Dr. Michael Greger’s book “How Not to Die” has become a phenomenon in the nutrition world, selling millions of copies worldwide and inspiring countless readers to reconsider their dietary choices. But does this influential book live up to its bold promises? This comprehensive review examines both the valuable insights and potential pitfalls of Greger’s work.
Understanding the Book’s Origins and Mission
Dr. Michael Greger’s passion for nutrition began with a personal miracle. As a young boy, he witnessed his grandmother’s remarkable recovery from heart disease through the Pritikin diet—a low-fat, plant-based approach that defied her doctors’ grim prognosis. This transformative experience set Greger on a lifelong mission to explore and promote the healing potential of food.
Today, Greger is an internationally recognized physician, lecturer, and founder of NutritionFacts.org, a science-based website that analyzes the latest nutrition research. “How Not to Die” represents the culmination of his decades-long work, offering a 562-page roadmap for preventing and reversing the leading causes of death through dietary intervention.
The book’s central thesis is straightforward: a whole-food, plant-based diet can prevent, treat, and even reverse many of America’s deadliest diseases. From heart disease to cancer, diabetes to dementia, Greger argues that the solution lies not in pharmaceutical interventions, but on our plates.
The Book’s Structure and Approach
“How Not to Die” is divided into two main sections. The first explores the fifteen leading causes of death in America, examining how dietary choices influence each condition. The second section outlines Greger’s “Daily Dozen”—twelve food groups he recommends consuming every day for optimal health.
Throughout the book, Greger distinguishes between “plant-based” eating and stricter terms like “vegan” or “vegetarian,” allowing some flexibility for readers. He acknowledges that occasional indulgences are part of being human, though he maintains that any deviation from plant-based eating is primarily for pleasure rather than health benefits.
The Strengths: What “How Not to Die” Gets Right
Comprehensive Research and References
One of the book’s greatest assets is its extensive bibliography. Greger cites hundreds of peer-reviewed studies, providing readers with a wealth of scientific resources. This extensive referencing demonstrates the author’s commitment to evidence-based recommendations and gives readers the opportunity to explore topics more deeply.
Empowering Health Information
Greger successfully democratizes medical knowledge, making complex scientific concepts accessible to general readers. His mission to bypass the traditional gatekeepers of health information and empower individuals directly resonates in an era of increasing health consciousness and patient advocacy.
Food as Medicine Philosophy
The book makes a compelling case for viewing food as preventive medicine. In a healthcare system often focused on treating symptoms rather than addressing root causes, Greger’s emphasis on prevention through nutrition offers a refreshing perspective.
Legitimate Concerns About Meat Safety
Greger raises valid points about certain risks associated with meat consumption, particularly regarding foodborne pathogens and cooking methods. His discussion of heterocyclic amines (HCAs)—carcinogens formed when meat is cooked at high temperatures—is well-supported by research. Studies have indeed linked high-temperature-cooked meat to increased risks of various cancers.
The book also addresses zoonotic diseases—illnesses transmitted from animals to humans—including recent discoveries about the connection between chicken-derived E. coli and urinary tract infections, and the link between pork consumption and hepatitis E virus.
Vindication of Misunderstood Foods
Greger successfully rehabilitates the reputation of several foods that have been unfairly maligned. His defense of fruit consumption amid sugar-phobia is particularly valuable, citing studies showing that even twenty servings of fruit per day had no adverse effects on weight, blood pressure, or metabolic markers.
He also rescues phytates—compounds in plant foods often criticized as “antinutrients”—by highlighting their antioxidant and anti-cancer properties. His discussion of legumes challenges unfounded fears about their carbohydrate and antinutrient content, presenting evidence of their benefits for weight management, insulin sensitivity, and cholesterol levels.
The Weaknesses: Where “How Not to Die” Falls Short
Selective Citation and Cherry-Picking
The book’s most significant flaw is its selective presentation of research. While Greger cites numerous studies, he often highlights only those supporting plant-based eating while ignoring or misrepresenting contradictory evidence. This approach, known as “cherry-picking,” undermines the book’s scientific credibility.
Misrepresentation of Research on Animal Foods
Several examples illustrate how Greger selectively presents research on animal products:
Fish and Respiratory Health: When discussing asthma and diet, Greger emphasizes associations between animal foods and respiratory problems while omitting that the same studies showed protective effects from fish consumption. In one Taiwanese study he cites, seafood was actually the most protective food against asthma—more so than soy, fruit, or vegetables.
Dairy and Asthma: Greger cites an Indian study linking meat consumption to increased asthma risk but fails to mention that the same research found milk consumption was protective against asthma, with non-milk drinkers having higher asthma rates.
Omega-3 Research: The book dismisses the cardiovascular benefits of fish oil based on a heavily criticized meta-analysis with acknowledged methodological flaws, including insufficient dosages and confounding factors like statin use. More recent, better-designed reviews support omega-3s for cardiovascular health.
Oversimplification of Diet and Dementia Research
Greger’s discussion of diet and Alzheimer’s disease demonstrates problematic interpretation of research. He points to the “Nigerian paradox”—high apoE4 prevalence but low Alzheimer’s rates—as evidence that plant-based diets protect against genetic risk factors.
However, he ignores that many hunter-gatherer populations with high apoE4 prevalence and substantial animal food consumption also have low Alzheimer’s rates. This suggests that factors beyond plant-based eating—such as physical activity, intermittent fasting, and unprocessed diets—may be responsible for the protective effect.
Additionally, research on Seventh-day Adventists—a group Greger frequently cites—shows mixed results. In the larger analysis of nearly 3,000 participants, vegetarianism showed no significant advantage for dementia risk compared to meat-eating.
Controversial Soy Claims
Greger presents soy as a breast cancer preventive and treatment aid, but fails to disclose how controversial and inconclusive the soy research actually is. Key issues include:
- Protective effects observed in Asian populations often fail to appear in Western populations
- Differences may relate to genetic factors, gut bacteria composition, or early-life soy exposure
- Clinical trials have been disappointing, showing no significant benefits on breast density or hormone levels
- In vitro studies show contradictory results, with some suggesting soy isoflavones may enhance breast cancer growth
By citing only studies supporting his thesis while ignoring the substantial body of conflicting evidence, Greger presents an incomplete picture of soy’s effects.
Flexible Definition of “Plant-Based”
Greger sometimes credits the success of diets that don’t align with his recommendations. For example, he attributes diabetes reversal to Walter Kempner’s Rice Diet—a program based largely on white rice, refined sugar, and fruit juice—hardly the whole-food, plant-based approach he advocates elsewhere.
The Bigger Picture: Context Matters
Quality Over Category
While Greger emphasizes the superiority of plant foods over animal foods, research increasingly suggests that food quality and processing level matter more than food origin. Wild-caught fish, pasture-raised eggs, and grass-fed meat from humanely raised animals differ substantially from their factory-farmed counterparts in nutrient composition and contamination risk.
The zoonotic diseases Greger discusses are largely products of industrial animal agriculture—overcrowded, unsanitary conditions that serve as breeding grounds for pathogens. These concerns are less applicable to animals raised in humane, sanitary conditions.
Individual Variation
The book presents one dietary approach as universally optimal, yet human nutritional needs vary based on genetics, age, activity level, health status, and even gut microbiome composition. What works optimally for one person may not work equally well for another.
The Role of Confounding Factors
Many studies cited in “How Not to Die” are observational, making it difficult to separate the effects of diet from other lifestyle factors. People who eat more plant foods often exercise more, smoke less, drink less alcohol, and engage in other health-promoting behaviors. Without controlled trials, attributing health outcomes solely to plant-based eating is problematic.
Practical Takeaways: Using “How Not to Die” Wisely
For Plant-Based Eaters
The book offers valuable guidance on which plant foods to prioritize and how to structure a nutritionally complete plant-based diet. The “Daily Dozen” checklist provides a practical framework for ensuring adequate intake of various nutrients.
For Omnivores
Even meat-eaters can benefit from Greger’s emphasis on increasing plant food consumption. The scientific consensus supports eating more vegetables, fruits, legumes, whole grains, nuts, and seeds—advice that doesn’t require eliminating animal foods entirely.
The book’s discussion of cooking methods is particularly valuable for anyone who eats meat. Switching from high-temperature cooking methods to gentler techniques like boiling, steaming, or slow-cooking can significantly reduce exposure to harmful compounds.
For Critical Thinkers
Use “How Not to Die” as a starting point rather than the final word. When Greger makes a claim that interests you, look up his cited studies and read beyond the abstract. Check for more recent research on the topic. Consider whether contradictory evidence exists.
Remember that nutrition science is complex, evolving, and often contradictory. Be wary of any source—whether promoting plant-based, low-carb, or any other dietary approach—that presents the evidence as simpler or more conclusive than it actually is.
The Bottom Line
“How Not to Die” is a passionate, extensively researched work that makes important contributions to public understanding of nutrition’s role in disease prevention. Greger’s emphasis on whole plant foods, his critique of the profit-driven medical establishment, and his mission to democratize health information are all commendable.
However, the book’s credibility is undermined by selective citation, occasional misrepresentation of research, and oversimplification of complex nutritional science. The evidence supporting plant-based diets is substantial, but it’s neither as overwhelming nor as unambiguous as Greger suggests.
For readers approaching the book with appropriate skepticism—willing to fact-check claims and seek additional perspectives—”How Not to Die” offers valuable insights. Its greatest value may lie not in providing definitive answers, but in encouraging readers to think critically about food, question conventional medical wisdom, and take an active role in their health.
Whether you’re plant-based, omnivorous, or somewhere in between, the book’s central message bears repeating: whole, minimally processed foods—predominantly plants—should form the foundation of a healthy diet. On this point, nearly all nutrition experts agree.
Final Recommendations
If you’re considering reading “How Not to Die,” here are some tips for getting the most from it:
- Don’t read it in isolation: Balance Greger’s perspective with other evidence-based nutrition resources that present different viewpoints
- Check the references: Don’t take claims at face value—look up the cited studies when something seems particularly important or surprising
- Focus on principles over dogma: Extract the universal wisdom about whole foods, plants, and disease prevention without necessarily accepting every claim uncritically
- Consider your individual needs: Any dietary changes should account for your personal health status, goals, and preferences. Consult with healthcare providers before making major dietary shifts, especially if you have existing health conditions
- Experiment and observe: Pay attention to how different foods make you feel. Your own experience is valuable data
“How Not to Die” has inspired many people to improve their diets and take control of their health. With critical thinking and balanced perspective, it can serve as a useful tool in your nutritional education—just not the only tool you’ll need.
Sources:
- PubMed Central – National Institutes of Health
- NutritionFacts.org – Dr. Michael Greger’s Website
- National Cancer Institute – Diet and Cancer Prevention
- American Heart Association – Healthy Eating
- National Institute on Aging – Alzheimer’s Disease Research
- NIH Office of Dietary Supplements – Omega-3 Fatty Acids
⚕️ 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.