Dr. (MD) Michael Greger is a popular medical figure in the plant-based healthful-eating community, being one of the biggest influencers for a purely whole foods plant-based diet.
Michael Greger is likely to be the most widely-known advocate for a WFPB (whole foods plant-based) diet.
The main outreach platforms he uses are his Youtube channel and his website Nutritionfacts.org.

Greger is a sorely needed person in the medical world, constantly providing--for free--some of the best (and in most cases the best) information on nutrition available, which is nothing short of impressive. The topic of nutrition is otherwise often neglected in the field of medicine due to lack of education in the subject for medical students, despite it being one of the most important factors in human health.
While there is valid criticism on Greger, he has definitely had a major net positive impact, seriously helping countless people (and animals).

Positive impact

Highly consistent schedule of science-based health-related informative videos

Since Greger started putting videos on Youtube, he has been uploading them very consistently.
He has currently uploaded 2063 videos (mid May 2021), in the span of 10 years and 2 months. That averages to be 203 videos a year, or 0.556 videos per day for over a decade.

The amount of information that can be found on the channel is nothing short of an encyclopedia of nutrition, and his work has been able to provide everyone (that is looking for it) valuable nutritional information that would otherwise be much harder to get to.
The average person cannot be expected to do research and find good scientific studies by itself, so Greger's work is a fundamental one of educating the public, and taking the hard science from thousands of medical studies and translating it in a comprehensive way to the public--while keeping true to the findings of the studies.

While Greger is not focusing on ethics, he does a good job of keeping people vegan by offering strong nutritional advice, and doing so consistently (thus reaching a bigger audience by sheer number of videos). A common cause of recidivism is poor nutrition, partly due to pseudoscientific sources, partly due to people's bad habits, so keeping people healthy and feeling good certainly helps in reducing the number of people going back to eating animal products.

Michael Greger's Daily Dozen and other useful work

Greger's Daily Dozen

Eating whole plants is better for your health on average than a diet with mock meats, and it is certainly better than eating a diet high in animal products. However, it is important to vary up the types of plants (and fungi) you get in your diet.

People eating a plant-based struggle quite a bit at a the beginning in understanding what is best to eat and how much, and some of them fail at staying on the diet because of that. On top of that, even if they keep being on the diet, they might not get what they need and develop eventual deficiencies--or even just nonoptimal levels. Therefore, one of Greger's most useful idea is 'Greger's Daily Dozen'.

Greger's Daily Dozen serves as a handy guide to get an idea of all the best food groups, what to eat, and which ones should be a bigger part of your diet. While a quick rundown of that would be beans, veggies, and nuts, Greger shows us a more granular version of it.

Every day (as shown in the picture on the right):

3 servings of beans
1 serving of berries
3 servings of other fruits
1 serving of cruciferous vegetables
2 servings of greens
2 servings of other vegetables
1 serving of flaxseed
1 serving of nuts
3 servings of grains
1 serving of spices
Exercise
Beverages

These food groups are necessary to maintain a healthy diet, as they all offer different types of nutrients and benefits.

This offers a very practical solution to the 'what should I eat?' concern that many new vegans have.

That said, there are two caveats to this list, such as the possibility of not getting enough of certain nutrients by blindly relying on this, or the fact that there is no reason to believe 4 servings of fruits would be optimal, and much less reason to believe they are needed.

When it comes to potentially not getting enough of certain nutrients, it is true that it is not possible to provide a failproof diet when it comes to generic dietary advice. However, Greger should encourage people to check for their nutrients (especially their hard-to-get ones) at least at the beginning of their diet to get an idea, rather than blindly relying on this, so as to eliminate the problem to begin with.

When it comes to the 4 servings of fruits (1 serving of berries and 3 servings of other fruits), it is not unlike Greger to do something like this, considering the bias he shows when it comes to fruits. There is really no point in having that many fruits, considering that antioxidants, something that fruits are rich in, have diminishing returns (so less-antioxidant-rich foods being eaten instead of the extra fruits would be a negligible loss), and it is a safe bet that the needed micronutrients found in fruits would already be there after eating 2 servings of them, such as the berries plus something else (meaning eating more fruits than that for the micronutrients present in fruits would prove useless).

If he replaced 2 of the servings of fruits, leaving berries plus something else, and put other food categories in their stead, it would better both the problem of potentially not getting enough of certain nutrients (fruits do not provide much in terms of nutrients, and other foods such as nuts/legumes/vegetables would provide much more), and the problem of there being too many fruits unnecessarily (empty calories and sugar, discussed below).

Weight loss videos

Greger has done an in-depth work into weight loss, having series of videos covering everything from fasting, to eating at certain times, to calorie restrictions, to studies on how specific foods affect weight loss, and other.
You can find all his videos on weight loss here.

Books and charity work

Greger has written and made eight books, including two cookbooks:

Heart Failure: Diary of a Third Year Medical Student (1999)
Carbophobia: The Scary Truth about America's Low-Carb Craze (2005)
Bird Flu: A Virus of Our Own Hatching (2006)
How Not to Die (2015)
The How Not to Die Cookbook: 100+ Recipes to Help Prevent and Reverse Disease (2017)
How Not To Diet: The Groundbreaking Science of Healthy, Permanent Weight Loss (2019)
The How Not to Diet Cookbook: Over 100 Recipes for Healthy, Permanent Weight Loss (2020)
How to Survive a Pandemic (2020)

All the revenue he gets from ebook revenue is split between Nutritionfacts (him and his team of researchers) and charities--although, the exact split does not seem to be disclosed.

"All proceeds Dr. Greger receives from his book, speaking engagements and DVDs is split between NutritionFacts.org and a donor advised charitable fund from which Dr. Greger distributes to amazing nonprofits that are translating evidence-based nutrition into policy, like Balanced and the Physicians Association for Nutrition." [1]

Even though the exact charity-salary split is not fully disclosed (and prior to 2014, Greger was taking no salary), revenue vs. salary and expenses of Nutritionfacts that you can find here should give you a general idea. One thing important to remember is that there is a team of researchers that has to be paid, and that money spent promoting Nutritionfacts could be just as good as money spent on charity, considering that Nutritionfacts is effectively a platform for free information for people and an important service for public health.

Controversies and unscientific stances

No amount of processed food being acceptable, dogmatically putting whole foods on a pedestal (even when certain processed foods are better than certain whole foods)

Greger dogmatically demonizes any kind of processed foods, and recommends people to avoid them to an unpractical level.

While processed foods are generally less healthy than whole foods, this really depends what is brought into comparison, as there are many exception.

Before delving into those, credit has to be given where credit is due, which is the case in the stance Greger takes in meat substitutes, by not painting them as a dogmatically unhealthy food--he instead gives the right picture, by saying that while heavily relying on meat substitutes could be less healthy than whole foods, mock meats are still healthier than the real thing, although the legumes (what mock meats are made of) themselves are the healthiest option.

"“Fake meat” is often more processed than whole plant foods (soy “bacon” versus soybeans) and contains more salt and oil and other additives. For that reason, relying heavily on fake meats for one’s protein can be less healthy than aiming for whole food proteins. A commercially-prepared lentil burger, even if prepared with additions of salt and oil, is still healthier than grabbing a meat sandwich. However, a healthier option is choosing the lentils themselves." [2]

He also says:

"we shouldn't let the perfect be the enemy of the good. Not everyone can go all, you know, kale and quinoa overnight" [3]

If Greger took that stance and applied it to other areas, there would not be nearly as much criticism as there is here to make on him.

Tempeh vs. tofu

Greger recommends tempeh over tofu, as can be seen in this video, and as he mentions other times.
This is because tempeh is whole foods and tofu is technically not--in fact, in his recipe book he only uses tempeh and no tofu, ignoring the fact that tempeh is much more expensive and not everybody can even get it, making veganism harder than it has to be (thus, increasing chance of failure).

In reality, when looking at the nutrition, tofu is much superior to tempeh.
This can be seen by comparing the two on the basis of protein (as they are both used as a staple/protein food) and difficult-to-get minerals (certain minerals can be a problem on a vegan diet if not paid attention to, and the main way to get them is through greens and protein foods).

Per 100 kcal, tempeh has:

10.6g protein
6% calcium (57.7mg)
5% potassium (214.2mg)
5% zinc (0.6mg)

Per 100 kcal, tofu has:

11.5g protein
26% calcium (256.6mg)
4% potassium (189.0mg)
10% zinc (1.1mg)

It becomes apparent who the winner is. Tofu has a bit more protein, more than 4 times the calcium, slightly less potassium, but then double the zinc.

Instead, when considering the nutrition per cost, it is even clearer who the winner is, as tempeh is usually much more expensive than tofu (even more than twice as much for the same kcal).

It is unclear why he thinks tempeh to be healthier. A possible explanation is the way tempeh feeds gut bacteria more than tofu, as tempeh is made of whole soy beans that the bacteria can feast on (as opposite to blended or tofu-like foods, that do not leave much in terms of stuff-to-digest for the bacteria)--however, that is a very negligible effect on a (mostly)whole foods plant-based diet, where there is already plenty of fibers and whole foods to feed our gut bacteria pretty much optimally.

Oil = 'death'

While it is true that oil is mostly just empty calories (negligible nutrition except for some vitamin E, and for some oils essential fatty acids) and many oils contain high amounts of saturated fats, Greger fear mongers it to an irrational level.

An accurate representation of his stance is:

"We’ve known for nearly two decades that a single fast-food meal, such as a Sausage and Egg McMuffin, can stiffen our arteries within hours, cutting in half their ability to relax normally. And, just as this inflammatory state starts to calm down five or six hours later, we may once again assault our arteries with another load of harmful food, leaving many stuck in a danger zone of chronic, low-grade inflammation. Indeed, unhealthy meals don’t just cause internal damage decades down the road, but within hours of consumption—and the relative paralysis of our arteries for hours after eating fast food may also occur after consuming olive oil." [4]

Classic as any fear mongering tactic, you are presented with a much worse situation as a comparison, listing all the wrong things with such a situation, and then comparing it with the current one.
In the same way, Greger compares eating oil to eating animal-based deep-fried fast foods--which is pretty much as unhealthy as food can get. Then he mentions all the wrong things with eating them, such as 'danger zone of chronic, low-grade inflammation', 'cause internal damage decades down the road', and 'relative paralysis of our arteries for hours after eating'. He then says that such paralyses may also occur after consuming olive oil.

In reality, the occasional dash of olive oil does not cause nearly as much damage as fast foods, being pretty much like a drop in the ocean in comparison. Olive oil does not have cholesterol, has some anti-inflammatory properties, has virtually no trans fats (unless fried), and is relatively low in saturated fat.
It is true that some oils are much worse, such as palm oil, which is significantly different--but therein lies the truth: putting every oil under the same umbrella of 'unhealthy oil' and generalizing them to be pretty much the same (when they are very different in how they affect our health) is incorrect and paints the wrong picture.

For example, when comparing flaxseed oil, olive oil, coconut oil, and palm oil for factors negatively affecting health, we get the following picture.

1 tsp of flaxseed oil: 0.4g saturated fats (and 2.4g omega3 fats, which is very good)
1 tsp of olive oil: 0.6g saturated fats
1 tsp of palm oil: 2.2g saturated fats
1 tsp of coconut oil: 3.7g saturated fats

It is clear that different oils have different impacts on health.

There's a grain of truth in that by frying some oils, especially when frying at high temperatures (as in traditional stir frying) or for long periods of time (deep frying), unsaturated fats (which would be otherwise good) can be degraded by oxidization and some can even become trans fats[5], which are very unhealthy. However, this degradation is insignificant for other preparation methods such as baking or lower temperature pan frying (which is akin to the at-home "stir frying" which is actually sautéing, as most people do). There is also virgin olive oil which is primarily monounsaturated fat and protected by antioxidative polyphenols[6], and other modern oils (like high oleic sunflower or safflower oil [not ordinary sunflower/safflower oil] that have been bred to increase the proportion of oleic acid) that are predominately monounsaturated fats and would likely be safe even for frying. In a certain sense, it's hard to win by frying (which is the largest application of oils for most food): you either use oils high in essential fatty acids and end up with more trans fats, or use foods low in EFAs and end up with less trans fats but more empty calories and often more saturated fat (the latter is the lesser evil).

Greger's recommended categorical avoidance of oils may work in an ideal world, but that is where Greger often fails--by not seeing the practical utility of reducing rather than eliminating foods that are slightly unhealthy, in order for people to succeed at keeping with a healthy diet by letting them have a little bit of bad that is very convenient, and for the WFPB movement to be appealing to a majority (thus helping many more people be healthier).

His recommendations and stances on how to be healthy often end up being a nirvana fallacy nirvana fallacy.

In the case of oils, letting people sauté with a little bit of olive oil at low temperatures or dress their salad with some flaxseed or canola oil (which have a benefit of essential fatty acids), in order for things to be tastier and faster (significant convenience), would likely outweigh the non-optimal-for-health factor of it by making them more likely to stick with their diet and not making it harder than it has to be for them to stay vegan.
Fear mongering people into avoiding something only slightly unhealthy but very convenient like a dash of olive oil which may add a few calories, usually has consequences against those people's best interests, as they will be more likely to completely fail and go back to their poor and unhealthy standard diet rather than stick to a 99% perfect diet. He could still recommend no oil for people that really want to maximize their healthful eating, while showing an accurate picture of oil and how varyingly unhealthy it is, explaining the difference between the occasional dash of healthier olive or canola oil and meals full of greasy deep-fried foods fried in the worst oils (palm, corn, or soybean oil) rather than fear mongering and painting it all as equally unhealthy (which is incorrect, on top of counterproductive).

Bias towards excessive amounts of fruits being good

Greger has shown throughout the years to have a bias towards any high amounts of fruits being a good thing, like in this video, even though science suggests otherwise.

He fails in three ways when addressing this:

1- Greger does not talk about how there are significant nutritional diminishing returns to eating many fruits, and instead focuses only on the positive aspects, with things such as fiber intake and antioxidants (ORAC value total amount).
He uses data from studies that are at best very weak--like, for example, the study that he cites and uses as evidence that eating large amounts of fruits is beneficial at 2:45 in the video linked above, that looks at a sample of 17 people only, and how they improved eating a lot of fruits from a bad standard diet.
In order to be able to claim that eating a lot of fruits is good, he should instead look at a non-high-fruit WFPB diet, vs. a high-fruit WFPB diet, which would be a fair comparison and a good way to understand whether high amounts of fruits are actually good--this is because pretty much any fiber rich food is a considerable improvement from a bad diet, so such studies offer little insight as to whether, for example, eating 9 apples and 1 broccoli floret is just as good or better than eating 1 apple and 9 broccoli florets. Such studies may not exist yet, but then it cannot be claimed that there are no downsides to eating fruits in large quantities, especially when considering the two points written below that indicate the opposite.
Using such weak evidence to further an unrelated point is desperate and bias at best, and dishonest at worst.

Study says/studies say: eating a lot of fruits shows improvements from a standard diet.
Greger's conclusion: eating a lot of fruits is either not a problem or optimal.
What the conclusion should actually be: eating a lot of fruits is an improvement from a standard diet, likely because they replace unhealthy foods with better ones, but that does not mean that eating a high-fruit diet is optimal, as eating even better foods is likely better.

2- Greger ignores or omits the fact that fruits are not the best 'bang for the bucks' in terms on nutrients for amount of calories, and as soon as getting what is needed from fruits (micronutrients and ORAC value not too far down the diminishing return scale) is done, it is a waste of calories to spend more of the remaining daily calories in your diet eating fruits rather than something magnitudes more nutritionally dense (such as legumes or greens).
While a certain amount of fruits is optimal to eat, to be able to get certain micronutrients and have a good amount of antioxidant, after a certain point fruits end up replacing more nutritious food that could otherwise be eaten in their stead.

3- Greger does not acknowledge that sugar in fruits causes dental problems, relying on:
3.1- weak evidence that polyphenolic compounds in fruits may reduce (and not eliminate) bacterial growth rate and bacterial adherence to tooth surface (therefore less cavities) [7]--he uses this study to show that sugar in fruits is not something to worry about, even though polyphenolic compounds possibly reducing bacterial growth leading to cavities does not mean that the bacterial growth is eliminated altogether or even in a significant amount
3.2- the protection that fiber and water found in fruits offer to the teeth, from the sugar in fruits (fiber and water enclosing a part of the sugars, thus those sugars not going into contact with teeth, therefore less cavities) - even though that protection is weak and a part of the sugars still does come in contact with teeth (therefore the more fruits, the more sugar comes into contact with teeth, the more cavities)

He uses those points as assurance that any related worries or potential downsides become negligible regardless of the amount of fruits eaten--when eating fruits in high amounts should clearly be a worry, since there is good reason to believe that the sugars found in fruits increase the risk of cavities and the nutrition on a high-fruit diet is poorer than the nutrition on a non-high fruit diet, and no good reason to believe the contrary.

Dates = 'almost ideal food'

One prime comedic, embarrassingly bad, example of this is his video where he claims dates to be an 'almost ideal food'. [8]
Dates are nutritionally extremely poor, being not very different than white rice--in fact, you could make a strong argument that vitamin candies would be better to eat, as they at least would provide a non-negligible amount of vitamins and a lower amount of sugar. On top of ignoring the obvious nutrition, the study he uses for the claim that dates are an almost ideal food is laughable. [9] Only ten people are taken into consideration, and they eat a small amount of dates per day, with no dietary control.

"The date consumption did not significantly affect the subjects' body mass index (BMI), their serum total cholesterol, or their cholesterol levels in the VLDL, LDL, or HDL fractions."

Yes, crazily, 100g of dates per day for a month replacing other foods did not significantly increase the 10 people's BMI. And even more crazily, the dates did not increase their cholesterol level (maybe because dates have no cholesterol and pretty much no saturated fats to begin with?). It was surprising to see the study did not also claim that dates did not increase risk of cancer significantly during the month, just to add another convenient obvious point.
In the other 'study' he cites [10], basic nutrition info of dates is put on paper, nothing extraordinary, while cherrypicking facts and comparisons to other fruits to make dates seem better (such as dates having 23 amino acids, while not disclosing the quantities of those amino acids being pretty much non-existent). The 'study' conveniently omits talking about nutritional facts about dates that would show how bad they are nutritionally, such as the fact that they are 80% sugar, they have a very poor amount of fiber and antioxidants, and pretty much no mineral or vitamin in non-negligible quantity. Then, a conclusion is drawn out of nowhere: 'In many ways, dates may be considered as an almost ideal food, providing a wide range of essential nutrients and potential health benefits.'

It is unfortunately, quite obviously, dishonest when someone as smart (and not naive) as Greger uses such studies to make such a claim.

What is even more unfortunately dishonest is his omission of the fact that these studies are funded by the date industry. It is dishonest because Greger is very adamant in constantly discrediting studies due to funding sources (even though, in reality, funding does not normally change the outcome of studies in terms of facts, just the way those studies are framed), and yet he is willfully ignoring that when those biasedly funded studies happen to support his side. This is very hypocritical, and stuff like this can discredit a lot of the work he has done.

Endorsing skepticism of the efficacy of chemotherapy for cancer treatment (2% gambit)

Greger, unsurprisingly considering his 'nutrition can fix all' approach and dislike for pharmaceuticals, endorses skepticism of chemotherapy and favors eating the best foods instead--when you could easily do both instead.

This debacle started in early 2016, when he made the video 'The Role of Vitamin C in the Treatment of Terminal Cancer'. While there is no problem with the majority of the video, at 3:00 he uses this study to state:

"People have this perception of chemotherapy will significantly enhance their chances for a cure, but put all our cancer-killing chemo together, and the overall contribution of 5-year survival is on the order of... 2%. All those side effects for 2.1%. At a cost... oh well maybe 100'000 dollars per patient per year. So, it may be worth looking deeper into therapies like IV vitamin C."

This is also knows as the '2% gambit'.
The paper he uses is severely flawed, as it has been shown multiple times by different experts.
2% is a wrong figure, because while patients may not benefit much from chemotherapy with certain cancers, with other cancers chemotherapy has been shown to be very successful--much more than 2%.

For example, when it comes to stage 1 colon cancer, chemotherapy alone only increases the success rate of survival in a 5-year period by less than 1%, but when it comes to stage 4 colon cancer, chemotherapy alone increases the success rate by 26%.
Similarly, when it comes to stage 1 lung cancer, chemotherapy alone only increases the success rate of survival in a 5-year period by 1%, but when it comes to stage 4 lung cancer, chemotherapy alone increases the success rate by 18%.
And so on.

Generalizing every situation to a 2% success rate is a glaring error, as each situation should be evaluated according to what is more likely to give the best results for that situation.
The success rates of doing chemotherapy depend greatly by the types and stages of cancers, and whether doing chemotherapy is a good idea or not should be weighed according to the most accurate numbers possible, thus by looking specifically at the success rate and pros/cons that chemotherapy would have in the patient's situation.

Salt being categorically bad

Another stance that Greger takes is that salt is seriously bad at any amount higher than a low-sodium diet.
He does this different times, mainly by using generalizing and grandiose statements that are far from what the studies even suggest themselves. Below are critiques of his stances on salt.

Before delving into the critiques, it is important to establish that a certain amount of sodium is needed in order to survive, and beyond that a certain amount is optimal. To understand what is the optimal amount, there are studies done on hundreds of thousands of people that can tell us with strong evidence what that quantity is.
As we went in-depth discussion about salt in our salt article,

"The recommendations are grossly outdated considering recent strong evidence, and would need a revision--especially when considering that the recommendations to reduce high blood pressure with low sodium intake, to then prevent heart failure, is based on weak evidence (e.g. nine studies, less than 100 people per study with a total of 479 people, and no data to show that salt restrictions reduced mortality).
It's more likely that the correlation between high sodium and increased risk of mortality would actually be because of the type of foods usually containing high amounts of salt, namely highly processed fast foods and meat, rather than the salt itself.
The most likely safe bet for salt is to keep the sodium amount between 4-5g (1.5 to 2 teaspoons of salt) daily, as more than 7g and less than 3g would increase risk of mortality. It's also important to make sure you're reaching the recommended intake of potassium and maintain a good ratio of potassium/sodium, as potassium regulates sodium and helps blood pressure directly. Considering this, it'd be more practical to adjust to a sodium intake level of about 4-5g daily and to maintain a good level of potassium intake, rather than having a low-sodium diet."

'Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.': https://academic.oup.com/ajh/article/27/9/1129/2730186

(study of 17'000 people) 'Sodium excretion of <3g/day was associated with... a significant increased risk of major CV disease': https://pubmed.ncbi.nlm.nih.gov/26683344/

(study of 133'000 people) 'Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations, while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets.' (as opposed to everyone): https://pubmed.ncbi.nlm.nih.gov/27216139/

You can read further in the article linked above.

NOTE: if you suffer from high blood pressure or other conditions that would be sensitive to salt intake and be affected negatively by salt intake higher than a certain amount, your specific case has to be looked at separately, as the generic advice may not be the best for your non-generic case.

---

Onto the critiques:

1- Here Greger states that 'If you put people on a low-salt diet, meaning only getting twice as much sodium as they need, as opposed to a usual salt diet where they’re getting five times more, you get a significant improvement in artery function.', using this study, and then doubles down on the stance with this study.
While it is true that a lot of people would benefit from a reduction in salt, that is because many people eat too much salt and the foods associated with salt are usually processed unhealthy junk foods--it is a safe bet to say that people eating high amounts of salt would be more likely to eat higher amounts of junk foods, thus the problems related to the salt could be related to the salty foods rather than just the salt itself.

These studies do not support the claim that the title makes, 'Why We Should Cut Down on Salt Independently of Blood Pressure'--as that would be true, by all means, when too much salt is taken, but dogmatically cutting down on it to an unknown extent could cause as much harm as good. There is no reason to believe that someone taking the shown-to-be optimal level of sodium would get any benefits cutting down on it, if anything the opposite.

He then goes on to state:

"So, independent of any effects on blood pressure, salt hurts our arteries, and that harm begins within minutes of consumption for our major arteries and even our tiny blood vessels."

This is a plain and simple non-sequitur, as, again, there is reason to believe salt would harm our arteries when taken in excess, and that excess is not at any point of taking salt whatsoever. In fact, (as shown at the beginning of this section) taking too little salt would prove troublesome for cardiovascular disease.

2- Here Greger talks about 'Healthier Salt Substitutes'. He starts the article by saying

"Eating too little fruit kills nearly five million people every year, and eating too much salt kills four million."

Yes, and diarrhea kills almost 1.6 million people every year, while shark attacks kill between 100 to 200 people every year. Would you rather be attacked by a shark, or have diarrhea?
Statistics such as this are there to be sensational and do nothing to show the validity of a scientific point.

You could also say eating too little salt kills even more people every year, due to the fact that having a bit more salt on vegetables would incentivize people to eat more of them rather than processed junk foods, thus significantly improving their health and reducing all-cause mortality.

It goes on to suggest reduction of processed foods, which is a good thing regardless of salt intake. It is important to note that reduction of salt being good is not just 'fake propaganda', there is legitimacy to it with many people's diets, but only to a certain extent (as shown at the beginning of this section).

3- Here Greger titles the article 'Don’t Be Confused by Big Salt', and goes on to use this study to say that there are other harmful effects of too much salt. Nobody doubts that too much salt causes problems, as the study says, but determining that 'too much' is the question. Greger's stance that salt should be reduced as much as claims it should, is not supported by these studies.

He goes on to (dishonestly) say:

"If salt leads to high blood pressure and high blood pressure leads to disease, doesn’t it follow that salt should lead to disease? I mean, if A leads to B, and B leads to C, then A should lead to C, right? The logic seems sound."

Yes, the logic is sound. The premise is what is incorrect.
Salt does not lead to high blood pressure, too much salt leads to high blood pressure. Greger interchangeably uses the two, when it is incorrect.
Too much of any one thing causes problems, it is about determining where that line is--in certain cases, anything more than zero is already too much (causes net negative regardless of amount consumed), in all the other cases it is a certain threshold, just like in the case of salt.

He goes on to say:

"Researchers never randomized people into two groups—one low-sodium and one not—and followed them for 20 years"

Studies may have not randomized people into two groups, but groups that have different sodium intakes have been followed, like in this study of 133'000 people--you do not need to randomize people into different groups and put them on a certain-amount-of-sodium diet, when you can easily see how much sodium they take through their excretions to begin with, allowing you to know how much salt they are taking and how they are doing.

He then cites this study to support his case.
The study follows 744 people, and separated them in two groups, one with intervention on salt reduction, one not. The risk of a cardiovascular event was 25% lower among those in the intervention group. Again, this only confirms that people eat too much salt, but not that salt is a problem itself. Just like people drinking too much water and having dizzy spells because of it would benefit from reducing water intake--that does not mean water is a problem.
There is very strong evidence suggesting that too much of a reduction would cause just as many problems (as shown at the beginning of this section).

He then states:

"Case closed, 2007. (in regards to the study showing those conclusions) But, when billions of dollars are at stake, the case is never closed. One can just follow the press releases of the Salt Institute."

No, a case is not closed after a study of 744 people, that does not even look at whether the people followed where on too much (very high) salt or not begin with--which is the entire point in understanding whether a low-sodium diet is better or not, rather than understanding that 'reductions may prove beneficial', which is obvious as long as there are people taking too much salt. For a low-sodium diet to be shown as better than not-low-sodium, instead, it would require people that are on a somewhat higher sodium intake than a low-sodium diet compared with people on a low-sodium diet, eating the same foods.
The study does not even say how much total salt the people 'studied' take at all, but just at how much the reduction is--which does not say anything but: there might be some people in this small study taking too much salt, who knows, that benefitted from a reduction in salt.

Following, he talks about this study of 17'000 people (the one cited at the beginning of this section), saying:

"What about the new study published in the American Journal of Hypertension that found the amount of salt we are eating is just fine, suggesting a kind of u-shaped curve where too much sodium is bad, but too little could be bad, too? Those biased less towards Big Salt and more towards Big Heart have noted that these studies have been widely misinterpreted, stirring unnecessary controversy and confusion. It basically comes down to three issues: measurement error, confounding, and reverse causality."

Looking at the study, the research they looked at did largely adjust for a number of things like CVD meaning the low-sodium groups aren't likely self-selecting. They also adjusted for BMI, though.

The All Cause Mortality is what went up with low sodium, but not deaths from CVD (which were normal for low sodium), deaths for CVD went up with high sodium (but not all cause mortality). So the high sodium group is bad for the heart, but low sodium is bad for other things like cancer--that would stand to reason if we were to learn that low sodium groups favor sweets and avoid vegetables because without salt they are too bitter for most people. Smoking and drinking were all largely controlled for.

Blood pressure was also controlled for in some suggesting the possibility of over-correction since the mechanism of action for low sodium diets is blood pressure reduction, but the differences between controlling for it or not in those studies that provided two data sets were apparently not significant, so this is not likely a source of bias in the data.

It is unclear how Greger or the AHA are waving this off.

"If you instead look only at the trials in which they did the gold-standard, 24-hour urine collections in healthy people to avoid the reverse causation and controlled for confounders, the curve instead has a continuous decrease of cardiovascular disease (CVD) events like heart attacks and strokes as sodium levels get lower and lower."

Yes, and it causes an increase in risk for all cause mortality. Why ignore that?
Again, there is no reason why someone with an already normal blood pressure would go on a low-sodium diet. If anything, it could prove more problematic than not, because of the increase to all cause mortality.

Only taking into consideration CVD and arbitrarily ignoring all cause mortality risk is an obvious mistake, as the goal would be to be as healthful as possible overall, not to just have low CVD risk.

4- Here, in an article titled 'Salt Is Put to the Test', Greger says:

"When you take people with high blood pressure and put them on a sodium-restricted diet, their blood pressure drops. Then, if you keep them on the low-salt diet and add a placebo, nothing happens. But, if you instead secretly give them salt in the form of a time-release sodium pill, their blood pressure goes back up. And, the more sodium you secretly give them, the higher their blood pressure climbs."

Yes, it is quite obvious that certain people, especially the ones with high blood pressure, would benefit from a sodium-restricted diet. This, again, does nothing to support the claim that low-sodium is optimal.

It would be as if someone said 'When you take people with hyponatremia (too low sodium concentration in the blood) and put them on a higher-sodium diet, their situation improves. But, if you secretly give them lower salt by substituting salt with potassium chloride (a compound that tastes similar to salt), their hyponatremia comes back. And, the less sodium you secretly give them, the more their hyponatremia worsens.', and used that as evidence that a high-salt diet would be best.
All it does is say that in a patient with hyponatremia increasing sodium usually leads to improvement of the condition, just like in a patient with high blood pressure lower sodium usually leads to improvement of the condition. Remove the condition, and the situation differs.

He then cites this study, that looks at 433 people and the effects that lowering sodium intake has on them.
First of all, it is unknown how much sodium the people taken into consideration were taking long-term before the study, which may have already been too much and they would have benefitted from a reduction regardless.
Secondly, 433 people is a very poor sample when put in comparisons with studies looking at over 100'000 people (such as the one cited at the beginning of this section).

He then also used this study, looking at two villages and their salt intake. There was an intervention of salt intake in one town.
However, the study actually found out that both systolic and diastolic pressures declined pretty much to the same extent in women of the two towns, effectively suggesting that the salt intake reduction had little to no effect on the women.
When it came to the men, the two towns also remained similar in results, with the intervention one only being somewhat lower.

This study is poor evidence that a low-sodium diet would be better long-term--and in fact, the study itself does not claim otherwise.

"More moderate salt restriction may constitute a more realistic goal, but its influence on blood pressure in the community at large is probably trivial."

Another study he cites is this one, that looks at 10'000 people from 52 centers, and the effects of a low-sodium diet on blood pressure over 24 hours, concluding:

"Four centres found very low sodium excretion, low blood pressure, and little or no upward slope of blood pressure with age. Across the other 48 centres sodium was significantly related to the slope of blood pressure with age but not to median blood pressure or prevalence of high blood pressure."

So, in the vast majority of the centers, sodium was not related to median blood pressure or prevalence of high blood pressure, and only to blood pressure with age.

The conclusions of this study are anything but 'low-sodium is a solution fits all'.
Not only the vast majority of centers barely showed any variations related to blood pressure when checked for sodium intake amount, but also assigning culprit solely to salt for blood pressure through a 24-hour sodium checkup correlating it with the blood pressure seen is laughable, as the people studied could have had just 1 day of high salt or 1 day of low salt while still having higher or lower blood pressure due to different amounts of sodium intake prior to the study--and it certainly does not determine whether low-sodium is good in the long-term.
In fact, risks associated with low-sodium such as cardiovascular disease and fatigue would certainly not be looked at when doing a 24-hour sodium intake checkup and only looking for blood pressure drops.
And then, when all of this is paired with the fact that sodium-rich foods are usually junks foods, it does not make the case any better, suggesting that it could be those foods causing blood pressure problems more than the salt itself. The study really does not further Greger's claim that a low-sodium diet is best.
Yes, low-sodium may lower blood pressure, although maybe because of the junk foods that are eaten along with the salt rather than the salt itself, but low-sodium increases risk of all cause mortality--and lowering blood pressure in people that are already within healthy parameters is not needed.

Greger then goes on to claim that those 48 centers were maybe just taking too much salt anyway, saying:

"You can imagine a similar result if this was instead lung cancer rates versus packs of cigarettes smoked every year. Whether you smoked 150 packs a year or 200 packs a year, it might not make much of a difference. To see a relationship between smoking and cancer, you’d have to compare smokers to those who rarely light up."

Smoking 150 packs vs. 200 packs a year does make a difference.
And on top of that, this is a fallacious comparison: while salt reduction of any amount tangibly affects blood pressure in a short amount of time already, smoking 150 packs of cigarettes vs. 200 packs may have no effect that is visible in the long-term, and cigarettes may have a high diminishing return with the damage caused (the more you smoke, the less damage each cigarette causes compared to the previous one) than too much salt taken, whereas salt usually has the opposite of a diminishing return (the more salt taken when it is already too much, the more damage per grain of salt than the previous one).

Even more-so if the people in the study that were taking way too much sodium were compared to the people in the study that were taking less but still too much sodium (as Greger suggests is the case in each center for the vast majority of the centers), there should be an even more significant reduction seen in blood pressure in such a comparison than in a comparison between people taking slightly too much sodium and people taking an OK level, with the same difference (e.g. going from 8g/day to 6g/day would prove a higher blood pressure loss than going from 6g/day to 4g/day, and the former would certainly not be 'making not much of a difference' as Greger suggests).
As stated before by other claims he made, even just a small amount of sodium reduction would affect blood pressure significantly--now he goes back on his words when it is inconvenient for his point, saying that the salt is too much and is too high in both A and B for the reduction from A to B to show effect on blood pressure (when the higher the salt is after the threshold of it being too much, the more X reduction would show its effect)?

5- Here Greger titles his article 'Who’s Right in the Salt Debate?', and goes on to say:

"there is strong scientific consensus that reducing salt saves lives, and—like the climate change debate—most authorities are on one side. On the other? Only the affected industry, their paid consultants, and a few dissenting scientists."

This is an incorrect claim, as, again, the strongest evidence available for low-sodium vs. not-low-sodium suggests the exact opposite (as shown at the beginning of this section).

He then states:

"The human experience is living for millions of years without Cheetos or a salt shaker in sight. We evolved to be salt-conserving machines, and when we’re plunked down into snack food and KFC country, we develop high blood pressure. But in the few remaining populations that don’t eat salt and only consume the small amounts of sodium found in natural foods like we had for millions of years, our leading killer risk factor, hypertension, is practically non-existent."

Not only is this an appeal to nature fallacy (something that he condemns when it does not suit him), but the population eating 'natural' foods also does not eat junk food--which brings up the point that the problematically high blood pressure may be a result of the junk food itself (eaten along with the salt) rather than the salt.

He continues by saying:

"Salt is big business for the processed food and meat industry. So, according to the head of the World Health Organization’s Collaborating Center on Nutrition, we get the familiar story. Just like the tobacco industry spent decades trying to manufacture doubt and confuse the public, the salt industry does the same, but the controversy is fake."

Salt is not 'big business' by itself. But it is true that it would be in the junk-food companies' best interests to leave salt untouched, as salty foods end up being tastier and selling more.
However, this alone is not reason to believe that salt would be bad--the burden of proof relies on the ones claiming only low-sodium to be good, and simply showing that there could be 'big business' in making people believe that salt would be fine in higher-than-low-sodium amounts does not prove that a low-sodium diet is optimal (especially when the strongest evidence says otherwise, and the low-sodium recommendations are based on ridiculously weak evidence, with nine studies and a total of 479 people in all the studies put together).

He then says:

"The likes of the World Hypertension League have been described as a “mere pop-gun against the weapons-grade firepower of salt-encrusted industries” who look disdainfully at the “do-gooder health associations…who erect roadblocks on the path to profits.” Lest we forget, notes an editorial in the Journal of the Canadian Medical Association, high blood pressure is big business for the drug industry, too, whose blood pressure billions might be threatened should we cut back on salt."

This is nothing but sensationalism and a suggested conclusion (that 'big business' hijacks the studies on salt) formed on nothing but naively pointing fingers following conjectures/presumptions, and science does not work on either sensationalism or conjectures/presumptions.

You could just as easily say:
'The likes of the people advocating to have juice-only diets have been described as a “mere pop-gun against the weapons-grade firepower of solid-food-encrusted industries” who look disdainfully at the “do-gooder health gurus…who erect roadblocks on the path to profits.” Lest we forget, obesity comes from eating a diet not solely based on juices, and obesity is big business for the drug industry, too, whose obesity billions might be threatened should we cut back on food that is not juice.'

Scientific consensus and recommendations should be based on the best current available evidence.
And as long as the best available evidence shows that low-sodium (as it is currently defined at < or = 1500 mg/day) is generally worse than not-low-sodium, unless you have specific cases where a low-sodium diet would be better, low-sodium should not be the recommendation.

Dr. Michael Greger

Contents

Positive impact

Popular outreach videos

Highly consistent schedule of science-based health-related informative videos

Michael Greger's Daily Dozen and other useful work

Greger's Daily Dozen

Weight loss videos

Books and charity work

Controversies and unscientific stances

No amount of processed food being acceptable, dogmatically putting whole foods on a pedestal (even when certain processed foods are better than certain whole foods)

Tempeh vs. tofu

Oil = 'death'

Bias towards excessive amounts of fruits being good

Dates = 'almost ideal food'

Endorsing skepticism of the efficacy of chemotherapy for cancer treatment (2% gambit)

Salt being categorically bad

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