How Not to Die By Dr. Greger – Plant-based nutrition book summary

I have long been a fan of NutritionFacts.org. Funded only by donations from individual visitors, Dr. Michael Greger and his team read every English-language journal article on nutrition every year and share their critical analysis free of charge. When it can feel like everyone is trying to manipulate and profit off of others, sources like these stand out as much more credible to me.

After a long wait from the library, I have finally read Dr. Greger’s book How Not to Die. Again, all proceeds go directly to fund his free educational website – he takes no compensation. For most books I discuss on here, I provide a comprehensive summary of the key takeaways as I see them. For this one, though, you can just go directly to NutritionFacts.org and search for any and all the information that interests you. If you’d still prefer a summary, check out the one done by Chewfo or the video published by Dr. Greger himself.

Instead, I’d like to share with you the little notes I took for myself to give you an idea of what the book offers.


First up, probably the most controversial: a whole foods, plant-based diet recommendation. This blog demonstrates how open I am to considering all different ways of eating and I still believe that there is no one right way – not only because we are individuals with different needs and different reactions to foods, but also because a good diet I can incorporate into my life is heaps better than a great diet I can’t keep up. All that said, this book devotes the first half to explaining exactly why a whole foods, plant-based diet is best for optimal health and avoiding the 15 leading causes of death.

One of those causes is depression. I’m aware that with the exception of the most severely depressed, anti-depressant medication has not been proven to be more effective than the placebo effect. If capable of exercise, 30 minutes of walking is at least as effective as those drugs without the negative side effects. And interestingly, certain foods are naturally beneficial for mood-enhancing neurotransmitters: apples, grapes, onions, green tea, cinnamon, and sesame, sunflower, or pumpkin seeds.

Plus, an intriguing theory was presented: since consuming a lot of manufactured highly-palatable foods can make a person less sensitive to the dopamine it continually spikes, which often leads people to overeat those foods trying to reach the original “high,” some people then find it harder to achieve their usual “reward” feelings from other sources in their lives – this can lead to the common symptoms of low motivation and reduced interest towards things enjoyed before depression. By eating mainly whole foods, not only will you soon better appreciate their tastes but you can also better appreciate the joys of life.

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Weight Science from Linda Bacon’s Body Respect – HAES Book Summary

We are constantly warned about the dangers of obesity and urged to manage our weight. These messages come from all directions, including authorities we trust and peers who judge us. But consider for a moment that our accepted assumptions may not represent fully what we know from scientific evidence.

To begin with, the following facts are from Body Respect by Linda Bacon, and you can confirm them in the peer-reviewed article at http://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

  • People who are categorized as overweight or moderately obese have shown time and time again to live as long as or longer than people with weight in the normal category (confirmed even by the CDC)
  • BMI standards were written by the pharmaceutical industry to increase weight loss drug profits, ignoring that health decrement hasn’t shown to occur until a BMI of 40 (they funded the international obesity task force that determined the WHO’s standards and therefore the U.S. standards)
  • Larger people are more likely to develop several diseases but fatness is not the cause – there are many confounding factors like fitness, stress from discrimination, and inflammation from calorie-restriction dieting and weight cycling – “blaming fatness for heart disease is a lot like blaming yellow teeth for lung cancer”
  • “There has never been a research study that has demonstrated long-term maintenance of weight loss from lifestyle change for any but a small minority” – the rare person who does maintain weight loss is as lucky as the smoker who lives to be ninety
  • Health can improve when diet and/or exercise improve – not as a result of weight loss – yet at the same time, health behaviours account for less than 1/4 of differences in health outcomes, while social differences (i.e. poverty and discrimination) are the main determinants (again confirmed by the CDC)

If you’re like me, you’re probably tempted to object to the above sample of facts because we fear fat so strongly. However, ignorance has hurt us through lifetime yo-yo dieting, obsession with food and body, disordered eating, weight discrimination, and even poor health, the very thing we think we’re helping by stigmatizing fatness.

Honestly, though… even if I can be healthy at my current weight, I still deep down really want to look the way I did when I was slimmer. In the past I was able to lose weight by manipulating calories – if only I’d just tried harder and longer! Mind you, I’m still stuck with these feelings years after I learned exactly why the belief that I can just force a caloric deficit long-term is, well, unfounded. So let’s forgive each other for not being without bias and just open ourselves up a little more to the possibility that there may be a better way than constantly forcing an attempt to lose weight.

Weight-Loss

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Sugar-Free! Day 1

I’m tired after about 7 hours of decent sleep but was able to get up at 6am on Day 1 because I’m committed to Dr. Hyman’s Blood Sugar Solution plan. I did 30 minutes of yoga (with Adrienne on Youtube) and felt good, though surprised how limited I was in twisting. By the end of the day, as usual, I was too tired with too much of a headache to concentrate at work. It’s hard not to get depressed when I feel like this so often.

The meals were good: smoothie, soup, veggies and dip, curried tempeh, and a lot of nuts (mmm nuts). The portions are large enough, I’m not hungry, but I do want more just because the act of eating and tasting is such a comforting habit. There were many times when I had to resist cookies, ice cream, even strawberries – and just as much, I had to confront my impulse to rationalize short term relief over long term vitality. I’ve read that if I weren’t addicted to sugar, caffeine, and flour, I wouldn’t think this much about eating. I’m excited to see if this no-sugar diet finally facilitates taking control of my health.

Why Diets Don’t Work & How to Naturally Reach a Healthy Weight

Almost any calorie restriction leads to weight loss in the short-term but 95% of the time, the weight (and then some) returns within 2-5 years. The few who do maintain long-term weight loss through dieting must continue adhering to strict restriction. And even they are an anomaly like the smoker who lives until 90 – it doesn’t prove that smoking doesn’t kill.

Why Diets Don’t Work

  • Just as with height, 50-80% of weight is determined by genetics – even the distribution of fat is 40% due to our genes. And just as there are average heights but no “ideal” heights, average or typical weights are likewise neither good nor bad.
  • Nobody would diet without negative thoughts about one’s body, which perpetuates the diet-binge cycle. Fuelled by shame, dieters experience depression, fatigue, weakness, irritability, social withdrawal, reduced sex drive, low sex-drive, low self-esteem, and low ability to concentrate and think clearly.
  • Though a “typical” woman generally expends around 2,000 calories per day to sustain basic life functions, perform physical activities, and digest food, the “caloric deficit” approach to dieting does not work because there are so many other factors at play, i.e. genetics, age, weight, body composition, stimulants like caffeine, exposure to cold, exercise, nutrient absorption, gut bacteria, environmental toxins like plastic, etc. Not to mention, reported calorie content is an approximation – food labels in the US are allowed a 20% margin of error.
  • Twin studies prove that, even given the same weight-loss program and full compliance, different people show different results.
  • Food restrictions almost always lead to overeating “forbidden foods” because (1) just a taste of forbidden foods disinhibits restrains, even when deprivation is only perceived, and (2) restriction leads the body to increase hunger and make high calorie foods (especially carbohydrates) more enticing for evolutionary purposes – this is proven by increased “hunger hormone” gherlin and decreased peptide YY and leptin’s hunger suppression. Chronic dieting leads to chronically less leptin release, which may explain why yo-yo dieters usually gain weight over time. Overeating after dieting is akin to breathing deeply after physical exertion – a natural response, not a sign of weakness.
  • Our ancestors were able to reproduce because their – and now our – bodies hold onto more fat after famine.
  • Within 24-48 hours of restriction, metabolism (i.e. fat burning) slows 15-30% and it stays low for as long as the body is at a lower weight. As restriction continues or repeats, this reaction is quicker and more severe each time.
  • While both fat and muscle are burned in total weight loss, only fat is put on from weight gain – meaning body size is larger and metabolism is slower.
  • If you constantly try to override your body’s natural ability to maintain weight with diets and binges, your body fights harder by setting a higher weight to maintain, i.e. a “settling point.”
  • Yo-yo dieters are at higher risk of heart disease and diabetes, regardless of current weight, and are 25-100% more likely to die prematurely.
  • Calorie restriction increases inflammation, even more so with cycles of weight loss and gain.
  • Dieting can lead to fatigue, poor sleep, mood changes, depression, obstructed menstrual cycle, reduced mental acuity, and obsession over food and weight loss, as demonstrated in Keys’ study.

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How much sugar is right for you?

According to the calories-in-calories-out approach, a daily 2,000 calories of cookies and ice cream is just fine because you likely won’t gain weight. Meanwhile, it’s actually harder to feel satisfied on that amount of sugar-based food because calories are so much more condensed, besides which eating a little chocolate generally makes people want more chocolate – and so, this approach isn’t very sustainable for most people, nevermind the worrisome lack of essential nutrient. Furthermore, a calorie is not the same as any other calorie – metabolic consequences can differ drastically.

Sugar, in particular, even when not increasing total caloric intake, is linked to insulin resistance and high triglyceride levels, and thus increased likelihood of type 2 diabetes and heart disease. It can even lead to tooth decay in the absence of adequate dental care. The World Health Organization and American Heart Association sets 100-150 calories (or 5% of total calories) as the limit on added sugars daily. That’s less than a can of pop, less than a chocolate bar. Even naturally occurring sugars, as in fruit, are only overall healthier because they come with vitamins and minerals, therefore those sugars should also be limited – the USDA recommends two cups of fruit per day.

One meal high in sugar won’t cause any lasting harmful effect overnight – even potential weight bloating goes away after a few days. Over time, though, chronically high sugar consumption can speed up our aging process and lower our cognitive functioning. Not to mention, it’s been shown that sugar activates the same regions of the brain as cocaine. In fact, a study showed mice overwhelmingly chose sugar over cocaine. There is even a convincing argument the inflammatory effect is linked to depression and anxiety.

Most health associations recommend moderation in everything, including sugar. The intention, one assumes, is to propose the most realistic improvement, or “reduced harm” as is an approach to drug addiction. Many health professionals, meanwhile, insist on “zero sugar,” some including fruit fructose. One theory is that keeping even a small amount of conventional candy in rotation will continue cravings for sugar as well as offset nutritional value from otherwise healthy meals, and even maintain side effects some people experience like headaches or the crash-and-burn of a “sugar high.”

My personal opinion, at this point in time, is to advocate for a modified cold turkey approach. For example:

  1. I am currently obsessed with President’s Choice chocolate peanut butter ice cream. This is first on my list to replace, reduce, and ideally eliminate. I believe it might be more effective to target that goal before going on to reduce the next worst culprit.
  2. When ready, I want to try out a day without any added sugar and keep total sugar (including naturally forming) for each meal below 5g, i.e. 1 tsp. I want to see how it feels. Maybe try it for a week. I definitely don’t want to calculate forever, but I understand the need to practice until I develop instinct on how much sugar works for me.
  3. The most important element in all this is to avoid feeling too stressed and behaving too strictly around sugar. I want to be able to eat ice cream every once in awhile without thinking and feeling too much about it.