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:

Eating the Way Nature Intended

The Paleolithic period, also known as the Stone Age, only goes back about two million years. Humans and other great apes have been evolving for the last 20 million years, starting back in the Miocene era. We hear a lot about the paleolithic diet, but that only represents the last 10 percent of hominoid evolution. What about the first 90 percent?

During the Miocene era, the diet “is generally agreed to have been a high-fiber plant-based diet…” For the vast majority of our family’s evolution, we ate what the rest of our great ape cousins eat—leaves, stems, and shoots (in other words, vegetables), as well as fruits, seeds, and nuts. I explore this in my video Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

“Anatomically, the digestive tracts of humans and great apes are very similar.” In fact, our DNA is very similar. So, what do our fellow great apes eat? Largely vegetarian diets with high greens and fruit consumption. Just largely vegetarian? It’s true that chimpanzees have been known to hunt, kill, and eat prey, but chimpanzees’ “intake of food of animal origin is still at a very low level…with only 1.7% of chimpanzee feces providing evidence of animal food consumption.” This is based on eight years of work collecting nearly 2,000 fecal samples. So, even the most carnivorous of great apes appears to eat about a 98 percent plant-based diet. In fact, we may be closest to the diet of bonobos, one of the less known great apes, who eat nearly exclusively plant-based diets, as well.

Even our Paleolithic hunter-gatherer ancestors must have done an awful lot of gathering to get the upwards of 100 grams of fiber a day they may have consumed. What would happen if researchers put people on an actual Paleolithic diet? Not a supermarket-checkout-aisle-magazine paleo diet or some caveman blogger diet, but an actual 100-grams-of-daily-fiber diet or, even better, a mioscenic diet, taking into account the last 20 million years of evolution since we split with our common great ape ancestors.

Dr. David Jenkins and colleagues gave it a try and “tested the effects of feeding a diet very high in fiber.” How high? We’re talking 150 grams of daily fiber, far higher than the recommended 20 to 30 grams a day. However, 150 grams is similar to what populations in rural Africa used to eat—populations almost entirely free from many of our chronic killer diseases, such as colon cancer and heart disease.

The high-fiber diet didn’t mess around. Lunch, for example, could include Brussels sprouts, okra, green peas, mushrooms, filberts, and a plum. And dinner? How about asparagus, broccoli, eggplant, carrots, and honeydew melon? Surely, simply eating a lot of fruits, veggies, and nuts can’t be very satisfying, right? Actually, it got the maximum satiety rating from every one of the ten subjects, unlike the starch-based and low-fat diets which scored lower. Why? “All of the diets were designed to be weight-maintaining,” meaning the researchers didn’t want weight loss to confound the data. So, to get a full day’s calories of whole plant foods, the subjects had to eat about 11 pounds of food a day! Not surprisingly, this resulted in some of the largest bowel movements ever recorded in the medical literature, with men on the high-fiber vegetable-based diet exceeding a kilogram of fecal weight per day. You know how some people on weight loss diets lose two pounds a week? Well, in this study, the subjects dropped two pounds in one sitting.

That wasn’t the only record-breaking drop: A 33 percent drop in LDL cholesterol within just two weeks was seen. Even without any weight loss, bad cholesterol levels dropped by one-third within two weeks. That’s one of the biggest drops I’ve ever seen in any dietary intervention—better than achieved on a starch-based vegetarian diet or  a low saturated fat American Heart Association-type vegetarian diet. This was a “cholesterol reduction equivalent to a therapeutic dose of a statin” drug. So, we need to take a drug to get our cholesterol levels down to where they would be normally were we to eat a more natural diet.

We’ve been eating 100 grams of fiber every day for millions of years. This diet is similar to what’s eaten by populations who don’t suffer from many of our chronic diseases. Maybe this shouldn’t be called a “very high fiber” diet. Maybe what we eat today should be considered a very low, extremely fiber-deficient diet.

Maybe it’s normal to eat 100 grams of fiber a day. Maybe it’s normal to be free of heart disease. Maybe it’s normal to be free of constipation, hemorrhoids, diverticulitis, appendicitis, colon cancer, obesity, type 2 diabetes, and all other the diseases of Western civilization.


How do we know our ancient ancestors ate more than 100 grams of fiber a day? We can examine their fossilized fecal matter, as I discuss in my video Paleopoo: What We Can Learn from Fossilized Feces.

For more evidence on what our natural diet is, see my What’s the Natural Human Diet? video.

Other popular paleo videos include:

Excited to share what you’ve learned about diet? Well, it turns out you can share more than my videos. Check out How to Become a Fecal Transplant Super Donor.

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:

How to Make Your Own CoQ10

Chlorophyll is the green pigment that makes green leaves green. If you search for chlorophyll in the medical literature, a lot of what you find is about fecal fluorescence, a way to detect the contamination of carcasses in the slaughterhouse with feces to reduce the risk of food poisoning from pathogens harbored within animal feces. Fecal matter gets on meat either “with knife entry through the hide into the carcass, and also splash back and aerosol [airborne] deposition of fecal matter during hide removal”—that is, when they’re peeling off the skin. If, however, the animals have been eating grass, you can pick up the poo with a black light. As you can see in my video How to Regenerate Coenzyme Q10 (CoQ10) Naturally, a solution of chlorophyll is green, but, under a UV light, it lights up as red. So, if you have a black light in a chicken slaughter plant, you can get a drop on the droppings. The problem is most chickens aren’t outside anymore. They’re no longer pecking at grass so there’s less fecal fluorescence. We could let them run around outside or we could save money by just adding a chlorophyll supplement to their feed so we can better “identify areas of gut-spill contamination” on the meat.

The reason I was looking up chlorophyll was to follow-up on the data I presented in my Eating Green to Prevent Cancer video, which suggests that chlorophyll may be able to block carcinogens. I found a few in vitro studies on the potential anti-inflammatory effects of chlorophyll. After all, green leaves have long been used to treat inflammation, so anti-inflammatory properties of chlorophyll and their break-down products after digestion were put to the test. And, indeed, they may represent “valuable and abundantly available anti-inflammatory agents.” Maybe that’s one reason why cruciferous vegetables, like kale and collard greens, are associated with decreased markers of inflammation.

In a petri dish, for example, if you lay down a layer of arterial lining cells, more inflammatory immune cells stick to them after you stimulate them with a toxic substance. We can bring down that inflammation with the anti-inflammatory drug aspirin or, even more so, by just dripping on some chlorophyll. Perhaps that’s one of the reasons kale consumers appear to live longer lives.

As interesting as I found that study to be, this next study blew my mind. The most abundant energy source on this planet is sunlight. However, only plants are able to use it directly—or so we thought. After eating plants, animals have chlorophyll in them, too, so might we also be able to derive energy directly from sunlight? Well, first of all, light can’t get through our skin, right? Wrong. This was demonstrated by century-old science—and every kid who’s ever shined a flashlight through her or his fingers, showing that the red wavelengths do get through. In fact, if you step outside on a sunny day, there’s enough light penetrating your skull and going through to your brain that you could read a book in there. Okay, so our internal organs are bathed in sunlight, and when we eat green leafy vegetables, the absorbed chlorophyll in our body does actually appear to produce cellular energy. But, unless we eat so many greens we turn green ourselves, the energy produced is probably negligible.

However, light-activated chlorophyll inside our body may help regenerate Coenzyme Q10. CoQ10 is an antioxidant our body basically makes from scratch using the same enzyme we use to make cholesterol—that is, the same enzyme that’s blocked by cholesterol-lowering statin drugs. So, if CoQ10 production gets caught in the crossfire, then maybe that explains why statins increase our risk of diabetes—namely, by accidently also reducing CoQ10 levels in a friendly-fire type of event. Maybe that’s why statins can lead to muscle breakdown. Given that, should statin users take CoQ10 supplements? No, they should sufficiently improve their diets to stop taking drugs that muck with their biochemistry! By doing so—by eating more plant-based chlorophyll-rich diets—you may best maintain your levels of active CoQ10, also known as ubiquinol. “However, when ubiquinol is used as an antioxidant, it is oxidized to ubiquinone. To act as an effective antioxidant, the body must regenerate ubiquinol from ubiquinone,” perhaps by using dietary chlorophyll metabolites and light.

Researchers exposed some ubiquinone and chlorophyll metabolites to the kind of light that makes it into our bloodstream. Poof! CoQ10 was reborn. But, without the chlorophyll or the light, nothing happened. By going outside we get light and, if we’re eating our veggies, chlorophyll, so maybe that’s how we maintain such high levels of CoQ10 in our bloodstream. Perhaps this explains why dark green leafy vegetables are so good for us. We know sun exposure can be good for us and that eating greens can be good for us. “These benefits are commonly attributed to an increase in vitamin D from sunlight exposure and consumption of antioxidants from green vegetables”—but is it possible that these explanations might be incomplete?


This blog post has it all: a mind-blowing mechanism, practical applicability, and poop. What more could you want?

Interested in learning more about the potential downsides of cholesterol-lowering statin drugs? I’ve produced other videos on the topic, including Statin Cholesterol Drugs and Invasive Breast Cancer and The Actual Benefit of Diet vs. Drugs.

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: