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

by Michael Greger

The U.S. health care system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the benefits of healthy eating. If doctors were instead paid for performance, there would be a financial incentive to treat the lifestyle causes of disease.

There may be no such thing as dying from old age. From a study of more than forty-two thousand consecutive autopsies, centenarians—those who live past one hundred—were found to have succumbed to diseases in 100 percent of the cases examined. Though most were perceived, even by their physicians, to have been healthy just prior to death, not one “died of old age.”1 Until recently, advanced age had been considered to be a disease itself,2 but people don’t die as a consequence of maturing. They die from disease, most commonly heart attacks.3 Most deaths in the United States are preventable, and they are related to what we eat.4 Our diet is the number-one cause of premature death and the number-one cause of disability.

Global spending for prescription drugs is surpassing $1 trillion annually, with the United States accounting for about one-third of this market.

we’re living longer, but we’re living sicker.

People who once ate vegetarian diets but then started to eat meat at least once a week experienced a 146 percent increase in odds of heart disease, a 152 percent increase in stroke, a 166 percent increase in diabetes, and a 231 percent increase in odds for weight gain. During the twelve years after the transition from vegetarian to omnivore, meat-eating was associated with a 3.6 year decrease in life expectancy.

The standard American diet rates eleven out of one hundred. According to estimates from the U.S. Department of Agriculture, 32 percent of our calories comes from animal foods, 57 percent comes from processed plant foods, and only 11 percent comes from whole grains, beans, fruits, vegetables, and nuts.47 That means on a scale of one to ten, the American diet would rate about a one.

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 percent of chronic disease risk. If you start from scratch and manage to tick off all four, you may be able to wipe out more than 90 percent of your risk of developing diabetes, more than 80 percent of your risk of having a heart attack, cut by half your risk of having a stroke, and reduce your overall cancer risk by more than one-third.51 For some cancers, like our number-two cancer killer, colon cancer, up to 71 percent of cases appear to be preventable through a similar portfolio of simple diet and lifestyle changes.

Weight loss through calorie restriction and an even more vigorous exercise program failed to improve telomere length, so it appears that the active ingredient is the quality, not quantity, of the food eaten. As long as people were eating the same diet, it didn’t appear to matter how small their portions were, how much weight they lost, or even how hard they exercised; after a year, they saw no benefit.72 In contrast, individuals on the plant-based diet exercised only half as much, enjoyed the same amount of weight loss after just three months,73 and achieved significant telomere protection.74 In other words, it wasn’t the weight loss and it wasn’t the exercise that reversed cell aging—it was the food.

It turns out a more plant-based diet may help prevent, treat, or reverse every single one of our fifteen leading causes of death.

A heart-healthy diet is a brain-healthy diet is a lung-healthy diet. The same diet that helps prevent cancer just so happens to be the same diet that may help prevent type 2 diabetes and every other cause of death on the top-fifteen list.

That one unifying diet found to best prevent and treat many of these chronic diseases is a whole-food, plant-based diet, defined as an eating pattern that encourages the consumption of unrefined plant foods and discourages meats, dairy products, eggs, and processed foods.

The primary reason diseases tend to run in families may be that diets tend to run in families.

Colon cancer mortality in Japan in the 1950s was less than one-fifth that of the United States (including Americans of Japanese ancestry).102 But now colon cancer rates in Japan are as bad as they are in the United States, a rise that has been attributed in part to the fivefold increase in meat consumption.

Three hours after eating a cup of broccoli sprouts, the enzyme that cancers use to help silence our defenses is suppressed in your bloodstream110 to an extent equal to or greater than the chemotherapy agent specifically designed for that purpose,111 without the toxic side effects.

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.2

In Uganda, a country of millions in eastern Africa, coronary heart disease was described as “almost non-existent.”

Then and now, in the industrialized world, heart disease is a leading killer. In central Africa, heart disease was so rare it killed fewer than one in a thousand.4

The extraordinarily low rates of heart disease in rural China and Africa have been attributed to the extraordinarily low cholesterol levels among these populations.

By eating so much fiber and so little animal fat, their total cholesterol levels averaged under 150 mg/dL,6,7 similar to people who eat contemporary plant-based diets.8 So what does all of this mean? It means heart disease may be a choice.

If you looked at the teeth of people who lived more than ten thousand years before the invention of the toothbrush, you’d notice they had almost no cavities.9 They never flossed a day in their lives, yet no cavities. That’s because candy bars hadn’t been invented yet. The reason people get cavities now is that the pleasure they derive from sugary treats may outweigh the cost and discomfort of the dentist’s chair. I certainly enjoy the occasional indulgence—I’ve got a good dental plan! But what if instead of the dental plaque on our teeth, we’re talking about the atherosclerotic plaque building up in our arteries? We’re not just talking about scraping tartar anymore. We’re talking about life and death.

Just as we could avoid sugary foods that rot our teeth, we can avoid the trans fat, saturated fat, and cholesterol-laden foods that clog up our arteries.

A systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the effects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on fish oil supplements but also studies on the effects of advising people to eat more oily fish. What did they find? Overall, the researchers found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.

If there’s anyone reading this over the age of ten, the question isn’t whether or not you want to eat healthier to prevent heart disease but whether or not you want to reverse the heart disease you very likely already have.

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.26 Notice a pattern here? The three boosters of bad cholesterol—the number-one risk factor for our number-one killer—all stem from eating animal products and processed junk.

To become virtually heart-attack proof, you need to get your LDL cholesterol at least under 70 mg/dL.

The cholesterol-lowering statin drug Lipitor has become the best-selling drug of all time, generating more than $140 billion in global sales.

Statin drugs also appeared to increase the risk of developing diabetes.37 In 2013, a study of several thousand breast cancer patients reported that long-term use of statins may as much as double a woman’s risk of invasive breast cancer.38 The primary killer of women is heart disease, not cancer, so the benefits of statins may still outweigh the risks, but why accept any risk at all if you can lower your cholesterol naturally?

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.

We’ve known for nearly two decades that a single fast-food meal—Sausage and Egg McMuffins were used in the original study—can stiffen your arteries within hours, cutting in half their ability to relax normally.

Originally, researchers blamed the animal fat or animal protein, but attention has recently shifted to bacterial toxins known as “endotoxins.” Certain foods, such as meats, appear to harbor bacteria that can trigger inflammation dead or alive, even when the food is fully cooked. Endotoxins are not destroyed by cooking temperatures, stomach acid, or digestive enzymes, so after a meal of animal products, these endotoxins may end up in your intestines. They are then thought to be ferried by saturated fat across the gut wall into your bloodstream, where they can trigger the inflammatory reaction in your arteries.

Why aren’t all my colleagues telling their patients to lay off the Chick-fil-A? Insufficient time during office visits is a common excuse physicians cite, but the top reason doctors give for not counseling patients with high cholesterol to eat healthier is that they think patients may “fear privations related to dietary advice.”65 In other words, doctors perceive that patients would feel deprived of all the junk they’re eating. Can you imagine a doctor saying, “Yeah, I’d like to tell my patients to stop smoking, but I know how much they love it”?

Today, Dr. Barnard says, “Plant-based diets are the nutritional equivalent of quitting smoking.”

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 cancer is our number-one cancer killer. Most of the 160,000 lung cancer deaths every year are the direct result of smoking. However, a healthy diet may help mitigate the DNA-damaging effects of tobacco smoke, as well as perhaps help prevent lung cancer from spreading.

Men who smoke are twenty-three times more likely and women thirteen times more likely to develop lung cancer than nonsmokers.

onto their products.4 If, despite all the evidence and warnings, you’re currently a smoker, the most important step you can take is to stop. Now. Please. The benefits of quitting are immediate.

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.8

Chemopreventive agents can be classified into different subgroups based on which stage of cancer development they help to fight: Carcinogen blockers and antioxidants help prevent the initial triggering DNA mutation, and antiproliferatives work by keeping tumors from growing and spreading. Curcumin is special in that it appears to belong to all three groups, meaning it may potentially help prevent and/or arrest cancer cell growth.

Foods of animal origin have been associated with increased asthma risk. A study of more than one hundred thousand adults in India found that those who consumed meat daily, or even occasionally, were significantly more likely to suffer from asthma than those who excluded meat and eggs from their diets altogether.50 Eggs (along with soda) have also been associated with asthma attacks in children, along with respiratory symptoms, such as wheezing, shortness of breath, and exercise-induced coughing.51 Removing eggs and dairy from the diet has been shown to improve asthmatic children’s lung function in as few as eight weeks.

the diet they used experimentally to impair people’s lung function and worsen their asthma was effectively the standard American diet.

In about 90 percent of strokes,3 blood flow to part of the brain gets cut off, depriving it of oxygen and killing off the part fed by the clogged artery.

In addition to its well-known effects on bowel health, high fiber intake appears to reduce the risk of cancers of the colon5 and breast,6 diabetes,7 heart disease,8 obesity,9 and premature death in general.10 A number of studies now show that high fiber intake may also help ward off stroke.

Unfortunately, less than 3 percent of Americans meet the minimum daily recommendation for fiber.12 This means about 97 percent of Americans eat fiber-deficient diets. Fiber is naturally concentrated in only one place: whole plant foods.

We do know that fiber helps control your cholesterol14 and blood sugar levels,15 which can help reduce the amount of artery-clogging plaque in your brain’s blood vessels. High-fiber diets may also lower blood pressure,16 which reduces the risk of brain bleeds.

One more apple, an extra quarter cup of broccoli, or just two tablespoons of beans a day during childhood could translate into a meaningful effect on artery health later in life.

Nowadays, less than 2 percent of Americans even reach the recommended daily intake of 4,700 mg.24 The major reason is simple: We don’t eat enough unprocessed plant foods.

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; in fact, they come in at number 1,611, right after Reese’s Pieces.27 You’d have to eat a dozen bananas a day just to get the bare minimum recommended amount of potassium.

43 As with lung disease,44 antioxidant supplements don’t appear to help.45 Mother Nature’s powers cannot be stuffed into a pill.

Sadly, beer represents Americans’ fourth-largest source of dietary antioxidants.

On average, plant foods contain sixty-four times more antioxidants than animal foods.