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How Not To Die Summary PDF


The vast majority of premature deaths can be prevented through simple changes in diet and lifestyle. In How Not to Die, Dr. Michael Greger examines the top causes of death in America. He explains how nutritional and lifestyle interventions can sometimes trump prescription pills and other pharmaceutical and surgical approaches, freeing us to live healthier lives. Peer-reviewed academic studies support each of Dr. Greger’s approaches. The overwhelming conclusion is that a whole food plant-based diet is the most effective ‘treatment’ to prevent and cure America’s biggest killers.

About Dr. Michael Greger

Dr. Michael Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. In 2017, Dr. Greger was honored with the ACLM Lifestyle Medicine Trailblazer Award and became a diplomat of the American Board of Lifestyle Medicine. 100% of all proceeds he has ever received from his books, DVDs, and speaking engagements always have and will always be donated to charity.

“I opened my eyes to the depressing fact that there are other forces at work in medicine besides science. The U.S. healthcare system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the benefits of healthy eating. If doctors were instead paid for performance, there would be a financial incentive to treat the lifestyle causes of disease. Until the model of reimbursement changes, I don’t expect great changes in medical care or medical education.”

– Dr. Michael Greger

The 14 Biggest Killer Diseases

“The primary reason diseases tend to run in families may be that diets tend to run in families.”

– Dr. Michael Greger

Dr. Greger structures How Not to Die around the leading causes of death, with the biggest killer being the first chapter and so on. For each chapter, Dr. Greger outlines the factors associated with this disease and how you can reduce your chances of getting and dying from each disease.

Heart Disease

Heart disease is the biggest killer in the world. Heart disease is primarily caused by high LDL levels, which is considered the ‘bad’ type of cholesterol. High LDL cholesterol levels can place added strain on your heart and can ultimately lead to a heart attack. People should aim to have a total cholesterol rating of around 150 mg/dL or lower. However, the US average for total cholesterol is currently 200mg/dL.

The most significant source of LDL cholesterol is dietary cholesterol, with the most common types being:

  • Trans fats – found in high amounts in processed foods, meat, and dairy products
  • Saturated fats – high in almost all animal products but incredibly high in red meat and dairy products
  • Other animal products that are naturally high in cholesterol, such as eggs

The primary treatment for heart disease is prescribed statins. However, statins have several side-effects. For example, statins have been associated with liver damage, muscle damage, and memory loss.

Animal products are often particularly high in cholesterol, but there are also other reasons for animal products being associated with artery inflammation. For example, meats are filled with endotoxins, which are bacteria that require sufficient temperatures to kill them off. However, if they are not killed off, they are absorbed by the blood. High levels of these endotoxins in our blood leads to artery inflammation and more significant strain on our heart. 

Decades of research have suggested that meat and dairy are the biggest drivers of heart disease. However, their lobbies are strong, which means that US Presidents are scared to recommend adding animal product abstinence to their national dietary guidelines. An example of the negative impact of the Western diet on heart disease can be seen in rural China and Africa. These societies lived without high levels of meat or dairy for centuries. Subsequently, these areas had very low rates of heart disease. However, since the introduction of the Western diet into their societies, heart disease levels have shot up. 

Dr. Greger’s tips for avoiding heart disease:

  1. Avoid Omega-3 fish oil supplements – Although a famous DART study suggested fish oil reduced mortality by 29%, on follow-up, those who had taken fish oil had a higher rate of mortality
  2. Eat brazil nuts – Just four Brazil nuts a month can lower cholesterol levels. However, do not eat too many as they are high in Selenium
  3. Eat lots of kale – Kale has been found to reduce LDL cholesterol levels and enhance good HDL cholesterol levels
  4. Avoid all animal products – Animal products are the most significant contributor to humans’ biggest killer


Lung Diseases

It has been clear for decades that smoking is the primary contributor to lung diseases. The American Lung Association suggests that smoking tobacco causes 90% of lung cancer deaths. Plus, smoking increases your chance of catching cancer by 10-20x. Even second-hand smoking can increase your cancer risk by 20-30%.

As well as avoiding smoking, you can make some dietary choices to avoid some lung diseases. For example, Dr. Greger explains that a plant-based diet can help with the prevention and cure of Chronic Obstructive Pulmonary Disease (COPD) and Asthma. Additionally, broccoli has been found to reduce the harmful effect of DNA mutations in smokers. Therefore, if you are struggling to give up smoking, broccoli could slightly reduce cigarettes’ impact.

Brain diseases (Stroke and Alzheimer’s)


Strokes are associated with high blood pressure. Dr. Greger outlines that one of the best preventive enzymes against strokes is Sirtuin. However, Sirtuin is suppressed by Advanced Glycation End Products (AGE). Dairy and meat products have the highest levels of AGE among all foods. 

Dr. Greger recommends the following tips to prevent your risk of stroke:

  1. Make sure you are sleeping well – Seven to eight hours of sleep is the optimal amount of time to avoid stroke. Sleeping too little or too much has been associated with an increase in stroke risk
  2. Fiber-rich foods decrease your stroke risk – For every 7 grams of fiber you eat, your risk of stroke is reduced by 7%
  3.  Eat your greens, beans, and sweet potatoes – Potassium is effective in cutting stroke risk. Greens, beans, and sweet potatoes are all particularly high in potassium. Research has suggested that 1640mg of potassium per day can reduce stroke risk by 21%
  4. Citrus fruits can reduce blood pressure – Citrus fruits contain high levels of Hesperidin, which has been shown to reduce blood pressure and increase blood flow. Dr. Greger also adds that Hesperidin can also help you feel warmer during a cold winter (because of the increased blood flow)


“Excess cholesterol in the blood can lead to excess cholesterol in the brain, which may then help trigger the clumping of amyloid seen in Alzheimer’s brains. Under an electron microscope, we can see the clustering of amyloid fibers on and around tiny crystals of cholesterol.”

– Dr. Michael Greger

Alzheimer’s Disease is caused by plaque deposition in the blood-supplying vessels to the brain. Dr. Greger explains that a defective version of the gene, ApoE4, can increase your chances of getting Alzheimer’s Disease. However, although Nigerians are the most susceptible to having this defective gene, they have one of the lowest rates of Alzheimer’s Disease. Dr. Greger attributes this to the significantly lower levels of animal fat in their diet.

Dr. Greger provides the following tips for reducing your chances of getting Alzheimer’s Disease:

  1. Regular exercise can improve your cognitive abilities if you have already been diagnosed with Alzheimer’s Disease
  2. Research suggests that saffron, the spice, is as effective as the leading medication for Alzheimer’s Disease, Donepezil. However, the leading drug is not very effective
  3. Finally, incorporate more cranberries, blueberries, strawberries, and grape juice into your diet. These foods contain polyphenols which can reduce cognitive decline in the elderly

Digestive Cancers

Again, the most significant contributing factor to digestive cancers is the consumption of animal products. Meat contains heme iron. Human bodies struggle to regulate heme iron levels, meaning that excess iron can build up. Excess iron has been consistently associated with cancer.

Additionally, Dr. Greger explains that animal fat has been consistently correlated with pancreatic cancer. In contrast, plant-based fat has not been associated with pancreatic cancer. Research has found that eating just 50 grams of chicken daily can increase your risk of pancreatic cancer by 72%. Dr. Greger explains that the main reason for this association seems to be the interaction between antibiotics and viruses in chickens. For example, slaughterhouse workers have nine times the risk of pancreatic cancer. Additionally, both red meat and poultry consumption have been correlated with esophageal cancer, potentially due to the acid reflux associated with these foods. 

Another significant risk factor for pancreatic cancer is smoking. Research has found smoking to double individuals’ risk of pancreatic cancer.

Here are Dr. Greger’s tips on how to reduce your risk of digestive cancers:

  1. Eat lots of vegetables, berries, apples, and citrus fruits. Each of these foods has been associated with significantly reducing the risk of digestive cancers
  2. If you already have esophageal cancer, strawberries could potentially help cure it
  3. Inadequate intake of fiber can cause constipation. Plus, fiber binds to toxins, such as mercury and lead, that have been associated with cancer
  4. Phytates, which are particularly high in plant seeds and beans, can reduce excess iron in your body. Excess iron can form free hydroxyl radicals that cause cancer
  5. Nuts, seeds, and dry fruits are good sources of irons that do not increase your risk of cancer
  6. A small amount of turmeric each day can reduce your risk of digestive cancers. This is why India has a much lower of colorectal cancer than the us


Again, Dr. Greger provides evidence of how animal products are the most significant contributors to one of the biggest killers. Eggs are consistently associated with salmonella poisoning. The most popular cooking method for eggs is sunny-side up. This cooking method does not kill salmonella. However, properly cooking your eggs or chicken will not prevent salmonella from spreading. By the time you have appropriately cooked these foods, they have already been picked up in the store, prepared by you, and been slid into the oven. These processes cover multiple surfaces and utensils with salmonella. Chicken preparation is the primary reason kitchen sinks have more fecal bacteria than toilet seats in the US.

On top of this, pork is associated with yersinia bacteria infections. Recent consumer reports have shown that two-thirds of pork samples are infected with these bacteria.

Here are Dr. Greger’s tips on how to reduce your risk of getting and spreading infections:

  1. Eat more fruits and vegetables as they boost your immune system
  2. Make sure you incorporate blueberries and cardamon into your diet as they boost your antibodies
  3. Broccoli and other cruciferous vegetables boost your immune system’s effectiveness against pathogens and pollutants
  4. Garlic is effective as a treatment for pneumonia
  5. Your gut bacteria are crucial for immunity. Therefore, eat prebiotics like legumes. Prebiotics are what good bacteria like to eat
  6. Regular exercise will improve your immune system and reduce your chances of the common cold
  7. Eating mushrooms can boost your immunity by increase IgA in your saliva by up to 50%


Abnormal levels of fat in your bloodstream can interfere with insulin functioning. This is called type two diabetes. Diets that are high in saturated fat, such as diets that include large amounts of animal products, have been correlated with type two diabetes. The reasoning behind this relationship is that LDL cholesterol kills insulin-producing beta cells. These cells are only produced until the age of 20. Therefore, we mustn’t kill them by eating diets high in cholesterol.

Dr. Greger explains that trimming your belly fat is one of the most effective approaches for preventing or reversing diabetes. However, instead of starving yourself, Dr. Greger recommends eating lots of legumes. Legumes are highly filling and calorie-dense. Therefore, you can eat more on a plant-based diet and be consuming significantly fewer calories. 

Dr. Greger does not just recommend reducing your meat intake. Instead, he recommends completely cutting out all animal products. A Taiwanese study found that vegetarians have a 50-75% lower chance of being diagnosed with diabetes than individuals who rarely eat fish and meat. Dr. Greger also recommends eating whole grains like brown rice. Whole grains have been found to reduce type two diabetes risk, while refined grains, like white rice, have increased type two diabetes risk.

High Blood Pressure

Healthy blood pressure is 120/80. 120 is systolic, which is when the heart is pushing. In comparison, 80 is diastolic, which is when the heart is resting.

One of the leading causes of high blood pressure is salt. For 90% of human history, we have consumed very low amounts of salt. Therefore, our body has learned to conserve salt. Subsequently, now that we consume excess salt, our body raises its blood pressure to push out the excess salt. Additionally, diets high in salt can reduce blood flow in the arteries. Dr. Greger explains that consuming enough vitamin C can overcome the adverse effects of excess salt. Not adding salt to your food can reduce your stroke risk by 22% and the number of strokes by 16%. In the US, vegans are repeatedly shown to have the lowest blood pressure. Even marathon runners who run 48 miles a week and are on a standard American meat diet have a higher blood pressure than vegans.

Meat companies frequently add salt to their meat to increase water retention and weight by approximately 20%. The most significant sources of salt across the American age ranges are as follows:

  • Children – Pizza
  • 20-50 years olds – Chicken
  • Older than 50 – Bread

Dr. Greger’s tips for reducing blood pressure are:

  1. Eating three portions of whole grains a day will lower your blood pressure
  2. Flaxseeds are effective in reducing blood pressure
  3. Wine is not healthy if alcoholic. However, non-alcoholic versions will reduce blood pressure
  4. The most effective tool for reducing blood pressure is hibiscus tea

Liver Diseases

Fatty liver disease is most commonly associated with heavy alcohol consumption. However, this is not the most common cause of liver problems. Instead, non-alcoholic fatty liver disease (NAFLD) is the most common cause. Dr. Greger explains that NAFLD is caused by sugar, animal fat, and cholesterol. For example, drinking just one can of soda per day increases your risk of NAFLD by 45%. 

Significantly, plant-based fat has never been associated with NAFLD. In contrast, animal fat is consistently associated with NAFLD.

Hepatitis is another prominent strand of liver disease. Hepatitis E virus originates from pork livers. Preventing the spread of the Hepatitis E virus is reliant on the effective cooking of the meat.

Dr. Greger’s tips for preventing liver disease are:

  1. Eat oatmeal and drink coffee every morning. Coffee, specifically, has been identified as an effective prevention technique for liver cancer and hepatitis C
  2. Anthocyanins are effective in reducing fatty cell deposition in the liver. Berries, grapes, red onions, and plums are high in anthocyanins
  3. If you already have liver disease, cranberries have been identified as the most effective food for killing liver cancer. Studies have identified that adding cranberries to a petri dish of liver cancer can kill cancerous cells. Instead of buying processed cranberry juices, you should buy frozen whole cranberries

Blood Cancer 

There are three main types of blood cancer: leukemia, lymphoma, and myeloma.

 Leukemia happens when an individual’s bone marrow produces too many abnormal white blood cells. Hence, these abnormal white blood cells crowd out healthy white blood cells.

Lymphoma happens when lymphocytes, which are a specific type of white blood cell, multiply too much. Subsequently, these white blood cells accumulate in the lymph nodes of the individual. Faulty lymph nodes then limit the individual’s ability to filter blood.

Finally, Myeloma happens when abnormal plasma cells, another specific type of white blood cell, produces too many antibodies. This excess of antibodies clogs the individual’s kidneys.

Chicken is frequently associated with all blood cancers. Dr. Greger explains that just 50 grams of chicken per day is associated with an increased risk of between 56 and 280% of being diagnosed with blood cancer. Dr. Greger attributes this increased risk to the poultry virus, as farmers and butchers have significantly higher blood cancer rates, irrespective of how much poultry they eat.

Dr. Greger’s tips for preventing blood cancer are:

  1. In general, a plant-based diet is highly effective in preventing blood cancer
  2. Specifically, Dr. Greger recommends eating lots of broccoli, cauliflower, and kale. These cruciferous vegetables are filled with sulforaphane, which is effective in tackling cancerous cells. Additionally, unlike chemotherapy, these vegetables will not kill healthy cells
  3. Studies have found acai berries to kill leukemia cells in a petri dish
  4. Certain vegetables have incredibly high levels of antioxidants, which are useful for preventing cancer. Dr. Greger outlines that purple cabbage is the best proportion of antioxidants per dollar

Kidney Diseases

Only 41% of Americans seem to have normal kidney function. This is due to chronic kidney disease, whereby individuals’ kidneys degrade over time. 

Dr. Greger explains that animal protein, animal fat, and cholesterol have all been associated with kidney degradation. In terms of mechanisms, animal protein causes inflammation and triggers hyperfiltration in kidneys. Hence, animal protein is associated with a higher risk of kidney stones. Conversely, this same risk is not identified with plant protein. 

In addition, high levels of phosphorus are associated with kidney and heart failure. Animal food contains high levels of easily absorbable phosphate. Contrastingly, plant food contains a phytate form of phosphorus. This form of phosphorus has not been linked to kidney or heart failure. It is standard practice in the US to add phosphate to coca-cola and chicken to enhance their color. Therefore, make sure you avoid buying anything, including pyrophosphate or sodium triphosphate.

Meat contains more nitrosamines, a cancer-causing compound, than cigarettes. In fact, Dr. Greger explains that eating one hot dog is equivalent to smoking four cigarettes.

Breast Cancer

Alcohol has been associated with breast cancer through its encouragement of Acetaldehyde production. Additionally, high cholesterol levels have been identified as a risk factor for faster breast cancer growth. 

On top of these points, Dr. Greger provides several tips for reducing your chances of developing breast cancer:

  1. Red wine or purple grapes can suppress the activity of the enzyme estrogen synthase. Therefore, they can suppress breast cancer growth. Alternatively, you can get the same benefits from eating pomegranates or white mushrooms
  2. Blind women have half the risk of breast cancer due to them producing higher amounts of melatonin. Research suggests that meat consumption, bad sleeping habits, and working late shifts can reduce melatonin production. Therefore, avoid each of these
  3. Walking at least an hour a day has been associated with a lower risk of breast cancer
  4. A high-fiber diet has been found to decrease the risk of breast cancer
  5. Apple peel is transformed into maspin, which is a cancer-suppressing compound. Additionally, sulforaphane, found in broccoli, fights against breast cancer cells
  6. Soybeans and tofu contain isoflavones. Isoflavones are a type of phytoestrogen that has been correlated with a lower risk of breast cancer and can help individuals who already have breast cancer


Mental health can have a significant impact on people’s physical health. Research suggests that arachidonic acid can increase the risk of depression. Arachidonic acid is found in eggs and chicken. Plus, you do not need this compound in your diet as your body naturally produces a healthy amount.

Depressed people have higher levels of monoamine oxidase enzymes. Antidepressants can boost these neurotransmitters, but certain foods have similar enzyme reduction effects. Plus, they have the benefit of no side effects. These foods are apples, grapes, onions, green tea, cloves, cinnamon, and nutmeg.

Dr. Greger’s top tips for incorporating natural antidepressants are:

  1. Exercise frequently
  2. Sesame seeds, pumpkins, and butternut squash are all high in tryptophan. Tryptophan is a building block of serotonin, so is good at curing social anxiety and depression
  3. Antioxidants and folates can fight against depression. Fruits and green leafy vegetables are high in antioxidants and folate
  4. Antidepressant pills are prescribed to 8% of the US population. However, they are no better than placebo and have multiple side-effects
  5. Saffron is as effective as Prozac, the leading antidepressant drug, at curing depression. However, saffron can be costly

Prostate Cancer

Research suggests that eggs and dairy products significantly increase your chances of developing prostate cancer. Specifically, organic cow’s milk increased the growth of human prostate cancer cells by about 30% within a petri dish. In contrast, almond milk suppressed the growth of cancer cells by 30%.

Although society is sold the idea that cow’s milk is vital for healthy bones, milk consumption is frequently associated with a higher fracture rate in women and a higher mortality rate in both men and women. 

Egg consumption has also been associated with a higher rate of prostate cancer. Eggs are very high in choline, which is converted to the toxin trimethylamine. However, the carcinogens in chicken and turkey are potentially the worst. This could be due to the high levels of Insulin-like growth factor-1. IGF-1 promotes cell division. Although cell division is vital at a young age, it promotes cancer in adulthood. Plant protein does not promote IGF-1 production, but animal protein does. 

Dr. Greger explains that a plant-based diet does not just prevent prostate cancer. Instead, research has suggested that it can help people get into remission. For example, strenuous cancer has a significant positive effect on cancer by encouraging their blood to kill 2000% more cancer cells. However, those who exercised and ate a plant-based diet killed 4000% more cancer cells.

The best foods for suppressing cancer are cruciferous vegetables and flaxseeds. Additionally, onion and garlic effectively reduce benign prostatic hyperplasia (struggling to urinate with age).

Parkinson’s Disease

Nicotine is actually associated with a lower rate of Parkinson’s. However, Dr. Greger does not recommend smoking. Instead, you can obtain the same amount of nicotine from tomatoes, bell peppers, and other nightshade vegetables.

Dairy consumption is very strongly correlated with Parkinson’s Disease. Although the underlying cause is not entirely clear, research suggests it could be the milk’s sugar, galactose, or the fact that milk suppresses uric acid. Uric acid is an essential antioxidant for the brain. 

Berries are useful tools for protecting everyone from Parkinson’s. Additionally, coffee has been found to reduce the effects of Parkinson’s. 

Daily Dozen checklist of Good Health

“The best way to minimize your exposure to industrial toxins may be to eat as low as possible on the food chain, a plant-based diet.”

– Dr. Michael Greger

In How Not to Die, Dr. Greger provides a simple guide to ensure you are eating the best foods to prevent you from developing any of the biggest killers. Plus, eating all of these foods will fill you up enough that you won’t be stretching for animal products. Dr. Greger also has a phone app that provides guidance on which foods fit into each category and allows you to tick off each of the daily dozen throughout the day. 

  1. Three servings of Beans
  2. One serving of Berries
  3. Three servings of other fruits
  4. One serving of Cruciferous vegetables
  5. Two servings of Greens
  6. Two servings of Other Vegetables
  7. One serving of Flaxseed
  8. One serving of Nuts
  9. One serving of Spices
  10. Three servings of Whole Grains
  11. Five servings of Beverages
  12. One workout session

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