Book Notes


How Not To Die by Michael Greger, M.D.

ISBN: 1250066115
Published: 2015
Read: 2018


With a plethora of resources on diet and our evolving understanding of nutritional science, it is easy to find conflicting information and opinions. I have no interest in exhaustively probing these depths, but I would like to live a healthy life, for which some understanding of diet is required. I found Dr. Michael Greger’s How Not To Die to be a helpful guide to diet, as well as a serious warning about the risks of chronic disease associated with certain lifestyle choices.

His research is a straightforward exploration of the rise of chronic disease as a result of the typical American diet: “Most deaths in the United States are preventable, and they are related to what we eat”.1 The first half of the book examines the link between diet and the top 15 killers in America today, from heart disease and diabetes to various common cancers.

Despite the role genetics plays in predisposition for certain diseases, risk of developing these chronic diseases is directly tied to lifestyle choices. Specifically, almost 80% of chronic disease risk can be eliminated by not smoking, not being obese, exercising for 30 minutes per day, and eating a diet high in fruits, vegetables, and whole grains while low in meat.2

Again acknowledging conflicting nutrition information from groups with different interests (doctors, food companies, pharmaceutical companies, insurers, etc.), Dr. Greger presents an evidence-based discussion of a healthy diet, backed by his medical research and personal experience. His citations are voluminous, running to 133 pages, and this research is the basis of his public service website NutritionFacts.org.

I appreciate how Dr. Greger is both simple and realistic. And example of his straightforwardness comes in the final chapter about exercise. Instead of recommending what he thinks is achievable—as many organizations and government agencies have done—he explains the results of a few studies that show more exercise is better. Where the official recommendation stands at 20 minutes of moderate aerobic exercise per day (a feat only half of Americans achieve), Dr. Greger cites research showing that doubling this amount may produce twice the benefit to your health in terms of a lower mortality rate.3 Why lie about what the research actually says? If decisions I make are detrimental to my health, I would like to know the details.

Being straightforward doesn’t require an unreasonably idealistic view of human willpower, however. That’s why when asked what the healthiest option is he responds with a question: “compared to what?"4 Living a healthy lifestyle is less about applying absolute principles and more about recognizing the opportunity costs associated with decisions we make. Choosing to eat a donut means a lost opportunity to eat one of the items from his Daily Dozen list below. Choosing to watch TV for an hour is time not spent walking. Therefore, the question about what is healthy is one of comparison.

Where does this leave us?

Eating a diet heavy in whole plant foods is not the default setting in America, and doing so requires effort. Echoing Pascal in his wager about God, Dr. Greger argues that the consequences are important enough and the effort small enough to justify this lifestyle. Even while lacking conclusive evidence that a whole plant based diet is key to preventing many chronic diseases, we do have significant evidence and “shouldn’t that be the default diet until proven otherwise?"5 To start moving this direction, take a look at his Daily Dozen below.

The Daily Dozen

Distilling a thoroughly-researched tome into a realistic checklist isn’t easy. Thankfully Dr. Greger provides such a summary in his Daily Dozen recommendations with serving size and recommended servings per day.

Item Serving Size Daily Recommendation
Beans 1/4 cup hummus or bean dip
1/2 cup cooked beans, split peas, lentils, tofu, or tempeh
1 cup of fresh peas or sprouted lentils
3 servings
Berries 1/2 cup fresh or frozen
1/4 cup dried
1 serving
Other Fruits 1 medium-sized fruit
1 cup cut-up fruit
1/4 cup dried fruit
3 servings
Cruciferous Vegetables
broccoli, brussel sprouts,
horseradish, kale, etc.
1/2 cup chopped
1/4 cup brussel or broccoli sprouts
1 tablespoon horseradish
1 serving
Greens 1 cup raw
1/2 cup cooked
2 servings
Other Vegetables 1 cup raw leafy vegetables
1/2 cup raw or cooked nonleafy vegetables
1/2 cup vegetable juice
1/4 cup dried mushrooms
2 servings
Flaxseeds 1 tablespoon ground 1 serving
Nuts and Seeds 1/4 cup nuts or seeds
2 tablespoons nut or seed butter
1 serving
Herbs and Spices 1/4 teaspoon turmeric 1 serving turmeric
Any other spices you enjoy
Whole Grains 1/2 cup hot cereal or cooked grains, pasta, or corn kernels
1 cup cold cereal
1 tortilla or slice of bread
1/2 a bagel or english muffin
3 cups popped popcorn
3 servings
Beverages
water, green tea,
hibiscus tea
1 glass (12 ounces) 5 servings
Exercise 90 minutes of moderate-intensity activity (walking, bicycling)
40 minutes of vigorous activity (jogging, tennis)
1 serving

Additional Resources


  1. Greger, Dr. Michael, How Not To Die (New York: Flatiron Books, 2015), 1. 

  2. Greger, How Not To Die, 6. 

  3. Greger, How Not To Die, 397-8. 

  4. Greger, How Not To Die, 256-7. 

  5. Greger, How Not To Die, 403.