When I scheduled How Not to Die last year as my book of the month for April of 2020, little did I realize that I would be seriously thinking about my own mortality! Most of us are working on washing our hands often and thoroughly, resisting the urge to touch our faces, and staying at home to keep away from others. Thus, Dr. Michael Greger’s book on healthy eating seems like a strange topic to discuss in these times. For most of us the emphasis on choosing suitable foods to prevent death is not at the top of our priority list right now.
Many of us are hoping to have enough food to keep alive when cooped up at home—the longer the shelf stability the better. I read this book upon the recommendation of my parish nurse after the two of us discussed my dietary restrictions associated with digestive issues. I view the book in a different light in retrospect, but it does seem to get lost in the minutiae and misses some important points. Responding to the author’s words in bold:
“Until recently, advanced age had been considered to be a disease itself, but people don’t die as a consequence of maturing. They die from disease, most commonly heart attacks.” (page 1) The hard-core message in the first few chapters is that we die from disease, suggesting that if we could do everything to prevent disease we could live forever. By the end of the book Greger softens his pitch to eating to prevent premature death, but that is not obvious early in the book. He provides a detailed literature review of journal articles with his emphasis on foods not nutrients. At times he describes the potency of some individual compounds in specific foods. The approach, however, is identifying foods that are particularly healthy and others that are particularly unhealthy without any hint that most foods have both positive and negative attributes.
“That one unifying diet found to best treat and prevent many of these chronic diseases is a whole-food, plant-based diet, defined as an eating pattern that encourages the consumption of unrefined plant foods and discourages meats, dairy products, eggs and processed foods.” (p.10) Although the author indicates that he is not advocating a vegetarian or vegan diet, his recommendations appear to be steering us to a plant-based, flexitarian diet. He thinks the anti-GMO crowd is off the deep-end, that we would be much better off limiting animal-based foods and processed foods. I am assuming that he would be against the plant-based meats showing up in refrigerated supermarket cases and fast food restaurants. He is not as rigid as many food writers these days indicating that we have to eat and make the most of what is available such as at an airport food court, but he suggests that most of us need a major re-evaluation of our diets.
“Constipation can be considered a nutrient-deficiency disease, and that nutrient is fiber.” (p.65) No! No! No! No! It’s just not that simple! I will give this young man a break figuring that he was about 43 years old when he wrote the book. As we get older we become more likely to have digestive issues. Fiber helps with “keeping regular,” but there is more to it than that. Maintaining a healthy microbiome, with or without probiotic supplements, is part of the story as are the fermentable substances we consume. Many of the fruits, vegetables and whole grains that contribute to our fiber consumption also contribute oligosaccharides, disaccharides, monosaccharides and polyols like sorbitol. These compounds in whole foods can ferment in our guts leading to a continual cycle of constipation and diarrhea. Most Americans could use more fiber in their diet, but equating insufficient fiber with vitamin and mineral deficiencies is not a scientifically valid concept. It’s not that fiber is unimportant, it’s just that it is much more complicated than the author projects.
“The single greatest public health burden in the United States in terms of food poisoning is Salmonella. It’s the leading cause of food poisoning-related hospitalizations, as well as the number-one cause of food-poisoning-related deaths.” (p.91) As a food scientist who has been scared witless in all the food microbiology courses I ever took, the tone of this chapter did not score with what I have been taught. Greger emphasizes pathogens in meats, not in foods from plants. Data from the CDC suggests that fresh produce is more likely to cause foodborne illness and almost as many deaths as meats and poultry.
The author seems to be obsessed with feces in meat, but he apparently has no clue that it can also be on fruits, vegetables and other unprocessed, plant organs. The difference is that most meat is cooked killing off the harmful microbes. That circumstance is not necessarily the case for foods from plants as they may be prepared and consumed without cooking. The processed items that he advises us to avoid are more likely not to be contaminated due to quality assurance testing by food manufacturers or to processing that eliminates the hazard.
“Dairy is the number-one source of calcium in the United States, but it’s also the number-one source of saturated fat. What kind of “baggage” do you get along with the calcium in green, leafy vegetables? Fiber, iron, and antioxidants—some of the very nutrients lacking in milk. By getting most of your nutrition from whole plant foods you get a bonus instead of baggage.” (p.260) There is baggage in any food. For one thing, greens have little protein and fewer vitamins and minerals than dairy products. There are lowfat or fat-free versions of dairy items. In addition, vitamins and minerals tend to have lower bioavailability in green, leafy vegetables than in meat, dairy, and eggs. Yes, iron is lacking in milk, but we can get it from meat where it is much more available than in greens.
Bioavailability means that our bodies need more of these nutrients when we consume them from plants than when we consume them from animals, because the chemical forms of those nutrients in animals are more readily absorbed during digestion. Actually, spinach is high in oxalates that binds both calcium and iron preventing us from the full benefit of these minerals. Some of this baggage could be alleviated by consuming plant-based milks and meat, but the problem with them is that they are considered ultra-processed foods and thus, we are told, should be avoided.
“Beyond being a prominent anticancer agent, sulforaphane may also help protect your brain and your eyesight, reduce nasal allergy inflammation, manage type 2 diabetes, and was recently found to successfully help treat autism.” (p.305) This miracle molecule can be found in crucifers. Broccoli, brussels sprouts, cabbage, cauliflower and collard greens are among my favorite vegetables. OK, kale not so much, but I find it edible when sautéed. Yes, there are journal articles that support these contentions, but is this chemical really that magical? And how much do we have to eat to derive the benefits? Do we need more or fewer of these crucifers to help protect our brains than to help treat autism? Sorry, Dina Rose, I guess it is about the broccoli after all. Let me say that “may” is the most operative word in this quote and throughout the book.
Bottom line is that the author seems to claim that we can avoid death or at least premature death by eating right. His dietary recommendations may even help boost our immune systems helping us to conquer COVID-19! However, I remain a skeptic that one needs to be so restrictive to have a productive healthy, long life. I found this book to be oversimplistic and too focused on individual studies with individual foods without providing the big picture. He claims that “food is killing us,” but right now food is keeping us alive! I am willing to admit that most of us, myself included, could improve our daily diets by consuming more plant-based products and less animal-based ones. His diet recommendations tend to be too restrictive and too extreme, however. They also could be socially off-putting. There are many foods that don’t fit his model that I enjoy and enjoy with friends. As far as processed food is concerned I contend that it can be part of a healthy, balanced diet. As I have indicated on this site before:
Not all processed food is junk and not all junk food is processed.
Dr. Greger has a companion book out, published after I read this one, How Not to Diet: The Groundbreaking Science of Healthy, Permanent Weight Loss. If I had known that the companion was coming out, I might have skipped How Not to Die and read How Not to Diet instead. I think I will just go on with my life and turn to other books on food for my reading pleasure.
Next week: What is a healthy diet for you? by Elizabeth Strawbridge, MPH, RDN.