Critical Review of Michael Greger’s “How Not to Die”


In an alarming and unforeseen plot twist, I have written two blog posts in one month.

This one’s a review of plant-based-diet advocate Michael Greger’s book, “How Not to Die.”  Enjoy!

“How Not to Die” by Dr. Michael Greger: A Critical Review



  1. Congrats to you Denise, the most courageous investigator out there. Thanks for including me on your emailing list. I always tell people about your book (Death By Food Pyramid) which is such an important cog in the nutritional science machine. I say courageous because you are so intrepid going up against so many researchers who develop vested interests in maintaining their sometimes inflexible claims. So glad to see you are still out there doing it. You wouldn’t believe the arguments I have gotten into at the local “Plant Based” restaurant in Santa Rosa CA ( the only one around) where a group of “How Not To Die” fans hold regular “meetings” with book in hand. ha ha. I try to tell them about your book and the sensible flexibility beyond their horizons. Such dogma is always out there with “true believers” in just about anything…..

    Myron Ort


    1. Myron: sorry to hear about your bad experience with some vegans, i do hope you won’t paint all of us with the same brush. I actually subscribed to Denise’s blog after hearing of her review of ‘The China Study’, because I like to see opposing critiques of vegan information sources, and judging for myself based on the strength of the evidence.

      To your point about ‘sensible flexibility’, Dr. Greger himself even says that there’s no evidence of harm for very little meat consumption, on his book and on his website, he’s very clear about that. He does make a good point though, that food is a package deal, and since there aren’t any animal-product-only essential nutrients, you can generally find the nutrients you need in a healthier source, or at least one with fewer drawbacks.

  2. Good review, Denise. I was curious about phytates, so did a bit of research. Dr. Weil says bad only for wheat-bran junkies, good in anti-inflammatory effects and lowering glycemic load. Dr. Harland says they may result in marginal mineral deficiencies, but that there is evidence that they may have beneficial effects. Heal Yourself At Home has a lot of information about phytates. When I was a WAPF member I pretty much bought everything. I no longer buy much of what passes for dietary advice unless I’ve thoroughly researched it. I no longer eat grains, and I no longer soak nuts (except pumpkin seeds, which I really like the Aztec way, with chile). So phytates occur in all plants; it is how they store some minerals. What’s not to like about that? In a reasonably wholesome diet they’re unlikely to be unhealthful for most people, and the contrary may be true. That’s my take, anyway.

  3. Sounds like “cherry picking” is pretty kind for some of these examples, which look more like flat out lies to me.

    Good information about viral and bacterial diseases from undercooked pork, though – I’d been starting to cook my pork less given lower trichina concerns, but it sounds like there are other reasons not to eat pork rare.

  4. Hi Denise. I had wondered where you had gone.If this is indeed you I am glad you are still on the scene. RCY

  5. Great review! I love your balanced and holistic approach, your reviews are definitely fodder for thought. And I might just have to retrain myself a bit: only use the grill for veggies, and slow cook any meat on low temperatures. Or eat it raw (unless it’s pork or chicken, naturally).

  6. Have you spotted any cherry-picking in chapters about heart decease and high blood pressure? For me they sound very convincing​ to restrict animal products to very few times per month.

    1. She took a sledgehammer to Michael Greger’s book and swung as hard as she could. The foundation of plant based diet remains firmly intact.

      1. Duane: What on Earth is a “plant-based diet?” Sure seems to me that it would apply to nearly any assemblage of foods which humans ordinarily eat, while leaving out one very important and nutritious kingdom, the Fungi. For example, the fruits and vegetables I consume are clearly members of Plantae. The meat and cheeses I eat are also plant-based, since the cows, pigs, goats, etc. on my menu thrive, prosper, and readily reproduce almost exclusively on plants. Same with the fish, molluscs, and crustaceans. The food chain at sea is nearly all based upon plants. So, with the exception of those on an air diet, we are all eating a plant-based diet. Warms the heart, no? Fungi could also fit, sort of, since about 80% of all plant species live in direct symbiosis with them, and could hardly make a go of it without them.

        1. @Gary Ogden: “Plant-based diet” refers to a diet in which animal-derived foods (fish, shellfish, meat, poultry, milk, cheese, and eggs) are excluded. This is pretty well known, though appaently not be everyone. Your suggestion that since animals eat meat, those foods are also “plant-based” seems a stretch but I can see how the literal-minded might unknowingly view the term that way. But that would be like saying our diets are “sun-based” since all the foods depend on energy from the sun. Perhaps “non-animal diet” would be a better term than “plant-based,” especially since “plant-based” as it is used includes fungi, which are not plants. So “non-animal diet” would be technically more accurate. However, almost everyone understands accurately that a “plant-based diet” means no animal products.

          Certainly, in my experience I’ve had no problem in communicating with people using the term “plant-based diet.” YMMV.

          1. ““Plant-based diet” refers to a diet in which animal-derived foods (fish, shellfish, meat, poultry, milk, cheese, and eggs) are excluded. This is pretty well known, though appaently not be everyone. ”

            This conflicts with a simple Google search AND the academic litterature. A plant-based diet is a diet consisting MOSTLY OR ENTIRELY of foods derived from plants, including vegetables, grains, nuts, seeds, legumes and fruits, and with few or no animal products. Vegans and vegan doctors themselves often refer to plant based indigenous societes around the world where they rarely eat any meat. Dr. Dean Ornish and Dr. Fuhrman both advocate a whole food plant based diet while allowing a restricted intake of animal products (less then 10 percent or so for their plant based diet to work (reverse or halt coronary disease)

  7. Thanks for through review! Have you spotted any cherry-picking in chapters about heart decease and high blood pressure? For me they sound very convincing​ to restrict animal products to very few times per month.

  8. Interesting report from Kansas State that black pepper, like herbs from the mint and myrtle family, can reduce HCA production in grilled meats to very low levels.

  9. So far I’ve purchased four copies of “How Not to Die” for myself and my relatives. Unfortunately, they seem to be too set in their habits to benefit very much from the information. At any rate, it makes me feel better that I tried to share the knowledge. In defense of low fat part two, please. Cheers!

    1. This previous post is very interesting for me to read again.
      I posted this comment on the morning of my father’s 80th birthday. On that afternoon, he received a call with a diagnosis of prostate cancer. For several months, he was treated with the typical medical protocols but the cancer spread to his hip by the fall (stage 4). At that point, he decided to try Dr. Greger’s advice from the chapter on prostate cancer in “How Not to Die”. About a month later, released a video of a man in the same condition that was sent to hospice but recovered on a plant based diet with tomato juice/sauce every day. This information gave my father some hope and he tried it out. A few months later, he had another scan and the cancer was gone from his hip which surprised his physician. Since then, I have spoken to thousands of people about his story and have given out scores of copies of “How Not to Die”. Health is Power!

  10. Ah, thank you! I’ve been looking forward to another post. I’m curious if you dare adventure into the Saturated Fat controversy surfacing again? I’d love some clarity around these claims.

  11. Please tell me, you’re going to write something about the new American Heart Association Guideline to dietary fats…they’re outright claiming that saturated fat causes heart disease (even coconut oil!) and we should consume polyunsaturated fats only. And supposedly they are basing this claim on the newest science and studies…but if it’s not true….how can highly qualified people like that not see the flaws in studies you see? They are not just some quacks with a youtube channel, after all. And I just can’t believe they would knowingly spread false information. My head is going to implode any day now 😦

  12. Hey Denise, I’m eagerly awaiting your follow up to your low-fat-high-carb blog post you did almost two years ago(?). I’m guessing you’re now writing a book with a similar theme instead of a blog post? I can’t think of why you’d delay writing/posting the second part seeing how sound and popular the ideas spread around the blogosphere. Looking forward to it either way!

  13. Like every other food-centric approach this book is a waste of time.

    The way not to die is to have high HDL, muscular thighs, a reasonable waist line and low systolic blood pressure. All those markers are improved most by exercise. Unless you stuff your face with too much food and get fat, ANY macro will do.

    Think Jack Lalanne and Ancel Keys as the standard. It’s a HUMAN condition. A pot of collards is not a human.

    1. ” All those markers are improved *most* by exercise”


      Again, I’m a huge advocate for exercise, but believe a plant based diet also helps immensely.

  14. Thank you for doing such a great job. As a novice in the study of health, your critical approach to published works has been eye-opening to me. I believe too many people simply drink down any written word as the truth.

    Your efforts in all areas are helpful and appreciated.

    Keep maintaining your high standards.

    Taylor, Michigan

  15. Great read.

    I don’t understand why there isn’t a comment section on, but so be it.

    As for the article itself – I’ve read a lot of claims of cherry picking of facts by Dr. Greger and frankly cannot fathom it.

    Let’s say that he did manipulate a bit the perspective of a certain study that did not exactly find causation between this bit and that bit, so what?
    The overwhelming body of evidence is that plant-based diets are better for us and do reduce risk factors.

    Moreover, are there any studies the meat is actually good for you and increases lifespan? or reduced risk factors? I don’t think so.

    Perhaps you are the one who is cherry picking, and not looking at the big picture.

    My entire family are doctors and scientists and we had a heated argument when I presented claims and studies regarding nuts. They defended their ways and didn’t want to ‘believe’ the evidence without a large enough body of evidence and their gold standards for research.

    Maybe those studies are in progress, maybe they don’t have funding, maybe they are concluding evidence as we speak, but then again – Eat your 1 Brazillian nut a day, what’s the harm in that? Why the million counter arguments and debates? It is 100% logical that it is good for you, or at least does way more good than bad..

    I do believe (obviously, after 30 years of being a meat eater) that plant based diets are a lot healthier for you, it seems logical to me than eating meat. Really no brainer, and why not? Cause we are used to the taste? That isn’t hard to change.


    1. So true! Dr. Greger’s book is logical and common sense. Find a study that says fruits and vegetables and other plants are bad for you. You can’t. There are many doctors and nutritional scientists that support a plant based diet. His website is full of health information and non-profit .. just trying to share the message that many lifestyle diseases can be prevented or treated with a healthier diet.

  16. Denise, I was particularly interested in the book’s claim that excess fats, not excess carbs, is the cause of type 2 diabetes. I found an NIH article (dated 2011) that reviews all the literature to date on this, along with original research, and it concludes that this theory is unsupported:

    The authors conclude, “The idea that increased adipose tissue mass leads to elevated plasma NEFA concentrations, and these in turn to insulin resistance in insulin target tissues, is appealing and entrenched in the literature. However, many studies over several decades lend credence to a different picture. As adipose tissue mass expands, NEFA release per kilogram adipose tissue is downregulated, not increased. In many obese individuals, this can lead to normalization of plasma NEFA concentrations.”

    So it appears the chapter on diabetes is also based on cherry-picked and out-dated research.

  17. Well Denise, its the 19th of October 2017, and I see that no one has made comments here about Greger’s ‘How Not To Die’ for months.

    But yesterday I was in a Salvation Army second hand Op shop here in Oz, and there in the book section was Greger’s book going for $4.00. So I bought it. just ‘on spec’, to see for myself if there is any value in it..

    I chose to start by reading his chapter on Type 2 Diabetes. I was hoping to see what he had to say about Glugogen as Dr Malcom Kendrick in the UK makes some interesting remarks about it in his blog on diabetes back in 2015.

    But I am perplexed. In the whole chapter on diabetes text there is nary a mention of glugogen. And there is no mention even in the index !

    And reading his chapter on type 2 diabetes, I was surprised to read that Greger thinks that diabetes happens because fat in the blood stream blocks the absorption of glucose by the muscle cells. Thus his solution to T2D is a low fat diet, preferably a vegan one.

    Greger cites some sources for this ‘Very low fat’ hypothesis.And I will have a look at them as I find time. But as you mentioned in your review Greger sometimes cites sources to support his

    And this is illustrated by what I have read today. On page 5 of his introduction he claims that ‘relapsing’ vegetarians eating meat, have “a 146% increase in the odds of heart disease, a 152% increase in strokes, a 166% increase in diabetes, and a 231% increase in weight gain.” …..compared to people who stayed vegetarian.

    His source for this interesting claim is an article by PN Singh, KN Arther, MJ Orlich et al. ” Global Epidemiology of Obsity, vegetarian dietary patterns & non communicable diseases in Asian Indians. Am. J Clin. Nitr. 2014, Supplement 1: 3595-645.

    I could not find the source on the web for a while but finally I found this:

    I have read it quickly. And here is no claim I can find about ‘relapsing vegetarians’ in the article. Further the authors are very careful to point out that the chronic diseases that afflict the tens of millions of newly urbanised poor in India are a result of an almost all vegetarian diet which is full of processed foods, white rice, refined flours, sugars and industrial fats with meat being a rare and expensive treat on festivals maybe.

    Frankly this does NOT inspire me to continue reading. It is an abuse of science and and an outright deception of readers. There are 120 pages of notes and about 20 sources a page. How can anyone be expected to filter out the scientifically valid claims from Gregers’s fakes ?

  18. A plant based diet IS lowering my sister’s need for insulin. She has only been following the diet for 7 months. Her doctor told her that he had never heard of a plant based diet controling diabetes but “to keep doing what she was doing”!

    I have been following the plant based lifestyle for almost a year. I have more energy, sleep better and have no need for cholesterol lowering or hypertension medications. Together we have lost 33 pounds.

  19. Any thoughts on the rumor that Denise has died? I haven’t seen anything of her on You tube and this blog site has been ignored. One has to wonder why if it wasn’t death or some serious illness?

  20. So many diets and strong, educated opinions. Are there any reliable biomarkers that tell us a diet is ‘working’ for us [along with how we look and feel]. My idea is to try some 100% meat and fat diet for 3 months, measure biomarkers and then see how I look and feel – then switch to say 80% carb [non-processed], 10% fat and protein and see what happens??

  21. Good review. I was headed toward a non-animal diet, but I think I’ll go for a primarily plant diet that (for example) includes poached fish.

      1. Lovely to hear from you! Powerfully coherent. Just what I’ve been pondering and attempting to fix, too.

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