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S5E20 Nutrition Facts for MS with Dr Michael Greger

Listen to S5E20: Nutrition Facts for MS with Dr Michael Greger

Welcome to Living Well with MS, where we are pleased to welcome Dr Michael Greger as our guest! Dr Greger is a physician, New York Times bestselling author, and internationally recognised speaker on nutrition, food safety, and public health issues. He speaks to Geoff about gluten and MS, how to get enough iron from food and how to ensure you don’t get a leaky gut.

Keep reading for the key episode takeaways and Dr Greger’s bio.

Make sure you sign up to our newsletter to hear our latest tips and news about living a full and happy life with MS. And if you’re new to Overcoming MS, visit our introductory page to find out more about how we support people with MS.

Selected Key Takeaways

Fibre from whole intact grains and legumes will decrease intestinal permeability AKA “Leaky Gut”

The most important thing to decrease intestinal permeability or [to] seal up a leaky gut is [to get enough] short-chain fatty acids that our body makes from fibre and resistance starch. These prebiotics that we eat are turned by our good gut bacteria into what are called ‘post-biotics’. What are the most concentrated sources of fibre in the diet? Number one, whole intact grains and legumes including beans, split peas, chickpeas and lentils are the most important sources of fibre.

There are many health benefits to eating ground flaxseeds

I’d rather people get their flaxseed oil within their flaxseeds, so from ground flaxseed (that’s part of my daily dozen). Just because, in addition to getting the short-chain Omega-3 alpha-linolenic acid in those flax seeds that are found in the oil, you also get a nice low soluble fibre [and] most importantly the lignans which are cancer-fighting compounds which are not found in oil.

Vitamin C improves the absorption of plant-based iron sources

To get enough iron from plant-based sources, you combine sources of iron like legumes and whole grains with Vitamin C-rich foods. Vitamin C actually improves the absorption of plant-based iron. Vitamin C-rich foods [are foods such as] citrus, tropical fruits, broccoli [and] bell peppers. You just want to have it all in your stomach at the same time and that will improve your absorption.

Transcript

Read the episode transcript here

Geoff Allix 

Michael Greger, MD is a physician, author and speaker. He wrote the international bestseller “How Not to Die” as well as the “How Not to Die Cookbook.” He founded nutritionfacts.org, the first science based non-commercial website to provide free daily videos and articles on the latest discoveries in nutrition. So, Dr. Greger Welcome to living with MS. Is that how you pronounce your name by the way?

Dr. Michael Greger 

Dr. Greger you nailed it.

Geoff Allix 

Excellent. So welcome to the podcast. So to start off with Could you introduce yourself? Tell us how you became interested in plant based nutrition and a bit about nutrition facts, the daily dozen and any other projects that you’re currently working on?

Dr. Michael Greger 

Ah, all right. Well, um, in terms of why I do what I do. It all really comes back to my grandmother. I was just a kid my grandma was diagnosed with end stage heart disease, and sent home in a wheelchair to die. She already had so many bypass operations basically run out of plumbing at some point confined a wheelchair crushing chest pain her life was over at age 65. This year what about this guy Nathan Pritikin, one of our early lifestyle medicine pioneers and what happened next is actually she’s detailed in Pritikin’s biography talked about Francis Greger, my grandmother, and they wheeled her in and she walked out. Though she was given a medical death sense at age 65, thanks to a healthy diet, was able to enjoy another 31 years on this planet to age 96 continue to enjoy her six grandkids including me. That’s why I went into medicine. That’s why I practice lifestyle medicine. Why I started nutritionfacts.org Why wrote the book, How Not to Die? Why all the proceeds from all my books are all donated directly to charity. I just want to do for everyone’s family what Pritikin did for my family.

Geoff Allix 

Well, that’s quite starry eyed, completely unaware of that. So Overcoming MS. I’m not sure if you’re aware is an evidence based program to help people living with MS. And through numerous studies, including originally Roy Swank’s longitudinal study and ongoing research, particularly at the neuro epidemiology unit, at the University of Melbourne, from Dr. Jelinik and elsewhere, that says a whole food plant based diet. And in our case, we have plus fish has a demonstrable positive impact on symptoms and quality of life for people with MS. And we’ll get back to the fish bit at a later question. But there’s many neurologists who claim that there’s no evidence for a specific diet for MS. So could you talk a bit about the history of controlled trials, the influence of big pharma, big tobacco, big sugar on the public’s understanding, and also medical professionals understanding of nutritional research?

Dr. Michael Greger 

Yeah, so you’ll see systematic reviews coming to the conclusion that diet has not been shown to impact the disease, but this is based on their criteria that may only accept randomized control trials as acceptable evidence. This is certainly a good a good practice when it comes to something like drugs, something like, you know, in the states here, 106,000 Americans are killed by prescription drugs, not overdoses, not illicit drugs, just drugs as prescribed. And so, I mean, if if they’re making them a leading cause of death, so um, for wiping out, we certainly want to make sure have excellent evidence that the drugs are going to cause more benefit than harm. But when we’re talking about some of the and so so that model that we want randomized, controlled, placebo controlled, ideally, randomized against the sugar pill, to make sure that the, you know, the pros outweigh the cons. That same mindset has been used to assess nutritional interventions. And the, which, I mean, and I mean, I like where that’s coming from, we want to have the most robust evidence possible. But there are no downsides to eating a healthier diet, or exercise or smoking cessation, etc. And so we don’t necessarily need the same vigor of evidence. So for example, there’s never been a randomized controlled trial of smoking cessation. They didn’t. I mean, they I mean, of because it’s very difficult for people to do it. And so because of problems with compliance, you cannot randomize a group of people to either smoke or not smoke for feedback and see who gets lung cancer,

Geoff Allix 

Especially the placebo, you know if you’re smoking.

Dr. Michael Greger 

And oh, that’s a good point, right? And so you’d have to have some kind of like tobacco flavored, like cigarette that didn’t actually have harmful smoke or something, right? I mean, right. Okay. So you can see you can’t do that today. So in that kind of “diet has no impact on MS” mindset, you could say, well, we don’t have evidence that stopping smoking, or it’s starting smoking causes lung cancer has never been randomized, controlled trial. But what we do have is this observational evidence where we follow populations of people who smoke versus those who don’t smoke, and we try to match them for other criteria. So we want, you know, smokers versus non smokers at the same weight that the same exercise levels, you match all those other criteria. And you find out, wow, the smokers have, you know, you know, you know, 10 times the lung cancer rates of non smokers mean, you do that a bunch of different ways. And so the best available evidence suggests you know, smoking is really a bad thing to do. And so even though there’s no randomized controlled trials, we don’t smoke, and we tell people not to smoke. And so that, so we’re in the same situation with in many cases with diet. It, there are certain foods that are so potent, like certain spices, you can actually put them in a pill like garlic powder or something into a capsule and randomize them against a sugar pill and actually show different effects. But most foods, you know, people know notice when something’s going into their mouth or not, it’s very difficult to do placebo controlled trials. And even randomized controlled trials are difficult because again, the compliance issue. And so we are left with this kind of observation levels, where you have cohorts of people, in fact, huge cohorts, some of the Harvard cohorts over 100,000 people, we have AARP core over half a million people, the UK Biobank, 400,000, people, follow them over to follow people, their diets and their diseases over time. And you can statistically tease out, “Oh, wow, the people that eat these foods tend to live longer, even when matched for all these other criteria.” And so based on that kind of evidence, you can say, well, you know, this drinking soda, no, does not look like it’s good for you. Oh, but drinking green tea. Oh, that does seem like it’s good for you. So we can make those kinds of and now now someone can say, “Wait a second. You’ve never done the randomized control trials?” And I’m like, yes. You’re in that pharmaceutical mindset. I understand that. But, you know, worst comes to worst. And, you know, broccoli really isn’t good for you. Like, what’s the worst thing that can happen? People eat broccoli, right? I mean, so that’s why it’s understandable that they want this hierarchy of evidence, they want those randomized control trials, we’re often just simply unable to give them, particularly because some of these diseases take decades to develop. And so we fall back on observational evidence. And we have tremendous mounds of evidence implicating certain foods in various diseases, and not only prevention, or rest, but even reversal in some cases. And, you know, we can look around the world and see how different different disease rates differ and have a sense “Oh, well, that’s not just genetic.” The fact that, you know, there’s, you know, 100 fold difference in lung cancer rates in different populations, you’d be like, “Whoa, maybe there’s some, there’s some factor that one population has higher rates than the other.” And you can do that with all sorts of diseases, then you do migration studies, where, you know, people, men from Japan, moving to San Francisco all of a sudden start. And when they start living like Americans, they start dying, like Americans their prostate cancer rates shoot up, but their stomach cancer rates drop, because they’re not eating some of the salted fish and some other things. And so that’s how we can tease out genetic factors, even though we don’t have really these best, the highest quality of evidence, which we require for drug trials. And so when you do that with MS, for example, and you look at some of the healthiest populations historically, like about a century ago, in Sub Saharan Africa, where people were, in the rural areas, were living almost exclusively plant based diets, extremely high fiber diets, no processed foods, no added salt, there is a study with a population of 15 million people, not a single case of multiple sclerosis in a population of 15 million. And so it says, “Wait a second. So maybe there are environmental causes, including diet that may play a role.” And that’s the kind of data that got Dr. Swank and others excited about the possibility of changing people’s circumstances and changing disease rates, and in his case, exact, you know, recurrence rates.

Geoff Allix 

And so to talk a bit about some specifics of the diet that we follow Overcoming MS recommends that people with MS can eat as many beans and legumes as they like. But there are other there’s several other MS diets, which are the major ones are very similar in many ways. But many of those say that beans and legumes do contribute to leaky gut syndrome. What’s your understanding that was the science about the causes of leaky gut and whether beans could contribute towards that?

Dr. Michael Greger 

The most important thing to decrease in intestinal permeability or kind of seal up a leaky gut is the short chain fatty acids that our body makes from fiber and resistance starch, those prebiotics that we eat are turned into by our good gut bacteria into what are called post biotics, short chain fatty acids like butyrate, which actually feed the lining of the cells that line our colon, and are able to establish those tight connections. So we’re not gonna have little pieces of food, you know, and bacteria slipping into our bloodstream. What are the most concentrated sources of fiber in the diet? Number one, well, whole intact grains and legumes, depending on which one in general probably legumes and beans, split peas, chickpeas and lentils are most important source of fiber, and also whole grains because they’re drier foods, since most of fruit and fruits and vegetables, certainly all whole plant foods have fiber. But you know, fruits are like 90% water. Vegetables, are like 80% water. And so that’s why some of these drier foods like the grains and legumes are the most constrained sources of fiber.

Geoff Allix 

Okay, so let’s get one for us. So we’re okay with beans or legumes that’s very, very good for me. I have quite a lot of beans and legume. And on a similar vein, Overcoming MS doesn’t eliminate gluten unless there’s a specific gluten problem. Now in the UK, we are routinely tested if you’re diagnosed with MS, they actually test you for gluten intolerance. And anyway so I was tested and so many tested with I had so many tests at the start blood test it would be I think, okay, I there was so many tests when I got diagnosed, because they test you for all the other things that could be other than MS. So I asked my neurologist regularly to tell you you were tested for that and I was unaware of this. He said yeah, it’s routine which is everything. So so one of those things it says it doesn’t eliminate gluten, it does recommend whole grains. You know, obviously not heavily processed breads and so on. But many other MS diets do eliminate gluten. And some of them even eliminate all grains. I think you’ve mentioned that grains are a good thing. But what what would the science say behind gluten sensitivity it does seem to be an increasing trend. And should you try to eliminate gluten Do you think?

Dr. Michael Greger 

That’s like saying you know are peanuts healthy? Well for most people but not for people with a peanut allergy obviously it can make a drop dead from eating peanut. And same thing with with gluten about one and 147 or so folks have celiac disease. About another 1%-ish have gluten sensitivity so they don’t have celiac disease but can be tested in a blinded challenge trials to show that they do have a gluten sensitivity even though most people actually fail that they think they’re gluten sensitive but then you give them you know wheat flour pills versus rice flour pills, they can’t tell the difference. And and then there’s about one to 1000 people have a wheat allergy actually. Either you know kind of tongue swells and throat closes. And so but other than that, so other than the kind of war maybe one and 50 who have either celiac or gluten sensitivity so 49 out of 50 people then we certainly wouldn’t want to cut out gluten containing grains you know wheat, barley, rye because they’re such good sources of fiber.

Geoff Allix 

And something that is a similarity with your daily dozen and Overcoming MS is to supplement with flaxseed oil. Overcoming MS recommends between 20 and 40 mil of cold pressed flaxseed oil daily and what are the health benefits of supplements that way and some places called linseed oil is where it’s not yeah.

Dr. Michael Greger 

I don’t I mean I’d rather people get there of flaxseed oil within their flax seeds. So from ground flaxseed so that’s part of my daily dozen. I’m just because in addition to getting the short chain Omega threes alpha linolenic acid in those flax seeds that’s found in the oil. You also get a nice low soluble fiber most importantly the lignans which are these cancer fighting compounds which are not found in oil. In fact, you can see some so called “high lignin” and flaxseed oil and then you look at the ingredients all it is is flaxseed oil plus ground flaxseed like they sprinkle a little ground flaxseed in and that makes them “high” but of course not anywhere compared to actual ground flaxseed. And so yeah, so I’d recommend a tablespoon ground flax every day, just because there’s there’s other things that you’d be missing, as well. And, and they they last much longer even less for, you know, months in a airtight container, even at room temperature as opposed to because the national you know, the whole whereas you know, flaxseed oil can go rancid pretty quickly.

Geoff Allix 

And what about other oils? Well, I mean that people, some people are using algee oil for similar Omega threes.

Dr. Michael Greger 

Oh, yeah, some of the longtail if you want sub men to directly get those long chain Omega threes as opposed to elongating the short chain Omega three is found in flax and walnuts and greens, then, right, you can certainly if you want a pollutant free source, you know, the mercury and some of the PCBs and other things found in fish oil products, because of our polluted world, then yeah, you can get algae, which just kind of like just grow it on a stainless steel tank and extract it. Yeah, so there’s algae based DHA, EPA,

Geoff Allix 

And they’re all as good as each other.  And one thing that’s common in people with MS is an iron deficiency. And this is something that’s brought up because I mean, me growing up, I would assume if you want more oil, if you want more iron, you would eat steak, because that’s what most people think so. So it is more common in people with MS than the general population. And it does contribute to some symptoms like fatigue. And so what’s the best way to keep your iron levels high or higher with a plant based diet.

Dr. Michael Greger 

Some vegetarians and vegans actually don’t suffer higher rates of iron deficiency anemia. But that’s not saying much. Because there’s such high rate, it’s one of the leading nutrient deficiencies, particularly among menstruating women. To get enough iron from plant based sources, you are combining sources of iron, like like legumes, whole grains with a vitamin C rich foods, the vitamin C actually improves the absorption of plant based iron. So vitamin C rich foods or citrus, tropical fruits, broccoli, bell peppers, you just want to have it all on your stomach at the same time. And that will improve your your absorption.

Geoff Allix 

And so this is this is something where I think there might be a difference certainly with the Overcoming MS diet pillar to yours is that it does include seafood, if desired. So it’s an it’s not a you should eat seafood regularly. But it’s if desired seafood is acceptable a couple of times a week to improve Omega three to omega six and nine ratio. So up to I believe three servings of oily fish a week. So firstly, what are the best ways to get DHA and the EPA? And what are the risks associated with fish consumptions? And is there a you know what’s the best alternative in a plant based diet?

Dr. Michael Greger 

So these are essential fats, meaning we can’t make them we have to get them in our diet. And they’re essential for the fish too, the fish don’t make these there, they get it from the bottom of the food chain, which are these algae so we can kind of skip the skip the middle fish and go straight to the algae source. And so the advantage of algae based is, is that we don’t have to worry about the pollutants, even distilled fish oil can get rid of some of the heavier compounds like mercury, but unfortunately we’ll still get like you know the flame retardant chemicals and then PCBs and dioxins and some of these these are organochlorine pesticides have been banned like DDT dieldrin etc. Unfortunately the oceans are basically humanity sewers, you know, all the mercury from all the coal plants in China, eventually, you know, settles into our waterways. And so the highest levels of these industrial pollutants really build in our waterways. And so if we could go you know, in a time machine back before the Industrial Revolution, it’s kind of a different thing, but now, we’ve just so polluted the world that you know, it’s probably better to get those omega threes, either from from you know, having our own bodies elongate them from the short chain right, and flax or taking directly from an algae or other pollutant free source.

Geoff Allix 

So you wouldn’t be a completely I mean, we whole food plant based diet but then you would be happy to supplement in in terms of things like, presumably algae, what you’d have as a you know whether it’s an algae oil or or you know be a supplement presumably.

Dr. Michael Greger 

Oh what I mean, I mean I’m nothing in principle against supplements from those who need it. I mean, I urge everyone on a plant based diet to ensure a regular reliable source of vitamin B 12. That’s probably the most important. Yeah, and so yeah, absolutely. I mean, and those who don’t get enough sunshine, may need vitamin D. I mean, it’s just kind of how we live, we’re pregnant, you may need some things for an alcoholic any different supplements. I mean, it’s just what a you know, what people need is what people need.

Geoff Allix 

Yeah. Okay. Because I mean, So personally, I you supplement with vitamin D, vitamin B complex, and, and flaxseed oil and take a probiotic as well, although I do try and have fermented foods. But yeah, I have a probiotic tablet every day. So that’s absolutely fine with your approach.

Dr. Michael Greger 

Ah, I mean, if you need it, if you think you need it, then then you know, I mean, I don’t recommend taking probiotics or, you know, feeding your own good gut flora, prebiotics so that, you know, they are fruitful and multiply without having to, to take any directly. I mean, we just don’t know enough about the microbiome to be able to use a few target species and growth in a way that our body, it’s hard to outsmart our bodies

Geoff Allix 

And fermented foods?

Dr. Michael Greger 

The problem is too many have added salt. And that’s particularly a concern for anyone with an autoimmune disease, you know, you do not hear a lot in the MS community talking about salt, but there are these th-17 These auto immune cells, these pro inflammatory immune cells, which are activated by sodium intake, you know, you do observational, here’s these population studies, again, those with MS who eat more, consume more sodium, have, you know, three times the exacerbation rates have, you know, twice the the brain lesions over time, and we do not yet have interventional studies where you randomize MS sufferer to low salt diet to see if it actually improves of course disease, but the best available data we have is we really need anyone with any autoimmune disease really needs to lower their sodium intake. And so something like sauerkraut which, you know, kind of does have a packed with salt and that’s the you know, diminish the growth of the bad bugs.

Geoff Allix 

Kombucha on the other hand doesn’t that’s that doesn’t have salt in it.

Dr. Michael Greger 

Oh, but yeah, yeah, I mean, there’s there are there are certainly, like Tempe is a fermented foods fermented with a fungus. And so you don’t have to use salt. Yeah, but typically fermented foods have a sodium problem.

Geoff Allix 

Yeah, we have discussed that with this podcast. And it’s quite interesting, because he’s, he lives in America lives in Europe as a chef and he said, So what you’ve got to think about is how much salt you’re actually using. People start to remove salt in the wrong way and they say that all they remove is they’re moving salt from the water they’re cooking pasta if you move remove a teaspoon of salt from the water you can pastoring you practically getting rid of no salt because you pouring that water away. You measure the amount of salt he was left on the pasta is hardly any it’s mostly used to separate the pastor and but what you’re doing is you’re still leaving a teaspoon of salt on your fries when you when you have those that you’re consuming all of it.

Dr. Michael Greger 

Processed foods tend to be just packed with salt.

Geoff Allix 

So one of the things that’s come up recently in the MS community is Epstein Barr Virus. They’re increasingly thinking this as a trigger fact for multiple sclerosis. But are there certain foods that reduce chances of viral flare ups in our diet?

Dr. Michael Greger 

Um, I think the only thing Ah, let me think I’m just looking at my nutrition facts. Right now. There’s only 2000 videos so I’m often going to my own site to figure out. So there’s a reduction in EBV reactivation with chlorella. I’m trying to see how much. So chlorella is a kind of a one cell green algae that’s Sep not blue green algae, but just it’s a green algae that’s been found, I’m actually not seeing the dose here, been found to not only boost IgA levels, which is an antibody released to your mucosal membranes, but significantly reduce reactivation of latent viruses like EBV.

Geoff Allix 

Okay, and that was This is from your website, you find him. So this is all available, and I would encourage people to look this huge amounts of information. So, another thing that I wanted to touch on was the gut brain access the vagus nerve, and that our gut is our second brain. So it’s referred to so how can we best feed our gut microbiota to promote a gut brain access Health? What’s the what’s the best thing we can do? I mean, we talked a bit about prebiotic. I mean, how does that What’s that look like?

Dr. Michael Greger 

Yeah, no, it’s, it’s one of the growth of our good gut bugs, which is feeding them with prebiotics. So that’s resistant starch, fiber, that’s what they eat. And, and they produce these short chain fatty acids resorbed in the bloodstream actually pass through the blood brain barrier, and can affect our mental states can affect our immune system, have anti inflammatory effects. That’s why fiber and the dietary, anti inflammatory dietary inflammatory index, the most anti inflammatory component in our diet is fiber. It’s because of what our good gut bugs do with it. So you know, you can you know, eat a fiber rich meal and immediately see reduced asthma, exasperation rates and has interplanetary effects throughout the body. And, yeah, it’s feeding our good gut bugs. And not feeding the bad ones, you know, like with carnitine, and choline, which foster growth of bad and gut bugs and make a toxin called trimethylamine oxide is associated with cardiovascular disease, as well as kidney disease.

 

Geoff Allix 

So overall, if we’re heading for plant based, healthy diet, high in fiber, low or no processed food,

 

Dr. Michael Greger 

Love it.

 

Geoff Allix 

then that’s going the right way. Yeah, there’s increasing veganism in the Western world. There’s a whole row in our supermarket of vegan food, I wouldn’t touch any of it. To be honest, it’s the most you just think it is vegan. Technically, there’s no animals in there. But that were heavily processed.

 

Geoff Allix 

And

 

Dr. Michael Greger 

I’m so glad you said that. That’s why That’s why I describe the healthiest diet as a whole food plant based diet. Not a vegan diet. I mean, vegan, that just tells me what you don’t eat, right? I mean, you can you know, I see you go to these, see these collegiate vegans living off of French fries, and beer is something completely vegan, but I mean, just absolutely abysmal, horrible diet. Whereas a whole food plant based Oh, you actually eat your vegetables? Oh, wow. There we go. Now we’re talking. Um, so yeah, you can eat a miserable die. That’s why I’m really concerned about these people that, you know, go towards a more plant based diet, not for health reasons, but for, like, ecology reasons, or animal welfare reasons. And so they just reach for a vegan doughnut. And that’s really not doing their bodies. any favors.

 

Geoff Allix 

And just as a final wrap up, is there any other studies on diet and MS or autoimmunity in general that we haven’t touched on that we should know about?

 

Dr. Michael Greger 

I think we hit the major ones. Ah, yeah, yeah. Saturated fat. Sodium, anti inflammatory. nailed all the good ones. Obesity increases the risk of, of MS. I know about once you already have it, but I know it’s associated with increase in incidence.

 

Geoff Allix 

But I’ve found everyone who follows the diet that we follow. Your body seems to naturally let go. They look people lose weight quite dramatically. And it seems to actually naturally level off and yeah, yeah, it does seem to be if you give your body natural food, it just seems to sort itself out in my non-expert opinion.

 

Dr. Michael Greger 

Remarkable.

 

Geoff Allix 

So with that, I’d like to thank you very much for joining. I encourage everyone have a look at the show notes because firstly, there’s the evidence. There’s your website with huge amounts of information. There’s every evidence in the How Not to Diet book and also one thing if people are moving to an Overcoming MS lifestyle and diet, we’re always looking for good cookbook. So it’s one of the go to cookbooks where you can basically everything on there is is pretty compliant. Anyway.

 

Geoff Allix 

So yeah I use for the How Not to Die cookbook is also a useful resource to thank you very much for joining us.

Dr. Michael Greger 

Absolutely thanks Keep up the good work!

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Dr Michael Greger’s bio:

A founding member and Fellow of the American College of Lifestyle Medicine, Michael Greger, M.D., is a physician and internationally recognised speaker on nutrition. He is a graduate of Cornell University School of Agriculture and Tufts University School of Medicine.

Dr Greger’s career
His science-based nonprofit, NutritionFacts.org, offers a free online portal hosting more than 2,000 videos and articles on myriad health topics.

Dr Greger is a sought-after lecturer and has presented at the Conference on World Affairs and the World Bank, testified before Congress, and was invited as an expert witness in Oprah Winfrey’s defence in the infamous “meat defamation” trial.

Dr Greger’s books
Dr Greger is also an acclaimed author. How Not to Die, The How Not to Die Cookbook, and How Not to Diet became instant New York Times Best Sellers. More than a million copies of How Not to Die have been sold. All proceeds Dr Greger receives from the sales of his books and speaking honoraria are donated directly to charity.