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"How Not To Die" - What are our Takeaways?

Dr Michael Greger starts "How Not To Die" with his grandma’s story.

As a heart disease patient, his grandma experienced crushing chest pain, open heart surgeries, and a general inability to function. Yet, she was up and running after only three months on a plant-based diet. Her health miracle triggered Dr Greger's desire to answer one question: if the plant-based diet is so effective, why don't more doctors recommend it to patients?

The answer, he says, lies in the profit motive of the American healthcare system. When a patient enters the doctor's office, the doctor does not have time to tell the patient how to eat or exercise per their physical ability. Instead, doctors prescribe medicine as often as possible, so they can meet more patients and make money. That way, the lining of the pharmaceutical companies grows deeper and deeper; you just become more and more dependent on medication until only more medicine can save you.

Health-wise, it does not matter what we eat on Thanksgiving or Christmas. It is our daily choices that have the most impact on our health and longevity. If that is the case, we can prevent many premature deaths through simple changes in diet and lifestyle. Thus, Dr Greger argues that simple nutritional and lifestyle interventions can help us live happier, healthier lives.

Here are the four major takeaways from the book.

  1. Going plant-based might just save you.

For many, a diagnosis of lifestyle diseases like heart disease or diabetes seems like an inevitable consequence of old age. Many accept their new report and continue eating the classical American diet until they die of heart disease, high blood pressure, high cholesterol, and others.

Still, countless research studies are suggesting plant-based diet stalls or even reverses such lifestyle diseases. For example, heart disease patients of lifestyle medicine pioneers (e.g. Caldwell Esselstyn Jr, Dean Ornish) fully recovered from heart disease after going plant-based. There was even a 91% reduction in angina attacks for Dr Ornish’s patients.

Why so? Dr Greger puts it down to bacterial toxins on animal foods called ‘endotoxins’. Not destroyed by cooking, digestive acid, or enzymes, endotoxins end up in your small intestine after a meal. They then travel through the gut wall into your bloodstream, triggering inflammation reactions in your arteries.

This response usually lasts for 5 to 6 hours, so your arteries stiffen. Since your next meal is often 5-6 hours after your last anyway, your body never recovers from eating animal foods, increasing your chance of disease. Sure, there is always the choice of medication, but those cost a lot more than the benefits going plant-based brings you.

2. Eat less trans fat, saturated fat and processed food.

Trans and saturated fat get a bad rep, and rightfully so. Found in meat, cheese, palm oil and more, these fats build up to form plaque and block off your arteries.

Frying fat, oil, or meat means chemicals that cause mutations soon discharge into the air. For example, a study of Chinese women found regular meat-eaters had threefold the risk of lung cancer as opposed to those who do not. Another study from UC Davis found fumes from cooking bacon or beef caused DNA mutations, while fumes from cooking a soy-based product do not. This shows eating animal foods comes with a higher risk of disease, none of which we want.

3. Prevent most types of cancer and chronic lifestyle disease by consuming less alcohol, not smoking, meats, eggs, dairy, refined processed foods, and sodium

Dr Greger goes through the top 15 causes of death in the United States, and digestive cancers, breast cancer, and prostate cancer rank among them. With a combined mortality rate of 175,000 people, cancer is an epidemic that is costly both of money and the health of its citizens. However, research suggests that a plant-based diet can reduce the chance of cancer progressing or even shrink the tumour. Therefore, we will explore each of them and see how different plant foods can affect the cancerous cells within our bodies.

  1. Digestive cancer

Have you heard of turmeric? A yellow-ish fragrant spice, South Eastern cooking often features turmeric.

Yet, did you know tumeric can also fight cancer? Why? Normally, cells in our body die to make room for new cells. Still, some cancer cells can hijack this mechanism so they can spread quickly throughout the body. However, researchers found that turmeric can turn on the ability of cancer cells to die when they should again. That is truly something to look out for!

2. Breast Cancer

Research has often found lower rates of breast cancer among Asian women compared to their North American counterparts. Why so? It may be because of their diet.

For one, studies of soy, mushrooms and green tea consumption - staples in different Asian cultures - suggest consuming such products will reduce your risk over their lifetime. Researchers say drinking soy milk reduces breast cancer risk by half because soybeans contain phytoestrogen, which counters some cancer-promoting effects of human estrogen. In another study, eating one mushroom per day saw women having a 64% lower risk of breast cancer. Research has linked green tea with a 30% lower risk of breast cancer.

Fibre also plays a role. Since Asian diets are often higher in vegetables and rice and lesser so of meat, Asian women might have a lower chance of breast cancer. A couple of dozen scientific studies all suggest that for every 20 grams of fibre eaten daily, your chance of breast cancer may decrease by 15%. Still, it may not be because of the fibre alone, but because women are eating more whole plant foods (which have more nutrients) and living a healthier lifestyle with lots of exercise. Sadly, while the recommended amount of daily fibre is 30 grams, the average American woman eats only half that. Thus, it is important to consume a wide range of unprocessed foods, especially fruits, vegetables, whole grains, and beans.

3. Prostate cancer

In a 2015 meta-analysis, results found that milk and dairy products seem to increase prostate cancer risk. This could be because cow’s milk contains high concentrations of growth hormones and sex steroid hormones like estrogen.

And again with the miracles - a vegan diet may stall or even reverse prostate cancer. A study of 93 men by Dr Dean Ornish found this set of astonishing results.

In this study, 50% of the men ate a plant-based diet of fruits, vegetables, whole grains and beans. They did regular exercise and relaxation activities. Meanwhile, the other half ate their regular diet with animal foods.

After a year, doctors measured the prostate-specific antigen (PSA) levels of all the men (PSA is an important indicator of prostate cancer growth). The men eating a regular diet had a 6% increase in PSA levels, so their tumours grew. However, those eating the plant-based diet saw their PSA levels drop by 4%, meaning their tumours became smaller.

And similar to tumeric, flaxseeds may also slow cancer cell growth. Various studies asked men to eat a couple of tablespoons of ground flaxseeds every day. Later, biopsies found the men had lesser growth of their prostate cancer tumour after eating flaxseeds. A small percentage even saw their PSA levels return to normal levels, suggesting cancer had gone. These are mind-blowing results, though even if you are sceptical, it will not hurt to add some tablespoons of flaxseed to your diet for the benefits and nutrients.

5. Promote regeneration and reduce ageing by eating more antioxidant-rich foods, soy, spices, green vegetables, flaxseeds (basically follow the plant-based diet)

Did you know eating just 7g more fibre every day can decrease your risk of stroke, cancer, heart disease, and obesity? That is roughly the amount in a bowl of oatmeal with fruit! The reason is fibre lowers cholesterol, blood sugar levels and even blood pressure.

Many people are also concerned about ageing and skincare. We age because of too many free radicals around our cells, causing cell damage called “oxidative stress", suspected to induce wrinkles, memory loss and eventually death.

This is where antioxidants come in. On average, plant foods contain 64 times more antioxidants than animal foods. Such foods include berries, greens, green tea, dark chocolate and coffee.

And if you are looking to lose weight, eating plant foods is the best way to do so.

A big North American study of vegans, vegetarians, meat-eaters and pescatarians found only vegans had a healthy average BMI of 23.6. The group of meat-eaters were on the verge of obesity with an average BMI of 28.8 and vegetarians slightly overweight at 25.7. Why so? Whole plant foods make you feel fuller faster. They have fibre, the part of the plant your body cannot digest or absorb, increasing the volume of food you eat without increasing the calories you digest. Fruits and vegetables can also contain over 80% water, which has this same effect. Hence, if you are looking to improve your skin, stop ageing and maintain weight, plant-based is the way to go.


Besides explaining why we should go plant-based, How Not to Die includes Dr Greger's Daily Dozen - a checklist of food we should consume daily. This means 3 servings of beans, 1 serving of berries, 3 servings of other fruits, 1 serving of cruciferous vegetables, 2 servings of greens, 2 servings of other vegetables, 1 serving each of flaxseed, nuts, and spices, 3 servings of whole grains, 5 cups of water, and 30 minutes of exercise.

While this might seem like a lot, Dr Greger argues it is all about perspective. Taking the time and effort to invest in a plant-based cupboard will pay off in terms of future healthcare costs and healthy years when you get old. Some actionable tips include buying frozen produce, batch-making meals, canned beans (unsalted), fresh fruit, etc. The worst thing we can eat is trans fats and processed meats; think margarine, lunch meats, hot dogs and so forth.

Another aspect he delves into is price and accessibility. Is eating plant-based more expensive than being an omnivore? To answer this, Greger draws on a Harvard study that shows that in terms of nutritional value, people should go for nuts, seeds, beans, and whole grains. Less healthy foods only beat them out on a cost-per-calorie basis. Sure, an average serving of veg costs four times more than junk food, but vegetables offer six times more nutrition per pound on a cost-per-nutrient basis.

Of course, there are some concerns with the content of this book. A common complaint is 'cherry picking', which means presenting research when supporting plant-based eating and ignoring it when it does not. Not everyone has the time to go through a case by case analysis of all the information in the book (try this link here to read a research review), but the overarching theme is that no matter the diet we go to, everyone can benefit from eating a more varied diet, more exercise, reducing risk factors, maintaining good posture, and sleeping 7-8 hours a day.

Written by Kadence Wong

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