Dr. Michael Greger’s “How Not to Die” has captured the attention of health-conscious readers worldwide, becoming an international bestseller that promises to help people prevent and reverse the leading causes of death through dietary changes. But does this 562-page guide deliver on its ambitious promises, or does it paint an oversimplified picture of nutrition science?
As a prominent physician, international speaker, and founder of the science-based website Nutrition Facts, Dr. Greger brings considerable credentials to the table. His personal motivation stems from witnessing his grandmother’s remarkable recovery from heart disease through the Pritikin diet—a transformation that doctors had deemed impossible. This experience launched his lifelong mission to promote the healing power of plant-based nutrition.
This comprehensive review examines both the valuable insights and potential shortcomings of “How Not to Die,” helping readers navigate the book’s extensive research while maintaining a critical, evidence-based perspective.
Understanding the Book’s Core Philosophy
At its foundation, “How Not to Die” advocates for a whole-food, plant-based diet as the ultimate weapon against chronic disease. Greger distinguishes this approach from strict veganism or vegetarianism, allowing some flexibility for human preferences and occasional indulgences. The book’s central thesis is straightforward: unprocessed plant foods promote health, while animal products and processed foods contribute to disease.
The book is divided into two main sections. The first examines the fifteen leading causes of death in America, presenting evidence for how dietary changes can prevent or reverse these conditions. The second section offers practical guidance on incorporating health-promoting foods into daily life, featuring Greger’s “Daily Dozen”—a checklist of foods to consume regularly for optimal health.
The Book’s Strengths and Valuable Contributions
Comprehensive Research and References
One of the book’s most impressive features is its extensive citation of scientific literature. Greger has compiled thousands of studies, making complex research accessible to general readers. This democratization of medical knowledge empowers individuals to make informed decisions about their health without relying solely on healthcare providers who may lack adequate nutrition training.
Challenging Medical Industry Conflicts
The book raises important questions about the profit-driven healthcare system and pharmaceutical industry. Greger highlights how financial incentives often prioritize treatment over prevention, and how dietary interventions—which cannot be patented—receive far less attention than prescription medications despite their potential effectiveness.
Rehabilitation of Misunderstood Foods
Greger successfully addresses several nutrition myths that deserve correction. He provides evidence supporting fruit consumption even for diabetics, noting studies where participants consuming up to twenty servings of fruit daily experienced no adverse metabolic effects. He also rehabilitates phytates—compounds often maligned as “antinutrients”—by discussing their protective effects against cancer.
The book’s treatment of legumes is particularly valuable, presenting clinical evidence of their benefits for weight management, blood sugar control, and cardiovascular health—countering popular low-carb narratives that vilify these nutrient-dense foods.
Critical Analysis: Where the Book Falls Short
The Problem of Selective Evidence Presentation
Despite its extensive references, “How Not to Die” suffers from systematic cherry-picking—the practice of highlighting studies that support a predetermined conclusion while ignoring or misrepresenting contradictory evidence. This pattern appears repeatedly throughout the book, undermining its credibility as an objective scientific resource.
Misrepresentation of Research on Kidney Stones
When discussing kidney stones, Greger claims that high-oxalate vegetables pose no risk for stone formation. However, the study he cites to support this claim doesn’t actually examine high-oxalate vegetables specifically—it only looks at total vegetable intake. More problematically, the researchers themselves suggested that high-oxalate vegetables in participants’ diets might have diluted the protective effects they observed.
Similarly, Greger cites the EPIC-Oxford study as evidence that animal protein increases kidney stone risk, stating that meat consumption correlates with higher hospitalization rates. While heavy meat consumption did show elevated risk, the study actually found that people eating small amounts of meat had lower risk than vegetarians—a finding Greger omits from his analysis.
Respiratory Health and the Animal Food Narrative
In the chapter on lung diseases, Greger presents multiple studies linking plant-based diets to reduced asthma and respiratory symptoms. However, his interpretation consistently overlooks findings that don’t fit his thesis. For instance, he cites a population study showing that adolescents consuming more plant foods had fewer respiratory problems—but neglects to mention that the same study found seafood consumption was inversely associated with all measured respiratory conditions.
A Taiwanese study he references found associations between egg consumption and childhood asthma symptoms. Yet the same research showed that seafood was negatively associated with asthma diagnosis and shortness of breath, outperforming all other foods measured, including soy, fruits, and vegetables.
This pattern of selective reporting extends to his treatment of dairy. While citing an Indian study showing meat consumption associated with asthma, Greger fails to note that the same research found regular milk consumption was protective against asthma—with those never consuming dairy products showing higher asthma rates.
Omega-3 Fatty Acids and Cardiovascular Disease
Greger challenges the cardiovascular benefits of omega-3 fatty acids from fish by citing a controversial meta-analysis that found no protective effects. However, this particular study faced extensive criticism from the scientific community for multiple methodological flaws.
Critics pointed out that the studies included in the meta-analysis used an average omega-3 intake of only 1.5 grams daily—half the amount recommended for cardiovascular protection. The analysis also employed an unnecessarily strict statistical threshold that may have obscured significant findings. Using standard statistical values, the data showed meaningful reductions in cardiac death, sudden death, and heart attack associated with omega-3 consumption.
Additionally, many participants in the reviewed trials were using statin drugs, which have mechanisms that overlap with omega-3s and could mask their benefits. More recent, well-designed reviews support continued omega-3 consumption from fish for cardiovascular health—evidence Greger doesn’t present to his readers.
Dementia, Diet, and Incomplete Context
When discussing Alzheimer’s disease prevention, Greger cites research comparing Africans in Nigeria (eating traditional plant-based diets) with African Americans in Indianapolis (eating omnivorous diets), noting dramatically lower dementia rates in Nigeria. While this observation is accurate, he omits the finding that fish consumption showed strong protective effects against cognitive decline in this same analysis.
He also discusses Japan and China’s rising Alzheimer’s rates alongside increased meat and dairy consumption. However, deeper analysis reveals that diagnostic criteria changes artificially inflated dementia diagnoses during this period. When researchers controlled for these changes, the apparent correlation between animal food consumption and dementia disappeared.
Greger’s treatment of the “Nigerian paradox”—where people carrying the high-risk apoE4 gene variant have surprisingly low Alzheimer’s rates—attributes protection to plant-based eating. Yet globally, apoE4 prevalence is highest among hunter-gatherer populations consuming substantial amounts of animal foods, many of whom also show low dementia rates. This suggests that lifestyle factors beyond plant-based eating may explain the protective effect.
Soy and Breast Cancer: An Oversimplified Story
The book’s discussion of soy and breast cancer resurrects outdated claims about soy’s protective effects without acknowledging the controversy and conflicting evidence in this research area. Greger cites studies suggesting soy protects against breast cancer and improves outcomes for cancer patients, but these references hardly represent the full picture.
The research on soy and breast cancer is notably inconsistent, with protective effects often appearing in Asian populations but not Western ones. Multiple meta-analyses have failed to find significant benefits of soy consumption for Western women. Some researchers attribute this difference to genetic factors, gut bacteria variations, or critical windows of early-life soy exposure.
Laboratory studies present contradictory findings, with some showing soy isoflavones inhibiting cancer growth and others demonstrating enhancement of breast cancer cell proliferation. This complexity deserves acknowledgment rather than the one-sided presentation readers receive.
Where Greger Gets It Right: Legitimate Concerns About Meat
Foodborne Infections and Zoonotic Diseases
One area where “How Not to Die” presents well-supported concerns involves meat-borne infections. Greger discusses emerging evidence that urinary tract infections may be zoonotic diseases transmitted through chicken consumption, rather than caused solely by our own intestinal bacteria. Research has identified clonal links between E. coli strains in chicken meat and those causing human UTIs, with these chicken-derived bacteria showing alarming antibiotic resistance.
The book also addresses legitimate concerns about pork-associated illnesses. Yersinia infections—nearly universally linked to contaminated pork—can trigger autoimmune arthritis and potentially contribute to Graves’ disease. Additionally, hepatitis E virus is routinely found in pork products, with approximately 10% of pig livers in American stores testing positive.
While these concerns are valid, it’s important to note that these risks are dramatically higher in animals raised in crowded, unsanitary commercial operations. The book doesn’t acknowledge that humanely raised, properly handled animal products pose substantially lower infection risks.
High-Temperature Cooking and Carcinogens
Greger provides a thorough, well-referenced discussion of heterocyclic amines (HCAs)—carcinogenic compounds formed when muscle meat is exposed to high cooking temperatures. These substances, unique to animal foods due to their requirement for creatine (found only in muscle tissue), have been linked to multiple cancer types in well-designed studies.
The book accurately explains that grilling, frying, and well-done meat significantly increase cancer risk in epidemiological research, with cooking method appearing to mediate much of the meat-cancer association. HCAs have been shown to promote breast cancer growth and act as complete carcinogens capable of initiating, promoting, and spreading cancer.
Importantly, Greger offers practical solutions for meat eaters: low-temperature cooking methods like boiling or slow-cooking dramatically reduce HCA formation, making these preparations significantly safer than high-heat methods.
The Rice Diet Contradiction
An interesting inconsistency emerges in Greger’s definition of “plant-based” eating. He credits Walter Kempner’s Rice Diet with reversing diabetic vision loss and treating chronic kidney failure, citing these as evidence for plant-based nutrition’s healing power. However, the Rice Diet was built on white rice, refined sugar, and fruit juice—hardly the whole-food, unprocessed approach Greger advocates elsewhere in the book.
This selective categorization raises questions about intellectual consistency: if highly processed, vegetable-free diets can be claimed as “plant-based” victories, the term becomes so elastic as to lose meaningful definition.
Understanding the Broader Context
The Value of Plant-Based Eating
Despite its biases and selective evidence presentation, “How Not to Die” makes a compelling case for increasing plant food consumption. The health benefits of vegetables, fruits, legumes, whole grains, nuts, and seeds are well-established and not seriously disputed. Most Americans would benefit enormously from eating more of these foods.
The book’s extensive discussion of specific foods’ health properties—from cruciferous vegetables to berries to herbs and spices—provides valuable, actionable information for readers looking to optimize their nutrition.
The Problem with Dietary Dogmatism
Where the book falters is in its insistence that health benefits can only come from plant foods, and that animal products are uniformly harmful. This black-and-white narrative, while appealingly simple, doesn’t reflect the complexity of nutrition science or human dietary diversity.
Throughout human evolution, populations have thrived on vastly different dietary patterns—from the traditionally plant-heavy diets of some agricultural societies to the meat-and-fat-centered diets of Arctic populations. This diversity suggests that humans possess remarkable dietary flexibility, and that multiple nutritional approaches can support health.
Who Should Read This Book?
“How Not to Die” offers the most value to readers who approach it as a starting point for learning rather than an infallible guide. Those who benefit most will:
- Currently eat few plant foods and want inspiration to incorporate more
- Are interested in understanding how dietary changes may help prevent or manage chronic diseases
- Possess the critical thinking skills to fact-check claims and seek additional perspectives
- Can appreciate the book’s strengths while recognizing its limitations
- Want to understand the scientific rationale behind plant-based eating recommendations
The book may be less suitable for readers seeking truly balanced, unbiased nutritional guidance or those prone to developing rigid, dogmatic relationships with food.
Practical Takeaways from the Book
Despite its limitations, “How Not to Die” offers numerous actionable insights:
The Daily Dozen
Greger’s “Daily Dozen” checklist provides a practical framework for ensuring adequate intake of health-promoting foods: beans, berries, other fruits, cruciferous vegetables, greens, other vegetables, flaxseeds, nuts and seeds, herbs and spices, whole grains, beverages (water and tea), and exercise. While not everyone may agree with every component, this checklist offers a useful daily reminder to consume nutrient-dense foods.
Focus on Whole Foods
The book’s emphasis on minimally processed, whole foods represents sound nutritional advice regardless of one’s dietary philosophy. Replacing ultra-processed foods with whole plant foods would improve most people’s health substantially.
Traffic Light Eating System
Greger introduces a simple classification system: green-light foods (eat freely), yellow-light foods (minimize), and red-light foods (avoid). While readers might quibble with specific food placements, the system provides a helpful conceptual framework for making daily food choices.
The Bottom Line
“How Not to Die” by Dr. Michael Greger is a passionate, extensively researched, but ultimately biased presentation of plant-based nutrition. The book excels at making complex scientific research accessible and challenging readers to question conventional medical wisdom. Its comprehensive scope and practical advice make it a valuable resource for those looking to increase their plant food consumption.
However, the book’s systematic cherry-picking of evidence, misrepresentation of research findings, and ideologically driven conclusions significantly limit its reliability as a balanced nutritional guide. Readers seeking truly evidence-based dietary advice should consult this book alongside other resources that present more balanced perspectives on nutrition science.
For those already committed to plant-based eating, “How Not to Die” offers inspiration and detailed information to support their dietary choices. For those exploring different dietary approaches, it provides one perspective among many, best consumed with a healthy dose of skepticism and supplemented with additional reading.
The book’s greatest contribution may be its reminder that food choices profoundly impact health, and that prevention through nutrition deserves far more attention in our healthcare system. If readers take away this message while maintaining critical engagement with the specific claims, Greger’s work will have served a valuable purpose.
Ultimately, “How Not to Die” accomplishes its stated goal of empowering individuals with health information—but that empowerment works best when readers approach the book as a conversation starter rather than the final word on nutrition. The democratization of health knowledge that Greger champions requires not just access to information, but the critical thinking skills to evaluate it fairly.
Whether you agree with all of Greger’s conclusions or not, his underlying message bears consideration: the foods you eat every day matter enormously for your long-term health, and taking control of your nutrition may be one of the most powerful health decisions you can make.
Sources:
- Nutrition Facts – Dr. Greger’s Official Website
- PubMed – National Library of Medicine Database
- JAMA Network – Journal of the American Medical Association
- Nature – International Journal of Science
- 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.