How Not to Die

  How Much Should You Exercise?

  The current official physical activity guidelines recommend adults get at least 150 minutes a week of moderate aerobic exercise, which comes out to a little more than 20 minutes a day.45 That’s actually down from previous recommendations from the surgeon general,46 the CDC, and the American College of Sports Medicine,47 which recommended at least 30 minutes each day. The exercise authorities seem to have fallen into the same trap as the nutrition authorities, recommending what they think may be achievable, rather than simply informing you what the science says and letting you make up your own mind. They already emphasize that any physical activity is better than none,48 so why not stop patronizing the public and just tell everyone the truth?

  It is true that walking 150 minutes a week is better than walking 60 minutes a week. Following the current recommendations for 150 minutes appears to reduce your overall mortality rate by 7 percent compared to being sedentary. Walking for only 60 minutes a week only drops your mortality rate about 3 percent. But walking 300 minutes a week drops overall mortality by 14 percent.49 So walking twice as long—40 minutes a day compared to the recommended 20—yields twice the benefit. And an hour-long walk each day may reduce mortality by 24 percent!50 (I use walking as an example because it’s an exercise nearly everyone can do, but the same goes for other moderate-intensity activities, such as gardening or cycling.51)

  A meta-analysis of physical activity dose and longevity found that the equivalent of about an hour a day of brisk (4 mph) walking was good, but 90 minutes was even better.52 What about more than 90 minutes? Unfortunately, so few people exercise that much every day that there weren’t enough studies to compile a higher category. If we know 90 minutes of exercise a day is better than 60 minutes is better than 30 minutes, why is the recommendation only 20 minutes? I understand that only about half of Americans even make the recommended 20 minutes a day,53 so the authorities are just hoping to nudge people in the right direction. It’s like the dietary guidelines advising us to “eat fewer sweets.” If only they’d just give it to us straight.

  That’s what I’ve tried to do in this book.

  Conclusion

  My friend Art was one of those guys you just wanted to be around. Successful, generous, kind, and hilarious, he was more than the public face of the natural foods business empire that he had started. He truly walked the walk, or rather, ran the run. An avid snowboarder and mountain biker, Art ate a whole-food, plant-based diet for more than two decades. He was one of the healthiest guys I ever met.

  He died while I was writing this book.

  At just forty-six years old, he was found dead in the shower of a health retreat he owned. My heart couldn’t deal with the grief of losing my friend, so my head took over, my mind spinning with possible causes of his death. I thought that if I could figure out what had happened, I could give his family some closure.

  I considered all the rare congenital heart disorders that can cause sudden death in young athletes. Maybe it was Brugada syndrome? I remembered there was a case of a marathon runner who had collapsed due to this rare genetic disorder,1 which can be triggered by heat.2 I looked it up, and indeed, there was a previous case tied to a hot bath,3 so it seemed plausible that this was what took Art’s life.

  The heat of the water was indeed the reason he’d died, but not in the way I had suspected. The sheriff called later that week to inform us that others had collapsed in the very same shower. These victims were medevaced to a nearby hospital and, thankfully, they survived.

  It turned out that Art had died of carbon monoxide poisoning. A newly installed hot-water heater must not have been vented properly. It was an unbearable tragedy. I haven’t been able to stop thinking about him.

  Art’s passing made me realize that no matter how well we eat or how well we live, we can always get hit by a bus—metaphorically or literally. We need to make sure to look both ways in life and before crossing the street. We need to take care of ourselves. We need to wear seat belts and bike helmets and practice safer sex. (After all, practice makes perfect!)

  And we need to make each day count by filling it with fresh air, laughter, and love—love for ourselves, for others, and for whatever we are doing with our one precious life. That’s what Art taught me.

  In Pursuit of Pleasure

  The idea of preventive health is that you do something now so that nothing bad happens later. You floss your teeth not because it makes you feel better but because, by doing so, one day you won’t feel worse. You could consider the healthy habits described in this book to be preventive—you eat a healthier diet now to avoid disease later.

  A healthy diet, however, does more than that.

  The food industries bank their billions by manipulating the pleasure centers within your brain, the so-called dopamine reward system. Dopamine is the neurotransmitter the brain evolved to reward you for good behavior, helping to motivate your drive for things like food, water, and sex—all necessary for the perpetuation of our species. This natural response has been and continues to be perverted for profit.

  The food industry, like the tobacco companies and other drug lords, has been able to come up with products that tap into the same dopamine reward system that keeps people smoking cigarettes and snorting cocaine. People have chewed coca leaves for at least eight thousand years without any evidence of addiction,4 but a problem arises when certain components are isolated and concentrated into cocaine—when the coca leaves are processed. The same may be true for sugar. After all, few people binge on bananas. The isolation of sugar from the whole food may be the reason you’re more likely to supersize fizzy drinks than sweet potatoes or why you’re unlikely to eat too much corn on the cob but can’t seem to get enough high-fructose corn syrup.

  The overconsumption of sugar-sweetened foods has often been compared to drug addiction. Until very recently, this parallel was based more on anecdotal evidence than on solid scientific grounds. But now we have PET scans, imaging technology that allows doctors to measure brain activity in real time. It all started with a study that showed decreased dopamine sensitivity in obese individuals. The more the individual being studied weighed, the less responsive to dopamine he or she appeared to be.5 We see the same reduction in sensitivity in cocaine addicts and alcoholics.6 The brain gets so overstimulated that it ends up trying to turn down the volume.

  It was healthy and adaptive for our primate brains to drive us to eat that banana when there wasn’t much food around, but now that fruit is available in fruit loop form, this evolutionary adaptation has become a liability.7 The original Coca-Cola formulation actually included coca leaf, but now, perhaps, its sugar content may be the addictive stand-in.

  The brain responds similarly to fat. Within thirty minutes of being fed yogurt packed with butterfat, research subjects exhibited similar brain activity8 to those who drank straight sugar water.9 People who regularly eat ice cream (sugar and fat) have a deadened dopamine response in their brains when drinking a milkshake. It’s comparable to the way drug abusers have to use more and more drugs to obtain the same high. A neuroimaging study found that frequent ice cream consumption “is related to a reduction in reward-region [pleasure center] responsivity in humans, paralleling the tolerance observed in drug addiction.” Once you’ve so dulled your dopamine response, you may subsequently overeat in an effort to achieve the degree of gratification experienced previously, contributing to unhealthy weight gain.10

  What do fatty and sugary foods have in common? They are both energy dense. It may be less about the number of calories than their concentration. Consumption of green-light foods, which are naturally calorie dilute, doesn’t lead to a deadened dopamine response, but a calorie-dense diet with the same number of calories does.11 It’s like the difference between cocaine and crack: It’s the same stuff chemically, but by smoking crack cocaine, a user can deliver a higher dose more quickly to his or her brain.

  Given our new understanding of the biological basis of food addicti
on, there have been calls to include obesity as an official mental disorder.12 After all, both obesity and addiction share the inability to restrain behavior in spite of an awareness of detrimental health consequences, one of the defining criteria of substance abuse (a phenomenon referred to as the “pleasure trap”).13 Of course, redefining obesity as an addiction would be a boon to the pharmaceutical companies that are already working on a whole array of drugs to muck with your brain chemistry.14

  For example, when researchers tried giving an opiate blocker to binge eaters (similar to how heroin addicts are sometimes treated with opiate blockers to minimize the narcotic’s effects), the binge eaters ate significantly fewer fatty and sugary snacks—the snacks just didn’t seem to do as much for them when their opiate receptors were blocked.15 In addition to new drugs, addiction specialists have urged that the food industry “should be given incentives to develop low calorie foods that are more attractive, palatable and affordable so that people can adhere to diet programs for a long time.”16 No need—Mother Nature beat them to it. That’s what the produce aisle is for.

  Rather than taking drugs, you can prevent the numbing of your pleasure center in the first place by sticking to green-light foods. This can help return your dopamine sensitivity to normal levels so that you can again derive the same pleasure from the simplest of foods. When you regularly eat calorie-dense animal products and junk foods like ice cream, it’s not just your taste buds that change but your brain chemistry. After eating a bunch of chocolate bars, not only may a ripe peach no longer taste as sweet on your tongue but your brain down-regulates dopamine receptors to compensate for the repeated jolts of fat and sugar. In fact, an overly rich diet could cause you to experience less enjoyment from other activities as well.

  There is a reason cocaine addicts appear to have an impaired neurological capacity for sexual stimulation17 and why smokers have an impaired ability to respond to positive stimuli.18 Related brain circuits wire all these sensations. Since they all involve overlapping dopamine pathways, what you put into your body—what you eat and what you drink—can affect how you experience all of life’s pleasures. Try it and see. Try it and feel.

  Do you see where I’m going with this?

  Eating a whole-food, plant-based diet and returning your brain’s dopamine sensitivity to its healthy, normal levels can help you live life to the fullest and allow you to experience greater joy, satisfaction, and pleasure from all the things you do—not just what you eat.

  Let Me Help

  I hope I’ve been able to persuade you that nutrition is not the stale, lifeless subject your middle school home-economics class may have led you to believe. It’s vibrant and overflowing with opportunity for the betterment of your life. This abundance can create a problem, though. Over the last year alone, more than twenty-five thousand articles on nutrition were published in the medical literature. Who has time to sift through them all?

  Every year, my team and I read through every issue of every English-language nutrition journal in the world so you don’t have to. Then I compile all the most interesting, groundbreaking, and practical findings we can uncover to create new videos and articles every day for my nonprofit site, NutritionFacts.org.

  Everything on NutritionFacts.org is provided absolutely free of charge. There’s no special member area where you pay a fee to get extra lifesaving information. What membership websites seem to be saying, in essence, is that if you don’t give them money, they’ll withhold information that could make your family healthier. That’s unacceptable to me. Advances in health sciences should be freely available and accessible to all.

  Since we refuse to sell products, advertisements, or endorsements, how do the bills get paid? NutritionFacts.org is a 501(c)(3) nonprofit organization that thrives on the Wikipedia model of simply accepting donations from visitors who appreciate the content. We reach so many millions of people that if even one in one thousand makes a small, tax-deductible contribution, we are able to pay for all the staff and server costs. (I personally don’t accept any compensation for my work on NutritionFacts.org; I’m privileged to be able to donate my time as a labor of love.) The hope is to offer a public service so valuable that viewers will feel moved to support it and keep this life-changing, life-saving resource free for everyone for all time.

  I welcome you to come and make NutritionFacts.org a part of your life. I’ve got new videos and articles every day on the latest in evidence-based nutrition. You can sign up for daily, weekly, or monthly e-mails highlighting all the new, fun, juicy information. It warms my heart to hear it’s become a Sunday ritual for many families. It exists to serve you.

  Taking Responsibility

  My goal is to give you the information to empower and inspire you to make healthy changes in your life, but in the end, it’s all up to you. Know, however, that there is only one way of eating that’s ever been proven to reverse heart disease in the majority of patients, a diet centered around whole plant foods. Anytime anyone tries to promote some new diet, ask just one simple question: “Has it been proven to reverse heart disease?” (You know, the most likely cause of death for you and everyone you love?) If it hasn’t, why would you even consider it?

  If that’s all a whole-food, plant-based diet could do—reverse our number-one killer—then shouldn’t that be the default diet until proven otherwise? And the fact that it can also be effective in preventing, treating, and arresting other leading killers would seem to make the case for eating this way overwhelming. Please give it a try.

  It could save your life.

  How Not to Die may seem to you a strange title for a book. After all, everyone is going to die eventually. It’s about how not to die prematurely. If there is one takeaway message, it’s that you have tremendous power over your health destiny. The vast majority of premature deaths can be prevented with simple changes in what you eat and how you live.

  In other words, a long and healthy life is largely a matter of choice. In 2015, Dr. Kim Williams became president of the American College of Cardiology. He was asked why he chose to eat a strictly plant-based diet. “I don’t mind dying,” Dr. Williams said. “I just don’t want it to be my fault.”19

  That’s what this book is about: taking responsibility for your and your family’s health.

  Acknowledgments

  There are many thanks I’d like to express: to my cowriters and editors, Gene, Jennifer, Miranda, Miyun, Nick, and Whitney, who helped turn my bite-sized chunks of science into a coherent, four-course narrative meal; to my fact-checkers, Alissa, Allison, Frances, Helena, Martin, Michelle, Seth, Stephanie, and Valerie; and to all the NutritionFacts.org volunteers who helped with the book: Brad, Cassie, Emily, Giang, Jerold, Kari, Kimberley, Laura, Lauren, Luis, Tracy, and especially Jennifer—no physician has ever known a better PA or a better friend. Also, much appreciation to Brenda and Vesanto for their keen insights and vast knowledge.

  This book would not have been possible without my wonderful staff—Joe, Katie, Liz, and Tommasina—and everyone at HSUS who supported me on the work front, and Andrea, my partner in life, and our beloved family, who supported me on the home front. NutritionFacts.org would not have even been possible without the Jesse & Julie Rasch Foundation, the design and coding genius of Christi Richards, and the thousands who have donated to enable my work to reach millions.

  Though it was my grandmother who made me the doctor I am today, it was my mother who made me the person I am today. I love you, Mum!

  APPENDIX

  Supplements

  By getting your nutrients from green-light foods, not only will you minimize exposure to harmful food components, such as sodium, saturated fat, and cholesterol, but you will maximize your intake of nearly every required nutrient: vitamin A carotenoids; vitamin C; vitamin E; the B vitamins, including thiamin, riboflavin, and folate; as well as magnesium, iron, and potassium, not to mention fibre.1 Dietary quality rating scales consistently rank the most-plant-based diets as the healthiest.2

&nb
sp; That said, because of the way we live in our modern world, there are important shortfalls that need to be corrected.

  For example, vitamin B12 is not made by plants; it’s made by microbes that blanket the earth. But in this sanitized modern world, we now chlorinate the water supply to kill off any bacteria. While you don’t get much B12 in the water anymore, you don’t get much cholera, either—that’s a good thing! Similarly, we evolved to make all the vitamin D we need from the sun, but most of us are no longer running around naked in equatorial Africa. You may be covered up, inside, at a high northern latitude and therefore need to supplement your diet with this “sunshine vitamin.” Thus, these two vitamins must be addressed.

  2,500 mcg (μg) Vitamin B12 (Cyanocobalamin) at Least Once a Week

  Given modern sanitary standards, a regular, reliable source of vitamin B12 is critical for anyone eating a plant-based diet.3 Though deficiency for those starting out with adequate stores may take years to develop,4 the results of B12 deficiency can be devastating, with cases reported of paralysis,5 psychosis,6 blindness,7 and even death.8 Newborn infants of mothers who eat a plant-based diet and who fail to supplement can develop deficiency much more rapidly with disastrous results.9