Which Parts of the Mediterranean Diet Extended Life?

Which Parts of the Mediterranean Diet Extended Life?
4.86 (97.14%) 28 votes

Of all the components of a healthy Mediterranean diet, which are associated with a longer lifespan?


How might adding a few nuts to one’s daily diet–in this case about four walnuts, almonds and hazelnuts–cut one’s stroke risk nearly in half? Well, olives and nuts are plant foods, and as such, packed with antioxidants, raising the antioxidant level of our bloodstream, resulting in lower fat oxidation and free radical DNA damage. But what’s happening inside people’s arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating the added nuts, or added extra virgin olive oil, or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. Now the nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque rendering them less likely to rupture.

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30%. If you look at the baseline adherence to Mediterranean diet principles, and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil or the wine or the fish, or cutting back on soda and cookies. Among the individual Mediterranean diet components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn’t appear to live any longer overall. And other studies have suggested that frequent nut consumption may indeed extend life–for example, the Harvard Health Professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease, and most importantly, fewer deaths overall, confirmed by all the other big major prospective studies, as of 2014, with a new one just published: 17,000 people followed for five years, and those who ate nuts had less than half the risk of dying.

Maybe this is just because people may eat nuts instead of meat, eggs, and dairy, and that’s why they live longer? No, since vegetarians who frequently eat nuts also have a dramatically reduced risk compared to those who don’t.

So what’s going on here with the PREDIMED study showing no longevity benefit from nuts? Did they just not wait long enough? Well, just because people were randomized to the nut group doesn’t mean they actually ate more nuts, and those randomized to the other groups didn’t necessarily stay away from nuts. If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn’t, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post-hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing the animal fat–anything to get people to eat less lard and butter.

What are the best kinds of nut? The greatest benefits were attributed to walnuts–particularly it seems, for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it’s just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet–including walnuts–may be the most critical message for the public.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Nancy Regan via Flickr.

How might adding a few nuts to one’s daily diet–in this case about four walnuts, almonds and hazelnuts–cut one’s stroke risk nearly in half? Well, olives and nuts are plant foods, and as such, packed with antioxidants, raising the antioxidant level of our bloodstream, resulting in lower fat oxidation and free radical DNA damage. But what’s happening inside people’s arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating the added nuts, or added extra virgin olive oil, or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. Now the nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque rendering them less likely to rupture.

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30%. If you look at the baseline adherence to Mediterranean diet principles, and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil or the wine or the fish, or cutting back on soda and cookies. Among the individual Mediterranean diet components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn’t appear to live any longer overall. And other studies have suggested that frequent nut consumption may indeed extend life–for example, the Harvard Health Professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease, and most importantly, fewer deaths overall, confirmed by all the other big major prospective studies, as of 2014, with a new one just published: 17,000 people followed for five years, and those who ate nuts had less than half the risk of dying.

Maybe this is just because people may eat nuts instead of meat, eggs, and dairy, and that’s why they live longer? No, since vegetarians who frequently eat nuts also have a dramatically reduced risk compared to those who don’t.

So what’s going on here with the PREDIMED study showing no longevity benefit from nuts? Did they just not wait long enough? Well, just because people were randomized to the nut group doesn’t mean they actually ate more nuts, and those randomized to the other groups didn’t necessarily stay away from nuts. If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn’t, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post-hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing the animal fat–anything to get people to eat less lard and butter.

What are the best kinds of nut? The greatest benefits were attributed to walnuts–particularly it seems, for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it’s just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet–including walnuts–may be the most critical message for the public.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Nancy Regan via Flickr.

Doctor's Note

This is the fourth of a six-part video series on the Mediterranean diet. Here are the first three in case you missed them:

  1. Why Was Heart Disease Rare in the Mediterranean?
  2. The Mediterranean Diet or a Whole Food Plant-Based Diet?
  3. PREDIMED: Does Eating Nuts Prevent Strokes?

And then there were two:

  1. Do Flexitarians Live Longer?
  2. Improving on the Mediterranean Diet

Think the effects of adding a few nuts to one’s daily diet are too good to believe? Check out my video Four Nuts Once a Month. For more on Walnuts and Artery Function check out the video, and for more on nuts and cancer prevention, see Which Nut Fights Cancer Better?

Nuts May Help Prevent Death and so may beans; see Increased Lifespan from Beans. What about Fruits and Longevity: How Many Minutes per Mouthful?

More on protecting ourselves from “brain attacks” in Preventing Strokes with Diet.

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

186 responses to “Which Parts of the Mediterranean Diet Extended Life?

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  1. Aweseome, delicious, and informative. Thank you for helping to clarify “the noise”/some from “the nuts” ;-)))

    How might adding a few nuts to one’s daily diet, in this case about 4 walnuts, almonds and hazelnuts cut one’s stroke risk nearly in half?

    Wondering? Four of each. Just four nuts on any given day/serving. Being high in fat and calories/albeit good calories, I am hoping you can help clarify approximately how many should be consumed.

    Best time of day, if any. With a meal? With a combination/ala Greens?

    Nutrition, as we know is “simple”/but it’s not that simple……

    Thanks so much for this four part series!!!!

    David K.

    1. Vegan also. To absorb all the nutrition in a plate of veggies (e.g. a salad), you need a tiny bit of fat. With the salad that we eat before dinner, we add about 1/2 ounce of chopped walnuts. For salad dressing, we just use an aged, sweet balsamic vinegar (which has no fat). Compared to other nuts, Walnuts are high in ALA (short-chain omega 3 fat).

      Another great source of ALA is flax (see multiple Greger videos on flax). I use a tablespoon of ground flax on my morning oatmeal.

    2. Hey there, Committed Vegan.

      I think it can be that simple. A few handfuls a day is fine, eat them when you most enjoy :) Sometimes toasted walnuts over a salad is a good way to go, tasty! Could mix it up, walnuts one day, almonds the next. Perhaps 1 brazil nut for selenium. If you combo nuts with greens you may receive benefits, as the fat soluble vitamins and phytochemicals in greens appear to be better absorbed with a bit of fat, in this case 5 walnut halves.

      1. I agree that it is always good to keep it simple. However the devil is in the details. I believe it is important for folks to apply the science to their own situation (e.g goals). FDA Serving size for cashews is 30 grams or about 19 nuts. My hand holds 45 cashews or 2 1/2 servings. I’m not sure I would agree with a few handfuls a day. For those folks who are trying to loose fat it might be a good idea to not overdo the nuts which tend to run 2600+ calories/pound. While it is true that weight gain in most studies show at the very least no weight gain. These studies usually involve 1 or 1 1/2 servings per day. See video’s in the series starting with http://nutritionfacts.org/video/nuts-and-obesity-the-weight-of-evidence/. If one has clinically apparent coronary artery disease you might want to avoid nuts altogether as Dr. Esselstyn recommends. He has had the most success with patients reported to date. Some nuts are better than others as it relates to arterial function. Dr. Greger discusses some of the issues with studies in http://nutritionfacts.org/video/walnuts-and-artery-function/. There is a difference in the Omega 6 to 3 ratio for instance in cashews it is about 100 to 1 whereas with walnuts it is about 4:1… flax seed on the other hand is almost all Omega 3. As Joseph mentioned the fat in the salad helps absorb the phytonutrients just as adding citrus to tea helps see video… http://nutritionfacts.org/video/green-tea-vs-white/ and the other video’s on tea which appears to be the healthiest beverage… http://nutritionfacts.org/video/the-healthiest-beverage/.
        Keep tuned to NutritionFacts.org as the science keeps coming.

        1. Thank you, Dr. Forrester. Correction: Look at the size of you hand before taking “a few handfuls” per day. My hands may be smaller than yours ;) At any rate, based on disease state, current body weight, activity level everyone will have a different intake level.

        2. Nut consumption should not raise concern with people with coronary artery disease, rather it’s the type of nuts consumed. More correctly, as Nathan Pritikin stated and knew, plant-based oils and cholesterol and saturated fat from animal products raises ones risk of coronary artery disease. Hence, raw nuts – not nuts cooked with plant-based oils – is fine for people with and without coronary artery disease. The issue with most cooked nuts in retail stores – they are cooked with lots of plant-based oils. Read the label on a can of Planters Peanuts, for example. Raw nuts lowers – not raises – the amount of lipids in the blood stream, lowering ones risk of heart disease and stroke. As the link you provided corroborates, fat from nuts does not causes weight gain.

          Hence we should encourage – not discourage – raw nut consumption in patients with and without coronary artery disease, despite what “Dr. Esselstyn recommends.” I doubt a little plant-based oil in cooked nuts will harm those without coronary artery disease, especially if they are on a healthy, whole food, plant-based diet.

          Some of our closest cousins – the primates – consume a lot of raw nuts, and they do just fine. Why do I mention our cousins? Because we have very, very similar physiology and nutritional needs, we need look no further than our cousins to discover what the diet we are supposed to be consuming – a plant-based diet. Our cousins consume mostly fruit and raw nuts.

          “There is a difference in the Omega 6 to 3 ratio for instance in cashews
          it is about 100 to 1 whereas with walnuts it is about 4:1… flax seed on
          the other hand is almost all Omega 3”

          You and Dr. Greger need to have a discussion concerning omega 3s, as his stance on omega 3s and 6s has changed.

          1. Hi Fiat,
            When dr Don says “Dr Esselstyn recommends” it was a statement based on the very sick coranory patients he was treating. Until we have research that states your belief that raw nuts are ok for sick coranory patients it is probably a good idea to follow Dr Dons recommendations.

            1. It’s not a “belief.” My statement is, more correctly, based on numerous studies. Familiarize yourself with the studies Nathan Pritikin brought to light. Thank you. Moving on.

          2. You make excellent points about the use of plant based oils and consuming a plant based diet. I’m also aware that Dr. Esselstyn’s comments on nuts and oils. He like most of us clinicians change our approach to patients as new science becomes available which is why I believe that NutritionFacts.org is so important. I agree we have a very similar physiology to our cousins. They most important differences that I have heard are Nathaniel Dominy’s work showing our increased number of amylase genes which allows for digestion of starches and Katherine Milton’s work showing increased small intestine volume by 40%. So I agree our biologic systems are adapted to a plant based diet. Of course we aren’t trapped around the equator eating nuts and fruit… courtesy of the ability to digest starches, grow and store food, cook (which allows for the assimilation of 10-15% more calories) and weapons… used for hunting. Prior to our use of weapons I believe we could most likely be classified as “hunted gatherers”. Many of us whose ancestors came from northern climes such as Europe are able to digest milk sugar courtesy of a mutation about 10,000 years ago. As in many things just because we can digest it doesn’t mean we should or it is healthy for us or the planet or the animals. I believe Dr. Greger and I would agree on the Omega 6/3 science. My only caution is that recommending specific nutrients is fraught with many of the pitfalls of prescribing medications. There is a difference in prescribing Vitamin C for an individual with scurvy and making a recommendation for the entire population to take Vitamin C. Even if it doesn’t have much potential to cause harm as a water soluble vitamin it does cost money and supports a belief that there are “special” nutrients. I see the same in my patients with heart disease who think by consuming Omega 3 supplements… best from algae sources see… http://nutritionfacts.org/video/algae-based-dha-vs-flax-2/ they can continue to consume diets with large amounts of Omega 6 in there diets. I guess my caution comes from 40 years of clinical experience where I have seen many drugs and nutrients touted as helpful only to be shown not helpful or even harmful. I do believe the science supports the use of supplemental Omega 3 in specific populations at this time especially if they are consuming a standard american diet or a poor plant based diet with alot of processed foods with added oil and sugar. I think Omega 3’s like all isolated nutrients need to be recommended with caution. I avoid across the board recommendation for entire populations with some exceptions like Vitamin B12. Of course all this is susceptible to change as new hypotheses arise and are tested so we need to support commercial free science based resources such as NutritionFacts.org. Thanks for your post.

            1. Dr. Forrester: This is a really wise post. I wanted to say something especially because of the end where you talk about omega 3s. I’ve been struggling for a very long time to try to figure out if I should be taking an omega 3 supplement or not. I feel the information on NutrtionFacts is contradictory and unhelpful. You just gave me a framework for helping to make that decision for myself. Thank you!

              1. Hi Thea…I think a reasonable recommendation for those who want to insure adequate Omega 3 intake is ground flax seed. Based on what I’ve been told by others it appears that a teaspoon a day is more than adequate. Of course even that might not be necessary given the rest of your diet. As I mentioned for specific populations (e.g. women with fighting hot flashes you might need to go up to for the most benefit) recommendations might need to be adjusted. The nice thing about flax seed is it comes with other helpful nutrients. Yes the science can appear contradictory but it is science and given what we knew in the 1980’s we have come along way. The journey continues….

                1. Thanks for the further clarification. The key for me is the part about “given the rest of your diet…” I’m not always getting flax in my diet. It really varies. And the rest of my diet is no where near good enough I think. (Though I do get better all the time.) I haven’t actually purchased the omega 3 pills yet, but for someone like me, I’m thinking taking an algae based omega 3 would be wise. In other words, I feel now like I have a clearer idea about what would be ideal for my current situation. Whether I do it or not remains another issue. Taking pills is really hard for me.

                  Thanks again!

                  1. The Omega 3 pills at least the ones made by Zen are capsules and not small. Ground flax seed meal on the other hand might be worth a shot before investing in something you won’t be apt to take. It is as you are finding out a journey… so keep on plugging away. Best.

        3. Thank you for this clarification. When I recently began the Optimal Diet promoted through the Complete Health Improvement Program (CHIP), I was way too generous with the nuts resulting in too many calorie dense snacks. Reducing this to no more than 1/4c / day and I began shedding 1 lb a week. I was not over weight but max on the BMI. That weight deserved to go! Thank you for your dedication to this fine work.

  2. How should we interpret the table at 1:45? Is HR = Hazard Ratio? Are the frequency values “the best” for each given question? For example, (3) How many servings of veggies?
    ≥2 HR=0.65. Is 1 serving worse? What about 3 servings? Olive oil (HR=0.77) in cooking seems nearly as significant as 30 g of nuts (0.75) and more hazardous than <12 g of butter daily.

    1. You need to look at the 95% CI, i.e. the confidence interval. For example, the line for Olive Oil in cooking was 0.77 (0.54 – 1.16). Statistically speaking, this means that there is a 95% probability that the “real” HR (hazard rate) was between 0.54 and 1.16. Below 1.0 is healthful and above 1.0 is harmful. Thus, we can’t say that cooking with olive oil is either helpful or harmful with a high-degree of confidence, based on the results of this study.

      On the 14pt Med Scale at 1:45, only Veggies and Nuts were statistically significant, e.g. with a CI below 1.0 or above 1.0. There are a few that came close – 5, 6, and 14.

    2. The confidence interval (CI) for olive oil ranges from 0.65 to 1.10. Since 1.0 is in this range, certainty can’t be justified and the hazard ratio or risk of eating that item in the amount reported may be the same, better or worse than doing nothing. The same is also true of butter. Since the CI for nuts stays under one, saying that nuts in this amount is beneficial is statistically justified. A larger or better designed study might clarify these issues, but probably not, since this was a large study and fairly well done. However, notice that fruits and legumes also fell into the uncertain category, while other studies show them to be helpful. It’s not possible to say if other serving amounts would be helpful unless a study is done on them and the results are reported.

      1. Thanks Fred and Douglas for your clear answers.

        The left column questions sound open ended, f.ex. “How many servings?” So, I wonder why the findings don’t display 2 servings of veggies with X HR+CI but 5 servings daily have Y HR+CI.

    3. Hey Alex, HR means hazard ratio. not sure if what frequency values are best? Researchers were using food questionnaires and they simply came up with those ranges/cut-off points. At any rate, they are validated questionnaires. It has to do with statistical significance why some HR’s may still show less than 1.0 yet not be significant, in this case, olive oil. The olive oil may have helped a bit (just like eating <12 g of butter/d) but it could have been by error.

      1. Thanks Joseph,

        My statistics knowledge is rusty to non-extant. Am I correct to understand that the researchers threw out the 5% anomolies and found unadjusted ranges correlating to each questionnaire answer? If so, “95% confidence in 0-12 g of butter halving or slightly increasing risk”, makes sense but strikes me as unnecessarily vague considering 7447 participants and modern computation.

        I would assume it would be easy to twease out other factors/answers. I’d expect we could group many of the unique combinations of answers and get very precise risk values with tiny P values for most. Even simpler: show the risk of, for example, consuming above 12 g vs below 12 g of butter, unadjusted.

        Any idea if the raw data is available?

  3. Most of your videos focus on increasing lifespan, but do not necessarily make the connection to quality of life. I think many more people would be willing to consider these suggestions if there were a way to prove that they will likely feel better on a vegan diet. The sad truth is, many people would rather die than live in the amount of pain that they have daily. So for those individuals, the only studies that even matter are the ones that demonstrate improvement of health to a point of well being; not the ones that simply lessen your chance of death. Can you make a strong correlation to convince people living in chronic pain to adopt a vegan diet?

    1. I guess it all depend on the type of pain. If the pain is in the lower back because the discs are being deprived of blood flow, then a vegan diet may improve the blood flow and, at the very least, slow the progression of the disk degeneration – maybe reduce it.

      Likewise, angina may be lessened or eliminated by opening up the blood vessels by switching to a vegan diet.

      Switching to a vegan diet doesn’t guarantee that past problems will go away, but there’s a very good chance that the progression of the problems will slow and possible reverse.

      There are no negatives to switching to a vegan diet – only possible positives. If you wade through the zillions of Dr. G’s videos, you’ll see that many deal with quality of life, not just length.

    2. Malcolm while I believe the improved quality of life aspect may be self evident, sometimes I’m too optimistic. e.g. Reversing obesity, type 2 diabetes and its associated problems of impotence, blindness, neuropathy, renal failure, arthritis et al certainly implies improved quality of life. Other aspects are dramatic as well. Still I think your point is a strong one. Many people have told me that I make a good case for longivity but they then will then respond that without their steak and associated fats and flesh they would rather cut things short because of the reduction in quality of life. So studies showing significantly improved quality of life would, I think, be helpful.

      In my case, I eliminated inflammatory arthritis with a wfpbd and that alone is so compelling an improvement in quality of life that I would have great difficulty eating animal even if stranded and starving.

    3. In addition to the helpful replies you’ve received here, I seem to recall that Dr. Greger has a number of videos on studies about the relationship between a plant based diet and various painful diseases such as rheumatoid arthritis; you might want to look through the archives for some of those. Personally I feel I have pretty good anecdotal evidence for a plant based diet leading to vastly improved quality of life, but that’s a longer story than anyone wants to hear…

        1. Indeed! We often start telling our stories and start to think no one is interested. So when someone else has an interesting anecdote it reaffirms that ours is not just a random improvement. I for one am always interested.

        2. Hi b00mer and Stewart – I don’t really mind sharing but as much of a supporter of advocates as I am and as valuable as shared experience can be, I think a lot of these stories are complicated and my natural habitat is sort of in the murky realm of the complexity. Though I have little doubt that my vegan diet has been the major contributor to a number of health improvements (lack of colds and flus, loss of chronic rhinitis, loss of muscle pain,…) it also provided additional energy for exercising more which itself is helping. So there are a number of interacting factors and given that I tend to shy away from doctrinaire proclamations I’m usually not particularly vocal about any one of them. But that doesn’t mean that when asked I’m not an unabashed supporter of the efficacy of a vegan diet both anecdotally via my own experience, and clinically via the numerous studies like the ones Dr. Greger reports on.

          1. Good to hear about your health improvements Karl. I agree, anecdotal evidence is definitely murky and should not be the basis for definitive proclamations. However you never know, your story might be the little kick in the pants that helps someone make a change in their life for the better. Sometimes all the research in the world can be convincing on an intellectual level but not necessarily motivating for certain personality types. Anyway, congrats on your improved health and for the purposes of a particular loved one dealing with the same issue, if you care to elaborate on your chronic rhinitis journey I would I would definitely be interested. Cheers!

            1. The rhinits story is pretty simple. For most of my life I had severe congestion, occasionally bordering on asthma type symptoms re. difficulty breathing. When I went vegetarian that changed a little but not much. The rhinitis “diagnosis” was a self diagnosis after a friend with similar symptoms told me that that’s what they had. When I ran that by my doctor at the time she basically concurred but didn’t feel there was much that could be done about it. When I went vegan about 7 years ago things improved drastically. I occasionally still have some very minor congestion that I assume is probably some antigenic response to a plant protein but given that it’s hardly noticeable compared with my previous state I haven’t worried about tracking it down.

      1. I’d love to see the sheer number of “dittos” to your last sentence, though I have gone on about it here before! I KNOW I’m not going to live forever, my major concern was improving the quality of my life, which following a whole foods plant based diet has absolutely done! My big issue was that even the recommended diets from leading “associations” didn’t come close in conferring the quick and obvious benefits that a WFPB diet offers! This info NEEDS to be universal, not shrouded in myths by those with an agenda to protect! Thank you Dr Greger!

        1. Charzie your story is one of the most inspiring I’ve seen in the comments sections here. I wish I could bottle your enthusiasm and pass it on to some of my loved ones :)

          1. Wow, thanks! I often almost forget how far I’ve come in making major changes because it is second nature now, but watching others I care about suffer, knowing they could easily do the same, is so painful and frustrating! I hoped my enthusiasm and results might have rubbed off a little, but no such luck, for the most part. I don’t even get invited out to eat anymore because apparently by comparison I make everyone feel guilty? Food can be such a complicated and psychological attachment issue, and it often takes some event to shake people into awareness. I can totally relate, I was there too. It’s a shame it took a diabetes diagnosis to slap me out of my stupor, but in retrospect it was a blessing in disguise because I was in big trouble had I gone the traditional route. I wasn’t oblivious to the issue before, I just avoided dealing with it, like most do. I wish I could figure out how to make that “AHA” moment tangible and pass it on.
            I enjoy coming here and reading the comments as much as the videos because most people here “get it” and are encouraging! With a few exceptions in real life, I so often feel like the outsider because my family and friends are all about “food”. You know…live to eat vs eat to live? They just don’t make the connection! I don’t preach or proselytize, just my presence seems to remind them of things they don’t want to deal with! I always try to contribute tasty and healthy choices at get-togethers, and it always gets eaten…*as long as they don’t know WHO brought it*! It’s crazy, and really cuts into the wonderful social aspect of sharing meals with loved ones…something I feel is a critical part of overall health too! But I try to remember that I am certainly not the only one dealing with these issues, and I am also reaping the rewards!

        2. Charzie, I agree with b00mer that your story is inspiring. And your point is well taken that unfortunately nutrition issues in the US are completely shrouded in agenda protecting myths. Though as you’ve probably noticed I’m not much of a proselytizer, trying to make sure that people at least understand the agendas that go into various arguments is pretty important to me.

          1. Thank you so much Karl, I appreciate the support! I won’t repeat my last (too lengthly) post, but it is also important to me to try to at least make the facts available, but because of all the phony garbage circulating on the web and elsewhere, it becomes “my opinion” a source of conflict, and nobody really wants to listen anyway, so I rarely say a word, unless directly addressed. Forget about sharing links, even entertaining videos…I’m not into the social media thing, but occasionally I will post something really important on FB, and it gets totally ignored! It doesn’t alter what I do for myself, but it does get to me sometimes. I got past my emotional connection with food, but we don’t get past our emotional connection with people! Or maybe I’m just a wimp. LOL!

    4. Actually this isn’t accurate. Dr. Greger focuses again and again on what promotes a longer healthy lifespan. Perhaps “longer healthy lifespan” sometimes gets shortened to “longer lifespan”, but the intent is very clear as so many of the videos focus on eliminating the root cause for so many of the chronic disease that, as you correctly point out, afflict so many on our society with a years of pain and disability to the point where death is a relief.

      In fact Dr. Greger put together an entire hour long video (http://nutritionfacts.org/video/from-table-to-able/) that focuses on the ability of a plant based diet to not only reduce the common causes of mortality (http://nutritionfacts.org/video/uprooting-the-leading-causes-of-death/) and morbidity (http://nutritionfacts.org/video/more-than-an-apple-a-day-preventing-our-most-common-diseases/) in our society, but to heal our painful conditions and bring us back to leading a life worth living. All three are always at the bottom of the home screen and so are just a click away.

    5. Is it not clear in the public’s mind that a reduction in diseases like diabetes, heart disease, cancer, and overall mortality is synonymous with an increase in quality of life?

      I understand the point and the question, but part of me wonders if I’m missing something because the answer seems so obvious.

    6. There is an abundant amount of evidence that shows that adopting a whole food plant based diet (WFPB) can not only increase our years, but can also increase the quality of those years. In Dr. Michael Greger’s video: “ From Table to Able: Combating Disabling Diseases with Food”, he explains how WFPB diets can reduce disability caused by our most common chronic diseases. (ie. Coronary Artery Disease (CAD), stroke, Type 2 Diabetes, and various cancers). You may be surprised to discover the science he shares revealing that our diets can actually be used to alleviate lower back pain, treat blindness caused by diabetic retinopathy, treat pain from diabetic neuropathy and prevent and treat Alzheimer’s disease. Dr. Greger also discusses why this information remains largely hidden from most Americans.

    7. This study didn’t really look at quality of life. You make a great point about the importance of quality of life! I mean, why do anything at all unless we feel healthier and good doing it? Chronic pain is widespread and people suffering have the right to know the research, and how modifying their diets may help. I checked out a few studies. Here is a one on vegan diets and rheumatoid arthritis “The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measures of rheumatoid arthritis.” And another one looking at antioxidants in a vegan diet and rheumatic disorders, showing similar findings. Oh and this one I just found, looks at a mostly vegetarian diet and fibromyalgia. Here are the results on Quality of Life Survey (QOLS), “The QOLS, scaled from 0 to 7, rose from 3.9 initially to 4.9 at 7 months (n = 20, P for trend 0.000001)” showing significance. Anywho, important questions you’re asking! Here is more on Chronic Pain from NutritionFacts. You might find more intervention studies in the citation of these videos.

    8. Great question, Malcolm fleX! You have solid points. I mean, why do anything unless we feel good doing it? QOL is very important and I think others who are not feeling well (perhaps they are overweight or diabetic) can have dramatic improvements in health and be convinced to do so once they see these results.! I have witnessed this in clinical research and lifestyle intervention studies. If interested, read these studies:

      A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study

      And, Nutrition intervention for migraine: a randomized crossover trial

      Other research exist . I feel it takes the right attitude and commitment, but you are right it is ultimately in the hands of the participant and less in the data on “risk of death” . Who knows? Let’s assume everyone can and will make these changes even if 1:100 actually do. Ok, stepping off my cheerleader horse – sorry for the rant.


  4. Am I wrong to interpret or over simplify; I heard today as it doesn’t matter, healthwise, whether you eat paleo or vegan style as long you eat your veggies and nuts life goes on equally well.

    1. There may be temporary gains from eating paleo such as weight loss- from fewer calories. But with all that saturated fat and pollutants from eating at the top of the food chain, in the long run, I don’t doubt that there will be a higher incidence of heart disease, cancer, stroke, hemochromatosis and other chronic ailments. Still, eating more veggies and less refined flour and sugar as the paleo diet recommends probably makes it a better diet than what most Americans are presently consuming.

    2. All diets contain things that promote health and others that detract from health. The overall healthfulness of a particular dietary pattern depends on how much the health promoting aspects off-set the health detracting aspects. We lay folk know, in large measure thanks to Dr. Greger and this website, that whole plant foods on balance tend to promote long term health and animal foods on balance detract from long term health.

      From this perspective the SAD is a perfect storm of bad dietary elements. Very little or no whole plant foods and tons of animal and refined plant foods. So eating paleo can be healthier than the standard american diet because it does have a focus on whole plant foods and avoidance of refined foods which do help to off-set the health impacts of the animal foods. But I don’t see how it could be healthier than a diet that only contained plant foods and avoid the negative health impacts of animal foods. So to me WFPB and paleo diets are not equally healthy just because both promote eating vegetables and nuts.

    3. The problem (if you can call it a problem?) with non-vegan diets is that you’re displacing whole plant foods with non-whole plant foods.. Your opportunity to eat health-promoting foods is being lost by choosing to eat unhealthy, or at least unhelpful foods. You’re far better off eating a diet of 70% whole plant foods and 30% animal carcass and carcass accessories than you would be eating only processed foods and meat, but you’d be better off still even only whole plant foods. For optimum health, you need to eat the optimum diet, which is whole plant foods. If you just want pretty good health, then add some animal products in. Only you can determine how important your health is to you vs how important eating meat is to you.

  5. Dear Dr. Greger.

    I have been astonished by the ever increasing evidence that so many parts of the Mediterranean Diet are associated with health benefits.
    I certainly believe we have not reached the end of this road, there is still much to explore when it comes to the preventive effect of this diet.

    Let me ask you if you also have found any reliable research on the effects of the flavones – e.g. in thyme and oregano. Do you know of any epidemiological studies or even better, clinical interventions with thyme and oregano? There are a couple of pre-clinical model studies pointing to positive effects of the combination of these two spices on the inflammatory response, and also of the combination of thyme, oregano. coffee, walnuts and clover. Would be very interesting to see if this part of the diet also could be shown to be of importance in studies with a higher level of evidence.

    Or have you seen any evidence of prevention of chronic disease associated with the consumption of the kinds of cheese common in the Mediterranean area?

    Best regards


    1. “I have been astonished by the ever increasing evidence that so many parts of the Mediterranean Diet are associated with health benefits. ”

      Actually from the video there are only two parts of the Mediterranean diet that are associated with health benefits, vegetables and nuts. All the rest, including the media darling olive oil, had no health promoting effects and many had negative effects on health. The diet as a whole is healthier than the standard Western diet because the health effects of vegetables and nuts is strong enough to not be offset by the negative impacts of the other components. So the real message is that to have even a better diet keep the veggies and nuts and get rid of the rest of the crap.

      As for flavones in particular foods, this type of reductionist thinking usually leads nowhere. Food is a package deal. thyme and oregano contains thousands of bioactive molecules in them. Trying to pin down the health effects to a single molecule or class of molecules is like trying to nail jello to the wall. Or another analogy is trying to understand why a particular piece of orchestral music is so pleasing by identifying which particular instrument is responsible for the effect. You have each instrument play its piece while the rest are silent and are baffled when none are responsible for the harmonious effect that you experienced when all were playing together. My bet is that research into isolated flavones will suffer the same fate. They may be like the violins, the most prominent part of the thyme and oregano orchestra, but they will never be able to play a health symphony without the support of all the other sections.

      1. Although sometimes multiple factors can be shown to work together, for better or for worse, reductionist studies are how most science is done. In double-blind placebo-controlled studies, an experimental group is treated exactly as the control group except for just one factor in order to see what difference that one molecule makes- this often produces statistically-justified results and is hardly like trying to nail jelly to a wall. Instead it may well nail down very securely the results of a nutritional study.

        1. Or it might produce completely misleading results. Or be misused to make dietary recommendations. Just look what was done with Omega-3s, especially DHA. True, very important to the body, no doubt at all. And perhaps in the context of the studies showing benefit it might be useful to give insight into a specific molecule’s functioning in the human body. But it is an enormous leap from these laser focus studies to a universal recommendation that we should all eat more fish. It is bad science to do this. Fish aren’t little swimming bags of DHA and EPA. They have animal protein, which other studies are finding to be an issue with cancer. Also they have all the environmental contamination, not to mention cholesterol and saturated fat. As a package, fish has many more negatives than positives. But the reliance on this highly reductionist thinking leads to this type of conclusion if applied out of context.

          It is like the story of a guy who comes across another guy in a dark parking lot crawling around on the ground under a light pole looking for something. “What are you looking for?”. “My keys”. “Where did you loose them?”. “Over there” pointing into the dark. “Why are you looking for them here?!”. “Because this is where the light is!”.

          If the only type of light you can see is double-blind, placebo-controlled light, then you only find answers that it can illuminate. In my opinion the quest to maximize human health and longevity will never be fully or even substantially illuminated by this type of research light. The subject is enormously too complicated.

          To mix metaphores, it is like using a pen light to try understand the architecture of a huge building. Sure you can determine the details of some of the bricks that make up the building as well as exactly determine what type of steel gets used in certain places. But it is exceeding difficult to get the bigger picture. For that you need to bring in some big flood lights and light the whole thing at once. Sure you’ll miss some of the finer details, but you will more than make up for it in whole-istic understanding. Of course the greatest understanding comes from a bunch of investigators with their tiny pen lights and those with their flood lights. One isn’t a better approach than the other and both are critical to a complete understanding.

          1. Jim Felder: *Really* well said. My favorite line is, “Fish aren’t little swimming bags of DHA and EPA.”

            I also like your analogies. I’m a big fan of Campbell. I recently ordered his Whole book. I haven’t had a chance to read it yet though. I’m not sure I need to now. You summed it up so beautifully. :-)

    2. As they say on other forums, “Search is your friend.” Dr. Greger has done numerous videos on the benefits of spices. Enter the word spice in the search box and you’ll find plenty of entertaining and informative material.

  6. WEBMASTER, We have just noticed the “someone is writing” and a new comment has just arrived features on the right of a given comment and the blue banner at top of comments notifying us of new comments since we came to the page. These are wonderful. As is your entire site! We know you work hard for us as do the unknown number of volunteers. Thank you!

  7. What miracle happened overnight that FDA changed its rating of EGGS from being bad for you to being a food good for you? Please share your views on the mainstream media….

  8. SUGGESTION for NEWCOMERS SECTION ON HOME PAGE: I have sent so many to this life-giving site! I tell them to go to the home page, scroll down to the Year-In-Review section lower half of page… etc. (too long) Do you think it worth your effort to have a photo (Say a couple sitting together looking at a computer screen with anticipation) welcoming newcomers that links to a good introduction and places to start? A paragraph about the site and Dr. Greger, including Kaiser’s esteem for the site and referrals to it. Then, “Here are a few good starting points:A B C. I would vote for the 2012 Y-in-R and suggest they follow on to the others. Then suggest they search a topic of interest by doing XYZ.

    1. This is a great idea, Gayle. The NF site is now so rich with information that it could be daunting to a tentatively interested newcomer.

    2. Great idea. I found my way here with a link to Dr. G’s leading causes of death video. I was hooked soon after, watching most of the videos here within a few days or so. For others though, a short video on a specific topic related to them may be hook that gets them in, so a brief but prominent explanation of how to use the search feature may help? :D

    3. I really like this idea. In addition to this I would love to see an attempt at a single blog post with a permanent link on the home page that compiles the strongest research results supporting eating a WFPB diet and the strongest ones for eliminating animal foods from your diet (they might be one in the same!). This would be great for us that aren’t new to the subject, but don’t have a full mastery of the subject to have a single place the strongest research results and why they point towards a whole-food, plant-based diet and away from one with much if any animal products.

      And I know it might be asking for too much, but it would be great if there were a coda to the above that contains a discussion of those papers that seem to make a strong case for eating animals and why/what is wrong/weak about them. A great example is plantpositive’s review of the the 2010 Siri-Torreno (sp?) and the 2014 Oxford (?) meta analysis that purport to show that saturated fat was OK. I know it took plantpositive several intensely researched videos to tear these studies apart and show why the studies they used did not support or actually showed the opposite of what their conclusion were and that there were a number of highly relevant studies that were simply omitted that would have changed the results considerably, but a shorter summary with perhaps a link to a longer explanation would be invaluable place to point those who have been hoodwinked by the animal food industry who funded these studies or at least the scientist who performed them. Gary Taubes might get his entire own page devoted to debunking his distortions and outright lies.

      Such a compendium would be a great place to point friends and family and maybe some frienamies to as a place they can get a really good understanding of the science for and against in one coherent package.

      Oh and while I am asking for the moon, rather than a simple link to the papers after the videos, if there could be a link to a page of perhaps Dr. Greger’s notes on each study pointing out their strengths and weaknesses, who funded it, did the researchers have reported or unreported conflicts of interest, are the results very narrow or do they have broad applicability, have the results been firmly supported by subsequent or prior research or is this a strong break with prior research .

      I am sure that by this point Dr. Greger has some kind of ranking review system worked out when he reads all those thousands of papers. How else could he winnow them down. In addition giving a great short summary, especially if the paper is behind a paywall and most of us can’t actually get it it, such a review summary would help all of us learn what questions to ask when were are out there reading papers for ourselves.

      Thanks so much for this website! Even without a single change it is bar none the best source of health and nutritional news I have yet to find.

      1. What a wonderful wish list, Jim! Yes, gathering the most cogent and powerful arguments in one place would be a big help. I could see giving or sending it to people who give me grief and just say this is what has convinced me; it may or may not lead you to reconsider what you eat, but at least you will understand why I made the shift to WFPB. P.S. I the 3-4 main questions that people bug us with(but never believe our answers) were listed with brief responses and references (How do you get enough protein, calcium, omega3, do vegans live longer?), that would help too.

  9. The answer is walnut balls! Combine walnuts with a bunch of other super healthy things, shape into a small ball, bake. Totally blows any meatball away. Serve to friends and family when you want to show them that eating plant based isn’t paying penance for past dietary sins. The great thing is that they are easy to make and freeze well so you can make up a huge batch, freeze in single recipe sized portions and never have to worry about what exactly is in the Trader Joe’s meatless balls ever again. Here are a couple of recipes that looked especially tasty. And with the recent focus on the awesomeness of tumeric, I wonder if I could slip a little into these.



    1. This is probably my favorite veggie meatball recipe. Being tofu/walnut based, it’s higher in fat than some readers here will like, but I don’t mind something like this once in a while. Also I leave out the salt. Plenty salty with just the soy sauce added. They have a lot of umami flavor, come out crispy even though they’re baked, make a ton per batch, go with nearly any type of sauce or gravy, and are easy to make.


    2. I’d be concerned about cooking walnuts. The heat may damage the delicate oils, turning them into dangerous chemicals similar to what we find in rancid oils. Perhaps someone could come up with a recipe that adds raw walnuts to the rest of the ingredients after they’re cooked.

      1. It is possible to cook them directly in a sauce. In fact I did that in my initial foray into making walnut balls. The only down side is that they tend to fall apart easily. But those first ones didn’t include ground flax seed in hot water as egg replacer. And even when they do, the sauce still tastes great, so no big loss. Just the baked ones stay together better and impress the hell out of folks who think that they will never experience food like they are used to eating and will subsist on “rabbit food” if they go plant based when you put a plate of spaghetti and “meatballs” in front of them especially when the meatballs are better than meatballs, if you know what I mean.

        But, while cooking temperature matters, it is even more important what type of food it is. Animal foods form thing like AGEs and Hetrocyclic Amines to a much higher degree than plant foods.


        So while baking the walnut balls might form more AGEs than cooking them in liquid, it will still be a lot less than the equivalent panfried or baked cowball.

    3. The recipe from the Oh She Glows site looks amazing for a holiday feast, but for everyday cooking the Veg Kitchen recipe would be more to my taste. I would adjust the recipe to not saute the onions, etc. in olive oil but instead just use a bit of water. And I’d lay down some parchment paper instead of oiling the baking sheet. And voila, oil-free walnut “meat” balls. Thank you for sharing this, I will be cooking this tonight!

  10. Walnuts are really expensive. Imagine if “the public” – all 320 million of them…and that’s just here in the US – got wind that eating them may extend their lives.

    Ay, caramba! Did you see what happened to the price of quinoa?

    1. Well if the public started to consume walnuts in bulk, then wouldn’t part of the subsidies that goes to raising farm animals shift over to the production of walnuts?

    2. Maybe walnuts should be considered staple food like some think meat is :) I’m sure then it would become cheap real quick. And I always thought quinoa is so expensive because it was not intended for poor people anyway (well except in Andes that is). It would be like saying caviar is too expensive or something…

      1. Quinoa is healthy for everyone to eat – rich and poor – but it is expensive because the demand for it is high. That means poor people are less able to afford it – even where it is grown. There have been a few stories about this…how farmers and people in countries where Quinoa is grown can no longer afford to eat it because of the demand here in the US.

        1. It’s not fair to compare the two because quinoa is cultivated only in the Andes and walnuts can be grown nearly all over the globe (if you check the list of top ten walnut producing countries on wiki). I don’t know how much wikipedia is a reliable source but they always cite their sources so according to wiki if you compare the production in metric tonnes, in 2011 the world production of quinoa amounted to 80,400 metric tonnes versus 3,282,398 metric tonnes of walnuts produced worldwide in 2012. Also quinoa was introduced to developed markets as some kind of super food from the beginning, as it offers much higher margins of profit as plain old walnuts. Maybe americans should eat more walnuts, as again if wiki is to be believed “The United States is the world’s largest exporter of walnuts” :)

          1. I could make several points, but in the end the bottom line is that both quinoa and walnuts are food products subject to the same law of supply and demand, so comparing the two is totally fair and appropriate. That the circumstances around their production or introduction or consumption differ doesn’t change my point, which is that if that health claims lead to an increase in demand for walnuts, like they did quinoa, I will not be able to afford to eat them.

            If you believe, however, that an increase in demand for Walnuts will lead to lower walnut prices, I would love to hear more about how you think that would work.

    3. My concern is not so much the price (more trees can be planted), but the resource consumption. Every almond requires 1.1 gallon of water, and every walnut 4.9 gallons, in the California central valley where most are grown. Its still only a fraction of the water requirement for meat, but I diversify my nut consumption to others like pecans that grow well in places that don’t require irrigation.

      1. I don’t eat meat so I allow myself to splurge on nuts with the knowledge that my dietary choices are a net positive for water use and the environment.

        I just looked up water use/crop in CA and it appears alfalfa uses 2.5 times the water as almonds, to which 10% of California’s ag water use is dedicated. As far as I know, alfalfa is mostly used for livestock feed.

        I think there’s value in marginal improvements like switching up nuts to reduce environmental impacts, but for me that’s low on my list for the reason above, and because walnuts appear to be healthier than other nuts…though I eat others too.

      2. I’ve read about the same concern, but even moreso because so many nuts are being consumed indirectly in faux milks made from nuts. Tell me, why do soy milks have 6-8g of protein per serving but almond and now cashew milks have 1g or less? Alergies aside, that’s just plain nuts!!

        1. Unsweetened almond milk has 30-40 kcal/8 oz, the caloric content of 4-5 almonds, and I imagine the other ingredients (chalk, thickeners, emulsifiers, salt, vitamins) may constitute more by weight, which is certainly true for the sweetened varieties.. The fiber and pellicle/skin where all the almond polyphenols reside are both discarded. I still use almond milk very sparingly on shredded wheat + bran when too rushed to prepare breakfast, but I’m under no illusions that it’s a whole plant food, or a good way to consume nuts.

            1. MacSmiley: re: soy milk and additives
              FYI: In the stores I shop at, Trader Joes and Market Of Choice, I’ve been buying boxed soy milks with nothing but the ingredients: soy beans and water. That’s it. And they taste very fresh/good. I find that they make really excellent bases for the sauces I make in my new favorite cookbook: Vegan Casseroles.

              Personally, I get conflicted on which type of on-diary milks to get: On one hand, I do want the chalk/calcium. On the other hand, I may not want the carrageenan and other stuff that goes with it. I haven’t seen a non-dairy milk that has the calcium, but not the other additives.

              Just sharing.

            2. Calcium carbonate, the most common calcium form in soy & nut-milks. Evidently others can’t taste it, but I can, particularly when I’ve added these to soups.

        2. I’ve just started making my own almond milk, bought a nut milk bag from amazon for less than $15 Canadian (and this nut milk bag is strong and will probably last for years), and it is so easy to do it myself. I could kick myself for not getting into this sooner!

          My recipe is to soak 1 cup of almonds in hot water for at least 3 hours, rinse and put in the blender with 3 pitted dates and 4 cups water. Blend on high speed, pour into nut milk bag and “milk” the liquid into a large container such as a bowl. Mix in a tsp of vanilla extract if you like, and keep refrigerated – lasts for 4-5 days in a covered container.

          I just made my 3rd batch, and I am really loving it. I found a recipe online today for crackers using the leftover pulp. It looks good but there is 3 tbsp of oil in it – any ideas on a low to no fat way of making savory crackers with the pulp? I’m not interested in making muffins and cakes, etc., as I am staying away from sugars. Here’s the link for the recipe:

      3. Very good point Darryl. I would sharpen that with another point about irrigated agricultural. I do not consider sustainable irrigation to be much of an issue. But when water is mined i.e. depleting a water table that may have taken thousands of years to charge, it is certainly not sustainable. A better allocation of agricultural activities is something we must strive for as a society for all crops. I do know that non irrigated and sustainably irrigated walnuts can thrive but not with curren short sighted practices.

    4. The general public is strapped for grocery cash. Not many will fork over $9 for a lb of walnuts when they stretch their $ by
      getting 7 Totino’s pizzas for the same price or many bags of rice and beans.
      I noticed dark chocolate is getting pricey too on top of organic veggies.
      Poor folks can’t afford to eat healthy.

      1. Yes, and that brings us full-circle back to what I was saying initially…

        which is the more aware the “average person” becomes of how food choices impact health and well-being, the more inaccessible those healthy foods will become to people without the means to buy them.

        In macro terms, it might be necessary to address food subsidies simultaneously with increased education and awareness because as awareness comes, and I believe it is coming, “real” food choices like the ones this website promote will become less of a reality for more and more people due to an inability to afford them.

    5. Wow, I paid something like $11/lb the last time I bought walnuts. Still it is cheap compared to animal sources of similar fat and protein profile like meat since you seldom eat a quarter of a pound, let alone the half pound of walnuts in a single meal like is common with meat, so cost per meal will be a lot lower.

      And then much, much cheaper foods like rice, beans, wheat, potatoes become the focus of the meal with nuts as a flavor enhancer.

      But you are right if tomorrow if the scales fell from everybody’s eyes and overnight those eating plant based jumped to 100%, the price of every non-meat item would sky rocket because none of the supply train is sized to supply the need. Some like wheat, corn and soy would immediately adjust as animal feed was redirected. But others like Walnuts and other tree nuts as well as things like apples, citrus would take a lot longer for additional supply to come on line.

      Still it might be worth the trauma in food price to break the nation of its fatal food addictions.

  11. Regarding ‘Which Parts of the Mediterranean Diet Extended Life?’ is there any evidence that walnut oil would be more healthful than olive oil?

    1. Hmmm not sure. Not much I could find. Sticking to the whole-food like walnuts or even whole olives, is perhaps better. Fiber, more antioxidants, etc.

    2. I would think that like olive oil is olives with none of the nutrients and just fat with a few low molecular weight aromatic compounds that give it its distinct flavor, walnut oil too would have little if any of the nutrients of the whole food. Unless of course the aromatic compounds responsible for the unique flavors is where all the nutritional content of the whole food comes from, but I am pretty sure that is not the case.

  12. I am pre diabetic, with insulin resistance, and would like to lower my hg A1c & prevent it from progressing. There appear to be 2 camps – the WFPB & the very low carb group, high protein paleo type, ways of eating for diabetes. I would like to eat plant based for both health & ethical reasons, but am concerned about the whole grains & legumes raising blood sugar levels & also causing weight gain. Currently, I still eat fish & egg whites occasionally, have gained a few pounds & my A1 C is not coming down. If it’s true that fats are responsible for insulin resistance in the cells, how can the low carb, high protein paleo type diet, which usually contains fair amounts of fat, be as effective as it seems to be in controlling blood sugars? According to Ornish, McDougall, etc. they also say most fats should be eliminated – is it for the same reason or is their opinion based on cardio protection mostly? Their position on fat also raises the questions re healthful nuts & seeds. I no longer know what to eat!

    1. I have tried the paleo diet properly for 6 months and it caused my cholesterol to shoot through the roof I went from 170 to 280 total cholesterol. I lost a bit of weight and my A1C came down initially just from cutting refined sugars but soon at the 4 month mark my A1C was worse than when I started. The only way I found to get control of my cholesterol and A1C is to go to a plant based diet. It seems to be the only thing that works long term. I tend to focus more on eating legumes with less grains and I eat lots of veggies, take a b12, vit D and algae tablet daily. I have learned to stay away from sweets and processed vegan foods. I feel better than ever and my numbers are great. There are videos pertaining to the science on the mechanism of diet and diabetes on this site. I know this testimony is anecdotal but I felt like sharing. All research shows that the ADA diet for diabetes and the paleo diet may slow diabetes progression it does not reverse diabetes like a whole plant food diet.

    2. Hi, Confused ;) SO many dietary approaches it seems. I know it can get confusing. I feel like the main theme here in Dr. Greger’s video points to the health benefits of nuts. The studies are not talking about adding huge amounts, just a handful a day or so. not sure the research supports prediabetics avoiding nuts completely. Also, beans, barely, and oats are all very low in the glycemic index and shouldn’t spike blood glucose. These foods don’t appear to lead to weight gain either, if anything, all these fibrous foods may help lower body weight. I have seen it in clinical studies. The fish may play a role in diabetes progression. I don’t think it is true that fats are directly responsible for insulin resistance in the cells, or that low-carb/high-fat diets are good for controlling blood sugars.

        1. Good catch! Let me clarify. I don’t think fat is the whole issue. Depends on type, perhaps? Nuts and seeds don’t seem to increase diabetes risk, and they have fat. In the video you linked, one study found more insulin resistance when infusing fat into muscle cells . The other showed low-carb high-fat diets also increasing insulin resistance. So my mistake, fat DOES have something to do with insulin resistance, clearly, but i believe the type of fat and amount is important to identify before making a claim that “fat causes insulin resistance” which is untrue.

      1. Isn’t it the saturated fat that one finds in meat and dairy that causes insulin resistance? I thought saturated fat caused this, but the monounsaturated and polyunsaturated fats that we find in nuts and seeds help make it better. Some nuts have some saturated fat, but most of the fat in nuts is not saturated.

        1. I think so too, come to think of it , my back pain stopped after I began eating vegan PBWF (omnivore diet previously) as this site suggested, and no saturated fats. I eat Walnuts daily now. I forgot all about the back pain until I read this discussion ! Better control of my blood glucose level too.

    3. The plethora of evidence presented by Dr. G in his videos point to the effectiveness of the WFPB diet.

      I “discovered” the good Dr. about 5 months ago and have been following the advice presented in his videos. In the beginning I was 210 lb (I’m 6’1″). Very quickly 20 lbs melted away with no calorie counting or going hungry. My A1C had been nudging the upper limit at 5.6. My total cholesterol had been 174 with the LDL portion at 122. My local Dr. put me on a low-dose statin (20mg Simvastatin). Now 5 months later my A1C is 5.3, my total cholesterol is 106 with the LDL portion at 55. One wonders if I really need the statin at this point – maybe continuing it will help to remove the arterial plaques build up over a lifetime of bad eating habits.

      My point with all of this rambling is that it’s well worth following Dr. G’s advise as presented in his videos. In my case it’s been easy-peasy. I never have to stay hungry. Just stay away from junk food and get 30 minutes of very moderate activity most days. For people with worse blood-chemistry numbers than mine, progress may come slower. But, I believe, progress will come.

          1. So – you do not know. Have you had a CT scan to determine the extent of the plaque? Also – what are your triglycerides? Have you tested your LDL-P?

            1. There’s a whole lot I don’t know.

              My Dr. noticed some arterial buildup in an X-ray taken for another problem. No big deal but noticeable. From what I’ve been reading, most of us who have grown up on a standard Western diet have some plaque buildup. Triglycerides are 120.

              An abundance of caution dictates that since all my numbers are getting better, that I continue on this same path. I may reconsider the statin use in the future.

                1. Triglycerides are a secondary risk factor for CVD. If the primary risk factor, total cholesterol, is below about 150 total, triglycerides do not appear to be a risk factor. Basically if you already have high total cholesterol, then high triglycerides can make it worse. But if cholesterol is low, then triglycerides level doesn’t seem to make much difference.

                  1. Any proof for the statement – “if cholesterol is low, then triglycerides level doesn’t seem to make much difference”

    4. Confused, you mentioned Drs. Ornish and McDougall. I wonder if you’re aware, too, of Dr. Barnard’s studies on & approach to diabetes; it’s fully laid out in _Dr. Neal Barnard’s Program for Reversing Diabetes._ There’s also a lesser known book/approach called _The 30-Day Diabetes Miracle_ by Drs. House (No, not *that* Dr. House!) and Seale that is also WFPBD-based. In the latter book, focus is on carb-counting within the vegan approach, so while it allows whole grains it does so in lesser amounts than do Ornish/McDougall/Barnard. House/Seale do include nuts as part of a healthy eating approach to diabetes as well as pre-diabetes & metabolic syndrome (which I, for one, consider to be pre-pre-diabetes). I hope this may help dispel your confusion somewhat in that you allow yourself to make small adjustments (nuts vs. no nuts) within the general framework of WFPBD and see how your system deals with them.

    5. “[…] how can the low carb, high protein paleo type diet, which usually contains fair amounts of fat, be as effective as it seems to be in controlling blood sugars?”

      My answer to this is that the low carb diet is not controlling blood sugars, it is simply limiting them. A healthy human body is equipped to digest sugars and use them for energy. If your body is not capable of doing this, it is in a diseased state. You can eat a low carb diet to restrict your sugar intake and thus your blood sugar, but you still have diabetes. Your body has lost its capability to properly process sugar, and consuming it will result in dangerously high blood sugar. Contrast this scenario with a low fat/high carb whole foods vegan diet, which has the capability to actually cure the underlying disease so that when you consume carbohydrate, your body has the capability to process it properly and maintain appropriate blood sugar levels.

    6. Confused, this is a topic with a seemingly counterintuitive answer. As a type 1 diabetic I have studied this question extensively and in depth. First, the paleo crowd is right about one thing, you, we, all should not be eating much in the way of simple sugars. From there on they part ways with science. The apparent reason for so many Americans developing diabetes is the growing epidemic of obesity. But that does not explain it all. It happens that people who go on a WFPBD often reverse their diabetes without first loosing weight. So why is this.

      OK, carbohydrates will raise blood sugar levels but meat and and animal fats will increase insulin resistance. Meat increasing insulin resistance comes from a variety of factors but the glycotoxins or Advances Glycation End Products are a major contributing factor. (Dr Greger has several videos on AGEs that are excelent but I especially like this article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953708/ which concludes; “several studies have shown that dietary restriction of AGEs is feasible in patients with diabetes or renal failure as well as in healthy persons and results in marked decrease in circulating AGEs and markers of oxidative stress, inflammation, endothelial dysfunction and insulin resistance.” So the appropriate answer is to reduce your glycemic index and reduce your insulin resistance.

      Carbohydrates are necessary as our most basic food, We just don’t need spikes. So a diet emphasizing beans, greens, whole grains, fungus, fruits and roots will accomplish the moderated blood sugar levels with little spiking while increasing insulin sensitivity. When I went with a whole food plant based diet my insulin intake was reduced by 25%. (remember, I produce no insulin myself so I can monitor insulin usage with my pump computer.). I attribute that to higher fiber, which certainly helps, and increased insulin sensitivity.

      For a very full discussion of the effect of paleo on insulin resistance I would suggest the link http://plantpositive.com/35-how-to-become-insulin-resis/ . Also note his discussion glyconeogenesis which may accompany a high meat low carb diet. These presentations are very well researched. He starts the discussion with a study done on two men in the 1920s who went on an all meat diet for one year. They both developed chronic hyperglycemia while on this diet and recovered when they began consuming carbs again. I really suggest you listen to that and read the transcript.

      Also just put in “insulin resistance in the search field on this site and you will get ample information on the effects of animal products on insulin resistance leading to metabolic syndrome and ultimately type 2 diabetes. Dr Greger has impeccable sourcing and by design is very easy to follow.

      Now one more thing. There is a growing numbe of individuals in adulthood who have metabolic syndrome or type 2 diabetes who in reality have an autoimmune disease which is slowly destroying the beta cells but just has not completed the job yet. There are many many pro-inflammatory factors in animal product which can provoke the autoimmune response. Again just note the above quote on dietary restrictions of AGEs or glycotoxins. If in fact your metabolic syndrome is a result of an autoimmune response, you will help yourself a great deal and possibly stop the development of diabetes by eliminating animal products. If your metabolic syndrome is simply the result of insulin resistance, then you will help yourself a great deal and probably stop the development of diabetes by eliminating animal products. (Hmm, same answer to two different cases. I guess that’s convenient.)

      Hope this is not too long winded.

      1. Thank you Richard. Appreciate your response – not too long winded at all – & will definitely follow-up on the links you sent. I had not heard about the autoimmune response, but that is certainly something to look into. I m a newbie to WFPB & having a difficult time giving up my fish protein. Will have to try harder.

    7. I eliminated my diabetes on a WFPB diet in 2 weeks, literally. I also went on to lose half my body weight, but the changes happened fast sticking religiously to the program, all plants, nothing processed, no added fat, no animal products. Try it…just start out with a 30 day trial like I did. That was 5 years ago and I have never looked back.

    8. You might try reading the book “Dr. Neal Barnard’s Program for Reversing Diabetes”. This book talks about the science behind diabetes and how a plant based diet can completely reverse it. Included are suggestions on the steps to take and what low glycemic index plant foods you should focus on to keep your blood sugar from spiking so high as your body heals. Note it is often said that the answer for a lot of diseases like heart disease, diabetes, high blood pressure, even cancer and autoimmune diseases is exactly the same low-fat whole-foods-plant based diet. And that is true in outline, but Dr. Barnard has some specific suggestions for plant foods to focus on as your sick body heals that are somewhat a subset of the larger diet.

      All the low-carb diet by their very nature have to be very high fat because there is just so much protein your body can handle (about 30-35% of calories). So if you are already eating animal products, then you are likely at the top end of the range of protein your body can handle. The only way to further reduce carbohydrates then is to replace them with fat, and fat is the root cause of Type II diabetes.

      As for how such a diet keeps blood sugar down, it does it by simply not allowing much sugar/starch to be eaten. If it isn’t in the food, it can’t show up in the blood. But this doesn’t reverse diabetes. All that fat is making it worse. It is just that you aren’t getting food that can be readily converted to glucose so it will even out your blood sugar level over time. But high blood sugar is a symptom of the disease, and not the cause. So simply controlling your blood sugar does nothing to reverse your disease.

      Your body can make glucose from protein by a processes called gluconeogenesis as well as from the glycerin it makes when breaking down the fat. So even if you eat zero carbohydrates, you will still have some blood sugar. Which is good because the red blood cells can’t use anything but glucose for energy and you would simply die if your body wasn’t able to do something about the lack of carbohydrates in your diet. But it can’t make a lot, so other tissues that would rather have glucose, like your brain, have to make do with ketone bodies, like acetone (also known as nail polish remover) which are also created from fat. As you can imagine nail polish remover doesn’t make the best fuel for your body and causes all kinds of other health problems can result if you stay in a ketogenic state for a long time. A ketogenic state, also known as starvation mode, was evolved as a way to live off stored body fat when no food at all was available and allow fuel to be made out of something other than protein so your body would have to break down a minimum amount of your muscles to survive the extended famine. But it is supposed to be temporary and you go back to the body’s preferred mode when you find more carbohydrate containing food. BTW, this shows definitively that we evolved to be plant eaters, because just eating meat while starving doesn’t get you out of ketogenesis as the Atkins diet amply demonstrates. Anyway I digress.

      So Paleo (and Atkins and South Beach and Wheat Belly and Grain Brain and the rest) are taking you deeper into insulin resistance, the root cause of Type II diabetes, not getting you out. A whole food, plant based diet addresses the root cause of diabetes, the insulin resistance caused by myocellular lipids (fat in the muscles). By making a specially focus on low glycemic index foods during the initial phase, you should be able to keep the sugar spikes to a manageable level. And those spikes won’t be around long enough to cause any lasting damage.

      But do take a commitment to go 100%. Partial adoption is likely to keep enough of the wrong kinds of fats in your diet to keep the insulin resistance in place even if it is not progressing. Then the addition of carbohydrates then will cause higher blood sugar that will persist without the elimination of the muscle fat and attendent insulin resistance. Then as the sugar spikes don’t diminish because of the persistent insulin resistance, your A1C levels will start to rise.

      And it is OK if in the beginning your diet is pretty repetitive as you learn your way around. Your focus is on the foods that will help you heal your insulin resistance. There isn’t any risk of deficiencies developing in a few weeks to a month or even two. Dr. Walter Kempner was reversing diabetes in the 1940 with a diet of just white rice, white sugar and fruit juice which his patients sometimes ate for months without issue. Not that I am suggesting his Rice Diet. I think it worked because it was essentially fat free. You can do the same with a much more nutritionally sound diet.

      Oh, and if you are on medications, please, please, please work with your doctor. This diet can sometimes work so well and so fast that unless your doctor is ready to start reducing some of your medications, especially those that directly lower your blood sugar like injected insulin, you could experience dangerously low blood sugar. Everyone varies in their response, but it is my understanding that this is the only diet that directly addresses the root cause of diabetes and so the only one that actually has a chance to cure rather than just try to slow down the progression of diabetes.

      Good luck.

    1. I hope you can do something with it. It has the sound of a great domain name! Nuts and Fungus are two of my favorite things! I am going to try to grow my on mushrooms this spring with one of Paul Stamet’s grow structures that has the mycelium already inoculated throughout the medium. I am trying pink oyster mushrooms first.

  13. I would like to have a template for what I should be eating everyday. E.g., which nuts and how many; how many cups of hibiscus tea, etc. I already eat 3 tablespoons of flaxseed mixed with yogurt and one tablespoon of chia seeds mixed with yogurt daily for breakfast. I also eat a cup of blueberries daily and one Brazil nut. Mould love to have a good daily template.

    1. One thing I can tell you is to drop the yogurt along with all other dairy products, unless your yogurt is made with soy instead of dairy.
      If you have any questions about the negative affect of dairy, see T. Colin Campbell, PhD’s book, The China Study.

  14. Dear Jim Felder.

    You might be missing the point that Dr. Greger actually posed the question “Which Parts of the Mediterranean Diet Extended Life”, not me.
    I find the question most appropriate, as you indeed also seems to do, judged by your comment. So there seems to be no reason to argue about that.

    My question regarding the flavones is based on the simple fact that the scientific literature clearly point to the conclusion that this is a class of polyphenols that has been investigated a lot less than the others, e.g. the flavanols – like the different sorts of catechins – and the flavonols, represented above all by quercetin, the isoflavones like genistein and of course all the different kinds of anthocyanins. Much research has also been done on other polyphenols like curcumin and resveratrol. But on the flavones, almost nothing.

    My opinion would be that this kind of research – some of it epidemiological, some interventional – could be of great value, as it brings to the table useful knowledge on what kind of bioactive substances in plants are preventing disease alone or in combination. As thyme and oregano are known to have large amounts of flavones in them, and are a common part of the Mediterranean diet as well, it would be at close to ignorance not to consider their potential for health promoting effects.
    My question is a real one, I would very much like to get to know if there has been done serious research on thyme and oregano, in all sorts of combinations that could provide more knowledge of their effects. To ask for the effect of the flavones in them would be only one place to start.

    From time to time I also like to remind myself of the fact that aspirin actually is a compound derived from the bark of the white willow – and a polyphenol as well. It definitely seems to have interesting effects on human health, to the benefit of millions during the last 250 years of history.
    I do agree with you, plants have marvelous properties and we should more than double the consumption of plant-derived food, but also include the herbs, tubers and berries together with fruit vegetables and nuts. In all sorts of combination of course.

    My first questions might have been misleading, I hope that this explanation could provide some clarification.

    Best regards


    1. Sorry I missed your reply to me. I do agree that there is indeed value to research into specific nutrients and their effect. My concern is that this type of research is often wildly extrapolated by people who want to make money off of selling the isolated nutrients, namely the vitamin and supplement industry. As a result the general public is completely mislead by these modern day snake oil salesmen into thinking they can purchase health in a bottle or even better health in a whole bunch of separate bottles, when in fact the benefits often only show up when the research nutrient is consumed as part of the whole food.

      There are exceptions of course, such as the fact that many drugs including aspirin originated from plant extracts. But aspirin is also a counter example. Sure it was originally extracted in large amounts from willow bark, but it is naturally occuring in many foods. Here is a list http://www.livestrong.com/article/296049-list-of-foods-with-suspected-salicylates/

      Doctors often prescribe low dose aspirin for people at risk of a heart attack. But if they instead prescribed a diet high in foods that naturally contain acetylsalicylic acid people could get the benefit of this particular compound while also gaining the health benefits from everything else in the food. So by taking acetylsalicylic acid out of context and reducing it to a pill it gave doctors and patients a discrete, easy to understand way to address a health issue. In the process they have lost all the other benefits that they would get from whole foods if instead patients were to get their aspirin by eating some fruits and vegetables. I would imagine in fact by this point that very few doctors even know that aspirin is present in commonly consumed foods since as a group there seems to be almost no interest if it doesn’t come in a pill or require a procedure.

  15. Your videos on the Mediterranean Diet are so informative and sensible. My question is about your strong endorsement and suggested value of nuts in a good plant-based lifestyle. Is there a valuable and equal alternative for those of us who have serious nut allergies?

    1. Hi Sunnyite, can you eat seeds? Magnesium, phytosterols, and omega-3 fatty acids are all implicated in cardiovascular health, and are found in seeds in even higher amounts than in nuts.

      Regarding phytosterols, from whfoods.com:
      “Sesame seeds had the highest total phytosterol content (400-413 mg per 100 grams), and English walnuts and Brazil nuts the lowest (113 mg/100grams and 95 mg/100 grams). (100 grams is equivalent to 3.5 ounces.) Of the nuts and seeds typically consumed as snack foods, pistachios and sunflower seeds were richest in phytosterols (270-289 mg/100 g), followed by pumpkin seeds (265 mg/100 g)”

      Also in a listing of foods with the highest magnesium content, three types of seeds are among the top contenders, with no nuts making the list:
      For more on magnesium and heart health:

      For omega-3 content, of course flax and chia seeds have high levels:

      1. Before you go crazy for phytosterols, you should understand that although they reduce serum cholesterol, studies indicate that they may actually increase risk of cardiovascular disease. See for example
        and several others noted in the right-hand panel of these studies.

    2. I have histamine intolerance, and walnuts contain a lot of histamine. In addition, they’re a histamine liberator. Eating walnuts means suffering to me. In place, I eat a lot of flax and hemp seeds, although I prefer the taste of walnuts.

  16. Hi Folks. I think this bit about walnuts is interesting and I commend Dr. Greger for bringing this to our attention. We have a tendency to think about ‘superfoods’ and ‘silver bullets’ that we should be incorporating into our diets. I have to wonder, however, how many walnuts our ancient ancestors (the ones whose DNA is floating around in our cells) had access to. My guess is not too many. I think, rather, the benefits of walnuts in the present context is to decrease the ratio of omega-6 to omega-3 fatty acids more in line with what our ancient DNA is used to seeing, and thereby conferring health benefits in the here-and-now. Therefore, I am not so much inclined to run out and buy walnuts (food ‘magnets’ in my pantry, I don’t know about yours…) thinking about superfoods. Rather, I will continue to eat my WFPB diet, believing my n-6/n-3 ratio is more tuned for the ancient DNA floating around in every cell. And, my microbiome seems to be happy with it as well-if ya know what I mean ;-)

    For more on this notion of ‘superfoods’ vs. diet totalityand the effects of diet on our microbiomes, have a look at this interesting lecture by Daphne Miller, M.D. Thanks and have a Plant Strong day!

  17. It is strange that the “Baseline adherence to the Mediterranean diet and major cardiovascular events: Prevención con Dieta Mediterránea trial” found no benefit to eating fruits and legumes. This is contrary to some studies that I have seen elsewhere. So if I accept the conclusion that nuts are good for preventing cardiovascular events, should I also conclude that fruits and legumes are not helpful. Note the legumes were statistically close to being a detriment.

    1. I don’t think so. As you mentioned, there are loads of studies supporting the inclusion of beans on cardiovascular health.

  18. Dr. Gregor, I am anxiously awaiting your fact-finding with regard to the Paleo folks. They seem to be armed with their own justifying research. Should be not only interesting and entertaining, but enlightening. Perhaps a debate with Dr. Kesser?

  19. yippee….raw walnuts are a VERY staple part of my diet…I add a palmful of them, ground up, to my oats 3-4 mornings each week…great stuff! My dad and brother both died of colon cancer, both smoked, and were pretty depressed at time of diagnosis, but heck…my dad’s side of the family has cancer all throughout, so am glad to eat a whole food plant based diet for many years now AND avoiding alcohol, on my mom’s side; she died of it, her only sibling died of it and her dad died of it and it’s all through their Irish heritage on our family tree…easy peasy for me–just don’t drink alcohol. Thanks Doctor Greger for ALL you do!

  20. http://www.eurekalert.org/pub_releases/2015-03/acoc-mdc030315.php
    Mediterranean diet cuts heart disease risk by nearly half

    WASHINGTON (March 4, 2015) — Adults who closely followed the Mediterranean diet were 47 percent less likely to develop heart disease over a 10-year period compared to similar adults who did not closely follow the diet, according to a study to be presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.

    Among the study’s paacrticipants, adherence to the Mediterranean diet was more protective than physical activity. The study, conducted in Greece, bolsters evidence from earlier studies pointing to the diet’s health benefits and is the first to track 10-year heart disease risk in a general population. Most previous studies have focused on middle-aged people.

    “Our study shows that the Mediterranean diet is a beneficial intervention for all types of people–in both genders, in all age groups, and in both healthy people and those with health conditions,” said Ekavi Georgousopoulou, a Ph.D. candidate at Harokopio University in Athens, Greece, who conducted the study along with Demosthenes B. Panagiotakos, Ph.D., professor at Harokopio University. “It also reveals that the Mediterranean diet has direct benefits for heart health, in addition to its indirect benefits in managing diabetes, hypertension and inflammation.”

    The study is based on data from a representative sample of more than 2,500 Greek adults, ages 18 to 89, who provided researchers with their health information each year from 2001 to 2012. Participants also completed in-depth surveys about their medical records, lifestyle and dietary habits at the start of the study, after five years and after 10 years.

    Overall, nearly 20 percent of the men and 12 percent of the women who participated in the study developed or died from heart disease, a suite of conditions that includes stroke, coronary heart disease caused by the buildup of plaque in the heart’s arteries, acute coronary syndromes such as heart attack, and other diseases. Other studies have shown Greeks and Americans have similar rates of heart disease and its risk factors.

    The researchers scored participants’ diets on a scale from 1 to 55 based on their self-reported frequency and level of intake for 11 food groups. Those who scored in the top-third in terms of adherence to the Mediterranean diet, indicating they closely followed the diet, were 47 percent less likely to develop heart disease over the 10-year follow-up period as compared to participants who scored in the bottom-third, indicating they did not closely follow the diet. Each one-point increase in the dietary score was associated with a 3 percent drop in heart disease risk.

    This difference was independent of other heart disease risk factors including age, gender, family history, education level, body mass index, smoking habits, hypertension, diabetes and high cholesterol, all of which the researchers adjusted for in their analysis.

    The analysis also confirmed results of previous studies indicating that male gender, older age,diabetes and high C-reactive protein levels, a measure of inflammation, are associated with an increased risk for heart disease.

    While there is no set Mediterranean diet, it commonly emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil and even a glass of red wine. Earlier research has shown that following the traditional Mediterranean diet is linked to weight loss, reduced risk of diabetes, lower blood pressure and lower blood cholesterol levels, in addition to reduced risk of heart disease.

    “Because the Mediterranean diet is based on food groups that are quite common or easy to find, people around the world could easily adopt this dietary pattern and help protect themselves against heart disease with very little cost,” Georgousopoulou said.

    Among study participants, women tended to follow the Mediterranean diet more closely than did men. Despite the fact that Greece is the cradle of the Mediterranean diet, urbanization has led many Greeks to adopt a more Western diet over the past four decades, he said.

    The study was limited to participants living in and around Athens, Greece, so the sample does not necessarily reflect the health conditions or dietary patterns of people in more rural areas or the rest of the world. However, previous studies have also linked the Mediterranean diet with reduced cardiovascular risks, including the Nurses’ Health Study, which included nearly 75,000 American nurses who were tracked over a 30-year period. Additional studies in other adult populations would further advance understanding of the diet’s influence on heart disease risk.

    The study, “Adherence to Mediterranean is the Most Important Protector Against the Development of Fatal and Non-Fatal Cardiovascular Event: 10-Year Follow-up (2002-12) Of the Attica Study,” will be presented on March 15 at 9:30 a.m. PT/12:30 p.m. ET/4:30 p.m. UTC at the American College of Cardiology’s 64th Annual Scientific Session in San Diego. The meeting runs March 14-16.

    1. Adherence to the Mediterranean diet is “the Most Important Protector Against the Development of Fatal and Non-Fatal Cardiovascular Events”? A more important protector than following SAD, certainly. But more important than heart-attack-proofing oneself with a WFPB SOS-free diet and a total cholesterol <150? I am doubtful.

  21. I wonder what Jeff Novick would say about some of these pro-nut studies. I’d love to watch a Jeff Novick – Michael Gregor or Jeff Novick – Joel Furhman debate on this topic.

    1. Somehow I got blocked by Jeff Novick on Twitter, though to my knowledge we’ve never had a conversation or exchange there or elsewhere online. (I don’t do Facebook.)

      Could it be the nuts?

  22. Hi Joney, those are interesting finds. It seems much of the research in regards to phytosterols is examining the effects of supplementation through enriched foods, as in the first two studies. In that sense, we might consider the negative side effects from phytosterols mentioned to be along the same lines as those seen with vitamin A and E supplements, the latter not necessarily being good evidence to reduce spinach and carrot consumption. A serving of phytosterol supplemented margarine may contain ten times the phytosterols of a serving of sunflower seeds, without any of the fiber or other phytonutrients found in the seed. While I’m not sure of the composition of the sterols used in supplemented foods, another possible issue is that they may not be an accurate reflection of the composition of various sterol or stanol compounds found in the natural whole food source, in the same sense of vitamin E and A supplements not containing the natural range of tocopherols/tocotrienols or carotenoids.

    In regards to the possible atherogenic risks seen in the general public with moderate elevations examined in the third paper, this 2014 review (free access) offers pleiotropy as a likely explanation:

    The third article focuses on a rare genetic disorder, which won’t affect most people.

    Nonetheless, I do agree with not “going crazy” with any particular nutrient or food and I hope my comment wouldn’t be interpreted as a recommendation to do such. Most whole foods plant based advocates generally recommend 1-2 oz nuts or seeds per day for most people, and with the exception of advanced heart disease patients, this appears to be a beneficial dosage for the general population. Is it due to the phytosterols? Maybe, maybe not. I think it’s important to remember the direction of the scientific process, in that once a food is observed to have beneficial effects, it’s then that researchers attempt to isolate the responsible individual compounds [which unfortunately are then typically isolated and recommended as supplements to a crappy diet]. My point being that if nuts/seeds themselves are shown to be beneficial, one shouldn’t worry about eating the nuts/seeds. Yes, one should worry about supplemental forms of isolated nutrients which reductionist research has determined to be the sole conferrer of such benefits, but negative side effects from those isolated compounds do not necessarily contradict the evidence seen in consumption of the whole food.

    1. Smith, what is your reference for what you consider relatively high or low in terms of methionine? While high in caloric density itself, walnuts are not high in methionine by caloric percentage. By calorie, they have half the methionine of black beans, a third compared to broccoli, and are equal to cucumbers. Do you think eating all of those foods will raise mortality risk? Contrast that with chicken, tuna, and beef, which have 13, 17, and 9 times the methionine respectively compared to walnuts. Walnuts are not a practical concern in regards to methionine consumption.

      1. a more useful comparision would be by servings. And the recommended servings is a cup or handful.

        As pointed out in the orginal article, there were no life extension, and the high methonine content may be a factor here.

        1. And why is a by-‘serving’ comparison more useful? By the way, a cup is a pretty greedy handful, in my opinion, and amounts to about 770 calories, which is a large fraction of daily calorie needs for most people.

        2. Actually smith, nutritional science as a whole favors recommendations by caloric percentage as it is much more meaningful. As largelytrue pointed out – your “serving” of walnuts is a cup??? This is four times the standard defined serving for nuts and seeds. No wonder you think they’re high in methionine. Can you see why quantifying nutritional characteristics by servings in regards to general recommendations is problematic?

          Aside from obvious problems in variations in interpretation on an individual level, another reason that stating content by calorie is more meaningful is that caloric intake differs among individuals. A person’s requirement for caloric intake, protein intake, and yes even methionine intake as it is an essential amino acid, is proportional to their size and activity level. Stating absolute values and amounts per serving is thus meaningless. A five foot tall sedentary person and a six foot tall athlete will have very different requirements for calories, macronutrients, and micronutrients, and those requirements will be proportional to their overall caloric intake. By stating requirements or recommendations by caloric percentage, each person can tailor those recommendations to their personal requirements.

          Another contrast can be seen in diet composition. Someone the same size as me with the same caloric requirements eating an animal product rich diet will be eating a fraction of the number of servings as I eat, since my diet is much lower in caloric density. Stating recommendations by serving would thus make the animal product rich diet appear more favorable than it really is in terms of methionine content, and would make the plant based diet appear worse than it is. If I’m eating a 2000 calorie diet, it doesn’t matter how many servings of food I’m eating, or what the volume of each food I ate was, it matters that the calories at the end of the day will total to 2000 and that a certain number of those calories came from methionine.

  23. A lot of studies, like those in this discussion, don’t distinguish between ischemic strokes (clotting) and hemorrhagic strokes (bleeding). Why is that? Does this mean that both kinds of strokes are equally affected by eating nuts, etc., or do they focus on ischemic which are the the most frequent?

    1. Hi plsteiner,

      I am not sure that is a good question. I think reducing stroke is reducing stroke and that is a good thing. So a few nuts can go a long way if these study hold true.

      1. Of course reducing stroke is a good thing. Maybe mine is not a good question in the epidemiological sense, but if you’ve had a hemorrhagic stroke, then it is a very good question, and an important one. So I’ll ask it again: why are all strokes treated as one kind of illness, when they have opposite ways of occurring (blockages vs. bleeds)? I understand that you’re interested in the general statistic–more or less strokes. But people reading and watching Dr. Greger are, I’m pretty sure, less interested in the overall prevention of disease than they are in the prevention of their own particular disease. Finally let me say, there are no bad questions, and labeling a question as not good is not likely to encourage discussion.

        1. Ugh. Silly misuse of a period. The first sentence above should have a big PERIOD between. Fro example”I am not sure. That is a good question!”

          That changes the way it comes off, doesn’t it? I did not mean to say you asked a wrong question, goodness, no!! I simply missed a period and capitalization, as you can see from my original response. So sorry. Now I feel obligated to look into your question :) It is totally valid and important to you therefore it is important to me. Give me some time I’ll investigate. And very sorry for the improper grammar. Please forgive me.


  24. Dr. Gregor seems to allow natural fat in his recommendations and recipes. Dr. Esselstyn screams at his audience, No oil. No oil. Is he being a little extreme? How much fat is recommended in a vegan diet?

    1. Vegcurious: Dr. Greger doesn’t recommend oils either. He just doesn’t yell about it. Both Dr.’s recommend that we get fat from whole plant foods rather than highly processed foods such as oil. Dr. Greger might be more comfortable with including more of the higher fat plant foods in our diet, but then again, Dr. Greger is making recommendations for the general public and Dr. Esselstyn is making recommendations for extremely sick heart patients. And Dr. Esselstyn has come right out and said that nuts are healthy. He’s not completely against even higher fat whole plant foods. His heart disease cookbook even includes a dressing with walnuts. This is why I really don’t think the Dr.’s are all that far apart in their thinking.

      To address your question about extremism – My take is that “no oil” is no more extreme than “no sugar”. I eat sugar, but I don’t kid myself that it is healthy. And I make a point of highly restricting sugar intake – or a least I try to. The same goes for oil. And in neither case do I consider it extreme if someone else wants to (and even better manages to) eliminate those unhealthy foods entirely. Good for them!

    2. I think fat intake varies widely in any diet so I cannot say what is best. The IOM guidelines say anywhere from

      20–35 % of calories from fat. Many folks find the lower end is a better fit, especially if they are reading the works of Dr. Esselstyn and others who have highly valuable materials on lower-fat diets. The purpose of this forum is to discus the science not label any diet by macronutrient percentages. But I like how you think, “natural fat” which means whole plant fat sources and we don’t require tons of it.

  25. Dr. Greger, you’ve seriously misunderstood the studies in which you say “If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn’t, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hock analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer.” Those two studies didn’t re-analyze the data from the trial: they actually weren’t trial data at all. These studies only evaluated baseline nut and olive oil consumption (respectively), before the trial had even begun, and only from a single food-frequency questionaire: it doesn’t tell you anything about how they ate after they were assigned to their diets, which was obviously the whole point of the trial. Also, even in these studies, “Higher baseline total olive oil consumption was associated with 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality.” It’s interesting that there may have been a “carryover” effect of earlier nut consumption on total mortality, and of olive oil on cardiovascular mortality, but don’t confound their earlier dietary habits (somewhat fuzzily assessed anyway) with what they did during the course of the trial itself, which is where the power of experimental science comes to bear.

    1. No misunderstanding; I just didn’t describe the study design as well as I should have. Indeed, these are effective cohort rather than interventional data. I am often torn between trying to make things short and simplified for the broader lay audience, while maintaining enough of the complexity and nuance to satisfy the more technically minded. That’s why I provide links to all the cited studies to inspire professionals who want to dig deeper. The links are up in the Cited tab, but here’s the direct full-text links to the nut and oil studies. Thanks so much for writing in!

  26. I am a type 2 diabetic still on insulin following Neal Barnard’s suggestion of only eating 20 grams of fat (plant based vegan diet) per day. I also follow Dr. Esselstyn’s advice of “NO OIL”. My weight has dropped from 240 pounds to 185. I still have 25 pounds to go. I have greatly reduced my insulin injections and would like to end the need to take insulin. I want to eat a very small package of walnuts and almonds a day but the 1/2 ounce packs contain 9 grams of fat… almost half my prescribed limit of fat per day. How does the fat from the nuts affect my insulin resistance? Do I as a diabetic need to avoid nuts?

    1. Thanks for reposting! I address many of these concerns in this comment. Also, as I mentioned before Dr. Barnard has had great success with Type 2 diabetes. I worked with him for 4 years. It is of course up to you if you want to include some nuts. The research seems to lean toward their inclusion in the diet for diabetics. I don’t think Dr. Barnard is against 1 ounce of nuts per day. 20 grams of fat seems very low, but of course many doctors still recommend low-fat diets and find great results. At any rate your weight is coming down and you are feeling better. I would stick to what is working!

      For more on Dr. Barnard’s research, study participants received either a low-fat strict plant-based diet or a typical diet for diabetes and found significant changes in weight loss and insulin levels. Dr. Greger presents the study in this video.

      Thanks again!

  27. Hello, congratulation for your videos: they are very well done – science-based – and very didactic. I fully agree with them. I work on holistic vs reductionist approaches in preventive nutrition : why not making a video about holism in nutrition? You can refer to some of my paper, those by Gyogy Scrinis, David Jacobs and Carlos mOnteiro. Yours sicnerely, Anthony FARDET (INRA senior research scientist)

  28. I had breast cancer and may be facing a recurrence. My doctor has recommended the Mediterranean diet and taking 4 TBL of organic extra virgin olive oil daily to help prevent a recurrence. This was based on a study which has been reported in the media. I’m wondering if you can shed some light on this study and olive oil? While I have been consuming raw unsalted nuts daily, I have been avoiding the use of oil and am confused about whether to use oil at all? Coconut oil which I thought was healthy according to my doctor may have raised my cholesterol.

    I have been a vegan for nearly 30 years. Your research-based recommendations are much appreciated and I am making adjustments to my diet based on your excellent videos and book. Thank you!

  29. HI I wonder why the chart 1:51 minute shows that increased consumption of Legumes (one of Dr. Greger’s favorite foods) was associated with MORE CV events???
    Any thoughts???

  30. Hi, Doctor Greger,
    could you make a video on Ancel Keys and his 7 countries study? It’s very (VERY) controversial, some people say it’s a scam.
    Only if you have some time of course.
    Thank you

    1. Dan: I know what you mean regarding the controversy. I thought you might be interested that Plant Positive did a fabulous detailed analysis of the controversy and explains where the people who say it’s a scam have twisted the truth. All you have to do is understand a bit of history and how science works to understand how Ancel Keys is being unfairly maligned. I would encourage you to start with this video if this topic interests you. Plant Positives other videos are also worth taking a look.
      Note: Plant Positive touches the Ancel Keys controversy in several videos. So, if there is a particular issue that you don’t think is covered in the page above, you can search on the site for additional videos.

  31. I am SO glad to see some information specific to olive oil in the mediterranean diet. I have friends who continue to eat a regular meat-based diet (animal flesh every day, most meals) who think that by adding gobs of olive oil on their salad and cooking with it that they are now eating a Mediterranean diet. This is not the traditional Mediterranean diet of decades ago which included, in fact, very little meat and did not slather – pour- olive oil all over everything.
    The current thinking is to eat whole foods, not refined foods. I don’t think people realize that olive oil – just like all oils – is a highly refined food even if it is the first pressing. Olive oil is not a whole food. The olive is the whole food. So here’s an interesting piece of information – How many olives does it take to make one Tablespoon of olive oil? It takes roughly 44 olives to make one tablespoon of olive oil. A friend of mine, who is Italian, exclaimed to me once, “When I learned how much fat is in olives I quit eating them !!!” But he still pours olive oil all over his food thinking its healthy. This is – in my mind – such a great example of how broadly and deeply we are disconnected from understanding what food is.

  32. Hi – thank you for all the amazing information. Do you have any suggestions for substitutes for butter and olive oil, two sources of fat that are still prevalent in my current diet as I move towards plant-based eating? Thanks!

    1. Jeff: I have several ideas that may help, but I need more information from you first. How are you using butter and olive oil? Are you sauteing with it? Part of salad dressing? Putting on potatoes? Baking? I would offer different suggestions depending on how you are currently consuming those extracted fats.
      re: moving towards plant-based eating. Good for you!!!

  33. at 1:50 what’s going on with the high hazard ratio for legumes? Some of the other foods also have good HRs, although their range extended about 1.0.

    1. Thanks for your comment Peter.

      Very interesting point, I had noticed yet.

      However, it’s important to note that there are other studies that find an inverse relationship between legume intake and risk of CHD (see here).

      Hope this answer helps.

    2. As one of the narrators on NF.org, I saw your question which certainly is valid if legumes are getting a relatively high hazard ratio. Unfortunately I could not find a source for that new information, after checking NF.org, MedLIne.plus, FDA and other data bases. The most recent study I found was from the European Journal of clinical Nutrition Feb 2016 which concluded “The present study indicated a strong inverse relationship between legume intake and the risk of cardiovascular events in old-aged Iranian people.” All other studies I found focused, not surprisingly on the benefits of legumes and did not mention hazards, as do many of the videos on this website. Perhaps you can mention study? Meanwhile we can focus on the benefits of those legumes and explore any hazards as we find them.

  34. Hello,

    If the nut group had reduced plaque that we attribute to eating nuts, why then do we next discount the compliance of nut eaters when considering mortality? Why do we reanalyze the data for mortality, but not plaque?



  35. It seems a bit strange that Dr. Greger usually discloses researchers’ relations to some industries in animal-food studies, yet he failed to disclose the conflict of interest of 2 researchers behind the study identifying intake of vegetables and nuts as the major factors reducing CVD and stroke risk in the Mediterranean Diet. Study: “Baseline Adherence to the Mediterranean Diet and Major Cardiovascular Events: Prevención con Dieta Mediterránea Trial” https://www.ncbi.nlm.nih.gov/pubmed/25111658

    “Dr Salas-Salvadó serves on the board of and receives grant support through his institution from the International Nut and Dried Fruit Council”
    “Dr Ros serves on the board of and receives travel support, as well as grant support through his institution, from the California Walnut Commission”

  36. Hmm, the message here appears to be “nuts good, olive oil no good”. I’m not sure I buy this.

    Firstly Nutritionfacts itself reported in a discussion on this subject and the PREDIMED study: “the diet with added extra virgin olive oil caused about a third fewer strokes. And adding nuts seemed to cut their stroke risk nearly in half.” https://nutritionfacts.org/video/predimed-does-eating-nuts-prevent-strokes/

    And as a much more detailed analysis I find the CR Societie’s Michael Rae advocating EVOO (along with nuts) as a healthy food is much more compelling, see for yourself: https://www.crsociety.org/topic/11719-olive-oil-healthy-or-not/#entry17306

  37. Hi All – Help Please – I’m trying to identify the name/title of one of his old videos ( ~2016/2017?)
    – where he talks about the AMA (American Medical Association) just announcing the recommendation for people to go plant based eating (“if all other factors such as meat industry etc were not considered”) and the WHO also recommended population to go plant based eating. I have had a good look around this website but cant find it?
    Any suggestions? Thanks everyone!

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