Dr. Michael Greger’s international bestseller “How Not to Die” has captivated millions of readers with its compelling message: that a whole-food, plant-based diet can prevent and reverse many of our deadliest diseases. But does the science truly support these bold claims? This comprehensive review examines both the strengths and weaknesses of this influential 562-page nutrition guide.
The Origins of Dr. Greger’s Mission
Michael Greger’s journey into nutrition advocacy began with a profound childhood experience. He witnessed his grandmother, diagnosed with end-stage heart disease and sent home by doctors to await death, make a remarkable recovery following the low-fat Pritikin diet. This “miracle” transformation sparked a lifelong mission to promote food as medicine.
Today, Dr. Greger operates the science-focused website Nutrition Facts and has become an internationally recognized lecturer and physician. His book “How Not to Die” represents the culmination of decades of research advocacy, presenting what he believes is an evidence-based roadmap for preventing our most common causes of death through plant-based nutrition.
The Book’s Core Philosophy
The fundamental message of “How Not to Die” is straightforward: unprocessed plant foods promote health, while animal products and processed foods contribute to disease. Greger distinguishes his approach by using the term “plant-based” rather than the more restrictive “vegan” or “vegetarian,” allowing readers some flexibility in their dietary choices.
To his credit, Greger acknowledges human nature, advising readers not to be overly harsh on themselves for occasional indulgences. However, he maintains that the scientific evidence clearly shows that optimal health comes from plant-based eating, with any deviation being for pleasure rather than health benefits.
Strengths of the Book
Despite its controversial aspects, “How Not to Die” offers considerable value to readers of any dietary persuasion. The book features extensive references, covers a vast scope of nutritional topics, and makes a compelling case for viewing food as medicine. It also validates concerns about the profit-driven aspects of the medical industry.
Addressing Common Nutritional Myths
One of the book’s strongest contributions is dispelling widespread nutritional misconceptions. Greger effectively defends fruit consumption against mounting sugar fears, citing studies showing that even consuming twenty servings of fruit daily produced no adverse effects on weight, blood pressure, insulin, or cholesterol levels.
He also rehabilitates the reputation of phytates—often maligned as “antinutrients”—by discussing their protective properties against cancer. Similarly, he explores the benefits of legumes, demonstrating their positive effects on weight management, insulin sensitivity, blood sugar control, and cholesterol levels.
Legitimate Concerns About Animal Products
While much of the book focuses on well-worn arguments about saturated fat and cholesterol, Greger does highlight some genuine risks associated with animal products, particularly regarding foodborne pathogens and cooking methods.
Zoonotic Diseases and Meat Consumption
The book presents compelling evidence that humans can acquire diseases not just from proximity to farm animals, but from consuming them. Research suggests that urinary tract infections may originate from E. coli strains in chicken meat rather than from our own gut bacteria. These chicken-derived bacteria often show antibiotic resistance, making infections particularly difficult to treat.
Pork products carry their own risks, including Yersinia poisoning, which significantly increases the risk of developing autoimmune arthritis and possibly Graves’ disease. Additionally, hepatitis E virus, frequently found in pig liver, can survive in undercooked pork products.
Cooking Methods and Cancer Risk
Greger provides solid evidence linking high-temperature cooking of meat to cancer risk. Heterocyclic amines (HCAs), which form when muscle meat is exposed to high temperatures, have been associated with increased risk of breast, colon, esophageal, lung, pancreatic, prostate, and stomach cancers.
The solution isn’t necessarily eliminating meat, but rather changing cooking methods. Low-temperature cooking methods, such as boiling, appear dramatically safer than grilling, frying, or high-temperature roasting.
Critical Weaknesses: Cherry-Picking Evidence
The book’s most significant liability is its systematic misrepresentation of research to support a predetermined plant-based ideology. Throughout “How Not to Die,” Greger employs selective citation—presenting studies that support plant-based eating while ignoring or creatively reinterpreting those that don’t.
Misrepresenting Study Findings
Numerous examples reveal discrepancies between Greger’s claims and the actual research cited. For instance, when discussing kidney stones and vegetable consumption, he cites a study claiming high-oxalate vegetables aren’t problematic. However, the study only examined total vegetable intake, not specifically high-oxalate varieties, and the researchers actually suggested that high-oxalate vegetables might offset protective effects.
Similarly, when citing the EPIC-Oxford study on animal protein and kidney stones, Greger states that meat eaters had higher risk and vegetarians had lower risk. The study actually found that people eating small amounts of meat had lower risk than vegetarians, though heavy meat consumption did show the highest risk.
The Asthma and Animal Foods Controversy
Greger’s discussion of respiratory health demonstrates selective citation at its most problematic. He cites a 56-country study showing that diets high in starchy foods, grains, vegetables, and nuts protected against asthma symptoms. However, he omits that the same study found seafood consumption was inversely associated with all three measured conditions, with fish showing significant protection against severe wheezing.
Another Taiwan study he references found eggs associated with childhood asthma symptoms, but failed to mention that seafood showed the strongest protective effect against asthma diagnosis—stronger even than soy, fruit, and vegetables.
Additionally, Greger overlooks evidence that milk consumption may protect against asthma. A large Indian study he cites found that people who never consumed milk products were more likely to report asthma than daily milk consumers.
Dementia, Diet, and Incomplete Analysis
When discussing Alzheimer’s disease prevention, Greger highlights that Nigerians eating traditional plant-based diets have far lower rates than African Americans consuming omnivorous diets. While true, he omits that the broader analysis showed fish—not just plants—as a protective factor, particularly in European and American populations.
His discussion of Japan and China’s rising Alzheimer’s rates alongside increased meat consumption also lacks context. More thorough analysis reveals that diagnostic criteria changes artificially inflated dementia rates, and when accounting for these changes, the correlation between animal fat and dementia disappeared.
Regarding the apoE4 gene variant’s connection to Alzheimer’s risk, Greger suggests plant-based diets explain why some populations with high apoE4 prevalence have low Alzheimer’s rates. However, he ignores that many hunter-gatherer groups with high apoE4 prevalence and omnivorous diets also show low dementia rates, suggesting that lifestyle factors beyond plant-based eating—such as physical activity and unprocessed food consumption—may be more important.
The Soy and Breast Cancer Debate
Greger’s treatment of soy and breast cancer represents perhaps the most problematic cherry-picking in the book. He presents soy as protective against breast cancer, citing studies showing benefits from soy isoflavones. However, he fails to disclose how controversial and inconclusive the soy research actually is.
The studies he cites focus primarily on Asian women, yet protective effects consistently fail to appear in Western populations. Multiple meta-analyses have confirmed that soy’s association with reduced breast cancer risk exists among Asian women but not Western women. Genetic and microbiome differences may explain these population-specific effects.
Furthermore, while some cell studies suggest soy isoflavones can reactivate cancer-suppressing BRCA genes, other research shows these same compounds can enhance breast cancer growth, creating contradictory findings that Greger doesn’t acknowledge.
The Omega-3 Controversy
When discussing cardiovascular disease, Greger challenges the protective effects of omega-3 fats from fish by citing a controversial 2012 meta-analysis that found no significant benefits. However, this particular study was heavily criticized for numerous methodological flaws.
Critics pointed out that the studies used dosages only half of what’s recommended for heart disease prevention, employed unnecessarily stringent statistical cutoffs, and included populations where most patients were already taking statin drugs—which could mask omega-3 benefits.
More recent and methodologically sound reviews support omega-3 consumption for cardiovascular health, recommending two to three servings of oily fish weekly, particularly for high-risk patients.
Understanding the Selective Citation Strategy
The pattern throughout “How Not to Die” is consistent: Greger presents research supporting plant-based eating while systematically omitting or misrepresenting research that doesn’t fit this narrative. This approach transforms complex, nuanced scientific literature into a simplified black-and-white story where plant foods are universally beneficial and animal foods are categorically harmful.
In some cases, Greger redefines what “plant-based” means to claim victories for his dietary team. For example, he credits the Walter Kempner Rice Diet—based on white rice, refined sugar, and fruit juice—with reversing diabetic vision loss and treating kidney failure, despite this highly processed regimen bearing little resemblance to the whole-food, plant-based diet he recommends.
Quality Matters: The Missing Nuance
While discussing the genuine risks of foodborne pathogens from animal products, Greger remains silent on an important factor: raising conditions. Animals at highest risk of transmitting diseases are those raised in overcrowded, unsanitary commercial operations. Humanely raised livestock from quality sources present significantly lower risk.
Similarly, plant foods carry their own food safety risks, which the book largely ignores. A balanced presentation would acknowledge that food safety issues exist across all food categories and that sourcing and handling practices matter significantly.
The Value Despite the Flaws
Despite its biases and selective presentation, “How Not to Die” offers substantial value to readers willing to approach it critically. The book’s extensive references provide a launching point for further investigation, and its scope introduces readers to important nutritional concepts often ignored in mainstream health discussions.
Greger’s fundamental mission—empowering individuals with health information directly rather than relying solely on medical gatekeepers—is admirable and increasingly relevant in our information-democratized age.
Practical Takeaways
Readers can benefit from the book by extracting its genuinely useful insights while maintaining skepticism about its one-sided narrative. Key legitimate takeaways include:
- Whole plant foods provide numerous health benefits and deserve prominent placement in any healthy diet
- Fruit consumption shouldn’t be feared, even in relatively high amounts
- Legumes offer significant health benefits for weight management, blood sugar control, and cardiovascular health
- Cooking methods matter significantly for meat consumption, with lower-temperature methods being safer
- Food safety and sourcing quality are important considerations for all foods
- Dietary patterns matter more than individual foods
A Balanced Perspective on Plant-Based Eating
The evidence does support that increasing whole plant food consumption benefits most people’s health. However, the science doesn’t necessarily support the complete elimination of all animal products for optimal health, nor does it validate treating all animal foods as uniformly harmful.
Many healthy dietary patterns exist across cultures, from Mediterranean diets including fish and moderate dairy to traditional Asian diets with small amounts of meat and seafood. The common threads among these healthy patterns are:
- Abundant vegetables, fruits, and other plant foods
- Minimal processed foods
- Appropriate caloric intake
- Regular physical activity
- Strong social connections
The Bottom Line
Dr. Michael Greger’s “How Not to Die” is a passionate, extensively researched work that makes important contributions to nutritional literacy. However, its systematic bias toward plant-based eating leads to cherry-picked evidence, misrepresented studies, and an oversimplified narrative that doesn’t reflect the complexity of nutritional science.
The book works best as a starting point for exploration rather than an authoritative final word. Readers who fact-check claims, examine cited references, and maintain healthy skepticism will gain valuable insights while avoiding the pitfalls of its one-sided presentation.
For those interested in plant-based eating, the book provides motivation and practical information. For those seeking objective nutritional guidance, it should be balanced with more comprehensive resources that acknowledge the full spectrum of dietary research.
Ultimately, the democratization of health information that Greger champions requires not just access to information, but also critical thinking skills to evaluate it. “How Not to Die” can be a valuable tool for health improvement—provided readers approach it with both open minds and discerning eyes.
Recommendations for Readers
To get the most from “How Not to Die” while avoiding its weaknesses:
- Cross-reference claims with cited studies to verify accuracy
- Seek out additional perspectives on controversial topics
- Recognize that nutritional science is complex and rarely black-and-white
- Focus on increasing whole plant foods rather than necessarily eliminating all animal products
- Consider food quality and sourcing alongside food category
- Consult with qualified healthcare providers before making major dietary changes, especially if you have existing health conditions
- Remember that individual responses to dietary patterns vary
The journey toward optimal health is personal and multifaceted. While “How Not to Die” offers one perspective, true health literacy comes from examining multiple viewpoints and understanding the nuance and limitations inherent in nutritional research.
Sources:
- NutritionFacts.org – Dr. Michael Greger’s Official Website
- PubMed Central – National Institutes of Health Database
- PubMed – Biomedical Literature Database
- JAMA Network – Journal of the American Medical Association
- Nature – International Journal of Science
- European Respiratory Journal
- Centers for Disease Control and Prevention
⚕️ Medical Disclaimer
This content is for informational purposes only and does not constitute medical advice. The information provided has not been evaluated by the Food and Drug Administration (FDA) and is not intended to diagnose, treat, cure, or prevent any disease.
Always consult with a qualified healthcare professional before making any changes to your diet, taking supplements, or starting any health regimen. Individual results may vary.