How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease

by Michael Greger

plaque accumulates inside the coronary arteries—the blood vessels that crown the heart (hence “coronary”) and supply it with oxygen-rich blood.

The restriction of blood circulation to the heart muscle can lead to chest pain and pressure, known as angina, when people try to exert themselves. If the plaque ruptures, a blood clot can form within the artery. This sudden blockage of blood flow can cause a heart attack, damaging or even killing part of the heart.

A large body of evidence shows there were once enormous swaths of the world where the epidemic of coronary heart disease simply didn’t exist. For instance, in the famous China-Cornell-Oxford Project (known as the China Study), researchers investigated the eating habits and incidence of chronic disease among hundreds of thousands of rural Chinese. In Guizhou province, for example, a region comprising half a million people, over the course of three years, not a single death could be attributed to coronary artery disease among men under sixty-five.

Immigration studies show that this resistance to heart disease is not just something in the Africans’ genes. When people move from low-risk to high-risk areas, their disease rates skyrocket as they adopt the diet and lifestyle habits of their new homes.

Later studies of accidental death victims between the ages of three and twenty-six found that fatty streaks—the first stage of atherosclerosis—were found in nearly all American children by age ten.

Just how early do these fatty streaks start to appear? Atherosclerosis may start even before birth. Italian researchers looked inside arteries taken from miscarriages and premature newborns who died shortly after birth. It turns out that the arteries of fetuses whose mothers had high LDL cholesterol levels were more likely to contain arterial lesions.23 This finding suggests that atherosclerosis may not just start as a nutritional disease of childhood but one during pregnancy.

To drastically reduce LDL cholesterol levels, you need to drastically reduce your intake of three things: trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and to a lesser extent dietary cholesterol, found exclusively in animal-derived foods, especially eggs.

The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where you start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop in cholesterol-lowering trials.28 An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study,

To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL. Dr. Roberts noted that there are only two ways to achieve this for our population: to put more than a hundred million Americans on a lifetime of medications or to recommend they all eat a diet centered around whole plant foods.

Caldwell Esselstyn Jr.

Let me share with you what has been called the “best kept secret in medicine”:41 Given the right conditions, the body heals itself.

Consider smoking and lung cancer risk: One of the most amazing things I learned in medical school was that within about fifteen years of stopping smoking, your lung-cancer risk approaches that of a lifelong nonsmoker.42 Your lungs can clear out all that tar buildup and, eventually, it’s almost as if you never smoked at all.

More is not better, however. Brazil nuts are so high in the mineral selenium that eating four every day may actually bump you up against the tolerable daily limit for selenium. Nevertheless, this is not something you have to worry about if you’re only eating four Brazil nuts a month.

Sadly, the history of medicine holds many examples of the medical establishment rejecting sound science when it goes against the prevailing conventional wisdom. There’s even a name for it: the “Tomato Effect.” The term was coined in the Journal of the American Medical Association in reference to the fact that tomatoes were once considered poisonous and were shunned for centuries in North America, despite overwhelming evidence to the contrary.

America’s number-two killer, lung disease, claims the lives of about 300,000 people each year. And like our number-one domestic killer, heart disease, it’s largely preventable. Lung disease can come in many forms, but the three types that kill the most people are lung cancer, chronic obstructive pulmonary disease (COPD), and asthma.

Unlike with heart disease, which has yet to be fully acknowledged as the direct result of an artery-clogging diet, there is widespread recognition that tobacco is by far the most common cause of lung cancer.

While breast cancer is the most common internal cancer among American women, lung cancer is actually their number-one killer. About 85 percent of women with breast cancer are still alive five years after diagnosis, but the numbers are reversed when it comes to lung cancer: 85 percent of women die within five years of a lung cancer diagnosis. Ninety percent of those deaths are due to metastasis, the spread of the cancer to other parts of the body.

The effects of meat fumes can be hard to separate from the effects of eating the meat itself, but a recent study on pregnant women and barbecuing attempted to tease them out. When meat is grilled, polycyclic aromatic hydrocarbons (PAHs) are also produced, one of the probable carcinogens in cigarette smoke. The researchers discovered that not only was the ingestion of grilled meat in the third trimester associated with smaller birth weights, mothers merely exposed to the fumes tended to give birth to babies with a birth weight deficit. Exposure to the fumes was also associated with a smaller head size, an indicator of brain volume.26 Air pollution studies suggest prenatal exposure to polycyclic aromatic hydrocarbons may then translate into adverse effects on children’s future cognitive development (as manifested by a significantly lower IQ).27

The bacon and burger fumes were mutagenic, but the tempeh fumes were not. Nevertheless, it’s still not a good idea to eat fried foods. Though no DNA changes were detected after exposure to tempeh smoke, the fried tempeh itself did cause some DNA mutations (though 45 times fewer than the beef and 346 times fewer than the bacon).

If it’s the antioxidants, why not just take an antioxidant supplement? After all, popping a pill is easier than eating an apple. The reason is simple: Supplements don’t appear to work. Studies have repeatedly shown that antioxidant supplements have no beneficial effects on respiratory or allergic diseases, underscoring the importance of eating whole foods rather than trying to take isolated components or extracts in pill form.

The two most serious brain diseases are stroke, which kills nearly 130,000 Americans each year,1 and Alzheimer’s disease, which kills nearly 85,000.2 Most strokes can be thought of as “brain attacks”—like heart attacks, but the rupturing plaques in your arteries cut off blood flow to parts of the brain rather than to parts of the heart. Alzheimer’s is more like a mind attack.

If you really want to be proactive, the best available science20 suggests you can minimize stroke risk by eating a minimum of 25 grams a day of soluble fiber (fiber that dissolves in water, typically found in beans, oats, nuts, and berries) and 47 daily grams of insoluble fiber (fiber that does not dissolve in water, found primarily in whole grains, such as brown rice and whole wheat).

Bananas, although they’ve been marketed for their potassium content, aren’t actually particularly rich in the mineral. According to the current U.S. Department of Agriculture database, bananas don’t even make the list of the top-thousand foods with the highest levels of potassium;

What are some of the truly potassium-rich foods? The healthiest common whole-food sources are probably greens, beans, and sweet potatoes.

So eating a few oranges before snowboarding may help keep your fingers and toes from getting as chilly. But while warm digits are nice, the reduced stroke risk associated with higher citrus intake is even nicer.

Higher stroke rates were found among individuals sleeping six hours or less, or nine hours or more. Those at lowest risk got around seven or eight hours of sleep a night.34 Large studies in Europe,35 China,36 and elsewhere37 have confirmed that seven or eight hours appears to be associated with the lowest risk. We’re not sure if the relationship is cause and effect, but until we know more, why not aim for that range? Sleep well!

Awarded the National Medal of Science, the highest honor for scientific achievement in this country, revered biochemist Earl Stadtman was quoted as saying, “Aging is a disease. The human lifespan simply reflects the level of free radical damage that accumulates in cells. When enough damage accumulates, cells can’t survive properly anymore and they just give up.”

Your body then passes these used-up electrons to an all-important molecule you may have heard of: oxygen. In fact, the way poisons like cyanide kill you is by preventing your body from giving up these spent electrons to oxygen.

When superoxide comes in contact with DNA, it can damage your genes, which, if not repaired, can cause mutations in your chromosomes that may lead to cancer.41 Thankfully, the body calls in its defense squad, known as antioxidants.

According to the theory, the resulting cellular damage is what essentially causes aging. Aging and disease have been thought of as the oxidation of the body.

Oxidant stress is thought to be why we all get wrinkles, why we lose some of our memory, why our organ systems break down as we get older. Basically, the theory goes, we’re rusting.

You can tell whether a food is rich in antioxidants by slicing it open, exposing it to air (oxygen), and then seeing what happens. If it turns brown, it’s oxidizing. Think about our two most popular fruits: apples and bananas. They turn brown quickly, which means there aren’t a lot of antioxidants inside them. (Most of the antioxidants in apples are in the peels.) Cut open a mango and what happens? Nothing happens, because there are lots of antioxidants in there. How do you keep fruit salad from turning brown? By adding lemon juice, which contains the antioxidant vitamin C. Antioxidants can keep your food from oxidizing, and they may do the same inside your body.

Knowing this, scientists set out to find the most antioxidant-rich foods. Sixteen researchers spanning the globe published a database of the antioxidant power of more than a whopping three thousand foods, beverages, herbs, spices, and supplements. They tested everything from Cap’n Crunch cereal to the crushed dried leaves of the African baobab tree. They tested dozens of brands of beer to see which has the most antioxidants. (Santa Claus beer from Eggenberg, Austria, tied for first place.)46 Sadly, beer represents Americans’ fourth-largest source of dietary antioxidants.47 You can check out the list to see where your favorite foods and beverages rank at this link: http://bit.ly/antioxidantfoods.

There is no need to necessarily cherry-pick individual foods to boost your antioxidant intake (though cherries do have up to 714!); you can simply strive to include a variety of fruits, vegetables, herbs, and spices at every meal. This way, you can continuously flood your body with antioxidants to help ward off stroke and other age-related diseases.

sprinkle on a single teaspoonful of dried oregano or marjoram, oregano’s sweeter and milder twin. That alone could double your meal’s antioxidant power, up to more than 300 units.

How about a bowl of oatmeal for breakfast? By adding just a half-teaspoon of cinnamon, you could bring the antioxidant power of your meal from 20 units to 120 units. And if you can stand the punch, adding even a pinch of cloves could bring your unassuming breakfast up to an antioxidant score of 160 units.

High-antioxidant fruits and vegetables, such as berries and greens, have been found to douse systemic inflammation significantly better than the same number of servings of more common low-antioxidant fruits and veggies, such as bananas and lettuce.

Cholesterol is a vital component of your cells, which is why your body makes all that you need. Consuming excess cholesterol, and especially trans and saturated fats, can raise your blood cholesterol level.80 Too much cholesterol in your blood is not only considered the primary risk factor for heart disease81 but is also unanimously recognized as a risk factor for Alzheimer’s disease.82

Drug companies have hoped to capitalize on this connection to sell cholesterol-lowering statin drugs to prevent Alzheimer’s, but statins themselves can cause cognitive impairment, including short- and long-term memory loss.87 For people unwilling to change their diets, the benefits of statins outweigh the risks,88 but it’s better to lower your cholesterol levels naturally by eating healthier to help preserve your heart, brain, and mind.

The lowest validated rates of Alzheimer’s disease in the world are found in rural India,96 where people eat traditional, plant-based diets centered on grains and vegetables.97

What does the ApoE gene do? It makes the protein that’s the principal cholesterol carrier in the brain.100 The E4 variant may lead to an abnormal accumulation of cholesterol within brain cells, which could trigger Alzheimer’s pathology.101 This mechanism may explain the so-called Nigerian paradox. The highest frequency of the ApoE4 variant occurs in Nigerians,102 who surprisingly also have some of the lowest rates of Alzheimer’s.103 Wait a second. The population with the highest rate of the “Alzheimer’s gene” has one of the lowest rates of Alzheimer’s disease? This contradiction may be explained by Nigerians’ extremely low blood-cholesterol levels, thanks to a diet low in animal fat104 and consisting mainly of grains and vegetables.105 So, it seems, diet can trump genetics.

When researchers tried to tease out the protective components, the critical ingredients appeared to be the diet’s high vegetable content and lower ratio of saturated to unsaturated fats.112 This conclusion aligns with that of the Harvard Women’s Health Study, which found that higher saturated fat intake (sourced predominantly from dairy, meat, and processed foods) was associated with a significantly worse trajectory of cognition and memory. Women with the highest saturated fat intake had a 60–70 percent greater chance of cognitive deterioration over time. Women with the lowest saturated fat intake had the brain function, on average, of women six years younger.113

Whole plant foods contain thousands of compounds with antioxidant properties,114 some of which can traverse the blood-brain barrier and may provide neuroprotective effects115 by defending against free radicals (see here)—that is, protecting against the “rusting” of the brain. Your brain is only about 2 percent of your body weight but may consume up to 50 percent of the oxygen you breathe, potentially releasing a firestorm of free radicals.116 Special antioxidant pigments in berries117 and dark-green leafies118 may make them the brain foods of the fruit and vegetable kingdom.

Polyphenols are one of the reasons I make specific recommendations for berries and green tea in part 2.

While there is no proven way to halt the progression of Alzheimer’s, if you do know anyone suffering from the disease, regularly cooking him or her saffron-spiced paella may help.

Where are these AGEs coming from? Some are produced and detoxified naturally in your body,146 but other than cigarette smoke,147 major sources are “meat and meat-derived products” exposed to dry-heat cooking methods.148 AGEs are formed primarily when fat- and protein-rich foods are exposed to high temperatures.149

Because sirtuin suppression is both preventable and reversible by AGE reduction, avoiding high-AGE foods is seen as potentially offering a new strategy to combat the Alzheimer’s epidemic.

Counting all the little folds, some scientists estimate that your gut would blanket thousands of square feet,4 vastly more expansive than your skin and lungs combined. What you eat may very well be your primary interface with the outside world. This means that regardless of the carcinogens that could be lurking in the environment, your greatest exposure may be through your diet.

Esophageal cancer, which affects the tube between your mouth and stomach, is also frequently fatal for its eighteen thousand annual victims.7 The foods you eat can indirectly affect cancer risk, for example, by exacerbating acid reflux, a risk factor for esophageal cancer, or through direct contact with the lining of the digestive tract.

Starting at age fifty until age seventy-five, you should either get stool testing every year, stool testing every three years plus a sigmoidoscopy every five years, or a colonoscopy every ten years.