Ep.36: How Not to Die with Dr. Michael Greger

Robyn:                    Hey, everyone, and welcome back to Your High Vibration Life. I am ecstatic today to introduce you to the author of what I think is the best health book in 2016. Now, I read a lot of books. I don’t even have just one whole bookshelf full of wellness and health, nutrition books, I have multiple entire bookcases of them. Best health book in 2016 that I read was How Not to Die by Dr. Michael Greger, and so, Dr. Greger, welcome to the show.

Michael:                 So excited to be here.

Robyn:                    Well, I have been listening to your talks in various places including recently in The Food Revolution by another one of my heroes, John Robbins. I loved your book for the massive amount of documentation, the trouble you’ve gone to show us 130 pages at the end of the book with, every page has probably got 50 references on it, thousands of studies about the power of plants in our diet, and so I was hoping you could tell us about some of your huge book on how not to die of pretty much every disease.

I’m hoping that you can just cherry-pick a little bit and tell us a few of the really exciting studies that tell us that eating more plants is a holy grail if we have one.

Michael:                 Well, the good news is in general that we have tremendous power over our health, destiny, and longevity. The vast majority of premature death and disability is preventable with a plant-based diet and other healthy lifestyle behaviors.

That’s the broad overview, and basically what I did in the book is just go through the 15 leading causes of death, 1 through 15 with a chapter on each, talking about the role diet may play in preventing, arresting, or reversing each of our 15 killers, and then the second half of the book is more practical putting the science into practice.

In terms of really standout studies, certainly Dr. Dean Ornish’s landmark Lifestyle Heart Trial published July 23, 1990 in the Lancet, the most prestigious medical journal in the world, showing for the first time that heart disease, the number one killer of men and women, could be reversed without surgery, without drugs, just a plant-based diet and other healthy lifestyle behaviors.

I assumed that that was going to be the game changer. Here it was in black and white published in some of the most prestigious places in the world, yet essentially nothing happened. I said, wait a second, effectively the cure to our number one killer could get lost down some rabbit hole and ignored, what else might there be in the medical literature that could help my patients, but it just didn’t have a corporate budget driving its promotion.

Well, I made it my life’s mission to find out. That’s why I started the website nutritionfacts.org. That’s what led me to write the book. When I did that, when I went through, wait a second, I found out it’s not just heart disease. Once Dr. Dean Ornish was victorious over our number one killer, he moved on to killer number two, cancer, to prostate cancer patients, put them on the same kind of plant-based diet as he did for heart disease, and saw a reversal on average of prostate cancer progression, something never before documented with dietary interventions alone.

It’s just absolutely remarkable to see these studies come out showing that healthy eating and living, it’s not just about preventing disease, not just slowing disease down, not even just stopping disease in its tracks, but actually reversing disease, curing disease, curing diseases like type 2 diabetes, hypertension.

Look, if that’s all a plant-based diet could do, reverse the number one killer of men and women, shouldn’t that be the default diet until proven otherwise? The fact that it can also prevent, arrest, and reverse other leading killers like diabetes and high blood pressure would seem to make the case for plant-based eating simply overwhelming.

Robyn:                    I’ve read that you say that nobody dies of old age. Can you explain that?

Michael:                 Yeah, no, it’s not that, that’s what the research shows. What they did is there was an autopsy series, thousands of autopsies, and they’re basically looking at centenarians, people who live over 100 years, and specifically at those who apparently died of old age, meaning they have no diagnoses. They weren’t diagnosed with anything, they appeared perfectly healthy then died. The question, you would just say, oh, they died of old age.

Okay, well, then they autopsied these people, this massive autopsy series, and in every single case they found that, no, they died of disease, most commonly heart disease. They had heart disease that they just didn’t know about, they had never diagnosed. In fact, that’s how most people die of heart disease. They die of something called sudden cardiac death, meaning you don’t even know you have heart disease, and then within an hour of first symptoms, that first pressure on your chest, you’re dead.

That’s why an ounce of prevention is way more than a pound of cure, because there is no cure for dead.

Robyn:                    Now, you talk at the beginning of how not to die, about how the average medical doctor knows, and you’re not saying this, this is a study that you reference, knows about as much about nutrition as the average person on the street. You and I both know that people generally ask their medical doctor for nutrition advice.

What does this mean for the regular person listening to this? Despite what you pointed out here, we seem to task our doctors with this. What should a person do if not ask their medical doctor?

Michael:                 Well, how about finding a doctor that actually knows something about literally the number one cause of death and the number one cause of disability? The Global Burden of Disease Study, which is the largest study of risk factors for disease in human history funded by the Bill and Melinda Gates Foundation, found that the number one reason people die in the United States is what they eat, and the number one cause of disability, number of years of healthy life lost, is our diet.

Now, this has now since bumped tobacco smoking to number two. Cigarettes now only kill about a half a million Americans every year whereas our diet kills hundreds of thousands more. Obviously, nutrition is the number one thing taught in medical school, right? It’s the number one thing your doctor talks to you about at every single visit, right?

There’s this disconnect between the science and the practice of medicine. We should find a physician that actually knows a little something about the number one reason we’ll get sick and die.

Robyn:                    Let’s get a little granular. Let’s just cherry-pick, pun intended here, cherry-pick a couple of the studies that you talk about that just show how very, very powerful food can be as prevention.

Dr. Greger talks about how there’s a specific food that if you ate a handful every day it would cut your heart attack risk in half. Is this right?

Michael:                 You know what that food is?

Robyn:                    I do. You tell us, though.

Michael:                 Yeah, it is nuts. A single serving of nuts every day is associated in these population studies with literally half the premature death rates. I mean, unbelievable.

This has actually been put to the test in interventional trials. The problem with population data is maybe people who eat nuts are health nuts. Maybe the people who eat nuts are also the ones that exercise and don’t smoke, etc, so maybe that’s part of the reason why they have such amazing public health statistics. Maybe it’s not the nuts themselves or maybe the nuts are only a small contributor. Maybe the nut consumption is just a marker for other healthy behaviors. That’s why it’s so important to do interventional studies where you take people, randomize them into two groups, half you give nuts, half you don’t give nuts.

This was done in the famous PREDIMED study, thousands of people for multiple years. What they did is they sent half of those people nuts in the mail every week to further goad them to include nuts in their daily diet. Those randomize to the nut intervention. For example, it would half the stroke risk, meaning not eating nuts every day, those kind of quantities, essentially doubles your risk of stroke. Nuts are one of the most powerful foods in terms of the data we have for single food items to dramatically improve health.

Now, there are short-term effects, too. You can eat walnuts and get within hours significant improvement in arterial function, your cholesterol drops, all sorts of wonderful things, but what’s nice is we can actually follow out to disease endpoints, to actual outcomes, and see, oh, my God, you add one palmful of nuts, an ounce of nuts, to your daily diet and you can, for example, cut your stroke risk in half, not just associated with lower stroke risk but actually shown, proven, to cut stroke risk in half. That is remarkable.

Robyn:                    That is really exciting, and I’m sitting on the beach on my 50th birthday reading How Not to Die, that is what I did with my 50th birthday, we were in Puerto Vallarta with my girlfriends.

About every ten pages I’d say listen to this and I’d tell them one thing that really struck me, and I’m putting you on the spot, maybe, here is, do you remember the details of a study on flax, a double-blinded placebo controlled study on the effects of flax versus all the ACE inhibitors and calcium channel blockers, the two classes of drugs that prevent or that treat hypertension? It was actually published in the journal Hypertension. Do you happen to remember the details of that?

Michael:                 Well, yeah, there’s a randomized double-blind placebo controlled trial showing that the consumption of a few spoonfuls of ground flax a day can bring down blood pressure two to three times better than our leading blood pressure medications.

Look, it only has good side effects, reducing the risk of breast cancer, prostate cancer, controlling cholesterol, triglycerides, and blood sugars, reducing inflammation, curing constipation. I encourage people to eat a tablespoon of ground flaxseeds every day.

Robyn:                    What else? You have some favorite foods that you think are just the big bang for the buck.

Michael:                 Oh, yeah, I centered my recommendations around a daily dose and checklist of all the foods I encourage people to fit into their daily diet. I talk about berries every day, the healthiest fruits, greens every day, the healthiest vegetables, particularly cruciferous vegetables, a tablespoon of ground flaxseeds, quarter teaspoon of tumeric every day. I talk about the best beverages, how much to exercise, just go through the list trying to inspire people to fit some of the healthiest foods in their diet in the hopes of crowding out some of the less healthy choices.

There’s a cute little app we made which is free for iPhone Android called Dr. Greger’s Daily Dozen, and just you can track your progress checking through the checklist and just see how you’re doing. You might be like, oh, I forgot to eat legumes today! Quick! Beans, split peas, chickpeas, lentils for supper!

Robyn:                    I love it, Dr. Greger’s Daily Dozen, and we can just get that on iTunes, right?

Michael:                 Yup, absolutely.

Robyn:                    Okay, it’s “Greger,” by the way if you’re listing, is G-R-E-G-E-R, G-R-E-G-E-R.

Okay, now, I really want to talk about this, because I have been watching, I’m old enough to have watched the diet fads for 30, 35 years now, and you see these new fad diets come into vogue and then they fall out of favor, and we don’t have to cover all of these, but just in my adult lifetime just hitting some highlights here or lowlights depending on how you want to look at them, grab one or two or three of these and tell me what you think of them.

My opinion is after watching this for all these years is that industry, especially the processed and packaged food industry and the diet industry, both of which are billion dollar industries, has to bring in a new one every few years so that we can usher in some “new and exciting new products.”

I’ve seen Weight Watchers, Atkins, low-carb, low-fat, paleo, blood type, ketogenic. Which one of those really gets your goat? Now, I actually, this is how much of a Greger fan I am. I’ve read your book Carbophobia. How Not to Die, big bestseller, everybody I talk to who’s into wellness at all has read it, but Carbophobia you take on the Atkins diet, so my guess is you’ll probably want to make a few comments about that.

Tell us, where has the diet industry gone wrong and which are your least favorite of these fads?

Michael:                 Yeah, they’re all like zombie diets. They’re unkillable, they come back. Atkins was first published in the early ’70s and then of course fell out of favor until it’s, they return it from the dead and then it’s the new Atkins diet. By now we’re on the new, new, new Atkins diet.

Basically, people love hearing good news about their bad habits. Tell people to eat bacon and butter sells a lot of magazines, sells a lot of books, but it sells the public short. It’s a classic tobacco industry tactic, selling confusion, muddying the waters in the hopes that people just throw up their hands and eat whatever’s put in front of them.

The reality is there’s a remarkable consistency in the nutrition science literature that we should boost our intake of healthy plant foods like fruits and vegetables, limit our intake of animal foods and processed foods. The public needs and deserves to know about the overwhelming global consensus regarding the core elements of healthy living.

Probably the farthest from that would be something like an Atkins diet, low-carb diet. Basically, as far as diets shift away from eating whole plant foods would be on the spectrum of worse versus better diet. For example, a Mediterranean diet, very much vegetable-centric, very much closer to what an ideal diet might look like, whereas even something like a paleo diet, look, paleo diet, any diet that gets people to stop eating donuts is going to improve the health of the American public.

If you actually survey paleo eaters, people that claim they’re eating paleo, the biggest thing that differentiates their diet from the standard American diet is actually vegetable consumption. They claim to eat more, significantly more vegetables than, look, if your definition of paleo diet is eat lots more vegetables, fantastic. Unfortunately, many people just use that “paleo” self-identity to just go out and eat garbage.

Basically, in fact there’s an index, there’s a dietary quality index that I talk about, I actually did a video about it. There’s all sorts of ways you can measure healthy eating, Harvard has one, you can measure concordance with the federal dietary guidelines. Well, this one is probably my favorite, and basically what it is, just what percent of your diet is whole plant foods? For example, in the United States about 55% of our diet is processed junk and about 40% is junk food, is animal products, excuse me, so that takes it down to about less than 10% actually whole plant foods, fruits and vegetables, beans, whole grains, legumes, that kind of thing.

You could actually, you could use that model to test how good diets are and just see the better number. In fact, they’ve actually, there’s been a number of studies that have actually looked at that index and looked at breast cancer survival, for example, or diabetes on down the list. Basically, the greater percentage in your diet of whole plant foods the healthier you are, the lower your risk of chronic disease.

Of course, standard American diets, it’s down at about 10 out of 100. It’s easy to move up and you can do that from a variety of ways, but the more whole plant foods the better.

Robyn:                    Well, I appreciate how hopeful you are in how you focus on many, many studies that give us so much hope if we’re eating, if the average American is eating 10% whole plant foods and 55% junk. There’s plenty of people who are trying to get their health back who are doing much, much better than that.

I think it’s actually really important to, well, giving ourselves hope with that, not compare ourselves to our neighbor who eats out of a fast food, out of a drive-thru three times a day and saying, well, I’m doing better than that so I’m a health nut. I think sometimes we need to bring our A-game, right? A step at a time, a step at a time, and baby steps are always great steps. If you’re going to sum up some of the themes or pick out little bits that are your favorites, because I have so many, I swear I’ve marked your book up so much, how do you not die before your time?

You have 15 different chapters. If you didn’t have a chapter on how not to die of a heart attack and how not to die of degenerative disease and how not to die of diabetes, if you smushed them all together, what are the universal truths that will extend anyone’s, it doesn’t matter what your blood type is, it doesn’t matter, what can extend our quality of life?

Michael:                 Well, the best, the Global Burden of Disease Study, which is the largest study of disease risk factors for death and disability in human history funded by the Bill and Melinda Gates Foundation, found that the number one cause of death in the United States is what we eat. Number one cause of disability in the United States is what we eat. Now it’s bumped tobacco and smoking to number two. Cigarettes only kill about half a million Americans every year whereas our diet kills hundreds of thousands more.

How long we live and how healthy we are, it depends primarily on what we eat, and the best available balance of evidence suggests that the healthiest diet is one that minimizes the intake of meat, eggs, dairy, and processed junk and maximizes the intake of fruits and vegetables, legumes, which are beans, split peas, chickpeas, and lentils, whole grains, nuts and seeds, mushrooms, herbs and spices. Basically, real food that grows out of the ground, these are our healthiest choices.

Robyn:                    I love it. Okay, now I’m going to ask you about two quick little strange food bunny trails, because what I’ve heard you say is counter to some of the food fads. The gluten-free industry is now $16 billion a year that people are spending on mostly packaged, processed, gluten-free foods thinking that they’re eating, I don’t know, health foods or super-foods or something.

Weigh in for a minute about wheat, your opinion on wheat based on the evidence, because I know you’re very, very evidence based, you’re very committed to looking at what the actual published literature says. Weigh in on wheat and then weigh in on soy.

Michael:                 Yeah, sure. I should get no props for being evidence based, for sticking to reality. It says something about our world right now that for someone to actually base their arguments and rationality in science, in facts, should somehow get credit. That’s just, that should be the baseline. Right, I have no opinions on any of these. All I do is try to just provide the best available balance of evidence and to pass it along.

In terms of gluten, basically, look, the food industry just wants to make money, and they will sell you gluten-free junk food, low-fat junk food, high-fat junk food, low-carb junk food, paleo junk food, any kind of junk food, because you can’t make money on real food. There’s only so much you can mark up fruits and vegetables. They’re perishable, it’s not like a Twinkie that sits on the shelf, and they’re not branded products. Even a broccoli grower is not going to put an ad on TV for broccoli, because you’ll buy a competitor’s broccoli. It just doesn’t make sense.

The system is set up to benefit somebody like Coca-Cola, which has dirt-cheap ingredients thanks to taxpayer subsidies, and sell it for a couple bucks a bottle. They’re not out to nefariously make kids fat, they just want to make money. They in fact have to for their shareholders, they have a fiduciary responsibility, and so how do you make money? Do you sell broccoli? That doesn’t make money, so you sell junk that makes money regardless of the devastating human cost. The gluten-free fad is just another way for the industry to charge more to make money.

Now, if your definition of “gluten-free” is eat an apple, great, but that’s of course not what gluten-free is about. It’s about giving you junk food in any way you want. It’s the same, look, there’s vegan junk food. A couple decades ago, if you were vegan you were healthy by default. What are you going to do? You shop in the produce aisle, but now you can get vegan donuts, vegan ice cream, vegan anything, and you’ll be just as unhealthy as everybody else. Same thing with celiac patients who really do need to avoid gluten, it used to be they were really healthy because you couldn’t eat any junk because everything has wheat in it, but now we can give you your gluten-free donuts and you can be just as unhealthy as anybody else.

Bottom line, it’s about 1 in 120 or so, 121 folks, have what’s called celiac disease. It’s an autoimmune reaction to gluten. They absolutely have to be on a strictly gluten-free diet their entire lives. About 1 in 1,000 people have a formal wheat allergy, and then maybe about 1% have what’s called nonceliac gluten sensitivity who have typically gastrointestinal symptoms to gluten ingestion but actually don’t have celiac disease.

For 98% of people, gluten, wheat protein also found in barley and rye, is a healthful plant protein like any other, but for 1 in 50 individuals gluten can be a problem. It’s just like, look, someone with a peanut allergy, they eat a peanut and drop dead, that doesn’t mean peanuts are bad for you. It means peanuts are bad for that person, definitely, but just because someone is sensitive to wheat doesn’t mean that that’s true for the vast majority of folks.

In terms of soy, soy is misunderstood as well. People don’t understand there’s two types of estrogen receptors in the body, alpha and beta. The phytoestrogens in soy and other healthy foods bind to the beta receptors. Our own estrogen binds to alpha receptors. The effect of soy on different tissues depends on the ratio of alpha to beta, and so estrogen actually has positive effects on some tissues, negative effects on others.

For example, estrogen’s good for your bones, bad for the breast in terms of breast cancer risks, so ideally we’d have some kind of selective estrogen receptor modulator, have estrogenic effects on some tissues but anti-estrogenic effects on others, and that’s exactly what the soy phytoestrogens do. Soy appears to lower breast cancer risk, which is an anti-estrogenic effect, at the same time reducing menopausal hot flash symptoms that’s a pro-estrogenic effect.

With soy, you get the best of both worlds, and so we should eat legume soy and other beans, chickpeas, and lentils every day.

Robyn:                    But not the processed versions, because lots of soy in lots of different packaged foods, right? You’re talking about, what are your favorites?

Michael:                 Whole plant food. Ideally, even some of them like tofu is processed, so it only has a fraction of the fiber. A cup of soybeans has 10 grams of fiber, a cup of tofu only has two grams for fiber, 80% of the fiber lost, lost a lot of minerals, too. Now, soybeans are so incredibly healthy you can lose 80% of nutrition and still have a really healthy food, but, hey, tempeh is even better. You can see the individual whole soybeans in there, it’s a whole soy food.

Tempeh, miso, edamame, the immature green soybeans in the pods themselves, tasty snack, that’s the best way we should get soy as opposed to these processed soy products. Something like soy yogurt is something, so much added sugar, you’re not really doing yourself much of a favor.

Robyn:                    So many helpful tips today. Dr. Greger, you are a super-super-busy doctor, researcher, author. I just want to thank you for your impact on my life, on my family’s life. I’m a single mom of four, and I have learned so much from you that I have brought into my practical real life raising kids by myself and also in my career online as Green Smootie Girl and author myself. I just want to thank you from the bottom of my heart and thank you so much for being with us today.

Michael:                 So happy to help out. Keep up the good work yourself.

Robyn:  Thank you.