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

by Michael Greger

“In conclusion,” the researchers wrote, “nearly the entire U.S. population consumes a diet that is not on par with recommendations.

Plant foods, with their greater protective nutritional factors and fewer disease-promoting ones, are healthier than animal foods, and unprocessed foods are healthier than processed foods. Is that always true? No. Am I saying that all plant foods are better than all animal foods? No. In fact, one of the worst items on store shelves is partially hydrogenated vegetable shortening—a product that has vegetable right in its name!

Michael Pollan, bestselling author of The Omnivore’s Dilemma, has said, “If it came from a plant, eat it. If it was made in a plant, don’t.”

What Does “Whole-Food, Plant-Based” Mean, Exactly?

This book is not about vegetarianism, veganism, or any other “-ism.” There are people who completely eliminate any and all animal products as part of a religious or moral stance and may indeed end up better off as a side benefit.

From a nutrition standpoint, the reason I don’t like the terms vegetarian and vegan is that they are only defined by what you don’t eat. When I used to speak on college campuses, I would meet vegans who appeared to be living off french fries and beer. Vegan, technically, but not exactly health promoting. That’s why I prefer the term whole-food, plant-based nutrition. As far as I can discern, the best available balance of evidence suggests that the healthiest diet is one centered on unprocessed plant foods. On a day-to-day basis, the more whole plant foods and the fewer processed and animal products, the better.

Goji berries, however, have the highest concentrations of melatonin.

blind, placebo-controlled, crossover trial of black currants found they can improve the symptoms of computer eye strain (known in doctor-speak as “video display terminal work-induced transient refractive alteration”).

concocted to fool the Germans. The more likely reason the Brits were able to suddenly target Nazi bombers in the middle of the night wasn’t because of bilberries but thanks to a top-secret new invention:

Fresh berries, of course, are divine. My family enjoys pick-your-own outings and then freezes the abundance. I’ve also been known to lay a sheet under branches of mulberry trees that grow in a park by our house and gently knock down a ripe bounty with a broom handle. Evidently, nearly all wild “aggregate” berries (meaning berries that look like clusters of little balls, like blackberries, raspberries, and mulberries) in North America are edible,45 but please be sure you make an ironclad identification before foraging. * * * Berries in all their colorful, sweet, and flavorful glory are protective little antioxidant powerhouses. The issue shouldn’t be how you are going to get your one minimum daily serving but rather how you are going to pry yourself away from them. In your smoothie, as a dessert, on your salad, or just popped right into your mouth—they are nature’s candy.

United States, the massive study determined that the leading cause of both death and disability was the American diet, followed by smoking.2 What did they determine to be the worst aspect about our diet? Not eating enough fruit.3 Don’t limit yourself to eating fruit just the way it comes plucked off the tree. Although fruit makes for a perfect, quick snack, don’t forget that it can be cooked as well. Think baked apples, poached pears, and grilled pineapple. If you like drinking your fruit, blending is better than juicing to preserve nutrition. Juicing removes more than just fiber. Most of the polyphenol phytonutrients (see chapter 3) in fruits and vegetables appear to be bound to the fiber and are only liberated for absorption by the friendly flora in your gut. When you merely drink the juice, you lose out on the fiber and all the nutrition that was attached

taste-wise, my personal favorite is Honeycrisp—or any pick-your-own variety I can find locally. If you’ve never tried an apple you picked right off a tree, you don’t know what you’re missing. Failing that, farmers’ markets can offer good

the half bushel. Dates My favorite fruit snack in the fall and winter is apple slices with dates, for the perfect mix of tart and sweet. Growing up, I never liked dates. They tasted dry and kind of waxy. But then I discovered there were soft, plump, moist varieties that didn’t taste like the chalky ones that haunted my childhood. Barhi dates, for example, are wet and sticky, but when frozen, they acquire the taste and chew of caramel candy. Seriously. Paired with my Honeycrisp, it’s like eating a butterscotch-flavored caramel apple. Locally, you should be able to find decent Medjool dates in Middle Eastern grocery stores and many natural foods markets, but for the too-moist-to-be-sold-commercially varieties, you’ll probably have to shop online. I have tried dates from most of the major online retailers and always go back to ordering from the Date People, a small farm in California. I am averse to commercial endorsements, but I’ve never tasted consistently better dates

and Olive Oil Olives and extra-virgin olive oil are yellow-light foods. Olive consumption should be minimized because they’re soaked in brine—a dozen large olives could take up nearly half your recommended sodium limit for an entire day. Olive oil is sodium-free, but most of its nutrition has been removed. You can think of extra-virgin olive oil a little like fruit juice: It has nutrients, but the calories you get are relatively empty compared to those from the whole fruit. (Olives are, after all, fruits.) Freshly squeezed olive juice already has less nutrition than the whole fruit, but then olive-oil producers also throw away the olive wastewater, which contains the water-soluble nutrients. As a result, you end up getting just a small fraction of the nutrition of the whole fruit by the time extra-virgin olive oil is bottled. Refined olive oil (nonvirgin) is even worse. I would classify it, along with other vegetable oils, as red-light

food snob, but if you’re going to eat something less than maximally healthy, I say pamper yourself and truly relish it. When I eat olives, there’s no way I’m going to eat those waxy black abominations in a can. I’m going to slice up some purple kalamatas that actually have some flavor. If you’re going to spoil yourself once in a while, I say do it right! Mangos Mangos are my favorite fruit treat during spring and summer, but you have to know where to look to get good ones. Check out Hispanic markets and Indian grocery stores. The difference between a mango from Walmart and one from an Indian spice store is like the difference between a hard, pale, tasteless, pink tomato and a ripe, flavorful, farm-stand heirloom. You should be able to smell the mango at arm’s length.

Seedless or not, watermelon contains a compound called citrulline that can boost the activity of the enzyme responsible for dilating the blood vessels in the penis that result in erections. A group of Italian researchers found that citrulline supplementation at the level of five servings of red watermelon a day improved erection hardness in men with mild erectile dysfunction, allowing for a 68 percent increase in monthly intercourse frequency.

without added sugar. I remember naïvely asking a friend in the food business why the industry felt the need to sugar-up an already sweet fruit. “Added weight,” he explained. Just as poultry processors inject salt water into chickens to add water weight, processed food companies often use sugar as a cheap way to bulk up products sold by the pound.

Otherwise, I only wait until just the outside is dry. The outer layer, encrusted with chia, gets a crispy texture while the core remains moist and ready to burst. It’s the kind of thing I can’t eat while watching a movie or reading a book. It tastes so good I just have to stop, close my eyes, and savor it. I also like drying thin apple slices. I either sprinkle them with cinnamon or rub them with freshly grated ginger. They can be just dried until chewy or completely dehydrated into crunchy apple chips. Eating a dozen dried apple rings a day may drop LDL cholesterol levels 16 percent within three months and

articles in the medical literature about the clinical benefits of kiwifruit. Is that because they’re better than other fruits? Or is it because the kiwi industry has more research dollars? One country, New Zealand, holds a substantial share of the global kiwi market, so it’s in its best interest to underwrite research on the fruit. As a result, there is no shortage of papers touting the benefits of kiwifruit. Kiwi is one of the fruits I’ve prescribed to my patients with insomnia (two an hour before bedtime appears to significantly improve sleep onset, duration, and efficiency)

When I realized it was all my fault, I crawled to the dean to beg forgiveness. I already had a history of run-ins with the administration over issues I had raised about the curriculum, and now this. I’ll never forget what he said to me that day: “Why am I not surprised you had something to do with this?” * * * When adding as much fruit as possible to your diet, you certainly don’t have to seek out weapons-grade stinky fruit, but you also don’t have to stick with the same old, same old. Treat yourself! Have fun sampling the many varieties of the many different fruits around. How lovely it can be to stroll through your farmers’ market on a weekend and pick up locally grown fruits that you can zest onto your meals, blend into smoothies, chew when dried, incorporate into your favorite dishes, or best of all, bite right into. The opportunities are ripe for the picking!

In 1777, General George Washington issued a general order that American troops should forage for wild greens growing around their camps “as these vegetables are very conducive to health, and tend to prevent … all putrid disorders.”

If you are on the drug warfarin (also known as Coumadin), talk with your physician before you increase your greens intake. The drug works (both as a rat poison and a human blood-thinner) by crippling the enzyme that recycles vitamin K, which is involved in clotting your blood. If your system gets an influx of fresh vitamin K, which is concentrated in greens, you can thereby undermine the effectiveness of the drug. You should still be able to eat your greens, but your physician will have to titrate the dose of the drug to match your regular greens intake. Eating greens nearly every day may be one of the most powerful steps you can take to prolong your life.

Decades ago, a search began for “interceptor” molecules that could serve as the body’s first line of defense against cancer. The theory was that if we could find something that could tightly bind to carcinogens and prevent them from slipping into our DNA, we might be able to prevent some of the mutations that lead to cancer. After years of combing for the existence of such carcinogen-binding molecules, an interceptor was found:

you were taught in high school biology wasn’t true. Then in graduate school, you unlearn all the oversimplifications you learned in college. Just when you think you understand something in biology, it always seems a little more complicated than you thought. For example, until recently, we assumed plants and plantlike organisms were the only ones that could directly capture and utilize the energy from the sun. Plants photosynthesize. Animals don’t. That’s because plants have chlorophyll and animals do not. Well, technically, you do have chlorophyll in your body—temporarily, at least—after you eat greens.

CoQ10, also known as ubiquinol, is an antioxidant. When ubiquinol extinguishes a free radical, it is oxidized to ubiquinone. To act as an effective antioxidant again, the body must regenerate ubiquinol from ubiquinone. Think of it like an electrical fuse: Ubiquinol can only be used once before having to be reset. That’s where sunlight and chlorophyll may come in. Researchers exposed some ubiquinone and dietary chlorophyll metabolites to the kind of light that reaches your bloodstream

of sunlight was only the formation of vitamin D and that the main benefit of greens was the antioxidants they contain. But now we suspect the combination of the two may actually help the body create and maintain its own internal stock of antioxidants. Eating a plant-based, chlorophyll-rich diet may be especially important for those on cholesterol-lowering statin drugs, as these medications can interfere with CoQ10 production. Green Can Taste Great I hope I’ve been able to convince you to eat greens as often as possible. The problem for many people is getting them to taste good. I’m afraid too many of us still suffer flashbacks from overcooked, slimy green lumps on school cafeteria trays. Take kale, for example. Fibrous and grassy tasting, right? Kind of bitter too? Some varieties are more palatable than others. In a good supermarket produce section, you may be able to find three types: green, black, and red. Nutritionally, the differences among them

rinsing the leaves thoroughly under running water. Then rip off the stems and tear the leaves into bite-sized pieces. Alternatively, after the leaves are removed from their stems, roll them up and slice into thin ribbons. If you want to make it even easier on yourself, just use whatever type you can find frozen. Frozen greens are cheaper, last longer, and come prewashed and prechopped. There’s a phenomenon called flavor-flavor conditioning in which you can change your palate by linking a less pleasant flavor (for instance, sour or bitter) with a more pleasant one (say, sweet). For example, when researchers tried adding sugar to sour grapefruit juice, people liked it better. No surprise. But within a few days, the study subjects began to like even unsweetened grapefruit

food to justify the use of a yellow- or red-light condiment to boost consumption, it would be the single healthiest of all foods: greens. I use a balsamic glaze even though it has some added sugar in it. It would be healthier, though, to add green-light sweetness in the form of something like figs or grated apples. The sweetness trick is why green smoothies can be so delicious (if not a little odd looking). Smoothies can be a great way to introduce greens into children’s diets. The basic triad is a liquid, ripe fruit, and fresh greens. I’d start with a two-to-one ratio of fruits to greens to start with before tipping heavier toward greens on the scale. So, for example,

greens with something you already love to make the greens more palatable, consider mixing them with a green-light source of fat: nuts, seeds, nut or seed butters, or avocados. Many of the nutrients greens are famous for are fat soluble, including beta-carotene, lutein, vitamin K, and zeaxanthin. So pairing your greens with a green-light source of fat may not only make them taste better but will maximize nutrient absorption. This can mean enjoying a creamy tahini-based dressing on your salad, putting walnuts in your pesto, or sprinkling some toasted sesame seeds on your sautéed kale. The jump in nutrient absorption is no small effect. When

In a sense, though, all fruits are just fruits, whereas vegetables can be any other part of the plant. Roots may harbor different nutrients than shoots. For this reason, it may be even more important to get in a variety of vegetables, so you can benefit from all parts of the plant, as one large cancer study of nearly a half-million people did indeed find.16 “Because each vegetable contains a unique combination,” a recent review concluded, “a great diversity of vegetables should be eaten … to get all the health benefits.”17 Variety is not only the spice of life; it may prolong it as well. Eating Better to Look Better We’ve all heard of the proverbial golden glow that’s often equated with health, vitality, and youth. But instead of using a tanning bed to achieve a more golden hue, you can do it with a bed of greens.

To make your own pesticide-reducing bath, add one part salt to nine parts water. Just make sure to rinse off all the salt before eating. Is Buying Organic Worth It? Stroll down the produce aisle of your grocery store. You’ll see lots of foods labeled “organic,” but what does that really mean? According to the USDA, organic farming practices preserve the environment and avoid most synthetic materials, including pesticides and antibiotics. Among other requirements, organic farmers must receive annual on-site inspections, use only USDA-approved materials, and not use genetically modified crops. In order to be counted in the $35 billion U.S. organic retail market, products receive a USDA organic stamp.

Nuts make for quick and delicious snacks on their own, but my personal favorite use for them is as green-light sources of fat to make rich, creamy sauces. Whether in a cashew Alfredo, a ginger-peanut sauce, or a tahini-based green goddess dressing, nuts and seeds can maximize nutrient acquisition by both improving absorption and increasing your total intake of vegetables by adding some creamy cachet.

Mix all the ingredients, and heat until the almond butter melts and the sweetener dissolves. Pour into a bowl, whisk until smooth, and put it in the fridge to cool. The chia and fiber from the cocoa powder help it thicken into an indulgent delight. (You can grind up the chia seeds first, but I like the tapioca-like texture the little chia balls form.)

Walnuts for the Win Which nut is healthiest?

suffer fewer deaths from cancer, heart disease, and respiratory disease. There was a lingering question, though: Did these findings show causation or merely correlation? It could be possible, after all, that nut eaters also tend to have other healthy lifestyle behaviors. Maybe those who eat nuts are more likely to be, well, health nuts. On the other hand, if scientists randomly assign thousands of people to various levels of nut consumption and the nuttier group ends up the healthiest, we could have more confidence that nuts aren’t just associated with

better health but actually cause better health. This is what PREDIMED ended up doing.9 More than seven thousand men and women at high cardiovascular risk were randomized into different diet groups and followed for years. One of the groups received a free half pound of nuts every week. In addition to eating more nuts, they were told to improve their diets in other ways, such as eating more fruits and vegetables and less meat and dairy, but weren’t as successful at any of those other goals compared to the control group. Nevertheless, having a free half pound of nuts sent to them every week for four consecutive years did indeed persuade them to start eating more nuts.10 (It’s too bad the researchers couldn’t have slipped in a little free broccoli too!) At baseline, before the study even started, the thousands assigned to the nut group were already eating about half an ounce of nuts a day. Thanks to the ensuing freebies, they ended up bumping up their consumption to a whole ounce (about a handful). As a result, the study was able to determine what happens when people at high risk for heart disease following a particular diet eat an extra half ounce of nuts every day. With no significant differences in meat and dairy intake, there were no significant differences in saturated fat or cholesterol intake. So, unsurprisingly, there were no significant differences in their blood cholesterol levels or the subsequent number of heart attacks. However, the added-nuts group did end up hav...

if you add a serving of nuts to your daily diet, won’t you gain weight? To date, there have been about twenty clinical trials on nuts and weight, and not a single one showed the weight gain you might expect. All the studies showed less weight gain than predicted, no weight gain at all, or weight loss—even after study subjects added a handful or two of nuts to their daily diets.

Then there’s the fecal-excretion theory. Many of the cell walls of chewed almonds, for example, remain intact in the gastrointestinal tract. In other words, it’s possible a lot of the calories in nuts just never get digested and wind up in your waste because you didn’t chew well enough. Both of these theories were put to the test by an international group of researchers who gave participants either a half cup of unshelled peanuts or a half cup of peanuts ground into peanut butter. If either the Pistachio Principle or the fecal-extraction theory were correct, the peanut-butter group would gain weight, since no calories would be left in undigested nuts, and no calories would be burned chewing.

Erectile dysfunction (ED) is the recurrent or persistent inability to attain or maintain an erection for satisfactory sexual performance. It is present in up to thirty million men in the United States and approximately one hundred million men worldwide.

Why does atherosclerosis tend to hit the penis first? The arteries in the penis are half the size of the “widow-maker” coronary artery in the heart. Therefore, the amount of plaque you wouldn’t even feel in the heart could clog half the penile artery, causing symptomatic restriction in blood flow.

“penile angina.”

In medical school, we were taught the forty-over-forty rule: 40 percent of men over age forty have erectile dysfunction. Men with erection difficulties in their forties have a fiftyfold increased risk of having a cardiac event (like sudden death).

vascular disease. Some experts believe that a man with erectile dysfunction—even if he doesn’t have cardiac symptoms—“should be considered a cardiac … patient until proved otherwise.”

As one medical journal put it, the take-home message is that “ED = Early Death.”

This is not just a male issue. Women with higher cholesterol levels report significantly lower arousal, orgasm, lubrication, and sexual satisfaction. Atherosclerosis of the pelvic arteries can lead to decreased vaginal engorgement and “clitoral erectile insufficiency syndrome,” defined as “failure to achieve clitoral tumescence [engorgement].” This is thought to be an important factor in female sexual dysfunction.

For fifty years, doctors have told patients with this common intestinal condition to avoid nuts, seeds, and popcorn, but when the issue was finally put to the test, it turns out these healthy foods actually appear to be protective.

Why You Should Include Turmeric in Your Daily Diet

Powdered fenugreek seed is a spice found commonly in Indian and Middle Eastern cuisines. Fenugreek appears to significantly improve muscle strength and weight-lifting power output, allowing men in training, for example, to leg press an extra eighty pounds compared to those ingesting a placebo.

One sign of changing U.S. demographics is that salsa has replaced ketchup as America’s top table condiment.

“Why not try it in my practice?”