Screening for Coronary Disease is not what most people think.

Coronary artery disease is the most common cause of death in the United States and the world. Briefly, when someone has a heart attack, it is due to coronary disease. Cholesterol plaques are deposited in the lining of the coronary arteries, which deliver blood to the heart itself. This causes inflammation and damage to the arteries, and clots can form. When the clot occludes the flow of blood, a heart attack can occur, causing damage to the heart muscle and sometimes dangerous and fatal heart rhythms. Even if complete occlusion doesn’t happen, narrowing of the arteries can cause chest pain and weakness of the muscle, leading to heart failure.

Unfortunately, many people have no idea that they have coronary disease until damage is done. Sometimes, the first sign of the disease is sudden death from a heart attack or arrhythmia. Like most conditions, we would like to diagnose coronary disease early, while there is time to prevent the dangerous signs and symptoms.

Most people do not know what it means to screen for coronary disease. They think that the doctor listens to their heart, checks their cholesterol, and they’re good to go. That is not what I’m talking about. Listening to the heart does not detect early or even late coronary disease in most cases. Checking cholesterol levels is extremely important, but cholesterol levels are a risk factor for heart disease, not heart disease itself. There are many risk factors for coronary disease: cholesterol levels, diet, smoking history, family history, body weight, body fat distribution, and others. Even if you have multiple risk factors, you may never develop the disease, and some people with coronary disease have few if any risk factors.

Sidenote: I have heard people say many things about cholesterol. One is that they don’t understand how they had a heart attack since their cholesterol is fine. A similar statement is that they aren’t going to have a heart attack because they have normal cholesterol levels. Elevated cholesterol is a risk factor for heart disease, and treatment to lower cholesterol lowers the risk of heart disease. (This is definitely true, and anyone who says otherwise is mistaken or lying.) But people can have heart disease without having an elevated cholesterol. Risk factors are just that.

This is true with many conditions. Family history of breast cancer is a risk factor for breast cancer, but most women with breast cancer have no family history. Many people involved in serious car accidents are good drivers with a spotless record and no prior history of accidents. While most cases of lung cancer are in smokers, not all are. During my career in medicine, I saw many, many cases of coronary disease in people who did not expect it.

So, how do we screen? A person’s risk of a disease affects how we screen for it. For example, a teenager has an exceedingly low risk of prostate cancer, so we don’t screen at all. The same is true for breast cancer. Most young women should not be screened for breast cancer. People at very low risk don’t need screening. People who already have proven coronary disease need testing, but not the screening tests that we are going to talk about.

Let’s look at specific types of people. First would be people who are at very low risk and should not get screened. Tests are not perfect. Since a young, healthy person with no risk factors for heart disease (no family history of disease at a young age, and no genetic cholesterol problem) has such a low risk, false positive tests would actually outnumber any positive tests that were real.

We often screen people without symptoms who want to start an exercise program. They or their doctor may want to make sure they are safe to participate. A stress test may be a good choice. The patient walks on a treadmill in a standardized, progressively more difficult protocol, while an ECG is running. Sometimes, an ultrasound (echocardiogram) or nuclear imaging test is also performed. Certain changes on the ECG or imaging would indicate an increased risk of the patient having diseased, narrowed arteries. Further testing, such as a coronary angiogram, would then be performed to determine the extent of disease and whether treatment is indicated.

People with no symptoms but who are at significantly elevated risk may not need screening. They are so likely to have coronary disease that the doctor could just assume that they do have it. For example, they may have a markedly elevated LDL cholesterol and multiple family members with coronary disease. Aggressive risk factor modification would be instituted without further testing. This includes good blood pressure control, cholesterol-lowering medication (typically a statin such as rosuvastatin, which I take), and an exercise program. A stress test might be performed, as mentioned above, to see if they can tolerate such a program.

Perhaps the most common type of patient to screen is one where the risk of disease is intermediate. They may have a family history, but the cholesterol is not markedly elevated. A smoker without a family history may fit in this category. Here, a stress test would not be good enough. Remember, a stress test only detects advanced disease. A routine ECG would be of little help and is not recommended to screen for coronary disease, because there are many false positives and negatives. In this patient, a coronary artery calcium scan may be best, and it was the test I preferred when I was in practice.

The scan itself is simple. You lie in a machine for a few minutes. It is not enclosed like an MRI, and I have never heard of anyone becoming claustrophobic. There are no injections and essentially no risk. When cholesterol plaque is deposited, it is soft and uncalcified. Over time, the plaque calcifies, and you can see it on the scan. You will get a numerical score reflecting how much calcium is found in the lining of the arteries. The best is zero. That means that you have no detectable calcification in the coronary arteries. The percentile tells you how you compare to others your age.

A low score when you are young may be in a high percentile. That same score when you are older will put you in a lower percentile. If you are under 50, most people have a zero score. That could be because there is no plaque, but it could also mean that it is there but hasn’t calcified yet. Some specialists would recommend repeating the scan every five years or so until you are 60, giving the plaque time to become visible.

The calcium score scan doesn’t tell you if the arteries are narrowed, though the higher the score, the more likely it is that there is some narrowing. Even without narrowing, plaque can cause a heart attack, but narrowing makes heart attacks more likely. If your doctor suspects narrowing, they may order a stress test or a CT angiogram, a more detailed scan that shows narrowing. The CT angiogram is more expensive than the calcium scoring and requires injection of a contrast agent and more time in the scanner. The CT angiogram is not an appropriate screening tool for most people.

I found the calcium score test to be very helpful. For example, if you are 50, one of your parents had a heart attack in their 50s, but your cholesterol is fine, and you have no other risk factors for heart disease. You might consider a scan. If there is no plaque, your doctor may just repeat the scan in five years. If there is plaque, they may recommend a change in diet and start a statin to slow or prevent further plaque deposition. Statins reduce the risk of a heart attack and save lives.

Everyone wants to have a longer, healthier life, but we all want to live life to the fullest. Many people watch their diet and exercise, but otherwise ignore their risk of the most common cause of death. Talk to your doctor about screening for heart disease. Maybe you haven’t reached the age where any specific screening is needed. If screening is considered, ask if a calcium score is a good idea.

Diminishing Returns are defined by Webster as “benefits that, beyond a certain point, fail to increase in proportion to extended efforts.”

Diminishing returns, sometimes called the Law of Diminishing Returns, often refer to businesses. For example, as a company increases the number of employees (labor), its productivity increases. After a while, the increase in benefits slows down—adding new employees doesn’t help as much as it used to. Eventually, the company will lose money if it continues to increase labor costs above a certain amount. I apply this law to health.

Look at this chart:

Along the bottom is the effort you put into a healthy habit. Let’s say aerobic exercise. On the left, going vertically, is the impact that exercise has on your health: on weight loss, heart attack risk, and a multitude of other issues. If you are at zero effort, meaning you don’t exercise at all, there is no impact, of course. As you put in more effort exercising and move along the curve to the right, the impact increases and your health gets better. When your effort reaches five or so on my chart, but every healthy habit is different for every individual, the increase in benefit diminishes. To clarify further, for each increase in exercise, you get less of an improvement in your health. It still improves, just not as much.

Here is a real-world example. As I said in a prior post, a key to good health is to concentrate on the big things first. Exercise is a big thing. Say you never exercise at all, and you start walking a mile, three days a week. As you increase to 7 days a week, your cardiovascular health improves significantly. You are on the left part of the curve, which we call the steep part of the curve. If you get in better shape and switch to running a few days a week, your health improves further, at a good rate. If after a year of working out, you’re running six days a week for three miles, you are probably at five or six on the graph, and the curve starts to flatten. If you increase how much you run, the benefits you see will not increase as much or as fast as when you started. That is the law of diminishing returns. Eventually, even with more effort, the benefits may not increase at all. This is called a plateau. Running six miles a day, six days a week is not much better than five miles a day. See my book for more details on the benefits of exercise.

The same law applies to the weight loss that follows as you improve your diet by cutting calories, cutting carbs, or, in my recommendation, getting rid of the bad carbs that hinder weight loss. When you cut back on enough calories or bad carbs, you lose weight. As you cut back more and more, you lose weight faster. Eventually, you may reach a level of cutting where the rate of weight loss slows down. You may still be losing weight, but not as fast. This happens more with cutting calories than bad carbs, but it can happen with any diet, even the new GLP-1 medications and bariatric surgery. If you use the diet I recommend, The Three Rules to Lose Weight and Keep It Off Forever, it usually doesn’t reach the plateau where weight loss stops until you reach your goal.

Sometimes, if you keep increasing whatever you are doing, you may start to make something worse. You know this intuitively because it’s true for many things. Sometimes, after the plateau, negatives occur. Adding salt to food is an obvious example. If there isn’t enough salt, adding salt makes it taste better. But too much salt will ruin the dish. This is the best portrayal I have seen.

This happens with many healthy habits. Cutting calories too much leads to malnutrition, and running too much can be dangerous. Most vitamins and supplements have diminishing returns at a fairly low level, and a plateau is quickly reached. After the plateau, if you keep increasing, even some vitamins can become toxic, including vitamins D and A. As you know, this often happens with medications, and the toxic dose varies for different medications. I am on a relatively low dose of a blood pressure medication. If I doubled the dose, I would probably have side effects. With medications and supplements, the problem is easily avoided by reading labels and checking with your doctor.

An important problem with diminishing returns is that you think you’re helping things by increasing efforts with one healthy habit, ignoring others where you could improve and make a difference. Many weightlifters keep increasing their efforts and ignore diet and cardiovascular exercise. Others take every supplement ever invented and don’t eat healthy or exercise. You can spend a lot of money eliminating more and more plastics from your diet and forget about losing weight. Some will read every label to eat only organic and non-GMOA and not work on their weight. You have to be aware of where your efforts fall on the curve above, and that may require consulting a medical source.

Ignoring the law of diminishing returns sometimes distracts us from things we could do for our happiness and well-being. Taking reasonable protection against infections is wise, but isolating yourself from others leads to loneliness and depression. Instead of exercising so much, I could spend more time with my family. I could also practice meditation or develop other habits that would help my mental health. Despite what some people say, butter and red meat have health risks. Working hard and cutting red meat and butter to twice a month can be helpful, especially if you’re at increased risk of heart disease. Cutting further to zero has no proven benefit. I like eating red meat and foods with butter in them, and will not eliminate them from my diet for no benefit.

I strongly recommend working on healthy habits and concentrating on the part of the curve that is to the left of the diminishing returns zone. A good guide is my book, The Six Rules for a Longer, Healthier Life. Now, there is one more thing I want to mention.

Keep in mind a very important concept: The Threshold Effect.

The threshold effect is when you attain little or no benefit until you reach a level of effort or change. This is extremely important if you are on a low-glycemic diet, such as The Three Rules to Lose Weight and Keep It Off Forever, or a low-carb diet like the Atkins Diet (similar to Keto), but it’s seen to some degree on a low-calorie diet. As you start to cut back on bad carbs or calories, you may not initially notice substantial weight loss, though some do. As you increase your efforts, the amount you lose on a weekly basis will increase rapidly. If you give up all bad carbs, as I usually recommend, you will definitely have crossed the threshold and will lose a substantial amount of weight every week. Eventually, you may eventually reach a plateau, usually when you’re at the weight level you want to be.

See the graph. You may not notice much, if any, weight loss until you reach the threshold. In my graph, I arbitrarily started the weight loss at about 2.5 units of effort. That might be eliminating 90% of bad carbs or cutting calories by a few hundred a day.

When you reach 2.5, you lose weight faster and faster until you get diminishing returns. You lose weight, but each time you cut calories or bad carbs, the weight loss diminishes. Eventually, you may reach a plateau.

A common mistake is to forget the Threshold Effect if you cut back on your efforts. You may expect to have continued success when you slack off a bit, because you are eating fewer bad carbs than when you started. Perhaps you started eating one or two cookies a day or a few pieces of bread a week. However, if you slack off enough, you will reach the threshold in reverse, and you are likely to stop losing weight and even gain weight. I have made that mistake too many times to count.

The threshold for weight loss can be very high for some people. To lose weight, some need to get below 1200 calories a day. On keto, they need to be below 20 grams of carbs a day, and on a low-glycemic diet, you may need to give up all or nearly all bad carbs. Fortunately, you can otherwise eat what you want and should never be hungry.

Cutting calories has an additional problem—tolerance. Your body becomes accustomed to the lower calorie intake. If you start at 2000 calories, your threshold for weight loss might be 1600 calories a day. But, if you eat that amount, you will see diminishing returns quickly, so that you lose none or virtually none after a month. You’ve reset the threshold. Now, if you go back to 2000 calories, you will gain weight when before you had been stable at that level.

Keep in mind where you are on the curves above. Push hard enough to cross a threshold, and be especially careful not to cross that threshold in reverse if you back off on your efforts. Additionally, if you have reached the level of diminishing returns, don’t continue to increase your efforts at the expense of another healthy habit you could work on.

The importance of water is obvious, yet most of us take the availability of clean water for granted.

I have been working with a start-up company, The Joseph Project. The mission of the company is to help people prepare for emergencies, large and small. The official launch is scheduled for the spring of 2026, but the website is up and running, and a few products are being sold.

I am the medical director of The Joseph Project, and one of my responsibilities is education. My first article/ blog post is on the website. I discuss the importance of water, how much we need, and how to prepare for the temporary lack of access to clean water. Even a few days without clean city water is a problem. If you have a well, you will need a backup plan to have water for yourself and your family.

Check out my article and the company if you are interested.

Go back to HaroldOster.com

Many people miss out on life by working too hard. Sometimes, they are trying to make more money, and sometimes they simply don’t know how to live otherwise. They work 60 hours a week, and work until they are too old to enjoy the things they should have done when they were younger. They miss the great experiences they could have had with their loved ones. Doctors are especially prone to this error, and I know many physicians who are still working into their seventies. Hard work is important and necessary, but too much can make you miss out on life. Aleksandr Solzhenitsyn, in his book One Day in the Life of Ivan Denisovich, wrote, “Work is what horses die of. Everybody should know that.”

There are other ways we can miss out on life, and I am at risk of one of them. I am a retired physician and spent more than thirty years working to improve people’s health and prolong their lives. I am also obsessive, maybe not reaching the level of obsessive-compulsive disorder, but obsessive enough. At times, I have been lax about my health, gaining and losing hundreds of pounds, 25 pounds at a time. I have often gone months or even years without any regular exercise. Now, I am the opposite. I eat very healthily and work out nearly every day. On vacations, my wife and I (and our son when he joins us) stay active. We hike, bike, or go to a gym. I do these things to live longer, but when I am too strict, I miss out on life.

Eating right and exercising can help you live longer. See The Six Rules for a Longer, Healthier Life. It makes sense to be active and eat healthy foods, but taken to an extreme, you can miss out on life. On vacation, I’ve gone to the gym instead of going to breakfast with my wife, son, and his girlfriend. I’ve chosen to eat the healthiest dinner possible at home and missed out on a dinner at a nice restaurant with friends. I have declined invitations and wonder now if it was sometimes because I didn’t want to eat unhealthy food at someone’s home or at a restaurant. I am certain I could have had a better balance between health and my enjoyment of life.

The only things that truly matter in a person’s life are their experiences. See the superb book, Die with Zero, if you want to know how to experience life in your later years. Hopefully, you have loved ones to share in these experiences. I look back with pleasure on vacations with my family as a kid and as an adult. I don’t care what type of car I owned, how fancy my house was, or whether my cholesterol was high in the summer of 2012, when I was watching our son and nephew sled on Sperry Glacier on garbage bags. If you focus on the things you can buy rather than the experiences you can have, you will miss out on life. You can also miss out on life by worrying too much about health and safety. A longer life is good, but only if it is filled with meaningful experiences.

I still intend to eat healthy and exercise to feel better and to live longer, but I am working to avoid focusing too much on diet and exercise. Because I am so addicted to bad carbs, I will still avoid them. See my book, The Three Rules to Lose Weight and Keep It Off Forever. I am not as strict as I used to be with foods that can increase the risk of heart disease and cancer, such as processed or red meat. Tonight, my wife and I are having steak, and last month, our son and his girlfriend made me the most decadent burger I’ve ever eaten. The “buns” were crisped cheese, and there was another ton and a half of cheese on the burger. If I had eaten a can of tuna while everyone else had burgers, I would have missed out on life.

Following every exercise and dietary recommendation in order to live longer makes sense, but taken to the extreme, what are you living for? Recently, my wife and I met our wonderful friend Suzanne for breakfast. I have known her since I was about two, longer than anyone else outside the family. We ate at the superb RH in Montecito, near where she lives. I knew ahead of time that there was nothing on the menu that was within the Three Rules except an egg dish. (Eggs dramatically raise my cholesterol.) We went to RH and had a wonderful time. Had I not gone or had I ordered nothing, it would have cost me, or at least diminished, an experience I will never forget. It seems crazy to some people that I even considered not eating the eggs, but think of how many people stopped seeing loved ones to avoid the risk of getting Covid. Government shutdowns cost children a year of school, leading to increased mental illness and inadequate education. Shutdowns also increased loneliness and depression in older adults.

Who can blame anyone who wants to live longer? I hope that I live as long as my mind is sharp, but we can’t be so fearful of dying that we miss out on life. There is a balance. You can eat healthy most of the time, exercise regularly, and maintain a normal weight without sacrificing meaningful experiences. You can lower your risk of getting an infection, and still see your loved ones. During outbreaks of infection, we can keep schools open and minimize the risks to teachers and children.

Work hard, be healthy, and don’t miss out on life.

Food Dyes are not as harmful as the foods they color.

Forty ice cream companies have agreed to phase out the use of artificial food dyes over the next few years. They’ve stated that the dyes are safe, and they are taking this step only to avoid disruption of sales as bans go into effect. The United States Department of Health and Human Services (HHS) has banned several food dyes in the last year.

When artificial food dyes are approved by the Food and Drug Administration (FDA), they have to be deemed safe. Increasingly, concerns have been raised about the actual safety of some of these dyes. Remember, not everything artificial is harmful, and not everything natural is safe. I would rather have a bowl of barley sweetened with saccharin than a natural cigarette. (I don’t use saccharin, if you’re wondering.)

Numerous studies have been conducted on artificial dyes. Some suggest harm in children, causing attention deficit and other behavioral issues. This is a review article, and I’ve looked at several of the studies they describe. Observational studies, where researchers observe what children eat without intervening, have several problems. This review article excluded such studies. The reason observation is inadequate is that food dyes are often found in foods that also have other risks. Most food dyes are in sweets, cereals, pastries, and sweetened beverages. Presumably, the dyes are added to make the foods more appealing. I wonder if they really help. If we eliminated the colors from Lucky Charms marshmallows, would kids still eat them? If blueberry ice cream weren’t as blue, would adults still eat it? I think so.

The review article stated that approximately half of the studies examined showed an increased risk of hyperactivity and similar symptoms. Yes, that sounds significant, but I’m not entirely convinced. Remember that there can be a publication bias. Any study that showed an increased risk is likely to be published. Studies that showed no risk may be less likely to be published. Even if that were not a problem, if only half of the studies showed risk and half did not, what does that tell you? It suggests to me that the risk is not that high. I would expect that nearly all smoking studies show significant dangers of smoking.

I am not saying that we shouldn’t ban artificial dyes. I think we should. They have no benefit to our health, may cause harm, and, worst of all, encourage people to eat food that definitely causes harm. As I mentioned, artificial (and sometimes natural) dyes are commonly found in sugar-sweetened foods. I have never heard of artificial dyes being put in unprocessed food. If you buy plain Greek yogurt, you won’t ever find red dye #3. You won’t find artificial dye in broccoli or steel-cut oats.

Ultraprocessed food and food with added sugar cause significant harm. Some have blamed obesity on food dyes, but we know that added sugar and high-carbohydrate foods can lead to obesity, yet these foods aren’t banned. I don’t care if the Twinkie contains artificial dye or not. (It does.) I don’t eat Twinkies because of all the other crap in them.

Similarly, banning food dyes may lower the risk of attention deficit because fewer kids will eat ultraprocessed foods, which are clearly linked to an increased risk of attention deficit.

Food dyes may cause harm. There are studies suggesting that they may increase cancer risk and other serious medical problems. But the most significant medical problem in the United States is obesity. Take a look around and see how many children are overweight. It contributes to diabetes, cancer, heart disease, pulmonary disease, mental disorders, and chronic pain. That is not from food dyes. It is at least partly due to junk food. I have two books that address the topic. Read my books for details: The Three Rules to Lose Weight and Keep It Off Forever and The Six Rules for a Longer, Healthier Life. The risk of food dyes is small compared to the risk of obesity. Maintaining a normal body weight is crucial for improving your overall health.

My new book is available on Amazon in Kindle and paperback formats.

We all want to be healthy and live longer, and there is no shortage of theories on how to do it. In my book, I explain what science really says about your health. The book outlines what you can do to make yourself healthier and what isn’t worth doing. Following the six rules will reduce your risk of the most common diseases and improve your quality of life. None of the rules are complex, but like any goal, becoming healthy requires effort. There are no guarantees—there will always be factors we can’t control. The Six Rules give you the best chance for a longer, healthier life. 

The Three Rules to Lose Weight and Keep It Off Forever is still available on Amazon.

Big things make the most difference in your health and life.

If you want to improve anything in your life, work on the big things first. The big things are often harder, so we usually put them off. Students will spend hours deciding on a font for their term paper rather than starting to write the paper. If a kid is failing math, he’ll do anything before he starts working on his math homework. When trying to learn a complex piano piece, I usually play the easy parts many times before I even get to the difficult sections. We all want to do the easy things first.

With health, we do the same. Everyone wants to make easy changes, but most cannot or will not do what it takes to get healthy. If you’ve read my book, The Three Rules to Lose Weight and Keep It Off Forever, I talk about this. To lose weight, you have to cut out the bad carbs. That means all of them. If you want to lose weight, you can’t eat the bun and the fries in the photo above.

Most people will do anything but what it takes. They will cut back on carbs, eat a little more protein, go for a walk in the afternoon, take off the top bun of a burger, or a host of other things. They won’t do the important thing: giving up all the bad carbs.

People want to be healthy, but often ignore their most important health problems. Someone with a drinking problem talks about their evening walks. A walk may help your health, but heavy drinking causes cancer, heart disease, liver disease, stroke, and cognitive decline. I have seen many smokers who believe, or at least say they believe, that a glass of wine at night helps their heart. A glass of wine might help a little (I doubt it), but smoking is the worst thing you can do for your heart and your general health.

I support veganism for ethical reasons and environmental benefits. Being a vegan is healthy if you take the vitamins you’re missing and avoid bad carbohydrates. However, the small health benefits of veganism don’t negate smoking, drinking too much, a lack of exercise, or obesity.

What about organic and non-GMO (genetically modified) foods? There may be a small benefit to eating only organic food. I am unaware of any substantive data showing a significant risk of consuming GMOs. If there is a benefit to eating organic and avoiding GMOs, it is small. Yet, people eat organic, at a significant financial cost, and don’t accomplish the important things, like losing weight. The reason is simple. Eating organic is easy—pay a few dollars more. Giving up your favorite bad carb foods is hard. Working out five days a week is hard.

I like the financial analogy of credit cards. Clipping coupons can save you money—several dollars a week. But, if you have a credit card debt with 19% interest, that is the important thing to work on. Keep clipping coupons, but work on your credit card debt right now.

As Franklin said, “There are no gains without pains.” If you want to get healthy, it takes hard work. Ten percent of Americans smoke. That is their biggest health problem. Over forty percent are obese. If they don’t smoke, then obesity is their biggest health problem. Lack of exercise is likely the third biggest health problem in the United States. It takes hard work to do the important things and correct these problems.

Do it anyway. The best day to start doing the work and getting healthy is today. Start with the biggest thing.

The Benefits of Flaxseed Oil are its effects on cholesterol.

Flax has been cultivated for centuries for its strong fibers and its oil. I used the oil as a kid to work in my baseball glove. When it is consumed, we call it flaxseed oil. When used in resins, solvents, and gloves, we call it linseed oil.

Flaxseeds are often taken to help with constipation, and flaxseed oil is usually taken to benefit the heart and possibly to prevent cancer or aid in cancer treatment. Flaxseed oil has antioxidant components and may have anti-cancer properties, but I am not convinced it is worth consuming for these benefits alone.

The benefits of flaxseed to the heart are a different story. Flaxseed oil has antioxidant and anti-inflammatory properties. Chronic inflammation is a risk factor for coronary artery disease, and anything that reduces chronic inflammation may benefit the heart.

The main benefit is its effect on cholesterol. Despite what you’ve read about seed oils, and maybe some are not so healthy, flaxseed oil is very healthy. Let’s save the cholesterol benefits for last. Flaxseed oil contains various chemicals that benefit our health, including lignans, tocopherols, polyphenols, and phytosterols. These give flaxseed oil antioxidant, anti-inflammatory, and anti-cancer properties.

Animal studies have shown beneficial effects of flaxseed oil on several different cancers, including breast cancer. Some of these effects were due to the oil’s non-lipid components, but alpha-linolenic acid (ALA), an omega-3 fat, also plays a role. This fatty acid has anti-inflammatory properties and holds promise in degenerative diseases, though we will have to wait for long-term studies to confirm a benefit.

Flaxseed oil is one of the best oils for our cholesterol and heart. It has been said that since flaxseed oil doesn’t have eicosapentaenoic acid (EPA), it is not as healthy as fish oil, which does contain EPA. Flaxseed oil contains alpha-linolenic acid. Don’t confuse that with linoleic acid (LA). I believe LA is also good for you, but it is at the center of the seed oil warnings from some people. What makes little sense is the claim that flaxseed isn’t as good as fish oil because it doesn’t directly have EPA. Who cares? So long as ALA and everything else in flaxseed oil is beneficial, what’s the difference how it got that way?

The EPA/ALA concept is at the heart of the problem with many medical theories. You can always have a theory, but you need empirical evidence to prove it’s right. Richard Feynman said, “It doesn’t matter how beautiful your theory is, it doesn’t matter how smart you are. If it doesn’t agree with experiment, it’s wrong.”

Flaxseed oil helps the heart through several mechanisms. One of my favorite little studies shows that linolenic acid lowers small, dense LDL, the most harmful form of LDL. LDL is often called bad cholesterol, but only certain forms of LDL are harmful. I have reviewed many studies on flaxseed oil. It shows promise in preventing heart disease, diabetes, and bone loss. Since I have yet to come across significant risks, I see no reason not to incorporate it into your diet. (If you are pregnant, I would talk to your doctor before taking anything new.)

So, how do you get more flaxseed oil? Well, you can take a supplement, but I prefer not to. Most studies on supplements and vitamins show that it is better to consume them through diet. Also, it is usually much less expensive to buy flaxseed oil that is made to be eaten with food. I have tried several products and prefer this one, but several are good.

You cannot heat flaxseed above about 200 degrees F. Above that temperature, it oxidizes, making it less beneficial and not as tasty. I like to mix it in yogurt. It adds creaminess and a slight nutty taste. You can also add it to a salad dressing as you would olive oil.

The best oils are the ones that you make healthy meals with.

If you keep up with the news, you’ve read about the debate about seed oils. Some people claim that seed oils are unhealthy, even poisons, because they may be inflammatory. They advise using animal fat, or tallow, instead of seed oils. Longstanding science has said that healthy plant-based diets that include unsaturated fats, are healthy, lowering the risk of heart disease and other chronic diseases.

The seed oils that are said to be the most dangerous are soybean, canola (rapeseed), corn, grapeseed, cottonseed, safflower, rice bran, and sunflower. Other oils made from seeds include flaxseed, sesame, almond, and walnut.

There are studies that suggest that some of the seed oils can increase levels of inflammation in the body. Chronic low-grade inflammation does have harmful effects, including autoimmune disease, heart disease, and cancer. However, there are few, if any, well-designed studies that show these harms occur more in people who consume seed oils. Most studies suggesting harm are in animals and at high doses. Even cottonseed oil, which is rarely defended as healthy, doesn’t appear to increase inflammation.

Numerous well-designed studies show that overall, unsaturated fats derived from plants and their seeds lower the risk of heart disease compared to animal fats. Rather than quoting and referencing hundreds of articles, I reference this superb review. Of note, the authors discuss inflammation and oxidative stress (another proposed risk of seed oils) and show the strong evidence that plant oils are not a cause of these problems. This study from 2025 shows that plant oils, including canola and soybean, lower the risk of dying of heart disease or cancer. I could go on and on. Unsaturated fats from plants, including seed oils, have unsaturated fats and clearly benefit human health.

For those of you who really want to learn about the science of fat and inflammation, I refer you to this article. It describes that both unsaturated and saturated fats can sometimes increase inflammation under certain conditions, such as the other foods the person is consuming.

A big problem with studies on fats is that rarely does someone eat only the fat being studied. And even if they do, something else always changes. If you take people who are eating a lot of olive oil and substitute canola oil for it, you may see something negative. But the apparent harm could be from the removal of olive oil. Replacing tallow and lard with plant oils has shown significant benefit. Some could be from the plant oils, and some from not eating the saturated fat. Regardless, you are better off.

The most important factors are what you eat the oils with and how you prepare the food. Over the last several decades, we have been eating far more seed oil than in decades past. Those against these oils blame the oils themselves. I don’t entirely dismiss that possibility, but we’ve also been eating far more ultra-processed food (UPF), which now represents more than half of the calories consumed in the United States. We know ultra-processed food causes inflammation, heart disease, diabetes, obesity, and cancer. Eating the high-calorie, high-sugar UPF is the cause of these conditions, not the plant oil. I bet if you made Twinkies and jelly doughnuts with olive or flaxseed oil, two of the healthiest fats known, people would still become ill.

If the rest of your diet is healthy, unsaturated plant-based oils are better for your health than saturated fats from meat. That is why the Mediterranean Diet is so good for you. If you use olive oil every day, you are better off than if you use tallow every day. If you believe you have evidence from well-designed human studies to the contrary, please email me.

If you want to be healthy, eat mostly plant-based oil. If you’re afraid of seed oils, though I think they’re fine, you can cook exclusively olive oil and avocado oil, as I do. Use avocado for high heat, and olive oil for everything else. You shouldn’t cook with flaxseed oil, but I add it to yogurt. It’s very healthy and makes it creamier. If you want to be as healthy as possible, don’t eat ultra-processed foods, regardless of the oils they contain.

One final point. Robert F. Kennedy, the Health and Human Services secretary, is pleased that some fast food chains are using beef tallow to make their french fries. I don’t have strong feelings about what a restaurant does, but the main point should not be their frying oil. The more important thing for your health is not to eat french fries. We know that frying food isn’t healthy, and french fries have a high glycemic index. With the other foods served at fast food restaurants, you’ll gain weight. Read my book. If you follow the Three Rules, you’ll lose weight. If you also follow the Mediterranean diet, with or without seed oils, you will be even healthier.

Vaccines Are Important.

As with only drinking pasteurized milk, there used to be much less controversy surrounding vaccines. Vaccines save lives. Now, people imagine conspiracies behind any public policy. The government recommends pasteurization of milk, it must harm us in some way. The COVID shot came out quickly, then it must be dangerous. Forget the fact that the COVID vaccine may have saved millions of lives.

Some government policies are indeed questionable. I am not sure we should continue adding fluoride to all municipal water. We have superb dental care and widely available topical fluoride products like toothpaste. Maybe it is time to change this policy.

Vaccination is not something anyone should want to change. Smallpox killed hundreds of millions of people in the 20th century. Now no one gets it. I don’t mean that few people get it. Because of the vaccination program, the virus is gone. Did some people have side effects? Sure. Some people died from the vaccine. But, not 500 million people. Some people are hurt by seatbelts. Far more are saved.

Some vaccines are better than others. The measles vaccine is one of the best. Before the vaccine, nearly everyone got measles. In the early 1900s, thousands died every year. In the decade before the vaccine came out, the United States recorded hundreds of deaths and about a thousand cases of encephalitis (brain infection). By 2000, measles was eradicated. Now, the virus is making a comeback because people aren’t vaccinating their kids.

The polio vaccine is right up there with measles, perhaps better. In the mid-twentieth century, 500,000 people around the world died or were paralyzed every year. The polio vaccine was available in 1955. By 1957, cases in the United States dropped from 58000 to 5600 yearly. In 1961, there were 161 cases.

Not all vaccines are the same. Since the influenza virus mutates all the time, the vaccine is not as good as that for measles. It still saves thousands of lives and prevents many more serious illnesses. The shingles vaccine probably doesn’t save many lives, because shingles doesn’t kill that many people. It still prevents many cases of a painful disease. Without the rubella vaccine, we would still have significant numbers of cases of congenital rubella syndrome, a major cause of congenital abnormalities. Some people think mumps isn’t serious. I am glad we have a vaccine that prevents most cases.

I understand why people are skeptical of anything new, especially if it comes from the government. Much of the controversy over vaccination has to do with the political divide in this country. When the Covid vaccine came out near the end of President Trump’s first term, many people on the left, including politicians, were skeptical and waited months to get the shot. Some waited until President Biden took over. Now, those on the right are hesitant to get the recommended vaccines.

It is difficult for vocal members of either party to agree on anything. I hope that we can all agree that vaccines are important. They are not perfect, but they help protect everyone.