How Not to Die: 9 Questions for Michael Greger, MD

Michael Greger, MD, is a Cornell graduate, physician, and internationally recognized speaker. His latest book, How Not to Die, is arguably the best guide ever written if you want to live a longer, better life. “Our diet is the No. 1 cause of premature death and disability,” he writes, and then goes on to reveal the “Daily Dozen,” foods that will add years to your life. How Not to Die dovetails perfectly with Blue Zones. It belongs on every bookshelf. Here’s a sneak peek.

1. In short, tell us about ‘How Not to Die’ and what do you reveal that we’ve not heard before?

The breadth of NutritionFacts.org can be a bit overwhelming. So far I’ve accumulated more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day. I do record annual year-in-review videos going through the science in 12-month chunks, but I really wanted to compile all the most compelling evidence in one place. To that end I have chapters on the role diet may place in preventing, arresting, and reversing each of our 15 leading causes of death backed up by about 3,000 scientific citations. But I didn’t want to just write a reference book. I also wanted it to be a practical guide on translating the mountain of data into day-to-day decisions, and so that’s what became the second half of the book. I center my recommendations around a Daily Dozen checklist of all the things I try to fit into my daily diet and routine.

2. You’re a big proponent of eating plants. Is there any place in our diet for meat and dairy and if so, what is the ideal amount? Or at least, how much meat and dairy can we eat without it negatively affecting our health?

From a nutrition standpoint, I’d much rather see people eat, for example, the traditional Okinawan diet, which is largely (but not exclusively) plant-based, than the strictest 100 percent vegan diet centered around French fries and vegan doughnuts. Unprocessed plant foods are the healthiest options, so the more we can squeeze into our daily diet the better. Health-wise it doesn’t really matter what we eat on holidays or special occasions; it’s our week-to-week choices that makes the most difference for our long-term health and longevity.

There was a study involving f4,00 participants that compared traditional Asian diets with and without occasional servings of meat. The researchers found that men who avoided meat altogether had only half the odds of diabetes compared to those eating a serving of meat every few days, and the vegetarian women had 75 percent lower odds of diabetes than women who were otherwise vegetarian but averaged a single serving of meat a week. We don’t know exactly where that dividing line is, but we do know based on the Adventist data that vegetarians who start to eat meat at least once a week appear to experience large increases in the risk of heart disease, stroke, diabetes, and weight gain. During the 12 years after the transition from vegetarian to omnivore, meat eating was associated with a 3.6-year decrease in life expectancy.

3. How much protein does the average American need and what is the best source?

The estimated average requirement is a paltry 42 grams a day, but the recommended daily allowance (to account for variation among individuals) comes out to be about 51 grams. Still, one PB&J could take you more than half of the way there. Most Americans (including vegetarians and vegans) are getting about 70 percent more protein than they need every day. The reason plant sources are preferable is the baggage that comes along with animal protein. Food is a package deal. As much as Burger King says you can have it your way, you can’t be like “I’d like the burger, hold the saturated fat and cholesterol.” Whereas what’s the “baggage” that accompanies plant protein? Many of the nutrients most Americans are lacking. A striking 97 percent of Americans don’t even reach the recommended minimum day fiber intake. 98 percent of Americans suffer from potassium deficient diets. Most of our dietary deficiencies are due to inadequate intake of whole plant foods.

4. If you were to nominate three super foods, what would they be and why?

Sweet potatoes (extra credit if they’re purple inside); a dark green leafy cruciferous vegetable, such as kale or collard greens; and a legume, probably lentils if I had to choose just one. These questions are making me hungry!

5. We found that beans were a cornerstone of longevity diets everywhere. What’s your take on beans and how much should we be eating?

The benefits of beans are one of the big takeaways from How Not to Die. Sadly, 96 percent of Americans don’t even reach the minimum recommended intake of three servings a week. I’m more inclined to agree with the American Institute for Cancer Research’s suggestion of three servings a day, beans, split, peas, chickpeas or lentils with every meal. Who eats beans for breakfast? Well, lots of people around the world do, from baked beans in traditional English breakfasts to miso soup in Japan and idle in India, a type of steamed lentil cake. Legume intake may be the most important dietary predictor of survival in older people from around the globe, with an 8 percent reduction in risk of premature death for every one-ounce increase in daily intake.

6. What four foods we should always buy and four foods we should never buy when we visit the grocery store?

I’m a big fan of convenience, so canned beans, fresh fruit, and bags of frozen greens and frozen berries are always on my shopping list. The worst things we can eat are probably trans fats and processed meats, so I would stay away from processed foods that contain hydrogenated oils like many margarines or canned frosting, as well as lunch meats and hot dogs.

7. What is the ideal diet for living the longest, healthiest lives?

As far as I can discern, the best available balance of evidence suggests that the healthiest way to eat is a diet centered around whole plant foods, including an array of whole grains, beans, fruit, nuts, and as many vegetables as we can stuff in our face.

8. If I’m overweight and I wanted to lose 10 pounds in 2016, what would you recommend? Do you have a favorite breakfast to start the day?

The key to healthy, sustainable weight control is to adopt a diet that emphasizes nutrient-dense, but calorically dilute foods, such that one never has to worry about calorie counting or portion control. We evolved over millions of years eating exceedingly fiber-rich diets, probably exceeding 100 grams a day (based on studies of fossilized human feces). The good bacteria in our gut convert the fiber into short chain fatty acids that are absorbed into our bloodstream and affect our metabolic hormones to reduce our appetite. When we don’t eat enough fiber-containing plant foods we rob our body of its natural satiety signals.

This morning I had chocolate cherry mint oatmeal: cooked oatmeal with some mashed cannellini beans, mixed with a tablespoon of cocoa, a drained can of tart cherries, pumpkin seeds, bahri dates for sweetness, and topped with some fresh mint leaves from the garden. Yum!

9. Why do you think people are hesitant to eat healthier?

Surveys show people wildly overestimate the power of pills and procedures to keep them healthy. For example, patients believe cholesterol-lowering statin drugs are about 20 times more effective than they actually are in preventing heart attacks. No wonder most people continue to rely on drugs to save them! But our leading killers aren’t caused by drug deficiencies. The dirty little secret is that most people surveyed said they wouldn’t be willing to take many of these drugs if they knew how little benefit these products actually offered. Treating the actual cause by cleaning up our diets is not only safer and cheaper but most importantly can be more effective in preventing, arresting, and reversing our leading causes of death.

More than a thousand of Greger’s nutrition videos are freely available at NutritionFacts.org, with new videos and articles uploaded every day. Greger started Nutrition Facts because most doctors are never taught the impact healthy nutrition has on the course of illness so they graduate lacking a powerful tool from their medical toolbox. He says, in general, doctors simply aren’t paid for counseling people on how to take care of themselves.