All Children Should Have Their Cholesterol Checked Between Ages 9 and 11

Coronary artery disease does not magically appear. The disease begins “during early childhood and progress[es] unrecognized for several decades to its often final and unexpected endpoint of chest pain, disability, or premature death.”

As I discuss in my video Should All Children Have Their Cholesterol Checked?, “we need to remind ourselves that atherosclerosis begins in childhood as fatty streaks” in the arteries, which “are the precursors of the advanced lesions that ultimately” kill us. By the time we’re in our 20s, 20 percent of the inner surface of the artery coming off the heart is covered in fatty streaks, as you can see at 0:58 in my video. Fifty years ago, pathologists began raising the question of whether heart disease is best handled by cardiologists or by pediatricians.

“By their 30s, many young adults already have advanced coronary atherosclerosis,” so, in reality, intervention during our 30s and beyond “is actually secondary prevention, because advanced atherosclerosis is likely already present.” Indeed, intervention is just trying to mediate the ravages of the disease rather than prevent the disease itself.

What’s more, we are exporting the problem around the world. A study of young, thin, apparently healthy individuals found 97 percent of their collected arteries had atherosclerosis, which you can see at 4:52 in my video. So, even in developing countries like Brazil, where they’ve acquired our eating habits, we’re seeing an epidemic of heart disease and sudden death.

“Moreover, the risk factors that correlate with the extent of such early lesions are the same risk factors that correlate with myocardial infarction [or, heart attacks] later in life.” In other words, it’s the same disease but in the early stages. So, pathologists, the ones doing the autopsies on all these young people and seeing all this coronary artery disease, “began urging many years ago that preventive measures should be instituted earlier in life.”

We’ve known that fatty streaks exist in young children for more than a century, but it wasn’t until 1994 that a task force convened by the government came up with a “radical” idea: “The strategic key, and the greatest opportunity in preventing [cardiovascular disease] CVD, is to prevent the development of CVD risk in the first place.”

In my video Heart Disease Starts in Childhood, I noted that fatty streaks, the first stage of atherosclerosis, were found in the arteries of nearly 100 percent of kids by age ten who were raised on the standard American diet. In recognition of this fact, the latest Academy of Pediatrics’ recommendation is for all kids to get their cholesterol tested starting between the ages of 9 and 11.

Of course, this has drug companies salivating at the thought of slipping statins into Happy Meals, but “long-term drug intervention is costly and may be associated with adverse effects.” So, the conversation is about lifestyle modification.

In my video How Many Meet the Simple Seven?, I revealed the breathtaking statistic that only about 1 in 2,000 U.S. adults met the seven American Heart Association criteria for a heart-healthy lifestyle. What about American teenagers? Of the 4,673 adolescents aged 12 to 19 who were studied, zero made the cut. Not one teen “exhibited ideal levels of all 7 cardiovascular health behaviors and health factors.”

Most teen boys and girls don’t smoke, and most aren’t overweight. What was the main sticking point? Almost no one ate a healthy diet. Indeed, less than 1 percent of young men and women met a minimum of healthy diet criteria.

This sorry state of affairs is what’s behind a “controversial valuation that the current generation of US children and adolescents may be one of the first generations to be less healthy and have shorter life expectancy than their parents.”


If you think atherosclerosis by age ten is bad, check out my video Heart Disease May Start in the Womb.

Adverse effects with cholesterol-lowering drugs? See Statin Muscle Toxicity. I don’t think most people realize—doctors and patients alike—realize how relatively ineffective these drugs are. Watch, for example, The Actual Benefit of Diet vs. Drugs.

Cholesterol can do more than just build up and block off our arteries. In fact, Cholesterol Crystals May Tear Through Our Artery Lining.

What’s the Optimal Cholesterol Level? Does Cholesterol Size Matter? Watch the videos to find out.

Let’s take a step back, though. What about all the “cholesterol skeptics”? Check out How Do We Know That Cholesterol Causes Heart Disease?.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How to Get the Benefits of Aspirin Without the Risks

For people without a personal history of cardiovascular disease, aspirin’s risks may outweigh its benefits, but aspirin may have additional benefits. “We have long recognized the preventative role of daily aspirin for patients with atherosclerotic [heart] disease; however, it now appears that we can hatch 2 birds from 1 egg. Daily low-dose aspirin may help prevent certain forms of cancer, as well, as I discuss in my video Should We All Take Aspirin to Prevent Cancer? In an analysis of eight different studies involving more than 25,000 people, “the authors found a 20 percent decrease in risk of death from cancer among those randomized to daily aspirin…” The researchers wrote, “[T]he search for the most efficacious and safe treatments for malignant disease remains an enormous and burdensome challenge. If only we could just stop cancer in its tracks—prevent it before it strikes. Perhaps we can.” Indeed, perhaps we can with salicylic acid, the plant phytonutrient that’s marketed as aspirin.

How does aspirin affect cancer? The Nobel Prize for Medicine was awarded to the team who discovered how aspirin works. Enzymes named COX (cyclooxygenase) take the pro-inflammatory, omega-6, fatty-acid arachidonic acid our body makes or we get directly in our diet (primarily from eating chicken and eggs), and turns it into inflammatory mediators, such as thromboxane, which produces thrombosis (clots), and prostaglandins, which cause inflammation. Aspirin suppresses these COX enzymes. Less thromboxane means fewer clots, and less prostaglandin means less pain, swelling, and fever. However, prostaglandins can also dilate the lymphatic vessels inside tumors, allowing cancer cells to spread. So, one way cancer tries to kill us is by boosting COX activity.

We think one way aspirin can prevent cancer is by counteracting the tumor’s attempts to pry open the lymphatic bars on its cage and spread throughout the body. Indeed, reduction in mortality due to some cancers occurred within two to three years after aspirin was started. That seems too quick to be accounted for by an effect only on tumor formation . Cancer can take decades to develop, so the only way aspirin could work that fast is by suppressing the growth and spread of tumors that already exist. Aspirin appeared to cut the risk of metastases in half, particularly for adenocarcinomas, like colon cancer.

Given this, should we all take a daily baby aspirin? Previous risk-benefit analyses did not consider the effects of aspirin on cancer, instead just balancing cardiovascular benefits with bleeding risks, but these new cancer findings may change things.

If daily aspirin use were only associated with a reduction of colon cancer risk, then the benefits might not outweigh the harms for the general population, but we now have evidence that it works against other cancers, too. “[E]ven a 10% reduction in overall cancer incidence…could tip the balance” in favor of benefits over risks.

How does the cancer benefit compare? We know that using aspirin in healthy people just for cardiovascular protection is kind of a wash, but, by contrast, the cancer prevention rates might save twice as many lives, so the benefits may outweigh the risks. If we put it all together—heart attacks, strokes, cancer, and bleeding—aspirin comes out as protective overall, potentially extending our lifespan. There is a higher risk of major bleeding even on low-dose aspirin, but there are fewer heart attacks, clotting strokes, and cancers. So, overall, aspirin may be beneficial.

It’s important to note that the age categories in that study only went up to 74 years, though. Why? Because the “risk of bleeding on aspirin increases steeply with age,” so the balance may be tipped the other way at 75 years and older. But, in younger folks, these data certainly have the research community buzzing. “The emerging evidence on aspirin’s cancer protection highlights an exciting time for cancer prevention…”

“In light of low-dose aspirin’s ability to reduce mortality from both vascular events and cancer to a very notable degree, it is tempting to recommend this measure…for most healthy adults…However, oral aspirin, even in low doses, has a propensity to damage the gastroduodenal mucosa [linings of our stomachs] and increase risk for gastrointestinal bleeding; this fact may constrain health authorities from recommending aspirin use for subjects deemed to be at low cardiovascular risk”—that is, for the general population. “Recent meta-analyses estimate that a year of low-dose aspirin therapy will induce major gastrointestinal bleeding (requiring hospitalization) in one subject out of 833…”

If only there were a way to get the benefits without the risks.

Those who remember my video Aspirin Levels in Plant Foods already know there is. The aspirin phytonutrient salicylic acid isn’t just found in willow trees, but throughout the plant kingdom, from blackberries and white onions to green apples, green beans, and beyond. This explains why the active ingredient in aspirin is found normally in the bloodstream even in people not taking aspirin. The levels of aspirin in people who eat fruits and vegetables are significantly higher than the levels of those who don’t. If we drink just one fruit smoothie, our levels rise within only 90 minutes. But, one smoothie isn’t going to do it, of course. We need to have regular fruit and vegetable consumption every day. Are these kinds of aspirin levels sufficient to suppress the expression of the inflammatory enzyme implicated in cancer growth and spread, though? Using umbilical cord and foreskin cells—where else would researchers get human tissue?—they found that even those low levels caused by smoothie consumption significantly suppressed the expression of this inflammatory enzyme on a genetic level.

Since this aspirin phytonutrient is made by plants, we might expect plant-eaters to have higher levels. Indeed, not only did researchers find higher blood levels in vegetarians, but there was an overlap between people taking aspirin pills. Some vegetarians had the same level in their blood as people actually taking aspirin. Vegetarians may pee out as much of the active metabolite of aspirin as those who take aspirin do, simply because vegetarians eat so many fruits and vegetables. “Because the anti-inflammatory action of aspirin is probably the result of SA [salicylic acid, the active ingredient in aspirin], and the concentrations of SA seen in vegetarians have been shown to inhibit [that inflammatory enzyme] COX-2 in vitro, it is plausible that dietary salicylates may contribute to the beneficial effects of a vegetarian diet, although it seems unlikely that most [omnivores] will achieve sufficient dietary intake of salicylates to have a therapeutic effect.”

Aspirin can chew away at our gut. With all that salicylic acid flowing through their systems, plant-eaters must have higher ulcer rates, right? No. Both vegetarian women and men appear to have a significantly lower risk of ulcers. So, for the general population, by eating plants instead of taking aspirin, we may not only get the benefits without the risks, we can get the benefits with even more benefits. How is this possible? In plants, the salicylic acid can come naturally pre-packaged with gut-protective nutrients.

For example, nitric oxide from dietary nitrates exerts stomach-protective effects by boosting blood flow and protective mucus production in the lining of the stomach—“effects which demonstrably oppose the pro-ulcerative impact of aspirin and other NSAIDs.”

The researcher notes that while “[d]ark green leafy vegetables…are among the richest dietary sources of nitrate…it may be unrealistic to expect people to eat ample servings of these every day,” so we should just give people pills with their pills, but I say we should just eat our greens. People who’ve had a heart attack should follow their physician’s advice, which probably includes taking aspirin every day, but what about everyone else? I think everyone should take aspirin—but in the form of produce, not a pill.


To see the pros versus cons for people trying to prevent or treat heart attacks and stroke, see my video Should We All Take Aspirin to Prevent Heart Disease?.

Does the COX enzyme sound familiar? I talked about it in my Anti-Inflammatory Life Is a Bowl of Cherries video.

Where does one get “dietary nitrates”? See Vegetables Rate by Nitrate and Veg-Table Dietary Nitrate Scoring Method. I also discuss nitrates in Slowing Our Metabolism with Nitrate-Rich Vegetables and Oxygenating Blood with Nitrate-Rich Vegetables.

Do some plant foods have more aspirin than others? Definitely. In fact, some foods have the same amount as a “baby” aspirin. Check out Plants with Aspirin Aspirations.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Dialing Down the Grim Reaper Gene

Only about 1 in 10,000 people live to be a 100 years old. What’s their secret? I discuss this in my video Animal Protein Compared to Cigarette Smoking.

In 1993, a major breakthrough in longevity research was published about a single genetic mutation that doubled the lifespan of a tiny roundworm. Instead of all worms being dead by 30 days, the mutants lived 60 days or longer. This lifespan extension was “the largest yet reported in any organism.” This methuselah worm, a “medical marvel,” is “the equivalent of a healthy 200-year-old human.” All because of a single mutation? That shouldn’t happen. Presumably, aging is caused by multiple processes, affected by many genes. How could knocking out a single gene double lifespan?

What is this aging gene—a gene that so speeds up aging that if it’s knocked out, the animals live twice as long? It’s been called the Grim Reaper gene and is the worm equivalent of the human insulin-like growth factor 1 (IGF-1) receptor. Mutations of that same receptor in humans may help explain why some people live to be a hundred and other people don’t.

So, is it just the luck of the draw whether we got good genes or bad ones? No, we can turn on and off the expression of these genes, depending on what we eat. Years ago I profiled a remarkable series of experiments about IGF-1, a cancer-promoting growth hormone released in excess amounts by our liver when we eat animal protein. Men and women who don’t eat meat, egg white, or dairy proteins have significantly lower levels of IGF-1 circulating within their bodies, and switching people to a plant-based diet can significantly lower IGF-1 levels within just 11 days, markedly improving the ability of women’s bloodstreams to suppress breast cancer cell growth and then kill off breast cancer cells.

Similarly, the blood serum of men on a plant-based diet suppresses prostate cancer cell growth about eight times better than before they changed their diet. However, this dramatic improvement in cancer defenses is abolished if just the amount of IGF-1 banished from their systems as a result of eating and living healthier is added back. This is one way to explain the low rates of cancer among plant-based populations: The drop in animal protein intake leads to a drop in IGF-1, which in turn leads to a drop in cancer growth. The effect is so powerful that Dr. Dean Ornish and colleagues appeared to be able to reverse the progression of early-stage prostate cancer without chemotherapy, surgery, or radiation—just a plant-based diet and lifestyle program.

When we’re kids, we need growth hormones to grow. There’s a rare genetic defect that causes severe IGF-1 deficiency, leading to a type of dwarfism. It also apparently makes you effectively cancer-proof. A study reported not a single death from cancer in about 100 individuals with IGF-1 deficiency. What about 200 individuals? None developed cancer. Most malignant tumors are covered in IGF-1 receptors, but if there’s no IGF-1 around, they may not be able to grow and spread.

This may help explain why lives appear to be cut short by eating low-carb diets. It’s not just any low-carb diet, though. Specifically, low-carb diets based on animal sources appear to be the problem, whereas vegetable-based low-carb diets were associated with a lower risk of death. But low-carb diets are high in animal fat as well as animal protein, so how do we know the saturated animal fat wasn’t killing off people and it had nothing to do with the protein? What we need is a study that follows a few thousand people and their protein intakes for 20 years or so, and sees who lives longest, who gets cancer, and who doesn’t. But, there had never been a study like that…until now.

Six thousand men and women over age 50 from across the United States were followed for 18 years, and those under age 65 with high protein intakes had a 75 percent increase in overall mortality and a fourfold increase in the risk of dying from cancer. Does it matter what type of protein? Yes. “These associations were either abolished or attenuated if the proteins were plant derived,” which makes sense given the higher IGF-1 levels in those eating excess protein.

The sponsoring university sent out a press release with a memorable opening line: “That chicken wing you’re eating could be as deadly as a cigarette.” It explained that “eating a diet rich in animal proteins during middle age makes you four times more likely to die of cancer than someone with a low-protein diet—a mortality risk factor comparable to smoking.” And when they say “low-protein diet,” what they actually mean is getting the recommended amount of protein.

“Almost everyone is going to have a cancer cell or pre-cancer cell in them at some point. The question is: Does it progress?” said one of the lead researchers. That may depend on what we eat.

“[T]he question is not whether a certain diet allows you to do well for three days,” a researcher noted, “but can it help you survive to be 100?” Excessive protein consumption isn’t only “linked to a dramatic rise in cancer mortality, but middle-aged people who eat lots of proteins from animal sources…are also more susceptible to early death in general.” Crucially, the same didn’t apply to plant proteins like beans, and it wasn’t the fat; the animal protein appeared to be the culprit.

What was the response to the revelation that diets high in meat, eggs, and dairy could be as harmful to health as smoking? One nutrition scientist replied that it was potentially dangerous because it could “damage the effectiveness of important public health messages.” Why? Because a smoker might think “why bother quitting smoking if my cheese and ham sandwich is just as bad for me?”

This reminds me of a famous Philip Morris cigarette ad that tried to downplay the risks of smoking by saying that if we think second-hand smoke is bad, increasing the risk of lung cancer 19 percent, drinking one or two glasses of milk every day may be three times as bad with a 62 percent higher risk of lung cancer. What’s more, doubling the risk is frequently cooking with oil, tripling our risk of heart disease is eating non-vegetarian, and multiplying our risk six-fold is eating lots of meat and dairy. So, they conclude, “Let’s keep a sense of perspective.” The ad goes on to say that the risk of cancer from second-hand smoke may be “well below the risk reported…for many everyday items and activities.” So, breathe deep!

That’s like saying we shouldn’t worry about getting stabbed because getting shot is so much worse. Or, if we don’t wear seatbelts, we might as well have unprotected sex. If we go bungee jumping, we might as well disconnect our smoke alarms at home. Two risks don’t make a right.

Of course, you’ll note Philip Morris stopped throwing dairy under the bus once they purchased Kraft Foods.


The IGF-1 story is so pivotal that it’s one of the first video series I ever produced for NutritionFacts.org. I’m so glad I was able to release this long-awaited update. If you want a blast from the past, watch the original series starting with Engineering a Cure.

For more parallels between the tobacco industry and the food industry, see:

What about the mobile phone industry? Does Cell Phone Radiation Cause Cancer?

For more on healthy aging and longevity, see:

It’s important to note the so-called low protein intake is actually the recommended protein intake, which is associated with a major reduction in cancer and overall mortality in middle age, under age 65. But did you notice that it says not among older individuals? All of this is covered in my video Increasing Protein Intake After Age 65.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: