What Diet Should Physicians Recommend?

What Diet Should Physicians Recommend?
4.77 (95.45%) 44 votes

Kaiser Permanente, the largest U.S. managed care organization, publishes patient education materials to help make plant-based diets the “new normal” for patients and physicians.


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

In 2013, a “Nutritional Update for Physicians” was published in the official journal of Kaiser Permanente, the largest managed-care organization in the United States, which covers about nine million people with about 15,000 physicians, who were told that “[h]ealthy eating may be best achieved with a plant-based diet,…define[d] as a regimen that encourages whole, plant-based foods and discourages meat, dairy…,eggs as well as all refined and processed [junk].”

“Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. Physicians should therefore consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”

The major downside is that it may work a little too well. If people are on medications, their blood pressure or blood sugar could actually drop too low, so “physician[s] may need to adjust medications,” or eliminate…[them] altogether.”

“Despite the strong body of evidence favoring plant-based diets,…many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic [diseases]. This could be because of a lack of [physician] awareness…or a lack of patient education resources.”

So, Kaiser sought to change that. Want to “lose weight,…feel better,…improve, stabilize, or even reverse chronic…disease,” get off some of your medications? If you answered ‘yes’ to any of these questions, then a plant-based eating plan may be right for you.” Side effects may include “[l]ower cholesterol, blood pressure, and blood sugar, reversal or prevention of [our #1 killer], [a] longer life, healthier weight, lower risk of cancer [or] diabetes—may [even] slow the progression of certain types of cancer,” and improve inflammatory conditions, like “rheumatoid arthritis.” They offer “Tips to Get Started,” meal plan ideas, and, I’m honored say, a good taste in websites.

The paper ends with a familiar refrain: “Further research is needed.” In this case, though: “Further research is needed to find ways to make plant-based diets the new normal for our patients and employees.”

Please consider volunteering to help out on the site.

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

In 2013, a “Nutritional Update for Physicians” was published in the official journal of Kaiser Permanente, the largest managed-care organization in the United States, which covers about nine million people with about 15,000 physicians, who were told that “[h]ealthy eating may be best achieved with a plant-based diet,…define[d] as a regimen that encourages whole, plant-based foods and discourages meat, dairy…,eggs as well as all refined and processed [junk].”

“Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. Physicians should therefore consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”

The major downside is that it may work a little too well. If people are on medications, their blood pressure or blood sugar could actually drop too low, so “physician[s] may need to adjust medications,” or eliminate…[them] altogether.”

“Despite the strong body of evidence favoring plant-based diets,…many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic [diseases]. This could be because of a lack of [physician] awareness…or a lack of patient education resources.”

So, Kaiser sought to change that. Want to “lose weight,…feel better,…improve, stabilize, or even reverse chronic…disease,” get off some of your medications? If you answered ‘yes’ to any of these questions, then a plant-based eating plan may be right for you.” Side effects may include “[l]ower cholesterol, blood pressure, and blood sugar, reversal or prevention of [our #1 killer], [a] longer life, healthier weight, lower risk of cancer [or] diabetes—may [even] slow the progression of certain types of cancer,” and improve inflammatory conditions, like “rheumatoid arthritis.” They offer “Tips to Get Started,” meal plan ideas, and, I’m honored say, a good taste in websites.

The paper ends with a familiar refrain: “Further research is needed.” In this case, though: “Further research is needed to find ways to make plant-based diets the new normal for our patients and employees.”

Please consider volunteering to help out on the site.

Doctor's Note

You can download the Plant-Based Diet booklet here.

So exciting to see the practice of lifestyle medicine. For more on this new medical specialty:

Unfortunately, much of medical training is substandard when it comes to nutrition:

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

171 responses to “What Diet Should Physicians Recommend?

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  1. I am sure it probably tastes ok but the black beans with kale and yams -looks totally unappealing. Consideration should be given to the presentation of food. The experience of food is more than just nutrients packed in different colours and textures put on a plate. Make food look nice and people are more likely to eat it. :-)

          1. Beans an kale are delicious they turn me on. Everyone needs to reprogram what they eat to be healthy and stop eating what hurts your body and our world and also your neighbors

      1. Funny, I love the combination of the kale, beans and yams and the colors are beautiful. I also know for a fact that they are delicious together too. :)

        1. I agree with you, since I worked in the field of culinary photography, my dad’s specialty. I answered to Kate-Frances to say why I think the photos are the way they are.

    1. I agree. They should have used a professional food photographer and stylist. People (including myself) will often look at a picture before text and will decide whether to continue based on the attractiveness of the image.

      1. I’m going to stereotype plant based eaters here.

        In my experience most plant based eaters are sort of rugged people. They don’t care too much about aesthetics.

        Maybe that affects advocacy?

        1. If you mean they tend to think about what they are consuming rather than how pretty something looks, then yes I have to admit to being rather that way.

    2. Imho, it looks delicious!! Before I went whole-food-plant-based, it would never have appealed to me. But now, omg. My tummy is growling. :) I just made some sweet potato/kale/black bean enchiladas. :p

    3. To me, the food looks great, but I see your point. The photo has an institutional look about it. They’re just starting out. Maybe the next time they can make the picture sing.

    4. I have to agree. The photography itself is poorly done, and personally, despite the fact that I eat all those foods, I never eat them in that sort of configuration. The average SAD eater may be more enticed were those foods made into a sweet potato black bean burger, some sort of pasta dish, chili, etc. Something really tasty looking with a caption to indicate what they’re made out of. I’m a serious bean eater but even I never just eat a pile of plain beans. If this were my first introduction to a wfpb diet, I would not be interested. And even as a seasoned wfpb eater, I’m still not interested… I’ll take my incredibly seasoned and aromatic chickpea ratatouille and crusty bread for lunch today thank you.

      But despite the poor presentation, I hate to sound like a negative nelly. I’m sure the photos will get better. Overall this is pretty great news. Many if not most people I encounter (even professional scientists) still have serious misconceptions about the healthfulness of a vegan diet.

    5. Having just read the 47 comments which mostly focus on the photography in the brochure, I was wondering why this huge shift in nutrition policy isn’t a major news story. Searching online I only found vegetarian and animal rights groups reporting on this new policy, ie; nothing in the NYTimes or any other large media provider. Also wondering why Dr. Greger reports this over a year after the fact. Anyway congratulations for your ongoing contribution Dr. Greger!

      1. I know he makes each “season” of videos in advance, then releases them one by one, so he may have made this one quite a while ago.

        I also noticed but was not surprised by the lack of media coverage when this came out. 9 million people, that’s about 1 in 30 Americans that this directly affects, and not a peep about it. What a shame.

      2. It would create cognitive dissonance. That probably wouldn’t help readership at the Times.

        Maybe that is why we haven’t seen it so widely reported on. Good thing we got people like Dr G tootin the horn.

    6. I think you judge the food on today’s standards, where absolute junk food is dressed up to look amazing. It’s trickery.
      Good looking food, is that that is nutritionally good, to me.

      1. A View Form The Next: Name calling is not allowed on this site. This site is for supportive and scientific dialog. Feel free to express your opinion without resorting to personal attacks.

    7. This looks delicious to me too…Food photography pimping (aka “putting lipstick on a pig”) is essential for serving up animal carcasses and feces. Real healthy foods don’t need it though.

    8. I totally agree. The colour of the plate is only the first thing wrong with that presentation – government institutional 1950s blue is not something that says “yum” and the “plop in on the plate like school lunches” just makes it worse. Honestly, it looks seriously unappealing (and I eat this way!!). It’s kind of no wonder many people think WFPB eating is unpalatable.

    9. It does look really appealing to me.

      But I think mmmeat has a point. If we are going to try to encourage a plant based diet as a way to make our communal health better, we need to modify our standards.

      I got a big mess of veggies going in the slow cooker right now, but not everyone views the world through veggie eyes.

    10. I would eat the HECK out of this dish! The picture was taken with flash which always makes things look a little less appealing. Even the most scrumptious food can look like crud with weird lighting!

    11. I’m more concerned with how much work a simple lunch would be. Instead of making a sandwich, which is slicing two tomatoes, laying down a piece of meat or eggs, I would have to cook beans, mix a kale saled (which also looks cooked), chop tomatoes, onions and lettuce into another salad, make a portion of what looks like hummus and then the strawberries and nuts are simple, but still, an awful lot of work.

    12. Who cares what it looks like. You should care about how nutritious it is. That’s what I tell my kids. Eat it because its good for you. Period!

  2. Kaiser has really been in the lead on this for a while. Kudos to them – and to Dr. Greger and all his colleagues who practice lifestyle-based medicine, encouraging (and embracing themselves) this healthy and compassionate way of eating and living!

  3. I think it is really great Dr. Greger’s website was cited by Kaiser Permanente. A lot more people will now be exposed to benefits of a plant based diet. Dr. Greger: congratulation and thank you very much for your hard work and everything you and your team do for all of us following your work!

  4. I attended a nutrition seminar sponsored by my local Kaiser. It was presented by a young RD who was not aware of the Nutritionfacts.org website. She wrote the website address on the flip chart and pretty much everyone wrote it down. People are “starving” for great nutrition resources. Glad to see Kaiser put your site on their list of recommended things to do to go plant-based. I consider myself an ambassador of the website as I have given it to many people looking for knowledge on going plant-based. It speaks to the issue so much better than I ever could.

    1. I know, me too. I am so excited to see this database of knowledge be further extended to the population! I pray daily that it can one day become as routine a check for medical questions as webMD.

    1. Having worked with KP for 30+ years I am glad to see that they are starting to get the message out. The booklet is well done and a major step in the right direction. I hope the next iteration will correct some of the many errors in the section discussing selected nutrients such comments on fatty fish helping heart disease and the difficulty in converting plant based omega 3’s… but on balance a big step forward. Thanks for posting the link.

  5. This is great news! Thanks for highlighting it.

    BTW: There’s a typo on the screen just before the end of the video showing the “Year in Review” videos. They should be labeled 2013 and 2014.

      1. Thanks Brenda. I guess the use of “2012-2013” and “2013-2014” as is used on the homepage is too big for the little screenshot.

      1. Misterimpatient: Perhaps a case of the right hand not knowing what the left had is doing? Or perhaps a case of the brain at war with the heart?

  6. Quote from the video: “They offer tips to get started, meal plan ideas, and, I’m honored say, good taste in websites.”
    Me: Last but not least!!!

    I loved this video. It was uplifting. Nice to get some good news about now.

    1. INDEED! It may be a start to turning this ship around…and we need all the help we can get here in America…so much DIS-ease and suffering that is not necessary.

  7. The second source cited looks intended to be a link to the patient education material, but it links to the same manuscript as the first link. I would like to see that patient education material. Am I missing something?

    1. Dr. Duda and Gayle: Tommasina from NutritionFacts has kindly fixed that second link. Thank you both for pointing out the problem.

      And thanks again to Shar for tiding us over.

  8. thank you so much Dr michael greger, i saw their findings a few weeks ago and i wished someone would simplify their findings.
    thank you for promoting a heathier life style that it isn’t part of the ordinary (drug prescription) way. your videos and articles are inspiring! and helps promote an compassionate life style!!

  9. Exciting to see Kaiser promoting plant based diets and it makes sense given that they profit when they reduce patient visits and procedures. I’m not sure how widespread the practice is, but a Kaiser in San Francisco featured a weekly farmer’s market.

  10. Excellent advice, but I think the photographs of the food and the meal suggestions in the booklet are enough to put anybody off! Imagine presenting someone used to eating, oh I don’t know…a Big Mac and fries, say, with a plate of plain Bok Choi and a slab of tofu and a mound of plain brown rice instead. How long are they likely to stick with their new meal plan?!
    There are so many amazing recipes on the web for plant based foods – so many inspiring blogs such as Green Kitchen Stories for instance, which look far more enticing for anyone about to change their eating habits. Seems like quite an old-fashioned view of ‘veganism’ offered by the nutritionist who designed the booklet.

    1. I agree. My dad is a professional photographer – now almost retired – his specialty was in culinary photography. I work with him for a little while. And I assure you that those photos could be much better. However I understand why the photos are the way they are, it give a crystal clear sense of volume and partition of the plate for average people. It could be more appealing indeed, but in doing so you could loose the educational purpose behind it.

      1. Indeed! Those photos are not appetizing. This reminds me of the required “advertisements” for the first electric cars by GM, the EV. They had a very old woman promoting it in a TV add and complained they just couldn’t get enough buyers!

  11. We were thrilled to view this and read the article! Alas, we saw it just after I had come home from the South San Francisco Kaiser where I supported a friend through surgery. As I have done at the two San Rafael,CA Kaisers, I checked out the cafe and the coffee shop. You would NEVER have known this paper had been published! And apparently over a year ago! I have written letters to Kaiser asking the walk the THRIVE walk, and at least offer some heathy plant based meals, snacks, lattes. I pointed out the docs I had watched enjoying their doughnuts etc. I got only form letter responses. Our three Kaiser Docs have never betrayed the slightest interest in, nor knowledge of WFPB diets. Yesterday’s nurse responded to my query about the quality of food at the hospital said they were trying to do away with french fries and have had huge resistance from the staff. And she said that there are regular games and staff competitions for which the prizes are ice cream nights.
    SO! Is there any hope? How come we have seen NOTHING to suggest anyone we have met at Kaiser have ever heard of these directives?

  12. What a fabulous, good news video! Thank you, Dr. Greger. As someone mentioned below, I too, was unable to get to the second source,

    Kaiser Permanente. The Plant-Based Diet a healthier way to eat. Kaiser Permanente 1-20.

  13. With a history of hemorrhagic stroke, should one eat a diet higher in fat and cholesterol? I just read a study that links low cholesterol and hemorrhagic stroke.

    1. I don’t have a link but I remember Dr Joel Fuhrman saying in a video or paper that people on an optimum vegan diet who are eating only good fats and oils (like whole food nuts and avocado) are at a higher risk of hemorrhagic stroke, because as a group, their blood tends to be thinner. But he goes on to say that that the risk is minimized by reducing sodium intake to reduce permeability of the blood vessels.

  14. So glad to hear this, BUT it is easy for Kaiser to publish some materials, but they are not really pushing their doctors to do this. It needs to become part of the treatment standards physicians use. The active promotion of plant based eating needs to be a REQUIREMENT, not just a suggestion. I left Kaiser, because I found a physician who really supports plant-based eating.

    1. K. Garcia: If you click on the Sources Sited link under the video, you will find a link to the actual .pdf, which you could then print out yourself.

      Also, I would refer you to the Physicians Committee For Responsible Medicine (PCRM) for other materials that can be used in education. They have some great pamphlets.




      Hopefully one of those pages will be helpful.

      What do you teach?

  15. I agree Mmmeat….I am a chef. NEVER serve food on a blue plate. No matter what it is it will always look unappealing. Kaiser should have looked me up to prepare a dish from my healthy cookbook, The Passionate Vegetable.

  16. Finally!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  17. Dear Dr.Gregor,

    I have been following the 80/10/10 diet “to a T” for 4 years (raw vegan carb based diet), and I was doing great until last year, then I suddently started loosing so much weight that I now are so thin that I look ill. My question is: since I havent changed my diet, why is this happening? And what changes should I apply to reverse this process? Should I switch to a cooked diet? Maybe follow Dr.McDougall’s dietary recomendations for instance?
    Your advice is much appreciated.

    1. Your history of sudden weight loss is concerning. I would work with your physician(s) to help figure out what is going on. If you can obtain an accurate diagnosis then you will be more likely to make the best decision. Good luck.

  18. My friend who works at Kaiser says they have promoted a plant based diet for 5 years and that some doctors think their patients need more protein than a plant based diet provides. So they don’t agree with what their employer, Kaiser, is promoting. Is this true? How many of their doctors actually suggest a Plant Based diet to their patients? How can doctors continue to promote the protein myth?

  19. Unfortunately, the facts are that it takes an average of 17 years for physicians to come around to changing their opinions after that facts are out. For example, lots of doctors still think saturated fats are bad, even though the AHA now admits they are not.

    On the bright side, the suggested diet seems much better than the USDA diet.

  20. Could this be a coincidence with the fact that Obamacare came into play? More common sense care equal less bills that the government will have to pick up. Either way, its good to see this is making it into the mainstream medical field.

  21. Where can I get my hands on this pamphlet? Not for myself, as I am a new/returning vegan. But for my father who has had prostate cancer. Suffers from Lupus and Rheumatoid Arthritis. He eats animal products at every meal and I just know if he had access to this information he’d feel better and might even reverse some of his conditions.

    1. Guest: Check the “Sources Cited” section above.

      Also, consider showing your father the documentary, Forks Over Knives. That movie had a big influence on my parents. It wasn’t compelling in and of itself – but it was a big factor in their eventual conversion to a plant based diet.

      Other resources that might help – consider over time also showing your father the year-end summary talks from Dr. Greger. They are so powerful! Here they are for free:

      Hope that helps.

  22. I have a patient with pre-diabetes. Her Kaiser doctor had her attend a diabetes prevention nutrition class at Kaiser Sunset Los Angeles last week. This booklet was not presented nor was plant based diet recommended. They got the 3 tennis balls of fruit, protein that fits the palm of your hand talk. Sad. At least she got the booklet and nutrifacts.org links from me!

  23. We eat with our eyes first. I’m not finding that image terribly appealing either my friend, especially on the seafoam-colored plate. In attempting to win over non-vegans, one could certainly do so much more with presentation, cooking techniques and garnishes. Check out rouxbe.com’s plant-based cooking course. There is a feast for the eyes, body and soul.

  24. Off topic: in the email and web page version of “My top 10 most popular videos of 2014”, there are two links that should be to this page – the one from the heading, and the one from the video picture. The latter points at the #2 video (about eggs). It’s too late to change the email, but perhaps the web version could be fixed?

  25. Imagine if everyone ate this way! I’ve seen figures that suggest up to 70% of chronic disease could be prevented with this type of diet. No doubt Kaiser realizes they would have far fewer claims if their subscribers widely adopt this plan, which would allow Kaiser to under price their competitors and still make more money. What a great idea to out compete the other insurers…and drive our rates down! We can be healthier and save money.

  26. Can anyone update with the good news that Kaiser is REALLY teaching WFPB to their docs and patients? We have seen no sign on our visits and the KP site makes it hard to find any mention of WFPB much less promoting it in the Health and Wellness section. I fear KP’s fear of offending big food clients has won out. Is there any hope? Anything we, as members, can do to cheer them on? (THEA, any ideas?) This week, UC Davis Integrative Medicine Program is making a big online splash including their Facebook page. So that is good news. They are offering a free virtual get started class April 23-26 UCD Summit on integrative…. Sign up advised to get in. https://www.facebook.com/ucdavis.integrativemedicine?fref=ts

  27. My (obese) doctor laughed at me when I told her… but I cleared most symptoms of “fibro” (whatever that really is) with diet. But it was a rather extreme diet which began with fasting on green juices and sweats to detox .. but in 3 days 25 years of pain was greatly reduced, in a week I began wondering if anything was really wrong with me.. .but problems do reoccur to remind me to keep mindful

    1. c: re: “…in a week I began wondering if anything was really wrong with me…” Wow! Good for you!!!! This site contains all sorts of testimonials from people who had to take their own health into their hands and were able to fix problems that way. I think those stories are a great inspiration to others. Thanks for sharing.

  28. I honestly think this look absolutely delicious, first thing I thought was , “Oh, I gotta make that!” and second, “OMG I gotta EAT that!!”

  29. Has Kaiser Permanente backed away from it’s Whole Food Plant Based diet recommendations since this publication? As a member, they seem to be recommending the USDA choose my plate dot gov format, which leaves 1/4 of the plate for “protein” (okay, could be beans), separate from the 50% of the plate for veg / fruit, 1/4 for grains and a circle beside the plate specifically for Dairy.

    1. Where did you see that recommendation? Online or is there a pamphlet? I imagine there will be a transitional period, and there are still some leftover educational materials, being handed out by doctors and nurses who didn’t get the memo? Boy, will their faces be red when they realize they’ve been recommending an out-dated disproven disease-producing diet!

  30. As a recently widowed gentleman, I would love the presentation. However, I am learning to cook for myself, I would make the same meal in one pot, the pressure cooker. Cook the beans first under pressure, about 30 minutes, then let the pressure drop naturally, then add cut sweet potatoes, and bring back to pressure, about 6 more minutes, then a natural release of the pressure. When pressure is down, remove the lid, and add the cut up greens and or other veggies, bring back to pressure for 1 minute, release pressure quickly by running cool water over the cooker. Open the lid, season to taste, (I use a variety of mostly Indian spices (cumin, cardamom, coriander, turmeric, black pepper, and sea salt, find your own favorites) and enjoy! Complete meal cooked from scratch in less than an hour, make enough for at least two meals and you have lunch for the next day! You can soak the beans for eight hours in cool water before cooking if you want to save even more time (about 10 minutes in first cooking)

    1. simplicity is the key

      I just boil my vegetables (cabbages, soy bean sprouts, squash; add dwenjang (Korean fermented soybean paste); add tofu) in a very big pot. Takes around an hour of preparation and lasts me 4 to 5 days.

  31. I have been eating to live about 95% of the last 15 years.
    I’m tired of these goofy smoothies that appeal more to taste than health. Even the Mayo basic smoothie appears wimpy.
    Let’s some of us get together online and design a 10 day CANCER (diabetic, heart, etc.) SUPER menu (like dr. Mc, E, O, etc) and RECIPES for meals and blended (not juiced) smoothies with plenty of spices watered down with hibiscus tea made from Kangen water (dr. G says u can get the ph by adding baking soda but the k water makes water taste so good u won’t ever go back to tap water.). Let’s design it based only on the highest nutritional value, not taste. Just adding the kale, red cabbage, Apple (skin, seeds and all), garlic, sour kraut, sprouted broccoli and wheatgrass and spices and nuts and ground flax seeds, rejuvalac, etc makes over A HALF GALLON AND TAKES ONE HOUR FROM washing the veggies to clean up (it wrecks the kitchen) even if u mix up the 12 or so spices in advance!!!!! I funnel it into 20 ounce recycled soda bottles and freeze what I can’t drink in one day. Next day, toss a couple in the gym bag and out the door. Plus, the recipe gets complicated: u have to add pepper to the turmeric, cook the tomatoes and broccoli, let the garlic sit for ten minutes, etc, etc. Then u have to stop by the grocery store every other day and need a second fridge. Girls won’t put up with this very long. If I still had kids and a job I could not manage.

    It is strange that u can get vegan and veggie meals in most jails and prisons but not n hospitals: They r called religious diets (I guess they r, why not?). The international food service providers and states and counties have been sued enough times by inmates that the word gets around. Too bad the doctors that run hospitals and idiots that run pubic schools are not smart enough. Maybe some do know but understand it is bad for business.

  32. Thank you for the Plant Based Diet booklet! In the comments there is a lot of objection to the food presentation/photography. If you are interested in contribution (donation) for an updated version please contact me. Though the main focus is on the important content a more contemporary presentation will give the brochure even more attention, especially from younger people.

  33. I eat pragmatically. What does my body need. How can I avoid pesticides, herbicides, other toxins, pathogenic bacteria? I don’t need fake meat, eggs, or dairy. That is what I will eat. It is not that I do not like tasty well presented food but that is secondary.

  34. Does the WFPB diet work its magic on the symptoms of Dupuytren’s Syndrome ? Are there any studies or anecdotal evidence out there?

  35. Wow! I’ve been a Kaiser Permanente member for over 2 years and I’ve never seen this gorgeous brochure. It’s interesting that on the last page they say, “if you cannot do a plant-based diet 100 percent of the time, then aim for 80 percent. Any movement toward more plants and fewer animal products can improve your health!” — So, does moderation kill or not?

    1. BigGregerFan: It is a matter of how much risk you want to tolerate. You can improve your chances of good health by moving toward a more whole food plant based diet, but you get your best chances by going all the way. If I remember correctly, Dr. Greger puts it like this (kind of joking to make a point): “Eating moderately and you can get moderate results! You can lose say just 2 toes instead of your whole foot.”
      One other thought: telling people to go part way to begin with can set people down a path that gets them 100% of the way in the future. Sometimes it it too overwhelming to consider a 100% change. A different approach may ultimately have the best results.

      What do you think?

  36. I ran my own little experiment. In November 2016 my cholesterol was 220. I switched to a plant-based diet (about 98% meat-free), with only the occasional fish and eggs, and my cholesterol results on Feb. 24th was 166. Not only that, the lab technician congratulated me as I walked into his office, as all my vital organs are performing better than they ever have done. Everything improved! I hadn’t even thought of that, I was just focused on my cholesterol. So happy that I followed Dr.Greger’s advice.

  37. Dr. Greger,
    Would you please give your opinion on zero carbohydrate diets that some people are using to enter a “Ketosis” state in order to lose an appreciable amount of weight in a fairly quick time frame? Thank you for you input.

      1. Thank you Katie, but I was hoping I could get an answer specifically aimed at “entering into the ketosis state” in order to lose weight, I’ve found nothing at all having to do with this on the website and because of my great respect for Dr. Greger’s research and opinion, was hoping to hear his take on it.I understand the doctor must be very busy so thanks anyway.

  38. Is this diet recommended for infants as well? For example, is soy formula better than standard formula, which is based on cow’s milk for a baby whose mother is not able to breastfeed? It seems that all of these data are mainly for adults, and some families are extrapolating this to infants – the families wishes make it very difficult to treat babies who are not growing or are having problems with soy formula. Blended foods is an option but is not recommended in young infants.

  39. I have just spoken to a nutritionalist regarding helping me with a whole plant diet. Her recommendation was to have DNA testing done first to find out what types of foods my body needs or disagrees with. She said that for example my body may need fish. Any comments regarding her thoughts?

  40. That looks really good to me. Especially since they didn’t mix the foods together into one mixture. I always use a sauce on my greens along with tiny bits of onions, carrots,mushrooms and Dr Weil’s Umami sauce recipe.

  41. Please address these findings. There has to be a hole somewhere. Maybe they aren’t specifying the type of carbohydrate……….

    High carbohydrate consumption may be harmful, research suggests
    Reuters (8/29, Seaman) reports that research suggests “global dietary guidelines should possibly be changed to allow people to consume somewhat more fats, to cut back on carbohydrates and in some cases to slightly scale back on fruits and vegetables.”
    TIME (8/29, Park) reports that investigators found that “people eating high quantities of carbohydrates…had a nearly 30% higher risk of dying during the study than people eating a low-carb diet.” Meanwhile, individuals “eating high-fat diets had a 23% lower chance of dying during the study’s seven years of follow-up compared to people who ate less fat.”
    MedPage Today (8/29, Husten) reports that the study “also found that the benefits of fruits, vegetables, and legumes top out at just three to four total servings per day.”
    Medscape (8/29, Hughes) reports that the research was presented at the European Society of Cardiology 2017 Congress and was “published as two separate papers in The Lancet – one on the fat and carbohydrate outcome data and one on fruit/vegetables/legumes outcome data.” An additional “paper in Lancet Diabetes and Endocrinology focuses on effects of the different dietary patterns on lipid levels and blood pressure.”

    1. The ONLY evidence based Scientifically proven lifestyle/diet that 100% matters to me is Dr. Esselstyn’s to reverse heart disease, it’s been doing exactly that and saving lives since 1985. Have a nice day!
      Paul G. Volk

      1. Unfortunately, the above quote is from today’s AMA posting:

        Good morning. Here are today’s top stories. August 30, 2017

        Which is why I would love to hear Dr. Greger’s dissection of the referenced articles.

  42. Hello,

    I am trying to raise my two year old son vegan (fighting my family tooth and nail however). Doctors say he needs to gain weight (due to birth defect). I have tried high calorie smoothies (which he will not drink), hiding avocado in a mango smoothie because he will not eat plain avocado, giving him as many almonds, cashews, nuts as I can but he seems to be tired of them. Any other high calorie WFPB ideas? Many thanks!

    1. Ram,

      Thea’s answer is amazing. I would just like to remind the possibility to check with your doctor why isn’t he gaining more weight since there could be hidden underlying medical cause. You should also weight the possibility of giving him some animal products. Of course, it’s not healthy at all but may be better than cachexia.

      Take care!

      Moderator Adam P.

  43. Ram: I’m sorry you are going through all that. If I were in that situation, my approach would be to take every opportunity to use a more calorie dense food over a lesser one. Ie, hit the problem from lots of angles, not a single food or two. Some ideas: dried fruits are more calorie-dense than fresh. Dried goods (breads, muffins, crackers–dried stuff made of flour) are more calorie dense than intact grains (rice, barley, etc.). One of the NutritionFacts videos leads me to believe that nut butters get absorbed better than whole nuts that have to be chewed. In addition to peanut butter and jelly, there’s a ton of nut-based sauces that you could poor over potatoes and veggies or bean burgers to make them delicious and give that extra bit of calories and provide lots of variety. (So he doesn’t get tired of them.) For that matter, you can blend avocado into a lot of sauces so that he doesn’t have to taste it plain. Firm tofu is somewhat high in calorie density with some extra fat that kids can use well. Cooked veggies are more calorie-dense than raw. (Not that cooked veggies are very calorie dense. It’s just that he still needs veggies and you want to take every opportunity to squeeze in more calories when possible.)

    Finally, while oil is not a whole food and not something that would generally be recommended, maybe your son is a special circumstance where sneaking in some olive or canola oil would be a good idea? Oil is the most calorie dense food that there is. It is also a nutritional wasteland, but it has calories. So, maybe if you are really desperate, a little oil along with the above ideas might be OK? Maybe popcorn topped with oil and nutritional yeast would be a good idea for your son? I’m not an expert, so please take this last idea for what it’s worth.

    When people need to lose weight, we tell them to eat low calorie-dense foods. The reverse is true for people who need to gain weight. (https://nutritionfacts.org/questions/what-is-a-healthy-way-to-gain-weight/ ) In your son’s case, it sounds like something medically different is going on and just knowing about calorie density might not be enough. It sounds to me like you need a knowledgeable plant based doctor in your corner. If you can’t find one in your area, Dr. Klapper with the True North Health Center does phone consultations. I don’t know how much he knows about kids, but he is extremely knowledgeable about nutrition and health. It might be worth checking out.

    Finally, I’ll mention that it seems to me like you have two main problems: 1) getting your son to a healthy weight, and 2) dealing with clueless, but well meaning I’m sure, family and doctors. To help with #2, I’m copying below a post that I have shared with others when they face similar challenges. There are some resources below that might help.

    Good luck!

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

  44. Hello all,

    Lately I have been wondering whether a Whole-food Plant-based Keto Diet could as well do the job that the low-fat, high-carb does. Has it been tested? Are there any drawbacks or concerns?

    In case anyone has any related info I would be glad to further discuss the topic. Let me know.



    1. Hey Adam, thanks for writing. After two mega-studies involving tens of thousands of individuals were published concluding that the more closely one sticks to a low-carb diet, the higher their risk is for dying from any and all causes, I think it is now obvious that a ketogenic diet should only be used where it is medically necessary, and NOT for weight loss.

  45. I have been on a plant based diet for approximately a month with the hope of improving my Intersticial Cystitis.
    It seems almost every other malady I have had has improved significantly yet my bladder seems to get worse by the day! I have run the gamut with treatments over 17 years…. I continue to review nutritional information to see if there is something that will aid in the repair of my bladder wall as 3 ulcers were discovered on my initial diagnosis. It would be great to know if I have missed any nutritional break throughs that are not getting the attention they should. I appreciate any advice and help, and I absolutely LOVE this site and the book.

  46. Dave,
    Patients taking warfarin do not need to avoid vitamin K, they just need to eat a consistent amount daily. They need to let their physician know so that their warfarin can be adjusted to their new vitamin K intake.

  47. I have a few questions. Are beans the biggest way for getting protein in a plant-based diet? As I’ve gotten older, my buddy can’t handle the gas-producing foods well at ALL, so I’m not sure how to stay away from beans or not have them affect me so badly. Also, I read about a lot of plants producing lectins, which are bad for you and do you should avoid them…? I don’t know the ins and outs about that, honestly, but need some direction with that as well, please!

    1. There are many WFPB protein sources. Beans is only one. Grains and nuts are great sources. Did you know that spinach is 51% protein which is much higher than beans? Eating a varied WFPB diet will provide plenty of protein. No one ever got sick from a protein deficiency on this diet without beans, but beans are super healthy! Excess gas is often due to the wrong gut bacteria. Try mixing in many raw veggies such as broccoli, cabbage, lettuce in the diet and make sure there are no processed foods and no animal products. This will help shift the bacteria over to beneficial ones that will not cause so much gas. It might take a few months, but the gas should settle down in time.

      Dr. Ben

    2. Jade Calaway: To add to the good answer you got already, the following protein 101 article is an easy read and does an awesome job of explaining what your protein needs are and how to meet them with plants. Using referenced data, you will quickly see that meeting your protein needs is very easy as long as 1) you are getting enough calories and 2) are eating a variety of whole plant foods (whether you eat beans or not) (ie, not just eat fruit): https://michaelbluejay.com/veg/protein.html

      NutritionFacts has a series of videos on the topic of lectins. So, if that topic really bothers you, can watch these three videos: https://nutritionfacts.org/?fwp_search=lectins&fwp_content_type=video Bottom line is: don’t worry about it. The worse type of lectins are in foods that you naturally cook and cooking removes the lectins. Also, people who eat high-lectin foods the most are *least* likely to get diseases like cancer. So, the idea that lectins are a terrible thing is probably not true from a practical/how-we-really-eat perspective.

      Also, the following NutritionFacts blog post on gas and beans has some good ideas: https://nutritionfacts.org/2011/12/05/beans-and-gas-clearing-the-air/

      Hope that helps!

    3. There is a lack of education. Nutritionist Think they know it all??? So they don’t study the evidence and information provided

      Sent from my T-Mobile 4G LTE Device

  48. So excited that I see “How Not To Die” in the hallway window of my local Kaiser facility. Their website advocate a plant-based diet too, yahoo!

    But, I just got their regular email, with their article “Eat Smart For a Healthy Heart.” It says:
    “Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best for your heart. Options include salmon, mackerel, lake trout, herring, and sardines.
    Limit saturated fat and cholesterol. To limit saturated fat and cholesterol, try to choose the following foods:
    Lean meats and meat alternatives, like beans or tofu
    Fish, vegetables, beans, and nuts
    Nonfat and low-fat dairy products
    Polyunsaturated or monounsaturated fats, like canola and olive oils, to replace saturated fats such as butter

    Why are they so inconsistent?

  49. I am new to learning the plant based diet (about 3-4 weeks). While I am finding things to eat that I like, I am never satisfied. I’m constantly thinking about what I can eat next, how long until the next meal, even if I have eaten until I am full. I hate this feeling. I am always wanting to cheat. What is the matter with me? Why is it so hard for me?

  50. Maureen,

    There is nothing wrong with you! Those feelings are completely normal when you are changing your lifestyle and diet. It takes a while for your mind and body to adjust. I felt the same way for months before everything just clicked and I started craving healthy foods. Remember that this is a process and be gentle with yourself. Focus on nourishing your body with nutrient-dense, high quality foods. The time will come when eating healthy is effortless. :)


    1. Thanks, Julia.  I will try to hang in there as I know how important this is to my health.

      Sent from my Samsung Galaxy , an AT&T LTE smartphone

  51. Hi, so I’ve recently been following Greger’s daily dozen and have been noticing an increase in flatulence. Also my hemmerroids have returned. I don’t blame ya for the latter, but I do give partial credit for the farts. Am I just not using the bathroom soon enough after meals? Is that really practical in a busy life? Should my leafy greens portions be higher? I’ve been following the dozen to a t so please tell me what I’m doing wrong. Also if I don’t want to spend the extra dough, should I supplement with iodine instead of buying sea vegetables? Thanks, Bob

  52. If you’re transitioning to a whole food plant based diet, you’re likely taking in much more fiber than previously. Many typical diets include about 5-10 g of fiber daily, but whole food, plant based diets include 45-65 g fiber per day! It helps to take it slowly: keep track of fiber grams, and increase over a week or two rather than all at once. Also, drink plenty of water throughout the day. Make sure beans are very well cooked/soft. Eating more greens can help also. The sea plant kombu can be added to cooking beans and can reduce gas from them. As you get accustomed to eating a healthy amount of fiber, it’s quite possible your hemorrhoids will improve. -Dr Anderson, Health Support Volunteer

    1. Thank you for the information. I must’ve jumped into the fiber pool too quickly. But I’m in it now so I wonder how long until my gut bacteria start to work to the added fiber challenge. Could you tell me if an iodine supplement is a good idea/cheaper option as opposed to sea vegetables?

  53. Hi this is a question in regards to weight gain! I started vegan because an emergency room doctor told me about it because of all my digestives issues! Crazy intense pain lack of bowel movements… I have no thyroid no gall bladder no ovaries no tubes also hysterectomy…. I have been eating clean vegan but my weight is going up daily! It’s this normal?? I am also very aware of calories etc… Not junk food vegan either!

  54. Lisa,

    Considering your brief health history….FULL STOP…. have your hormones checked asap, along with a well done review of systems (ROS) to start the detective work. You should not be gaining weight.

    For your hormone panel see if your provider will use a salivary panel as it’s more accurate and in depth.

    A GI workup using tests, such as the CDSA2 panel (GenovaLabs) or a similar test is very much in order. These are standard and will help evaluate the situation quickly.

    Let us know how you’re doing after the evaluation.

    Dr. Alan Kadish Health Support volunteer for Dr. Greger <a href

    1. Hi…. I have had my ovaries tubes.. Hysterectomy.. And thyroid and gall bladder removed.. No point in having hormone work.. I don’t use any replacement.. Due to nasty side effects… All I use is Synthroid my doctor gets me to test every 6 to 8 weeks.
      I have had gi tests nothing ever came back.. They say I have ibs… I have tried medication which does not much of anything.
      I believe it’s motility disorder of some kind… Nothing wants to move out..
      Since switching to vegan I don’t have the pain and nasty bloating… But the scale goes up because nothing comes out… I think. I have been to naturopaths.. Specialists etc.. They tested me for sibo. It didn’t come back positive but they treated me anyway because was in conclusive… Are they heredity motility disorders? My uncle when he died they did an autopsy he was literally full of fecal matter… I have dealt with this as long as I can remember..
      Thank you in advance Lisa

  55. I am just an RN and can’t address your specific motility problems, but I am wondering, as a vegan, what all are you eating? There are lots of things that the vegan diet allows that are not good for you. Have you ever researched what these might be to see if there is something you’re eating that might be working against you? ie: vegan vs whole food, plant based diet?

    1. Hi I am eating whole foods.. Vegetables… Whole grains etc as it says too do.. Not the processed stuff out there.. Even though it is vegan… I have dealt with slow motility for as long as I can remember! I am using the things it says to use… I am going to try acupuncture for motility.
      Thank you for your thoughts

  56. Hello Lisa, and thank you for your questions,
    I am a family doctor with a private practice in lifestyle medicine, and am a Health Support Volunteer for this website. I am sorry to hear about your problems with chronic constipation. There are MANY causes of constipation. Probably the most common ones are insufficient fluid intake, insufficient fiber intake, and not enough exercise.

    It sounds like you probably eat enough fiber, but it would be wise to calculate how many grams of fiber you average per day, and shoot for at least 30 grams per day, with 1/4 of that being from soluble fiber (as opposed to insoluble).

    You probably are not drinking enough fluids, like most of us. You should drink at least 3 liters (13 cups) per day, and more is better.

    Exercise is very important to get your bowels working properly. You should walk for at least 30 minutes per day.

    There are also many medical problems that can cause chronic constipation. One of the more common is hypothyroidism. Since you’ve had your thyroid gland removed, it is very important to be sure that you are taking an adequate replacement dose, so you should be sure to get your thyroid levels checked regularly.

    Certain medications are well known to cause constipation, including narcotic pain medications. You should review the medications you take with your doctor.

    You also mention about hereditary disorders of intestinal motility. These certainly occur, but are far less common, and you should first pay attention to the issues I’ve already mentioned. Here is an article I found about the subject, from Medscape, which is reasonably reliable: https://emedicine.medscape.com/article/179937-overview#showall.

    I hope this helps.
    Dr. Jon
    Health Support Volunteer for NutritionFacts.org

    1. Hi Dr Jon Thank you for your information and taking the time to give me your thoughts..
      I have dealt with this basically as far back as I can remember… So when I was young.. I was sexual abused for years.
      I do walk 30 minutes a day sometimes more… I used to walk 10 miles a day and do weights or kickboxing.. It didn’t change anything.. The thyroid has been a mess first I was over medicated which you would get diarrhea no not me.. Then they removed it… And can’t get it stable it’s been 3 years! I get it checked every 6 to 8 weeks..
      I can say my water would be around that amount.. I know I measured it . At one point it was 1.5 liters to 2 and my doctor said too much..
      Eating vegan has definitely made a difference in the fact I have no pain in my intestines! It’s just a matter of getting the meals the right balance!
      It was an emergency room doctor who told me to do this! He is vegan for last 25 years! Why do dieticians and doctors not tell people to eat this way? Makes me angry I have gone through over 5 years of this at its worst!
      I am going to do acupuncture.. I start Tommorw..
      As far as medication I take my thyroid.. Plus some herbal remedies given to me by a professional… That’s the last while… I stopped taking the prescription by doctor resotran as it did nothing!
      Thank you so much I will do some changes and hopefully before long I will be happier intestinal Ly!

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