Dr. Michael Greger’s “How Not to Die” has captured worldwide attention as an international bestseller, promising readers the secrets to preventing and reversing chronic diseases through plant-based nutrition. But does this 562-page guide live up to its bold claims? This comprehensive review examines both the valuable insights and significant shortcomings of this influential work.
Understanding the Book’s Foundation
Dr. Michael Greger’s journey into nutritional medicine began with a personal experience: watching his grandmother recover from severe heart disease through the low-fat Pritikin diet. This transformative moment launched him on a decades-long mission to promote food as medicine, eventually leading to his website Nutrition Facts and the publication of “How Not to Die.”
The book’s central thesis is straightforward: a whole-food, plant-based diet can prevent and reverse our most common deadly diseases. Greger distinguishes his approach from strict veganism or vegetarianism, acknowledging that occasional dietary flexibility is acceptable. However, the underlying message remains clear—plant foods are therapeutic, while animal products and processed foods are harmful.
With sprawling references and ambitious scope, the book tackles the leading causes of death in developed nations, from heart disease to cancer, offering dietary solutions for each condition.
The Problem of Selective Evidence Presentation
Perhaps the most significant weakness of “How Not to Die” is its repeated use of cherry-picking—selectively presenting evidence that supports plant-based eating while ignoring or misrepresenting contradictory findings.
Misrepresentation of Research Studies
Throughout the book, readers who cross-check citations against original sources will frequently discover discrepancies. For example, when discussing kidney stones, Greger claims high-oxalate vegetables aren’t problematic, citing a study that doesn’t actually examine high-oxalate vegetables—only total vegetable intake. More concerning, the researchers explicitly noted that high-oxalate vegetables “might increase the risk of stone formation” and could have “offset some of the protective association” found in their study.
Similarly, when citing the EPIC-Oxford study on animal protein and kidney stones, Greger states that meat eaters had higher risks while those who ate no meat had lower risks. However, the actual study showed that people consuming small amounts of meat had the lowest risk—lower than vegetarians.
The Omega-3 Controversy
Greger’s treatment of omega-3 fatty acids exemplifies selective evidence use. He cites a 2012 meta-analysis suggesting fish oil provides no cardiovascular protection, concluding that it might be “snake oil.” However, this particular meta-analysis received substantial criticism from the scientific community for multiple methodological flaws.
Critics pointed out that the studies included used only half the recommended omega-3 dosage for heart disease prevention, applied unnecessarily strict statistical cutoffs, and included many participants already taking statin drugs—which could mask omega-3 benefits. More recent, methodologically sound reviews have confirmed cardiovascular benefits from consuming two to three servings of oily fish weekly.
Examining Specific Disease Claims
Asthma and Respiratory Health
When discussing lung diseases, Greger presents plant-based diets as superior for respiratory health while suggesting animal products worsen breathing problems. However, a closer examination of his cited studies reveals a more complex picture.
A population study spanning 56 countries did show that diets rich in starchy foods, grains, vegetables, and nuts were associated with fewer asthma symptoms. However, the same study found that seafood, fresh fish, and frozen fish were inversely associated with all three measured respiratory conditions—information Greger omits.
In another Taiwanese study of asthmatic children, while eggs showed some association with symptoms, seafood demonstrated the strongest protective effect against both diagnosed and suspected asthma—surpassing soy, fruit, and vegetables. Additionally, research on dairy consumption in India found that people who never consumed milk products were more likely to report asthma than daily dairy consumers.
Dementia and Cognitive Health
Greger argues that plant-based eating protects against Alzheimer’s disease, citing lower dementia rates among Nigerians eating traditional plant-based diets compared to African Americans. However, the broader study he references found that fish—not just plants—showed strong brain-protective effects, particularly among Europeans and North Americans.
Regarding Japan and China’s rising Alzheimer’s rates alongside increased meat consumption, Greger doesn’t mention that diagnostic criteria changes created an artificial increase in diagnoses. When researchers accounted for these diagnostic changes, the positive relationship between animal fat intake and dementia prevalence disappeared.
Studies of Seventh-day Adventist vegetarians present mixed results. While one small matched analysis showed lower dementia risk among long-term vegetarians, larger unmatched studies found no significant cognitive benefit from avoiding meat.
Soy and Breast Cancer
Greger resurrects the claim that soy is protective against breast cancer, citing studies showing reduced risk and improved survival among women consuming soy products. However, he fails to disclose the highly controversial and conflicting nature of soy research.
The protective effects observed in some Asian studies consistently fail to replicate in Western populations. Multiple meta-analyses have confirmed that soy’s breast cancer benefits appear limited to Asian women, with no protective association among Western women. This geographical difference may relate to genetic factors, gut microbiome differences, types of soy products consumed, or critical windows of early-life exposure.
Furthermore, some laboratory and animal studies have shown that soy isoflavones can enhance breast cancer growth, directly contradicting the protective effects Greger emphasizes. The scientific consensus remains that soy’s role in breast cancer prevention is far from settled.
Where the Book Gets It Right
Despite its biases, “How Not to Die” offers valuable information that readers of any dietary persuasion can benefit from.
Defending Fruit Against Sugar Fears
Amid growing sugar anxiety, Greger provides evidence-based reassurance about fruit consumption. He discusses how low-dose fructose from whole fruits may actually benefit blood sugar control, notes the absence of harm in diabetics consuming fruit, and cites a remarkable study where participants ate twenty servings of fruit daily for months without adverse effects on weight, blood pressure, insulin, cholesterol, or triglycerides.
Legitimizing Legumes
Greger effectively counters myths about beans and lentils, exploring their clinical benefits for weight maintenance, insulin sensitivity, blood sugar control, and cholesterol management. He also rehabilitates phytates—often criticized as antinutrients—by discussing their antioxidant and anti-cancer properties.
Meat-Related Health Risks
The book makes legitimate points about certain risks associated with meat consumption, particularly regarding foodborne infections and cooking methods.
Zoonotic Infections
Greger highlights emerging evidence that some infections previously thought to originate from our own bacteria may actually be transmitted through meat. Clonal links between E. coli in chicken and human urinary tract infections suggest meat handling and consumption as potential infection sources, with concerning antibiotic resistance in these bacterial strains.
Pork consumption carries risks including Yersinia poisoning—associated with significantly elevated autoimmune arthritis risk—and hepatitis E, which can survive in undercooked meat. The correlation between pork consumption and liver disease mortality parallels the relationship between alcohol consumption and liver fatalities.
High-Temperature Cooking Hazards
Greger accurately describes how high-temperature cooking of muscle meat creates heterocyclic amines (HCAs), compounds linked to multiple cancers including breast, colon, esophageal, lung, pancreatic, prostate, and stomach cancers. Since HCA formation requires creatine—found only in muscle tissue—even overcooked vegetables won’t produce these carcinogens.
The solution isn’t necessarily eliminating meat, but rather using lower-temperature cooking methods like boiling, stewing, or slow-cooking instead of grilling, pan-frying, or high-temperature roasting.
The Medical-Industrial Complex
One valuable contribution of “How Not to Die” is validating concerns about profit-driven healthcare. Greger reminds readers that questioning pharmaceutical industry influence, understanding financial conflicts of interest in medical research, and seeking prevention-focused approaches to health aren’t conspiracy theories—they’re reasonable responses to systemic issues in modern medicine.
Critical Perspective for Readers
The fundamental challenge with “How Not to Die” is distinguishing between its strengths and weaknesses. The book contains genuinely useful information about whole foods, disease prevention, and nutritional science, but this valuable content is intertwined with misrepresented research and oversimplified conclusions.
Readers should approach the book as a starting point for exploration rather than an unquestionable authority. The extensive references provide excellent opportunities for independent research, but checking original sources reveals how often Greger’s interpretations diverge from the actual findings.
A Balanced Dietary Perspective
While Greger presents nutrition as a simple choice between healing plants and harmful animal products, the scientific literature reveals a more nuanced reality. Many traditional diets that include animal products in moderation—Mediterranean, Japanese, and various indigenous diets—demonstrate excellent health outcomes.
The emphasis on whole, unprocessed plant foods has strong scientific support, but the categorical dismissal of all animal products doesn’t align with the full body of nutritional research. Quality matters tremendously: humanely raised livestock, wild-caught fish, and traditional food preparation methods may pose fewer risks than the industrial products Greger rightfully criticizes.
Final Assessment
Dr. Michael Greger’s “How Not to Die” succeeds in democratizing nutritional information and empowering readers to take control of their health through dietary choices. The book’s passionate advocacy for whole, plant-based foods and its critique of processed foods and industrial agriculture offer genuine value.
However, the repeated misrepresentation of research to support predetermined conclusions significantly undermines the book’s credibility. Readers must approach it with critical thinking skills engaged, fact-checking claims that seem suspiciously absolute, and recognizing that optimal nutrition likely exists on a spectrum rather than in rigid dietary camps.
For those seeking to increase whole plant food consumption, reduce processed food intake, and understand food’s role in disease prevention, “How Not to Die” provides useful motivation and information. Just remember that the most nutritious approach to reading this book involves a healthy serving of skepticism alongside your vegetables.
Note: Before making significant dietary changes, especially if you have existing health conditions, consult with a qualified healthcare provider who can offer personalized guidance based on your individual health needs.
Sources:
- Nutrition Facts – Dr. Michael Greger’s Official Website
- PubMed Central – National Institutes of Health
- JAMA Network – Journal of the American Medical Association
- Nature – International Journal of Science
- European Respiratory Journal
⚕️ 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.