are near the top of my list.

    1. Would that I could, June Bug. Flax, chia, and hemp all seem to REALLY gas me up. And I’ve tried. Can’t seem to get past at most 1 teaspoon and it just becomes something I’m not willing to deal with. Hubs eats ’em all and has no problems, but I’m not so lucky. If anyone has any suggestions…

      1. Teresa – You might try Youtubing Dr. Will Bulsiewicz. He is a plant-based GI Doc and is all bout healing the gut. https://theplantfedgut.com/ He has a new book out. I’m going to guess that he would suggest you try an even smaller amount of flax. . .. perhaps a sprinkling. . . . to begin to inoculate your gut. I understand the gas and bloating issue. When I made the switch to a WFPB diet the advice was that in 2 weeks the gas and bloating from beans would be gone. For 2 years I produced enough gas to power a hot air balloon I think! But I stuck with it and now I can eat as many beans as I like. Here is an interview of Dr. B with Rich Roll that you may find helpful or perhaps interesting – https://www.youtube.com/watch?v=EABZqi3HtRM

      2. Teresa,

        Perhaps you might find that a digestive enzyme mix with the flax, chia or hemp does the trick. It’s not uncommon to find someone with low hydrochloric acid levels having your issues. It could also be a matter of insufficient pancreatic enzymes or a combination. There are a number of testing options to confirm these issues, however a simple test with some enzymes might be a good starting point.
        As a note there are a ton of enzyme products on the market and you may need to take more than one per meal to experiment and find an answer.
        The other option is to do some GI testing with the new methods you will be able to evaluate if any of the correct bacterial milieu is present and also chemically what’s going on that may be causing the gas. Consider looking at the offerings at either GDX.net or DiagnosticSolutionslab.com as two considerations.

        Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

      1. Corrections are welcome.

        June Bug wrote:

        “Surprised more vegans and vegetarians don’t eat flaxseeds everyday! It’s mandatory!”

        A reality check:

        If you look at the five longest lived populations in the world via Dan Buettner Blue Zones work – Okinawa (Japan); Sardinia (Italy); Nicoya (Costa Rica); Icaria (Greece); and among the Seventh-day Adventists in Loma Linda, California – I do not believe that even one of these populations has used flax seed meal as part of their traditional diets.

        Please correct me if I am wrong – any Seventh Day Adventists out there?

        And tall these populations seem to be doing just fine without flax seed, thank you.

        Better than most of us will ever do, in fact.

        As far as I have seen, the whole flaxseed omega-3 fad has arisen among vegetarians to counter the fish oil omega-3 fad among non-vegetarians.

        These fads developed over approximately the same time frame – flaxseed trailing fish oil.

        And the fish oil fad among non-vegetarians seems to currently be imploding.

        Which makes me wonder further about the flaxseed fad.

        But the proof of actual good in regards to the omega-3s is – tenuous. Inconsistent. Variable.

        The flaxseed work is interesting – intriguing – but at this point, I think it best not to take it too seriously.

        Plenty of other ways to get reasonable amounts of omega-3s in a Whole Foods Plant Based diet – to the extent that the omega-3s are needed. Nuts and seeds various. Plants.

        Omega-3 / omeaga-6 ratios seem to be relevant. But that also is inconsistent.

        A good strategy might be to focus on reducing omega-6 fatty acids. But even that – in regards to reducing omega-6 weighted nuts – is not panning out in peer reviewed studies – last time I looked, anyway.

        Note bene: the traditional Okinawan diet is 6% total fat – that may be telling us something very, very important that we may easily overlook in the omega-3 debate.

        Not a lot of omega-6s. Not a lot of omega-3s.

        And they are doin’ fine.

        There is a lot up in the air.

        Bottom line – if you have issues in regards to problems with flaxseed – don’t sweat it.

        The Okinawans, the Sardinians, the Nicoyans, the Icarians, and the Seventh-day Adventists aren’t worried about it – and they are doin’ just fine, thank you.

        This puts you in very good company.

        What – me worry?

        Vivamus

          1. Paleo is a fad.

            And they justify their nutrition faddism by citing their version of Paleolithic dietary patterns that far predate Hippocrates and Charlemagne.

            Hey – they beat out Hippocrates by thousands and millions of years.

            References to historic (and even prehistoric) food patterns are a common tactic in nutrition faddism.

            You see it also in Linus Pauling’s Megadose Vitamin C literature.

            And with the Gluten-free For Everyone literature, as well.

            Historic references are a hallmark of nutrition faddism.

            ——————————

            Lemme see –

            In the late 1960s or early 1970s, Atkins ran his high protein diet fad. Father was science-based – Atkins was able to quote all sorts of very convincing scientific reasoning.

            Father fell for it – hook, line, sinker.

            Think of the Adkins diet as a secular religion. There is a faith aspect.

            And it worked – faithful disciple Father lost all sorts of weight.

            Father found his prophet and his miracle.

            But he started looking unhealthy. Nothing you could put your finger on. Kinda gray. Slowed movement. I spoke with him – I was beginning to wonder what it would be like not to have a Father anymore. Nothing could sway him.

            Finally he stopped the diet. I asked why?

            People were dropping dead nationwide with renal failure. This was prior to the transplant era.

            Yup.

            —————————–

            Next up – Linus Pauling. Not one, but two – count them – two Nobel prizes . Nuthin’ to sneer at. Pure science and pure reason. 1960s-1970s – convinced me to go the Megadose Vitamin C route.

            He wrote whole books on the topic. Totally convincing. Lotsa sound scientific references. I fell for it – hook, line, sinker.

            Just like my old man.

            According to Pauling – the magic bullet of chemical vitamin C was just as good as vitamin C from food.

            Better, actually. Because chemical vitamin C was cheaper and because it was more concentrated.

            Pauling finally had to be hospitalized for gastritis – 10 g of oral vitamin C / day.

            Ripped up his gastric mucosa. He was advised to cut back.

            The body excretes anything over ~200 mg. / day of Vitamin C, anyway.

            I finally regained my senses – now I get my vitamin C from food – among all the myriad other nutrients.

            Pauling presented Vitamin C as a magic bullet.

            Nothing magic about it.

            Only one component of a vast nutritional symphony.

            Exaggerated all out of proportion.

            —————-

            Next up – 1988 – oat bran on everything to reduce serum cholesterol.

            Fiber cereals everywhere.

            Did you fall for it, too?

            Tasted like dust.

            Finally figured out that soluble fiber is actually everywhere – legumes, oats, barley, fruit.

            No oat bran or high fiber cereal in the house currently.

            Oat bran was just another nutrition fad.

            Totally convincing during its time.

            With a grain of truth – blown out of proportion.

            —————————

            Next nutrition fad: gluten free diets for everyone.

            The literature is very convincing,

            I finally started to wise up – but family and acquaintances were taken in.

            These guys use the same techniques – primitive nutrition, historical trends, current peer-reviewed papers supporting their points, current poor population health, convincing spokesmen . . .

            You know the drill pretty well by now.

            —————————

            I’ve skipped a few, I know.

            After you have fallen for a few nutrition fads – or had friends and family members fall for them – you begin to be able to see them coming – like your cousin Lonnie approaching you asking for another loan –

            Nutrition Fad Indicators:

            (1) The passion of nutrition fad adherents. They develop a tremendous loyalty – and identification – with their particular nutrition fad.

            Whether it is Atkins or Vitamin C or Oat Bran or Paleo or Gluten-free – or Flaxseed.

            (2) Food fad adherents are often very intelligent.

            It seems to me that the more intelligent you are, the more susceptible you are to nutrition fad reasoning.

            How can that be?

            There may be a secular religion aspect.

            A simple answer for complex questions.

            These fads tend to play both to reason and to the vanity aspect of one’s intelligence.

            Intelligence is no defense from nutrition faddism. It may actually be something of an increased vulnerability.

            Which is kinda interesting in itself.

            (3) The nutrition fad is always backed up by impeccable logic in regards to human – and human precursor – biology. By discussion of cultural dietary changes. By focus on historical facts. Current medical papers. Current poor health trends. All put together in one totally convincing package.

            Whether it is Atkins or Pauling’s Megadose Vitamin C regimen or Paleo or Oat bran – or Flaxseed.

            ——————————-

            So – how can you tell if something is a food fad, and not really a keeper?

            Well – you cannot be certain. Every food fad certainly contains some grain of truth – though that grain may be magnified well out of proportion.

            The best way to evaluate a food fad that I have found – if your goal is health and longevity – is to evaluate in relation to currently living traditionally long lived peoples.

            Not the people of Crete from 8000 years ago. Because we cannot know their health and longevity status.

            But from long-lived peoples who are alive and kicking today.

            Hey – if multiple groups of currently living traditional long lived peoples do not eat Paleo or anything close to Paleo – I’m not eating Paleo.

            Not gettin’ anywhere near it.

            If multiple groups of currently living traditional long lived peoples do not eat 10 grams of chemical Vitamin C a day – then I’m not going to do so.

            If multiple groups of currently living traditional long lived peoples do not pour oat bran over everything they can get their hands one – neither will I.

            This is a very quick and simple reality check.

            And multiple groups of currently living traditional long lived peoples simply do not give a hoot about Ground Flaxseed.

            And they are the best yardstick that we have by which we can measure actual real present day human health and longevity.

            Not by focusing on diets of long dead peoples – whose health and longevity we do not even know.

            This is the simplest reality check we have.

            So – what do the currently living traditional long lived peoples have in common?

            Well – there’s the famous Venn Diagram – but note that they tend to be largely WFPB – very much inclusive of legumes:

            https://en.wikipedia.org/wiki/Blue_Zone

            And there is lots of other excellent material out there on the Blue Zones.

            A simple web search – and you are there.

            All the best –

            Vivamus

        1. Vivamus, I am not sure about the Blue Zones, but I researched flax some time ago since I was curious to find out what the ancient Israelis ate. Flax is in fact one of the earliest cultivated crops.

          ” Flax production goes back to ancient history. Flax remnants were found in Stone Age dwellings in Switzerland, and ancient Egyptians made fine linens from flax fiber…. Flaxseed is one of the oldest crops, having been cultivated since the beginning of civilization (Laux 2011). The Latin name of the flaxseed is Linum usitatissimum, which means “very useful”. … Because it was one of the first domesticated plants, flax is recognized as a foundation crop of modern civilization.  … Although the early Egyptians had established many utilizations for flax, the Greeks and Romans continued to extol its virtues as a food, fiber and medicine. Written records of the ancient Greek and Roman civilizations dating back to the 6th century B.C. mention flax cultivation. … About 650 B.C.  Hippocrates, the father of medicine, advocated flax for the relief of abdominal pains. …Gauls (an ancient people of present day France and Belgium) and Celts (an ancient Indo-European people), the earliest flax growers in Western Europe, learned about flax from the Romans. German archaeological digs of Iron Age settlements have uncovered remains of bread prepared from millet, wheat and flaxseed. … For thousands of years, flax was a winter crop of major importance in the ancient Levant, second only to wheat and barley. It was cultivated from the beginning of the early Neolithic period through to Roman times and it is still grown there today. Flax seeds (linseed) contain high concentrations of two essential polyunsaturated fatty acids—linoleic acid (ω-6) and α-linolenic acid (ω-3), which cannot be produced by the human body. Their oxidation occurs rapidly in the air. So, long term storage of linseed needed airtight containers, and tightly stoppered bottles could be used to keep its oil as a remedy.”

        2. And as for chia, that was a staple of the diet south of the border, cultivated since ancient times.

          Aztecs and Mayans consumed chia seeds regularly, grinding them into flour, pressing them for oil, and drinking them mixed with water. The Aztecs boast the first record of chia as early as 3500B.C., and it was a staple food in the Aztec diet. Between 1500 and 900B.C, it was grown in Mexico by the Teotihuacan and Toltec people. Chia seed was used in medicine, ground into flour, mixed as an ingredient in drinks, and pressed for oil. It could be stored for relatively long periods of time, and so was perfect for travelers. It was sacred and even used as a sacrifice in religious ceremonies…. In Mayan, “chia” means “strength.”  Ancient warriors attributed their stamina to consuming chia. The Mexican Tarahumara tribe is famous for their runners, who drink a mixture of chia seeds, lemon, and water called Iskiate. After drinking this, they are said to be able to run hundreds of miles.

          1. Caroline,

            Thanks for sharing your research results about flaxseed and chia seeds; a very nice concise but informative summary.

            I always add flaxseed meal to my whole grain sourdough bread (at about 10% by weight), and I often add intact flaxseeds and chia seeds (as well as sesame and sunflower seeds) — and it seems odd to me, but the bread appears to rise higher in the oven when the seeds are added. Just an observation. (It also seems to rise higher when I add raisins and walnuts, or cranberries and pecans. Since I don’t vary the flour in my bread dough recipe much, I like the variety of other added ingredients.)

            I’ve wondered if it’s possible to make sourdough bread from a soaked porridge of seeds, without grinding them. I’ve not seen any recipes or descriptions of making bread this way.

  4. The vegetarians were eating only about 3 grams more fibre than the meat eaters and almost the same percentage of calories from saturated fat and total fat. So the diets were really very similar…

  5. There’s a lot of room left on that chalkboard graphic, for more potential reasons to cross off the list.

    And I just learned that I was an “ethical” vegetarian, since I stopped eating meat almost 50 years ago for environmental and sustainability reasons. For some reason, I associated “ethical” eating with animal welfare, not planetary welfare.

    But now I eat whole plant foods for both health and ethical reasons, and have added animal welfare (and worker welfare) to my list of ethical reasons (as well as global warming, development of antibiotic resistance, and now development of pandemics.) It’s a long list.

  6. Off-topic comment: Just wondering if anyone has heard about the strange seeds that people in the U.S. are randomly receiving from China.
    Since many commenters here grow their own small gardens, including myself, they may be tempted to plant the seeds. The article explains:

    “The U.S. Department of Agriculture Animal and Plant Health Inspection Service has identified 14 types of plants from unsolicited seed packages homeowners received from China.

    “This is an evolving situation, and we are working closely with Federal authorities to ensure we are evaluating every possibility,” the FAQ document reads.

    Art Gover, a plant science researcher at Penn State University, warned against planting the seeds because they could introduce problematic weeds and diseases, according to The Times.

    Unidentified seeds could also turn out to be invasive species and harm the environment, Bernd Blossey, a professor in the department of natural resources at Cornell University in Ithaca, New York, said.

    “Any time you gain something unknown, my suggestion is burning them, not even throwing them in the trash.”

    The USDA is still encouraging anyone who receives an unsolicited package of seeds to contact his or her state regulatory official or APHIS state plant health director.

    “It is important that we collect and test as many seeds as possible to determine whether these packets present a threat to U.S. agriculture or the environment,” the FAQ document reads.

    Canada, Australia and European Union member nations have also reported the receipt of unsolicited seed packages.

    https://thefederalistpapers.org/us/usda-able-identify-mysterious-seeds-americans-received-china

    1. Darwin,

      I heard about that. One of the theories is that the companies are trying to bolster their ratings on e-commerce sites.

      That is a common practice and in the past, I have heard of other types of things sent for that purpose.

      They said that the seeds were mostly sent to gardeners, so that gives the e-commerce theory some credibility.

      The USDA has been evaluating the seeds and, so far, the seeds have things like cabbage, broccoli, kale, tomato, celery; basil, coriander, rosemary, mint, sage, lavender; roses, sunflower; and morning glory.

      At one point, I received magazines that I didn’t want and was never billed for by some company. It is scary when it happens. It feels like someone might be about to do an identity theft process. I don’t think it ever happened, but I did do the yearly credit check and nothing was missing, but then one of the credit check companies had their information stolen and now I get letters that if someone steals my identity because I checked my credit, I need to contact them and become part of the lawsuit, so if anybody ever steals my identity, please let it be during the time covered by that process.

        1. Yes.

          The sports announcers started talking about that today. The media is starting to notice.

          Every area of life is affected.

          Complexity could become a college major.

  7. Besides the mercury issue, Omega 3s oxidize easily and many products contain amounts of oxidized omega 3s which may lesson/reverse some of the benefits. One can find places that test/publish these to choose an omega 3 for yourself, but unlikely all the studies were done with optimal omega 3 supplements.

  8. I have been eating a whole food plant based diet since just before Christmas and it’s great. These videos are interesting, but I really hope he gives us the answer on this before I have a stroke…

    1. “These videos are interesting, but I really hope he gives us the answer on this before I have a stroke…”

      Ashley, suspense is killing me too!
      Let’s don’t die before we get the answer…

  9. PLEASE, Dr Greger, go back and look at your videos from several years ago, and go back to your normal speaking voice and delivery. The long ‘growls’ (ehhhhh) before some statements, the speed up and slow down of the voice that’s sometimes raised and sometimes dropped to a mumble… it’s all very distracting. The older videos have a clear, non-intrusive narration that allowed one to focus on the information. Maybe try seeing what happens if you use Google to create automatic closed captions and if it comes out as nonsense, it might be a sign that you’re not speaking clearly enough for the hearing impaired or non-native speakers of English.

    1. Hi Bill, I guess is a matter of opinion, since I really like the current format with ups and downs in his voice.

      Regarding: “for the hearing impaired or non-native speakers of English.” -> could they use the transcript that comes with almost every video?
      One can find the button at the bottom of the video.
      Cheers
      Gustavo.

    2. I just read the transcripts because the videos take way too long to get through and you can skim over all the stuff that’s just filler. And that way you also don’t have to listen to his weird way of talking which I agree is super annoying. (Sorry, love the guy, just not his delivery!)

  10. Dear Dr. Greger, I highly value and appreciate your work and diligence. Yet I prefer you not tease us with only aspects of your topic, instead please include the answer implied by the video title you will be providing in the video. I’m referring to your conclusion, where you say: “Find out in the next video.” If this does not suit you, at least include in your title, Part 1 and then Part 2. This would be less of a tease. Thanks so much, Michael

  11. He sure is dragging these out ! And interesting that this set of videos seems to supersede an old video I saw by him, years ago, that argued that vegetarians/vegans need to supplement for B12 and Omega 3’s to get the full health benefits associated with the diets, I can’t find that old video (haven’t looked terribly hard though) but it may have been referring to heart disease and not particularly on stroke which I guess might make that video consistent with this newer set.

    1. There’s new research about supplements. I saw a video we’re Dr Fuhrman said they were linked to causing cancer. We are always learning and changing. There are so many variables when these studies are done. I’m Just grateful he’s doing this. I can’t imagine the time and effort it takes to research and then make the videos. Not an easy task.

      1. Becky,

        I go back to Dr. Ornish using Omega 3 supplements while he reversed prostate cancer in his study.

        Hard to believe that he could have succeeded with reversing it in that study if the Omega 3 was causing it.

      2. Although, Dr. Fuhrman was specifically talking about fish oil.

        His position is:

        High-dose fish oil is not only suspected to increase risk of prostate cancer, but also the DART 2 study showed that those with heart disease had a 26 percent of increased risk of cardiac death and increased risk of sudden cardiac death in the group that used supplements containing 3 grams/day of fish oil.

    2. Karl,

      The video was about mortality in general.

      There are things such as brain heath where he still recommends Omega 3 DHA to preserve brain volume.

  12. Vegetarian is an almost useless term when trying to determine the health benefits of diets. My husband’s family now believes that being a vegetarian is pointless because one of the SILs died of liver cancer in her sixties after being a lifelong vegetarian. Well, I was very familiar with her kitchen, cooking, and diet, and as far as I’m concerned, anyone who replaces meat and potatoes with cheese and potatoes is eating a meat-based diet for health evaluation purposes. Her diet was based on dairy and eggs with support from flour products and no more vegetables than a SAD diet. Lots of sweets. She did make everything from scratch – she was a gourmet cook – so not a lot of prepared foods, at least. Always plenty of wine while cooking, during dinner, and after dinner because “wine is healthy.” Her philosophy was that meat was bad but dairy was good, and hard liqueur was bad, but wine was good. I think she was representative of a lot of vegetarians in my generation, and they will throw off most studies of the benefits of dietary habits.

    I came into vegetarianism for environmental reasons and became plant-based to address health issues (and to improve my environmental actions). There was a time when I chose vegan shoes, belts, and clothing. Now I prefer things that will eventually rot with as little plastic content as possible. Both have good arguments behind them. Reasons change over a lifetime. It won’t really help to ask people about their motivations. We have to do studies based on what they are actually eating. There are people who consider themselves omnivores who eat more like I do than some vegetarians.

    1. Anne S.,

      I was vegetarian for decades and was that same type of vegetarian, except for the wine.

      It would be grilled cheese for lunch. Pizza for dinner.

      Or pizza for lunch, lasagna for dinner

      Macaroni and cheese for lunch, Pizza for dinner again

      Pizza for lunch, Stroganoff Hamburger helper with TVP for dinner mixed with a package of cheese.

      Baked goods, ice cream, huge iced coffees with more milk than in a latte.

      Reeses peanut butter cups

      Yes, it is not healthy.

      Though I have outlived my mother who was not a vegetarian and she was a person who would eat fish every day some weeks.

      My father grew up in a Scandinavian house and hated fish to the point that he could not have it in the same house as him.

      Maybe that is why we went to restaurants.

      1. Deb,

        Your diet as a vegetarian reminds me of my brother, who was a vegetarian for about 10 years before he had a heart attack. (He was also quite overweight.)

        When I asked him what he thought caused his heart attack, he responded: “I liked cheese too much?” That’s probably correct. Plus, I think he ate quite a bit of processed and prepared foods. (He now eats whole plant foods.)

        And I remember decades ago, a friend confided that her cholesterol levels were almost through the roof. When I asked her what she was eating, her list included at least a half a pound of cheese daily! I was astonished, and told her that this was way too high, that a small serving of an ounce or two a day was more than enough. (Of course, now I don’t eat it at all.)

        And I have a friend now who claims that when she stops eating cheese, her cholesterol levels drop by 50 points. What is strange is that she continues to eat it — but she claims to do so in small quantities. And yet she is worried that she might have clogged arteries.

      2. Deb – Geese, . . no wonder you’ve complained so much about your weight. If I ate the pizza/pasta/cheese vegetarian diet I’d be a blimp too. This is one reason that so many of us find Jeff Novick’s calorie density video so informative and helpful – which I know you know about.

  13. I suspect the solution lies in the fat intake. Many vegetarians and vegans consume high-fat diets which combined with the high sugars in fruits and other high carb foods are a health disaster.
    I have seen almost no stroke risks in low fat vegans. But ton of health issues in high fat vegans.
    Just my two cents.

    1. Constantine,

      When the low fat vegans you encounter become ill and when they die – what do the causes seem to be?

      Cardiovascular? Cancer?

      Or just kinda windin’ down?

      I have not really witnessed the decline and death of low fat vegans – such people are rare here.

      It might be good to know.

      Best regards,

      Vivamus

  14. I’m vegan and have been eating a WFPB diet for many years. However, my weakness is dark chocolate which I know contains a lot of saturated fat. (I don’t use coconut oil and try to limit oil in cooking.) It’s really just too much chocolate that I eat and I don’t think I’m alone so maybe Constantine is correct?

    1. Laurie in Canada,

      I used to be a chocoholic.

      Brought home the bar – ate it in one sitting. No control.

      Brought home dark chocolate – 60% – inhaled it.

      75% – gobbled it right on down.

      88% – it didn’t last the day.

      90% – same.

      100% – nope. I was able to eat just one square a day.

      Then it occurred to me. I wasn’t really a chocoholic at all.

      I was a sugarholic.

      Take the sugar out – and you may find, your can control that weakness for chocolate.

      Eat it with some fruit with a little intrinsic fruit sugar to take off the bitter chocolate edge.

      Now chocolate is largely just another food – healthy in moderation.

      This might work for you if you want to try it –

      Vivamus

      1. Vivamus,

        Same for me.

        Major chocolate addict.

        100% cacao bar on the counter and I end up forgetting to eat it.

        100% cacao nibs in my oatmeal and it doesn’t cause me to eat a second bowl.

        Buy almond chocolate pudding cups and eat 2.

        Buy a dark chocolate peanut butter Lara bar, end up eating them every night. I bought a box of peanut butter without the chocolate and it is better. I eat them when I have a sweet tooth.

        Many of the other vegan bars cause a sweet tooth. Lara bars are pretty good but the fewer ingredients the better.

      2. Cocoa was traditionally used to prepare an alkaline, bitter, spicy, unsweetened beverage. See https://www.allrecipes.com/recipe/216166/xocolatl-aztec-chocolate/ if you want to try this; you might find it unpleasant since there is no sugar or fat.

        “The Maya seasoned their chocolate by mixing the [fermented and] roasted cacao seed paste into a drink with water, chile peppers and cornmeal [masa harina], transferring the mixture repeatedly between pots until the top was covered with a thick foam.”

        If you were to add the masa, that needs to be simmered until it thickens, like atole, a Mexican beverage. This recipe might be similar to the Mayan drink, and easier to prepare, calling for red chile powder and chocolate almond milk. Use blue masa if you can find it, unsweetened chocolate almond milk if you crave bitterness, and pour from cup to cup to cool it. https://mjskitchen.com/2015/02/spiced-chocolate-atole-champurrado-recipe/https://mjskitchen.com/2015/02/spiced-chocolate-atole-champurrado-recipe/

          1. Deb,

            Curt Richter at Johns Hopkins did work that you may find relevant in this regard.

            An extraordinary man.

            Exemplary scientist!

            “His work on poison avoidance (neo-phobia) was a precursor to the modem work on taste avoidance learning (Garcia & Ervin, 1968).”
            https://link.springer.com/content/pdf/10.3758/BF03337826.pdf

            This one is by memory – memories are imperfect – I will do my best.

            In one of Richter’s more – well ethics were different back then – call it “ethically questionable” experiments . . .

            He had undergraduates sample various heavy metal poisons -and, I am happy to say, spit them out.

            All in relatively pure form that would not be encountered in nature.

            Now – would you have thought to do this?

            I would not have thought to do this.

            But he thought to do this

            Result – all the heavy metal poisons tasted bitter.

            Now – why in the world would the human body have in place a warning system for something it would never encounter in nature?

            It – it just doesn’t make any sense.

            Still – there it is.

            For most of us – and for animals – bitter is a warning not to eat whatever it is eating.

            Poisonous plants are polite in their way.

            Not all of them – but for some, it is kinda like being a rattlesnake.

            Only their rattle is tasting bitter.

            Me?

            I try not to be bitter.

            I find it bad for the digestion.

            Deb.

            Best regards –

            Vivamus

      3. No, thats just 100% dark chocolate is disgusting and it gave you more cafeine/theobromine/theophyline shot for a smaller amount because it is more concentrated and sweet taste as a frugivorous specie taste great to us.

    1. Chelsea, Take a look at the upcoming videos listed below the current video. Then do some detective analysis. I’ll bet you find the answer ;-)

      Upcoming videos:

      Vegetarians and Stroke Risk Factors—Vegan Junk Food?
      Vegetarians and Stroke Risk Factors—Saturated Fat?
      Vegetarians and Stroke Risk Factors—Animal Protein?
      Vegetarians and Stroke Risk Factors—Vitamin B12 & Homocysteine?
      How to Test for Functional Vitamin B12 Deficiency
      Should Vegetarians Take Creatine to Normalize Homocysteine?
      The Efficacy and Safety of Creatine for High Homocysteine

      Note: I really don’t know the answer yet either, but I have a good hunch :-)

  15. New study that may be worth including the next time Dr. Greger addresses TMAO:

    A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood—Meat Eating Alternative Trial

    Seems pretty well conducted (within the limitations of non metabolic ward nutrition studies), but I don’t have access to full text.

    1. Authors Erica D Sonnenburg, Justin L Sonnenburg are gut health researchers with their own lab at Stanford. Perhaps their website has more details. TMAO should not be a concern for vegans. Others can have TMAO levels tested at Quest labs.

    2. Eating plant-based meat lowers some cardiovascular risk …med.stanford.edu › plant-based-meat-versus-animal-meat
      1 day ago –

  16. Dr. Greger in his book recommends fiber, Potassium, citrus, and antioxidants for stoke. So bran or Uncle Sam Cereal, Potatoes, beet greens, sweet potatoes, and swiss chard greens, oranges and orange juice, and alma and blackberries would prevent stroke. Citrus has vitamin C and other compounds in it. Vitamin C, like in bell peppers, can prevent stoke, and the whole food is better than the individual nutrient. So a high antioxidant, high Vitamin C fruit containing, high fiber, and high potassium diet could prevent stroke. Isn’t that something to strive for?

  17. Spoiler alert- vegans must lower their intake of salt or they are at greater risk of hemorrhagic strokes as compared to meat eaters. This is per Dr. Joel Fuhrman. He states that studies have shown that low serum cholesterol could enhance vulnerability of all small intraparenchymal cerebral arteries and lead to the development of strike in the presence of hypertension.

  18. While reading “How Not to Diet” (I read “How Not to Die” after) I switched from a junk food vegan to WFPB. What a difference. And because the maternal side of my family is prone to strokes I’m doing all that I can to prevent that. Keep getting better. I’m also a vegan for many more reasons. Thanks fir this series on strokes.

  19. Hi Vivamus! I now try not to eat any food that has extra added salt such as vegan fast food or processed vegan food. We can get all the sodium we need from a whole food plant based diet. Good luck!

    1. “We can get all the sodium we need from a whole food plant based diet.”

      I hope that this continues to do well for you. Some of us have found out the hard way that it can lead to hyponatremia and that is dangerous.

      1. cp,

        May I ask about symptoms? Labs?

        I know of one such case of dietary hyponatremia. Not on medication.

        Symptoms: “I feel a might poorly.”

        Serum sodium was below 100 (normal, by memory, is in the 130 -140 range).

        Lowest serum sodium I ever heard of – I would not have imagined that such a level was compatible with life.

        Cardiac arrhythmia? But no – Na+ is not K+.

        Hey – everyone’s physiology is different.

        After that – I looked into official numerical targets for salt.

        These are always quoted in the US literature as mg of Na – not NaCl.

        As I recollect, some of the European literature uses NaCl instead – so be careful about comparing numbers in the literature – you can get apples and oranges.

        Levels out there are typically given as “under some mg” – without ever giving a bottom range.

        By memory:

        From the USDA types: “< 2300 mg."

        From the Medicos: "< 1500 mg."

        From the Cardiologists: "< 1200 mg."

        But notice – never a bottom number.

        I finally found an official bottom number out of the Academy of Sciences: 500 mg.

        So I target 500-1200 mg daily.

        And there is some naturally occurring NA in food, as well. I never bother to calculate that in – I figure it as a fudge factor – a buffer.

        In recent years – I note significant orthostatic hypotension on rising – definitely woosy on quickly leaping out of bed.

        Actually fell one morning on rising – I keep the partially crumpled laundry hamper around as a reminder.

        It sacrificed itself for me. Thank you, laundry hamper – I'm glad you were there.

        Call it loyalty.

        Butcha know – orthostatic hypotension is a typical symptom of people on BP medications.

        I kinda figure that going low salt is akin to being on natural BP medication.

        And the BP remains fine.

        It beats increasing dietary Na and having to take BP medications and getting the same symptoms from the medications – and more.

        So – I just take rising slow and easy – stay near the bed – and it quickly goes away fine. No recurrence the rest of the day.

        Labs are always fine.

        And I keep an eye toward keeping the potassium up, as well. If you are interested in dietary K+, scroll down to the orange chart several screens down, titled:

        World's Healthiest Foods ranked as quality sources of potassium
        http://www.whfoods.com/genpage.php?tname=nutrient&dbid=90

        cp.

        To your health!

        Vivamus

            1. Mr Fumblefingers,

              This is most interesting – not only the Na information, but particularly the new 2019 recommendations on Potassium.

              The 2005 DRI for potassium of 4700 mg / day led to the widespread claim that “97% of adults are potassium deficient.”

              Which was never credible.

              People discounted it out of hand.

              Any time you get an extreme claim like that, it is obvious that you have to wonder about the whole system behind the claim.

              The new DRI of 3400 mg looks a lot more credible.

              We’ll see how it pans out.

              My thanks –

              Vivamus

        1. My symptoms were: Slight Nausea, not wanting to eat
          Headache
          Confusion: not thinking straight, difficult to make a decision
          Loss of energy, drowsiness and fatigue
          Restlessness and irritability
          Muscle weakness
          Elevated blood pressure

      2. No, hyponatremia is caused by a too high intake of water in litterature, make sense since the physiological minimal need for sodium is around 100-150mg per day without sweating a lot, just dont drink over thirst or because you think you may benefit from more water.

          1. Probably not unless you are not thirsty at all because you are eating a diet based on a large amount of high water content foods like fruits and vegetables mainly raw with a low or no intake of added sodium and peeing regularly or often.

    2. From memory, I recall Dr. G recommendations on adding salt- if any, then it should be table salt with sodium, rather than sea salt because the strict WFPB NFNSuNSa eater can in fact not get enough sodium.

      He has also mentioned that somehow the fermentation of soy in particular seems to cancel out the damage from salt intake. Therefore Miso is the way to get our salt.

      Does anyone here think the stroke risk is also lessened?

      (I’ve taken to getting my salt from Miso and sometimes Tamari, and my fat from Avocados, hoping this is a good course)

  20. Interesting about the reasons for being vegetarian/vegan in the US vs the UK. I’ve noticed during my time in the UK that they are, compared to North America, very concerned with animal welfare in general. Very soft-hearted about their pets, farm animals etc. I am that way, too, so it was nice to see a population that cares so much.

    1. Mia,

      Yes, I watch people like earthling Ed and I love him so much. Emotion. Passion.

      I watched him interviewing Mic the vegan and Mic is also passionate but much more cerebral about it.

      When the American vegans speak they debate honey and talk about wool rugs and owning pets and all sorts of rules.

      When searching ed speaks, he affects my heart.

      It is interesting to me because the WFPB doctors pull me toward veganism. Much of the legalism of the USA vegan movement causes me to back up. Then, earthling Ed rips my heart out.

      Dr Greget’s animal footage might have impacted me the most (Did he shoot that footage? I listened to him talk about it and he was involved in it somehow)

      Was he sneaking onto farms and taking footage?

      The cows being dragged. Those poor pigs.
      The chickens on the commercials being manipulatively portrayed as if they are treated well.

      Those images affect me deeply.

      And yet I still back away from the movement ever though I am allergic to wool and don’t really eat honey.

      1. I mentioned Mic and it isn’t Mic who causes me to back up. It is somehow the movement itself is ”I am better than you” and ”You aren’t perfect enough at it” in the USA and instead of generating compassion for the animals, it causes me to put up a wall to protect myself.

        To be fair, I am a Vhristian and I respond the same way on the inside when Christianity does the same thing.

        I watched God’s Not Dead 1 and wanted to walk out but watched it to understand what was bothering me other than every single thing.

        1. The thing is, the advertising end of things also draws me to veganism.

          It is so odd that the faux meat and faux leather and vegan products and vegan cosmetics can draw me in but the USA vegans still cause me to jump back.

          But not Dr Barnard.

          And he us probably the politedt activist in the universe and he can say all of it without triggering me even once.

          1. And I know that I am annoying because I think about things a long time and make multiple comments that only some leadership person might be interested in.

            But the USA IS nOT health-oriented AT ALL but these WFPB doctors are the ones who are succeeding at the message.

            A big hug to Dr Greger. You are doing things the way that is getting through to people.

    1. Not per day, per week. California had 934 over the most recent 7 days, or 134 / day.

      By March (and alarming outbreaks in places like Manaus, Brazil) it was becoming apparent this disease wasn’t seasonal in the way influenza is. Its primarily transmited by respiratory aerosols, and outside treatment wards, the most hazardous places seem to be building interiors with poor ventilation. Of the sort everyone retreats to in the summer heat.

      We’re just seeing the first wave pass through rural and suburban areas: places that didn’t have the high number of seeding events from international travellers as say the NYC area, but which only belatedly took the mitigation measures required to get Rt (the effective reproduction number for the virus) below 1. So case numbers just grew slowly but inexorably, and poor outcomes followed with a roughly 3 wk delay.

      It appears not enough of us have the sense of civic duty to take all the mitigation measures (masking, physical distancing, washing hands, avoiding large events, restricting travel) to get Rt well below 1 and see the marked drops in cases seen in the rest of the developed world. I hate that those of us who are conscientious are at the mercy of the least civic minded and most credulous amongst us, but that’s a problem that’s been brewing for decades.

      1. Thanks, Darryl,

        I was reading on my cell phone and I have vision problems.

        That is less terrifying.

        I did find some interesting new COVID-related things.

        First, I liked Vox’s video of where young people volunteer to be infected to test the vaccines to take 3 to 4 years off of the time.

        https://www.youtube.com/watch?v=r2fxJI_cP58

        And the Aero-Nabs inhaler which they called an internal PPE

        https://news.yahoo.com/scientists-uc-san-francisco-develop-030721855.html

          1. “Also, the NY Times believes the USA has already had over 200,000 deaths.”

            You had me at the NYT believes! They always get things right.

            Fear. Fear. Fear. Russia. China. Fear. Covid. Fear. Fear. Trump. Fear. Fear. Be Safe!. Fear. Fear.

            Breathe…meditate…live life.

            Oh yes and blueberries are very good for this sort of thing.

            …except for Chinese and Russian blueberries of course.

            1. jazzBass,

              Laughing.

              I understand the politics and hate all the drama.

              As far as COVID goes, the CDC will do the adjustment at the end, but the NY Times did the excess deaths through July.

              I don’t find data fearful.

              The rest of the political debate creates stress in my opinion but correcting the data brings clarity.

              Breathe, Meditate, Live Life, but that doesn’t mean bury your head in the sand.

              I grew up with a family that buries their head in the sand all the time and that is stressful, too.

            2. jazzBass,

              The war of information was exceedingly stressful when I began this process and most of the people around me just check out or just choose Keto and COVID is a scam and just set boundaries to avoid looking at the information.

              The exceedingly stressful changed to moderately stressful and that changed to comforting to read everything from both directions.

              I think it became good for me, like exercise.

              Throwing one side out was like avoiding mammograms, which I do, but now I feel quite fine about it. I used to have an undercurrent of not feeling fine at the same time I enjoyed not doing it and didn’t want the pain of it and didn’t like that I wasn’t taking responsibility. Now, information has taken away the undercurrent entirely and I can make the exact same decision, but now it is an informed decision.

              I LOVE informed decisions. I HATE decisions altogether, but I found out that was because everybody is lying and manipulating and hiding information and I heard a young person talking about how their generation has such trust issues that they can’t just accept information from anybody and that will be a deficit for them for a few years, but the ones who don’t run away from the process may become healthier mentally than anybody.

              I say that as someone who seriously had their brain torn into pieces by it when I first started to try to figure it out 7 years ago. I mentally broke down. Now, it is as if I would be someone keeping track of blood pressure and cholesterol numbers after a stroke. Nope, not stressful anymore at all. It becomes useful data when things shake out and I think it becomes like doing exercises that trick your muscles into being stronger.

              Brain plasticity is what I think is happening.

              I still have the stress of the economy and the reality that people around me died during COVID and I know people will die this winter. Over 1000 people per day in the USA are dying from it every day and those cases have COVID tests and are double-checked by medical examiners and I don’t have to worry about it. Most of them were tested both to figure out which floor in the hospital to place them and to figure out if the body is safe for the funeral parlors to work on them.

              1. Do you see exercise as stress? Maybe sports as stress.

                Just stretching keeping inwardly meditative no stress, no competition at all.

                Pilates was invented to help injured athletes, but it is so much gentler and more peaceful, why do the actual sports.

                But if you watch the person who wins the championship, they say that the sport training and competition gave them all sorts of life skills.

                I think the thinking process is restoring my brain and if I keep going, I won’t be as confused and decisions will be easier and I will also have developed systems for everything that was based on the best information possible.

                Having systems is the opposite of confusion and stress.

                For COVID, I wake up and look at the Rt number for the states and go to Worldometer and look at the death tolls and go to the news and look at the hospitalizations and deaths and then look at the newest ways to treat it and there are some fabulous new things that will be here in a few months. I find that process so informational and so encouraging. I already know the debates from both sides, so now it is like I am standing on a surfboard rather than tumbling in the waves. It took a while, but it is so rewarding now.

  21. I have a question about minerals, vitamins and sublingual absorption. Say you eat something and you chew for a minute or two instead of chewing for a few seconds and swallowing. Would you absorb minerals and vitamins through the mouth and bypass the intestines?

    I’m suffering from reflux now. I swallowed a b12 tablet (it wasn’t chewable or sublingual just a regular tablet) on an empty stomach and burnt my stomach. I didn’t know about this risk about pills. I should have waited to ask my doctor at the next visit instead of being impatient. I googled ‘low carbohydrate diet and GERD’ and found many sites, a few journal articles about it. I suppose you can confirm any bias you want with a Google search but still there’s evidence there.

    1. That’s odd. B12 supplementation is often recommended for GERD patients because many of the medicines prescribed seem to deplete B12 levels,

      Also, why would anyone want to eat a low carb diet for GERD (or anything else for that matter)? It increases mortality risk and most low carb diets are high in fat. That is a big no-no for people with GERD.
      https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/eating-diet-nutrition

      If you are eating a low carb diet high in fatty foods, that is more likely to be a cause of GERD than B12. The B12 tablet may have just been an innocent passer by that happened to be there when your symptoms emerged.

      1. Not medical advice. Merely informational. For medical advice, work closely with your wise and learned locally licensed Physician.

        Arthur,

        A few tips and tricks for GERD.

        (1) Pursue variety and moderation in pursuing the material, below. Avoid fanaticism:

        (2) “Low carbohydrate diet” is just a synonym for a high fat, high protein diet. These diets tend to exacerbate GERD – and have other negative health consequences, as well. Get as far away from that literature as you can – it can be very convincing, but it is probably not in your best interests to pursue such diets. I suggest, instead, that you may wish to focus your web searches on key words along the lines of “low fat Whole Food Plant Based diet.”

        (3) Note that fat closes off your pyloric sphincter and traps food in you stomach – with peristaltic churning – for hours. This exacerbates GERD symptoms. The fat intrinsic to animal flesh, cheese, oils, avocados, nuts, seeds and chocolate are all sufficient to bring about this effect.

        A low fat diet reducing or eliminating much of the above is a good place to start to combat GERD.

        (3) Ice-cold food and drinks tend to open up the pyloric sphincter and empty the stomach, reducing GERD symptoms. When you do drink, try drinking ice water. Avoid carbonated beverages – the carbonation just expands the stomach and exacerbates GERD symptoms.

        (5) Graze – multiple small meals and snacks instead of three large meals a day.

        (6) Different people have different triggering foods. Look for yours and avoid as appropriate.

        (7) Do what you can to reduce abdominal pressure. If overweight, lose weight. A BMI of 21 may be a useful target. Or a waist-hip ratio of .95 or better (.85 in females). Or a waist circumference that is ~50% of height. Pick a target, any target. Better yet – all three.

        (8) Avoid clothing that increases abdominal pressure – particularly when sitting down. For gentlemen this may mean buying larger-waist underwear and pants than the ones you have been wearing since high school – getting away from elastic waists – and switching from belts to braces or suspenders – such changes can make a world of difference. For ladies – it may mean switching to less constrictive foundation garments and switching from trousers and skirts and elastic waists to dresses which are loose around the waist.

        (9) Elevating the head of the bed four to six inches may be helpful – but back off if this results in ankle swelling. Just flipping up the top portion of a hospital bed tends not to be as helpful – unfortunately, this increases abdominal pressure.

        (10) Of course, avoid eating for three or so hours before sleeping. Individualize as appropriate. It may be helpful to have a smaller colder very low fat last meal of the day.

        (11) You might try switching sleeping positions. If you normally sleep on your back, try sleeping on your side. If normally on one side, try the other side. Sleeping on one side or the other may make all the difference. This may require different pillows in order to be comfortable. Couples may tend to each have their own side of the bed, and may tend to “spoon” on their sides when going to sleep – or roll away, for that matter. It may be helpful to flip sides – this may require each member of the couple changing their side of the bed – switching over lamps and alarm clocks and such. This will not always help – if it hurts, just switch back – but when it does help, the change can be marked.

        (12) And, heck – try sublingual B12.

        (13) Note that the antacid regiment that you may be prescribed may reduce absorption of B12 and iron and zinc and copper and molybdenum – and other nutrients unknown. Your stomach is “designed” to be an acid factory – when that is curtailed medically, there are profound effects on digestion. Still – you do what you have to do.

        Your B12 and iron levels should best be periodically monitored by your Physician while you are on any such medications. A gentle question or reminder to your Physician may be helpful to make sure that this is occurring.

        Antacid medications may include aluminum. If this is true in your case, you may wish to look further into the matter.

        (14) Pay attention to your body. It tells you things – if only you will listen. Adjust as appropriate.

        Arthur.

        All the best –

        Vivamus

        1. Typo correction – “regimen,” not “regiment.”

          (I do not usually bother to repair typos, but this one was more painful than most).

          Vivamus

          1. NutritionChat.net

            (1) I retain the copyright.

            (2) Best to ask beforehand.

            (3) Who are you?

            (4) Where are you located?

            (5) Please include the included disclaimer as originally written: “Not medical advice. Merely informational. For medical advice, work closely with your wise and learned locally licensed Physician.”

            [There may be medico-legal considerations in regards to posting such materials on the Internet of which you are unaware – varying by jurisdiction. Disclaimers are always there for a reason.]

            (4) Please include the phrase: “A few tips and tricks for GERD.”

            (The phrasing is crafted deliberately: (a) the list is incomplete; (b) not all of these “tips and tricks” are “standards of care” items, and some might be challenged. Hence the carefully chosen deceptively casual phrasing, implying a casual post. I understand the role of the editor – but I also understand the nuances of health writing which might not be evident to an editor upon first glance.)

            Vivamus

            1. Wow! Thanks for your reply, Vivamus, and apologies for the delay in getting back to you. (I wish that the NF comments system would alert on replies and new posts … which is one of the reasons why I started the forum!)
              1. Of course!
              2. Noted – I will do this in future. As said, this comments section is not good for 2-way interactions, and I didn’t actually expect you to check back.
              3. Just an enthusiastic fan of NF & Dr Greger (and previous NF volunteer).
              4. SE Asia. Why?
              5. Added.
              4. Added.
              Thanks again for your valid contributions.

        2. Didn’t expect that answer. Thanks. Swallowing the tablet was bad but I didn’t notice many problems initially. The problem got worse for me probably because afterwards I was chewing my tablets for a few weeks. Those tablets weren’t meant to be taken that way; they should be just swallowed after a meal like I had done for so long. All those tablets must have messed up something; i got this strange taste at the back of my throat and a dry chalky feeling around the inside of my mouth too. Sleeping on the right side made things worse for me where I started to get a sore throat (could be lpr). Sleeping on my left side made things better. I’ll consider raising the bed height. I’ll see how I go just sleeping on my left side. I took a break from tablets of any kind for a week. I got some sublingual cyano-b12 tablets and I’m going to take those now. I took one today on an empty stomach and it seems OK. I stopped eating all my fats while i was unwell and that may have helped too. I stopped eating an orange a day and reduced the amount of tomato sauce in my bean-veg soup. I’m trying to add more raw greens and strawberries for vitamin c. Still eat the mandarin since they’re in season and they’re not that acidic. It’s too early to tell if i have resolved the issue. Symptoms have reduced.

          The calcium as an excipient in a supplement, I wonder if it would act as an antacid. It depends on the dose I guess.

    2. Why associate this with low carb diets though? There is nothing low carb about WFPB that I am aware of?

      3 servings of grains plus all the fruits and veggies and beans is not low carb as far as I understand… do I have that wrong?

      1. I have heard though that in SOME patients it has been observed that some carbs bring on GERD. LIke Oatmeal of all things, and Ive seen recommendations re: GERD to avoid same. There may be some studies on this Im sure…

        1. jazzBass wrote:

          “Why associate this with low carb diets though? There is nothing low carb about WFPB that I am aware of?”

          Arthur, the Original Poster in this thread wrote: “I googled ‘low carbohydrate diet and GERD’” – suggesting that he was associating the two.

          “3 servings of grains plus all the fruits and veggies and beans is not low carb as far as I understand… do I have that wrong?”

          You have it exactly right.

          Sounds pretty good, actually.

          I think I’m gettin’ hungry. ;-)

          ———————————-

          jazzBass wrote:

          “I have heard though that in SOME patients it has been observed that some carbs bring on GERD.”

          Yup.

          Lotsa different triggers out there for lotsa different people. Each person needs to keep track of what does and does not work for him and proceed accordingly.

          ———————————-

          jazzBass.

          A question: what jazz bass would you recommend?

          My knowledge of such matters is woefully deficient.

          Anything you might direct us to on YouTube or elsewhere?

          Thank you –

          Vivamus

          1. Vivamus,

            I think that would often be SIBO.

            I think Dr. Greger said that he has a video that will be coming out on that.

            It is still mostly that people need good bacteria to digest the fermented carbs when it is related to that.

            That is what I have read.

          2. So many greats!

            Would want to know what genre (within jazz itself) one were interested in.

            A birds eye survey might start in the 20’s and come through to the present, each with his/her own voice.

            Lets see…

            Perhaps for starter s- and omitting hundreds of equal ability and notoriety:
            Jimmy Blanton, Paul Chambers, Major Holley, Ray Brown, Richard Davis, Scott LaFaro, Eddie Gomez, Dave Holland, Ron Carter, Christian McBride, John Patitucci, etc…

            Here’s a link I found of 10 greats (some mentioned above) that also includes 2 or three electric players. https://www.youtube.com/watch?v=eBvRV0vqsis

            Cudos if you can guess which two I’ve actually studied with. lol

              1. jazzBass

                “Would want to know what genre (within jazz itself) one were interested in.

                Well – in today’s world – I guess it better not be Dixieland . . .

                What little I know about jazz can be written on the wind and running water . . .

                (respect to Catullus)

                “Perhaps for starter s- and omitting hundreds of equal ability and notoriety:
                Jimmy Blanton, Paul Chambers, Major Holley, Ray Brown, Richard Davis, Scott LaFaro, Eddie Gomez, Dave Holland, Ron Carter, Christian McBride, John Patitucci, etc…”

                It looks like I may have some exploring to do . . .

                “”Here’s a link I found of 10 greats (some mentioned above) that also includes 2 or three electric players. https://www.youtube.com/watch?v=eBvRV0vqsis

                Cudos if you can guess which two I’ve actually studied with. lol””

                Well, that’s easy. For starters, it’s gotta be:

                Mr. Pettiford.

                Other than that – I’m not so certain.

                I did particularly enjoy Messieurs Patitucci, Bona and Clarke.

                I would guess that that I more enjoy ensemble play and what I would call “musicality” than solo displays of machine gun virtuosity.

                Though I, of course, respect the latter.

                I am reminded of child prodigy drum solos on black and white television variety shows.

                Pretty neat, I suppose. But I prefer to be moved.

                Probably slower work – something on the deeper and hungrier and more seductive end of things.

                The following may be painful for a bass virtuoso to listen to – but it might give you an idea of one area of my current capability of appreciation:

                Red Dress
                https://www.youtube.com/watch?v=3bOvJ0DnTa8

                jazzBass.

                Tutoring from an expert is a unexpected gift.

                All the best –

                Vivamus

    3. It appears you received a wealth of helpful information, Arthur, but as a volunteer on this website I noticed your question on where vitamins and minerals are absorbed was not addressed. Here is the answer:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956471/ Physiology of Intestinal Absorption and Secretion
      “Virtually all nutrients from the diet are absorbed into blood across the highly polarized epithelial cell layer forming the small and large intestinal mucosa.”
      Now it appears some starches begin the digestive process and some calories may be absorbed in the mouth, but as far as nutrients such as the vitamins and minerals you asked about, that absorbtion begins lower in the intestinal track. Hope that helps

    4. Hi, Arthur! Adequate chewing is very important. This is partly because some nutrients may be absorbed in the mouth, but mostly because saliva plays a role in digestion, and chewing physically breaks down food to make the next steps in digestion more effective. Most nutrients are absorbed in the stomach and intestines. A low-carbohydrate diet is not likely to help with GERD, because of the high fat content, and it is likely to increase the risk of other chronic illnesses, such as cardiovascular disease. You can find everything on this site related to GERD here: https://nutritionfacts.org/topics/gerd/ I hope that helps!

  22. These EPIC study vegetarians were clearly not eating a whole plant-based diet. Their fiber consumption was only 22 grams per day! I average 60-100 grams, three to five times as much. Also their saturated fat consumption was high (too much egg & dairy?): 10.2% of calories is nearly as bad as the meat-eaters’ 11.5% of total calories. The AHA recommends no more than 7%. Egg consumption was not listed, but these vegetarians ate more cheese than the meat eaters and drank as much milk.

    In short, this was a pretty unrepresentative group of vegetarians–no doubt of the ‘ethical’ variety.

    Still, I’m curious as to the ultimate cause of the vegetarians having a much higher stroke risk, especially hemorrhagic. Lack of B-12? Folate? Dr. Greger has covered these in an earlier video from 15 years ago–in relation to CVD, if not strokes specifically.

    I wonder if the stroke outcomes were ‘massaged’ statistically by considering other factors, like blood pressure, smoking, activity, etc?

    1. Yeah good point, i get around 50gr of fiber a day on a fruit based diet because they are lower in fibers than legumes and some whole grains, 20-30gr of fiber a day is not healthy enough.

    2. Jason Clark,

      “Massaged” statistics … right bang on according to the Drs Sherzai who analyzed the study over a year ago, and published this 10 min video. https://m.youtube.com/watch?v=_HuWw2DPP5M

      They speak about the tiny number of vegans in the study and the fact that vegans and vegetarians were lumped together. There were problems in mis-catagorizing strokes, allowance for error vs actual number, and more. Have a look and see what you think.

      This couple are neurologists with Loma Linda University and have written a book on wfpb lifestyle and other factors that help to protect from Alzheimers. They have many short educational videos available on youtube.

    3. Jason,

      Dr. Greger covers your questions.

      I saw the webinar and love this series.

      There are things like the pescetarians not having a cardiac advantage at all in the chart and fish is something that gets debated because of the pescetarian Adventists, and because of fish studies, but this one the pescetarians did much worse in cardiac disease.

      I love the whole series.

    4. Jason Clark, here is another article fromthe same authors that Dr Greger referenced. https://nutritionfacts.org/video/vegetarians-and-stroke-risk-factors-omega-3s/ I found it helpful because it tables clearly the amounts of foods each group typically ate. As someone noted above, there was little difference between the categories.

      Other tables/diagrams show the results where fish eaters had less heart disease than meat eaters, and less stroke risk than vegetarians. The food groupings reflect an imperfect world. The vegans were lumped in with vegetarians, and fish eaters were also consuming dairy products (a lot!) unfortunately.

      I found this link helpful and clear in describing risk factors for stroke, and symptoms that we might not be aware of. https://www.stroke.org/en/about-stroke/stroke-risk-factors/women-have-a-higher-risk-of-stroke

  23. I even love that Dr. Greger is wearing his green shirt.

    He had me at making videos that strive to be entertaining.

    He can wear anything he wants and talk any way he wants.

    I just like hearing the information very much.

  24. t appears that one may be able to get the same benefits of fish from taking vegetarian algae oil

    See the following studies

    Supplements containing omega-3-rich algal oil were more effective at boosting DHA levels in omnivores than fish oil supplements, says a new open-label randomized pilot study with 31 healthy adults.”
    https://www.nutraingredients.com/Article/2014/09/03/Fish-and-algal-oil-are-practical-sources-of-DHA-but-it-s-premature-to-say-if-one-is-better-GOED-VP-on-new-study

    “In a small study published in 2008 in the Journal of the American Dietetic Association, researchers recruited 32 healthy adults to consume either algal-oil capsules or cooked salmon with an equivalent amount of DHA each day for two weeks. The groups showed similar increases in their blood levels of DHA, leading the authors to conclude that “algal-oil DHA capsules and cooked salmon appear to be bioequivalent in providing DHA to plasma and red blood cells,”
    https://www.berkeleywellness.com/supplements/other-supplements/article/algal-oil-omega-3s

    In a pilot study published in 2013 in Proceedings of the Nutrition Society, algal-oil supplements produced similar improvements in blood DHA levels to fish-oil supplements. This was true both in people who were vegetarians (including vegans) and had low levels of DHA to start and in omnivores, who had higher levels of DHA at baseline.”

    https://www.berkeleywellness.com/supplements/other-supplements/article/algal-oil-omega-3s

    Fish actually get their Omega 3s from eating algae, so acquiring it from algae oil seems to be getting it straight from the source * See Getting Brain Food Straight from the Source .

    https://www.npr.org/templates/story/story.php?storyId=15823852

    1. Brad,

      Thanks for the links.

      I like the algal oil point.

      I am taking it for my brain.

      Not sure it is going to help.

      I think my brain is going backwards and maybe backwards and forwards at the same time.

      Found out that the doctors want my cousin to do hospice. That means the next infection he gets, he agrees to die ready or not.

      We talked and laughed about old times tonight but he gets infections and they just got him to agree to die the next one and I have such brain problems that I alienate people except the oldies because they have brain problems, too.

      My cousin fell tonight for the first time in months while telling a loved one that he is going to probably due soon and he opened up his foot wound.

      He was able to use my people mover to get up but I am going to lose the people who love me and I don’t have the brain power to get new people and I don’t know if DHa will help.

      1. Deb:

        We all face some deterioration at some point unless we die early. Try to improve, but also try to accept things if /when improvement is impossible. (Acceptance is often easier said than done.) Perhaps reminiscing on past good experiences is helpful?.

        I wish you peace and solace.

        1. Brad,

          The acceptance versus brain plasticity is something I meditated on yesterday.

          My step-mother stopped trying to improve from her stroke and when you stop trying to improve you stop improving but it takes so much effort for small gains and she is choosing a peaceful life rather than improvement and she has gone very far backwards doing that but is living a more peaceful life with less effort.

          1. I was talking to my cousin and he is still so intelligent and articulate and is taking care of himself and still is laughing and they are telling him that it is time to die. And it became a war between my family and medical because we don’t see antibiotics as cruel. I don’t know if he will get an infection from reopening his wound yesterday and they will already be saying that he agreed to die. They get so mean if you change your mind and ask for antibiotics. I know that it is things like that where I get alienated from medical care. I don’t know if he will just let them knock him out with Morphine. He only heard about it yesterday and was surprised that he is that close to the end.

            1. He never became bed bound and never reached not being able to live independently. I feel like they are so aggressive with end of life processes.

  25. I like Hershey’s cocoa, 100%, unsweetened, by the pound. I put several tablespoons of it in my oatmeal canister mix. I also like to put it in my coffee, along with matcha green tea, turmeric, cinnamon and clove spice. That’s enough antioxidants, anthocyananins and anti-cancer compounds to annialate all anti-pathic bad actors.

    1. That’s impressive Dan.

      However, I am not convinced that it always works that way. My suspicion is that we need to cut down on the ‘baddies’ as well as load up on the ‘goodies’

      For example, all those paleo/low carb meat eaters who make a point of telling us about the high levels of vegetables and fruits they eat

      ‘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.

      Objective: We evaluated 2 large prospective cohorts of Swedish men and women (the Swedish Mammography Cohort and the Cohort of Swedish Men) to determine whether the association between red meat consumption and the risk of all-cause, CVD, and cancer-specific mortality differs across amounts of FV intake.

      Design: The study population included 74,645 Swedish men and women. Red meat and FV consumption were assessed through a self-administered questionnaire. We estimated HRs of all-cause, CVD, and cancer mortality according to quintiles of total red meat consumption. We next investigated possible interactions between red meat and FV consumption and evaluated the dose-response associations at low, medium, and high FV intake.

      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.

      Conclusion: High intakes of red meat were associated with a higher risk of all-cause and CVD mortality. The increased risks were consistently observed in participants with low, medium, and high FV consumption. ‘
      https://academic.oup.com/ajcn/article/104/4/1137/4557128

  26. Hi Mr. Fumblethingers:

    I do not eat meat, but the Paleo people would tell you the same thing you tell me. That is, that correlation does not equal causation. They would say that many red meat eaters have unhealthy habits (smoking, drinking, lack of exercise, lack of other nutrition etc…) and that it’s those other habits and not the red meat that is the problem. They would also point to some studies showing no negative effect of red meat

    The above is not my position. I am just pointing out the arguments of the Paleo folks.

    1. Brad

      Well, they would, wouldn’t they? Poor devils.

      Of course in that study I linked above ‘All multivariable models were adjusted for sex, pack-years of smoking, physical activity, educational status, BMI (in kg/m2), alcohol consumption, diabetes, fish consumption, and total energy.’ so I am not sure that trying to blame those factors for the results has any legs at all.

      That said, meat consumption isn’t the only dietary risk factor. Trans fats, saturated fats, high fat dairy, eggs, refined carbs and processed foods generally are all risk factors too. If those things aren’t controlled for, deliberately or not, it could appear that eating red meat is no worse than eating a meatless Standard American Diet.

      There are also two other points

      1. yes studies usually show harm but also sometimes show no harm at all. However, I am not aware of any studies showing a longevity benefit from eating meat ….. other than perhaps international studies comparing people in rich advanced countries possessing good public health and medical systems, with people in poor countries with poor medical systems. In that case, people in rich countries can be seen to both live longer and eat more meat than people from poor countries.

      2. the argument ignores all the known risk factors contained in meat eg saturated fat, cholesterol, IGF1, Neu5Gc, animal growth hormones and animal protein.

      It may be worth revisiting Dr G’s videos on the paleo crowd’s arguments
      https://nutritionfacts.org/?s=paleo

      There is also pretty much a scientific consensus that eating red meat on the scale seen in paleo diets is unhealthy. I write ‘pretty much’ because there are always some groups and individuals with a history of industry ties who will try to argue to the contrary.
      https://www.npr.org/sections/thesalt/2019/09/30/765722916/no-need-to-cut-back-on-red-meat-controversial-new-guidelines-lead-to-outrage

      1. Hi Mr. Fumblethingers:

        I totally agree. I am also not aware of any peer reviewed studies (or any studies for that matter) that show a high meat diet yields a reduction in mortality or disease. Whereas the reverse tends to be true for plant based and majority plant based diets. That is, there are several studies that show that plant based and majority plant based diets correlate with both a reduction in mortality and disease.

        Dr. Saladino claims to have some evidence of an improvement of some biomarkers on high meat diets, but I doubt his studies are peer reviewed. Furthermore, even if true, biomarker improvement is not the equivalent of a reduction of mortality or disease. I have not really investigated his work in any sort of detail as I have already found some of his claims to be inaccurate.

  27. Hi Dr. Greger – I really appreciate your collation of all this dietary information on PBD! But don’t you think the increased stroke risk could be due to the increased bleeding time that can be the result of a vegan diet? Think turmeric, ginger, garlic… I think that could be the obvious explanation, esp. since the increased risk was observed for hemorrhagic stroke. Warm regards
    Wiebke Hellenbrand MD MPH

    1. .I agree with the above comment.. In the BMJ study, the vegetarians faced an increased risk of Hemorrhagic strokes.

      Some vegetarians or vegans may go to the extreme of having very little or no fat in their diets. Extremely Low cholesterol is associated with hemorrhagic stroke. It is widely debated whether low cholesterol is causitive of hemorrhagic stroke though. No one really knows for sure. Harvard points to some factors indicating that low cholesterol is not a risk factor

      Nevertheless, I would speculate that extremely low blood cholesterols brought upon by extreme diets coupled with some other unknown risk factors (perhaps antithrombotic foods, extreme exercise or high blood pressure) may increase hemorrhagic stroke risk

      Low cholesterol linked to higher risk of bleeding stroke in women
      https://www.sciencedaily.com/releases/2019/04/190410163018.htm

      https://www.health.harvard.edu/heart-health/low-ldl-and-stroke-a-closer-look#:~:text=In%20both%20studies%2C%20low%20LDL,likely%20to%20rupture%20and%20bleed.

      https://www.health.harvard.edu/blog/ldl-cholesterol-how-low-can-you-safely-go-2020012018638

  28. When is the big D (and E) word going to make an appearance between vegans and vegetarians? Dairy and eggs are massive health differences between vegans and vegetarians. No ethical vegan eats those excretions.

  29. Hi, Jennifer Godfrey! Those topics have been covered extensively here on NutritionFacts. Historically, it was common to lump vegans and vegetarians together when they were included in research studies, partly because there were so few members of either group. That practice made it difficult to separate the health effects of lacto-ovo vegetarianism from those of veganism. As vegetarians and vegans increase in number, more studies are being conducted that separate the two groups. You can find everything on this site related to dairy here: https://nutritionfacts.org/topics/dairy/ Everything related to eggs may be found here: https://nutritionfacts.org/topics/eggs/ I hope that helps!

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