Dr. Michael Greger’s bestselling book “How Not to Die” has captured the attention of health-conscious readers worldwide, promising insights into preventing and reversing our most common chronic diseases through dietary changes. But does this 562-page guide live up to its ambitious claims? This comprehensive review examines both the valuable contributions and potential limitations of this influential nutrition resource.
Understanding Dr. Greger’s Mission and Background
Dr. Michael Greger’s journey into nutritional advocacy began with a personal experience: witnessing his grandmother’s remarkable recovery from heart disease through the Pritikin diet. This transformative event inspired him to dedicate his career to promoting food as medicine.
Today, Dr. Greger operates the science-based website Nutrition Facts and has become an international speaker on plant-based nutrition. “How Not to Die” represents the culmination of his decades-long mission to make nutritional science accessible to the public, bypassing what he calls the “medical-industrial complex.”
The book’s central thesis is straightforward: a whole-food, plant-based diet represents our best defense against the leading causes of death and disability in modern society. While Greger distinguishes “plant-based” from stricter terms like “vegan,” his message is clear—unprocessed plant foods should form the foundation of a health-promoting diet.
The Strengths of How Not to Die
Despite its controversial aspects, “How Not to Die” offers numerous valuable contributions to nutritional literature. The book succeeds in several important areas that deserve recognition.
Extensive Research and References
One of the book’s most impressive features is its comprehensive citation of scientific literature. Greger draws from a vast array of studies, clinical trials, and epidemiological research to support his arguments. This extensive referencing allows readers to verify claims and explore topics in greater depth.
Demystifying Food Myths
Greger effectively challenges several common nutritional misconceptions. He rehabilitates the reputation of fruits amid sugar-phobic dietary trends, presenting evidence that fruit consumption doesn’t harm blood sugar control and may actually benefit metabolic health. He cites fascinating research showing volunteers who consumed twenty servings of fruit daily for months without adverse effects on weight, blood pressure, or cholesterol levels.
The book also defends phytates—compounds in plant foods often criticized as “antinutrients”—by highlighting their antioxidant properties and potential cancer-protective effects. Similarly, Greger makes a compelling case for legumes, addressing concerns about their carbohydrate content while emphasizing their benefits for weight maintenance, insulin sensitivity, and cholesterol management.
Legitimate Concerns About Meat Consumption
Beyond conventional discussions of saturated fat and cholesterol, Greger raises valid concerns about meat-related health risks that deserve attention.
Foodborne Infections
The book presents compelling evidence about zoonotic diseases—illnesses transmitted from animals to humans through food consumption. Greger explains how urinary tract infections may originate not just from our own bacteria but from E. coli strains in chicken meat. He notes that chicken-derived E. coli often shows antibiotic resistance, complicating treatment.
Similarly, pork consumption carries risks of Yersinia poisoning and hepatitis E virus. Research suggests that hepatitis E can survive the temperatures reached in rare-cooked meat, and areas with high pork consumption show elevated rates of liver disease. These concerns, while not arguments against all meat consumption, highlight the importance of proper food handling and cooking methods.
Cooking Methods and Carcinogens
Greger provides well-documented information about heterocyclic amines (HCAs)—carcinogenic compounds that form when muscle meat is exposed to high temperatures during grilling, frying, or broiling. These substances don’t form in overcooked vegetables because they require creatine, found only in muscle tissue.
Studies link HCAs to increased risk of breast, colon, esophageal, lung, pancreatic, prostate, and stomach cancers. The book explains that cooking methods significantly mediate the relationship between meat consumption and cancer risk, with grilled, fried, and well-done meat posing the greatest concerns.
The practical solution Greger offers is straightforward: choose low-temperature cooking methods like boiling, braising, or slow-cooking to minimize HCA formation while still safely preparing meat.
Critical Limitations and Concerns
While “How Not to Die” contains valuable information, it suffers from significant methodological issues that readers should understand before accepting its conclusions at face value.
Cherry-Picking Research Evidence
The book’s most serious limitation is its selective presentation of scientific evidence—a practice known as cherry-picking. Throughout the text, Greger often cites studies that support plant-based eating while omitting or misrepresenting research that contradicts his thesis.
Kidney Stones and Oxalates
For example, when discussing kidney stones, Greger claims that high-oxalate vegetables don’t increase stone risk. However, the study he cites doesn’t actually examine high-oxalate vegetables specifically—only total vegetable intake. The researchers themselves expressed concern that high-oxalate foods in participants’ diets might have “offset some of the protective association” they found for vegetables overall.
Similarly, when citing research on animal protein and kidney stones, Greger states that meat eaters have higher risk while vegetarians have lower risk. The actual study showed that people who ate small amounts of meat had the lowest kidney stone risk—better than both heavy meat eaters and vegetarians.
Asthma and Respiratory Health
In discussing respiratory diseases, Greger presents evidence suggesting plant-based diets protect lung health while animal products increase asthma risk. However, his citations tell a more complex story.
A population study he references found that while starchy foods and vegetables correlated with reduced asthma symptoms, seafood and fish consumption showed even stronger protective associations. Another study in Taiwan that found eggs associated with asthma symptoms also revealed that seafood was negatively associated with asthma diagnosis and shortness of breath—information Greger doesn’t mention.
Multiple research studies suggest omega-3 fatty acids in seafood can reduce inflammatory cytokines and benefit lung health. The book’s selective reporting obscures this potentially important relationship.
Cognitive Function and Dementia
Greger attributes low Alzheimer’s rates in Nigeria to traditional plant-based diets, suggesting that dietary choices can overcome genetic predisposition to dementia. While dietary factors certainly matter for brain health, the explanation may be more nuanced than the book suggests.
Research on Alzheimer’s disease in East Asia reveals that apparent increases in dementia rates partly resulted from changes in diagnostic criteria rather than true prevalence increases. When researchers accounted for these diagnostic changes, the positive relationship between animal fat consumption and dementia disappeared.
Studies of Seventh-day Adventists—often cited as evidence for vegetarianism’s brain benefits—show inconsistent results. While one small matched analysis found reduced dementia risk among long-term vegetarians, larger unmatched studies showed no significant cognitive differences between meat eaters and vegetarians.
Soy and Breast Cancer
The book presents soy as a powerful breast cancer preventive, but this representation overlooks the controversial and inconclusive nature of soy research.
While some Asian studies suggest possible protective effects, these findings consistently fail to translate to Western populations. Multiple meta-analyses confirm that soy’s apparent benefits in Asia don’t extend to Western women. The reasons remain unclear but may involve differences in gut bacteria, soy product types, or the importance of early-life soy exposure.
Clinical trials examining soy isoflavones have generally disappointed, finding no significant benefits for breast density or hormone levels—key risk factors for breast cancer.
Understanding the Omega-3 Controversy
Greger challenges fish oil’s cardiovascular benefits by citing a meta-analysis showing no protective effects. However, this particular study received substantial criticism from other researchers who identified multiple methodological problems.
Critics noted that most studies in the meta-analysis used doses only half the amount recommended for heart disease prevention. The analysis also employed unusually stringent statistical criteria that may have obscured real benefits. Additionally, many study participants were taking statin medications, which might mask omega-3 effects.
More recent, methodologically sound reviews continue to support omega-3 consumption for cardiovascular health, recommending two to three servings of oily fish weekly for high-risk patients.
The Bigger Picture: Food Quality Matters
One notable gap in “How Not to Die” is its lack of distinction between different quality levels of animal products. The infectious disease concerns Greger raises about meat apply primarily to animals raised in crowded, unsanitary commercial operations—not to all animal agriculture.
Similarly, the book treats all plant-based diets equally, sometimes crediting refined, processed diets (like Walter Kempner’s Rice Diet based on white rice and fruit juice) with benefits that should reasonably apply only to whole-food plant-based approaches.
This all-or-nothing thinking oversimplifies the complex relationship between food quality, sourcing, and health outcomes.
Who Should Read This Book?
“How Not to Die” offers the most value to readers who approach it as a starting point for exploration rather than absolute truth. The book succeeds in:
- Introducing evidence-based nutritional concepts to general audiences
- Challenging the profit-driven aspects of modern healthcare
- Presenting compelling reasons to increase whole plant food consumption
- Highlighting legitimate concerns about certain dietary practices
- Providing extensive references for further research
However, readers should remain critical and verify claims independently, especially those that seem to oversimplify complex scientific debates.
Practical Takeaways
Despite its biases, several practical lessons from “How Not to Die” have solid scientific support:
Increase Whole Plant Foods
Regardless of dietary philosophy, most people would benefit from eating more vegetables, fruits, legumes, nuts, and whole grains. These foods provide fiber, phytonutrients, vitamins, and minerals often lacking in modern diets.
Choose Cooking Methods Wisely
If you consume meat, opt for lower-temperature cooking methods like braising, boiling, or slow-cooking to minimize carcinogenic compound formation. Avoid charring or burning any foods.
Prioritize Food Quality
Whether choosing plant or animal foods, quality matters. Seek out minimally processed options and, when possible, foods produced through sustainable, humane practices.
Question Nutritional Dogma
Greger’s broader message about questioning conventional medical wisdom and taking personal responsibility for health has merit. Stay informed, ask questions, and don’t accept dietary advice—from any source—without critical evaluation.
Conclusion
“How Not to Die” represents Dr. Michael Greger’s ambitious attempt to democratize nutritional information and empower individuals to take control of their health through dietary choices. The book’s extensive research compilation, myth-busting discussions, and passionate advocacy make it a valuable resource despite its limitations.
However, readers must navigate the book’s significant biases and tendency to cherry-pick evidence supporting plant-based ideology. By presenting nutrition science in absolute terms—plant foods good, animal foods bad—the book oversimplifies complex research that often defies such neat categorization.
The most beneficial approach involves extracting the book’s genuine insights while maintaining healthy skepticism about its more extreme claims. Verify information independently, consider multiple perspectives, and remember that optimal nutrition likely varies among individuals based on genetics, health status, and personal circumstances.
If you’re considering significant dietary changes based on this or any nutrition book, consult with qualified healthcare providers who can offer personalized guidance based on your individual health needs.
Ultimately, “How Not to Die” succeeds as a thought-provoking introduction to plant-based nutrition and preventive medicine, provided readers approach it as the beginning of their journey toward nutritional literacy rather than its conclusion.
Sources:
- NutritionFacts.org – Dr. Michael Greger’s Official Website
- PubMed Central – National Institutes of Health
- PubMed – Biomedical Literature Database
- JAMA Network – Journal of the American Medical Association
- 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.