For those of you who have not yet read or listened to How Not to Die, I encourage you to pick up a copy at your local bookstore or library. I have no personal financial stake in book sales. All the proceeds I receive from sales of any of my books, DVDs, and speaking engagements are donated to charity. So, it’s not for personal gain that I hope you’ll check out my last book. I truly believe it can help you live a healthier and happier life.
What follows here is a very brief summary of How Not to Die’s subject matter. This quick synopsis will help you understand the reason I’ve included these specific (and delicious) recipes in this companion cookbook—they all contain the whole plant foods that may be most helpful in warding off disease and restoring health.
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In the late 1950s, forty-one-year-old engineer Nathan Pritikin was diagnosed with coronary heart disease. His doctors told him there was nothing he could do but take lots of naps, avoid stairs, and spend as much time as possible with his family. But instead of waiting for the inevitable, Pritikin took matters into his own hands and devoured everything he could find on his disease. His research eventually inspired him to adopt a plant-based diet, and within two years, his cholesterol plummeted from over 300 to below 160. Rather than dropping dead from a heart attack, Pritikin went on to help countless others reverse their own heart disease. One was my grandma who, as detailed in Pritikin’s biography, became one of his most famous success stories.4
My grandmother’s miraculous recovery is what inspired me to go to medical school. When I got there, however, I was shocked to find out this whole body of evidence on reversing chronic disease with lifestyle changes—opening up arteries without drugs or surgery—was largely being ignored by mainstream medicine. If effectively the cure to our leading cause of death could get lost down the rabbit hole and ignored, what other information might be buried in the medical literature? I made it my life’s mission to find out. That’s what led me to start NutritionFacts.org and that’s what led me to write How Not to Die.
Plant-based nutrition is the only diet that’s ever been proven to reverse heart disease in the majority of patients. If that’s all a plant-based diet could do—reverse our number one killer—then shouldn’t that be the default diet until proven otherwise? Even more so, since it can also be effective in treating, arresting, and reversing some of our other leading killers as well.
In How Not to Die, I cover the role diet may play in preventing and reversing each of the fifteen leading causes of premature death. Here they are, in order, starting with the most common condition, and the one my grandma was able to reverse so successfully.
CORONARY HEART DISEASE. Our number one killer lays waste to 375,000 Americans each year.5 But, as the China-Cornell-Oxford Project suggested, it doesn’t have to be that way. Led by Professor Emeritus T. Colin Campbell, this exhaustive study examined the dietary habits and mortality rates of several hundred thousand rural Chinese and later became the basis for Dr. Campbell’s best-selling book The China Study. Amazingly, Campbell and colleagues found that many of our Western epidemics of chronic disease, including coronary heart disease, were absent among plant-based Chinese populations.6 Similar studies conducted early in the twentieth century in rural Africa found the same thing: plant-based populations appeared to suffer one hundred times fewer heart attacks compared to Americans of the same age.7
Autopsies of accidental death victims have revealed that heart disease begins very early in life.8 In fact, heart disease may even begin in the womb if your mother had high cholesterol.9 In 1953, a study in the Journal of the American Medical Association examined three hundred fallen American soldiers from the Korean War, with an average age of twenty-two. The researchers found that 77 percent of the soldiers already had visible evidence of coronary atherosclerosis, and some even had arteries that were blocked off by 90 percent or more.10 Other studies of accidental death victims have shown that fatty streaks—the precursor to plaque buildup—tend to appear by age ten among those eating the standard American diet.11
We couldn’t be sure it was the food, though, until it was put to the test. Dr. Dean Ornish was the first to prove in a randomized controlled trial that a plant-based diet and other healthy lifestyle changes could reverse heart disease.12 Dr. Caldwell Esselstyn Jr. followed up using just the dietary component. In 2014, he published a study involving nearly two hundred patients with severe heart disease—some like my grandma who couldn’t make it to the mailbox without being crippled over in pain. At the onset of the trial, Dr. Esselstyn told his patients to adopt a whole-food, plant-based diet. After making the switch, more than 99 percent of his compliant patients avoided further major cardiac events.13
LUNG DISEASES. Lung cancer, chronic obstructive pulmonary disease (COPD), and asthma collectively kill 296,000 Americans every year.14 A plant-based diet may be able to help prevent all three. While the best way to prevent lung cancer is to avoid smoking, a single stalk of broccoli per day can boost the activity of detoxifying enzymes in the liver, helping to prevent lung-cancer–causing DNA damage at the cellular level.15 Each daily serving of fruit is associated with men having a 24 percent lower risk of dying from COPD—a condition including emphysema that makes it difficult to breathe and gets worse over time. Finally, high vegetable consumption is associated with just half the odds of children developing asthma.17 As far as treating asthma, simply adding a few more servings of fruits and vegetables to your diet has been shown in a randomized controlled trial to cut asthma attacks in half.18
BRAIN DISEASES. The two most serious brain diseases are stroke and Alzheimer’s, which collectively kill 215,000 Americans each year.19 Both have touched my life: my mom’s father died of a stroke, and her mother of Alzheimer’s. With most strokes, blood flow to the brain is cut off, depriving it of oxygen. The consequences wrought by a stroke depend on which area of the brain was damaged. People who experience a brief stroke might only need to contend with arm or leg weakness, whereas those who suffer a major stroke can be struck with paralysis, lose the ability to speak, or, as is too often the case, die.
Fortunately, a plant-based diet may reduce the odds of a stroke. Increasing intake of fiber (which is found only in plants) by only 7 grams per day—that’s about a cup of raspberries—is associated with a 7 percent risk reduction.20 In addition, a meta-analysis in the Journal of the American College of Cardiology found that increasing your potassium intake by 1,640 mg—a cup of cooked greens or a half-cup of beans—was associated with a 21 percent reduction in stroke risk.21
Alzheimer’s, a horrendous disease that destroys our memory and sense of self, can neither be cured nor treated effectively. However, there is an emerging consensus that the same foods that clog our arteries can also clog our brain. A senior scientist at the Center for Alzheimer’s Research entitled a review article “Alzheimer’s Disease Is Incurable but Preventable.”22 Autopsies have shown repeatedly that Alzheimer’s patients tend to have significantly more atherosclerotic plaque buildup and narrowing of the arteries within the brain.23
Numerous studies have shown that Alzheimer’s is not a primarily genetic disease. For example, the Alzheimer’s rates among Japanese men living in the United States are much higher than those of Japanese men living in Japan.24 The same goes for African Americans in Indianapolis compared to Africans in Nigeria.25 The problem may be the typical American diet, which can choke the arteries within the brain. Where is the world’s lowest validated rate of Alzheimer’s? Rural northern India,26 where people traditionally eat a plant-based diet centered on grains and vegetables.27
DIGESTIVE CANCERS. Every year, 106,000 Americans die from cancers that might well have been prevented.28 While some cancers have a significant genetic component, common digestive cancers are more likely the result of poor dietary choices. If you were to flatten out your intestines, they could cover thousands of square feet.29 This means an extraordinary amount of surface area interacts with your food as it travels through your digestive tract. Food is our single greatest exposure to the outside environment. Colorectal (colon and rectal) cancer is one of the most commonly diagnosed cancers in the United States, but it’s relatively rare in India. Comparatively, American men have eleven times more colorectal cancer diagnoses and women have ten times more.30 One possible reason? Spices, such as turmeric, a staple of Indian cuisine, including curry powder, appear to have a variety of anticancer properties.31 Another possibility is the food in which the turmeric-laden curry powder is used: India is one of the world’s largest producers of fruits and vegetables, and only about 7 percent of the adult population eats meat on a daily basis. What most of this population does eat daily are legumes (beans, split peas, chickpeas, and lentils) and dark green, leafy vegetables,32 which are packed with another class of cancer-fighting compounds called phytates.
Pancreatic cancer is among the most lethal cancers, with only 6 percent of patients surviving five years after diagnosis.33 This is why prevention is paramount. The National Institutes of Health–AARP study, which followed 525,000 people aged fifty to seventy-one for years beginning in 1995, found the consumption of fat from animal sources was significantly associated with pancreatic cancer risk. No such correlation was found with consuming plant fats.34 Likewise, the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which followed 477,000 people for a decade beginning in 1992, found a 72 percent increased risk of pancreatic cancer for every 50 grams of poultry (about a quarter of a chicken breast) consumed daily.35
INFECTIONS. With each breath, we take in thousands of bacteria. With each bite of food comes millions more. Most microbes are harmless, but some cause serious infections, such as influenza and pneumonia, which alone kill fifty-seven thousand Americans each year.36 A plant-based diet may be able to boost your immunity to keep you safer. In a 2012 study published in the American Journal of Clinical Nutrition, elderly volunteers who were randomized to eat five or more servings of fruit and vegetables daily had an 82 percent greater protective antibody response to a pneumonia vaccine compared to those who ate two or fewer servings a day.37 In other words, you can bolster your immune system function just by eating more produce. Broccoli and other cruciferous vegetables have been shown to boost the effectiveness of intraepithelial lymphocytes, a special type of white blood cell that is the first line of gut defense against pathogens.38 Blueberries, meanwhile, have been shown to almost double our levels of natural killer cells, which are vital members of the immune system’s rapid response team against viruses and cancer cells.39
TYPE 2 DIABETES. More than twenty million Americans are currently diagnosed with diabetes, the “Black Death of the twenty-first century”—a tripling of cases since 1990.40 Diabetes currently causes about 50,000 cases of kidney failure, 75,000 lower extremity amputations, 650,000 cases of vision loss, and about 75,000 deaths every year in the United States.41 Type 2 diabetes is caused by our body’s resistance to the effects of insulin, a vital hormone that shuttles glucose (blood sugar) into our cells, thereby preventing dangerous levels from accumulating in the blood. This insulin resistance is primarily caused by a fatty buildup inside our muscle cells.42 This fat can come from excess fat in our diet or from excess fat on our body. Up to 90 percent of people who develop diabetes are overweight.43
A plant-based diet can help keep off the pounds. There appears to be a step-wise drop in obesity rates as one moves from nonvegetarian diets to flexitarian (part-time vegetarian) diets to pescatarian (fish-eating vegetarian) to vegetarian to vegan. Those eating strictly plant-based were the only dietary group that was on average at an ideal weight, with an average body mass index (BMI) of 23.6. (A BMI over 25 is considered overweight.) Nonvegetarians topped the charts at an unhealthy 28.8.44 If you are trying to lose weight, including plant-based foods in your diet could help you: simply adding beans to diets was found to be as effective at slimming waistlines and improving blood sugar markers as calorie-cutting portion control.45
Based on a study of tens of thousands of adults in the United States and Canada, people who cut out all animal products, including fish, dairy, and eggs, appear to have a 78 percent reduced risk of diabetes.46 If you already have diabetes, a plant-based diet may even reverse it. Even without weight loss, a plant-based diet can enable those who have had type 2 diabetes for decades get off all their insulin injections in as few as two weeks.47 That’s why if you’re on medications to lower blood sugar or blood pressure, it’s critical that you make these healthy changes under close medical supervision, so you can be rapidly weaned off these drugs if necessary. Otherwise the diet can work so well that your blood sugars or blood pressure can drop too low. Once your body has a chance to start healing itself, you can find yourself overmedicated very quickly.
HIGH BLOOD PRESSURE. Also known as hypertension, high blood pressure is the number one risk factor for death and disability worldwide,48 laying waste to nine million people each year globally49 and sixty-five thousand in the United States.50 Increased blood pressure puts strain on your heart, can damage the sensitive blood vessels in your eyes and kidneys, and cause bleeding in the brain. Many doctors are under the impression that increased blood pressure is a natural consequence of aging, just like getting gray hair and wrinkles—after all, 65 percent of Americans over age sixty can expect to be diagnosed with hypertension.51 But we’ve known for nearly a century that blood pressure can remain stable throughout life or actually decrease after age sixty.52
On average, high blood pressure medications reduce the risk of heart attack by 15 percent and the risk of stroke by about 25 percent.53 But in a randomized, controlled trial, three portions of whole grains a day were able to help people achieve this same benefit without medication.54 A cup of hibiscus herbal tea with each meal can lower systolic blood pressure by 6 points compared to a control group.55 A double-blind, placebo-controlled, randomized trial found people with hypertension who consumed a few spoonfuls of flaxseeds every day for six months lowered their blood pressure on average from 158/82 to 143/75. That could be expected to result in 46 percent fewer strokes and 29 percent less heart disease over time.56
LIVER DISEASE. Many people assume that liver disease, which kills sixty thousand Americans each year,57 is the result of heavy alcohol consumption or intravenous drug use. But nonalcoholic fatty liver disease (NAFLD) has quietly become the most common cause of chronic liver disease in the United States, afflicting an estimated seventy million people58 and nearly 100 percent of those who are severely obese.59 As with alcoholic fatty liver, NAFLD begins with the buildup of fat on the liver. In rare cases, this can cause inflammation and lead to fatal scarring of the liver, called cirrhosis.60 Drinking just one can of soda per day appears to raise the odds of fatty liver disease by 45 percent.61 People who eat the meat equivalent of fourteen chicken nuggets daily have nearly triple the rate of NAFLD compared to people who eat seven nuggets’ worth or less.62 One plant-based way to fight liver inflammation: Eating oatmeal was found in a double-blind, randomized, placebo-controlled trial to be able to significantly improve liver function among overweight men and women—and help them lose weight as well.63
BLOOD CANCERS. Leukemia, lymphoma, and multiple myeloma are sometimes referred to as liquid tumors because the cancer cells often circulate throughout the body rather than get concentrated in a solid mass. Every year these cancers kill fifty-six thousand Americans.64 One of the largest studies on diet and cancer found that people who consume a more plant-based diet are less likely to develop all forms of cancer combined, with the greatest apparent protection against blood cancers.65 The Iowa Women’s Health Study, which has followed more than thirty-five thousand women for decades, showed that higher broccoli or other cruciferous vegetable intake was associated with a lower risk of non-Hodgkin’s lymphoma.66 This is consistent with a study at the Mayo Clinic that found people who ate about three or more servings of green, leafy vegetables per week appeared to have only about half the odds of getting lymphoma compared with those who ate less than one serving a week.67 This protection may be due to the high antioxidant content of plant foods. It’s important to note that this benefit is not found for antioxidant supplements.
KIDNEY DISEASE. Your kidneys filter 150 quarts of blood every twenty-four hours to produce the 1 to 2 quarts of urine you pee out each day. If the kidneys aren’t functioning correctly, metabolic waste products can accumulate in the blood and eventually lead to dangerous problems, including weakness, shortness of breath, confusion, and abnormal heart rhythms. Eventually they can fail altogether, resulting in death unless regular dialysis is performed—a fate that befalls nearly forty-seven thousand Americans each year.68
A recent national survey found that only 41 percent of Americans tested had normal kidney function.69 Most people with kidney disease may not even know they are suffering from it.70 Researchers at Harvard University followed the diet and kidney function of thousands of healthy women for more than a decade. They concluded that three specific dietary components are associated with declining kidney function: animal protein, animal fat, and cholesterol.71 Each is found only in one place: animal products.
Animal protein triggers an inflammatory reaction in the kidneys.72 Within hours of your consuming meat, your kidneys rev up into hyperfiltration mode.73 (Hyperfiltration means that your kidneys start to work overtime as increasing pressure builds up within them.) A lifetime of overeating animal protein may take its toll on your kidneys, causing them to be less and less efficient as you age. But your kidneys can handle the same amount of plant protein without a problem.74 Plant protein may even help preserve function in ailing kidneys.75
BREAST CANCER. Killing forty thousand American women each year,76 breast cancer is among the most feared diagnoses a woman can receive—and what we eat matters. The Long Island Breast Cancer Study Project found that postmenopausal women eating more grilled, barbecued, or smoked meats over their lifetime were associated with as much as 47 percent higher odds of breast cancer.77 In the largest study on cholesterol and cancer to date—with more than a million participants—a 17 percent increased breast cancer risk was found in premenopausal women who had total cholesterol levels over 240 compared with women whose cholesterol was under 160.78 This means that the same plant-based diet that helps lower a woman’s risk of heart disease may also help lower her risk of breast cancer. The Black Women’s Health Study, which followed fifty thousand African American women beginning in 1995, found that women who ate two or more servings of vegetables a day had a significantly decreased risk of a kind of breast cancer that’s hard to treat: estrogen-receptor-negative and progesterone-receptor-negative.79 In premenopausal women, a high-fiber diet was associated with an extraordinary 85 percent lower odds of that type of estrogen-receptor-negative breast tumors.80
SUICIDAL DEPRESSION. Forty-one thousand Americans take their life every year,81 and depression is a leading cause.82 While anyone experiencing suicidal thoughts should seek professional help, lifestyle interventions can help heal the mind as well as the body. One way to fight the blues may be with greens: higher consumption of vegetables may cut the odds of developing depression by as much as 62 percent.83 In general, eating lots of fruits and veggies may present “a non-invasive, natural, and inexpensive therapeutic means to support a healthy brain.”84 Additionally, the spice saffron was found to be as effective at treating mild to moderate depression as the antidepressant drug Prozac85—and it tastes a lot better.
PROSTATE CANCER. Prostate cancer is much more common than most people think: autopsy studies have shown that about half of men over the age of eighty suffer from it.86 Most die of other diseases first, but prostate cancer still kills twenty-eight thousand men every year.87 Recent studies have revealed a link between diet and prostate cancer. Population studies have suggested the prevalence of prostate cancer increases as animal consumption increases. For example, the death rate of prostate cancer in Japan has increased twenty-five-fold since World War II, and this dramatic spike coincides with a twenty-fold increase in dairy consumption, a seven-fold increase in egg consumption, and a nine-fold increase in meat consumption.88 Dairy consumption has been consistently associated with risk: a 2015 meta-analysis and review found that high intakes of dairy products—milk and cheese (including low- and nonfat varieties) but not nondairy sources of calcium—appear to increase total prostate cancer risk.89
If you have early-stage prostate cancer, you may be able to reverse its progression with a plant-based diet. After conquering our number-one killer, heart disease, Dr. Dean Ornish moved on to killer number two, cancer. Prostate cancer patients were randomized into two groups: a control group that wasn’t given any diet or lifestyle advice beyond whatever their personal doctors told them to do, and a healthy-living group prescribed a plant-based diet centered on fruits, vegetables, whole grains, and beans, along with other healthy lifestyle behaviors. After a year, the control group’s blood PSA—a marker of prostate cancer growth inside the body—tended to increase, but the plant-based group’s PSA levels tended to go down,90 which suggests their prostate tumors actually shrank. No surgery, no chemotherapy, no radiation—just eating and living healthily.
PARKINSON’S DISEASE. A disease of prizefighters and NFL linebackers who sustain repeated head trauma, Parkinson’s disease, which kills twenty-five thousand Americans every year,91 may also be due to brain damage caused by exposure to pollutants and toxic heavy metals that build up in the food supply. Poultry and tuna have been found to be the leading food sources of arsenic; dairy, the number one source of lead; and seafood, including tuna, the number one source of mercury.92 An analysis of more than twelve thousand food and feed samples across twenty countries found that the highest contamination of the toxic chemical polychlorinated biphenyl (PCB) was found in fish and fish oil, followed by eggs, dairy, and then other meats. The lowest contamination was found at the bottom of the food chain, in plants.93 Those who eat a plant-based diet have been found to have significantly lower blood levels of a PCB implicated in increasing the risk of developing Parkinson’s disease.94
Wait a minute, Doc, some of you eagle-eyed readers might be thinking. That’s only fourteen. Indeed! The fifteenth killer is actually the third-leading cause of death, responsible for 225,000 deaths annually.95 Oh, and it’s not a disease.
It’s doctors.
That’s right. Medical care is the third-leading cause of death. Whether it’s death caused by a hospital infection,96 unnecessary surgery, receiving the wrong medication, or an adverse side effect from the right medication,97 the sad reality is that you can head into a routine procedure and never return home. While hospitals are striving to reduce medical error and the spread of infections, they remain dangerous places.98 Did you know that getting a routine chest CT scan is estimated to inflict the same cancer risk as smoking seven hundred cigarettes?99 Or that 1 middle-aged woman in every 270 may develop cancer after a single CT angiogram?100 Or that when it comes to cholesterol, blood pressure, and blood-thinning drugs, the chance of even high-risk patients benefiting from them is typically less than 5 percent over a period of five years?101 Doctors and patients alike wildly overestimate the power of pills and procedures to ward off death and disability.
To me, the true tragedy is all the lost opportunities to address the root causes of chronic disease. Our modern medical system is great at fixing broken bones and curing infections, but it fails woefully at preventing and reversing the most common causes of death. Until the system changes, we have to take personal responsibility for our own health and our family’s. We can’t wait until society catches up to the science, because it’s a matter of life and death. I wrote How Not to Die to help you understand the role foods can play in preventing, arresting, or reversing the fifteen leading causes of death. I wrote this book to help you actually do it, right in your own kitchen.