Dr. Michael Greger’s “How Not to Die” has captured the attention of health enthusiasts worldwide, becoming an international bestseller that promotes plant-based eating as the solution to our most deadly diseases. But does the science truly support all of the book’s bold claims? This comprehensive review examines both the strengths and weaknesses of Greger’s 562-page guide to disease prevention.
Understanding Dr. Greger’s Mission and Background
Dr. Michael Greger’s journey into nutrition advocacy began with a personal experience. As a child, he witnessed his grandmother’s remarkable recovery from heart disease through the low-fat Pritikin diet—a transformation that doctors had deemed impossible. This early encounter sparked a lifelong mission to promote food as medicine.
Today, Greger is an international lecturer, physician, and founder of the science-based website Nutrition Facts. His book “How Not to Die” presents a comprehensive argument for whole-food, plant-based eating as the primary defense against preventable diseases.
The book distinguishes itself by using the term “plant-based” rather than the more restrictive “vegan” or “vegetarian,” allowing readers some flexibility in their dietary choices. However, the underlying message remains clear: unprocessed plant foods are beneficial, while animal products and processed foods pose health risks.
The Problem of Cherry-Picked Evidence
One of the most significant concerns with “How Not to Die” is the selective presentation of research. Cherry-picking—the practice of highlighting studies that support a predetermined conclusion while ignoring contradictory evidence—appears throughout the book.
The Kidney Stone and Oxalate Controversy
Greger claims that high-oxalate vegetables don’t increase kidney stone risk, citing a study that examined only total vegetable intake—not high-oxalate vegetables specifically. More problematically, the researchers of that very study suggested that high-oxalate vegetables might actually dilute the protective effects they observed from vegetable consumption overall.
Similarly, when discussing the EPIC-Oxford study on animal protein and kidney stones, Greger states that meat eaters had higher risk than vegetarians. However, the study actually found that people consuming small amounts of meat had lower kidney stone risk than strict vegetarians.
Asthma and Animal Foods: Missing the Full Picture
In the chapter on lung disease prevention, Greger presents multiple studies linking plant foods to reduced asthma symptoms. While this isn’t untrue, he omits crucial findings from the same studies showing that seafood consumption was inversely associated with asthma, wheezing, and shortness of breath.
One Taiwanese study found that seafood provided more protection against asthma than soy, fruit, or vegetables. Multiple other studies have demonstrated that omega-3 fatty acids from fish can reduce inflammatory cytokines and benefit respiratory health—facts conspicuously absent from Greger’s discussion.
Additionally, Greger cites an Indian study linking meat consumption to asthma while failing to mention that the same research found milk consumption significantly reduced asthma risk, with milk-free diets identified as a risk factor alongside smoking and unhealthy BMI.
The Omega-3 Fish Oil Debate
To argue against fish oil’s cardiovascular benefits, Greger relies on a heavily criticized 2012 meta-analysis. What he doesn’t disclose are the numerous problems experts identified with that study, including inadequate omega-3 dosages, overly stringent statistical thresholds, and failure to account for statin drug use among participants.
More recent, methodologically sound reviews support omega-3 consumption for cardiovascular protection, with researchers recommending two to three servings of oily fish weekly for high-risk patients.
Dementia, Diet, and Incomplete Analysis
Greger presents Nigeria’s low Alzheimer’s rates compared to African Americans as evidence that plant-based diets prevent dementia. While the comparison is valid, he omits the finding that fish consumption—not just plant foods—showed protective effects against Alzheimer’s disease in the broader international analysis.
When discussing Japan and China’s rising Alzheimer’s rates alongside increased meat consumption, Greger fails to mention that diagnostic criteria changes artificially inflated dementia diagnoses. After accounting for these changes, the apparent connection between animal fat and dementia disappeared.
Regarding the apoE4 gene variant and Alzheimer’s risk, Greger suggests that Nigeria’s plant-based diet explains the “Nigerian paradox”—high apoE4 prevalence without corresponding Alzheimer’s rates. However, this protective effect appears globally among hunter-gatherer populations consuming varied diets including animal foods, suggesting that traditional dietary patterns—not just plant-based eating—may confer protection.
The Soy and Breast Cancer Controversy
Greger presents soy as protective against breast cancer, citing studies primarily from Japanese populations. However, he doesn’t disclose that soy’s protective effects consistently fail to appear in Western populations, with multiple meta-analyses confirming this geographical disparity.
The reasons remain unclear but may involve genetic differences, gut bacteria variations (specifically equol-producing bacteria, which are twice as common in Asians), or the types and timing of soy consumption. The soy-cancer relationship is far more complex and controversial than “How Not to Die” suggests.
Research on soy isoflavones and breast cancer remains highly conflicted, with some studies showing potential benefits and others indicating possible harm. This nuanced reality deserves acknowledgment in any comprehensive nutrition guide.
Where the Book Gets It Right
Despite its biases, “How Not to Die” offers valuable insights that transcend dietary ideology.
Defending Fruit Against Sugar Fears
Greger effectively vindicates fruit consumption amid growing sugar anxiety. He presents evidence showing that low-dose fructose from whole fruits can benefit blood sugar control, that diabetics aren’t harmed by fruit consumption, and that extremely high fruit intake (up to 20 servings daily) produced no adverse effects on weight, blood pressure, insulin, cholesterol, or triglycerides in research subjects.
Rescuing Misunderstood Plant Compounds
The book rehabilitates phytates—often vilified as “antinutrients”—by exploring their cancer-protective properties. Similarly, Greger defends legumes against low-carb critics by examining their beneficial effects on weight maintenance, insulin sensitivity, blood sugar control, and cholesterol levels.
Legitimate Meat Concerns: Infections and Carcinogens
Perhaps most importantly for omnivores, Greger highlights genuine health risks associated with meat consumption that deserve serious attention.
Foodborne Infections From Animal Products
Beyond the tired debates about saturated fat and cholesterol, meat carries real infection risks. Urinary tract infections may stem from chicken-derived E. coli strains rather than our own intestinal bacteria, with these chicken-sourced infections proving resistant to most antibiotics.
Pork presents particular concerns, with Yersinia contamination linked to dramatically increased autoimmune arthritis risk and possible Graves’ disease development. Additionally, hepatitis E virus—found in approximately one in ten pig livers from American grocery stores—can survive the temperatures reached in rare-cooked pork, potentially contributing to elevated liver disease rates in high pork-consuming regions.
However, these risks primarily apply to animals raised in overcrowded, commercial operations. Quality and sourcing matter significantly for infection risk, though the book doesn’t explore this distinction.
High-Temperature Cooking and Cancer Risk
Greger presents compelling evidence about heterocyclic amines (HCAs)—carcinogens formed when muscle meat is cooked at high temperatures. These compounds have been linked to breast, colon, esophageal, lung, pancreatic, prostate, and stomach cancers, with cooking method serving as a major mediator for meat-cancer associations in epidemiological studies.
The practical solution isn’t necessarily meat elimination but rather cooking method modification. Low-temperature cooking methods like boiling dramatically reduce HCA formation compared to grilling, frying, or high-temperature roasting.
Evaluating the Book’s Overall Value
“How Not to Die” contains extensive references, broad scope, and valuable information about the medical-industrial complex’s profit-driven nature. It effectively empowers readers to take health into their own hands and question conventional nutritional wisdom.
However, the book’s greatest liability remains its repeated misrepresentation of research to support plant-based ideology. Studies are frequently cited selectively, with inconvenient findings omitted or spun creatively to fit the predetermined narrative.
Who Should Read This Book?
Readers approaching “How Not to Die” as a starting point rather than absolute truth will benefit most. The book works best when readers:
- Fact-check claims against cited references
- Seek out additional research on controversial topics
- Recognize that nutrition science rarely supports black-and-white conclusions
- Extract valuable insights while maintaining healthy skepticism
- Consult healthcare providers before making major dietary changes
Final Thoughts: Democratizing Health Information
Dr. Greger’s stated mission is to democratize health information, bypassing medical gatekeepers to empower individuals directly. “How Not to Die” largely succeeds in this goal, offering extensive research compilation and thought-provoking arguments about food as medicine.
The book’s fundamental problem isn’t its plant-based advocacy but rather its selective evidence presentation that undermines scientific integrity. Nutrition is complex, with legitimate debates and contradictory findings that deserve honest acknowledgment.
For health-conscious readers willing to engage critically—questioning claims, checking references, and seeking balanced perspectives—”How Not to Die” provides valuable fuel for the journey toward optimal health. Just remember that the path to wellness rarely involves absolute dietary dogma, and the best nutritional approach often lies somewhere between extremes.
If you’re considering significant dietary changes based on this book or any other source, consulting with a qualified healthcare provider or registered dietitian is essential for personalized guidance appropriate to your individual health needs.
Sources:
- PubMed Central – National Institutes of Health
- Nutrition Facts – Dr. Michael Greger’s Official Website
- 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.