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

by Michael Greger

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 same ethnic group are compared between their current locale and their homeland. For example, the Alzheimer’s rates among Japanese men living in the United States are significantly higher than those of Japanese men living in Japan.91 The Alzheimer’s rates among Africans in Nigeria are up to four times lower than those of African

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.

risk the drug’s side effects, most typically nausea, vomiting, and diarrhea.133 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. Gerontotoxins Each of us contains tens of billions of miles of DNA—enough for one hundred thousand round trips to the moon if you uncoiled each strand and placed them end to end.134 How

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.

feet.3 And your intestines? 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. Three of the most common cancers of the digestive tract kill approximately one hundred thousand Americans each year. Colorectal (colon and rectal) cancer, which claims fifty thousand lives annually,5 ranks among

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.

You can measure your own oral-anal transit time by eating some beets and noting when your stools turn pink. If that takes less than twenty-four to thirty-six hours, you’re probably meeting the healthy half-pound target.23 Constipation is the most common gastrointestinal complaint in the United States, leading to millions of doctor visits each year.24 But beyond just the discomfort, the straining associated with trying to pass small, firm stools may play a role in a host of health problems, including hiatal hernia, varicose veins, hemorrhoids,25 and painful conditions with names like anal fissure.26 Constipation can be considered a nutrient-deficiency disease, and that nutrient is fiber.

For many years, phytates were maligned as inhibitors of mineral absorption, which is why you might have heard advice to roast, sprout, or soak your nuts to get rid of the phytates. In theory, this would allow you to absorb more minerals, such as calcium.

But more recently, in light of actual human data, phytates’ image has undergone a complete makeover.40 Those who eat more high-phytate foods actually tend to have a greater bone mineral density,41 less bone loss, and fewer hip fractures.42 Phytates appear to protect bone in a manner similar to that of antiosteoporosis drugs like Fosamax,43 but without the risk of osteonecrosis (bone rot) of the jaw, a rare,

who ate red meat at least once each week had about double the risk of developing colon cancer; that risk appeared to triple, however,

When you eat whole grains, beans, nuts, and seeds, phytates are rapidly absorbed into the bloodstream and readily taken up by tumor cells. Tumors concentrate these compounds so efficiently that phytate scans can be used to trace the spread of cancer within the body.

they all appear to be good. High phytate intake has been associated with less heart disease, less diabetes, and fewer kidney stones. In fact, some researchers have suggested that phytates be considered an essential

budding tumors. Colorectal cancer, however, grows out of the inner lining of your intestines, so what you eat may have a direct effect regardless. So researchers decided to give berries a try. Familial adenomatous polyposis is an inherited form of colorectal cancer caused by a mutation in your tumor-suppression genes. People who are affected develop hundreds of polyps in their colons, some of which inevitably turn cancerous. Treatment can involve prophylactic colectomy, where the colon is removed early in life as a preventive step. There was a drug that appeared able to cause polyps to regress, but it was pulled from the market after it killed tens of thousands of people.61 Could berries also cause polyps to retreat without the fatal side effects? Yes. After nine months of daily treatment with black raspberries, the polyp burden of fourteen patients with familial

though, was anything but natural. The researchers used a shortcut, giving the berries as suppositories. Don’t try this at home! After they inserted the equivalent of eight pounds of raspberries into patients’ rectums over those nine months, some of the patients suffered from torn anuses.63 The hope is that research will one day show similar cancer-fighting effects

the form of iron found predominantly in blood and muscle. Because iron can generate cancer-causing free radicals by acting as a pro-oxidant,67 iron can be considered a double-edged sword—too little of it and you risk anemia,

Iron on a Plant-Based Diet Compared with people who eat meat, vegetarians tend to consume more iron (as well as more of most nutrients),76 but the iron in plant foods is not absorbed as efficiently as the heme iron in meat. While this can be an advantage in preventing iron overload, about one in thirty menstruating women in the United States lose more

The healthiest sources of iron are whole grains, legumes, nuts, seeds, dried fruits, and green, leafy vegetables. Avoid drinking tea with meals, as that can inhibit iron absorption. Consuming vitamin C–rich foods can improve iron absorption. The amount of vitamin C in a single orange can enhance iron absorption as much as three- to sixfold, so those trying to boost their iron absorption should reach for some fruit instead of a cup of tea.80 PANCREATIC CANCER My grandfather died of pancreatic cancer. By the time the first symptom arose—a dull ache in his gut—it was too late. That’s

of patients surviving five years after diagnosis. Thankfully, it’s relatively rare, killing only about forty thousand Americans each year.81 As many as 20 percent of pancreatic cancer cases may be a result of tobacco smoking.82 Other modifiable risk factors include obesity and heavy alcohol consumption.83 As we’ll see, specific dietary factors may also play a significant role in the development of this deadly disease. For instance, how the fat in one’s diet may contribute to pancreatic cancer risk has long been a subject of debate. The inconsistency of research findings on the impact of total fat intake may be partly because different fats affect risk differently. The previously

children.85 It all started generations ago with the asbestos workers. The first asbestos-related cancers occurred in the 1920s among miners digging up the stuff. Then came a second wave among shipbuilders and construction workers who used asbestos. We are now in the third wave of asbestos-related disease, as buildings constructed with asbestos are beginning to deteriorate.86 As the history of asbestos shows, to see if something causes cancer, scientists first study those who have the greatest exposure to it. That’s how we’re now learning about the potential cancer-causing effects of poultry viruses. There has been long-standing concern about the possibility that wart-causing chicken cancer viruses are being transmitted to the general population through the handling of fresh or frozen chicken.87 These viruses are known to cause cancer in the birds, but their role in human cancers is unknown. This concern arises out of studies that show that people who work in poultry

cancer (mesothelioma), which was virtually unknown before widespread asbestos use.92 But because the pancreatic cancer one might get from eating chicken is the same pancreatic cancer one might get from smoking cigarettes, it’s more difficult to tease out a cause-and-effect relationship. There are diseases unique to the meat industry, such as the

suffering severe side effects.94 Curcumin, the colorful component of the spice turmeric, appears able to reverse precancerous changes in colon cancer and has been shown in laboratory studies

patients with pancreatic cancer? In a study funded by the National Cancer Institute and performed at the MD Anderson Cancer Center, patients with advanced pancreatic cancer were given large doses of curcumin. Of the twenty-one patients the researchers were able to evaluate, two responded positively to

The primary risk factors include smoking, heavy alcohol consumption, and gastroesophageal reflux disease (GERD, also called acid reflux), in which acid from the stomach gurgles up into the esophagus, burning the inner layer and causing inflammation that can eventually lead to cancer. Besides avoiding tobacco and alcohol (even light drinking appears to increase risk),100 the most important thing you can do to prevent esophageal cancer is to eliminate acid reflux disease—and that can often be accomplished through diet.

Chronic inflammation caused by acid reflux can lead to Barrett’s esophagus, a precancerous condition that involves changes in the esophageal lining.102 To prevent adenocarcinoma, the most common type of esophageal cancer in the United States, this sequence of events must be stopped—and that means halting acid reflux in the first place.

Over the past two decades, about forty-five studies have examined the link between diet, Barrett’s esophagus, and esophageal cancer. The most consistent association with cancer was the consumption of meat and high-fat meals.

How does this happen? Within five minutes of eating fat, your sphincter muscle at the top of your stomach—which acts like a valve to keep down food inside the stomach—relaxes, allowing acids to creep back up into the esophagus.

Billions of dollars are spent on medications to alleviate heartburn and acid reflux by reducing the amount of stomach acid produced, but these drugs can contribute to nutrient deficiencies and increase the risk of pneumonia, intestinal infections, and bone fractures.

The protection afforded by plant-based eating may not be based just on the foods that are reduced, though. Centering your diet around antioxidant-rich plant foods may cut in half your odds of esophageal cancer.115 The most protective foods for cancer at the esophagus-stomach border appear to be red, orange, and dark-green leafy vegetables, berries, apples, and citrus fruits,116 but all unprocessed plant foods have the advantage of containing fiber.

While fat intake is associated with increased risk of reflux, fiber intake appears to decrease that risk.117 High fiber intake may reduce the incidence of esophageal cancer by as much as one-third118 by helping to prevent the root cause of many cases of acid reflux: the herniation of part of the stomach up into the chest cavity.

If you regularly strain to push out stool, over time the increased pressure can push part of the stomach up and out of the abdomen, allowing acid to flow up toward the throat.

the pressure from straining at the toilet may herniate outpouchings from the wall of the colon, a condition known as diverticulosis. The increased abdominal pressure may also back up blood flow in the veins around the anus, causing hemorrhoids,

Our bodies were designed to expect an ever-flowing fiber stream, so it dumps such unwanted waste products as excess cholesterol and estrogen into the intestines, assuming they will be swept away. But if you aren’t constantly filling your bowels with plant foods, the only natural source of fiber, unwanted waste products can get reabsorbed and undermine your body’s attempts at detoxifying itself.

died. We weren’t as lucky with swine flu, which the CDC estimates killed twelve thousand Americans.4 Nearly three-quarters of all emerging and reemerging human diseases arise from the animal kingdom.5 Humanity’s dominion over animals has unleashed a veritable Pandora’s ark of infectious diseases. Most modern human infectious diseases were unknown before domestication led to a mass spillover of animal disease into human populations.6 For example, tuberculosis appears to have been originally acquired through the domestication of goats7 but now infects nearly one-third of humanity.8 Meanwhile, measles9 and smallpox10 may have arisen from mutant cattle viruses. We domesticated pigs and

SARS or Ebola. Although many of these exotic pathogens receive a lot of press coverage, more lives are lost to some of our most common infections. For example, such respiratory infections as influenza and pneumonia kill nearly fifty-seven thousand Americans each year.16 Bear in mind that you don’t need to come in contact with a sick person to fall ill with an infection. There are latent infections that may exist within you, waiting to strike should your immune function falter. That is why it’s not enough to just wash your hands; you have to keep your immune system healthy. Protecting Others To protect others when you’re sick, you need to practice good respiratory

The latest recommendations from the World Health Organization favor the use of alcohol-based sanitizing rubs or gels over hand washing for routine disinfection of your hands throughout the day. (Products containing between 60 and 80 percent alcohol were found to be more effective than soap in every scientific study available for review.) The only time hand washing is preferable is when they are dirty or visibly contaminated with bodily fluids. For routine decontamination—that is, for all other times—alcohol-based products are the preferred method for hand sanitation.

attack and engulf pathogens directly, and natural killer cells that put your cells out of their misery if they become cancerous or infected with a virus. How do natural killer cells recognize pathogens and infected cells? They are often marked for destruction by antibodies, which are special proteins made by another type of white blood cell, known as B cells, that home in like smart bombs and stick to invaders.

(they have poisonous spurs on their heels, you know). For your whole life up until that point, the B cell in your body that produces antibodies against duck-billed platypus venom was just hanging around, twiddling its thumbs, until that very moment. As soon as the venom is detected, this specific B cell begins dividing like crazy, and soon you have a whole swarm of clones

Compared with the control group, people eating five or more servings of fruits and vegetables had an 82 percent greater protective antibody response to the vaccine—and this was after only a few months of eating just a few extra servings of fruits and vegetables a day.22 That is how much control the fork may exert over immune function. Certain fruits and vegetables may give the immune function an extra boost. Kale Americans eat far too little kale. According to the U.S. Department of Agriculture, the average American may consume about 0.05 pounds of kale each year.23 That’s about one and a half cups per person … per decade. As a dark-green, leafy vegetable, kale is not only one of the most nutrient-dense foods on the planet—it may also help fight off infection. Japanese researchers tried dripping a minute quantity of kale on human white blood cells in a petri dish, about one-millionth of a gram of kale protein. Even that miniscule quantity triggered a quintupling of antibody production in the cells.24 The researchers used raw kale, but the scant amounts of kale Americans consume are often cooked. Does cooking kale destroy its immune-boosting effects? It turned out that even boiling the veggies nonstop for thirty minutes did not affect antibody production. In fact, the cooked kale appeared to work even better.25 However, this property was discovered in a test-tube study. Even kale aficionados don’t mainline it like heroin, which is presumably the only way intact kale protein...

in Japan found that phytonutrients in such plant foods as fruits, vegetables, tea leaves, and beans can block the effects of dioxins in vitro. For instance, the researchers found that having phytonutrient levels in the bloodstream achieved by eating three apples a day or a tablespoon of red onion appeared to cut dioxin toxicity in half. The only catch was that these phytonutrient effects lasted only a few hours, meaning you may have to keep eating healthy foods, meal after meal, if you want to maintain your defenses against pathogens as well as pollutants.35 The ability to block toxins isn’t limited to plant foods, however. There is one animal product that has also been shown to potentially block the cancer-causing effects of dioxins—camel urine.36 So next time your kids don’t want to eat their fruits and veggies, you can just say, “Hey, it’s either the broccoli or camel

unnatural, it’s a completely harmless and temporary condition called beeturia.37 It’s a vivid reminder of an important fact: When you eat plant foods, many of the pigment phytonutrients that act as antioxidants in your body (such as lycopene and beta-carotene) are absorbed into the bloodstream and bathe your organs, tissues, and cells. In other words, beet pigments find their way into your urine because they are absorbed through the gut and then travel into the bloodstream, where they circulate throughout the body until eventually being filtered out by the kidneys. During this trip through the body, even your blood becomes a bit pinker too. The same principle causes garlic breath. It isn’t just the residue in your mouth that’s scaring everyone off; it’s also the health-promoting compounds that were absorbed into your bloodstream after you swallowed the garlic, which are then exhaled pungently from your lungs in your breath. Even if you just had a garlic enema, you’d still get garlic breath. For this reason, garlic can potentially be used as an adjunct treatment for critical cases of pneumonia, as it may help clear bacteria on its way out of the lungs.38

natural killer cells are a type of white blood cell that’s a vital member of the immune system’s rapid-response team against virus-infected and cancerous cells. They’re called natural killers because they don’t require prior exposure to a disease to be activated, unlike some other parts of the immune system that can only respond effectively after a history of exposure,

There are about two billion of these elite, special-ops fighters patrolling the bloodstream at any one time, but research suggests that you can bolster their ranks by eating blueberries.

(probiotics) might have immunity-enhancing effects. The first such study demonstrated that white blood