Food as medicine

The DO Book Club, June 2021: How Not to Die

In this book, Michael Greger, MD, and Gene Stone provide a rigorous overview of the disease-preventing power of food and a road map for adopting a more healthful diet.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Welcome back to The DO Book Club!

For June, I read How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease by Michael Greger, MD, and Gene Stone.

If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email me at rraymond@osteopathic.org.

Plot summary

Michael Greger, MD, begins the book by telling the story of his grandmother, who had end-stage heart disease at age 65. After many bypass operations, she was confined to a wheelchair. Her doctor told her there was nothing more he could do for her, and she was essentially sent home to die. Soon after, she happened to see Nathan Pritikin, a lifestyle medicine specialist, on TV. Pritikin had studied the diets and heart disease prevalence of different populations throughout the world and used what he learned to create a diet and exercise regimen that was reversing terminal heart disease in some of his patients.

Pritikin had learned that many groups of people who eat a whole foods, plant-based diet—these are diets almost entirely absent of animal products and processed foods—have a greatly reduced incidence of heart disease, high blood pressure and high cholesterol when compared to Americans eating a standard diet. He had opened centers where people could come to be placed on a plant-based diet and graded exercise regimen.

In desperation, Dr. Greger’s grandmother moved into one of Pritikin’s centers. She quickly went from not being able to walk without crushing chest pain to walking 10 miles daily. Remarkably, she lived another 31 years.

Witnessing her experience inspired Dr. Greger to become a physician and to examine modern medicine with a critical eye. Throughout the book, he talks about the scanty nutrition education that medical students receive (he graduated around 1999) and the limited time physicians have to advise patients on nutrition. He also discusses the watering down of dietary recommendations from the government and other authorities for various reasons, including because they assume people won’t be willing to adopt a whole foods plant-based diet.

The first half of the book is divided into sections dedicated to different ailments such as heart disease, lung disease, liver disease and diabetes. In each section, Dr. Greger goes over what is happening in the body with these illnesses and also shares extensive details on research on how a whole foods plant-based diet can prevent or in some cases reverse such disease states.

In the second half of the book, Dr. Greger offers advice on how to adopt a whole foods plant-based diet. He shares his “daily dozen”—the specific food groups, along with beverages and exercise, he recommends consuming daily for optimum health. Dr. Greger strives to adhere to this diet himself, so he also shares many anecdotes and recipes from his own experience.

Dr. Greger’s daily dozen

  • Beans: Three servings per day (Serving examples: 1/2 cup cooked beans, 1/4 cup hummus)
  • Berries: One serving per day (Serving examples: 1/2 cup fresh/frozen, 1/4 cup dried)
  • Other fruits: Three servings per day (Serving examples: 1 medium fruit, 1/4 cup dried fruit)
  • Cruciferous vegetables: One serving per day (Serving examples: 1/2 cup chopped, 1 tbsp horseradish)
  • Greens: Two servings per day (Serving examples: 1 cup raw, 1/2 cup cooked)
  • Other vegetables: Two servings per day (Serving example: 1/2 cup nonleafy vegetables)
  • Flaxseed: One serving per day (Serving example: 1 tbsp ground)
  • Nuts and seeds: One serving per day (Serving examples: 1/4 cup nuts, 2 tbsp nut butter)
  • Herbs and spices: One serving per day (Serving example: 1/4 tsp turmeric)
  • Whole grains: Three servings per day (Serving examples: 1/2 cup hot cereal, 1 slice of bread)
  • Beverages: 60 ounces per day
  • Exercise: One serving per day (Serving examples: 90 minutes moderate or 40 minutes vigorous)

Interesting tidbits for DOs

Osteopathic medicine emphasizes the whole patient—mind, body, and spirit—and many DOs will appreciate learning more about the impact of diet on whole-body health. Many DOs will also relate to Dr. Greger’s anecdotes about modern medicine too often relying on medication to treat ailments that could be alleviated by lifestyle changes.

A skeptic may say that the average patient would not be willing to make such dramatic changes to their diet. This is the attitude of many authorities who provide dietary guidance, the book notes. Dr. Greger provides a detailed analysis of how this attitude impacted the DASH diet (dietary approaches to stop hypertension), which is recommended by the American Heart Association, the American College of Cardiology and the CDC for patients with high blood pressure.

The DASH diet emphasizes whole grains, fruits, vegetables, low-fat dairy and limited meat consumption. The physician who chaired the committee that developed the diet was aware of research showing that a vegan diet would be best for reducing or eliminating hypertension, but instead designed a diet that would have the blood-pressure-lowering benefits of a vegetarian diet but include enough animal products to be palatable to omnivores.

“This is a recurring theme in official dietary recommendations,” the authors write. “Instead of simply telling you what the science shows and then letting you make up your own mind, experts patronize the population by advocating what they think is practical rather than ideal. By making the decision for you, they undermine those willing to make even greater changes for optimal health.” (Chapter 7)

Notable quote

Taken as a whole, the book’s dietary recommendations can initially be overwhelming and come across as extreme, especially when examined alongside the standard American diet, which includes plenty of meat, dairy and processed foods.

However, in the book’s introduction, Dr. Greger provides a stripped-down overview of the major chronic disease risk factors that is much more manageable to process:

“The truth is that adhering to just four simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases: not smoking, not being obese, getting a half hour of exercise a day, and eating healthier—defined as consuming more fruits, veggies, and whole grains and less meat. Those four factors alone were found to account for 78% of chronic disease risk.” (Introduction)

Many people know that the four factors listed above promote better health, but I found their association with such a high percentage of chronic disease incidence to be surprising.

Takeaways

This book contains much useful information about diet and how it contributes to disease, as well as practical advice on adapting one’s own diet to be more healthful and plant-based and less dependent on processed foods.

I understand that Dr. Greger wants to provide readers with the best diet recommendations possible, extreme as they may be, and let them decide whether/how extensively to implement them. However, one component missing from this book is a discussion of the social aspects of eating and the demonstrated health benefits of social interaction. For instance, Dr. Greger discusses how salt contributes to high blood pressure and then makes the sweeping recommendation to avoid eating out as much as possible because restaurant food tends to be highly salty.

For many Americans, following this recommendation would serve to limit socializing, which is also detrimental to health.

While I really enjoyed this book, learned so much, and wholeheartedly recommend it, I would have liked it even more if it discussed moderation or the fact that totally adopting a whole foods plant-based diet will be difficult for many, but that numerous health benefits can be attained by any steps taken in that direction.

July’s book

For July, The DO Book Club will be reading Mutual Rescue: How Adopting a Homeless Animal Can Save You, Too by Carol Novello. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

As a reminder, if you read How Not to Die or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email me at rraymond@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, April 2021: When Breath Becomes Air

The DO Book Club, February 2021: Womb With a View: Tales from the Delivery, Emergency and Operating Rooms

6 comments

  1. Moderate changes in diet may lead to only moderate benefit in health. If one prefers to achieve maximum health benefits, it might be wise to follow all of Dr. Greger’s evidence based recommendations. For those who already have chronic diseases like obesity, heart disease, diabetes, arthritis, etc. moderate changes in diet may not reverse the disease process. As for the social aspects…the goal here would be for our society to focus on what would bring us health…so restaurants that change their menu to serve health promoting foods could be rewarded by tax breaks or other incentives. When there are enough restaurants that serve actually healthy foods, then the recommendation could change from don’t eat out to eat out with your friends at places that serve health promoting options. And most important of all…is climate change. If you are at all concerned about the effects of climate change on the world and everyone’s health and well being, you must recognize that we all need transition away from raising animals for our food source and embracing plants as the healthiest choice for preventing global warming. “Meat is heat” should be taken seriously. And this book shows us the path to health. Yes it may seem extreme to change ones diet. But we have seen extreme in the fires in Australia, the flooding in Venice, the melting of the ice caps. Embrace the extreme and obtain personal health while saving our planet!

    1. Very insightful comments, Dr. Ross, thank you for sharing! I love the idea of offering incentives to restaurants to make their menus more healthful.

  2. I think all doctors should subscribe to Dr. Gregory emails and read this book. I have learned so much and in the past year,
    4 patients have changed their diets to WFPB based on my recommendation of his book. A 58 yo male cancelled his total hip surgery after 4 months on the diet. He is still pain free 15 months later. A 72 yo woman lost 40 lbs and cancelled her scheduled complex bunion surgery and shoulder surgery and went off all NSAIDs. A 46 yo woman lost all the arthralgia/myalgias of her “seronegative spondyloarthropathy” after 6 weeks WFPB. A 60yo woman lowered her LDL by 50 points and got total relief from her chronic myofascial pain and sleep disorder. Each one surprised me by readily agreeing to try the diet and now they are huge advocates of it. Food is medicine!

    1. Dr. Bayno, it’s wonderful to hear that dietary changes have helped your patients so much! These are incredible stories — thank you for sharing!

  3. Great review. Super agree about the moderation comment at the end, and from the comment above the climate issues associated with our overemphasis on animal products. I’ve been working on getting patients to shift to more plant-based diets and less processed foods for decades, and I’m glad to see other doctors finally getting on board. Funny aside, I got certified in Lifestyle Medicine last year, and during the conference it was entertaining to see Dr Greger lecturing from his treadmill (although seasickness from someone moving on zoom is a thing I also learned) – he really does take his own advice.

    1. AJ, thank you for sharing! That’s amazing that Dr. Greger lectures from a treadmill desk. I believe in the book he writes that he wrote most of it while walking 15 miles per day on a treadmill desk. Very impressive dedication to health!

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