Vegetarians and Stroke Risk Factors—Vitamin D?

Vegetarians and Stroke Risk Factors—Vitamin D?
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Could the apparent increased stroke risk in vegetarians be reverse causation? And what about vegetarians versus vegans?

Discuss
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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.

The risks of heart disease and stroke in meat eaters versus vegetarians over 18 years of follow-up. Not surprisingly, vegetarian diets were associated with less heart disease––10 fewer cases per 1,000 people per decade compared to meat-eaters––but vegetarian diets were associated with three more cases of stroke. So, eating vegetarian appears to lower the risk of cardiovascular disease by seven overall. But why the extra stroke risk? Could it just be reverse causation?

For example, when studies have shown higher mortality among those who quit smoking compared to continuing smokers, we suspect reverse causality. When we see a link between quitting smoking and dying, instead of quitting smoking leading to people dying, more likely dying led people to quit smoking. It’s the same reason why nondrinkers can appear to have more liver cirrhosis, because it was their failing liver that led them to stop drinking. This is the so-called “sick-quitter effect.” And you can see it when people quit meat too.

See how new vegetarians can appear to have more heart disease than non-vegetarians? Well, why would some older person all of a sudden start eating vegetarian? Maybe it’s because they’ve just been diagnosed with heart disease; so, that may be why there appears to be higher rates at first: the sick quitter effect. To control for that, you can throw out the first five years of data to make sure the diet has a chance to start working, and indeed, when you do that, the true effect comes clear: a significant drop in heart disease risk

So, does that likely explain the apparent increased stroke risk? No, because they still found higher stroke risk, even after the first five years. Huh, okay; then what’s going on? Let’s dive deeper into the data to look for clues. This is what you get when you break down the results by type of stroke and type of vegetarian—vegetarian versus vegan.

There are two main types of strokes: ischemic strokes and hemorrhagic stroke. Most are ischemic strokes, or clotting strokes, where an artery in the brain gets clogged off, as opposed to hemorrhagic strokes, or bleeding strokes, where a blood vessel in the brain ruptures. In the United States, it’s about 90:10; 9 out of 10 strokes are clotting, one out of 10 the bleeding type. And that’s what the vegetarians appeared to have significantly more of. Now the vegans didn’t, in fact, statistically have significantly higher risk of any kind of stroke. But that’s terrible news for vegans—vegans have the same stroke risk as meat-eaters? What’s going on? What’s so increasing their stroke risk that it’s offsetting all their natural advantages? And the same could be asked of vegetarians.

Even though this was the first study of vegetarian stroke incidence, there have been about a half dozen studies on stroke mortality, and the various meta-analyses have consistently found significantly lower heart disease risk, but the lower stroke mortality was not statistically significant. Now, with this new study, vegetarians can take comfort in the fact that at least they don’t have a higher risk of dying from stroke. But that’s terrible news for vegetarians—statistically vegetarians have the same stroke death rate as meat-eaters? What’s going on? What’s so increasing their stroke risk that it’s offsetting all their natural advantages?

Let’s run through a couple possibilities. If you look at the vitamin D levels of vegetarians and vegans, they do tend to run consistently lower than meat-eaters, and lower vitamin D status is associated with an increased risk of stroke. But who has higher levels of the sunshine vitamin? Those who are outside running around and exercising, and maybe that’s why their stroke risk is better. What we need are randomized studies, and when you look at people who have been effectively randomized at birth to have lifelong lower vitamin D levels just genetically, you do not see a clear indicator of increased stroke risk; so, the link between vitamin D and stroke is probably not cause-and-effect.

And so, in terms of an answer to our question, vitamin D doesn’t seem to fit. We’ll explore some other possibilities, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

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

The risks of heart disease and stroke in meat eaters versus vegetarians over 18 years of follow-up. Not surprisingly, vegetarian diets were associated with less heart disease––10 fewer cases per 1,000 people per decade compared to meat-eaters––but vegetarian diets were associated with three more cases of stroke. So, eating vegetarian appears to lower the risk of cardiovascular disease by seven overall. But why the extra stroke risk? Could it just be reverse causation?

For example, when studies have shown higher mortality among those who quit smoking compared to continuing smokers, we suspect reverse causality. When we see a link between quitting smoking and dying, instead of quitting smoking leading to people dying, more likely dying led people to quit smoking. It’s the same reason why nondrinkers can appear to have more liver cirrhosis, because it was their failing liver that led them to stop drinking. This is the so-called “sick-quitter effect.” And you can see it when people quit meat too.

See how new vegetarians can appear to have more heart disease than non-vegetarians? Well, why would some older person all of a sudden start eating vegetarian? Maybe it’s because they’ve just been diagnosed with heart disease; so, that may be why there appears to be higher rates at first: the sick quitter effect. To control for that, you can throw out the first five years of data to make sure the diet has a chance to start working, and indeed, when you do that, the true effect comes clear: a significant drop in heart disease risk

So, does that likely explain the apparent increased stroke risk? No, because they still found higher stroke risk, even after the first five years. Huh, okay; then what’s going on? Let’s dive deeper into the data to look for clues. This is what you get when you break down the results by type of stroke and type of vegetarian—vegetarian versus vegan.

There are two main types of strokes: ischemic strokes and hemorrhagic stroke. Most are ischemic strokes, or clotting strokes, where an artery in the brain gets clogged off, as opposed to hemorrhagic strokes, or bleeding strokes, where a blood vessel in the brain ruptures. In the United States, it’s about 90:10; 9 out of 10 strokes are clotting, one out of 10 the bleeding type. And that’s what the vegetarians appeared to have significantly more of. Now the vegans didn’t, in fact, statistically have significantly higher risk of any kind of stroke. But that’s terrible news for vegans—vegans have the same stroke risk as meat-eaters? What’s going on? What’s so increasing their stroke risk that it’s offsetting all their natural advantages? And the same could be asked of vegetarians.

Even though this was the first study of vegetarian stroke incidence, there have been about a half dozen studies on stroke mortality, and the various meta-analyses have consistently found significantly lower heart disease risk, but the lower stroke mortality was not statistically significant. Now, with this new study, vegetarians can take comfort in the fact that at least they don’t have a higher risk of dying from stroke. But that’s terrible news for vegetarians—statistically vegetarians have the same stroke death rate as meat-eaters? What’s going on? What’s so increasing their stroke risk that it’s offsetting all their natural advantages?

Let’s run through a couple possibilities. If you look at the vitamin D levels of vegetarians and vegans, they do tend to run consistently lower than meat-eaters, and lower vitamin D status is associated with an increased risk of stroke. But who has higher levels of the sunshine vitamin? Those who are outside running around and exercising, and maybe that’s why their stroke risk is better. What we need are randomized studies, and when you look at people who have been effectively randomized at birth to have lifelong lower vitamin D levels just genetically, you do not see a clear indicator of increased stroke risk; so, the link between vitamin D and stroke is probably not cause-and-effect.

And so, in terms of an answer to our question, vitamin D doesn’t seem to fit. We’ll explore some other possibilities, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

So far in this series, we’ve looked at what to eat and not eat for stroke prevention, and whether vegetarians really do have a higher stroke risk.

It may be worth reiterating that vegetarians don’t have a higher risk of dying from a stroke, but do appear to be at higher risk of having a stroke. How is that possible? Meat is a risk factor for stroke, so how could cutting out meat lead to more strokes? There must be something about eating plant-based that so increases our stroke risk it counterbalances the meat-free benefit. Might it be because we don’t eat fish? We turn to omega 3s next: Vegetarians and Stroke Risk Factors—Omega 3s?

And then, coming up:

If you want to just get to the conclusion, these videos are all available on a digital download here.

There certainly are benefits to vitamin D, though.  Here is a sampling of videos where I explore the evidence:

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

170 responses to “Vegetarians and Stroke Risk Factors—Vitamin D?

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      1. where did you find and sign up for a webinar?

        another question: when I click the link for other videos the message is that they are no longer available. Does anyone have an explanation why the links are not working?

        1. Hi Kathy,

          Sorry for the confusion. Some of the videos are not live yet, so the links say “not found.” I will edit the description to make it more clear those are coming up. We pre-populate them in the descriptions so that we don’t have to always go back and make changes after the forthcoming videos are live.

      1. Vague accusations like that are easy to make. We see the carnivore/low carb/Atkins suckers making them all the time.

        They can never substantiate those accusations though – can you? It seems a particularly silly accusation since here he has ‘conceded’ that so-called ‘vegetarians’ and ‘vegans’ displayed worse stroke rates than meat eaters.

      2. Very true. He is not objective. He is a propagandist. Not objective at all. He will never tell you about studies that refute his position. And they exist! See my comment about the June 24, 2020 study in the Journal of American Cardiology that concluded, based on the last 10 years of evidence, that saturated fat does not cause heart disease, stroke or diabetes and in fact reduces the risk of stroke.

        1. No they don’t exist. Misrepresenting associational studies as proving causation is just simple minded but if it’s all you got, then you have to bang that drum over and over again I suppose.

          As for saturated fat, only cranks, low carbers (but I repeat myself) and people with relationships with the meat/dairy industries, Atkins Foundation etc cleave to the view you expressed. Every credible health authority on the planet recognises that saturated fat consumption is a risk factor for those things… and they’ve published the evidence to prove it..

            1. How gullible do you think people are?

              That article was authored by a bunch of professional saturated fat apologists. Ronald Krauss for example has received many, many millions of dollars in grants from the meat and dairy industries over the years. Nobody who knows who they are takes their claims seriously. The Nutrition Coalition is just another low carb ‘saturated fat is good’ front organisation.
              https://www.politico.com/story/2015/10/the-money-behind-the-fight-over-healthy-eating-214517
              https://thehill.com/blogs/congress-blog/healthcare/257353-coalition-is-full-of-baloney-on-nutrition-guidelines

              If you really want to know about saturated fat and diseases risk, read scientific reports by credible health authorities eg

              https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510
              https://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/
              https://www.gov.uk/government/publications/saturated-fats-and-health-sacn-report

              Choosing to believe instead a bunch of agenda-driven individuals, many with ties to industry or low carb/keto organisations and businesses, just because they have managed to get an article published in a reputable journal sounds extremely unwise to me.

              1. Dr. Greger is no less agenda driven than anyone else. You have to look at the evidence, which you prefer to sweep under the rug. Take for example the Golestan Dairy Food Intake Study, a 10 year study with 42,000 subjects. Funded not by the dairy industry, but by the NIH, the National Cancer Institute, Harvard and other research institutions. https://pubmed.ncbi.nlm.nih.gov/28369205/ originally published in the J. of Epidemiology, April 2017. Here is the abstract. Note the last sentence in particular. “High consumption of dairy products, especially yogurt and cheese, may reduce the risk of overall and CVD mortality.”

                “We investigated the association between dairy product consumption and all-cause, cardiovascular disease (CVD), and cancer mortality in the Golestan Cohort Study, a prospective cohort study launched in January 2004 in Golestan Province, northeastern Iran. A total of 42,403 men and women participated in the study and completed a diet questionnaire at enrollment. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. We documented 3,291 deaths (1,467 from CVD and 859 from cancer) during 11 years of follow-up (2004-2015). The highest quintile of total dairy product consumption (versus the lowest) was associated with 19% lower all-cause mortality risk (hazard ratio (HR) = 0.81, 95% confidence interval (CI): 0.72, 0.91; Ptrend = 0.006) and 28% lower CVD mortality risk (HR = 0.72, 95% CI: 0.60, 0.86; Ptrend = 0.005). High consumption of low-fat dairy food was associated with lower risk of all-cause (HR = 0.83, 95% CI: 0.73, 0.94; Ptrend = 0.002) and CVD (HR = 0.74, 95% CI: 0.61, 0.89; Ptrend = 0.001) mortality. We noted 11% lower all-cause mortality and 16% lower CVD mortality risk with high yogurt intake. Cheese intake was associated with 16% lower all-cause mortality and 26% lower CVD mortality risk. Higher intake of high-fat dairy food and milk was not associated with all-cause or CVD mortality. Neither intake of individual dairy products nor intake of total dairy products was significantly associated with overall cancer mortality. High consumption of dairy products, especially yogurt and cheese, may reduce the risk of overall and CVD mortality.”

                Other large studies support this one. For example, the two large, long-term Harvard observational studies, the Nurses Study and the Professionals Study found a similar result. So, why doesn’t Dr. Greger mention these studies?

                1. @Alan, I didn’t check your link but will believe the referenced studies results for the moment. Will checklater to see who wrote it and how the study was conducted.

                  The question I have is:
                  Are you saying the countless studies which do show fast and obvious benefits from eating a diet of whole foods veggies, fruits nuts and seeds are not true and accurate, including the China Study, and that people should be eating processed foods, cheese, milk, and meat? (Even as this diet is typical in the most unhealthy parts of the world?)

                  Not a rhetorical question, I am really curious what you are trying to say here by suggesting Greger is biased? (since his main purpose appears to be to share the highlights of eating WFPB.)

                  I can tell you the results of an unofficial personal study: Summary: I ate plants, and my cholesterol and BP went from “borderline” to perfect.

                  Prior to that I was on Keto, and I was eating dairy and meat like it was the only menu on the planet. My blood test numbers went up, steadily.
                  I ate charcuterie, I put butter in my coffee, I grilled NY strip and pork chops, and every morning I ate 3 eggs, bacon, and cheese cooked in butter every morning for breakfast.

                  SO one day, I was in France, and my Italian friend excitedly told me about our immanent lunch, including the tomatoes from his garden, and I flatly told him I cant eat a tomato as it would throw me “out of Ketosis”. His look showed me he was aghast, as it was just a harmless freakin’ tomato after all! … and I took two steps, and realized, “man, this diet is ridiculous. ” On it, you literally avoid veggies and fruits like they are cyanide. I realize its extreme, but I really believe that avoiding those colorful unprocessed natural foods is a bad idea, and processing and slaughtering is likely not a better option. I also realize that this belief is no more scientific than belief in God or Santa Clause (same guy?) but it has been my rudder in improved and optimized health.

                  But that moment with the tomato? That’s when I went to the colorful world of plants.

                  Basically, if I read your posts correctly, I interpret that you are either refuting the seemingly overwhelming claims and studies, that WFPB is a healthier lifestyle, OR that Greger is an opportunist ideologue, OR both?

                  ….or what is your main point in referencing a few studies here about meat and dairy being apparently awesome, under the winking eye of a group of most powerful industries and banks of lobbyists in Meat and Dairy – against the hundreds of studies that are slowly and finally coming out to the contrary from “BIG BROCCOLI” ?

                  I am actually truly curious and not attacking here.

                  1. I don’t like being misrepresented and my meaning is extremely clear. Saying that the studies I mention, the Golestan Study and the Harvard studies, which are the gold standard of observational studies are “under the winking eye of a group of most powerful industries and banks of lobbyists in Meat and Dairy” is kind of dishonest. The Golestan study and the Harvard studies have nothing to do with the dairy industry. The Golestan study was an NIH and NCI funded study.
                    My point here is obvious. Large and important studies show the powerful benefits of eating dairy, particularly yogurt and cheese for reducing all-cause mortality, cardiovascular disease and death from cardiovascular disease. If you don’t think this is important, I have no interest in convincing you. Given the profound problems with the numerous deficiencies of the vegan diet, deficiencies which people here are grappling with everyday, I think the more open-minded would find this information valuable. And they may want to know, because they want to know what the healthiest diet is. I don’t think it is a vegan diet, even though I probably eat more vegetables than you and 90% of vegans. I am not speaking against the whole foods you mention. I just don’t think it is enough for health. As for Dr. Greger, he routinely attacks dairy as being unhealthy despite the powerful evidence to the contrary, evidence that he never tells you about. Draw your own conclusions about his motives.

  1. well that was a waster of time… i love the videos but they are getting more long winded and less to the point. Nothing learned in that one really.

    1. Paul,

      No matter what, Dr. Greger has to explain the basics of stroke and veganism and vegetarianism.

      We learned that being vegan and vegetarian didn’t give a statistical advantage and we learned that Vitamin D probably wasn’t why.

      I watched the webinar and totally forgot the Vitamin D and stroke logic, so I just re-learned that part.

    2. I learned a new term: the “sick-quitter” effect. I’ve known about the concept for many years, but never heard it called that.

    3. It’s unfortunate that some people didn’t learn anything from the video.
      I really appreciate that Dr. Greger teaches me *how* to interpret scientific studies. I learn a lot from him about making conclusions, assumptions, ways data can be skewed etc.

  2. So the rest of the series on the question of “Vegetarians and stroke risk” have been deleted and replaced with a $20 digital download.

    Dr. Greger, is this really still you behind the wheel?

    “C’mon man”, as Joe Biden would say.

      1. Mr. Litrov (Global Volunteer Director),

        Tact is so important in moderating strangers.

        Suggesting that another person is not speaking truly – these are fighting words in many localities.

        And may not be easily forgotten or forgiven.

        Moderators set the tone – preferably for a spirit of civility. By the example of their words.

        Preferably a spirit of – moderation.

        I do not doubt that this just involves a misunderstanding.

        The very best to you and yours –

        Vivamus

        1. I don’t think there is anything wrong or even slightly uncivil with Steven Litrov’s response, nor did I think he was suggesting the other person was being “untruthful”. I’m glad he got it out in the open with the first sentence so there is no mistake that the videos on the rest of the series are free to watch as they are released.

          1. Lesley Nicol: “nor did I think he was suggesting the other person was being “untruthful”.”

            Steven Litrov (Global Volunteer Director): “That’s not true.”

            Vivamus

            1. There’s a world of difference between ‘that’ is not true and ‘you’ are not being truthful.

              I thought that Stephen’s response was polite and civil. Especially considering that the accusation made was factually incorrect and left an unpleasant taste in the mouth

              1. Thank you Mr Fumblefingers, my thoughts exactly. If those words were said to me, I would not have been offended but would have rechecked where or how I came to such a conclusion made by Dale.

            2. To Vivamus –
              You are unnecessarily splitting hairs on a ‘truth problem’ that simply does not exist. The moderator stated a direct, clear reply of fact. If that’s a problem, from your perspective, then the person who has the problem is you.

    1. Dale, the videos have not been deleted. Nothing has been deleted. The links will become viable as the videos are released on Mondays and Wednesdays to come, for free.

      The first sentence under ‘Doctor’s Note’ links the videos in this series that have been released so far.

        1. Dale, in the first sentence under ‘ doctor’s notes’, the greyed out words “what to eat”, and “not eat” , and ” vegetarians really do have a higher stroke risk” are links to the first videos in the series. They work for me, (i just checked them again) but if a video doesn’t show up for you, maybe check your settings or contact NF support.
          Sorry for the difficulties!
          The list of titles below that are the videos that will be released in coming weeks and the links will work then.

  3. I watched this anticipating direction and advice but neither were forthcoming, were they. Very disappointing and I feel misled. I have a need to reduce my weight by nearly 100 pounds and have been researching nutrition info for a few weeks. I thought Dr. greger was the professional offering the most sound information. This useless and junky video makes me wonder.

    Of note: while doing the nutritional research, I have been following my own program of no sugar, no flour, and nothing … othing processed …aka a Whole Foods Diet. I’m pleased to report a success of -18 pounds.

    Where to go from here to be sure I am getting the nutrition my body needs to restore and maintain good Health.

    I have just bought How Not to Diet. I hope it will prove to be a good investment …. but not on the strength of this last video !

    1. Simrose,

      I don’t even know how to respond to your comments.

      I guess you could just believe everybody else that vegan will protect you from stroke and not watch the rest of the series.

      Dr. Greger is the only one I saw to do this series and give the answers. Everybody else just said that it probably wasn’t really true that vegans and vegetarians have strokes. I found their videos useless. Dr. Greger is trying to break the information down so that we can figure out what will help and what won’t help.

      I don’t find that junky or useless at all.

      I honestly still have Vitamin D on my list and needed to watch this video again.

      1. Thank You Deb.

        When I started adding Vitamin D to my supplement regimen, my energy level soared. This was a welcome change. Hope you experience the same.

        All the best of good health to you –

        1. Hi Simrose, It sounds like you are doing a great job in taking on your health management. There is another reason to take Vitamin D, it is recommended to boost your immune system in this age of COVID-19. Many people, especially those with darker skin, or those who do not spend much time in sunlight, are deficient in vitamin D. The recommendation to supplement vitamin D has now come from many very reputable sources (I suggest the Medcram website, one of the most medically reputable sources of COVID-19 treatment protocols for doctors treating COVID-19).

          Stay the course, the benefits of a whole-grain plant-based diet are numerous, and will serve you well even into very old age. With time you will likely be able to stop all prescriptions (make sure that your doctor/bloodwork supports this decision). Make exercise a daily part of your life as well. Exercise has been called the “miracle drug” due to the wide-reaching dramatic effects it imparts.

        2. Simrose,

          You wrote:

          “I have a need to reduce my weight by nearly 100 pounds and have been researching nutrition info for a few weeks . . . while doing the nutritional research, I have been following my own program of no sugar, no flour, and nothing … othing processed …aka a Whole Foods Diet. I’m pleased to report a success of -18 pounds.

          Where to go from here to be sure I am getting the nutrition my body needs to restore and maintain good Health.”

          Congratulations on your weight loss success. Excellent!

          “Researching nutrition . . .” – looks like you are on the right track.

          As far as healthy weight loss is concerned – people have many methods. Below is what I have seen work.

          The place that I always start when dealing with healthy weight loss is the psycho-social. If you just start with the nutrition science and the psycho-social underpinnings are not in place – you are wasting everyone’s time. You are just setting the person up to fail.

          So – first session involves examining motivations, past weight history, social setting – evaluating trade-offs, pitfalls, etc. It involves a lot of listening, a lot of questions. All very individualized.

          Purpose is to get the person thinking. This is not just about him – it is about his whole ecosystem.

          If the person is ready – you proceed. If not – he is welcome to work on it, or go elsewhere if that feels best.

          Everyone always has a choice.

          Only then – the nutritional details.

          Some thoughts for you. Everyone is different, of course. But it is common to find that:

          (1) Losing weight is easy. Keeping it off is hard. Prepare for the landing now. Have a plan for a hard landing.

          (2) Rebound is common – almost the rule, with relatively few exceptions. The quicker that you take weight off, the quicker you tend to put weight back on. A slow-and-steady approach is generally advised.

          Unless you have a definite health need for immediate weight loss – take your time.

          A lifetime tortoise lifestyle change. Not a hare’s diet sprint.

          (3) It can be like a light switch. Suddenly you feel in complete control and weight loss is easy – and you can’t believe that you will ever backtrack. Unthinkable!

          Months or years later – you look up, you have backtracked and overshot, and you can’t believe you once had such great self control. Hard to remember – was that really me? – looking back in a fog.

          Welcome to being human.

          (4) You know yourself better than anyone else does. If you have had a yo-yo weight pattern in the past – with multiple sizes of clothes in the closet – consider how things got derailed in your past. Consider long and hard. Start putting a plan in place now to avoid following that pattern once more.

          (5) It can be helpful to think of improper eating as an addiction, and treating it as such. Many of the techniques that people apply to substance abuse – alcohol or drugs – can be used to dealing with dietary addictions. Getting stuff out of the house. Identifying and avoiding triggering events and avoiding toxic situations and toxic people. Consider what sets you off – and learn to deal with it while you are feeling strong – and thereby develop new habits, a new lifestyle.

          (6) Consider your relationships before you even start. Will weight loss cause friction in those relationships? If so – is it worth it? Are you ready to face the consequences? There may be people in your life who attempt to discourage you from healthy weight loss. It may be appropriate to speak with them about such matters – or even, regretable as it may be – it may be appropriate to let them go.

          (7) If you live alone, then no problem – you are just battling yourself. If you are married – well, that is why both Ornish and McDougall invite spouses along on their programs – without the spouse on board, you are gonna see a lot of problems. Typical is passive aggressive sabotage – “I made your favorite pie, Dear! – With ice cream!” All smiles. It can be better to die of cardiovascular disease than to muck around with a marriage – this choice is made all the time, eyes wide open. I never argue the point – I am just there to help. Full family at home with a kitchen full of ice cream, cake, candy, soft drinks and chips? All the best to you!

          (8) I have seen numerous situations where people are losing 20 lb. per month. Never ten, never 15 – always 20. I do not know why. Do you? I try to get them to slow it down to 2 lb. a month – maximum of 2 lb./week. I cannot prove it, but I think you get a better health result and a better cosmetic result.

          Less strain on kidneys. Less strain on liver.

          Take it slow and easy.

          People usually took decades to get where they are. If they lose weight at a rate of 2 pounds a month – that is 24 pounds a year – four years to a ~100 pound weight loss.

          More years . . . more potential weight loss if appropriate.

          Weight loss that may be sustainable for the rest of their lives.

          (9) I have seen with Dr. Kempner’s Duke Rice Diet patients the physical changes that obesity wrought even after significant weight loss is achieved. Permanently altered gait: widened hip stance. Permanently altered “barrel” chest (horizontal ribs). “Deflated balloon” skin.

          Slower weight loss is probably better. Really.

          Body may not return to original youthful bathing suit status – but health is much improved. It is best to accept changes gracefully and see victory where you find it.

          (10) Be kind to yourself. A good place to start on that can be to make a special practice – as difficult as it may be – of developing the habit of being kind to others.

          (11) Technical details – there are many of them:

          You wrote:

          “no sugar, no flour, and nothing … othing processed …aka a Whole Foods Diet”

          Deprivation doesn’t work in the long term.

          Will power doesn’t work in the long term.

          DISPLACEMENT works.

          With the two keywords being Variety and Moderation.

          My primary suggestion in regards to displacement is that you expand your food choices as you never have before. Instead of just cutting unhealthy foods out of your diet – which may knock out three quarters or more of your normal diet and leave you with limited, monotonous fare – always displace an unhealthy food choice with healthy ones. Start increasing your diet to include every vegetable, fruit, whole grain and nut (except peanuts), herb and spice that you can shake a fork at. Hey – we are stuck at home these days – this is an excellent time for you to expand your cooking and food presentation skills.

          The following is an excellent resource for both expanding food choices – and for understanding nutrition choices:

          World’s Healthiest Foods 2nd Edition (3rd edition “coming soon”)
          http://www.whfoods.com/book2015/promoletter.html

          Along with the Website:
          http://www.whfoods.com/
          (I have no connection)

          Once your palate has become accustomed to healthier food, you develop the accompanying healthier gastrointestinal microbiome – remember, you are eating for your microbial democracy, not just for yourself. The old saying during pregnancy is that the pregnant woman is “eating for two” – and we are all aware of the irresistible cravings that can come from that wondrous state of being. Well – now that we know about the gastrointestinal microbiome, we can amend that to: “you are eating for trillions” – with those cravings just as powerful. You might look into the topic of the human microbiome if you have not done so, already. Dr. Greger no doubt has videos on the topic. You will find, over the weeks and months, that food cravings change as your prior microbiome is displaced – instead of craving various pastries and candies, or favorite restaurant meals as you drive home from work, you may find yourself craving apples and oranges and veggies with grains and such. Gee – I can’t wait to get home and eat an – apple? Ya gotta be kiddin’!

          The effect is very noticeable. Many comment on it.

          “I just no longer want meat. You know what I had for breakfast today . . . ” Told enthusiastically – do your best to pretend to be interested – it is only kind.

          It is funny how you then go to a party – back when there were parties – anyone remember parties? – and find yourself unmoved by foods that you would previously have found irresistible.

          No will power involved. You appetites have simply been redirected.

          —————————-

          SLOW DIGESTION:

          Slow digestion – which leaves one feeling full and which slows insulin spikes and fatty acid spikes and all the rest – via the following simple techniques:

          30-90 fat calories whenever you intake food (varies with the individual and daily fat allowance and food intake frequency). Advocado, nuts, seeds, 100% cooking chocolate, minimal extra virgin olive oil. [No high heat cooking – sautéing or baking – with extra virgin olive oil – smoke point of real extra virgin olive oil is traditionally given as 250-300 degrees]. Sufficient fat with each snack/meal will typically close off the pyloric sphincter and keep food in the stomach for ~2-3 hours – making you feel satisfied (“full”) – plus later the fat brings about contraction of your gallbladder so that you do not end up with gallstones. Gallstones are otherwise a not uncommon bane of dieters.

          Avoid cold beverages. Cold beverages can open your pyloric sphincter in seconds, emptying your stomach and then you no longer feel nearly as full. This is why restaurants encourage cold drinks – with lotsa ice! – your stomach now empty, you have lots of room for more food – maybe even desert!

          Never partake in smoothies. You want to slow digestion – not speed it up. It’s pretty simple. Smoothies are just a way of selling blenders – and raising your blood sugar spikes.

          Eat slowly and savor your meal. Consider cloth tablecloth. Cloth napkins. Music. Centerpiece. Candlelight. Humans.

          Eating should be an event – not just the most efficient method possible to sustain life.

          We are not Jetsons.

          —————————-

          My own take on a healthy diet specifics is simple, but specific to my own health status. Yours may vary as per your own particular health status. If you have health issues – diabetic, blood pressure or cholesterol medications or other medications – diet only with close collaboration with your locally licensed Physician.

          In order of priority:

          Variety. Moderation. Whole foods plant based diet: Vegetables, legumes, whole grains (preferably unprocessed), fruits, avocado, nuts, seeds, minimal extra virgin olive oil, guilty pleasures.

          Protein: 9-13%. Consider going for the low end if decreased renal function is a concern. Recommendations on liver compromise have changed – and may be complex – I have not kept up. Kempner went down to 4% protein – but that was closely monitored by people who knew exactly the what when and how of exactly what they were doing! Do not try this at home! Stick primarily with morning and evening meal protein.

          Fat: 10-20% – consider going for the low end if acute cardiovascular disease is a concern. Note that Ornish encourages ~10%, Pritikin went 5%, Kempner went 2.3%. Esselstyn encourges no added fat in severely affected cardiovascular patients (no nuts, avocados etc.) – but there is actually some small amount of fat in veggies (corn – 8%), whole grains, etc. Low fat appropriate to cardiovascular patients may be inappropriate as they slim down and they have depleted their intrinsic fat reserves – at that point you may see dry skin and dry brittle hair – back off!

          Complex Carbohydrates: “. . . and the rest . . .” https://www.youtube.com/watch?v=cfR7qxtgCgY
          (Think of Dr. Greger as the Skipper . . . )

          Na+ – 500-1200 mg daily

          Added sugar / refined carbohydrates – < 6 teaspoons of sugar = <~90 calories (sugar) = <~25g. (sugar)

          B12

          Vitamin D – probably best via minimal solar noon exposure

          Physician Vegetarian / Vegan monitoring as appropriate: (1) B12 (2) Fe (CBC – I like Hb, others like Hct, Haematologists like MCV – whatever); Transferrin is useful here and there, but has more pitfalls in interpretation. (3) If Fe abnormal, get Zn – particularly if undergoing Fe supplementation. (4) If Zn abnormal, get Cu – particularly if undergoing Zn supplementation. (5) If Cu is low, throw up your hands and run around like a duck. Or – if there is any way to check molybdenum, do so – we are now way out of my knowledge zone.

          ——————————

          For myself, in addition to the above I chose to add oysters – cooked – only after encountering iron and zinc deficiencies. Diagnosed by a skeptical Board Certified (x3) M.D. Haematologist – one of the best. I hate being right! Oysters are very high in Zn, Fe and Cu. So – while Veganism did not work for me, I did give it my best shot. I will note, in passing, that in Dan Buettner's Blue Zones work – none of the world's longest lived populations are Vegan, which may give some of us a red flag in regards to Veganism – and four out of five of the longest lived populations typically eat some form of animal ~4-5 times a month. My motivation on diet is health and longevity, not ethics – others with a primarily ethical Vegan orientation tend to reject the Blue Zones data. Fully understood and respected.

          ——————————

          I commend Dr. Greger's daily dozen to your attention. That should take care of your nutritional requirements:
          https://www.youtube.com/watch?v=MqmSMunAtss

          You may find the following to be of interest, as well:

          What Are the Healthiest Foods?
          https://nutritionfacts.org/video/what-are-the-healthiest-foods/

          ——————————

          John A. McDougall's Free McDougall Program may merit your attention:

          https://www.drmcdougall.com/health/education/free-mcdougall-program/

          There is a lot of other good information on Dr. McDougall's site, as well.

          Well worth exploring.

          ——————————

          For controlling weight – losing, stabilizing or gaining – nothing beats the work of Jeff Novick, MS, RDN. Warning: the following may be life altering:

          Calorie Density: How To Eat More, Weigh Less and Live Longer
          https://www.youtube.com/watch?v=0CdwWliv7Hg

          ——————————

          If you would like to see issues from the viewpoint of a Dietitian, I have found Virginia Messina's The Dietitian's Guide to Vegetarian Diets: Issues and Applications – to be useful. Now in it's 3rd Edition. To read this, it may be helpful to have a biological science background – this is more a dense information-filled scientific textbook than it is an accessible layman's book:

          https://www.amazon.com/Dietitians-Guide-Vegetarian-Diets-Applications/dp/0763779768/ref=sr_1_5?dchild=1&keywords=Virginia+MEssina&link_code=qs&qid=1597119930&sourceid=Mozilla-search&sr=8-5&tag=wwwcanoniccom-20

          There.

          Simrose.

          That should get you started.

          Bon appétit –

          Vivamus

          1. The body makes all the fat (and cholesterol) it needs except for the two essential fatty acids – ALA and LA.

            The long lived Okinawans on their traditional diet obtained just 6% of total calories from fat. Other Japanese obtained 8% of total calories from fat. They too were noted for exceptional longevity.
            https://www.researchgate.net/publication/5859391_Caloric_Restriction_the_Traditional_Okinawan_Diet_and_Healthy_Aging_The_Diet_of_the_World's_Longest-Lived_People_and_Its_Potential_Impact_on_Morbidity_and_Life_Span

            That said, from memory, I think that the WHO advises that a minimum of 15% of total calories should come from fat while the US has recommended 20%

            1. Mr Fumblefingers,

              By memory – USDA recommendations used to be 20-35% fat. That is why I was surprised that I could not find a percentage recommendation in the 2015-2020 guidelines.

              I accept you earlier explanation of the reasons that they moved away from specific percentage recommendations on such matters.

              Thanks, again.

              But I still find percentages to be very useful.

              Keeps me focused.

              By memory – I once read a Nutrition Action article article stating that ~40% of dietary fat (U.S) came from fried foods and ~20% from dairy.

              I remember thinking – you mean I can eliminate 60% of dietary fat just by knocking out fried foods and dairy? Heck – I can do that!

              Excess pounds started meltin’ away . . .

              As you get down to the lower percentages of dietary fat – you start thinkin’ – instead of fats being “BAD” – uh – gee – what remaining fats should I actually be getting?

              Saturated – no. Transfat – no. Rancid – no. Heated past smoke point – no.

              Turns out it looks like a balance of omega-3s and omega-6s. Typically meaning a reduction of omega-6s, without outright elimination.

              With some remaining skepticism that present-day science really has a full understanding of these fats – or any nutrition topic – fully down.

              So I also go with the variety / moderation – and consideration of traditional practices of long-lived peoples – as a backstop.

              The Okinawans seem to be as good – or better – a yardstick as anything from modern nutritional science.

              Those wild and crazy Okinawans – they sure know how to party!

              Mr. Fumbelfingers.

              See ya about –

              Vivamus

              1. The 20% of total calories from fat figure comes from the old Institute of Medicine RDAs as a MINIMUM requirement
                https://www.nap.edu/download/10490

                But you are right, the Guidelines RECOMMENDED amount was that 25-35% of total calories should come from fat. These figures are actually still in the US Dietary Guidelines but they are not up-front ….. they are buried in Appendix 7 where no-one is likely to find them
                https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-7/

                I don’t know why the National Academies 20-35% figure is different from the Dietary Guidelines 25-35% figure. I’d probably have to read both documents from beginning to end to figure that out and, well, I am not getting any younger.

                1. Mr Fumblefingers,

                  This is VERY helpful.

                  “The 20% of total calories from fat figure comes from the old Institute of Medicine RDAs as a MINIMUM requirement
                  https://www.nap.edu/download/10490

                  Good stuff! Thanks.

                  Copy downloaded.

                  I hadn’t realized that this stuff has largely not been updated since 1998-2001.

                  I wonder how they determined their “minimum” level of 20% fat calories.

                  <>

                  Thanks, again!

                  I am reading 20-35%. Column: Male, 51+, 2000 calories.

                  But close enough.

                  I had looked through the 2015-2020 US Dietary Guidelines several times for the fat percentage numbers, but gave up. I will admit, I somehow did not reach Appendix 7. ;-)

                  Mea culpa.

                  But that was pretty well buried.

                  Good find.

                  Now – probably best to move on to today’s Dr. Greger video and let this thread rest.

                  See ya in the future time –

                  Vivamus

        3. Simrose,

          That is a nice testimonial.

          Pre covid, I started taking Vitamin D and for weeks and weeks I slept at night after decades of insomnia.

          Something happened during covid that I stopped sleeping again, in spite of taking D3.

          I think in the beginning, I was afraid for my loved ones and we had someone at work call in saying that they tested positive.

          I switched back to processed food during that time and my brain problems and sleep problems came back with a vengeance.

          Probably the oils in the packaged foods.

          I am not sure.

          Not sleeping has probably resurrected the brain problems.

          My brain had been so much better and the D3 seemed to help my sleep.

          I did switch brands because of COVID.

          Boy, I would like to sleep again.

    2. Simrose, congratulations on both your weight loss and on your decision to address the problem. You might look into the Ornish and Esselstyn whole foods plant based diets too. Those are designed to prevent and even reverse heart disease and diabetes, conditions that are common in people who need to lose weight. Medicare actually covers the cost of the Ornish program, but it is not offered in very many cities.

      Also, and I am not sure whether this is true (who knows whether anything one reads or hears is true these days!) but my physician said to eat the amount of calories recommended for your weight on alternate days, and cut calories on the intervening days. That way your body won’t adapt to the lower caloric intake by becoming more efficient with calories and thus slowing weight loss. She personally does religious fasts in addition.

      If you are on a statin and go on one of these diets, you can track your progress by watching for an improvement in inflammation (CRP) and LDL. If you already have plaque buildup, the advice is to track your progress with a calcium score test annually. The radiation is supposedly similar to that involved in a mammogram.

      If you have high Lp(a)–a genetically determined independent risk factor for heart disease– I believe the recommendation is a raw foods vegan diet, although I am not sure whether the benefit to the participants in the study came from the amount of fruits and vegetables they consumed or from what that restrictive diet prevented them from eating. You can track any influence of diet with an inexpensive blood test for Lp(a). The study concluded that exercise had no impact on levels, but the vegan diet did help to reduce levels of Lp(a).

    3. Simrose,

      “How Not to Diet” is a great book!! 5000+ cited references — which is so many that they are only available online (They would take up too many pages in an already very thick book), where you can click on the links to the see the publicly available parts of the articles. The book is long, but packed full of information. I found it fascinating — and I don’t need to lose weight. I first lost weight as a vegetarian by practicing portion control and making healthier choices, and then lost even more without trying after switching to eating whole plant foods, and avoiding animal products, and processed and prepared foods. And, avoiding added sugar, oil, and salt.

      That said, it didn’t happen really fast. The first time I lost about 25 lbs over about 18 mos, and the second time about 10 lbs and I can’t remember over what time period. Each time, I have kept the weight off (22+ years and about 4 years).

      Good luck! You seem to be heading in the right direction.

      As for the video series, I think they are excellent. He lays out the current state of the research very clearly, and it takes time to do that. That’s why I find this website one of of the most credible sources about nutrition out there.

    4. Great job @simrose. SO, if by whole foods diet you mean not just veggies fruit and nuts seeds and legumes but also NO meat dairy fish – i hope, then you are on the way and will likely see real results in your blood tests at your docs office -if you haven already.

      Except: Please find and take B-12. This advice, for a similar question, was given to me by Dr. G himself, with NO OTHER ADDITIONAL INSTRUCTIONS.

      I was surprised, and I do know he suggests other supplements intake, but the rule of thumb here is that following your Daily Dozen plus the 21 tweaks (free in app store), PLUS B-12, is likely better than the majority of vegans! like really 95% of them.

      (Its sort of a set-it-and-forget-it thing.)

      If something pops up in your health it may show a deficiency…you will notice it right a way since you will be operating optimally except for a few tweaks, like Vitamin D for instance, or Sodium, if you are going no salt as well.

      Hope this helps

  4. I’ve been a strict vegetarian for 48 years and a vegan for 46 of those years. I suggest looking at iron levels which I was disappointed to find has been a problem for me. I’m back in the normal range with supplementation. Vegetarian iron is harder to assimilate. It would seem to be a problem for vegetarians and more of one for vegans.

    1. “To maximize iron absorption, consume legumes [lentils and beans] with foods high in vitamin C, such as tomatoes, greens, [peppers, kiwi] or citrus fruits.”
      “Also avoid foods, beverages, and supplements that reduce iron absorption for up to 2 hours before and after iron-rich meals. These include black tea, calcium supplements, coffee, dairy, eggs, peppermint tea, red wine, and antacid medications.”.

      1. Caroline and Stephen, that isn’t enough for some patients. I advise taking a product called Raw Iron derived from plants for those with iron deficiency anemia.
        It’s easy on the gut unlike the type most docs prescribe. Also less likely to feed cancers which intravenous iron can do. This type is non-heme iron making it a safer form.
        Heme iron is absorbed by the body even if you are already too high, which is why I don’t use it.
        I ask all patients to have a baseline ferritin test done. How the body handles iron varies widely. It’s surprising how many people have problems with iron levels, both too high or too low.

      2. Caroline, the other day we were talking about b12 levels that were “too high”. Just wanted to let you know that I had mine retested last week, and it came in perfect according to the doc. The result was over 700 last January, but with taking nothing the first 3 months, and averaging 2 x 1000 mcg b12 per month afterwards, it has settled at a good spot.

        Also, my iron is finally back on track at 26, which is really good considering past results.

        Lastly, the big surprise was a large improvement in kidney eGFR which went from around 60 to 65 to 84!
        I only post these so that people will know it’s possible to improve the numbers.

        1. Barb,

          Excellenter!

          The improved eGFR results may not be unexpected. Dr. Greger has some excellent videos along that line.

          I find that lowering dietary protein – particularly reducing animal protein – but also plant protein – may have a beneficial effect in renal labs over time.

          You might consider evaluating your own protein intake.

          Just don’t overdo any changes – variety and moderation. And keep protein intake fairly steady, day by day – protein is water soluble and doesn’t really stick around that long – if you go without, you may have to cannibalize your muscle mass – not the purpose of this exercise, which is imporved health, not decreased health.

          Breakfast and dinner are probably the best times for protein intake – not the trypical American lunch and dinner.

          Consider looking at the protein intake of the traditional Okinawan diet – a restricted calorie diet.

          The following is largely from an excellent earlier “Toxins” post on NutritionFacts (is Toxins still out there, somewhere? – excellent posts!)

          Traditional Okinawan Diet
          (longest lived females on the planet – note that the traditional Okinawans can be said to be Whole Foods Plant Based, but they are not Vegetarian)

          “The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span
          Ann. N.Y. Acad. Sci. 1114: 434–455 (2007).

          9% protein
          85% carbohydrate
          6% fat (2% saturated fat)

          Data derived from analysis of U.S. National Archives, archived food records, 1949 and based on survey of 2279 persons.

          Some points

          Their diet was 85% carb, and 6% fat. Sweet potatoes (a Japanese sweet potato) made up almost 70% of their calories.Nuts were less than 1% of calories (the equivalent of 1/10 of an ounce a day) Oil was less than 2% of calories (which is about 1 tsp a day) and sugars were less than 1% of calories (less than a tsp a day)

          The total animal products including fish was less than 4% of calories which is less then 70 calories a day. That is the equivalent of around 2 oz of animal products or less a day.”

          Barb.

          Be well –

          Vivamus

          1. Thank you Vivamus! Very helpful comments! There is always room for improvement in my menu plan, and protein has been on my mind. With increasing exercise, and attention to kidney health, I will endevour to get a little protein on a regular basis. My energy is picking up as well. All good :) thank you again!

          2. Questions about B-12 and Protien:

            B-12. it came to me that (aparently like Iron) B-12 must be a supplement we take if we follow WFPB diet, low or no salt suger fat added.
            But – my question is: How can this be a recommended diet if the foods we eat cannot give us all our body needs? (goes to the question of is this natural for humans? Aren’t we hunter gatherers?etc…)

            Protien:
            How do we truly know if we get enough, or too much? (assume its all plants based for this question)

            1. A WFPB diet is not necessarily totally vegetarian.

              It can include small amounts of animal foods. Indeed WFPB diets like the traditional Okinawan, Japanese, rural African and traditional rural Chinese diets all did. They would have provided sufficient B12 to meet people’s needs although it is possible that small amounts may also have been provided from unchlorinated stream/river/well water etc and unwashed vegetables.

              1. I assume they washed vegetables. Ive interpreted Dr G’s suggestions that even a small of amounts of animal protein produces an endothelial catastrophe and unleashing of inflammation and free radicals, as direction that they should therefore be avoided.

                So, at 2 oz. of salmon per day for the Oki’s, is that sufficient to give us enough B-12 given the absorption rate?

    2. Apart from adding Vit C to your meal for better mineral absorption, the following also helps:
      -Soak legumes overnight to absorb minerals better.
      -Germinate rice to get to the same result (and to decrease arsenic).
      -Eat only sourdough bread

    3. Source of Life Raw Iron is the best iron I have ever come across. Made from whole food, not ferrous sulfate. No bad stomach effect. 3 per week for a man keeps me out of anemia.

      1. Dear Reality Bites, do you mean, Garden of Life as that is the site I was taken to when looking up this product as I have been diagnosed low in iron and told to supplement. Does the product you use also include other vitamins. Thank you Lesley

    1. Sweet Marilyn,

      Always helpful.

      I think that high homocysteine could have been a big part of my brain problems.

      Hard to say because it would have been blood sugar, aluminum, homocysteine, saturated fats, and lack of certain nutrition, including Vitamin D.

      I just looked up whether saturated fat also is linked with high homocysteine and foods with oils and fats, including vegetable oils were linked to high Homocysteine, even after adjusting for B vitamins (folate, riboflavin, and vitamins B-6 and B-12) in addition to age group, sex, energy intake, smoking, and coffee intake

      Pre-diabetics and diabetics have higher homocysteine (which already makes sense with it being linked to saturated fats.) It was interesting to me that glycemic status only had a close association with homocysteine in diabetic males only. They think because of sex hormones, so maybe the fact that my brain breakdown happened post-menopausal, it may still be that blood sugar was a key factor. But saturated fat probably was a bigger factor.

      I was also noticing that heavy metals can influence Homocysteine metabolism.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022705/

      I guess when you have all of it, the equation becomes harder to unwind things.

      What becomes clear is that I could fix my nutrition levels but if I don’t fix my fats and keep away from the heavy metals, B12 might not work.

      My confession is that during COVID, I had gone back to things like Vegan pizza and I also went back to cooking that on aluminum foil and I did start having hallucinations again. I am back on the Fiji water.

      But it just shows that more than one thing is involved with the brain problems.

      1. Deb, you are right, it all plays together.
        For high aluminum levels I use Boron. Because it is in the same family as aluminum it can block absorption and lower aluminum levels in the body.
        If fact, I suspect Boron deficiency is one of the reasons some people’s levels of aluminum are too high.
        Boron is so helpful for arthritis also. And it’s fairly cheap. The studies were done with Boron from the form Calcium Borogluconate.

        I know many here don’t approve of supplements. But not all people have the same genetics. And for some people supplements are necessary. Many companies do produce reliable, tested products.

        Abstract on aluminum and boron. You can just read the last sentence for the ‘bottomline’. :)
        https://pubmed.ncbi.nlm.nih.gov/20663653/

        1. Marilyn,

          Wow, thank you so much!

          Boron is a new topic for me. Very cool.

          I will definitely be looking it up.

          I know that the Fiji water got rid of most of my hallucinations but that I got them back one time when I had symptoms of low B12 when I was on Methyl B-12.

          Hallucinations are so emotionally painful.

          Once I start having them, it affects my sleep so much.

          It is hard to sleep because they are so distracting and I become afraid of losing my mind again.

          I haven’t gone back to where I was years ago.

          These dietary changes have helped.

          Sleep might help but I lost it again during COVID.

          It and the fact that I haven’t had power and the fact that I couldn’t get on any website other than Nutritionfacts.org at all might be partly why I over-post.

          I will try the boron.

          Thanks again.

          1. Deb, You are having to handle so much right now.
            Covid has been stressful for many people and that makes it harder to make good food choices.
            Sure hope and pray you get power turned on soon!

          2. Deb, I surely have no idea what causes your hallucinations, but schizophrenia/schizoaffective disorder runs in my family. My father’s nutrition book from med school in the 1940’s said low B vitamins are often to blame for that condition. More recent discussion: “Folate (B9) and B12 are often deficient in schizophrenia, and associated with symptom severity. Furthermore, B-vitamin supplementation can significantly reduce symptoms of schizophrenia and reverse some neurological deficits associated with the disorder.”  academic.oup.com › schizophreniabulletin › article…”Over the past 35 years numerous studies have shown a high incidence of folate deficiency correlated with mental symptoms, especially depression and cognitive decline in epileptic, neurological, psychiatric, geriatric, and psychogeriatric populations…In adult patients presenting with megaloblastic anaemia due to folate deficiency,…the degree of anaemia is poorly correlated with the presence of neuropsychiatric disorders, but if these anaemias were left untreated nearly all patients would eventually develop neuropsychiatric complications.”

            Since quite a few people in my family unfortunately have this condition, I did genetic testing with one of the genealogy websites, and had the results interpreted by promethease.com.  I found that I have a number of the gene variants associated with the condition, plus difficulty converting folic acid to folate. I will have to look again to see if there was impaired B12 absorption too. So I am avoiding anything with folic acid. It is found in most vitamins and nutritional yeast products, and in many processed foods. I am assuming that folic acid, which I cannot convert well, might block absorption of folate.  And of course I take a B-12 supplement too.

            I don’t know if this might apply to your condition, but my brother who is schizophrenic noticed that his hallucinations are triggered by low frequency noises, like the hum of a ceiling fan in the next room. His brain misinterprets this as people talking. “Patients with schizophrenia (ScZ) often show impairments in auditory information processing. These impairments have been related to clinical symptoms, such as auditory hallucinations. Some researchers have hypothesized that aberrant low-frequency oscillations contribute to auditory information processing deficits in ScZ.”

      1. But “vegetarians” then, can also have both markers high though right?. They can consume lots of animal foods, like dairy, eggs and fish. An Ovo-pescatarian who loves yogurt for instance, consumes enormous amounts of animal foods.

        The Taiwanese study showing 1/2 the risk of stroke is including the more strict vegetarians I presume? (No eggs and fish but some dairy perhaps)

        Why would they show half teh risk as a vegetarian when Gregers studies show higher risk of stroke for Veggies?

  5. To all the newcomers, videos are posted daily or close to it. This series on Stroke will all come on the site over the next 2-3 weeks. If you don’t want to wait, then the paid download (or the webinar that precedes it) are options. If you don’t want to pay, just wait a tiny bit.

    Being patient is a wonderful positive emotional quality. Your stroke risk is not going to change significantly in 2 weeks.

    But if you don’t want to wait, read https://nutritionfacts.org/2014/12/18/the-vitamin-everyone-on-a-plant-based-diet-needs/.

  6. So Veg has similar risk of stroke to Meat, so why not just accept it? At this point you want to avoid risk of cherry picking data to promote a bias. Incidentally, I am mostly vegan but have a balanced diet that includes some meat. Veg is better but meat is not all bad. Just limit consumption.

    1. Dr Greger has been making the point for many years that most so-called vegetarian and vegan diets are just as unhealthful as omnivore diets. That’s why he promotes whole food plant based diets (not ‘vegan’ diets).

      These can include small amounts of animal foods.

      As for cherry-picking data, Dr Greger didn’t mention the recent Taiwanese study which showed that ‘vegetarians (vs nonvegetarians) had only about half of the risk of overall stroke throughout various models.’ This was despite the fact that ‘vegetarians’ had higher levels of homocysteine and of B12 deficiency than non-vegetarians. The authors discuss the differences between their findings and those of the EPIC Oxford study.
      https://n.neurology.org/content/94/11/e1112\

      In any case, even the EPIC Oxford study showed that vegetarians/vegans had 10 fewer heart disease cases versus 3 more stroke events for a total of 7 fewer cardiovascular cases overall. How does that validate your decision to eat meat? It seems a bit like that cherry-picking of data to support your position that you mentioned in your post.

      1. In the June 2020 Journal of the American College of Cardiology, a respected group of nutritionists rejected the association of saturated fat with cardiovascular disease. JACC is THE authority on cardiology in the US. The title of the article is: A Reassessment and Proposal for Food Based Recommendations: Saturated Fat and Health: JACC State-of-the-Art Review.

        This is a review of numerous full-blown randomized clinical trials and observational studies on saturated fat and heart disease and metaanalyses of these studies. It points to the abundant evidence that has been accumulating in the past 10 years that saturated fat is not bad for us. Evidence that Dr. Greger never talks about. Better science than what came before. For example, Chowdhury, 2014 Annals of Internal Medicine found that high levels of saturated fat had no effect on coronary disease. Siri-Tarino 2010, Amer. J. of Clinical Nutrition- 5-23 year follow-up of 347,747 subjects found that intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. EPIC trial with 500,000 middle-aged adults in 10 countries found that red meat was not linked to CVD mortality. I may be mistaken, but didn’t Dr. Greger quote the EPIC trial as finding a link between meat and CVD? Processed meat, as I recall, but not red meat.

        Here is what the authors of the JACC review said. Astrup & others- “Although SFA’s increase LDL-C in most individuals, this is not due to increased levels of small, dense LDL particles, but rather larger LDL, which are much less strongly related to CVD risk. Whole-fat dairy, unprocessed meat, eggs and dark cholcoate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.

        Alpha linoleic acid, polyphenols, and omega-3 fatty acids present in nuts, EVO and oily fish rapidly attenuates inflammation and coronary thrombosis.”

        This is why eating omega-3 fish or taking fish oil is so beneficial. The benefits are 50 times greater than the risks. Here is a discussion of the JACC review by Dr. Ford Brewer, a former head of preventive medicine at Johns Hopkins. https://www.youtube.com/watch?v=mNm6Sa2RZLQ
        I believe that the JACC review also said that saturated fat reduced the risk of stroke, but I don’t have that reference. It might have been in one of the studies that were reviewed.

        On dairy, see the Golestan Dairy Food Intake Study, a 10 year study that found a lower risk of all cause mortality and CVD and CVD mortality in 42,000+ subjects. It also found no association between dairy intake and cancer. It found that the highest quintile of subjects saw the greatest benefits. This was not a dairy industry study, but was funded by the National Institutes of Health, the National Cancer Institute, Harvard, Mount Sinai and some research institutions. Makes for interesting reading. https://pubmed.ncbi.nlm.nih.gov/28369205/

        1. That article is just propaganda by a bunch of professional saturated fat apologists – the self-styled Nutrition Coalition – bankrolled by the same billionaire low carber who funded the laughable NuSi initiative of Gary Taubes and Peter Attia.
          http://plantpositive.com/display/Search?moduleId=19496100&searchQuery=nusi

          This Nutrition coalition is just as dodgy as NuSi … but money talks.
          https://thehill.com/blogs/congress-blog/healthcare/257353-coalition-is-full-of-baloney-on-nutrition-guidelines
          https://www.politico.com/story/2015/10/the-money-behind-the-fight-over-healthy-eating-214517

          1. As if Dr. Greger is not a propagandist and idealogue! He certainly is. He will never tell you about evidence that refutes his position. Very lacking in objectivity. He cherry picks his evidence as others have pointed out. JACC is THE authority in this country on cardiology.

            1. That was not a position paper by the JACC. It was merely an article published in a journal.

              I saw that article a week or two.ago. Few people are dumb enough to believe a paper by a bunch of professional saturated fat apologists bankrolled by a naive low carb billionaire. Obviously.Greger is not one of them.

              That’s why every credible health authority in the world recognises that saturated fat is a risk factor for heart disease. It is only the meat, dairy and egg industries, the Atkins Foundation and various low carb/keto sock puppets that argue differently.

              You are either very naive or a low carb troll. Whichever way, your accusation that Greger is a cherry picking idealogue is a breath-taking example of gaslighting.

              1. Look at the Golestan Dairy Intake Study. I just produced the links in response to another comment of yours. It’s absolutely false that every credible authority in the world recognizes that saturated fat is a risk factor for heart disease. This is untrue if you are talking about FOOD, as the Golestan Study shows. This study funded by the NIH, the National Cancer Institute, Harvard and other research institutions found an inverse correlation between dairy and all-cause mortality, CVD, and CVD mortality. This was especially true for yoghurt and cheese. This result has been confirmed by other reputable studies, including the two huge Harvard observational studies, The Nurses Study and the Professionals Study.

                No, I am not gaslighting when I say that Dr. Greger is an agenda driven propagandist. There is nothing wrong with being agenda driven, or an idealogue, when you have have facts on your side and you are dispassionately seeking the truth, rather than ignoring facts that don’t fit your agenda. How often does Dr. Greger refer to a study that shows that his position is at least controversial, if not actually wrong?

        2. It 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

      2. I haven’t seen or read Greger suggest we eat a single ounce of animal protein. To teh contrary he has shown what even one serving does to the bodyin terms of damage.

        Can you point me to his years of recommendations to include a bit of animal that you suggest in your post?

        (I have heard him say he will eat a slice of birthday cake like once a year etc, but haven’t heard recco’s to make sure one includes it in their diet.)

        Now….I have seen people here tease you about ice cream consumption, so perhaps you are projecting the “years of recommendations” on Greger? ;)

  7. Looking at the provided charts it appears the raw data suggest that both I.S and H.S. is lower for Vegans. If the original study was established with a homogeneous group this would indicate that vegans had lower stroke levels. If the original group was not homogeneous the the study is at best slightly flawed.

    IS meat eaters =7.75 per 10,000 therefore vegans would expect 24 vs the actual 19.
    The same for the HS group.

  8. People eating hot pepper had much lower but not significantly lower stroke risk. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222470/ Vitamin D3 and B12 are recommended for reducing stoke risk. Dr. Greger in his book recommends potassium rich foods to prevent stroke. Are there other minerals like Magnesium to prevent ischemic stoke? Pumpkin seeds which are rich in Magnesium and other plant compounds can reduce risk of stroke, maybe more than the mineral. Other foods that can reduce the risk of stroke include spinach, garlic, walnut, pumpkin seed, dark chocolate, avacado, whole grain, beans, nut almond, banana,vegetable, sweet potatoes and oatmeal. Tea reduced the risk of stoke. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411099/ Do you think the brain is very acid from all the chemistry and oxidation? The body uses Silicon to stop acid erosion. If an ischemic stroke is acid erosion wearing through the lining of the brain, than Silicon is the mineral to take to stop acid erosion. Do potatoes and bananas reduce iscehmic strokes? Yes they do and they are rich in silicon. They thought it was the potassium. Maybe it was the silicon and the other more superior compounds in them. The Silicon and the Potassium and the other nutrients work as a whole to stop ischemic strokes.

    1. Matthew Smith,

      Thanks for the list of foods that can reduce stroke risk which includes DARK CHOCOLATE!!

      My day has already improved!

      I eat all the rest of the foods on that list, but dark chocolate iss a special treat, a guilty pleasure. In moderation, of course. I knew it had fiber, and phytonutrients…now I can add one more benefit. And lose the guilt.

  9. I have questions related to sunshine, not Vitamin D per se. Ever since it was recommended to use sunscreen and avoid the midday sun, skin cancer incident rates have been skyrocketing. From 8 per 100,000 in 1975 people to 26 in 100,000 in 2016.
    Source: https://progressreport.cancer.gov/sites/default/files/graphs/lbox_din11.jpg

    I know that we eat less raw fruits than ever before. I also know that the ozone hole was an issue in the past but 15 years it’s been normal again. Is it possible that sunscreen and midday-sun avoidance have created a situation that combines the worst of all world? Because of sunscreen and afternoon sun, we feel saver but actually get more UV, more toxins and less Vit D?

    Yes, sunscreen can protect from skin cancer. So do hats and shirts. Such a comment is scientifically meaningless without context. The real question is, is avoiding the the sun more beneficial than producing Vit D, Q10 and melatonin? Similarly, yes the afternoon sun has less total UV rays but it also produces less Vit D or none at all. Are 10 minutes unprotected midday sun really worse than 2 hours protected afternoon sun? Without context and risk/benefit analysis, we cannot say for sure. Also, what does it say that people who get skin cancer tend to live longer than people who don’t get skin cancer?

    I was just made aware recently that the FDA does not approve “cosmetics” scientifically, the same way they do with food and drugs. “Cosmetic products are not, in general, subject to premarket approval by the FDA”. This explains a lot imo.
    https://en.wikipedia.org/wiki/Food_and_Drug_Administration#Cosmetics

    The WHO has warned re skin absorption since 2005. It was only in January 2020 that the FDA tested skin absorption of sunscreen for the first time.
    FDA Blog: https://www.fda.gov/news-events/fda-voices/shedding-more-light-sunscreen-absorption
    WSJ: https://www.wsj.com/articles/sunscreen-chemicals-accumulate-in-body-at-high-levels-11594978201
    Full Study: https://jamanetwork.com/journals/jama/fullarticle/2759002

    The main finding: “all ingredients of all sunscreens are always absorbed by the skin and all enter the body and bloodstream”. It does not matter what type of sunscreen or how often you use them. The FDA planned follow up studies for Nov 2020 but the Trump administration cancelled funding according to the WSJ. Imo, no further research is needed. All we have to do is ban all cosmetic ingredients that are not approved as “food”. E.g. zinc is approved as a food supplement, but what about all the other ingredients usually present in mineral lotions?

    How does the FDA respond? “Given the recognised public health benefits of sunscreen use, the FDA strongly advises all Americans to continue to use sunscreens as this important rulemaking effort moves forward”. In other words: “please use XYZ while we check the risks involved”. If somebody claimed that a drug like Hydroxychloroquine was beneficial for treating Covid-19, the FDA usually goes out and does a randomised control study to evaluate cost/benefits. If the risks of taking Hydroxychloroquine are higher than the risks of Covid-19, the drug does not get approved/recommended to the general public. The regulatory world is very different when it comes to cosmetics, including sunscreen. At least Covid-19 forced the FDA to look deeper into sanitizers:
    https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use

    I hope that we do not wait years to apply the same science we use for food & drugs to cosmetics as well. We have known for decades that the skin is our biggest organ and absorbs everything we put on it. That’s why nicotine patches work. Anything we put on our skin is part of our diet. Unless you would eat the same amount of sunscreen or soap regularly, don’t use it.

    A bit of lemon juice (Vit C) applied topically can protect you from the sun and wrinkles without preventing Vit D production. Eating enough Vit C and chlorophyll is even better, but who does that?
    https://lpi.oregonstate.edu/mic/health-disease/skin-health/vitamin-C#photodamage
    https://pubmed.ncbi.nlm.nih.gov/8869680/

    The cosmetics industry knows about all of this but doesn’t want you to know about this. Why? “The stability of vitamin C in topical solutions is a concern, as exposures to air, heat, and/or light may slowly degrade vitamin C. Although the natural form of vitamin C, ascorbic acid, is the most effective for topical administration (11), it is the least stable in solution. However, stable synthetic derivatives, such as ascorbate phosphate, are considered to have limited permeability (11) and function in skin (13, 14).”

    Ie, Vit C is not ideal for products that require a shelf life that is longer than 1-2 weeks. Imagine something really cheap that protects you from the sun, aging and from wrinkles while enabling Vit D production. No sunscreen or lotion on the market can compete with this. You don’t have to exercise for hours in the sun with sunscreen on. My takeaway is, get accustomed to 10-15 min midday sun and use Vit C and greens as your protectors. Reduce afternoon sun exposure. In other words, reduce your total UV and toxins (sunscreen) exposure while increasing your Vit D. Trust peer-reviewed research science but do not trust political bodies too much. Demand proper control studies and cost-benefit analysis from your advisors. If you only hear, “avoiding the sun and sunscreen reduces skin cancer”.. run. It’s not worth your time and health.

    1. Note: It amuses me that we make fun of Trump regarding his suggestion to ingest sanitizer. Given that is a well established fact that the skin absorbs everything we put on it, we’ve been doing this knowingly for a long time without checking health risks in detail? The joke is on us?

    2. Hugo,

      There is a documentary on Amazon Prime about healing cancer from the inside out.

      Some of the WFPB doctors are in it and that topic came up.

      If I remember they also discussed diet and how the Okinawan’s smoked and had serious air pollution but didn’t get diagnosed with lung cancer until they added animal products in their diets.

      Dr Greger talked about the Japanese and I think he said that they did have cancer upon autopsy, it just wasn’t growing all that fast without the IGF-1.

      One of the doctors speculated that the same phenomenon might be happening as to why people who never go outside keep getting skin cancer.

      My friend had it where the sun don’t shine.

      1. Thanks for this, Deb.

        90+% of skin cancer arises in areas that don’t get enough sun exposure. E.g. Bob Marley spends 8 months in the UK wearing shoes. Then he visits Jamaica and goes barefoot for the first time and gets skin cancer there. He felt safe because he is half-black. We wouldn’t run a marathon without training first. But most of us ask our skin to do just that. Instead of training we use performance enhancing drugs aka sunscreen.

        Because of sunscreen, we have lost the art of getting accustomed slowly to the sun. E.g. 5 min unprotected midday sun in April, 10 min in May, 15 min in June…

        Yes, Dir Gregory has a few relevant videos in this regard. Sunburn is inflammation and many plants can prevent and decrease inflammation. E.g. There is a video that shows how topical application of broccoli sprouts reduces burns and inflammation on the skin. Another video shows how greens reduce wrinkles. However, broccoli sprouts or leafy greens are not ideal for topical applications. I try to eat them as much as possible.

        The same with Vit C. The official RDA is far too low. Those who eat enough Vit are better protected against the sun. We’ve known this for decades. For those who don’t have time to eat enough Vit C on a daily basis (berries, melons, red peppers, mangos, citrus fruits etc) – a topical application can work. It’s easy to apply fresh lemon juice topically where needed.
        Please read: https://lpi.oregonstate.edu/mic/health-disease/skin-health/vitamin-C#photodamage

        Vit C will not allow you to stay in the sun 50 x longer like sunscreen claims. But it can add an extra 50% and it will not prevent your body from producing Vit D, like sunscreen does. Sunscreen offers a false sense of security and leads to more total UV exposure and less Vit D. Sunscreen most likely causes many cancers as well that have higher 5y mortality rates than skin cancer. Skin cancer has the lowest mortality of all cancers.

        If you are 65 years old, Covid-19 is more dangerous than the sun. The ingredients in sunscreen however may be worse – we don’t know for sure. We should stop wearing sunscreen and start wearing masks. At least we apply sanitizers only to our hands only and not our whole body. I only use soap made out of 100% native olive oil for the same reason. I only use native olive oil in case I need a moisturizer. The result is also that I produce far less plastic waste when it comes to packaging.

    3. Hugo,

      Speaking of sunscreen to prevent skin cancer, Dr Greger has an old video from 2012 on how Chlorophyll from eating dark greens (spinach, kale, etc) can stop DNA damage and lower the risk of cancer. Now, whenever I have go out in the sun for a long time, I make sure to eat a load of green leafies instead of using sunscreen. (And I do wear a hat, just to be on the safe side :-)

      https://nutritionfacts.org/video/eating-green-to-prevent-cancer/

      1. Thanks, Darwin!

        I know this video well. I find it insanely great. We need the sun for more than just Vit D and Q10. Sunshine apparently regulates up to 3,000 cell functions. Also try to get some blue light in the mornings´. Blue light produces melatonin naturally in our body, which regulates our internal clock and sleep cycles.

        There are some things that we can apply topically however. I mix a bit of lemon juice (Vit C) with a bit of olive oil (Vit E) into a lotion that I apply on areas of the skin I don’t want to age or that require getting accustomed to the sun. I also didn’t know that the most effective way to reduce wrinkles is also the cheapest and most natural.

        Please read this re Vitamin C: https://lpi.oregonstate.edu/mic/health-disease/skin-health/vitamin-C#photodamage

        Vitamin C (in combination with Vit E) limits the damage induced by ultraviolet (UV) light exposure. Vitamin C is not a “sunscreen” because it does not absorb light in the UVA or UVB spectrum. Rather, the antioxidant activity of vitamin C protects against UV-induced damage caused by free radicals (33). Vitamin C transport proteins are increased in keratinocytes in response to UV light, suggesting an increased need for vitamin C uptake for adequate protection (7, 8).

        The accumulation of oxidative damage to proteins is a distinguishing feature of both photodamage (photoaging) and intrinsic aging; such oxidative damage can lead to changes in skin structure. In addition to its antioxidant functions, vitamin C regulates the synthesis of the structural protein collagen. The role of vitamin C in the hydroxylation of collagen molecules is well characterized (46). Hydroxylation of collagen is necessary for its extracellular stability and support of the epidermis.

        In cell culture models, vitamin C supplementation has many beneficial effects in combating photodamage. Specifically, vitamin C has been shown to stabilize collagen mRNA, thus increasing collagen protein synthesis for repair of the damaged skin (47). This occurs concurrently with a decrease in elastin production; the elastin protein is often overproduced in response to photodamage (48). Vitamin C also increases the proliferation rate of fibroblasts, a capacity that is decreased with age (49). Further, vitamin C stimulates DNA repair in cultured fibroblasts (50).

        Human studies often assess skin health by changes in depth or number of wrinkles and by the individual’s perception of skin health. Two observational studies found that higher intakes of vitamin C from the diet were associated with better skin appearance, with notable decreases in skin wrinkling (51, 52). The use of vitamin C (3-10%) in topical applications for at least 12 weeks has been shown to decrease wrinkling (21, 23, 25, 27), reduce protein fiber damage (25), decrease apparent roughness of skin (21), and increase production of collagen (26, 27). Topical vitamin C has also been shown to reverse some of the age-related structural changes in the interface between the dermis and the epidermis (22). However, the effects of topical vitamin C are not apparent in all individuals, and interestingly, one study found that individuals with high dietary intakes of vitamin C showed no or little effect of a topical administration (26).

        The accumulation of oxidative damage to proteins is a distinguishing feature of both photodamage (photoaging) and intrinsic aging; such oxidative damage can lead to changes in skin structure. In addition to its antioxidant functions, vitamin C regulates the synthesis of the structural protein collagen. The role of vitamin C in the hydroxylation of collagen molecules is well characterized (46). Hydroxylation of collagen is necessary for its extracellular stability and support of the epidermis.

        In cell culture models, vitamin C supplementation has many beneficial effects in combating photodamage. Specifically, vitamin C has been shown to stabilize collagen mRNA, thus increasing collagen protein synthesis for repair of the damaged skin (47). This occurs concurrently with a decrease in elastin production; the elastin protein is often overproduced in response to photodamage (48). Vitamin C also increases the proliferation rate of fibroblasts, a capacity that is decreased with age (49). Further, vitamin C stimulates DNA repair in cultured fibroblasts (50).

        Human studies often assess skin health by changes in depth or number of wrinkles and by the individual’s perception of skin health. Two observational studies found that higher intakes of vitamin C from the diet were associated with better skin appearance, with notable decreases in skin wrinkling (51, 52). The use of vitamin C (3-10%) in topical applications for at least 12 weeks has been shown to decrease wrinkling (21, 23, 25, 27), reduce protein fiber damage (25), decrease apparent roughness of skin (21), and increase production of collagen (26, 27). Topical vitamin C has also been shown to reverse some of the age-related structural changes in the interface between the dermis and the epidermis (22). However, the effects of topical vitamin C are not apparent in all individuals, and interestingly, one study found that individuals with high dietary intakes of vitamin C showed no or little effect of a topical administration (26).

  10. I am still amazed at how differently this audience processes this information as compared to the webinar audience.

    I think it is because we got all of the answers at once, plus we got to be up-close with Dr. Greger in the on-topic Q&A’s.

    https://www.youtube.com/watch?v=evhUeWVSe6w

    https://www.youtube.com/watch?v=auZDWTMLM8I

    I think with these short videos, on this site, we are trying to learn the information where the webinar, we can’t pause and learn it, so we listen and enjoy it.

    A totally different experience.

    Plus, people who pay anything at all appreciate things more. (Pretty sure that was the concept from a study from my Persuasion class in college.)

    Though, when people start off getting the information for free, any charge at all can offend people.

    Someone recently used the example of grocery store plastic bags.

    Charge people 5 cents per bag and people won’t use the plastic bags and the ones who got it for free can feel cheated by it as a concept.

    Where the environmentally-oriented people pay much more for their recyclable bag and get more satisfaction out of the process because they have a higher purpose.

    I leave every webinar feeling happy and then I come here and everybody trashes the videos that I have already loved, re-watched and still like them when they show up again as if they were old friends.

    Strange, huh?

    1. Please refrain from making broad generalizations and using words like “everybody”. It is condenscending and unnecessary.

      Some of us have been here a long, long, time. (a decade longer than yourself), and have loyally supported Dr Greger in every which way we can, including mega hours of looking up links for newcomers. We deeply appreciate what Dr Greger offers, and have faithfully applied his recommendations (Daily Dozen – hello!) to good result. We continue to enjoy the site and enthusiastically recommend it to others.

      1. I thought Deb’s use of ‘everybody’ was just exaggeration for dramatic effect. It’s a common literary device. It didn’t seem at all condescending to me.

      2. Barb – I’m with you. Deb blathers on like she’s some sort of Greger-know-it-all-teacher’s-pet. She apparently feels that she must comment of every other comment in this discussion page. But she’s really just a narcissistic conversation hog. Like you, I’ve been here close to the beginning of Greger’s site but don’t feel it’s my place to monitor-by-constant-comment the conversations here.

    2. Deb,

      Regarding your comment: ” … people who pay anything at all appreciate things more. (Pretty sure that was the concept from a study from my Persuasion class in college.) Though, when people start off getting the information for free, any charge at all can offend people.”

      That’s not a strange observation at all, just part of human nature! That’s the reason why private ownership works so well in society as a whole, and collectivism always fails. When a person works for something, they tend to appreciate it and take good care of it, as opposed to someone who receives it for “free”.

      At least that’s what the philosopher, Ayn Rand tells us ;-)

  11. It is fascinating to me that the people who pay to see it feel like they are rewarded and the ones who watch it for free feel cheated.

  12. Buying it after the live event isn’t as satisfying a concept as watching it live. That tells me that it is the living, breathing, thinking Dr. Greger is part of the equation.

  13. I sure hope that the cause of the relatively high stroke risk is nothing that cannot be overcome by proper B12 supplementation and adequate omega 3 intake (flax, chia, walnuts) and corresponding avoidance of omega 6 (vegetable oils) because that would mean I have been giving my plant-based-eating children and grandchildren (and whoever else is willing to listen) poor nutrition advice. At my advanced age (69) I find that I have to take my B12 (most commonly available dosages are sufficient) pill twice a day in order to absorb enough B12. When I was taking only one pill a day my B12 levels were at the low end of the acceptable range. My children however seem to absorb B12 better, and get by with a lower frequency of B12 supplementation.

  14. Most of the comments on the last teaser video were talking B12, not Vit D. Is he going to go through everything that it isn’t before getting to the point? Easier to just go elsewhere and read what he is going to parrot.

    1. Reality bites,

      You are probably right about that.

      I think I like that he is going to go through the things that it isn’t because I have previously done a process trying to figure out what it is and there are studies such as the Vitamin D study where it looks like they could be related.

      Omega 3 is next and he previously had hypothesized the Omega 3 and 6 ratio years ago, so he is reviewing the “usual suspects” and I think that we often do hypothesize about the EPIC-Oxford study. We wonder how much vegan junk food they ate and if they supplemented B-12, etc.

      To be fair, I watched the webinar, so he basically got to the point within the time, plus, he answers just about every topic question in the webinars, so those are such a different experience, but I pre-had my own list because of the BBC putting down veganism back when the most recent EPIC-Oxford study results came out, plus, it was Dr. Greger’s old “shocking vegan” video that had introduced me to the EPIC-Oxford study and I was interested in whether he still had the same answers.

      I had gotten confused trying to figure out the Japanese people eating well but having such high stroke risks and things like that, so the series itself is more helpful to me that he didn’t just jump to the answer and not explain.

      But, in this format, on this site, it takes longer to get to the answer and his old video style made it easier to learn more.

      I think the “suspense” which Dr. Greger clearly loves to write into the videos, doesn’t work as well for this site’s audience, but neither does a long video format.

      1. Reality bites,

        When I watched the whole webinar, I felt like Dr. Greger had read our whole discussion about EPIC-Oxford and he answered us.

      2. Quest labs can test your omega-3 levels. From the test description, use the ratio % AA ÷ % EPA to predict risk of cardiac events: “In contrast to omega-3 PUFAs, omega-6 PUFAs (eg, arachidonic acid [AA] and linoleic acid [LA]) and their metabolites are more pro-inflammatory than anti-inflammatory. Two proposed markers of cardiovascular risk incorporate both omega-3 and omega-6 fatty acids: the omega-6/omega-3 ratio and the AA/EPA ratio. The omega-6/omega-3 ratio is still used by some physicians, but the clinical utility of the ratio has been called into question; see Harris for a review.7 More recent data indicate that the AA/EPA ratio, which includes specific types of omega-6 and omega-3 fatty acids, can be a useful alternative.4,8 Higher AA/EPA (lower EPA/AA) ratios are associated with higher cardiac risk.8”

        1. The Omega Check test costs around $50, I believe. https://testdirectory.questdiagnostics.com/test/test-detail/91001/omega-3-and–6-fatty-acids?cc=DAL

          According to Quest, reference ranges are as follows:
          Arachidonic Acid 5.2-12.9 %
          EPA 0.2-1.5 %
          EPA/Arachidonic Acid Ratio ≤0.2

          If your numbers are in range (they were for me), you probably do not need to worry about supplementing with omega-3. High dose omega-3 (over 3g/day) increases the risk of internal bleeding. My eye doctor did suggest taking a supplement to bring EPA up to 1.5% in order to prevent dry eye. To diagnose dry eye, he looks for staining patterns on the corneas and measures how long it takes before the tears evaporate. Drinking more water helps too, he said.

          In addition to the Omega Check test, “Quest Diagnostics offers a comprehensive menu of advanced inflammatory marker testing to help you assess cardiovascular risk more completely.” https://www.questdiagnostics.com/home/physicians/testing-services/condition/cardiovascular/advanced-inflammatory-marker-testing/ At about $50 for each test, this starts to add up though, unless your cardiologist says that these tests are medically necessary and your insurance company agrees. Fortunately, due to my multiple gene variants favoring CVD and a strong family history, my cardiologist felt the tests were necessary and insurance covered virtually the entire cost.

  15. Kudos to Dr. Greger on this one.

    This has the best explanation of the “Sick Quitter” effect that I have seen.

    Thank you, Dr. Greger.

    I have been seeing this for decades – enough that I do not take most large statistical studies including a small number of vegetarians and vegans too seriously, assuming that these studies may be largely confounded by this effect.

    Let me tell you what I mean –

    Note – I am not part of a Seventh Day Adventist or Hindu or similar community where eating plant-based from birth may be commonplace. My milieu is omnivorous/carnivorous – Grandfather raised cattle, my uncle raised hogs – my immediate family used to raise it’s own cattle, as well.

    ‘Most every male that I know who has converted to a Whole Foods Plant Based Diet has done so for medical reasons. Usually only AFTER entirely predictable and preventable medical complications/interventions. With the result that, if you pooled this group about their health – well – you would get a very unhealthy cohort.

    Myself – my physician took a look at my serum lipid profile a few decades ago and let me know that I will likely need to be on statins for the rest of my life.

    I asked him what to do.

    “You know what you have to do,” he said.

    Probably the best thing he could have said.

    He gave me a medication reprieve to try to clean up my act.

    Off to the bookstore. Enter Dr. Ornish – lifestyle changes – serum cholesterol plummets from the 250s to 146 – weight plummets – and my Physician relents.

    Thank, you, Wise Sir.

    Examples of people with whom I deal:

    Person 1 – Typical WW II veteran. Coronary stenting x 2, then Coronary Artery Bypass Surgery. Only after being forced to face his own mortality (yet again) does he finally switch from pizza and ice cream to a largely healthful Whole Foods Plant Based Diet. Now 98 years old, true – but in a large statistical survey, he might be proof that a largely WFPB diet is unhealthful and “is associated with” coronary artery disease.

    Person 2 – just had radical prostate surgery. Hey, I did what I could in the years previous, but he – of course – would not listen. Gentlemen rarely do. A big chicken eater before this – only after diagnosis (but prior to surgery) goes healthful WFPB – helped by Dr. Greger’s “old style” prostate cancer videos – thank you, Dr. Greger. Excellent work! Makes a difference! Surgical pathology came back way, way tamer than the surgeon expected: “never seen anything like it.” But in a large statistical survey, depending on how it was designed, this gentleman might be proof that a largely WFPB diet is unhealthful and “is associated with” radical prostatectomy.

    Person 3 – Lifetime “genetic” high triglycerides. Prediabetic. Increasing PSA. Grim family history – early male deaths. All are completely tamed when he finally goes healthful WFPB – plus major decreases in cholesterol, as well. Unfortunately, Dr.Greger has not taken on Triglycerides in his videos – last time I looked, anyway – I request that Dr. Greger do so for the greater good. So I had to do that, myself – and it worked fine. He’s a smart guy. Butcha know – in 60+ years of being doctored – and having a vegetarian wife – no one could offer him anything to deal effectively with his triglycerides – until a few hours of clear basic diet education did the trick. In a large statistical survey, depending on how it is designed, this gentleman might be proof that such a diet is unhealthful and “is associated with” a history of high triglycerides, prediabetes and elevated PSA.

    And so it goes . . .

    You do a study on the crew described above – and as a cohort, they will probably be a lot less healthy than the general population – “proving” that the WFPB diet is unhealthy.

    But taken as individuals – not as peer-reviewed study statistics – each man in this group is probably a lot healthier than people in his respective situation who did not make the switch to a healthy WFPB lifestyle.

    Which is why I read the studies – and interpret them with a grain of saltpeter. And then use my own judgement and experience to actually deal with individuals.

    [And I do what I can to keep people away from the dieticians. Why? A lot of our local dieticians seem to have gone keto. Weird but true. Particularly the certified diabetic educators: “cheese is an excellent source of protein” is about the time that I gave up on one of our local certified diabetic educators as I sat in on one of her introductory patient lectures. You want to know why the diabetics are not doing as well as they were doing decades ago? Sit in on the patient diabetic educator lectures – she sent chills up my spine.]

    No adult male that I have encountered – outside of a few gentlemen with specific religious backgrounds and a PETA person or two – has been WFPB for any reason except declining health or other health warnings from a Physician. Usually only after unpleasant interventions have already occurred.

    We males are a stubborn crew. Testosterone is a mind-altering drug.

    It just comes with the territory.

    Studies adjust for sex, age, smoking, weight etc. – and I do suppose that pre-screening in decades-long studies may deal with the Sick Quitter effect to some extent – but I wonder how often the matter may be overlooked, particularly when you see incidental study findings reported on smaller populations of the larger study group – findings that may not have been a part of the original study design.

    Just something to keep in mind.

    Vivamus

    1. Vivamus,

      I loved Dr Greger’s sick quitter effect examples, too.

      And you gave such great examples! Excellent!

      I keep praying for my family members to switch!

      I have had several elderly people who are in the opposite situation.

      Healthy late beginners.

      I looked up the years of my great-grandmothers generation and most of her life, until she was over 65, she was in one food shortage and food rationing after another- relying on gardens and canning at things like oatmeal and nuts and beans. Lots of baked bean sandwiches for dinner.

      The thing is, most of the younger generation knew the laughing woman with laughing sisters who all wanted a slice of every type of pie.

      I always marveled that they could eat anything at all. Meat and potatoes and every kind of dessert with not much wrong until she was reaching 90.

      Same thing for my 90 year old aunt and uncle from the next generation.

      Poverty and low calories mostly fruits and vegetables and grains and now it looks like they are McDonald’s and ice cream every day.

      Sneaky

      1. The healthy late beginners trick the next generation into thinking they don’t have any genetic predispositions.

        And get them to think a poor diet is the secret to longevity.

  16. If ab is around, I read an article today about whether COVID came from the lab in Wuhan and it said that all of them were tested for the virus and for antibodies and none of them seem to have ever have been exposed.

    I think they will investigate the Europe theory, too.

  17. What point was made? I’ve always expected information from Dr. Greger’s videos. Did anyone gain anything from this video?????????????

    1. Mary,

      Dr Greger explained concepts.

      They might be concepts that you are already familiar with but I honestly wouldn’t have known anything about strokes if my step-mother hadn’t had one.

      There are several videos in this series but he had to start with the basics.

      1. Christine, Deb, et al:

        I think the people reacting to this vid are fully aware that the point was to rule out Vitamin D. They learned this by the end of watching the vid.

        The main question is likely: why?

        It can be finally learned at the end, that you could substitute whale lard with Vitamin D as the absolute ruled out cause of stroke since we are also deficient in that generally. (Shout out to historical Eskimos of course)

        So the general feeling could be that its a bit of a teaser or “filler” rather than actionable and useful info. We are a results oriented society after all, and not very patient as well. :)

        Zen-like objectivity and complete absence of expectation are needed first, in order to absorb the relevant background and related information given, while one sits waiting for the Vitamin D stroke culprit shoe to drop – since that is the initial inference from the title.

        He’s keeping one on their toes for sure, but I do understand the busy person tuning in to learn what they thought they would learn, only to find out its not the case that Vitaimn D is the culprit.

        At that point the video watching experience likely goes into the casual viewers category of what we call: “click-bait’, even if it isn’t the intention obviously.

        Hope this helps.

    1. Barb,

      Wonerful!

      A friend gained 11 pounds one year out of nowhere. He couldn’t figure out what was going on.

      We were talking over the phone: “Only thing I can think of is that with my new place of work (Silicon Valley) we get free soft drinks in the office as perk.

      We did the math then and there – by the old 3500 calories per pound estimate, he should have gained over 20 pounds. Maybe it was less from all the exercise he was getting walking back and forth to the soda machine.

      “Oh,” he said. “I didn’t realize.”

      Things go better –

      Vivamus

  18. I am surprised no one mentioned low cholesterol as potentially causing stroke issues

    “Having extremely low cholesterol may increase the risk for stroke, a new study suggests. Researchers found that very low LDL, or “bad” cholesterol, and very low triglycerides are associated with an increased risk for hemorrhagic stroke, the type caused by a ruptured blood vessel in the brain.Apr 10, 2019”

    https://www.nytimes.com/2019/04/10/well/live/very-low-cholesterol-may-increase-stroke-risk.html#:~:text=Having%20extremely%20low%20cholesterol%20may,blood%20vessel%20in%20the%20brain.

    Also, do vegetarians really have a higher risk of stroke?

    “In the first group of 5,050 people, there were 54 strokes. For ischemic strokes, which are strokes when blood flow to part of the brain is blocked, there were three strokes among 1,424 vegetarians, or 0.21%, compared to 28 strokes among 3,626 non-vegetarians, or 0.77%. After adjusting for age, sex, smoking and health conditions like high blood pressure and diabetes, researchers found vegetarians in this group had a 74% lower risk of ischemic stroke than non-vegetarians”.

    “In the second group of 8,302 people, there were 121 strokes. For both ischemic and hemorrhagic strokes, also called bleeding strokes, there were 24 strokes among 2,719 vegetarians, or 0.88%, compared to 97 strokes among 5,583 non-vegetarians, or 1.73%. After adjusting for other factors, researchers found vegetarians in this group had a 48% lower risk of overall stroke than non-vegetarians, a 60% lower risk of ischemic stroke and a 65% lower risk of hemorrhagic stroke”.

    https://www.sciencedaily.com/releases/2020/02/200228102225.htm#:~:text=After%20adjusting%20for%20age%2C%20sex,people%2C%20there%20were%20121%20strokes.

    1. There is no physiological reason why low cholesterol should increase stroke risk.

      That article simply simply showed that there was an association between low LDL and stroke. It didn’t prove causality.but certain groups always like to argue that it does and then only in one direction.

      Nobody seems to even mention the possibility that poor cardiovascular health could lower LDL levels. I mean we already know that heart attacks lower cholesterol.

      We also know that people with genetically low LDL levels do not have excess stroke risk. Further, it is known that people using statins to lower LDL cholesterol do not have excess stroke risk.

      Conditions that both lower LDL and increase stroke risk include regular high alcohol consumption and being underweight.

      See also

      https://www.inquirer.com/health/low-ldl-cholesterol-study-statins-stroke-20190502.html

    2. Hi, Brad! You might be interested in this video, in case you have not already seen it: https://nutritionfacts.org/video/can-cholesterol-be-too-low/ Adverse effects of low cholesterol are generally related to cholesterol levels that have been reduced with medication, rather than dietary means. Our bodies make all the cholesterol we need, and there is no need for dietary cholesterol at all. I hope that helps!

    3. Harvard Health says that there is not a stroke/cancer risk from low cholesterol levels. They do however suggest lowering your statin dose, if a lower dose would still put your lipids in the desirable range. Short term studies show no ill effects of very low LDL; longer studies have yet to be done.
      https://www.health.harvard.edu/heart-health/is-my-ldl-cholesterol-too-low

      I am not sure that NYT is as reliable a source of information as more scholarly websites. Understand who is writing the articles for that newspaper.

      1. Hi Caroline:

        NYT is a fine source. They are just quoting a study, so you should question whether the study is a good one.

        Your Harvard reference is a bit dated (2012). Try a more recent one.

        Low LDL and stroke: A closer look
        https://www.health.harvard.edu/heart-health/low-ldl-and-stroke-a-closer-look

        Also see

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

        Cholesterol Depletion Increases Membrane Stiffness of Aortic Endothelial Cells
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1304801/

        Cholesterol Levels and Risk of Hemorrhagic Stroke
        A Systematic Review and Meta-Analysis
        https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.113.001326

        and unrelated to stroke, but:

        Is low total cholesterol levels associated with suicide attempt in depressive patients?
        https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-017-0144-4

        Given these studies, I think it’s a mistake not to consider extremely low cholesterol levels as a potential health problem

        1. These statements/references are sadly symptomatic of the arguments put forward by the self-styled cholesterol sceptics.and other people pushing high fat diets (for fun and profit).

          They hold no water whatsoever.

          Simple associations don’t prove causality. In fact, studies show that a variety of conditions cause cholesterol levels to decline. These include infections of various kinds, trauma, sepsis, heart attacks, Alzheimer’s, certain cancers and chronic alcoholism. These are sufficient to explain any observed associations between low cholesterol levels and ill health. Also lowering LDL to very low levels as a result of medication in not associated with excess stroke risk. in fact they appear to reduce stroke risk eg
          https://www.upi.com/Health_News/2020/07/07/Statins-cut-heart-attack-stroke-risk-even-in-older-adults-study-says/1251594129118/

          And the lower the cholesterol level achieve, the lower the stroke risk
          https://www.nejm.org/doi/full/10.1056/NEJMoa1910355

          Nor are genetically low levels of cholesterol.associated with excess stroke risk. As it happens, genetically low levels of LDL appear to confer a protective effect against stroke although the protective effect is less than the protective effect against coronary heart disease
          https://pubmed.ncbi.nlm.nih.gov/30787162/

          There is also no known mechanism by which low levels of LDL cholesterol would increase stroke risk. The study you cited ‘Cholesterol Depletion Increases Membrane Stiffness of Aortic Endothelial Cells’ has nothing to do with plasma cholesterol levels. It concerns cholesterol levels within cells in a petri dish that are artificially lowered by putting them in a bath of various chemicals. It’s worth adding that all animal cells biosynthesise cholesterol.. They are not reliant on circulating plasma cholesterol levels although it is sometimes more energy efficient to sequester circulating plasma cholesterol than to manufacture it.

          It is important to be wary of claims that low cholesterol is a health risk from people selling low carb/keto/Atkins/paleo etc diets and from academics with funding ties to industries selling high cholesterol and high saturated fat foods. Their arguments appear to be entirely based on spurious but convenient associations.

          I would suggest viewing Dr Greger’s many videos on cholesterol eg

          https://nutritionfacts.org/video/how-do-we-know-that-cholesterol-causes-heart-disease/

          1. Hi Mr Fumblefingers:

            First, almost all studies show correlation and not causation.

            Second, the studies you cited are for Ischemic Stroke. Low cholesterol is associated with hemorrhagic stroke.

            Third, In the BMJ study, Vegetarians experienced a roughly 20 percent higher stroke risk than meat eaters, and it was mostly due to hemorrhagic stroke.

            Do you have studies that show a correlation between a decrease in hemorrhagic stroke and extremely low cholesterol levels?

            I am vegetarian by the way and am not pushing any sort of diet. I am only suggesting that it may be be unwise to have extremely low blood cholesterol levels.

            Nieither you nor I nor anyone else knows for certain whether extremely low cholesterol is a definitive risk or not. However, we do know there is a correlation between (1) hemorrhagic stroke and vegetarianism , (2) hemorrhagic stroke. and low cholesterol, and (3) in many instances, low cholesterol and vegetarianisms / veganism.

            You and others may choose to ignore these correlations. I will not. I certainly do not want high cholesterol levels, but I do not want extremely low levels either. It rarely a good idea to have an extremely high or extremely low biomarker level or to have an extremely high or low level of any nutrient.

            1. Observational studies are often confounded by uncontrolled variables. Many disease states promote low cholesterol but there no evidence that low cholesterol achieved by a healthy diet and lifestyle or prescription drugs increases haemorrhagic stroke risk. The claim that it does is based on an association found in the EPIC Oxford that could well be confounded by uncontrolled variables such as diagnosed or undiagnosed disease states.. Experimental studies on the other hand show that lowering cholesterol to very low levels.actually reduces heart attacks and strokes. That’s very inconvenient for the ‘low cholesterol’ is bad crowd so they just ignore them.

              There is also no known medical/physiological reason why low cholesterol would promote haemorrhagic stroke. If the association is actually valid and not just a statistical fluke because of the small numbers of cases, the odds are therefore that low cholesterol is just a marker for eg an eating disorder, alcoholism or other condition which increases haemorrhagic stroke risk.

              As for ignoring correlations, you seem to be ignoring others to concentrate on the one study that suits your agenda., For example, the Taiwanese study found ‘vegetarians (vs nonvegetarians) had only about half of the risk of overall stroke throughout various models’. Further, the total number of haemorrhagic strokes was too small to allow any reasonable analysis. Clearly there was something different about what the EPIC Oxford ‘vegetarians’ were doing compared to what the Taiwanese vegetarians were doing..
              https://n.neurology.org/content/94/11/e1112

              As far as I know, the only people who promote the ‘low cholesterol is bad’ agenda are low carb/keto/paleo/carnivore types who almost all have high cholesterol.or at least sell diets that cause people’s cholesterol levels to rise on average.

              The evidence seems to show that low cholesterol is only ‘bad’ when it is the result of disease states or trauma. Very low cholesterol as a result of a healthy diet and lifestyle, or prescription drug treatment is another matter. Studies seem to show the lower the better. Of course, the egg industry and people selling keto/low carb etc diets find this intensely annoying. It’s very bad for business. So they have to scour he literature for some association that suits their agenda and promote it heavily in various media.

              https://nutritionfacts.org/video/can-cholesterol-be-too-low/

              ‘On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.’
              https://jamanetwork.com/journals/jamacardiology/fullarticle/2695047

              1. In regards to your comment:

                “As far as I know, the only people who promote the ‘low cholesterol is bad’ agenda are low carb/keto/paleo/carnivore types who almost all have high cholesterol.or at least sell diets that cause people’s cholesterol levels to rise on average.”

                By the way, I have relatively low cholesterol and eat a relatively low cholesterol diet compared to 90% of the rest of the world. I eat no meat, chicken or fish, at most, two eggs per week, and a minimum amount of cheese (at most an ounce per day). I am not a cholesterol pusher per se. Nevertheless, I have concerns about very low cholesterol levels.

  19. A friend of mine, “vegetarian” for decades (in his 60’s now), uses dairy (cheese, cottage cheese, yogurt, etc) as his primary source for protein. Some “vegetarians” also eat eggs, some “vegetarians” eat chicken (i.e., do not eat red meat). The use of the word “vegetarian”, especially in a scientific article, always leaves me questioning any results because I still do not understand exactly what the “vegetarian” is consuming unless it’s detailed somewhere in the report. And, as has been discussed ad infinitude on this site, even a vegan diet is a question to me as I’ve seen some fairly horrible vegan options especially in restaurants.
    So I am hoping that Dr. G will be peeling back the layers in this set of videos. I am looking forward to the rest of the information in this series.
    Thanks Dr. G.
    And, Deb, you do not need to comment. . . .

  20. Hi, Ruth! You are right in stating that many people have flexible definitions with regard to vegetarian diets, although vegan diets tend to be defined as excluding animal products, and may or may not be healthy, depending on what they do include. Most studies comparing dietary patterns define those patterns carefully. You can see for yourself! Access the studies featured in any NutritionFacts video by clicking the “Sources Cited” link beneath the video window. I hope that helps!

  21. Vegetarians tend to eat even more dairy than average omnivores and vegans.

    Dairy has the highest amount of trans fat in western diets. Trans fats lead to strokes. We regulated trans fats from plant sources but ignored animal sources. Dr Gregory has a video on this I believe?

    Please read: “Heart Foundation: Butter has 20 times the trans fats of margarine”
    https://www.ausfoodnews.com.au/2010/09/28/heart-foundation-butter-has-20-times-the-trans-fats-of-marg.html

    To me, vegetarians are a subtype of omnivores. Just like WPBD is a subtype of vegan.

  22. I prefer brief solar noon sun exposure for Vitamin D for a variety of reasons – in season.

    But information on supplementation may still be useful:

    Be Careful When Buying Vitamin D Supplements As There Are Many Forms – Cholecalciferol (D3), Ergocalciferol(D2), Calcifediol, And Calcitriol
    https://www.thailandmedical.news/news/covid-19-supplements-be-careful-when-buying-vitamin-d-supplements-as-there-are-many-forms-cholecalciferol-d3,-ergocalciferol-d2,-calcifediol,-and-calc

    Vivamus

  23. I ended up looking up broccoli sprouts to see if a food could be recommended that could do the same thing as the drug that lessens the severity of COVID by dealing with cholesterol and fat in the lungs.

    I found some things, but then I found other things which are above my scientific understanding, but if there is a scientist nearby, could you tell me if my PEMF might do something AMAZING to my broccoli sprouts?

    And how about the UV light.

    I am intrigued.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458888/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152207/

    https://pubmed.ncbi.nlm.nih.gov/22773681/

    Now I have to look up red light and infrared.

    My broccoli sprouts like gadgets?

    1. The best part is that the broccoli sprouts and I can alternate the gadgets and who knows how many good things will happen.

      Ihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315201/

  24. In posts above, I highlighted extremely low cholesterol and low triglycerides as potentially increasing stroke risk. Low protein levels may also increase stroke risk.
    I am vegetarian, but I am being cautious about my protein intake and my cholesterol levels.

    “Our findings suggest that higher dietary protein intake is associated with a reduced risk of stroke in the general Japanese population.”

    Dietary Protein Intake and Stroke Risk in a General Japanese Population
    https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.116.016059

    1. Brad,

      A most interesting study!

      I ask your help with your take on the following:

      Looking at Table 1, it appears that the low protein group was also the group that had the highest smoking rate, the highest rate of alcohol consumption, the highest average diastolic blood pressure – and, perhaps paradoxically, the highest rate of proteinemia – i.e, the highest rate of kidney dysfunction.

      Lowest dietary protein with the highest rate of proteinemia? Strange. It looks like this particular low protein group may have a tendency toward poorer renal function – perhaps secondary to cardiovascular damage from their higher smoking rate, and/or renal damage secondary to their higher average blood pressures or other effects from their higher alcohol consumption.

      The article specifically mentions that there is no knowledge of participant socioeconomic status. Socioeconomic status can affect health – and, of course, dietary and smoking/alcohol intake differences can be surrogate markers for socioeconomic status.

      Additionally – one notes that the group with better outcomes had higher dairy intake. I note that one of the sponsors of the study was Meiji Holdings – a Japanese dairy, confectionery and health care conglomerate https://www.meiji.com/global/products/lineup/. Which also – coincidentally? – sells a dairy-based protein supplement: https://www.meiji.com/global/products/lineup/whey-protein/ I wonder if there could be any conflict of interest behind the funding of this study?

      What do you think?

      Overall – if you actually look at the data within the study, the conclusion of the study as written: “Therefore, an increased intake of protein, with an attempt to balance the animal and vegetable protein intakes, can be recommended as an effective strategy for preventing stroke” might simply be read as marketing material for the sponsor’s own whey protein supplement: https://www.meiji.com/global/products/lineup/whey-protein/

      I think – if you actually use the full data from the study, the conclusion should actually read: “Therefore, increased smoking, increased alcohol intake and increased blood pressure – in conjunction with decreased kidney function – are all risk factors for stroke.”

      Which we all already knew.

      Yet none of these matters was mentioned in the article abstract, the summary, or the conclusion.

      Odd.

      Don’tcha think?

      And one can easily believe that people who smoke and drink more are likely less concerned about their overall health than those who smoke and drink less – this may affect many of their other lifestyle choices, as well.

      Add in the much higher smoking, salt intake and hemorrhagic stroke incidence in the Japanese population overall compared to the US population – and I feel very little concern that this study can be applied to an American practicing a non-smoking / low alcohol / low salt / healthy WFPB lifestyle

      But maybe that’s just me.

      Reasonable people, of course, will disagree.

      Brad.

      All the best –

      Vivamus

      1. Hi Vivamus:

        You could be right on your theory. That is, that the study conclusion in the study I cited may be invalid due to not accounting for smoking and drinking and other factors.

        I usually look for multiple studies with similar findings. There are other studies that have similar findings.

        For example, see https://www.livescience.com/46267-high-protein-stroke-risk.html

        I can’t say that I know the answer for sure. I am only raising the protein / stroke connection as a possible rationale as to whey vegetarians /vegans may have a higher stroke risk in the BMJ study

        1. Brad,

          Thank you for your thoughts.

          A few thoughts from this end.

          Even a third of fourth year medical student would have picked up the flaws in this study by the third or fourth month of Journal Club.

          And they’re barely out of the cradle, yet.

          It is not enough to do a web search and read the abstract and the discussion and the conclusion of a study.

          You would be well-advised to take the time and effort to actually READ AND ANALYZE IN FULL – any article you post prior to posting.

          If you post bad science – it is YOUR reputation that is damaged, not the reputation of the authors of the bad science.

          Now. Full analysis takes time.

          And there are a lot of very poor studies out there.

          It is not enough to assume that something must be true because it is published in the popular press. Or even in a reputable peer-reviewed scientific journal.

          Articles published in reputable journals get blown out of the water all the time.

          It is not enough to assume that newer articles disprove contrasing earlier articles.

          Older articles often have much more solid science than newer articles.

          You wrote: “I usually look for multiple studies with similar findings. There are other studies that have similar findings.”

          You. You sure do.

          You are describing echo-chamber science.

          This shows in your work.

          Looking for articles that are presorted to have the results that you are looking for – while avoiding the articles that have other results.

          That is not the way that quality science is done.

          You cannot simply machine gun a slew of bad science at people and expect them to accept what you are doing as useful or correct. Then pile it on higher and deeper when challenged.

          It doesn’t work that way.

          That just compounds the error.

          Imagine the damage some idiot with a search engine can do if lives depend upon it.

          And lives sometimes do.

          Instead – if you continue with this level of work – people will end up not taking your efforts seriously – even if one day, perhaps by chance, you come up with a legitimate article.

          Now. Take as deep breath.

          Stop machine-gunning bad science at people. Garbage stacked upon garbage does not impress.

          Analyze EACH ARTICLE fully before posting. Take the time – for each individual article that you post.

          Take full responsibility for each and every article that you post.

          Mr Fumblefingers is trying to help you. He knows what he is doing. Accept his generous guidance.

          No fool, he. I always listen to what Mr Fumblefingers has to say.

          You would be wise to do so, as well.

          I am happy to help you, as I can, as well.

          Brad.

          All the best to you –

          Vivamus

          1. Hi Vivamus:

            Your first response came across as kind. Your second response came across as pedantic (at best). Furthermore, you misconstrued my statement regarding looking for multiple studies with similar findings. What I meant by that was that I do not consider a finding to be potentially valid until the same finding has occurred in multiple studies.

            Also, note that one of the world’s leading scientists on longevity posted the same exact source I did with respect to cholesterol, which many here (including you) have criticized directly or indirectly.

            Prof. Valter Longo
            September 1, 2019 ·
            Very high and also extremely low cholesterol blood level could be dangerous for your health, as examined in a study, which monitored around 28,000 women for as long as 19 years. Scientists investigated a positive correlation between low cholesterol level and increased stroke risk.
            https://www.nytimes.com/…/very-low-cholesterol-may-increase…
            For this reason, the Longevity Diet recommends sources of unsaturated fats such as olive oil, nuts, seeds, and fish. Please read Valter Longo Foundation’s suggestions to learn more. ‍⚕️

            https://www.facebook.com/profvalterlongo/posts/2467298573596271?comment_id=2481666732159455&reply_comment_id=2482968435362618

            “Dr. Valter Longo is the Edna M. Jones Professor of Gerontology and Biological Sciences and Director of the Longevity Institute at the University of Southern California –Leonard Davis School of Gerontology,”

            Dr. Walter Longo is certainly more well respected in diet and longevity than anyone on here. You may disagree with him, but he is considered to be a top tier, upper echelon scientist.

            And by the way, Dr. Longo had this to say about too little protein in one of his papers with respect to those over 65

            “. . .it is possible that the oldest members of the cohort actually benefited from the increase in protein intake. In support of this conclusion, this study also found that individuals over 65 that consumed a low protein diet demonstrated increased mortality compared to individuals with a higher protein intake”

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807119/

            Furthermore, there was nothing wrong with the Live Science Article that I posted. It simply pointed out a correlation between low protein and stroke. It did not state that low protein was the cause of stroke. There are also further correlations with low protein and higher blood pressure, which is also correlated with stroke. I will forego posting the studies because you will undoubtedly find fault with them. (There are faults in all studies)

            While you and Mr. Fumblefingers and others here may find the theories that too little cholesterol and too little protein may cause stroke (or other health issues) are without merit, some of the world’s best scientist disagree will disagree with you. This includes many scientists from the peer reviewed “journal of the month clubs.”

            I think it’s best to keep an open mind. You and Mr. Fumblet fhingers have made some valid points, but I do not think you or anyone else can speak with certainty on these issues. I have an open mind. Everything I have pointed out is a correlation. I never said it was the definitive cause.

            It should also be noted that I am not a fan of high protein diets or diets that yield high cholesterol levels, so my position on that also should not be misconstrued.

            Also, there is no need to give me instruction on what I should or not post or who or who I should not listen to for guidance.
            Thank you.

    2. Associations don’t prove causality. The can however be very useful marketing tools. The study was sponsored by a major producer and seller of dairy products,

      The obvious explanation for the finding of that study is that people eating a low protein diet were perhaps more likely to be eating a traditional Japanese diet which was low in protein but high in sodium. Sodium is a risk factor for stroke. Another possible explanation is alcohol – a known risk factor for stroke. As the study itself noted

      ‘Both types of protein intakes were negatively correlated with intakes of rice and alcohol’

      The study was sponsored by a major producer and seller of dairy products,

      1. Sodium as a risk factor should be renamed into “low potassium as a risk factor”. A guy got a nobel prize in the 60s, showing that the body (kidneys) can deal with Sodium easily as long it gets enough potassium.
        https://en.wikipedia.org/wiki/Na%2B/K%2B-ATPase

        As long as 98% of Americans are potassium deficient, I wouldn’t dare to mention issues related to sodium as a genuine scientist.
        https://nutritionfacts.org/video/98-of-american-diets-potassium-deficient/

        1. ‘ I wouldn’t dare to mention issues related to sodium as a genuine scientist.’

          Perhaps you should let the US Government in on the secret because sodium has been a nutrient of concern ever since the first US dietary guidelines were issued. It still is
          https://www.cdc.gov/salt/index.htm

          Not to mention the World Health Organization
          https://www.who.int/news-room/fact-sheets/detail/salt-reduction

          The people pushing this ‘sodium isn’t really a problem line’ are the same people pushing the ‘saturated fat and cholesterol aren’t dangerous’ line. Dairy and meat tend to be high in sodium. So are processed foods. Consequently, researchers making this argument tend to have links with those industries or with the Atkins Diet/Virtus Health constellation.

          Real scientists around the world however recognise that sodium is an issue. The industry and its sock puppets never give up though

          Dr Greger has an enlightening series of videos on this general topic.
          https://nutritionfacts.org/?s=salt

          1. “I wouldn’t dare to mention issues related to sodium as a genuine scientist.”

            Mr Fumbelfingers.

            I shake my head in wonder.

            This one is just sad.

            I can begin to see what you’re up against.

            I am reminded of the labors of Sisyphus.

            Keep rollin’ that rock uphill –

            Vivamus

            1. You guys already have a narrative running that has your BS detectors running wild? I get it, there are a lot of people who cannot distinguish between bad and good science etc. Please read the following links and then let’s try this again with a blank piece of paper?

              https://www.cdc.gov/salt/potassium.htm

              https://www.health.harvard.edu/staying-healthy/potassium_and_sodium_out_of_balance

              https://nutritionfacts.org/video/98-of-american-diets-potassium-deficient/

              To me, good science is about context. How useful is a salt study if it doesn’t take potassium levels into account? How useful are salt studies if only 2% of participants had adequate potassium levels to start with?

              There are many such examples in the history of science. For ages we looked at calcium intake only when it comes to bone health but ignored that without enough Vit D, we will not absorb calcium properly.

              “I shake my head in wonder. This one is just sad. I am reminded of the labors of Sisyphus.”. Careful with the windmills…

          2. This came off wrong. I didn’t mean to say “sodium is not an issue”. What I meant to say is that it’s not worth looking at sodium alone without knowing potassium levels. What I meant to say is that potassium deficiency turn salt into a health issue and 98% of Americans are deficient. Please don’t confuse this with a denial of slight blood-pressure increases associated with salt.

            When we talk about mineral deficiencies we usually do mention adding Vit C for better absorption. When we talk about calcium we also advice to check Vit D levels. When it comes to salt and sodium… nothing. Just reduce it and keep it low. This, to me is not good science, given what we know about the kidney and sodium-potassium pump.

            Again, how can we acknowledge that 98% of American are potassium deficient and then try to mitigate this by reducing sodium first? I await an update regarding the potassium and sodium connection from Dr Gregory soon. At least some “random” articles have started acknowledging this:
            https://www.health.harvard.edu/staying-healthy/potassium_and_sodium_out_of_balance

            I never meant address you personally with my comment, more the health community at large. I do trust peer-reviewed research. I trust political bodies that form our dietary recommendations far less.

          3. Also, for some clarification re ‘saturated fat and cholesterol aren’t dangerous’. I’ve been vegan since 1991. I follow a low-oil WPBD. I do not think that ‘saturated fat and cholesterol aren’t dangerous’ merely because I mention potassium as a key player in the salt debate.

            I personally like it salty. But if I compared my generous salt intake to an omnivore, I wouldn’t even come close. Generally, meat eaters consume too much saturated fat and salt via meat. Dairy eaters also consume too much saturated fat and salt, especially via cheese and butter. Vegetarians might also consume the most trans fats of all segments.

            It was only in 1997 that I personally learned about the sodium-potassium connection when the nobel prize was awarded to Jens Christian Skou for his amazing research in the 60s. Ever since I take potassium seriously. This doesn’t mean I ignore salt.

            Salt was the first global nutritional supplement. Animals risk their lives to get it in the wild and it was a life saver in ancient times. Many words like salary or salvation derive from it. Now it’s omnipresent everywhere. Yes, we should be careful not to overdo salt. But if you had to choose between lowering your salt intake (without lowering your meat & dairy intake) or consuming more potassium aka fruits, I’m certain that increasing your potassium will lead to better overall health.

            Why do I mention this so vigorously? Every national dietary recommendation already includes “more fruits” and “less salt” in their guidelines. Most of my friends take the “less salt” and “less processed sugar” recommendations more seriously than “less meat and more fruits”. I think this is part of the reason why life expectancy has been decreasing in the US for a few years straight. Saturated fats are worse than simple sugars. From what I understand based on the research, lack of potassium aka not enough fruits is worse than too much salt.

  25. Darwin,

    Can you help me with a math-thing?

    If enzymatically activated broccoli sprouts and treated with pulsed fields, it increases their sulfurophane content 4.2 fold.

    Pulsed fields alone increase it 2,5 fold, I think. (I mentally lost the exact number while typing this but it is above 2-fold.)

    In the broccoli sprout study for autism, the kids either had to eat 2 cups of broccoli or 2 tablespoons of broccoli sprouts. 1 tablespoon for smaller children.

    How many tablespoons of broccoli sprouts would it be if we used treated broccoli sprouts?

    The parents with autistic kids have trouble getting them to eat that much. Plus, more than one person has said that they can’t afford the sprouts, but the study freeze dried them and crushed them into a powder.

    I am interested to see if it can become a very small amount needed.

    1. I think ”fold” works that if I started with 2 tablespoons of broccoli sprouts and wanted to change it by 4.2 fold, do I just multiply or divide?

      2 divided by 4.2

      Less than a half tablespoon?

      1. Mustsrd seed is also 4-fold with broccoli.

        I wonder if pemf plus hack and hold plus mustard seed extract would increase it even more.

  26. I am also trying to figure out if chopping broccoli sprouts is a way to enzymatically activate them?

    I have been having so many brain problems and the broccoli sprouts really helped me last year. But I don’t like large quantities of them either.

  27. UvB and UVA light with a 24-hour rest, increased the glucosamine by maybe 31% or 36%. I don’t understand how the numbers are written in the study but there was an increase of the glucosamine’s 24 hours after exposing 7-day old broccoli sprouts to UV light. They didn’t test UVC.

  28. UVC light was tested on sprouts and it increased the phenolic content from 30% to up to 70_something percent.

    https://sproutnet.com/germination-and-exposure-to-uv-light/

    The concept that I can use the UVC and kill any bad stuff while increasing the phenolic content is interesting.

    Do they list labs that experiment on broccoli sprouts anywhere?

    I would like a test of treating them with UVC and PEMF together and whether chopping them before eating increases sulfuraphane more than 4-fold.

  29. I’m curious what research has been done around the association between vegetarian diet and stroke risk as it relates to Vitamin K? I’m wondering if that is a consideration given the amounts of Vit K in leafy greens and its potential relationship to blood clotting. Would love to read more on this as well as the possibility of garlic and/or ginger as a potential counter measure. Thanks!

    1. Hi Liz: The vegetarian stroke risk in the BMJ study was was primarily associated with hemorrhagic strokes, which happens when a weak blood vessel bursts and bleeds as opposed to ischemic strokes, which is associated with clots.

  30. First of all, thank you Dr. Greger for sharing your knowledge about a true WFPB diet, and the Daily Dozen. We can argue about all of the studies in the world about what is best, but for me, the best evidence is when my body was put to the test. I lived overseas and ate mostly fruit and vegetables, and beans, but also, fish and chicken and some dairy. My cholesterol was 225, and was borderline hypertensive, weighing 120 lbs. I regularly exercised (walking and jogging), and have never smoked. In 2010, I moved back to the US, enjoying the “good food”, which was a significant increase In dairy (low-fat yogurt almost daily, cheese, eggs 2x per month), increased fish and chicken consumption. I continued to eat vegetables and fruit, as well as beans. By 2016, I had gained 15 pounds – an all time high of 135 (before then, I never gained weight), cholesterol consistently high, and became hypertensive. Other than medicine, I tried everything to lower my cholesterol (except changing my diet because I was told that I ate healthy by doctors), and nothing helped. I finally decided to take medicine to lower my blood pressure to mitigate the risk of stoke. A friend introduced me to Nutrition.fact.org. I trusted her and believed that I had nothing to lose. Now, after following a WFPB diet for 1 year 10 months, I weigh 115 (and exercise less than I used to), have low cholesterol, and normal blood pressure without medication. I am the study. After watching my health improve, my husband and daughter are now on a WFPB diet. Also, my other children are moving in this direction. Following Dr. Greger’s guidance of no added salt, no oils, no refined foods, and really following a WFPB diet has made the difference in my life, and my health speaks for itself. Again, thank you Dr, Greger for sharing your wisdom with the world.

  31. As someone on a plant based whole food diet with low Vitamin D I have been looking for a vegan supplement (99% of the supplements we have found contain gelatin) that is also certified by either ConsumerLab.com, NSF International, or U.S. Pharmacopeia (USP). Is anyone aware of a 5,000 IU vitamin D supplement that meets all those criteria? Thank you!

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