How Not To Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease
Authors: Michael Greger, Gene Stone
Publication Year: 2017
Page Count: 672
Overview and Purpose
How Not To Die is a comprehensive, evidence-based guide that explores the role of diet and lifestyle in preventing and reversing the leading causes of premature death, including many cancers and chronic diseases. Dr. Michael Greger, a physician and internationally recognized nutrition expert, draws on a vast body of scientific research to detail how whole-food, plant-based diets rich in fruits, vegetables, legumes, nuts, seeds, herbs, spices, and whole grains can dramatically reduce risk factors and improve health outcomes. The book is designed to empower readers—patients, caregivers, clinicians, and the general public—with practical, actionable knowledge to take control of their health through nutrition and lifestyle changes.
The book is structured into two main parts: Part 1 focuses on specific diseases and how diet and lifestyle influence their development and progression, while Part 2 provides practical dietary guidance, tools, and recommendations to implement the principles discussed.
Intended Audience
The book targets a broad audience including individuals seeking to prevent or manage chronic diseases, healthcare professionals interested in nutrition-based interventions, caregivers, and anyone motivated to improve longevity and quality of life through diet. It addresses the gap in medical education regarding nutrition and advocates for lifestyle medicine as a primary approach to health.
Part 1: Disease-Specific Evidence and Prevention Strategies
Preface and Introduction
The author’s personal motivation stems from witnessing his grandmother’s reversal of end-stage heart disease through a plant-based diet, inspiring his medical career focused on nutrition. Despite robust scientific evidence supporting diet and lifestyle interventions, modern medical practice remains heavily reliant on pharmaceuticals and procedures, partly due to financial incentives and insufficient nutrition education in medical training. Dr. Greger founded NutritionFacts.org to provide free, evidence-based nutrition information to the public.
Chronic diseases such as heart disease, cancer, diabetes, and neurodegenerative disorders are largely preventable and often reversible through lifestyle changes. The book emphasizes primordial prevention—preventing the development of risk factors themselves—primarily through diet and lifestyle. Meat and processed animal products are identified as significant contributors to disease risk, while whole plant foods offer protective benefits. Four key lifestyle factors—avoiding smoking, maintaining healthy weight, regular exercise, and a healthy diet—can reduce chronic disease risk by up to 90%. Additionally, diet and lifestyle influence cellular aging mechanisms, including telomere length and gene expression.
1. How Not to Die from Heart Disease
Coronary heart disease remains the leading cause of death in the United States, primarily driven by atherosclerosis. Populations consuming traditional plant-based diets, such as rural Chinese and African communities, historically exhibit low rates of heart disease and low cholesterol levels. Transitioning to Western diets rich in animal products correlates with increased disease risk.
Elevated low-density lipoprotein (LDL) cholesterol is the primary modifiable risk factor, with an optimal target of 50-70 mg/dL. While statins effectively lower cholesterol, they carry side effects. Plant-based diets reduce LDL cholesterol naturally and safely, with clinical trials (Pritikin, Ornish, Esselstyn) demonstrating reversal of heart disease through diet and lifestyle changes.
Animal products contribute to rapid arterial dysfunction via endotoxins. Specific foods like Brazil nuts have been shown to sustainably lower LDL cholesterol. Despite compelling evidence, medical practice often neglects dietary counseling due to industry influence and perceived patient resistance.
2. How Not to Die from Lung Diseases
Lung diseases including lung cancer, chronic obstructive pulmonary disease (COPD), and asthma are largely preventable. Smoking accounts for 90% of lung cancer deaths, and cessation yields immediate health benefits. Cruciferous vegetables reduce DNA damage from tobacco carcinogens, while turmeric exhibits chemopreventive properties.
Dietary exposure to secondhand smoke carcinogens occurs during frying of meat, and processed meats increase lung cancer risk. Plant-based alternatives produce fewer harmful compounds. Fruits and vegetables improve asthma symptoms and lung function, reducing medication dependence.
3. How Not to Die from Brain Diseases
Stroke and Alzheimer’s disease are major contributors to brain-related mortality and morbidity. High dietary fiber and potassium intake reduce stroke risk by protecting arteries and reducing inflammation. Alzheimer’s disease is linked to brain artery atherosclerosis, which diet can modulate.
Plant-based and Mediterranean diets slow cognitive decline. Specific foods such as blueberries, strawberries, and saffron may enhance cognition. Reducing intake of advanced glycation end products (AGEs) from cooked animal products may be beneficial. Aerobic exercise improves brain function and can reverse brain shrinkage.
4. How Not to Die from Digestive Cancers
Diet plays a critical role in digestive cancers including colorectal, pancreatic, and esophageal cancers. Turmeric’s active compound curcumin reduces colorectal cancer precursors. Indian diets rich in phytates from legumes confer protection. Meat consumption increases colorectal cancer risk, while beans and berries reduce it.
Excess heme iron from meat is linked to cancer risk. Pancreatic cancer risk is elevated by smoking, obesity, alcohol, and poultry consumption; curcumin shows promise in treatment. High-fat diets increase acid reflux and esophageal cancer risk, whereas fiber reduces hiatal hernia and related conditions. Strawberries have reversed precancerous esophageal lesions in studies. Plant foods enhance immune function and block environmental carcinogens.
5. How Not to Die from Infections
(Not detailed in the provided text; presumably discusses diet’s role in immune function and infection resistance.)
6. How Not to Die from Diabetes
Type 2 diabetes is a global epidemic driven by insulin resistance caused by fat accumulation in muscle and liver cells. Plant-based diets reduce diabetes risk and can reverse the disease. Consumption of meat, eggs, and dairy increases risk, while legumes promote weight loss and glycemic control.
Saturated fats impair insulin secretion and action. Plant-based diets improve insulin sensitivity, reduce medication needs, and alleviate neuropathy. Waist-to-height ratio is a superior predictor of health risk compared to BMI. Early intervention in prediabetes and childhood obesity is critical for prevention.
7. How Not to Die from High Blood Pressure
Hypertension causes approximately 9 million deaths annually worldwide. Excess sodium intake is a major risk factor; humans evolved consuming very low sodium levels. Reducing sodium lowers blood pressure and prevents cardiovascular deaths.
Processed foods and injected salt in poultry contribute to high sodium intake. Whole grains lower blood pressure and disease risk. The DASH diet emphasizes fruits, vegetables, and low-fat dairy but is not exclusively plant-based. Vegetarian and vegan diets achieve greater blood pressure reductions.
Flaxseeds and hibiscus tea effectively lower blood pressure. Nitrate-rich vegetables like beetroot and leafy greens improve arterial dilation and enhance athletic performance.
8. How Not to Die from Liver Diseases
Liver disease mortality is rising, with alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD) common. Alcohol causes fatty liver and cirrhosis, but abstinence can reverse damage. NAFLD is linked to obesity, sugary drinks, and meat consumption. Dietary cholesterol triggers liver inflammation.
Hepatitis viruses (A-E) have various transmission routes; vaccines exist for A and B. Some supplements and herbals can cause liver injury, highlighting the need for caution. Whole grains and anthocyanin-rich foods protect liver health. Coffee consumption lowers chronic liver disease and liver cancer risk.
9. How Not to Die from Blood Cancers
Blood cancers include leukemia, lymphoma, and multiple myeloma. Plant-based diets are associated with nearly 50% lower risk. Cruciferous vegetables contain sulforaphane, which induces apoptosis in leukemia cells. Higher vegetable intake improves lymphoma survival.
Antioxidant supplements may increase mortality risk; food synergy is important. Poultry consumption is linked to increased lymphoma risk, possibly due to viral contamination. Pet ownership correlates with lower lymphoma risk, potentially due to immune modulation.
10. How Not to Die from Kidney Disease
Chronic kidney disease (CKD) is common and often undiagnosed. Animal protein causes kidney hyperfiltration and damage, whereas plant protein does not. Fruits and vegetables neutralize dietary acid load, protecting kidney function.
Phosphate additives in processed meats and poultry increase kidney damage risk. Plant-based diets protect kidney function and reduce kidney stone risk.
11. How Not to Die from Breast Cancer
Breast cancer risk is reduced by limiting alcohol, consuming plant-based foods, and maintaining healthy weight. Alcohol is a carcinogen with no safe consumption level. Melatonin suppresses cancer growth but is disrupted by light pollution and night shifts.
Exercise lowers breast cancer risk. Heterocyclic amines (HCAs) from well-done meat increase risk, while high cholesterol is linked to increased breast cancer incidence. Plant-based diets, broccoli, flaxseeds, and soy reduce risk and improve outcomes. Soy isoflavones reactivate tumor suppressor genes. Asian diets rich in soy, green tea, and mushrooms correlate with lower breast cancer rates.
12. How Not to Die from Suicidal Depression
Depression is linked to inflammation and diet. Plant-based diets reduce arachidonic acid intake, lowering depression risk. Fruits, vegetables, and spices contain natural monoamine oxidase (MAO) inhibitors.
Saffron matches antidepressants in efficacy with fewer side effects. Coffee reduces suicide risk. Conventional antidepressants have limited efficacy and notable side effects. Exercise is as effective as medication. Lifestyle interventions offer safer alternatives.
13. How Not to Die from Prostate Cancer
Dairy, eggs, and poultry consumption are linked to increased prostate cancer risk. Plant-based diets combined with exercise improve blood’s ability to suppress cancer cells. Flaxseed reduces tumor proliferation.
Insulin-like growth factor 1 (IGF-1) promotes cancer; animal protein raises IGF-1 levels, while plant protein lowers it. Lifestyle changes can slow or reverse prostate cancer progression.
14. How Not to Die from Parkinson’s Disease
Environmental toxins and animal fat consumption increase Parkinson’s disease (PD) risk. Plant-based diets reduce toxin exposure. Nicotine from smoking and nightshade vegetables may be neuroprotective. Dairy intake is linked to increased PD risk.
Flavonoids and caffeine reduce PD risk and symptoms. Antioxidant-rich diets and physical exercise provide neuroprotection.
15. How Not to Die from Iatrogenic Causes
Medical errors cause up to 300,000 deaths annually in the US. Hospital infections and unnecessary procedures contribute significantly. Diagnostic radiation carries cancer risk; plant-based diets protect against radiation damage.
Drugs often offer modest benefits; plant-based diets are more effective in prevention. Aspirin reduces heart attack and cancer risk but has side effects; salicylic acid in plants offers similar benefits safely. Colonoscopies carry risks; safer alternatives exist but are underused. Lifestyle medicine focuses on prevention and reducing iatrogenic harm.
Part 2: Practical Dietary Guidance and Tools
Part 2 provides actionable advice for adopting a health-promoting diet. The Traffic Light system categorizes foods as green (eat more), yellow (moderate), and red (avoid), helping readers make informed choices. The Daily Dozen checklist encourages daily consumption of key food groups.
The Standard American Diet (SAD) is characterized by low intake of fruits, vegetables, and whole grains, and high intake of processed foods. The book defines processing as “nothing bad added, nothing good taken away,” encouraging consumption of minimally processed whole foods.
Flexibility is encouraged to improve adherence, with emphasis on removing unhealthy foods first. Resources for recipes and community support are provided.
Legumes, Berries, and Cruciferous Vegetables
Legumes (beans, lentils, chickpeas, soy) are recommended at three servings daily, providing protein, fiber, and phytochemicals. Whole soy foods (edamame, tempeh, miso) are preferred; concerns about GMOs and pesticides are addressed.
Plant-based meat alternatives are healthier than meat but less nutritious than whole legumes. Lentils exhibit a “second-meal effect,” improving blood sugar control. Beans reduce cholesterol and cancer risk; flatulence decreases with adaptation.
Berries are rich in antioxidants and recommended at one serving daily. Diverse colorful fruits and vegetables provide a spectrum of antioxidants. Cruciferous vegetables contain sulforaphane, a potent anticancer compound; cooking methods affect its availability. Greens are nutrient-dense and recommended at two servings daily. Pairing greens with sweet flavors or healthy fats enhances taste and nutrient absorption.
Vegetables, Nuts, Herbs, and Spices
Cooking methods influence nutrient retention; microwaving preserves antioxidants better than boiling or deep-frying, which may increase cancer risk. Washing produce with saltwater or vinegar removes pesticides more effectively than water alone; organic produce has higher antioxidants but is costlier.
Flaxseeds (one tablespoon ground daily) benefit blood pressure and reduce breast and prostate cancer risk. Nuts and seeds consumed daily (about 30 grams) extend lifespan and reduce cancer and cardiovascular mortality. Walnuts have the highest antioxidants and omega-3 content. Nut consumption does not cause weight gain due to satiety and metabolic effects. Pistachios improve erectile dysfunction by enhancing blood flow.
Herbs and spices such as turmeric, ginger, garlic, and cinnamon have antioxidant and anti-inflammatory properties. Turmeric’s curcumin is extensively studied for multiple diseases; black pepper increases its bioavailability. Turmeric supplements may have safety concerns; whole turmeric powder is safer. Fenugreek improves muscle strength and has anticancer properties; coriander reduces inflammation and uric acid. Capsaicin (cayenne pepper) treats cluster headaches and reduces gastrointestinal pain. Ginger is effective for migraines, menstrual pain, and nausea.
Whole Grains and Gluten
Whole grains reduce inflammation and risk of heart disease, diabetes, and cancer. Polyphenols bound to fiber contribute to these benefits. Pigmented whole grains have anticancer and anti-allergic properties. Oats contain unique anti-inflammatory compounds beneficial for skin and colon health.
Gluten-related disorders are complex; gluten-free diets are not beneficial for the general population and may harm gut flora if unnecessary.
Hydration, Beverages, and Sweeteners
Water is essential for health. Coffee and tea consumption are linked to reduced mortality and disease risk, though some cautions apply for specific conditions. Artificial sweeteners have mixed effects on weight and metabolism; erythritol is considered safer than others.
Physical Activity and Obesity
Physical inactivity and prolonged sitting increase mortality risk. Exercise improves vascular health, reduces oxidative stress, and supports brain function. Obesity shares neurobiological mechanisms with addiction; whole-food, plant-based diets restore dopamine sensitivity and aid weight management.
Supplements
Supplements are necessary only for critical nutrients that may be insufficient in plant-based diets. Vitamin B12 is essential for all plant-based eaters. Vitamin D supplementation is recommended for those with insufficient sun exposure. Iodine intake is important, especially during pregnancy. Algae-based omega-3 supplements are preferred over fish oil due to contamination risks.
Strengths and Contributions
How Not To Die stands out for its exhaustive review of scientific literature linking diet and lifestyle to prevention and reversal of major diseases. It bridges the gap between research and practical application, providing clear, accessible guidance supported by clinical trials and epidemiological data. The book’s disease-specific chapters offer detailed insights into mechanisms, risk factors, and dietary interventions, making it a valuable resource for clinicians and patients alike.
The inclusion of Part 2 with practical tools such as the Traffic Light system and Daily Dozen checklist facilitates implementation. The emphasis on whole-food, plant-based nutrition aligns with emerging evidence in lifestyle medicine and public health.
Limitations and Cautions
While the book extensively advocates for plant-based diets, it acknowledges that flexibility and individual preferences are important for adherence. Some supplements and herbs discussed require cautious use due to potential toxicity or contamination. The book does not replace individualized medical advice but complements it by emphasizing prevention and lifestyle modification.
Relevance to Cancer-Options Reference Database
This book is highly relevant for cancer prevention and survivorship contexts, providing evidence-based dietary strategies to reduce risk and improve outcomes for multiple cancers including breast, prostate, colorectal, pancreatic, esophageal, and blood cancers. Its detailed exploration of phytochemicals, antioxidants, and anti-inflammatory foods supports integrative oncology approaches.
Moreover, the book’s focus on reversing disease processes through nutrition offers hope for patients and caregivers seeking non-toxic, accessible interventions. The comprehensive nature of the work, combined with practical guidance, makes it a valuable reference for clinicians advising patients on lifestyle modifications to complement conventional cancer therapies.
