Discover the foods scientifically proven to prevent and reverse disease
Life gets busy. Has How Not to Die been on your reading list? Learn the key insights now.
We’re scratching the surface in this How Not to Die summary. If you don’t already have Michael Greger’s popular book on health and nutrition, order it here or get the audiobook for free on Amazon to learn the juicy details.
Disclaimer: The content presented here is for entertainment purposes only. It is not a replacement for professional medical advice.
Do you want a long and healthy life? Making the right choices today can make a big difference in the years ahead.
The vast majority of premature deaths can be prevented through simple changes in diet and lifestyle. How Not to Die examines the top causes of death in America. When it comes to tackling these key causes of death, nutritional and lifestyle interventions can sometimes trump prescription pills and other pharmaceutical and surgical approaches. 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.
You may be used to hearing that you should avoid eating certain foods. The common link between the most harmful foods is that they are animal products. Here you can find out why they are so damaging to your health. What you may not realize is that many foods are actively beneficial and some can help prevent and even treat killer diseases. Learn what to eat and what to avoid to give yourself the best chance of a long life. Other lifestyle changes, like regular exercise and stopping smoking, can help you on your way.
Listen to The audiobook summary of How Not to Die.
About Dr. Michael Greger and Gene Stone
Dr. Michael Greger is a physician specializing in clinical nutrition. He is also a New York Times bestselling author and an internationally recognized speaker on nutrition, food safety, and public health issues. Dr. Greger is a founding member and Fellow of the American College of Lifestyle Medicine. He is licensed as a general practitioner specializing in clinical nutrition. He graduated from 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. 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
Gene Stone is an American author who is best known for his book “How Not to Die.” Stone has also written several other books on health and wellness, including “The Engine 2 Diet,” “The Secrets of People Who Never Get Sick,” and “The Ultimate Guide to Plant-Based Nutrition.” He has also co-authored several books with other authors, including “The Cancer Survivor’s Guide” and “The Survival Handbook.” Stone has a background in journalism and has worked as a writer and editor for various publications.
StoryShot #1: There Are 14 Top Killer Diseases
How Not to Die tackles the leading causes of death in turn, starting with the worst offender. We learn the factors associated with each disease. We then learn how to reduce your chances of contracting and dying from each disease.
According to the book, the 14 biggest killer diseases are:
- Heart disease
- High blood pressure
- Kidney disease
- Liver disease
- Neurological diseases (such as Alzheimer’s and Parkinson’s)
- Lung diseases (such as COPD and lung cancer)
- Digestive diseases (such as inflammatory bowel disease and colon cancer)
- Infectious diseases (such as AIDS and pneumonia)
- Mental health disorders (such as depression and anxiety)
These diseases are responsible for the majority of deaths worldwide. They can often be prevented or reversed through lifestyle changes. This includes following a healthy diet and exercising regularly.
StoryShot #2: Prevent Heart Disease
Heart disease is the biggest killer in the world. It is primarily caused by high LDL levels, the ‘bad’ type of cholesterol. High LDL cholesterol levels can place added strain on your heart and can ultimately lead to a heart attack. Aim to have a total cholesterol rating of around 150 mg/dL or lower. The US average for total cholesterol is currently 200 mg/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;
- and 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, they have been associated with liver damage, muscle damage, and memory loss.
Animal products are often particularly high in cholesterol. But there are other reasons animal products are associated with artery inflammation. For example, meats are filled with endotoxins. These are bacteria that require sufficient temperatures to be killed. Otherwise, the blood absorbs them. High levels of these endotoxins in your blood lead to artery inflammation and more significant strain on your 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 change the 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. They had very little heart disease. But since the introduction of the Western diet into their societies, heart disease levels have shot up.
Dr. Greger’s tips for avoiding heart disease are as follows:
- Avoid Omega-3 fish oil supplements. A famous DART study suggested that fish oil reduced mortality by 29%. But on follow-up, those who had taken fish oil had a higher rate of mortality.
- Eat brazil nuts. Just four Brazil nuts a month can lower cholesterol levels. However, do not eat too much, as they are high in selenium.
- Eat lots of kale. Kale has been found to reduce LDL cholesterol levels and enhance good (HDL) cholesterol levels.
- Avoid all animal products. Animal products are the greatest contributor to our biggest killer.
StoryShot #3: Prevent 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 percent of lung cancer deaths. Plus, smoking increases your chance of catching cancer by 10-20 times. Even second-hand smoking can increase your cancer risk by 20-30 percent.
As well as avoiding smoking, you can make some dietary choices to avoid some lung diseases. For example, 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. So, if you are struggling to give up smoking, broccoli could slightly reduce the impact of cigarettes.
StoryShot #4: Prevent Brain Diseases (Stroke and Alzheimer’s)
Strokes are associated with high blood pressure. 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.
To reduce your risk of stroke:
- Make sure you are sleeping well. Seven to eight hours of sleep is the optimal amount to avoid stroke. Sleeping too little or too much has been associated with increased stroke risk.
- Fiber-rich foods decrease your stroke risk. For every 7 grams of fiber you eat, your risk of stroke is reduced by 7 percent.
- 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 1640 mg of potassium per day can reduce stroke risk by 21 percent.
- 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. Hesperidin can help you feel warmer during a cold winter (because of the increased blood flow).
Alzheimer’s disease is caused by plaque deposition in the vessels supplying vessels to the brain. 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 significantly lower levels of animal fat in their diet.
To reduce your chances of getting Alzheimer’s disease:
- Exercise regularly. Regular exercise can improve your cognitive abilities if you have already been diagnosed with Alzheimer’s disease.
- Eat saffron. Research suggests that saffron, the spice, is as effective as the leading medication for Alzheimer’s disease, donepezil. However, donepezil is not very effective.
- Incorporate more cranberries, blueberries, strawberries, and grape juice into your diet. These foods contain polyphenols which can reduce cognitive decline in the elderly.
StoryShot #5: Prevent 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.
Animal fat is 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 percent. 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 average risk of pancreatic cancer. Additionally, both red meat and poultry consumption have been correlated with esophageal cancer. This is potentially due to the acid reflux associated with these foods.
Another significant risk factor for pancreatic cancer is smoking. Smoking will double your risk of pancreatic cancer.
To reduce your risk of digestive cancers:
- Eat lots of vegetables, berries, apples, and citrus fruits. Each of these foods has been associated with significantly reducing the risk of digestive cancers. If you already have esophageal cancer, strawberries could potentially help cure it.
- Eat enough fiber. Inadequate intake of fiber can cause constipation. Plus, fiber binds to toxins that have been associated with cancer, such as mercury and lead.
- Avoid excess iron. 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.
- Consume non-heme iron. Nuts, seeds, and dry fruits are good sources of iron that do not increase your risk of cancer.
- Eat turmeric. A small amount of turmeric each day can reduce your risk of digestive cancers. This is why India has a much lower rate of colorectal cancer than the U.S.
StoryShot #6: Avoid Infections from Animal Products
Animal products are the most significant contributors to another of the biggest killers. They can contain deadly infections.
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, even 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 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.
Pork is associated with Yersinia bacterial infections. Recent consumer reports have shown that two-thirds of pork samples are infected with these bacteria.
To reduce your risk of getting and spreading infections:
- Eat more fruits and vegetables. They boost your immune system.
- Incorporate blueberries and cardamon into your diet. They boost your antibodies.
- Eat broccoli and other cruciferous vegetables. They boost your immune system’s effectiveness against pathogens and pollutants.
- Eat garlic. It’s an effective treatment for pneumonia.
- Eat prebiotics like legumes. Your gut bacteria are crucial for immunity. Prebiotics are what good bacteria like to eat.
- Exercise regularly. It will improve your immune system and reduce your chances of catching the common cold.
- Eat mushrooms. They boost your immunity by increasing IgA in your saliva by up to 50%. IgA is a protein that neutralizes toxins and pathogens.
StoryShot #7: Prevent Diabetes
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 have been correlated with type two diabetes. This includes diets that include large amounts of animal products. 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.
Trimming your belly fat is one of the most effective approaches for preventing or reversing diabetes. However, instead of starving yourself, eat lots of legumes. Legumes are highly filling and calorie-dense.
Don’t just reduce your meat intake. Cut out all animal products. A Taiwanese study found that vegetarians have a 50-75% lower chance of being diagnosed with diabetes than individuals who eat a traditional Asian diet, which includes very little fish and other meat. Dr. Greger also recommends eating whole grains like brown rice. Whole grains have been found to reduce type two diabetes risk. Refined grains like white rice increase type two diabetes risk.
StoryShot #8: Avoid 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 bodies have learned to conserve salt. Now that we consume excess salt, our bodies raise their blood pressure to push out the excess salt. Diets high in salt can also reduce blood flow in the arteries.
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 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 old – chicken;
- older than 50 – bread
To reduce your blood pressure:
- Eat three portions of whole grains a day.
- Consume flaxseeds.
- Switch to non-alcoholic wine.
- Drink hibiscus tea.
StoryShot #9: Prevent Liver Diseases
Fatty liver disease is most commonly associated with heavy alcohol consumption. However, this is not the most common cause of liver problems. Non-alcoholic fatty liver disease (NAFLD) is the most common cause. 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%.
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. The hepatitis E virus originates from pork livers. Cook pork thoroughly to prevent the spread of the hepatitis E virus.
To prevent liver disease:
- Eat oatmeal and drink coffee every morning. Coffee has been identified as an effective prevention for liver cancer and hepatitis C.
- Eat berries, grapes, red onions, and plums. These foods are high in anthocyanins. Anthocyanins reduce fatty cell deposition in the liver.
- Eat cranberries. If you have liver cancer, cranberries have been identified as the most effective food for suppressing the growth of cancerous cells in the liver. Instead of buying processed cranberry juices, you should buy frozen whole cranberries
StoryShot #10: Prevent 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. These abnormal white blood cells crowd out healthy white blood cells.
Lymphoma occurs when lymphocytes, which are a 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 ability to filter blood.
Finally, myeloma happens when abnormal plasma cells, another type of white blood cell, produce too many antibodies. This excess of antibodies clogs the kidneys.
Chicken is frequently associated with all blood cancers. Eating just 50 grams of chicken per day is associated with an increased risk of between 56 and 280 percent of being diagnosed with blood cancer. Dr. Greger attributes this increased risk to poultry viruses, as poultry farmers and butchers have significantly higher blood cancer rates, irrespective of how much poultry they eat.
To prevent blood cancer:
- Adopt a plant-based diet. This will reduce your cancer risk.
- Eat 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
- Eat acai berries. Studies have found acai berries can kill leukemia cells in a petri dish.
- Consume antioxidants. Certain vegetables have incredibly high levels of antioxidants, which are useful for preventing cancer. Purple cabbage offers the best proportion of antioxidants per dollar
StoryShot #11: Prevent 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.
Animal protein, animal fat, and cholesterol have all been associated with kidney degradation. Animal protein causes inflammation and triggers hyperfiltration in the kidneys. Hence, it 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 products contain high levels of easily absorbable phosphate. Contrastingly, plant-based 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. Make sure you avoid buying anything that includes pyrophosphate or sodium triphosphate.
Meat contains more nitrosamines, a cancer-causing compound, than cigarettes. In fact, eating one hot dog is equivalent to smoking four cigarettes.
StoryShot #12: Prevent Breast Cancer
Alcohol has been associated with breast cancer through its encouragement of acetaldehyde production. High cholesterol levels may also accelerate breast cancer growth.
To reduce your chances of developing breast cancer:
- Eat purple grapes, pomegranates and white mushrooms and drink red wine (in moderation). This can suppress the activity of the enzyme estrogen synthase. Therefore, they can suppress breast cancer growth.
- Eat apples and broccoli. Apple peel is transformed into maspin, which is a cancer-suppressing compound. Sulforaphane in broccoli fights against breast cancer cells.
- Eat soybeans and tofu. They contain isoflavones, a type of phytoestrogen that has been correlated with a lower risk of breast cancer. They can help individuals who already have breast cancer.
- Preserve your melatonin. Blind women have half the risk of breast cancer as they produce higher amounts of melatonin. Research suggests that meat consumption, bad sleeping habits, and working late shifts can reduce melatonin production. Therefore, avoid these.
- Walk at least an hour a day. Regular exercise reduces your cancer risk.
- Adopt a high-fiber diet. Fiber is essential for a healthy diet.
StoryShot #13: Avoid Depression
Mental health can have a significant impact on physical health.
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.
Antidepressant pills are prescribed to 8% of the US population. However, Dr. Greger claims that they are no better than a placebo and have multiple side-effects. Dr. Greger also claims that there are alternatives to taking pills. To benefit from natural antidepressants:
- Exercise frequently. It can help you feel better.
- Eat sesame seeds, pumpkins, and butternut squash. They are all high in tryptophan. Tryptophan is a building block of serotonin, so is good at curing social anxiety and depression.
- Eat fruits and green leafy vegetables. They are rich in antioxidants and folates that can fight against depression.
- Eat saffron. Saffron compares favorably to Prozac, the leading antidepressant drug for curing depression. However, saffron can be costly.
StoryShot #14: Prevent 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%.
We are sold the idea that cow’s milk is vital for healthy bones. But 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 high levels of insulin-like growth factor-1 (IGF-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.
A plant-based diet does not just prevent prostate cancer. Research has suggested that it can help people get into remission. So can strenuous exercise. It has been shown to encourage the blood to kill 2000% more cancer cells. However, those who both 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).
StoryShot #15: Prevent Parkinson’s Disease
Nicotine is 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 help protect you from Parkinson’s. Additionally, coffee has been found to reduce the effects of Parkinson’s.
StoryShot #16: Use the Daily Dozen Checklist for Good Health
Use the “daily dozen” checklist. It’s a simple guide to ensure you are eating the best foods to prevent the biggest killers. Eating all of these foods will also 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. It allows you to tick off each of the “daily dozen” throughout the day.
Your daily dozen is comprised of:
- Three servings of beans
- One serving of berries
- Three servings of other fruits
- One serving of cruciferous vegetables
- Two servings of greens
- Two servings of other vegetables
- One serving of flaxseed
- One serving of nuts
- One serving of spices
- Three servings of whole grains
- Five servings of beverages
- One workout session
Final Summary and Review
Dr. Michael Greger is a physician and author who has dedicated his career to promoting public health. In How Not to Die, he argues that many premature deaths can be prevented through simple lifestyle changes, particularly those related to diet.
Dr. Greger presents evidence to support the idea that a plant-based diet, rich in whole grains, fruits, vegetables, and legumes, can be effective in preventing and reversing many of the leading causes of death and disease. He discusses the role of specific nutrients and phytochemicals found in plants, and how they can help to support the body’s natural defenses against illness.
Other lifestyle factors can impact health, such as physical activity, stress management, and sleep. Dr. Greger provides practical tips and strategies for making healthy choices in these areas. He emphasizes the importance of taking a holistic approach to health and well-being.
Overall, How Not to Die is a comprehensive guide to living a healthy and disease-free life. It is a valuable resource for anyone looking to improve their health and reduce their risk of premature death.
We rate How Not to Die 4.5/5.
How would you rate Michael Greger and Gene Stone’s book?
How Not to Die Infographic
This piece was first published in August 2021. It was updated and revised in February 2023.
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