Title: How Not to Age
Author: Michael Greger
Number of Pages: 601
Original Published Date: 2023
I’ve been a watcher and follower of the website and YouTube page NutritionFacts.org for many years now. Their short-form video summaries of research studies and nutrition data packed into easy-to-understand parlance are informative and enjoyable. All of their videos are free (and free of ads) and narrated by Dr. Michael Greger with the focus on finding the most nutritious diet and way of living for optimal human health.
I read Dr. Greger’s first book How Not to Die when it was published in 2015 and in that book, he introduced his Daily Dozen (see below) which is a checklist of what we should eat and drink daily to increase the health of our life. At the time of reading, I was gung-ho about incorporating the recommendations for increasing health, but most of the changes never stuck and I fell back into many of my old habits. I’d like to change that now. My new goal is to impart much of the data and suggestions (those that I agree with and work for me) from both How Not to Die and How Not to Age and weave them into my life. However, there are recommendations that I’m not convinced of and other studies that contradict some of the evidence in this book where I will veer from the suggestions.
Dietary and exercise studies are continuously ongoing and findings are constantly being published so data can quickly become outdated as more information is learned. Also, different studies can have contradictory conclusions and when this occurs, one must find what works best for their lifestyle or continually dig to find the truth as bias of results may need be teased out depending on who funded the study and the preferences of findings that were desired. It’s reasonable to believe that some people can thrive better on different diets and it’s not a one size fits all for everyone. It’s highly likely that “decided” diet and nutrition science can be a ‘one size fits most’ where conclusions work for a large majority of the population.
Dr. Greger’s Daily Dozen:
- Minimum of three servings of beans (legumes)
- One serving of berries
- Three servings of other fruits
- One serving of cruciferous vegetables
- Two servings of greens
- Two servings of other veggies
- One serving of flaxseeds
- One serving of nuts and seeds
- One serving of herbs and spices
- Three servings of whole grains
- Five servings of beverages
- One serving of exercise (90 minutes at moderate intensity or 40 minutes of vigorous activity)
Although I didn’t implement as much as I’d hope from the first book, one thing that did stick around was consuming more greens and veggies which I’ve tried to accomplish via homemade green smoothies. I’ve been regularly drinking green smoothies for years as I’ve always found it to be the easiest way to get my greens and fruits into my diet in the most convenient manner. After reading How Not to Age, I used Dr. Gregor’s Daily Dozen as the template for my smoothie design ensuring that I’ve added as many of the recommendations into the smoothie as possible and have continued to make changes to the recipe as more information is disseminated from studies. My latest addition is adding broccoli sprouts as they have an incredible amount of health benefits and only costs pennies when grown on my kitchen counter. New study data is also suggesting that adding bananas to smoothies may reduce some of the smoothie’s benefits so I’m experimenting with finding a new recipe that eliminates bananas yet still tastes great.
The Daily Dozen is just the start though. There are pages and pages of research and recommendations for healthy living peppered throughout How Not to Age and I’ve summarized what I plan to include into my life and the reason why below. My list below is hardly exhaustive of the data within the 600+ pages of the book so I’d recommend anyone to read it for themselves as there are many things that I’ve omitted that may benefit others. One example is drinking coffee, as it has legitimate benefits, but I’ve simply never cared for coffee and know that it’s not something I would ever add to my diet.
Both books are tomes with hundreds of pages and can take hours to read, but I really enjoy learning the research behind the recommendations for “DOs and DON’Ts” and the “WHYs” of healthy living. As I’ve reached my 40s, I’ve been deep diving into nutrition and health more but the study of nutrition can almost leave one more confused then when they began because of how contradictory the experts and research can differ. It’s almost incredulous that we know the perfect diet for gorillas, koalas, and other animals, but still can’t agree on what’s best for the human body. Perhaps it’s because we’re omnivores and we’ve adapted to be able to consume a highly-variable diet that there isn’t one agreed-upon “best” diet at this time. At the end of the day, I think it’s important to take in the research and depending on one’s likes, dislikes, and reasons behind eating or not eating food, make the most informed decision one can.
With all that said, below are my takeaways and the changes I plan to incorporate into my personal diet based on Dr. Gregor’s How Not to Age and How Not to Die books. I’ve also listed where I disagree with Dr. Greger’s recommendations and what I plan to do differently.
Dietary Additions/Changes and Why:
- Jane’s Smoothie (as of January 2025):
- 3 servings of fruit
- 1 serving of strawberries or blueberries
- 1 lemon1 serving of additional fruit
- High fruit and veggie intake (to slow down epigenetic clock)
- Berries: top to bottom in antioxidants- blackberries, cranberries, raspberries, blueberries, strawberries
- Ingredient in the Daily Dozen
- 2 servings of veggies
- 1 serving of kale
- 1 serving of broccoli sprouts (to reduce oxidative stress)
- Cruciferous veggies (kale, broccoli, cauliflower, cabbage, and collards) can reduce DMA damage and inflammation.
- Ingredient in the Daily Dozen
- Blending greens in a smoothie can release more of its lutein
- 1 teaspoon of Ginger
- To reduce inflammation
- 1 tablespoon of Flaxseeds
- To reduce inflammation
- Ingredient in the Daily Dozen
- 3 servings of fruit
- Daily Half Serving of Nuts:
- Half serving of walnuts daily
- Having a healthy fat with greens can release more of the carotenoids; have my smoothie with nuts on the side
- Half serving of nuts daily can reduce mortality by 15%
- Walnuts are healthiest
- Hibiscus tea to boost AMPK
- Green and Chamomile Tea:
- Green tea consumption (to Reduce mTOR and extend telomeres)
- Add cinnamon to tea (to reduce oxidative stress)
- Green tea and nutritional yeast can lower incidence of respiratory infections
- Lunches/Dinner Ideas:
- Vegetable Soups
- Rice and Beans/Tofu and Broccoli
- Sweet Potatoes
- Add tempeh and mushrooms as they provide ergothioneine as a “longevity vitamin”
- Legumes may be the most important dietary item. Eat a variety of legumes and beans daily.
- Add garlic to soup (to reduce inflammation)
- Add 1/5 tsp black cumin and turmeric. Black cumin (to boost AMPK and reduce inflammation). Turmeric to (reduce inflammation and oxidative stress)
- Five or six prunes a day may help preserve bone density
- Nori and seaweed salad (wakame)
- Two sheets of nori (not required daily)
- Soy milk:
- Soy milk (to reduce oxidative stress)
- Soy, soy milk, and miso can lower risk of heart disease
- Soy and soy milk has been shown to decrease some cancers, lower risk of fractures, and lower cholesterol
- Drinking soy beverages on a weekly basis was associated with a 62% lower odds of moderate to severe hair loss
- Cacao Powder:
- Natural cocoa powder ingested can help with skin elasticity and decrease wrinkle depth
- Cocoa can reduce inflammation
- Important to find cocoa powder that has been tested and not high in heavy metals
- Need Vitamin B12 supplement of 2000mcg a week (preferably in a chewable, liquid, or sublingual)
- 12% daily calorie restriction:
- To slow down epigenetic clock
- To Reduce mTOR (rapamycin)
- Caloric restriction without malnutrition is one of the most powerful ways to extend health and lifespan across species
- Theorized that dropping 30% of calories in your 40s could add a few years to your life
- Cal restriction bio marker algo showed rate of aging dropped to 0.1 which is like not aging at all
- Study review stated fasting likely has limited efficacy unless combines with high nourishment diets and low protein aka RDA amount
Physical Additions/Changes and Why:
- One serving of exercise daily (90 minutes at moderate intensity or 40 minutes of vigorous activity):
- Limit chronic, vigorous exercise to no more than one hour a day and 5 hours a week with 1-2 days off a week
- To boost spermidine and enhance Autophagy
- WFPB and exercise can lengthen telomeres
- FGF21 is a hormone known as the “longevity hormone” and the “starvation hormone” can be raised with aerobic or strength exercise or by a high carb and “low” protein diet
- High exercise frequency and duration (to slow down epigenetic clock)
- Exercising has not shown to increase longevity but it does fight off disease
- Recommended to run no more than 30 miles a week
- Plant based athletes have been shown to have superior cardiorespiratory fitness and an endurance advantage
- Don’t exercise near high traffic or on heavy pollution days as it can undo your cardio benefits. Air pollution is the 5th leading cause of death worldwide; cruciferous veggies can help detox from pollution; broccoli and broccoli sprouts are the best
- Strength training is essential:
- Weight bearing exercise needed for strong bones
- Best way to preserve muscle mass during weight loss is to resistance train 3 + times a week
- Exercising 3 times a week can help with osteoarthritis
- 3-5 grams of daily creatine with strength training can improve strength but be careful of the brand
- Greens slow our metabolism because of the nitrates which may translate into living longer
- Nitrates can improve muscle strength and function
- Hormesis: theory that a little of a bad thing can be good; exercise-induced oxidative damage where DNA damage after intense exercise but week later less damage than before
- Sleep and stress management:
- Sleep 7 hours a night (no more than 8 hours as sleeping 9+ hours has shown increase in mortality)
- Stress has not been shown to decrease mortality
- Warm shower, bath or foot bath 1-2 hours bed can improve sleep quality
- Petting or looking into dog’s eyes leads to oxytocin release in humans and dogs
- Forest bathing (surrounding yourself with trees) can lower cortisol levels and boost natural killer cell activity
- Recommends 2000 IU daily supplement of vitamin D for those getting sun exposure and 600 mg of calcium via food (dark green leafy veggies except spinach)
- Best to use glass containers instead of plastic for food storage and use
- Younger-looking skin:
- 80-90% of facial aging is due to sun exposur
- “Golden glow” of yellower skin can be achieved from plant foods
- Daily use of sunscreen is the best anti-aging ingredient
- Natural cocoa powder ingested can help with skin elasticity and decrease wrinkle depth
- Low fat diets resulted in a tenfold drop in skin cancer rates
- Greater vitamin C may lower varicose veins
- Don’t cut or pushback cuticles or file down the mail surface; avoid nail hardeners; use non- acetone polish remover
- Vitamin D through sun or supplements is a must
- Sunscreen has been shown to soak into the skin so only titanium dioxide and zinc oxide are recommended. I haven’t found a suitable replacement yet for my chemical sunscreen
- Mind:
- Cholesterol is a risk factor for Alzheimer’s Disease
- “brain health equals heart health”
- High salt diet is a risk factor for dementia
- Non-meat eaters cut dementia risk in half
- Miscellaneous:
- Eating twice the portion of plants compared to the Standard American Diet (SAD) may reduce odds of breast cancer by 90%
- Low carb eaters have higher rates of CD, shorter lives, die from cancer more, and higher levels of pollutants
- WFPB and high antioxidant food can help prevent hearing loss
- Saturated fat and high cholesterol can impair hearing
Where I plan to veer/ Where I disagreed with the suggestions:
In my opinion, the recommended protein requirement is too low. In How Not to Age, protein restriction is recommended to:
- Reduce mTOR (rapamycin) and reduce oxidation)
- Protein restriction is the only intervention that blocks every one of the eleven aging pathways
- FGF21 is a hormone known as the “longevity hormone” and the “starvation hormone” can be raised with aerobic or strength exercise or by a high carb and “low” protein diet
- The amino acid (building blocks of protein) methionine strongly correlates with maximum lifespan in mammals (more methionine decreases lifespan)
- “Hoffman effect” – one of the universal hallmarks of cancer is methionine addiction in cancer cells
- Methionine restriction could be feasible as a life extension strategy; fish, poultry, eggs, red meat, then dairy (except butter) have highest amounts with lowest in fruits, veggies, grains, nuts, then beans
- BCAAs should be kept lower (avoid animal protein) and avoid BCAA supplements; supplements “does not support the efficacy of supplementation in muscle strength and hypertrophy”
Dr. Greger recommends we eat the Recommended Daily Allowance (RDA) of protein (.36 grams per pound of body weight), but more studies are being published that suggest we increase our intake of protein as a way to gain muscle or fight off muscle loss, especially as we age.
Strength training is listed as essential, but extra protein is not required in How Not to Age. This goes against almost every other source I’ve read for gaining and preserving muscle and also my own experience. I used to lift heavy weights (heavy for myself) but didn’t concentrate on upping my protein. I haven’t eaten meat in over twenty-five years so my protein intake is relatively low if I don’t concentrate on consuming sources of protein or supplement with protein powders. However, once I made sure to track that I was intaking at least 100 grams of protein a day, my strength increased and I was finally able to see physical differences in my body.
The book states that most studies fail to show a beneficial effect in preserving muscle strength with increased protein (page 408) and that those studies that do show a positive effect are “consultants for the National Cattlemen’s Beef Associations and members of the Whey Protein Advisory Panel for the National Dairy Council” which implies there is a bias in the studies results. This is one of the reasons why it’s so difficult to find untainted data. The results could absolutely be true but the groups that fund studies and perform studies may have an incentive for a certain outcome of data. However, Dr. Greger is clearly in favor of avoiding animal products so one could argue he has a bias which may be reflected in which studies he chooses to highlight.
Dr. Greger strongly recommends a Whole-Food Plant Based Diet (which is often high-carb, low protein though there are WFPB and vegan eaters that consume high protein) and minimizes protein from animal sources, but he does have studies cited in the book that back his recommendations that the RDA protein is acceptable and ideal. All I know is that higher protein has benefited me, and that closer to .78 grams per pound of protein is working for me at this time.
Protein: Your Comprehensive Guide – Tufts Health & Nutrition Letter
Another area of How Not to Age where I disagreed with Dr. Greger was in his chapter titled Preserving your Skin where he discusses tretinoin, more popularly known as Retin-A. He admits that tretinoin “has by far the most robust track record of efficacy” but doesn’t recommend it as it may increase your risk of premature death.
Tretinoin is the closest that science has come to a fountain of youth and I will absolutely not give it up without a very good, highly-credible reason that convinces me I will die early if I continue with its use. After reading his statement I found the study he cited and yes, the study was shut down early because of excess mortality in the treatment group. However, when I dug a little deeper, I found an article where a doctor examined the data and the study and “further investigation did not support tretinoin as a cause of death. e.g., there was no clear link between how much cream was used and death”.
Although its usage is advised against in How Not to Age, the fact that tretinoin has been in use since the 1950s and I’ve personally found it to be effective for skin aging, has not convinced to give it up and I continue to use tretinoin in my nightly skin care routine.
Long-Term Topical Tretinoin and Excess Mortality in Older Patients
Patients Using Retinoid Cream More Likely To Die (medicalnewstoday.com)
An oddity I noticed in the book is that Dr. Greger recommends vitamin D supplements in the Preserving Your Skin chapter as a way to avoid sun over-exposure (page 456) but advises against them in the Anti-Aging Eight chapter (page 489). It seems to come down to weighing the risks/rewards of low vitamin D against skin cancer with the suggestion that vitamin D supplementation being the answer. Then a few chapters later stating the meta-analysis doesn’t show statistically significant mortality benefit to supplementing with vitamin D even if one has low vitamin D levels.
Self-Experiment and calculation of calories and protein for all Daily Dozen recommendations:
C=Calories
P=Protein
Dr. Greger’s Daily Dozen:
- Minimum of three servings of beans (legumes) (approx. 350 C and 21 P)
- One serving of berries (84 C and 1 P)
- Three servings of other fruits (approx. 120-220 and ~2-3 P)
- One serving of cruciferous vegetables (approx. 35 C and .5 P)
- Two servings of greens (approx. 15-70 C and ~1-2 P)
- Two servings of other veggies (approx. 200 C and ~4-6 P)
- One serving of flaxseeds (55 C and 2 P)
- One serving of nuts and seeds (140 C and 8 P)
- One serving of herbs and spices (zero)
- Three servings of whole grains (approx. 200 C and 15-18 P)
- Five servings of beverages (zero)
Total Calories for Daily Dozen: 1199-1354
Total Grams of Protein: 55-62
For a woman with my height and weight, the Mayo Clinic calculator states I need 1900 calories per day to maintain an “Active” lifestyle which is suggested as item #12 in the Daily Dozen. If I take the suggestion of 12% calorie restriction to slow down my epigenetic clock in How Not to Age that leaves me with 1672 calories a day to play with.
With these numbers I can eat per the Daily Dozen requirements (with about 300-500 calories to add of healthy choices) but it doesn’t seem like a lot of food nor a lot of protein (though well within healthy RDA limits). I could be misjudging since there would be a lot of fiber and perhaps the multiple servings of grains, beans and fruits is more than satisfying. But to quote Dr. Greger, I won’t know until I put it to the test.
Therefore, I will create a plan to hit all of the Daily Dozen recommendations and the guidance I listed above from How Not to Age for three days to see how I feel and report back if it was satisfying for the tongue and tummy. I’m sure I will supplement a protein powder with my extra calories, but I will stay true to the recommendations. By hitting all 12 on the list and not going over calories, I’m left with little room for unhealthy food (which I’m sure is the intention) and will use them wisely.
Conclusion:
In conclusion, there is an abundance of helpful knowledge in How Not to Age that can help us live longer, healthier lives and even if we only impart a fraction of the suggestions, I think we can become a healthier society. Dr. Greger does back up what he writes with links to studies, but with my tretinoin example above, I’m not convinced that every study cited has the latest and/or best data associated.
“Diet is understood to be the number one determinant of how long we live”
Unpleasant stats from How Not to Age:
After decades of increasing life expectancy, the trend started to reverse in 2015 and this generation may live shorter lives than their parents.
Only 1 in 500 Americans even gets close to a modestly healthy diet.
U.S. life expectancy expected to drop to 64th rank in world by 2040 even though we spend more money on healthcare than anyone else in the world.
Problem isn’t healthcare access but rather because the root problem isn’t getting treated; leading risk factor for death in American is our diet.