Book Review: How Not to Die by Michael Greger, MD

NutritionFacts.org

Excellent. Excellent.

Read this book and prepare to fall in love with fruits and vegetables, beans, nuts, seeds and whole grains. Love spices: turmeric, cinnamon, oregano, cumin, cardamom, saffron. How could you not?

"You should eat more fruits and vegetables as if your life depended on it, because maybe it does," writes Dr. Michael Greger.

And not just a few more — a lot!

In How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease, Dr. Greger dives into nutrition science providing overwhelming compelling evidence for food as medicine. He takes the reader through numerous well-conducted scientific studies that show how foods nourish and protect us. He points the eater to foods (like flaxseeds) proven to be more powerful and beneficial than medicine — if only we will eat to live.

Dr. Greger became interested in nutrition science because of his grandmother, Frances. She was put on hospice due to a heart condition and told there was nothing more doctors could do. Instead of dying, his grandmother found Nathan Pritikin, changed her diet and lived 31 years longer. She was featured in Pritikin's biography: Pritikin: The Man Who Healed America's Heart.

Greger was inspired to study medicine, became interested in nutrition science and changed his own diet after reading Dr. Dean Ornish's 1990 landmark Lifestyle Heart Trial study which showed how heart disease could be reversed with a plant-based diet and other lifestyle changes (no drugs, no surgery). 

Greger repeatedly points out that a whole-foods, plant-based diet can prevent and reverse heart disease — and he doesn't stop there. In part one of the book, Greger goes through the 15 leading causes of death and systematically shows how a plant-based diet may prevent or even reverse each of these ills.

"It turns out a more plant-based diet may help prevent, treat, or reverse every single one of our fifteen leading causes of death," he writes.

He makes the case that there's an opportunity cost to food. At every meal, we can choose lifesaving nourishment, which builds our strength and resilience — or we can eat junk. Eating is about so much more than satisfying a craving or indulging a taste — it's about truly satiating hunger and sustaining and fortifying our bodies. 

I became interested in eating a plant-based diet in 2009. My mother had a heart attack and a stent placed in 2001 in her early sixties. Seeing her in that hospital bed terrified me. In 2009, she needed more stents and I went with her to get her blood work up before the procedure. A woman in the testing room happened to be reading The China Study by T. Colin Campbell. I had no idea what the book was about, but I am a curious book voyeur. When I looked it up I was amazed, it was about how diet can prevent and reverse heart disease.

After reading the book, I remember going with mom to her follow up cardiology appointment. I made a point of asking her cardiologist directly: "I read this book The China Study and it said a plant-based diet could prevent and reverse heart disease. Could that be true?"

"It might be helpful," the interventional cardiologist said. "But most people can't do it."

Plant the Plate
Union of Concerned Scientists

Dr. Greger takes issue with just this type of attitude seen time and again in silent doctors and watered down dietary guidelines. Rather than assuming what people can or can't do, Greger recommends providing people with the evidence and letting them make their own choices about their health, "First, it shouldn't matter what I or anyone else eats, says or does. The science is the science."

"Heart attacks are considered 96 percent avoidable in women who eat a wholesome diet and engage in other healthy lifestyle behaviors. The number-one killer of women need almost never happen." — European Heart Journal

I'd been vegetarian for 20 years, but I went vegan after reading The China Study convinced that the casein in dairy and other animal proteins were certainly doing my heart and body more harm than good. I also began my journey toward a whole-foods, plant-based diet eating far more fruits and vegetables.

"That one unifying diet found to best prevent and treat many of these chronic diseases is a whole-food, plant-based diet, defined as an eating pattern that encourages the consumption of unrefined plant foods and discourages meats, dairy products, eggs, and processed foods. In this book(How Not to Die), I don't advocate for a vegetarian diet or a vegan diet. I advocate for an evidence-based diet, and the best available balance of science suggests that the more whole plant foods we eat, the better—both to reap their nutritional benefits and to displace the less healthful options."  

Since I'm not eating the "Standard American Diet" but am surrounded by it, I find it helpful to read the latest books and information when it comes out to reinforce the eating choices I make every day. I've become a fan of Dr. Michael Greger's Nutrition Facts videos — a free online resource offered by a nonprofit charity — in which he talks about the latest nutrition research. I pre-ordered How Not to Die as soon as I heard it was coming out.

As Dr. Greger says, "We can’t wait until society catches up to the science, because it’s a matter of life and death."

How Not to Die reads a lot like The China Study to start. It systematically goes through a bunch of horrible, chronic diseases and presents scientific studies, which conclude that the disease is preventable with a plant-based diet. It becomes a familiar refrain — and increasingly frustrating.

Why is this not more widely known and practiced? Dr. Greger has been talking about plant-based diets and food as medicine for 25 years (and he's certainly not a lone voice in the wilderness - see pairs well with below). Still, when the International Agency for Research on Cancer (22 experts from 10 countries) of the World Health Organization, after considering more than 800 studies on cancer in humans, showed a causal link between processed meat and colorectal cancer and declared bacon a known carcinogen and red meat a probable carcinogen, people who would on any other day say, "Fuck cancer!" were suddenly defending it. Eating death and suffering— for the love of bacon! How bizarre.

What if there is already a cure?

"Diets that revolve around whole plant foods — vegetables, whole grains, fruits and beans—cut the risk of many cancers, and other diseases as well." — American Institute for Cancer Research 

Dr. Greger points out that agribusiness is big business and that U.S. dietary recommendations are mixed in with the Department of Agriculture's goals of promoting consumption. There is money to be made in processed foods, whereas watermelons, sweet potatoes, kale and turmeric are inexpensive health solutions.

Then, people claim they would not enjoy life if they had to give up certain foods. Again, Dr. Greger looks to the science. On the contrary, studies show people feel better and enjoy eating plant-based diets. For diabetic patients, for example, a plant-based diet is less restrictive, easier to follow and more enjoyable than other options. It's a particularly great choice for people who love to eat. Following a plant-based lifestyle, you are encouraged to eat a lot of healthy, tasty, colorful, flavorful foods at every meal.

Despite the sad state of the average American diet today, How Not to Die remains upbeat. Throughout the book, Greger amply employs wit, humor and silly puns (my favorite of which is "Them's some block-rockin' beets!" in reference to the benefits of beets for athletic performance.).

Bizarro! by Dan Piraro

The second part of How Not to Die talks about how to make those food choices — it's about eating a lot of certain fruits, vegetables, legumes and spices every day. Dr. Greger talks about his favorites and how much to eat. Again, lots!

"One of their (World Cancer Research Fund) summary cancer-prevention recommendations is to eat whole grains and/or legumes (beans, split peas, chickpeas, or lentils) with every meal. Not every week or every day. Every meal!"  

To be clear, How Not to Die is not a book about immortality. It is a book about preventative medicine and living well — how not to die prematurely and how not to suffer from chronic disease.

As the president of the American College of Cardiology, Kim Williams, MD said in advocating for and adopting a plant-based diet as written in "Heal Thyself," in the University of Chicago Magazine (Jan./Feb/ 2015), "Unlike those who find enjoyment or comfort even in foods they know are unhealthy, Williams takes solace in the belief that, with each bite, he’s doing no harm. 'I don’t mind dying,' he says, 'I just don’t want it to be my fault.'"

The book ends on a sweet and loving note as Dr. Greger acknowledges the transience of life: "And we need to make each day count by filling is with fresh air, laughter, and love—love for ourselves, for others, and for whatever we are doing with our one precious life."

Pairs well with: 

• The China Study and Whole: Rethinking the Science of Nutrition by T. Colin Campbell, Ph.D 
• The Campbell Plan by Thomas Campbell, MD
• Forks Over Knives
• Eat for Health by Joel Fuhrman, MD 
• Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure by Caldwell Esselstyn 
• My Beef With Meat by Rip Esselstyn
• DrMcDougall.com, website of John McDougall, MD
• Proteinaholic by Garth Davis, MD 

 See also: 

• Rich Roll's excellent podcast #199 about the book, Michael Greger, M.D. on How Not to Die
• Dr. Greger's Daily Dozen App — a great way to track if you're getting enough good food 
• The Global Burden of Disease Study (500 researchers, 300 institutions, 50 countries) funded by the Bill & Melinda Gates Foundation, "In the United States, the massive study determined that the leading cause of both death and disability was the American diet, followed by smoking. What did they determine to be the worst aspect about our diet? Not eating enough fruit." 
• The Union of Concerned Scientists estimates that if the nation increased its consumption of fruits and veggies to meet the dietary guidelines, we might say the lives of more than one hundred thousand people a year (Investing in Healthy Food Will Save Lives and Dollars, 2013)
• Kaiser Permanente's guide "The Plant-Based Diet: A Healthier Way to Eat" — "Any movement toward more plants and fewer animals products can improve your health!" 
• 21daykickstart.org a free online nutrition program via the Physician's Committee for Responsible Medicine
• The Top 10 Plant-Based Research and News Stories of 2015 via the T. Colin Campbell Center for Nutrition Studies

Quotable:

"Plant-based diets are the nutritional equivalent of quitting smoking." — Dr. Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine 

"Eating greens nearly every day may be one of the most powerful steps you can take to prolong your life. Of all the food groups analyzed by a team of Harvard Researchers, greens turned out to be associated with the strongest protection against major chronic diseases, including up to about a 20 percent reduction in risk for both heart attacks and strokes for every additional daily serving." — Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) Study

"Meat consumption was associated with increased risk of dying from cancer, dying from heart disease and dying prematurely in general. Again, this was after controlling for other diet and lifestyle factors, effectively excluding the possibility that people who ate meat also smoked more exercised less, or failed to eat their fruits and veggies. The accompanying editorial in the American Medical Association's Archives of Internal Medicine (titled "Reducing Meat Consumption Has Multiple Benefits for the World Health) called for a 'major reduction in the total meat intake'." 

"The (Global Burden of Disease) study also noted which foods if added to the diet, might save lives. Eating more whole grains could potentially save 1.7 million lives a year. More vegetables? 1.8 million lives. More seeds and nuts? 2.5 million lives....Worldwide, if humanity ate more fruit, we might save 4.9 million lives. That's nearly 5 million lives hanging in the balance, and their salvation isn't medication or a new vaccine — it may be just more fruit."

"The truth is that adhering to just four simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases: not smoking, not being obese, getting a half hour of exercise a day, and eating healthier—defined as consuming more fruits, veggies, and whole grains and less meat. Those four factors alone were found to account for 78 percent of chronic disease risk." — Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study.

"Know, however, that there is only one way of eating that's ever been proven to reverse heart disease in the majority of patients, a diet centered around whole plant foods. Anytime anyone tries to sell you on some new diet, ask just one simple question: 'Has it been proven to reserve heart disease?' (You know, the most likely cause of death for you and everyone you love?) If it hasn't, why would you even consider it? If that's all a whole-food, plant-based diet could do — reverse our number-one killer—then shouldn't that be the default diet until proven otherwise? And the fact that it can also be effective in preventing, treating, and arresting other leaders killers would seem to make the case for eating this way overwhelming. Please give it a try. It could save your life."