In "How Not to Die," Dr. Michael Greger presents a compelling case for the power of nutrition in preventing and reversing many of the leading causes of death in modern society. This eye-opening book challenges conventional wisdom about diet and health, offering evidence-based insights into how the food we eat can dramatically impact our longevity and quality of life.
Dr. Greger, a renowned nutrition expert and founder of NutritionFacts.org, draws on extensive scientific research to demonstrate that many of the chronic diseases plaguing our society are not inevitable consequences of aging, but rather the result of poor dietary choices. He argues that by adopting a whole-food, plant-based diet, we can significantly reduce our risk of premature death and even reverse existing health conditions.
The book is divided into two main parts. The first part examines the top 15 causes of death in the United States and how nutrition can play a crucial role in preventing or treating each of them. The second part provides practical advice on how to incorporate these life-saving foods into our daily lives, offering a comprehensive guide to healthy eating.
Key Ideas
1. The Power of Diet in Preventing Premature Death
Dr. Greger begins by highlighting the alarming fact that poor diet is the number one cause of premature death in modern society. Despite advances in medical technology and pharmaceutical interventions, our eating habits continue to be the primary driver of many chronic diseases.
The author points out that while many people are living longer, they are not necessarily living healthier. A study of autopsies on centenarians (people who lived to be 100 or older) revealed that a large percentage died from diseases rather than simply old age, even though they were considered healthy right up until their deaths. This suggests that longevity alone is not a sufficient measure of health.
The typical American diet, dominated by meat, dairy, eggs, and processed foods, is identified as a major culprit in the prevalence of chronic diseases. Studies have shown that people who consume diets rich in these food groups are at greater risk of heart disease, diabetes, and other chronic ailments. The author cites a striking example of how dietary habits can impact health: Japanese-Americans who adopted U.S. eating habits were found to be at as great a risk of suffering a heart attack at 40 as their Japanese counterparts were at 60.
Dr. Greger also criticizes the medical profession for its lack of focus on nutrition. He notes that only 25 percent of all U.S. medical schools offer even one course in nutrition, marking a 37 percent decline from just 30 years ago. This gap in nutritional education has led to a healthcare system that relies heavily on prescription drugs rather than addressing the root causes of many diseases through dietary interventions.
2. The Benefits of a Plant-Based Diet
One of the central arguments in "How Not to Die" is that a plant-based diet can provide better treatment for many chronic diseases than pharmaceuticals. Dr. Greger presents compelling evidence to support this claim, drawing on numerous scientific studies and real-world examples.
The author cites a 2014 study published in the American Journal of Clinical Nutrition, which found that vegetarians of 12 years who began eating meat just once a week saw a drop in life expectancy of 3.6 years. This stark finding underscores the significant impact that even small changes in diet can have on our health and longevity.
Dr. Greger also highlights the China-Cornell-Oxford Project of the 1980s, which studied the eating habits of rural Chinese people. The study found an inverse correlation between eating a plant-based diet and experiencing heart disease. In Guizhou province, where rates of animal-based food consumption were among the lowest in the country, not a single death among men under 65 could be attributed to coronary disease.
Perhaps most strikingly, the author discusses how plant-based diets can not only prevent but also reverse certain diseases. He cites the work of lifestyle-medical pioneers Nathan Pritikin and Dean Ornish, who put patients with advanced heart disease on plant-based diets similar to those traditionally enjoyed by some populations in Asia and Africa. The results were remarkable: not only did the progression of heart disease slow down, but in many cases, it actually reversed. Patients saw marked improvements in their conditions, with their bodies beginning to dissolve the plaque that had built up in their arteries.
Dr. Greger contrasts this approach with the pharmaceutical-focused model of modern medicine. He notes that while doctors often find it easier to prescribe drugs than to change a patient's diet, medications like statins (used to lower cholesterol) can come with significant side effects. Meanwhile, plant-based diets have been shown to be just as effective in many cases, without the associated risks.
3. The Importance of Fruits and Berries
Dr. Greger devotes significant attention to the health benefits of fruits, particularly berries. He recommends consuming four servings of fruit per day, with at least one of these servings being berries.
The author emphasizes the importance of eating whole fruits rather than drinking fruit juice. He cites Harvard research showing that drinking fruit juice correlates to a higher risk of type-2 diabetes due to its high ratio of sugar to fiber, whereas whole fruit has been correlated to a lower risk of the same condition.
Fruits are praised for their ability to improve lung function. Dr. Greger notes that just a single extra serving of fruit per day could result in a 24 percent decrease in the risk of Chronic Obstructive Pulmonary Disease (COPD). This is attributed to the rich antioxidant content of fruits, which helps limit cellular damage and reduce inflammation.
The author also addresses concerns about the natural sugar content in fruits, explaining that only the fructose in added sugars is associated with health problems. The fiber, antioxidants, and phytonutrients in whole fruits can actually combat the adverse effects of fructose. Moreover, natural sugar from fruit can help balance insulin spikes caused by foods with a high-glycemic index, like white bread.
Berries are singled out for their exceptional health benefits. Dr. Greger describes them as powerhouses for immune-boosting functions, cancer-fighting abilities, and prevention of diseases affecting the liver and brain. He cites a 2014 study of 14 patients with hereditary colon polyps, where consuming black raspberries for just nine months resulted in a 50% reduction in polyp load.
The author explains that the incredible antioxidizing power of berries is believed to come from their pigmentation. In fact, berries are second only to herbs and spices as the most antioxidant-rich foods, with an average of ten times more antioxidants than other fruits. To put this in perspective, Dr. Greger notes that while apples contain around 60 units of antioxidants, a cup of blackberries contains 650!
4. The Vital Role of Vegetables
Dr. Greger emphasizes the crucial role that vegetables play in preventing life-threatening diseases. He recommends consuming five servings of vegetables per day, with specific recommendations for different types of vegetables.
The author explains that whole vegetables, as opposed to processed ones, have been found to protect cellular telomeres – nucleotide "caps" that keep DNA healthy as cells divide and age. He highlights the benefits of specific vegetables:
Broccoli and cabbage can aid liver and lung function while cutting the risk of lymphoma and prostate cancer. A 2010 study found that longtime smokers who consumed large amounts of broccoli for ten days showed 41 percent fewer DNA mutations than smokers who didn't eat broccoli.
Kale, dubbed the "queen of greens," has been shown to potentially reduce cholesterol levels. Dr. Greger cites a 2008 study where men with high cholesterol who drank kale juice daily for three months saw a dramatic reduction in bad cholesterol and an increase in good cholesterol equivalent to the effects of running 300 miles.
The author recommends that out of the five daily servings of vegetables, two should be leafy greens like kale, arugula, and chard. One should be a cruciferous vegetable like broccoli, cabbage, or cauliflower. The other two should include a variety of vegetables such as carrots, beets, and mushrooms.
Dr. Greger places special emphasis on cruciferous vegetables due to their production of sulforaphane, a potentially powerful anti-inflammatory and cancer-fighting molecule. He advises that these vegetables are best eaten raw since the enzyme that activates sulforaphane is destroyed by heat. However, he notes that chopping them up before cooking can activate the enzyme, preserving the sulforaphane even when cooked.
The author also highlights the importance of dark leafy greens, describing them as the most nutritious foods per calorie on earth. For those who don't enjoy the taste, he suggests blending them into fruit smoothies as a way to incorporate them into the diet.
5. The Benefits of Beans and Whole Grains
Dr. Greger strongly advocates for the inclusion of beans and whole grains in our daily diet. He recommends eating a serving of beans or legumes with every meal, citing their high protein content and additional benefits like fiber.
While soy is the most popular bean in America, the author advises against processed versions like tofu. Instead, he recommends tempeh, young whole soybeans, or other whole soy-based foods. For those who don't like soy, Dr. Greger notes that navy and pinto beans can lower bad cholesterol just as effectively. He also praises lentils for their ability to cut sugar spikes, even hours after a meal, and their high prebiotic content.
For those short on time, the author reassures that canned beans are just as healthy as dried ones, with the caveat that sodium-free versions should be chosen to avoid excessive salt intake.
When it comes to whole grains, Dr. Greger cites a 2015 analysis showing that people who eat whole grains – regardless of their other dietary habits – tend to live longer lives. Whole grains have been found to reduce the risk of heart disease, type-2 diabetes, obesity, and even strokes.
The author encourages consuming colorful whole grains, explaining that the more color a grain contains, the higher its antioxidant content. He dispels fears about the taste of whole grain products, noting that new technology has improved their flavor. Even popcorn is recommended as a healthy whole grain option, as long as it's air-popped and eaten without butter.
Dr. Greger advises caution when choosing packaged grain products, warning that labels like "multi-grain" or "stone-ground" do not necessarily indicate whole grains. He recommends checking nutritional labels to ensure that the ratio of carbohydrates to fiber is five to one or lower.
6. The Nutritional Power of Nuts and Seeds
Dr. Greger presents compelling evidence for the importance of including nuts and seeds in our daily diet. He cites the Global Burden of Disease Study, which found that eating too few seeds and nuts was the third leading dietary risk for death and disability worldwide. The author suggests that increased consumption of nuts and seeds could potentially save 2.5 million lives annually.
Some of the specific benefits of nuts and seeds highlighted in the book include:
- Cholesterol reduction: A single serving of brazil nuts has been found to lower cholesterol levels even faster than statin drugs.
- Cancer prevention: The phytates found in nuts and seeds can detoxify excess iron from the body, potentially reducing the risk of colorectal cancer.
- Bone health: While phytates were once considered inhibitors of mineral absorption, recent research suggests they may actually increase bone density.
Dr. Greger addresses concerns about the high calorie content of nuts and seeds, explaining that clinical studies have found no weight gain when these foods are added to a diet. He suggests that the body may not absorb all of the fat from nuts and seeds, and that these foods may actually boost the body's fat-burning metabolism.
The author recommends a variety of seeds, including chia, hemp, pumpkin, sesame, and sunflower. He suggests a serving size of a quarter cup of straight seeds or two tablespoons of seed butter. For those looking to incorporate more nuts and seeds into their diet, he recommends adding them to sauces and dressings.
Among nuts, Dr. Greger singles out walnuts as the most nutritious, noting their high levels of antioxidants and omega-3s. He also mentions an interesting study on pistachios, which found that consuming three to four handfuls daily could potentially improve blood flow to the male genitalia, potentially decreasing erectile dysfunction.
7. The Disease-Fighting Power of Herbs and Spices
Dr. Greger dedicates a significant portion of the book to discussing the health benefits of herbs and spices. He describes these flavorful additions not just as taste enhancers, but as powerful fighters of disease, particularly cancer.
The author explains that herbs and spices contain the highest levels of antioxidants of all food groups. To illustrate this point, he notes that a bowl of whole wheat pasta with tomato sauce and broccoli contains about 150 units of antioxidants, but adding just a single teaspoon of oregano doubles this to 300 units.
Dr. Greger cites several studies demonstrating the health benefits of various herbs and spices:
- A 16-week study of Alzheimer's patients found that those who took saffron had much better cognitive function than those who received a placebo.
- Spices like cloves, cinnamon, oregano, and nutmeg have been found to inhibit an enzyme known as monoamine oxidase, which can spark depression. This effect is similar to certain antidepressant drugs but without the potential serious side effects.
Among all herbs and spices, Dr. Greger singles out turmeric as particularly beneficial, especially for cancer prevention and treatment. He explains that turmeric contains curcumin, a molecule that gives the spice its deep yellow hue and appears to be effective in treating colon, lung, and pancreatic cancer. The author recommends consuming a quarter teaspoon of turmeric, either dried or fresh, daily.
Interestingly, Dr. Greger notes that the combination of turmeric and black pepper, common in Indian curry powder, may explain the lower rates of certain cancers in India compared to the United States. Black pepper helps slow the body's elimination of turmeric, potentially enhancing its benefits.
However, the author cautions against relying on turmeric supplements, as these focus solely on curcumin, and there's no proof that this molecule is the only disease-fighting component in turmeric. He also warns that people with gallstones or kidney stones should limit their turmeric intake due to its effects on the gallbladder and its high oxalate content.
8. The Importance of Proper Hydration
Dr. Greger emphasizes the crucial role of proper hydration in maintaining good health. He recommends aiming for at least five 12-ounce beverages per day, with water being the ideal choice. The author references the Beverage Guidance Panel, which ranks water as number one on its six-tier scale of recommended beverages.
While many sources suggest drinking eight glasses of water per day, Dr. Greger notes that there's little scientific support for this specific recommendation. He reassures readers that water intake can come from various sources, including other beverages and fruits and vegetables.
In addition to water, the author identifies two other beverages as beneficial choices:
Coffee: Dr. Greger cites studies showing that coffee can benefit liver and brain health. He notes that people who drink more than two cups of coffee per day experience half the risk of both chronic liver issues and suicide.
Tea: The author highlights the potential medicinal effects of tea, citing a Tufts University study which found that hibiscus tea significantly lowered blood pressure in prehypertensive patients more effectively than a placebo.
However, Dr. Greger warns against most other beverages. He particularly advises against milk consumption, noting that the Beverage Guidance Panel has ranked it alongside beer, recommending zero ounces per day due to its potential link to prostate cancer.
The author is especially critical of soda, which ranks last on the Beverage Guidance Panel's scale. He also addresses alcohol consumption, noting that while moderate drinking (one drink a day for women and two for men) has been associated with some heart health benefits, it's also correlated with increased cancer risk. Moreover, a 2008 study found that the only people who saw benefits from alcohol were those who lived sedentary and unhealthy lives, suggesting that for those already leading a healthy lifestyle, the potential risks of alcohol may outweigh any benefits.
9. The Crucial Role of Exercise
While much of "How Not to Die" focuses on nutrition, Dr. Greger also emphasizes the critical importance of physical activity in maintaining good health and longevity. He points out that our increasingly sedentary lifestyles are major contributors to poor health outcomes.
The author cites a 14-year study by the American Cancer Society that followed over 100,000 Americans. The study found that men who remained sedentary for six hours per day or longer were 20 percent more likely to die than those who sat around for three hours or less. Shockingly, this increased mortality risk held true even for those who exercised for an hour a day, highlighting the dangers of prolonged sitting.
Dr. Greger links these sedentary habits to the alarming rise in obesity rates. He notes that over two-thirds of all American adults are overweight, and childhood obesity has tripled in just 30 years. Comparing current eating habits to those of the 1970s, the author calculates that Americans would need to walk two hours more every day just to burn off the extra calories they're now consuming.
While the author stresses that healthy eating is essential, he argues that its benefits can be significantly enhanced by adding regular exercise to one's routine. Dr. Greger recommends 90 minutes of moderate exercise or 40 minutes of intense exercise daily. He provides examples of moderate activities (such as hiking, fast walking, and recreational swimming) and vigorous ones (like basketball, circuit weight training, and tennis).
However, Dr. Greger also points out a discrepancy between scientific recommendations and official guidelines. He notes that the U.S. Office of Disease Prevention and Health Promotion suggests just 20 minutes of exercise per day is sufficient, a recommendation he believes is based more on what they think is realistic rather than what the science indicates is optimal.
For those who find these recommendations daunting, Dr. Greger offers some encouragement. He cites a study published in the International Journal of Epidemiology in 2011, which found that even a simple hour of walking per day can cut mortality rates by 24 percent. This suggests that even modest increases in physical activity can have significant health benefits.
Practical Application
Throughout "How Not to Die," Dr. Greger not only presents the scientific evidence for the benefits of a plant-based diet but also offers practical advice on how to incorporate these principles into daily life. Here are some key takeaways for putting the book's recommendations into practice:
Prioritize whole plant foods: Focus on consuming a variety of fruits, vegetables, whole grains, legumes, nuts, and seeds. These should form the foundation of your diet.
Eat the rainbow: Consume a wide range of colorful fruits and vegetables to ensure you're getting a diverse array of nutrients and antioxidants.
Include berries daily: Aim to eat a serving of berries every day due to their exceptionally high antioxidant content.
Embrace leafy greens: Include at least two servings of leafy green vegetables in your daily diet. If you don't enjoy their taste, try blending them into smoothies.
Don't forget your beans: Try to include a serving of beans or legumes with every meal for their protein and fiber content.
Choose whole grains: Opt for whole grain products over refined grains, and be wary of misleading labels on packaged foods.
Snack on nuts and seeds: Incorporate a serving of nuts or seeds into your daily diet, either as a snack or added to meals.
Spice up your life: Use a variety of herbs and spices in your cooking, with a special emphasis on turmeric combined with black pepper.
Stay hydrated: Drink plenty of water throughout the day, and consider incorporating coffee and tea (without added sugars) into your beverage routine.
Move more: Aim for at least an hour of moderate exercise or 40 minutes of vigorous exercise daily. If this seems daunting, start with regular walking and gradually increase your activity level.
Limit processed foods: Reduce your consumption of processed foods, especially those high in added sugars, unhealthy fats, and artificial ingredients.
Be mindful of portion sizes: While whole plant foods are generally less calorie-dense than animal products and processed foods, portion control is still important for maintaining a healthy weight.
Plan your meals: Meal planning can help ensure you're getting a balanced diet and make it easier to stick to healthy eating habits.
Educate yourself: Continue to learn about nutrition and health through reputable sources, and be critical of health claims that seem too good to be true.
Make gradual changes: If transitioning to a plant-based diet seems overwhelming, start by making small, sustainable changes to your eating habits and gradually build from there.
Conclusion
"How Not to Die" presents a compelling case for the power of nutrition in preventing and even reversing many of the chronic diseases that plague modern society. Dr. Michael Greger's thorough examination of scientific research provides strong evidence for the benefits of a whole-food, plant-based diet in promoting longevity and overall health.
The book's central message is clear: what we eat matters immensely. By shifting our diets away from processed foods and animal products towards a variety of whole plant foods, we can significantly reduce our risk of premature death from leading causes such as heart disease, cancer, and diabetes.
Dr. Greger's approach is not about deprivation or strict rules, but rather about making informed choices that can have profound impacts on our health. He emphasizes the importance of eating a diverse range of fruits, vegetables, whole grains, legumes, nuts, and seeds, each offering unique health benefits.
The author also stresses the importance of looking beyond individual nutrients to focus on whole foods and dietary patterns. This holistic approach to nutrition recognizes that the synergistic effects of various components in whole foods often provide greater benefits than isolated nutrients.
While the book primarily focuses on diet, Dr. Greger also acknowledges the importance of other lifestyle factors, particularly regular physical activity, in maintaining good health. He encourages readers to adopt a comprehensive approach to wellness that combines proper nutrition with regular exercise and other healthy habits.
One of the most empowering aspects of "How Not to Die" is its message that many chronic diseases are not inevitable consequences of aging, but are largely preventable and sometimes even reversible through dietary and lifestyle changes. This perspective shifts the focus from treating diseases after they occur to preventing them from developing in the first place.
Dr. Greger's work serves as a wake-up call to both individuals and the medical community about the critical role of nutrition in health. He challenges the overreliance on pharmaceutical interventions and advocates for a greater emphasis on dietary approaches to preventing and treating disease.
However, the author is careful to note that while nutrition is powerful, it's not a panacea. He encourages readers to work with their healthcare providers, especially when dealing with existing health conditions, and to view dietary changes as a complement to, not a replacement for, appropriate medical care.
In conclusion, "How Not to Die" offers a roadmap to better health through better eating. By following Dr. Greger's evidence-based recommendations, readers can take control of their health, potentially adding years to their lives and life to their years. The book serves as both a comprehensive guide to nutrition and a call to action, empowering readers with the knowledge they need to make informed decisions about their diet and health.