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How Not to Die by Michael Greger, MD

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From the blog of Physically FITch...

How Not to Die by Michael Greger, MD

We recently read the New York Times Bestseller, How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease (2015). In How Not to Die, Dr. Michael Greger, the internationally-recognized lecturer, physician, and founder of NutritionFacts.org, examines the fifteen top causes of death in America—heart disease, various cancers, diabetes, Parkinson’s, high blood pressure, and more—and explains how nutritional and lifestyle interventions can sometimes trump prescription pills and other pharmaceutical and surgical approaches, freeing us to live healthier lives.

Dr. Greger provides peer-reviewed research to support eating a whole-food, plant-based, fairly low-fat diet while providing guidelines for recommended foods and their portion sizes. He also includes lifestyle changes to make to increase longevity. While some of Dr. Greger recommendations may seem strict to some people, he lists foods as those to eat and those to avoid into the categories of "green-light," "yellow-light," and "red-light" foods.

In addition to showing what to eat to help prevent the top 15 causes of death, How Not to Die includes Dr. Greger’s Daily Dozen—a checklist of the foods we should try to consume every day. Full of practical, actionable advice and surprising, cutting edge nutritional science, these doctor’s orders are just what we need to live longer, healthier lives.

You can check out the author's website for additional information as well as ChewFo, who posted a wonderful summary of Dr. Greger's diet plan. Here are the major takeaways...

- Eat unprocessed plant foods.
- Minimize processed plant foods and unprocessed animal foods.
- Avoid ultra-processed plant foods and processed animal foods.
- Buy the most colorful foods you can find – purple rather than white eggplant, the reddest of strawberries, the blackest of blackberries, the most scarlet tomato, the darkest green broccoli you can find.

Daily Dozen eating recommendations:
- 3 servings of beans/legumes
- 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 of flaxseeds
- 1 serving of nuts
- 1 serving of spices
- 3 servings of whole grains
- 5 servings of beverages
- 1 exercise

The Reasoning Behind How Not to Die
Telomeres, found at the top of each chromosome, have been thought of as your life “fuse.” They can start shortening as soon as you’re born, and when they’re gone, you’re gone. The book notes a study (Ornish, Blackburn) in which 3 months of whole-food, plant-based nutrition and other healthy lifestyle changes could significantly boost telomerase activity, the only intervention ever shown to do so. Weight loss through calorie restriction and vigorous exercise programs failed to improve telomere length, so it appears that the active ingredient is the quality, not quantity, of the food eaten. Also, the book claims that a more plant-based diet may help prevent, treat, or reverse every single one of our fifteen leading causes of death.

“In this book, I don’t advocate for a vegetarian diet or a vegan diet. I advocate for an evidence-based diet, and the best available balance of science suggests that the more whole plant foods we eat, the better— both to reap their nutritional benefits and to displace less healthful options.”

The diet in this book claims to reduce the risks for: acid reflux / GERD, Alzheimer’s disease, anal fissure, angina, asthma, atherosclerotic plaque, Barrett’s esophagus, blood infections, brain diseases, cancer (brain cancer, breast cancer, colon cancer, colorectal cancer, esophageal cancer, kidney cancer, leukemia, liver cancer, lung cancer, lymphoma, myeloma, non-Hodgkin’s lymphoma (HNL), pancreatic cancer, prostate cancer, skin cancer), chronic obstructive pulmonary disease (COPD), cirrhosis, claudication, clinical depression, constipation, coronary heart disease, depressions, diabetes, pre-diabetes, diabetic neuropathy, heart disease, hemorrhoids, hepatitis E (HEV), hiatal hernia, high blood pressure, high blood sugar, high cholesterol, insulin resistance, kidney disease, kidney stones, liver disease, lung cancer, lung diseases, nonalcoholic fatty liver disease (NAFLD), overweight/obesity, Parkinson’s disease, respiratory infections, stroke, suicidal depression, varicose veins.

Foods to Eat in How Not to Die
Green-Light Foods — Unprocessed Plant Foods

Beans/Legumes
- Recommended: 3 servings per day
- Serving size: 1/4 cup of hummus or bean dip; 1/2 cup of cooked beans, split peas, lentils, tofu, or tempeh; 1 cup of fresh peas or sprouted lentils
- Beans (black beans, butter beans, cannellini beans, great northern beans, kidney beans, navy beans, pinto beans, small red beans); chickpeas/garbanzo beans; black-eyed peas; split peas (yellow or green); lentils (beluga, french, and red varieties); soybeans (edamame, miso, tofu, tempeh); sprouted beans; english peas/garden peas
- Canned beans are okay, but buy no-salt added varieties.
Fruits
Berries
- Recommended: 1 serving per day
- Serving size: 1/2 cup fresh or frozen; 1/4 cup dried
- Acai berries, barberries, bilberries, blackberries, black currants, blueberries, cherries (sweet or tart), cranberries, goji berries, concord grapes, kumquats, mulberries, raspberry (black or red), strawberries
Other fruits
- Recommended: 3 servings per day
- Serving size: 1 medium fruit; 1 cup of cut-up fruit; 1/4 cup dried fruit
- Apples (including the peel), apricots, avocados, bananas, cantaloupe melon, clementines, dates, dried figs, grapefruit, other grapes apart from concord grapes (preferably with seeds), honeydew melon, kiwifruit, lemons, limes, lychees, mangos, nectarines, oranges, papayas, passion fruit, peaches, pears, pineapple, plums (especially black plums), pluots, pomegranates, prunes, rhubarb, tangerines, watermelon
- If you buy dried fruit, look for no-sugar added and unsulfured varieties.
- Inform your physician if you eat grapefruit, as it can interact with more than half of commonly prescribed drugs.
Vegetables
- Eat a mixture of raw and cooked vegetables. Some vegetables are more nutritious raw (e.g. bell peppers); some benefit from cooking (e.g. carrots, celery, and green beans); some are hardly affected (artichokes, beets, onions).
- Buy organic when you can.
- You can grow micro greens.
Cruciferous vegetables
Recommended: 1 serving per day
- Serving size: 1/2 cup chopped; 1/4 cup brussels or broccoli sprouts; 1 tablespoon horseradish
- Arugula; bok choy; broccoli; brussels sprouts; cabbage; cauliflower; collard greens; horseradish; kale (black, green, and red); kohlrabi; mustard greens; radishes; red cabbage; rutabaga; turnip greens; wasabi; watercress
- Tip: “Hack and hold”—chop the cruciferous vegetable, wait 40 minutes, then cook as much as you want without destroying its beneficial compounds.
- Frozen cruciferous vegetables are blanched, so they don’t contain all the beneficial compounds. To compensate, add some mustard powder, horseradish, or raw cruciferous vegetables.
Green leafy vegetables
- Recommended: 2 servings per day
- Serving size: 1 cup raw; 1/2 cup cooked
- Arugula; beet greens; collard greens; kale (black, green, and red); mesclun greens (assorted young salad greens); mustard greens; oak leaf lettuce; sorrel; spinach; swiss card; turnip greens
- Note: If you are taking warfarin/Coumadin, talk with your physical before you increase your greens intake
Other vegetables
- Recommended: 2 servings per day
- Serving size: 1/2 cup raw or cooked non-leafy vegetables; 1/2 cup vegetable juice; 1/4 cup dried mushrooms
- Acorn squash; artichokes, asparagus; beets; bell peppers; carrots; celery; corn; cucumber; eggplant; endive; fennel; garlic; green beans; green onion; leeks; mushrooms (button, oyster, portobello, shiitake); okra; onions; purple potatoes; peppers; pumpkin; radicchio; red onions; scallions; sea vegetables (arame, dulse, nori); snap peas; squash (delicata, summer squash, spaghetti squash); sweet potatoes/yams; tomatoes; zucchini
Nuts and seeds
Flaxseeds
- Recommended: 1 serving per day
- Serving size: 1 tablespoon of ground (also known as flaxseed meal or milled flaxseed)
- Golden or brown
Nuts or other seeds
- Recommended: 1 serving per day
- Serving size: 1/4 cup of nuts or seeds; 2 tablespoons of nut or seed butter
- Almonds; brazil nuts (at least 4 per month); cashews; hazelnuts/filberts; macadamia nuts; peanuts; pecans; pistachios, walnuts
- Almond butter, peanut butter
- Chia seeds; hemp seeds; pumpkin seeds; sesame seeds; sunflower seeds
- Note: Chestnuts and coconuts do not nutritionally count as nuts.
Spices and herbs
- Recommended: 1 serving per day
- Serving size: 1/4 teaspoon of ground turmeric root, plus any other salt-free herbs and spices you enjoy
- Cinnamon: Ceylon is preferable to Cassia.
- Make sure your spice mixes are salt-free
- Limit poppy seeds and nutmeg
- Note: If you suffer from gallstones, turmeric may trigger pain. Too much turmeric may increase the risk of certain kidney stones.
- If pregnant, limit ginger to 20 grams per day (about 4 teaspoons of freshly grated ginger).
Whole grains
- Recommended: 3 servings per day
- Serving size: 1/2 cup hot cereal or grain; 3 cups of air-popped popcorn
- Includes pseudo-grains (amaranth, buckwheat, millet, quinoa, teff)
- Use the Five-to-One Rule for whole grain foods. Look at the nutrition facts label on the package and see if the ratio of grams of carbohydrates to grams of dietary fiber is 5 or less. If more than 5, the food should be avoided.
Beverages
- Recommended: 5 servings per day
- Serving size: 1 glass/12 ounces; have 5 glasses a day in addition to the water you get naturally from the foods in your diet
- Water; green and white teas (e.g. green tea, jasmine tea, matcha tea, white tea); black tea (e.g. chai tea, earl grey tea, oolong tea); herbal tea (e.g. chamomile tea, hibiscus tea, lemon balm tea, peppermint tea, rooibos tea)
- Hot chocolate (no milk)
- Coffee: Moderate daily ingestion of unsweetened coffee may be helpful against liver damage, depression, and Parkinson’s disease. Be careful if you have GERD or glaucoma. However, green tea is preferable to coffee as a healthy beverage.
- Unless you have a condition like heart or kidney failure or your physician otherwise advises you to restrict your fluid intake, the author recommends you drink five glasses of tap water a day (not bottled water, which may have chemical and microbial contamination); that water can be flavored with fruit, tea leaves, and/or herbs.
Sweeteners
- Blackstrap molasses and date sugar
- Stevia: Up to 2 stevia-sweetened beverages per day
- Erythritol: If you need a sweetener in order to eat a healthy food; do not use it as an excuse to eat junk food
Condiments and pantry
- Mustard, nutritional yeast, vinegar
- Liquid smoke is ok

Foods to Minimize with How Not to Die
Yellow-Light Foods — Processed Plant Foods & Unprocessed Animal Foods
These foods should be for special occasions only, or in very limited amounts for daily use to promote the consumption of green-light foods.

Processed plant foods
Unprocessed animal foods
- Meat: The animal’s diet matters
- Grass-fed and finished beef
- Wild-caught seafood
- Pastured eggs
- Pastured poultry
Salt
White potatoes
Olives
Sweeteners
- Natural caloric sweeteners do not have much to offer nutritionally
- Honey
- Less processed cane sugars
- Maple, agave, and brown rice syrups
- Sorbitol and xylitol

Foods to Avoid with How Not to Die
Red-Light Foods — Ultra-Processed Plant Foods & Processed Animal Foods

Vegetables
- Alfalfa sprouts—these are often linked to salmonella outbreaks
Processed animal foods
- Grilled, stir-fried, broiled, barbecued meats and fish
- Cured meats (e.g. bacon, bologna, ham, hot dogs, sausage, salami)
Fats
- Refined olive oil and other vegetable oils (e.g. corn oil)
- Trans fats—found in processed foods and naturally in meat and dairy
- Saturated fat—found mainly in animal products and junk foods; also in cocoa butter, coconut oil, and palm kernel oil
- Dietary cholesterol (less important to lower LDL cholesterol levels)—found exclusively in animal-derived foods, especially eggs
- Fried foods in general—fried meat foods are worse than fried plant foods but both have varying degrees of DNA mutations
- If you fry at home, good ventilation, or grilling outside, may reduce lung cancer risk from toxic volatile chemicals with mutagenic properties
Processed foods
- Sodas and sugary drinks
- Ultra-processed plant foods (e.g. breakfast cereals, chips, pastries)
- Salty processed foods
- Foods containing partially hydrogenated vegetable oil/shortening
- Foods with artificial additives
Sweeteners
- Sugar
- Artificial sweeteners
Alcohol
- One or two drinks lower the risk of heart disease for people living unhealthy lifestyles, but not for people with even the bare minimum of healthy behavior. The underlying ingredients are better eaten in their non-distilled form.
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