How Not to Die

How Not to Die is a book by Dr. Michael Greger published in December 2015. It has become a top-rated book on Amazon, with over 1,000 five-star reviews. Dr. Greger is a remarkable physician who has made it his life mission to make accurate up-to-date nutritional information easily available to anyone who wants it. His website,, provides free updates on the latest in nutrition research, with a thousand bite-sized videos on nearly every aspect of healthy eating. New videos and articles are uploaded every day. How he accomplishes all this is as remarkable as the man himself.

Dr. Michael Greger

Dr. Michael Greger

He tells us briefly about the “why” in the introduction to his book. His beloved grandmother suffered from crushing chest pain even in a wheelchair. Her surgeons had done so many bypass operations that they couldn’t do any more, and her doctors had reached the limit of anything else they could do for her. She was sent home to die with the diagnosis of end-stage heart disease. By chance, she saw a segment on 60 Minutes about Nathan Pritikin and his new Pritikin Longevity Center in California. Pritikin was an engineer, not a physician, but he had become a nutritional and lifestyle expert who was gaining fame for his success in reversing terminal heart disease.

In desperation, Greger’s grandmother somehow made it to Pritikin’s Center in Santa Barbara, where physicians confirmed that she had very severe heart disease. She was put on the Pritikin plant-based diet and started on a carefully graded exercise program. As Greger puts it, they wheeled her in, but three weeks later she walked out. She was able to walk ten miles daily, and thanks to her healthy diet and lifestyle, she lived another 31 years to age 96. Michael was only a kid then, but he never forgot the dramatic turnaround in his grandmother’s health. It’s what eventually inspired him to go to medical school and to immerse himself in nutritional science.

Here’s a link to a 19-minute video of Greger telling this story and discussing heart disease, our No. 1 cause of illness and death.

Unfortunately, most physicians and medical schools are still mired in the old paradigm of treating heart disease with pills and surgery. Pills and surgery treat symptoms, but they do not address the underlying causes of disease. To quote Greger:

“Most deaths in the United States are preventable, and they are related to what we eat. Our diet is the number-one cause of premature death and the number-one cause of disability.”

He adds with considerable irony, “Surely, diet must also be the number-one thing taught in medical school, right?”

The answer? “Sadly, it’s not. According to the most recent national survey, only a quarter of medical schools offer a single course in nutrition, down from 37 percent 30 years ago. The teaching of nutrition in medical schools has actually declined over the past three decades, even as evidence has grown very strong that poor nutrition is a major factor in almost all of our major causes of death and disability.

Realizing this, Greger made it his goal while still in medical school to speak at every medical school in the country to make the new generation of doctors aware of the power of nutrition. He has become an internationally recognized author and speaker on nutrition and food safety. To keep current, he and his team review every scientific article about nutrition in the medical and scientific literature every month. Thousands of such articles are published monthly, so that’s no mean feat, but it makes him the top nutritional authority in the world.

The Plan of the Book

How Not to Die coverPart I of the book consists of 15 chapters that deal with the top 15 causes of death in the United States. Each chapter title incorporates the theme and title of the book. Chapter 1 is titled, “How Not to Die from Heart Disease”; Chapter 2 is “How Not to Die from Lung Disease”; and so on. Each chapter goes into the causes and epidemiology of the disease and then lays out the evidence that good nutrition helps prevent the disease or significantly improves the body’s ability to resist the disease.

With regard to heart disease, we know today that the early stages of atherosclerosis are found in nearly all American children by the age of ten. By the time we’re in our 20s and 30s, most have advancing stages of this disease, and by our forties, this disease starts killing us off. Often it has no symptoms until then. Yet this silent disease not only damages the structure of major arteries, but it also disturbs their normal functioning. To quote Greger:

“We’ve known for nearly two decades that a single fast-food meal can stiffen your arteries within hours, cutting in half their ability to relax normally.”

Medical science has made it clear over the past few decades that a healthy plant-based diet stops this disease process and even begins to reverse it. Medical education has not yet caught up with medical science, and public dietary policy remains deeply mired in the past.

Medical Care is a Leading Cause of Death

I won’t summarize each chapter, but Chapter 15, “How Not to Die from Iatrogenic Causes” (or “How Not to Die from Doctors”), is especially thought-provoking. Greger says: “Doctors excel at treating acute conditions, such as mending broken bones and curing infections.” Yet for chronic diseases, which are the leading causes of death and disability, “Conventional medicine doesn’t have much to offer and, in fact, can sometimes do more harm than good.” He shows the various ways in which this has been documented and concludes by citing Dr. Barbara Starfield’s scathing commentary in JAMA that medical care is the third-leading cause of death in the United States.

Although most doctors are skilled and caring, medical errors of one kind or another are made in significant enough numbers to be a serious concern. It’s better to avoid preventable diseases in the first place. That’s much better than living carelessly, thinking that doctors can fix whatever goes wrong. Doctors and medical technology can do marvelous things today, but God-given health is far superior to any kind of medical fix.

forkDr. Greger’s Daily Dozen

In Part 2 the author answers the question he gets asked most often in his presentations: “What do you eat every day, Dr. Greger?” He clearly identifies the foods that he and his family eat every day. They can be divided into eleven basic vegan groups, to which he adds exercise. Posting this “Daily Dozen” check-list on a little dry-erase board on their fridge, his family made a game of checking off the boxes as they were achieved during each day. He devotes a chapter for each category to explain its benefits, including a chapter on exercise as an essential component of a healthy lifestyle.

In his concluding chapter, Greger emphasizes that despite the title of the book, the point of living a healthy lifestyle is not to avoid dying. We’re all going to die some day. The real thrust of his book is how not to die prematurely. Unfortunately, suffering chronic illness or dying prematurely has become standard for too many people. Average 20-year-olds in America today may live for 59 more years but will suffer from the consequences of heart disease, cancer, diabetes, stroke, or other chronic disease for their final 13 years. They may not even be able to perform basic life activities for their last two years. This is not how life should be lived.

Greger points out that the purpose of living a healthy lifestyle is to make each day of our lives “count by filling it with fresh air, laughter, and love.

“Eating a whole-food, plant-based diet can help you live life to the fullest and allow you to experience greater joy, satisfaction, and pleasure from all the things you do – not just what you eat.”

My Concluding Thoughts

Dr. Greger has written a valuable book. (With more than 130 pages of references, it can be used as a nutritional reference book.) Based on his comprehensive research of the nutritional literature, his book makes it clear that what we eat is the major determinant of our health status. He says, “If there is one takeaway message, it’s that you have tremendous power over your health destiny.” I’ve heard Dr. Greger speak at the American College of Lifestyle annual meetings. He’s passionate about his message. He’s also an entertaining speaker with a wonderful sense of humor. His message about taking charge of your own health is never dull or boring.

I agree with his message, but will simply add that your mindset about lifestyle is immensely important. If you approach the concept of healthy living with the idea that it will be too hard for you, it will be. If you think that it’s going to be drudgery to live healthfully, it will be. But if you approach a healthy lifestyle with the idea that you can make it a great adventure, it will be. Your mindset will set the tone and it will make all the difference.

Be Well!
Ed Dodge, MD, MPH

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This post was published first in Dr. Ed Dodge’s Wellness Newsletter, Volume VIII, No. 8 • August 20, 2016.