“How Not To Diet” by Dr Michael Greger

Review of ‘How Not To Diet’ by Dr Michael Greger

Reviewed by George Jacobs, PhD, www.georgejacobs.net

Dr Michael Greger will be familiar to most of the people reading this review. Among his more recent accomplishments was serving as scientific adviser to the documentary Game Changers, available on Netflix, and in 2015, he published the New York Times best-selling book How Not To Die. But MG the MD is most famous as founder of many people’s go-to source for research-based nutrition information: NutritionFacts.org. NutritionFacts.org is a media behemoth, consisting of a website, free apps, blog/vblog posts (including a team who respond to reader/viewer feedback), free notification emails five times a week, social media, speeches, interviews and more, all based on a large team of people including those who comb through the scientific literature on nutrition, looking for what is new, relevant and of sufficient quality for sharing.

Note: The detailed style of the NutritionFacts.org team does not suit everyone’s taste. For instance, the other day, a fellow activist for plant-based eating was telling me that they prefer nutrition advice in a more concise form, whereas NutritionFacts.org tends to regale us with the twists and turns of the research story that brought us to current thinking on a particular health topic. I usually like this “detective” style. In fact, I’m hoping that MG the MD will turn his pun-filled hand to a new literary genre: food detective writing. To get him started, let me suggest a couple possible titles: Shercook Holmes and Dr Potson, or Sherlock Whole-Food and Dr Plant-Based.

Full disclosure: I used to be a volunteer with the NutritionFacts.org team.

Putting It to the Test

This new book, How Not To Diet, applies MG the MD’s “put it to the test” methodology to the overcrowded world of diet books. ‘Put it to the test’ means that the NutritionFacts.org team only puts in their books, in the blog posts, etc. that which has been verified in published, peer-reviewed research. Thus, How Not To Diet does not include OMG stories about people how lost 100kgs in one week, because that is anecdotal evidence; great stories, but not research. Dr Greger calls the use of stories, “a deliberate attempt at credibility engineering.” Testimony to MG the MD’s devotion to research is on mountainous display in the approximately 5000 citations (!) in the book. Fortunately, the reference section at the end of the book is only one page, thanks to a QR code leading people to the online references. That’s a lot of trees and money saved.

On the topic of research, my view is that even research done to a gold standard – randomized, placebo-controlled, double-blind – may not provide the complete picture; plus, what’s true today, may not be true tomorrow, and what is true in one place with one type of people may not be true in other places and for other people. Furthermore, as MG the MD notes of page 340, “As so happens in science, however, just when you think everything is nearly wrapped up with a bow, a paradox arises.”

Whoops – MG the MD does include one OMG story in his book. It’s the same story he often uses, the story of his grandmother who at age 65 was told that she had end-stage heart disease, and was sent home from the hospital because the doctors could do nothing more for her. Fortunately, instead of giving up, she switched to a plant-based diet under the guidance of Dr Nathan Pritikin and lived another 31 years till age 96, spending time with her grandchildren and influencing one of them to devote his life to teaching the benefits of plant-based diets.

The book’s title, How Not To Diet, seeks to differentiate this book from others. So many diet books exist (in 2019, Amazon offered in excess of 30,000 diet books): “they always sell because they always fail”. MG the MD proposes that the best diets are based on the strong foundation of a lifetime whole food plant-based diet.

Part 1 – The Problem

The book consists of five parts of greatly varying lengths. Part 1, The Problem, overviews the obesity epidemic that besets the developed and, increasingly, the developing world. First, the epidemic’s causes and consequences are considered. Then, non-diet solutions are reviewed, including surgery, diet drugs, weight-loss supplements and public policy fixes, such as taxing fattening foods, subsidizing fruits and vegetables, controlling advertising (especially to children), public education on the importance of healthy eating, working with industry to cooperate on across-the-board changes (such as the reduction in sodium levels of foods served in the U.K.) and banning unhealthy foods (such as those with transfats).

Part 2 – Ingredients for the Ideal Weight-Loss Diet

 Part 2, Ingredients for the Ideal Weight-Loss Diet, explains 17 characteristics we should include in our diets, and each of the 17 sections in this part concludes with tips for integrating each characteristic into our diets. Here are those 17 characteristics:

a. Anti-Inflammatory

Acute inflammation can be good, such as when we bang a finger and it swells as part of the healing process. What’s bad is chronic, a.k.a., metabolic, inflammation, which is linked to many diseases, including obesity and heart disease. The spices turmeric, ginger and garlic rate especially high in anti-inflammatory properties, with green tea as a star beverage and, as to food, any food high in fibre.

b. Clean

Science has discovered a new category of pollutants, labelled obesogenic because they promote obesity. To reduce exposure to obesogens, to the extent possible, avoid plastics, pesticides, herbicides and seafood.

c. High in Fibre

You already know about this. Whole, less-refined foods contain lots of fibre.

d. High in Water

Like fibre, water makes food more filling without adding calories. Eating foods with high water content – almost all fruits and veggies, except dried ones (such as raisins instead of grapes) – promotes a healthy weight. Drinking water is good, but also eat lots of watery foods.

e. Low in Glycemic Load

High glycemic foods encourage us to eat more, while low glycemic foods promote the burning of fat. One memory trick is that we grow low glycemic foods, but we make high glycemic foods. For instance, we grow fruit, such as oranges, while we make orange-flavoured candy.

f. Low in Added Fat

Whole foods contain fat naturally; so, no need to add fat from processed foods, such as cooking oil. We can bake and fry without adding oil.

g. Low in Added Sugar

Just as with added fat, whole foods already contain sugar; no need to add processed sugar. Plus, whole foods start to taste sweeter as we stay away from processed sweeteners.

h. Low in Addictive Foods

Tens of thousands of years of scarcity have programmed humans to crave salt, sugar and fat. Big Food engineers their processed products to excite these cravings and promote addiction. Fortunately, after a few weeks of mindful eating, whole foods can begin to satisfy these same cravings.

i. Low in Calorie Density

When seeking to understand weight management, an important point to grasp is that not all calories are the same. The book gives the example that a calorie of carrots is not the same as a calorie of Coca-Cola. Ten carrots contain about 240 calories, the same approximately as a bottle of Coke, but while we can drink that bottle of Coke in about a minute, how long would it take to eat those ten carrots? Much longer, because the carrots come with so much fibre. The Coke is calorie dense and nutrient light (or absent), while the carrots are nutrient dense and calorie light. Both the Coke and the carrots are plant-based, but the Coke is highly processed, while the carrots are a whole food.

j. Low in Meat

While it’s best to go plant-based, factory farmed meat is even worse than the meat the old-fashioned way, today’s farmed animals are now raised and genetically manipulated to up their fat content, not to mention the horrific confinement and the use of growth hormones and anti-biotics.

k. Low in Refined Grain

Governments have been telling us this for years. MG the MD offers an explanation of the weight loss effects of whole grains: (1) upping our metabolic rates; (2) upping the calories that leave our bodies through our feces.

l. Low in Salt

Did you know that the meat industry adds salt to many types of meat, including fish flesh? For example, salt supposedly enhances the taste of the flesh of fishes. Another surprise to me was that, at least in the U.S., bread is the #1 source of sodium for people over 50 years of age.

m. Low in Insulin Index

When our insulin levels go out of whack, we increase our risk of diabetes. Plant-based diets lower the risk of Type II diabetes and can even reverse the disease.

n. Microbiome-Friendly

One of the advantages of being a regular free subscriber to NutritionFacts.org is that I already knew about the microbiome before I started seeing it mentioned in the popular media. The microbiome consists of all the bacteria living in our bodies. Amazingly, the ‘visitor’ bacteria among the bacteria in our bodies outnumber all the bacteria that are our own. If we feed our microbiomes well – with whole food, plant-based diets – we are more likely to maintain a proper weight.

o. Rich in Fruits and Vegetables

You already knew this; so, just a couple tips: (1) go for smoothies instead of juice, because juice usually means that the fibre is removed; (2) place fruit and veggies where you and others can see them to encourage you all to eat more. Also, don’t forget that spices, such as onions and chili, are plant foods, too.

p. Rich in Legumes

Legumes, like meat, are rich in protein, but unlike meat, legumes also contain fibre. A pressure cooker allows us to quickly prepare our own legumes, even without presoaking.

q. Satiating

Satiety is the feeling that we have eaten enough. We have two different appetite control systems. The homeostatic system is the rational one, encouraging us to eat when our energy reserves are low and discouraging eating when energy reserves are sufficient. In contrast, our hedonic system asks not whether we need food but whether the food tastes good. Thus, we should keep our hedonic system happy by eating a wide variety of tasty, whole, plant-based foods.

Part 3 – The Optimal Weight-Loss Diet

After Part 2’s weighty almost 200 pages, Part 3 comes in at a thin less than 20 pages. Two points stood out to me. First, Dr Greger reminds us that if we follow his advice and opt for a whole food, plant-based diet, we need to remember to include a source of Vitamin B12. I was reminded of this recently when a friend, who years ago influenced me to switch to 100% plant-based diet, told me he was experiencing possible symptoms of B12 deficiency. I immediately told him to get himself tested and gave him a bottle of the B12 supplements I take. Second, How Not To Diet makes the point that a diet that enables us to escape being overweight must also boost our overall health. Fortunately, a great deal of research supports the view that a whole plant-based diet not only helps people achieve an optimal weight, it also helps us achieve optimal health overall.

Part 4 – Weight-Loss Boosters

Part 4 is the book’s longest section and the section I was most interested in, because it promised to tell me what else I could do to achieve an optimal weight. You see, I’ve followed a whole plant-based diet for more than ten years and a vegetarian diet since 1980, and for most of that time, weight and body fat have not been an issue, but now that I’m in my late 60’s, it has become an issue. I’m writing this review of How Not To Diet in early 2020. Check back with me in mid-2020, and I’ll tell you how the advice in this part worked, but, of course, advice only works if people implement it.

The 20 sections of Part 4, just like the sections of Part 2, each have Food for Thought summaries at the end.

a. Accountability

We can hold ourselves accountable for our weight by regularly weighing ourselves, keeping track of our findings and perhaps sharing the data we collect with others. New technology can help.

b. Amping AMPK

AMPK is adenosine monophosphate kinase, and a kinase is a type of enzyme. In this case, the enzyme burns body fat. We activate AMPK by exercising and fasting. Tobacco activates AMPK via nicotine but with bad effects. Fortunately, healthy foods have nicotine, although in much smaller amounts. These foods include capsicum (bell peppers), tomatoes, potatoes and aubergine (eggplant). Two other ways to raise AMPK are adding vinegar to our food, and eating a dried fruit, barberries. Barberry also possibly relieves acne, but is not recommended for those who are pregnant or breastfeeding.

c. Appetite Suppression

We can reduce our appetites with flaxseeds (which need grinding) and ground flaxseed meal (but not flaxseed oil or extracts) and with many spices, including cumin, black cumin (which belongs to an entirely different plant family than cumin), and saffron.

d. Chronobiology

Chronobiology looks at how our bodies are affected by time, especially time of day. MG the MD’s research-based suggestions in this area include: do our heavier eating earlier in the day; eat dinner at least 2.5 hours before sleeping and don’t eat after dinner; get enough sleep; and eat a couple pistachio nuts (we only need a couple) to get enough melatonin.

e. Eating Rate

When we eat slower, we usually eat less. Ways to eat slower include using chopsticks instead of a spoon or using a smaller spoon, drinking smoothies in a bowl (maybe with some oats), chewing our food more and eating harder, chewier, whole grain foods.

f. Exercise Tweaks

As to establishing and maintaining a healthy weight, diet outweighs exercise. “If we eat two chicken legs, we’d better get out on our own two legs and run an extra three miles that day just to outrun the calories” (p. 357). Of course, exercise boosts our health, even if exercise doesn’t necessarily result in weight loss. Thanks to exercise, we can gain muscle, lose visceral fat, strengthen our heart, etc.  Furthermore, we can exercise in ways not normally considered exercise, such as preparing a meal in the kitchen, ironing, helping children straighten up their room and even just standing instead of sitting.

g. Fat Blockers

Dark green leafy vegetables act as fat blockers. Hibiscus tea can also be useful. The only caveats are: (1) no more than one serving a day of high-oxalate greens (spinach, beet greens and swiss chard); (2) after drinking hibiscus tea, we should rinse our mouths with water to wash off the acid in the tea (just as we should do after eating citrus).

h. Fat Burners

For burning fat, How Not To Diet recommends green and oolong tea, ginger, chili and maybe cinnamon (be sure it’s from Sri Lanka, formerly known as Ceylon),

i. Habit Formation

It is estimated that we make about 200 food-related decisions a day, most just out of habit, with little or no thought. “Most of the time we do what we do most of the time” (p. 422). I had heard and repeated that it takes about 21 days to form a new habit, but MG the MD says that the average is more like 66 days. The best way to develop new habits is to make them easy and convenient. The best way to fend of feelings that we’re entitled to some junk food is to remind ourselves that what we’re really entitled to is to be healthy.

j. Hydration

Drinking water is good for our health, althoug it’s not the great weight loss tool that many people think it might be. One benefit of water consumption flows from the fact that water crowds out unhealthy drinks, such as soda and cows’ milk.

k. Inflammation Quenchers

As mentioned earlier, chronic inflammation leads to a host of negative health conditions, and no, products from fishes may not reduce inflammation. The best way to lower inflammation? Lots of whole plant foods. All-stars include gogi berries (a.k.a., wolfberries or boxthorn fruit), tomatoes, turmeric and nutritional yeast.

l. Intermittent Fasting

Dr Greger urges caution and medical supervision when fasting. He concludes, “combining intermittent-fasting regimens, such as early or midday time-restricted feeding, with a healthier diet during the feeding windows may prove to be particularly powerful” (p. 488). NutritionFacts.org had a number of blog posts on various types of fasting in late 2019 (see their searchable list of topics).

m. Meal Frequency

U.S. data suggest that in the past 50 years meal size has increased by less than 10%, while meal frequency has increased by about 20%, with people now eating five times a day, about every three waking hours. Eating less often and eating less junk aids weight control.

n. Metabolic Boosters

The book recommends drinking two cups of cold water a few times a day on an empty stomach, but being careful not to drink more water than our kidneys can easily process.

o. Mild Trendelenburg

Trendelenburg refers to lying with our feet slightly higher than our head. While it may induce a little weight loss, a number of cautions apply.

p. Negative Calorie Preloading

Beginning meals with low calorie foods, including water, salad, soup, fruits and veggies may lead to consuming fewer total calories.

q. Sleep Enhancement

Sleep deprivation correlates with weight gain, even when calorie intake is the same.

r. Stress Hormone Relief

People with unduly high stress levels tend to eat more overall and, in particular, more junk. Animal protein raises stress levels; so, eat veg and use other destressing methods, including exercising, laughing (even fake laughing) and listening to relaxing music. While eating, focusing on what we’re eating rather than our phones may lower food intake.

s. Wall Off Your Calories

The point here is to take the whole food, plant-based concept a step further. “Eating whole grains is good, but eating whole grain kernels is even better” (p. 556). Kernels are also known as groats. For instance, even wholegrain bread isn’t so good, as the cell walls of the grain have been destroyed to make flour. With groats, the walls remain.

Part 5 – Dr. Greger’s Twenty-One Tweaks

For a number of years, NutritionFacts.org has provided an app, Dr. Greger’s Daily Dozen, for free download, recommending ‘green light’ foods we should try to eat regularly (although not necessarily all 12 every day). These recommended foods contrast with yellow light and red light foods, which should be eaten with caution, less often or not at all. Now, the app also includes ideas to help with weight loss, ideas explained earlier in the book. Part 5 refreshes our memory so that we can use the app well.

Conclusion

This almost 600-page book contains a detailed Table of Contents and an even more detailed index to make How Not To Diet  highly searchable, and I guess the e-book will be even more searchable. While the book is science-heavy, our friends MG the MD and his team have many years of experience making nutrition science fairly understand, without removing the inconvenient truth that life is complicated. Fortunately, the talented team also does well at mixing in some humor to help the science go down more easily. If you are considering buying one or more copies of How Not To Diet in whatever form including audiobook, remember that 100% of the proceeds go to charity. Michael donates to charity because he and the team want to do for other people’s families what Dr Pritikin did for Michael’s.