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'How Not to Die' by Michael Greger MD - a review

Anyone who knows me, has heard me speak, read my website, follows me on Twitter, Facebook etc. will know that I embrace all aspects of veganism. I am wholly vegan for reasons of eliminating animal exploitation, reducing environmental destruction via animal agriculture and for the maintenance of my health.

As far as I can see, the benefits to our health are often not emphasised enough – yet there is now a huge amount of evidence to demonstrate the massive improvement in health and longevity amongst those who adopt a vegan diet – most especially a Whole Food Plant based Diet.

Much of this evidence is being publicised in the US – and one of those at the forefront of this is Dr Michael Greger. He is probably best known for his website, and for some of the books he has written on the subject. The latest of these is HOW NOT TO DIE.

For me, this is a book that should be read by everyone – especially those who consume animal products and / or are currently suffering from some chronic condition and taking medication which is, at best, holding their condition at bay.

Essentially, Dr Greger has a clear message – if we want to avoid ill health we should minimise (ideally remove) animal products from our diet and adopt a Whole Food Plant Based Diet (WFPB) i.e. a diet which is 100% plant based and includes whole plants which are as close to their natural, original form as possible - no processed foods, refined flour, added sugar, oil etc.

I shall begin this review with some quotes from the book:

Thomas Edison (1903)

‘The Doctor of the future will give no medicine , but will instruct his patient in the care of the human frame in diet and in the cause and prevention of disease’.

‘We are now in the age of Degenerative and man-made diseases’.

‘The pandemic of chronic disease has been ascribed, in part, to the near universal shift toward a diet dominated by animal sourced and processed foods – in other words, more meat, dairy, eggs, oils, soda, sugar and refined grains’.

‘Most deaths in the United States are preventable and they are related to what we eat. Our diet is the number one cause of premature death and the number one cause of disability. Surely, diet must also be the number one thing taught in medical schools, right? Sadly, it’s not’.

Dr Walter Willett (Chair of Nutrition at Harvard University’s School of Public Health)

‘The inherent problem is that most pharmacologic strategies do not address the underlying causes of ill health in Western countries, which are not drug deficiencies’.

Dr Neil Barnard (President of the Physicians Committee for Responsible Medicine)

‘Plant-based diets are the nutritional equivalent of quitting smoking'.

The first half of the book is devoted to how to avoid early death from a wide range of chronic conditions, including:

Heart Disease, Lung Disease, Brain Disease, Digestive Cancers, Infections, Diabetes, High Blood Pressure, Liver Diseases, Blood Cancers, Kidney Disease, Breast Cancer, Suicidal Depression, Prostate Cancer, Parkinson’s Disease and Iatrogenic Causes (side effects of medication)

He cites plenty of evidence for all of his claims. In order to obtain a full understanding of this, it is absolutely essential to read the book. Here, I will highlight some of the important points he makes in each chapter. Clearly, as Dr Greger is based in the USA, it is from there that all the quoted figures are derived.


An American dies from heart disease every 83 seconds – annually, it kills more than ALL past wars combined.

It is caused by a build-up of fatty deposits, called ATHEROMA, in the arteries. On a standard diet this can begin in children – possibly before birth!

Dr William C Roberts (Editor in Chief of the American Journal of Cardiology) has stated that the only critical risk factor for the build-up of atherosclerotic plaque (atheroma) is cholesterol – specifically LDL (Low Density Lipoprotein) cholesterol in the blood.

There is no doubt that these levels are raised by consumption of trans fat, from processed foods, meat and dairy and saturated fat from animal products.

In some parts of the world, where populations consume minimal amounts of meat and animal products, rates of heart disease can be close to zero – at the very least, considerably lower than in the US.

Various medical practitioners, including Nathan Pritikin, Dean Ornish and Caldwell B Esselstyn Jnr have demonstrated that Heart Disease is actually REVERSIBLE (and preventable) by the consumption of a WFPB diet!

I was interested to read that consuming Brazil nuts is a very effective way of maintaining low cholesterol – and it only needs as few as FOUR nuts per month! Brazil nuts also contain high levels of selenium – so are also a good source of this mineral – but 4 nuts every day and you might run the risk of consuming too much!


These kill 300,000 Americans every year – lung cancer, Chronic Obstructive Pulmonary Disease (COPD) and asthma.

Whilst the first two are largely associated with smoking, asthma is one of the most chronic diseases amongst children and is probably largely preventable with a plant-based diet.

As far as cancer is concerned, Dr Greger highlights the anti-cancer properties of cruciferous vegetables (especially broccoli, but also cabbage and cauliflower) and turmeric (the active part of which is the bright yellow pigment, curcumin). These are all highly beneficial, whether you smoke or not!

Some time ago, studies at Columbia and Harvard Universities demonstrated that the consumption of cured meat – bacon, ham, hotdogs, sausages, salami etc – can increase the risk of COPD – most probably due to the nitrites used as preservatives. However, the anti-oxidant and anti-inflammatory effects of a diet rich in fruit and vegetables may help to prevent and stop the progression of this condition.

The same appears to be true with asthma – foods of animal origin are associated with an increased risk and there is evidence that diets including an increased amount of fruit and vegetables can be significantly beneficial.


The two most serious brain diseases are strokes and Alzheimer’s – strokes killing approximately 135,000 Americans per year, Alzheimer’s about 85,000.

Strokes can be thought of as equivalent to a heart attack in the brain – a build-up of plaque, leading to damaged arteries and, therefore, cutting off blood flow to some parts. Just like heart disease, this could start in children, but the risk can be lowered by reducing cholesterol and blood pressure.

Many studies have shown that the risk can be reduced by through high fibre intake, potassium and citrus fruits.

Contrary to popular belief, bananas do NOT contain huge amounts of potassium – the best sources are green vegetables, beans and sweet potatoes. The benefits of citrus fruits is possible via a phytonutrient called hesperidin.

Yet again, a diet rich in antioxidants almost certainly reduces the risk of strokes. Antioxidant intake can be boosted dramatically by eating plenty of broccoli (again!), sprinkled with various herbs, such as oregano or marjoram. Also, by adding a teaspoon of cinnamon to your oatmeal or porridge.

As far as Alzheimer’s is concerned, the lowest rates in the world are recorded in parts of India – where the diet is mostly plant-based, centred on grains and vegetables. Again, cholesterol probably plays a big part – generating plaque in the arteries of the brain, helping to seed the amyloid plaques associated with Alzheimer’s. Saffron would appear to reduce significantly the development of Alzheimer’s.

Another group of chemicals, known as Advanced Glycation End products (AGEs – very appropriate) are known to accelerate aging and are found in high levels in the brains of Alzheimer’s patients.

AGEs are formed mostly when protein and fat-rich foods are cooked (an argument for a RAW diet?!) and their levels are found to be MASSIVELY higher in animal products, compared with plants.


The most common of these are colorectal, pancreatic and esophageal.

Rates of the majority of cancers is much lower in India, compared with the US. The prime reason for this appears to be the fact that their diet tends to be based around green, leafy vegetables and legumes, such as beans, split peas, chickpeas and lentils – all of which are packed with another class of anti-cancer chemicals, called phytates. They also consume a lot more turmeric.

The antioxidant properties of berries are also beneficial.

Haem iron (found in large quantities in meat) also acts as a pro oxidant and leads to the formation of cancer-causing free radicals.

Pancreatic cancer can often be the result of obesity, smoking and heavy alcohol consumption. However, there is also much evidence that there is an increased risk is associated with the consumption of animal fat – but not plant oils.

Another amazing statistic is that, if you have smoked for 50 years, you will probably Have doubled your chances of getting pancreatic cancer. However, poultry workers – especially those who slaughter chickens – who are exposed to poultry cancer-causing viruses, have a NINE TIMES greater chance of pancreatic and liver cancers!

The European Prospective Investigation into Cancer and Nutrition (EPIC) suggested that every 50 g of chicken consumed per day gives a 72% increased risk of pancreatic cancer.

As far as esophageal cancer is concerned, one of the main causes is acid reflux (stomach acid leaking into the base of the esophagus). There is no doubt that this is more likely to occur when animal products and their associated fats are consumed and is much less likely to occur when fibre intake is increased – as in a plant-based diet.

Finally, a plant-based diet significantly decreases the transit time of food through the intestine, resulting in larger and more frequent bowel movements. There is no doubt that this is healthy and also helps to reduce the risk of cancers of the digestive tract.


Dr Greger makes the interesting point that the vast majority of human infections were non-existent before the domestication of animals and the transfer of infections from the animals to humans.

It is our immune system that should provide protection against such infections – but as we get older, our immune functions tend to deteriorate – possibly, simply a result of aging, but it may also be diet related. Yet again, there is evidence that certain fruit and vegetables help to boost our immune system – notably, kale, broccoli, beetroot, a range of berries and possibly mushrooms.

Personally, I do a lot of exercise (cycling) and use nutritional yeast in my diet – it is probable that both of these can boost our immune system.

Food poisoning ca be a major problem - but this is almost entirely associated with animal products (reheated rice being a possible exception!). Pathogens include Salmonella in eggs and poultry, Campylobacter in poultry, Yersinia in pork and various fecal bacteria found in a range of meat products.

Perhaps, most worryingly, is the huge increase in the number of infections with the ‘Superbug’ Clostridium difficile. This used to be regarded as a hospital-acquired infection, but has now been found to be present in a high percentage of packaged meat products.

Unfortunately, cooking does not always destroy these bacteria.

As we face the prospect of increasingly ineffective antibiotics, we surely need to give careful consideration to the extent to which our food might be the source of infection.


There are two kinds of Diabetes – Type 1 and Type 2.

Type 1 is about 5% of all cases – it occurs in childhood when the βcells of the pancreas are destroyed and so insufficient insulin is being produced. The exact cause is still unknown, but there is a possibility that it could be the consumption of cow’s milk.

Type 2 is also called ‘Insulin Resistance’ – muscle cells, in particular, become insensitive to insulin and stop taking up glucose from the blood.

Currently, in the US, Diabetes causes, annually, 50,000 cases of kidney failure, leads to 75,000 amputations, 650,000 cases of lost vision and 75,000 deaths.

Almost certainly, Type 2 is a result of the accumulation of fat in muscle cells, which causes a blockage of the insulin receptors.

The answer? A WFPB diet – what else?!

Dr Greger cites numerous cases where people have been diabetic for 20 years or more and have recovered by switching to a plant-based diet. The benefits can occur in a matter of a very few weeks!


This was an interesting chapter for me – my family have a history of high blood pressure. At one stage, I was on medication, but, on my WFPB diet, it is now well under control!

Basically, it is the No 1 risk factor for early death all round the world and contributes to death from aneurysms, heart attacks, heart failure, kidney failure and stroke.

Undoubtedly, high levels of salt in the diet is a major contributory factor – all processed foods contain added salt and chicken carcasses are routinely injected with salt water to inflate their weight – but can still be labelled ‘100% Natural’!

By far the best way to reduce blood pressure is to eat a diet based around whole plant foods and low in sodium. Foods particularly helpful include whole grains, flax, Hibiscus tea and nitrate-rich vegetables. The body converts nitrates to nitric oxide, which relaxes muscles in the walls of arteries – thereby opening them up and allowing more blood flow. Green vegetables and beetroot are especially good sources of nitrates.


Around 60,000 Americans die every year from Liver Disease – the most common causes are alcohol consumption and diet (fatty liver disease).

The most common cause of fatty liver is Non Alcoholic Fatty Liver Disease (NAFLD) – in the film ‘Super Size Me’, Morgan Spurlock ate only McDonalds for a month and was well on the way to developing NAFLD. There is much evidence that NAFLD is associated with the consumption of soft drinks (sodas) and meat – high levels of cholesterol is also a risk factor in developing NAFLD.

Another common liver disease is Hepatitis (A, B, C, D and E) - B and C are transmitted via blood and D can only occur in someone already infected with B. A and E, however, are food borne – A usually through food and water contaminated with faeces.

Investigation has shown that the Hepatitis E virus is often found in pork and there is a close correlation between pork consumption and the incidence of this disease.

Starting the day with oatmeal (my preference is overnight soaked oats) and a cup or two of coffee would appear to provide important protection against inflammation of the liver. A review in 2013 suggested that people drinking the most coffee had half the risk of developing liver cancer than those who drank the least.

A class of plant chemicals, called anthocyanins, have been demonstrated to reduce, or prevent, fat accumulation in the liver – lab investigations have shown that the best fruits in this respect are fresh cranberries – dried cranberries and juices or sauces are less effective and usually contain other additives such as High Fructose Corn Syrup (to be avoided!).

Dr Greger suggests a recipe for a pleasant Whole Cranberry Cocktail!


There are three types of blood cancer – LEUKEMIA, LYMPHOMA and MYELOMA – all resulting from abnormal white blood cell production in the bone marrow.

According to the American Cancer Society, every year, 52,000 are diagnosed with leukemia and 24,000 die. The most common lymphomas are Non-Hodgkin’s – of which there are around 70,000 per year (19,000 deaths). Myeloma is diagnosed in around 24,000 per year, of which 11,000 die.

Research at Oxford University has concluded that the incidence of blood cancers amongst vegetarians is half that of those eating meat.

Yet again cruciferous vegetables (broccoli, cauliflower, kale etc.) appear to provide significant protection – possibly via the compound sulfuraphane. Other evidence show that other green vegetables, salads and citrus fruits are helpful – most probably due to their antioxidant properties.

Multiple myeloma is one of the most dreaded and aggressive cancers – and researchers at the University of Texas demonstrated the remarkable ability of curcumin (in turmeric) to prevent the growth and development of myeloma cells.

The transfer of some viruses from animals to humans may also have responsibility for some blood cancers – transfer from poultry could well be the worst of these. Indeed, workers in poultry slaughterhouses are known to have higher rates of cancer of the mouth, nasal cavities, throat, esophagus, rectum, liver and blood. An analysis of death certificates has shown that those being brought up on animal farms are much more likely to develop blood cancer in later life (not the case on farms growing only crops) – and those living on poultry farms appear to have a three times greater chance of developing blood cancer.


Researchers at Harvard University have found that declining kidney function is associated with the consumption of animal protein, animal fat and cholesterol. There appears to be no such decline with the consumption of protein or fat from plant sources.

In the US, during the two decades between 1990 and 2010, the number of deaths from chronic kidney disease has doubled. Much of this can be put down to the levels of saturated fat, trans fat and cholesterol in processed food. In addition, added refined sugar and High Fructose Corn Syrup leads to raised blood pressure and the production of uric acid – both of which are damaging to the kidneys.

The acidity of animal products is another problem – higher consumption of fruit and vegetables helps to neutralise the acid in our kidneys.

What about kidney stones? Again, the evidence is that the alkalinity of plant based foods helps to prevent these. As long ago as 1979, it was reported that the increase in the occurrence of kidney stones since the mid 20th century seemed to be associated with an increasing consumption of animal protein.

High levels of blood phosphorus also appear to increase the risk of kidney failure (and heart failure).

We are much more likely to absorb phosphorus in the form of phosphate from animal based foods than we are in the form of phytate from plant based foods.

However, the biggest problem is phosphate additives :

  • Added to meat and Coca Cola to enhance their colour

  • Added to chicken to enhance colour and increase the weight of water

A supermarket survey showed that over 90% of chicken products contain added phosphates.

Each year, about 64,000 Americans dies from kidney cancer – tobacco smoke contains a group of carcinogens called nitrosamines which are a major risk factor.

The same chemicals (a s well as nitrosamides) are found in processed meats (one hot dog has the equivalent amount as 4 cigarettes) and also fresh beef, chicken and pork.

At the end of this chapter, Dr Greger explains the link between nitrites, nitrates and nitrosamines. Essentially, problems arise when nitrites and nitrates are converted to nitrosamines and nitrosamides. To do this, amines and amides need to be present – and they are found in abundance in animal products.

Vitamin C and other antioxidants in plant foods block the formation of such carcinogens.


Every year, 230,000 American women are diagnosed with breast cancer – and 40,000 of them will die.

The American Institute for Cancer Research has a series of recommendations to reduce cancer risk.

From the point of view of diet, they say ‘Diets that revolve around whole plant foods – vegetables, whole grains, fruit and beans – cut the risk of many cancers’.

In 2010, the World Health Organisation classified alcohol as a definitive human breast carcinogen – not the alcohol itself, but it’s breakdown product, acetaldehyde. Curiously, red wine appears to be the exception – most probably because it contains a compound which suppresses an enzyme associated with the development of breast cancer.

As far back as 1939, a paper was published, titled ‘Presence of Cancer-Producing Substances in Roasted Food’. These have now been identified as Heterocyclic Amines (HCAs) – and are known to be formed when beef, pork, fish and poultry are cooked at high temperatures. The same compounds are also found in cigarette smoke!

However, they are not found in measurable quantities in cooked vegetables.

It has also been demonstrated that a high level of cholesterol may well play a role in the development and progression of breast cancer.

As with other cancers, there is considerable evidence of much less risk seen in those on a plant based diet. Research at Yale University has demonstrated the benefit derived from a high fibre diet. Premenopausal women on high fibre diets were shown to have 85% lower odds of developing certain types of breast cancer!

Eating at least one apple per day would appear to be beneficial – most probably because of the antioxidant properties of the peel.

Also (yet again!) cruciferous and green vegetables are known to reduce significantly the risk of breast cancer.

Flaxseeds contain very high levels of a group of plant chemicals called lignans (technically, they contain the precursors of lignans, which are activated by good bacteria in the gut). Lignans are associated with much reduced rates of breast cancer. Consuming a tablespoon of milled flax per day is undoubtedly highly protective.

Soy beans contain high levels of a class of phytoestrogens called isoflavines. The development of breast cancer is certainly associated with high levels of estrogen – but the phytoestrogens in soy can attach to the same receptors as estrogen but have a weaker effect – so can block the more powerful animal estrogen. In short, they almost certainly protect against breast cancer.

Women in Asia are known to have much lower rates of breast cancer than US women. Why? Probably because they eat less animal products and have a much higher consumption of soy, green tea (full of antioxidants) and mushrooms!


Around 40,000 Americans take their own lives each year – depression appears to be the main cause.

Studies on those eating plant-based diets suggest that eating less meat is not just good for us physically – but also emotionally!

There are two possible reasons for this :

  • Those eating better diets might be happier because they are healthier. Also, they are less likely to be on drugs or medication

  • Animal products contain a particular inflammatory compound called arachidonic acid – research suggest that this might ‘adversely impact mental health via a cascade of neuroinflammation’

In fact, anti-inflammatory drugs, like aspirin and ibuprofen work by blocking the action of arachidonic acid.

The top 5 sources of arachidonic acid are chicken, eggs, beef, pork and fish – chicken and eggs contributing more than the others combined. On balance, omnivores appear to consume about nine times more arachidonic acid than those on a plant-based diet.

A review in the journal Nutritional Neuroscience concluded that, in general, eating more fruit and vegetables may present a ‘non-invasive, natural and inexpensive therapeutic means to support a healthy brain’ – and could cut the odds of developing depression by 62%!

When people are depressed, they appear to have elevated levels of a particular enzyme in their brains. This is called monoamine oxidase and it reduces the levels of certain important neurotransmitters.

Plant foods, including apples, berries, grapes, onions and green tea contain phytonutrients that inhibit this enzyme – as do spices, such as cloves, oregano, cinnamon and nutmeg.

Seratonin is the so-called ‘Happiness Hormone’. Although it is present in plant foods, it cannot pass the blood-brain barrier and we need to make it from the amino acid tryptophan.

Investigations have concluded that we absorb tryptophan most effectively when it is part of a low protein, high carbohydrate diet. Over a 12 month period, people on a high carbohydrate diet experienced significantly less depression, hostility and mood disturbance than those on a low carbohydrate diet.

The best sources of dietary tryptophan would appear to be sesame, sunflower and pumpkin seeds.

Saffron is also a very effective anti-depressant – however, it is also the world’s most expensive spice!

Coffee also appears to be beneficial – though it needs to be taken without sugar or artificial sweetener!

Indeed, artificial sweeteners are associated with depression and a study on aspartame back in the 1980s concluded that ‘Individuals with mood disorders are particularly sensitive to this sweetener and its use in the population should be discouraged.’

Today, artificial sweeteners can be found in over 6,000 products. Avoid this by eliminating processed foods!

Many studies suggest (again!) that antioxidants are beneficial – most especially the red pigment, lycopene, in tomatoes and the B vitamin, folic acid, in beans and green vegetables.

At the end of this chapter, Dr Greger discusses the efficacy of anti-depressants (currently prescribed to around 8% of Americans). Almost certainly, they do not work as well as the right diet, combined with moderate exercise.


The consumption of cow’s milk and other dairy products (seems bizarre to me!) is now being questioned by more and more people.

It is hard to imagine that the naturally occurring hormones and growth factors – as well as the bovine growth hormone, which is routinely injected to increase milk production – can be good for humans.

As regards prostate cancer, it has been shown that, when milk is dripped on prostate cancer cells in a petri dish, it stimulates their growth by up to 30%. In contrast, almond milk will decrease their growth by 30%.

In 2015, an analysis of dairy intake and the incidence of prostate cancer concluded that a high intake of dairy products DOES increase the total prostate cancer risk.

At present, around 28,000 US men die per year from prostate cancer.

A study at Harvard University reached the conclusion that the consumption of chicken and eggs can significantly increase the risk of developing prostate cancer.

The chicken is probably via the production of heterocyclic amines – also associated with other cancers.

Eggs contain a compound called choline, which is converted into a toxin, trimethylamine, by bacteria in the gut of meat eaters. As well as promoting prostate cancer, this appears to increase the risk of heart disease and stroke.

Research by Dr Dean Ornish and the Pritikin Research Foundation has shown that the blood of plant-based eaters can slow down the growth of cancer cells up to eight times better than the blood from someone on a Standard American Diet. The effect is even greater if the plant eaters also exercise on a regular basis. They also demonstrated that a fully plant-based diet can actually REVERSE the growth of prostate cancer.

In Asia, there are significantly lower rates of prostate cancer than in the US – quite possibly because of the higher consumption of soy, which contains the phytoestrogens called isoflavines (as discussed in relation to breast cancer).

As with other cancers, the consumption of flaxseeds also appears to provide a good degree of protection.

Various cancers (including prostate) appear to be related to the levels of a cancer-promoting growth hormone, called Insulin-like Growth factor (IGF-1)

The release of IGF-1 appears to be triggered by the consumption of animal protein (whether from meat, eggs or dairy) – while those on a plant-based diet have been demonstrated to have significantly reduced levels in their blood.

The final sentence in this chapter is ‘A prostate-healthy diet is a breast-healthy diet is a heart-healthy diet is a body-healthy diet’.


Parkinson’s Disease is the second most common neurodegenerative disease after Alzheimer’s.

The principal cause would appear to be a variety of toxic chemicals in our food. Unbelievably, these include several that have been banned – in some cases for decades – including DDT, Dieldrin and PCBs.

The highest levels are found in fish, followed by eggs, dairy and other meat.

Also, heavy metals, like arsenic are prevalent in poultry and tuna, lead in dairy products and mercury in seafoods.

A phenomenon known as ‘bioconcentration’, means that there are more of these toxins further along the food chain. I you want to avoid them, eat as close as possible to the start of the food chain i.e. plants.

Dioxins are highly toxic and accumulate in animal fat – it has been estimated that a plant-based diet will reduce dioxin intake by 98%!

For a variety of reasons, consumption of dairy products (milk and cheese) appears to be associated with an increased incidence of Parkinson’s Disease. The culprit may be the sugar, galactose, in milk – which has also been associated with another neurodegenerative disorder, Huntington’s Disease.

Equally, milk consumption is known to lower levels of uric acid – an important brain antioxidant.

That said, high levels of uric acid are responsible for gout and are also associated with kidney and heart disease.

Diary free plant-based diets appear to provide optimal levels of uric acid.

However, it would certainly appear to be residues of pesticides in food which are the biggest threat – the ONLY way to reduce these significantly is to eat plants.

The Mad Cow Disease fiasco exposed the fact that herbivorous animals raised for food are now routinely fed processed animal products and this brings about a considerable concentration only one step along the food chain!

Foods which show some promise in counteracting the presence of pesticides are berries such as blueberries and strawberries – and the caffeine in coffee and tea may also help to protect against Parkinson’s Disease.


This literally means ‘death caused by Doctors’ – and includes misdiagnosis, the side effects of medication, deaths during / following surgery, infections contracted in hospital etc.

It is the THIRD most common cause of early death in the US (after heart disease and cancer).

Dr Greger makes the point that modern medicine is good at dealing with broken bones and infections, but not so good at dealing with the many chronic conditions outlined in his book.

Clearly, only those ON medication can be killed by the side effects.

The good news is that most visits to doctors are for diseases that can be prevented with a healthy diet and lifestyle.

The best way to avoid dying from iatrogenic causes is to avoid getting ill in the first place!

Radiation exposure during X-Rays and other scans can be an issue. It is possible that diagnostic scans may cause tens of thousands of cancers in the US every year.

When flying at high altitudes we are exposed to considerable levels of cosmic rays from outer space – so airline pilots would be expected to be more at risk than most.

An investigation by the National Cancer Institute concluded that pilots who consumed the most dietary antioxidants (NOT supplements) suffered the least amount of DNA damage i.e. those who consumed the most Vitamin C via fruit and vegetables.

It appears to be a similar story amongst survivors of the nuclear attacks on Hiroshima and Nagasaki and those living close to the damaged nuclear reactor at Chernobyl in the Ukraine.

In the US, physicians dispense around 4 billion prescriptions every year – top of the list are cholesterol lowering and blood pressure lowering medications. Many people rely on these medications, whilst continuing to eat a poor diet.

The reality would appear to be that the majority of drugs are not particularly effective and moving to a plant-based diet could be dramatically more beneficial.

This was demonstrated by Dr Caldwell B Esselstyn Jr when, in 2014, he published case studies of around 200 heart patients – 99% of whom he effectively cured on a WFPB diet!

Aspirin is probably the most widely used medication in the world – its active ingredient is Salicylic Acid, an extract of willow tree bark.

It certainly has its benefits – it may reduce the risk of cancer, thin the blood to reduce the chances of clotting and is an anti-inflammatory.

However, it also has harmful side effects – it can cause bleeding in the brain and damage the lining of the digestive tract.

Salicyclic Acid is also found in a wide range of fruit and vegetables – and levels in the blood of plant-based eaters can often be quite high.

The great thing about this is that Salicyclic Acid derived in this way has all the benefits – but none of the harmful side effects of Aspirin!

Chilli powder, paprika, turmeric and cumin are particularly rich in Salicyclic Acid.

Every year in the US doctors perform around 14 million colonoscopies. They require an elaborate preparation, are uncomfortable (and sometimes painful) and can occasionally lead to serious complications – such as perforations and bleeding. About 1 in 2,500 can lead to death.

So, do the benefits outweigh the risks?

Well, there are other ways to screen for colon cancer – though doctors often do not make the options clear to patients and recommend colonoscopy.


The New York Times reported that, in most developed countries, a colonoscopy may cost just a few hundred dollars – but thousands of dollars in the US! It is clear that doctors recommend colonoscopies because of what they get paid!

The US Government Accountability Office has estimated that doctors are making at least one million more referrals every year than they would if they were not personally profiting!


So, exactly what should our diet be looking like to make sure we do avoid all the chronic conditions outlined in the first part of this book – as well as helping us to maintain our optimum weight and a good level of health and fitness?

In the second part, Dr Greger makes recommendations, based on what he eats every day. He appreciates that it may be difficult for people to make the transition from a Standard American Diet and makes it clear that an occasional lapse is not the end of the world – as long as the transition is made eventually.

As a guide, he suggests a ‘DAILY DOZEN’ – then, chapter by chapter, lays out how this can be achieved.

An essential aspect of a WFPB diet is to make sure that we are only eating plants and in a ‘whole’ form i.e. as close to its original state as possible – no refined sugar, flour or oil and no processed foods. His system of ‘Traffic Lights’ categorises food as follows :

On this basis, the diet should, ideally, be 100% ‘Green Light’ foods – maybe a small amount of ‘Yellow Light’ occasionally but avoid all ‘Red Light’ foods!

He points out that there is a massive amount of help and information available on the internet and, for starters, suggests three websites :

There are then 12 chapters – one for each of the ‘Daily Dozen’.

There is no need to go into detail here – get the book and read it!

Dr Greger does discuss GMO foods v non-GMO and Organic v non-Organic.

Some other points of note are :

  • Eat plenty of beans – including soy and lentils.

  • Berries are packed with antioxidants – eat blueberries, strawberries, raspberries, blackberries etc.

  • Don’t hold back on other fruits – apples, mangoes, citrus etc.

  • Try and eat cruciferous vegetables every day – broccoli (much emphasised by Dr Greger!), cauliflower and kale. I was interested to learn that these are best eaten raw – or, if cooked, chop them up then leave it for 30 – 40 minutes before cooking. The chopping activates an enzyme which produces sulfuraphane, the beneficially active molecule. This enzyme is denatured when cooked.

  • Eat plenty of green and other brightly coloured vegetables – the coloured pigments are the beneficial phytonutrients and antioxidants.

  • Add a tablespoon of ground flax every day – rich in lignans and Omega 3

  • Don’t ignore the benefits of a whole range of nuts and seeds – walnuts, Brazil nuts, hemp, sesame, chia seeds etc.

  • Herbs and spices pack the most antioxidants – Dr Greger is a HUGE fan of turmeric – also, ginger, marjoram, oregano and many others!

  • Always eat WHOLE grains – brown and wild rice, quinoa, whole wheat pasta etc. He suggests an interesting 5 : 1 rule – when buying ‘Wholewheat’ products, check the nutrition label – divide the weight of carbohydrate by the weight of fibre – if the result is less than 5 it is fine – if more than 5, put it back on the shelf!

  • Water is best to drink. Coffee is fine (think there is some controversy about coffee) – but also try and drink plenty of white and green tea (packed with antioxidants!). These may be best made with cold water and allowed to steep overnight in the refrigerator. Also, drink various fruit teas – Dr Greger particularly recommends Hibiscus tea. If you need to sweeten your drinks, he recommends a sweetener called erythtritol – found natural in some fruits and available commercially.

Finally, he recommends at least moderate amounts of exercise on a daily basis. I do a huge amount of exercise (on my bike!) and have found that my WFPB diet has improved my stamina and (very importantly) after a long ride I need little, if any, recovery time – just a shower and a good night’s sleep!

At various points throughout this book, Dr Greger addresses the issue of whether nutrient supplements are worth the expense.

On balance, he concludes that supplements are pretty ineffective compared with eating the appropriate wholefoods.

However, it is well documented that those on a WFPB diet may well be short of Vitamin B12 and possible D. He does recommend that we consider taking supplements for these.

Possibly also iodine – the best plant based source of this is seaweed – he suggests nori, arame or dulse.

For those who are cynical about some of his claims, there are around 140 pages of notes – these are references to published (and, therefore, peer reviewed) scientific papers on which he has based the information and recommendations in this book.


I learnt a lot from reading this book.

Has it made any difference to what I eat?

I was already eating what I think is a pretty good WFPB diet, but I have made a few changes :

  • Trying to eat more TURMERIC

  • Adding a teaspoon of cinnamon and a pinch of cloves to my morning oats

  • Eating a few more Brazil Nuts

  • Drinking more green and white tea

  • Drinking Hibiscus tea

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