Review: How Not to Die by Michael Greger and Gene Stone

This book has me torn. It contains so much good… and yet, it has so many problems. It’s an important read for everyone… but also misleading. Overall, I learned a lot from it… but also ended up more confused than ever.

Let me break it down.

The good

• The general recommendation is spot on. Just about everyone should eat more veggies, fruits, nuts, seeds, and whole grains and less processed foods and animal products. This isn’t exactly a controversial claim. For the most part, this book does a good job of covering the vast amount of research backing the health benefits of fruits & veggies (though see below for some of the issues with the research).

• Many of the leading causes of death in the US are a choice. Most heart disease, lung disease, liver disease, kidney disease, cancers, and so on are due to lifestyle choices. You can dramatically reduce your chance of death from these diseases by choosing a different diet and lifestyle. One of my favorite lines from the book: “I don’t mind dying. But I don’t want it to be my fault.”

• The author, Michael Greger, says all the proceed from the book will go to charity, his website (nutritionfacts.org) is a donation-driven nonprofit, and he doesn’t offer any products (in fact, his main recommendation is to avoid any products and just eat whole, natural food!). Unlike many other authors of diet books, it doesn’t seem like Greger is trying to sell anything here.

• Greger makes a strong case in the book that the contents of your fridge are far more important to your health than the contents of your medicine cabinet. Most supplements and magic pills don’t work, are expensive, and have nasty side effects. Whole, natural foods have powerful beneficial effects, don’t cost much, and have only positive side effects. If drug companies could create a pill that reduces your risk of death by 10% and only had positive side effects, they’d make billions; the good news is that fruits and veggies are just such a pill!

• I learned a lot of distressing health facts. Examples:

  • Hospital care is one of the leading causes of death in the US (roughly ~3rd)! A huge number of people die every year from prescription side effects, infections, medical errors, and so on.
  • It is legal (at least in the US) to inject chickens with lots of additives to increase the chicken’s weight, and it turns out those additives (e.g., phosphates) can have serious negative health consequences.
  • There is such a thing as “3rd hand smoke” (i.e., the smoke that stays in the walls, carpets, etc.) and it also has negative health consequences. Smoking in any indoor area is not safe.
  • One theory of aging is that oxidation is damaging our DNA. We are literally rusting!

• Doctors in the US receive very little or no nutritional training. Worse yet, they are paid for performing more procedures and prescribing medication, but make no extra money for recommending diet and exercises. This creates a horrible conflict of interest.

• There are even bigger conflicts of interest with the governmental agencies in the US that make recommendations around food and health (e.g., the FDA). Many of these organizations take in huge amounts of money from corporations (e.g., from Coke and Pepsi) and ignore scientific findings when making recommendations. Greger’s argument is that we should show people the science and let them decide, rather than making (biased) recommendations.

The bad

• Although Greger tries to dance around it, his ultimate recommendation is that everyone should become a vegan. He says he doesn’t subscribe to any diet “ism,” and instead is merely recommending a “plant based diet.” But let’s be honest: in this book, he categorizes ALL meat and animal products as “red light” foods which should be completely avoided. Do the math, and you end up with veganism. Why is he avoiding that term? Perhaps it’s because veganism has been studied quite a bit. Some of the findings are good and some are not. One of the downsides, for example, is that almost all vegans must take B12 supplements; some will also need vitamin D and iodine supplements. This is a critical point, as it shows a purely plant based diet is (a) lacking critical nutrients and (b) not “natural,” as it would not have been possible in the wild until supplements were invented in the 20th century. Moreover, Greger spends much of the book talking about how supplements don’t work, but the very diet he recommends doesn’t work without supplements!

• Greger often praises “traditional diets” of Japan, India, China, etc and argues that those diets are responsible for the lower incidences of many diseases in those countries. However, most of the people in these countries are NOT vegans. Some eat meat; some eat fish; some eat animal products such as milk. Sure, those cultures probably eat more plant-based foods too, but their diets are still very different than what Greger recommends.

• Greger mentions frequently how the US gov should just “show us the science and let us decide.” And yet, Greger himself doesn’t do that. He shows us some of the science, but it turns out his data is VERY heavily cherry picked. In other words, it’s not that he’s lying (though the interpretation of some of the studies is definitely questionable), but omitting critical facts. For example, Greger comes down very hard on dietary fat and cholesterol, but many recent studies have shown compelling evidence that these are not as bad for you as we used to think. Greger’s recommendations around Omega 3 fatty acids, fish, fat, impact of vegetarianism/veganism on health, soy, and many other topics are questionable, at best. There’s a great overview of some of the cherry picking here: https://www.healthline.com/nutrition/how-not-to-die-review.

• The fact that the research was so cherry picked is what frustrates me the most about this book. Surely Greger and his team know of the MANY studies that contradict his claims. Why not show us this science and let us decide, as he advocates in the book? And if these contradictory studies are in some way invalid, why not say so? The book would’ve been so much stronger if he had taken on these counterpoints head on. Instead, they are completely missing, and I’m now left to try to figure out who to believe. I’m not a nutrition expert, so how should I know if Michael Greger (go vegan!), Gary Taubes (avoid carbs!), or Michael Pollan (eat traditional diets!) is right?

• Greger seems a little too eager to recommend things, even those with relatively little research about them, saying “why not try it?” Why not? Because (a) it could have unintended side effects (e.g., Americans who started eating less fat ended up eating more refined carbs, which may be worse) and (b) making lifestyle changes is hard and we shouldn’t waste our time and energy on things that might not work.

Conclusion:

Overall, this book is worth reading. There’s no doubt it’ll make you reconsider some of your dietary habits. I’m already trying to get more veggies, berries, and beans into my diet. But if you take the time to research things yourself, you find that the story is not nearly as simple as Dr. Greger makes it out to be. In part, this is because the food industry intentionally funds bogus studies that confuse the issue. But in part, it’s because the human body is complicated, and the state of food science and research today is still quite primitive.

At the end of the day, the most reasonable advice to me seems to be that of Michael Pollan: Eat food. Not too much. Mostly plants.

Rating: 3 stars