The Good and the Not So Good about the Ornish Plan for Optimal Health

Book Review

Dean Ornish and his wife Anne Ornish have a formula for achieving optimal health and avoiding or reversing heart disease and other chronic diseases in their new book, UnDo It! – How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (Ballantine Books, 2019). Dean Ornish was the first to show coronary heart disease could be reversed by a very low fat diet (Dr. Dean Ornish’s Program for Reversing Heart Disease, 1995). With the help of his wife Anne, a yoga and meditation instructor, they direct the Preventive Medicine Research Institute, a nonprofit program based in Sausalito, California. For decades they have been restoring health to people willing to follow their program.

As presented in UnDo It!, their program consists of four parts: Eat Well, Move More, Stress Less and Love More. Each of these is described in detail with many case examples. The book also has recipes from the “Ornish Kitchen” and guidance for a two week diet and how to stock your kitchen. Healthy nutrition is the centerpiece of the Ornish program.

I first listened to the book on The authors narrate the text which has additional benefit as their express their commitment and experience with this lifestyle approach. I am impressed by the major role Anne Ornish in complimenting her famous husband. There is no doubt that this nutrition and lifestyle approach restores health and avoids chronic disease, especially cardiovascular diseases and cancer.

The whole food plant based diet (vegan) espoused by the Ornishs is one well established option for optimal health. The diet has challenges in regularly supplying all the micronutrients and protein. Only 3% of the American public are willing to eat only plants ( Chris Kresser is a nutrition expert I follow, spent two years as a vegan and switched to a healthy paleo diet because he had better health (

I have three criticisms of this book. The first is that the Ornishs and other proponents of a whole food plant based diet believe that eating any foods from animals is bad and causes disease. They selectively cite references including animal studies to support their beliefs. They seem to ignore the health and disease reversal studies that use a healthy Mediterranean diet with intermittent fasting, such as the Bredesen Protocol for reversing cognitive decline (The End of Alzheimer’s, 2017). They hold on to the notion that meat causes diabetes when the recent epidemic of type 2 diabetes is clearly caused by the rising use of refined carbohydrates and sugar that only come from processed plants. To be fair this book criticizes the use of processed carbohydrates and sugar.

My second criticism is that the Ornishs hold on to the notion that all saturated fat is bad and to be avoided. It has become clear that healthy saturated fats from natural food sources such as nuts, seeds, avocado and tree oils (olive and coconut) are healthy and reduce disease. Processed saturated fats such as with chips and French fries are to be avoided along with trans fats and fried foods.

My third criticism is that there is very little detail about the reversal of specific chronic diseases beyond cardiovascular disease. No description or examples are given for the reversal of type 2 diabetes, auto-immune diseases, GI problems and cognitive decline. The Ornish diet and lifestyle undoubtedly prevents most chronic diseases but disease reversal is underdeveloped here.

UnDo It! will be welcomed by the vegan community but will tell them what they already know. Health advocates who want serious disease reversal methods will be disappointed. As Chris Kresser recently wrote, there is no diet that is optimal for everyone, and when healthy eaters argue with each other, big food wins ( In America our culture has moved toward a diet that is killing us with overweight, obesity, fatty liver, type 2 diabetes and dementia. Choose a diet based on Superfoods that restore health and Dean and Anne Ornish have made a contribution to this end.

Are There Genius Foods?

Joseph E. Scherger, MD, MPH

A young filmmaker and health care journalist, Max Lugavere, teamed with a concierge wellness physician in New York, Paul Grewal MD, to write Genius Foods: Become Smarter, Happier, and More Productive While Protecting Your Brain for Life (HarperWave, 2018). After reading three detailed books on brain health and nutrition, Brain Maker by David Perlmutter, MD, and two books by Daniel Amen, MD, Memory Rescue and Change Your Brain, Change Your Life, I wondered if this book would offer anything new. Genius Foods is a fun read and while not breaking any new ground, the book summarizes and prioritizes what is known about nutrition and keeping a healthy brain.

Lugavere and Grewal list and describe 10 “genius foods”.  These chapters are interspersed with chapters on what not to eat.  For example the first genius food is Extra-Virgin Olive Oil.  What follows is a chapter on other “fantastic fats” to eat and the “ominous oils” to avoid.  Inflammatory vegetable oils abound in our processed foods and are certainly not good for our brain health.

The other nine genius foods are:



Dark Chocolate


Grass-Fed Beef

Dark Leafy Greens


Wild Salmon


Each of these have a chapter and are placeholders for related foods that are healthy for the brain such as other tree nuts such as walnuts, macadamias, Brazil nuts, and pistachios as “equally excellent options”.

Advocates of a whole food plant based diet will not like this book since three of the ten genius foods come from animal sources.  The most controversial here is the recommendation to eat beef.  The overall health problems with red meat, even if organic and grass-fed, would not make it in the top ten superfoods.  Daniel Amen does not recommend beef in his 52 best foods for the brain and David Perlmuter suggests we eat red meat sparingly as a “condiment”.  These experts agree that healthy eggs and wild salmon (and other fish) certainly belong here.

The book is loaded with other health advice such as eating organic whenever possible, what soaps to use, be outdoors, and consume filtered water.  Appropriate emphasis is given for avoiding sugars and refined carbohydrates.  Any healthy brain diet must include a strict avoidance of toxic foods and this book does that well.

The book closes with two summary and resource chapters, The Genius Plan and Recipes and Supplements.  The number of supplements is modest and covers the most important ones such as vitamin D, vitamin K2 and turmeric.  References are given for each chapter and are not as extensive as those cited by Perlmuter and Amen.  

Some physicians and nutrition scientists will consider this book superficial, but I find it a worthwhile read and none of the advice is counter to that given by well-informed functional medicine clinicians.  Promoting healthy nutrition is a movement today that is countering the overwhelming influence of the commercial food industry and our cultural addiction to refined carbohydrates.  I hope Genius Foods is read widely and influences a new generation of healthy food advocates.

A Code for Healthy Longevity

Joseph E. Scherger, MD, MPH

Kris Verburgh, MD is a young scientist from Belgium who also teaches at Singularity University in the Silicon Valley of California.  The singularity refers to when man and technology merge and become one.  Singularity University was founded to advance that future and houses visionary scientists, engineers and others who want to invent a future where we understand and can manipulate our biology in ways never seen before. The future may be a whole new civilization where people may live 1000 years and even have their consciousness in other bodies.

In his book, The Longevity Code (2018 Second Edition) Verburgh explores how we may live well longer today.  I like his approach and it deviates from other techno-futurists who eat and live how they want and believe technology will save them from disease.  Verburgh has coined the term “nutrigerontology”, a scientific discipline that studies the role of nutrition in the aging process.  As you might expect, he recommends a diet of natural and healthy foods, and an avoidance of processed foods, grains and sweets.  He recommends mainly a whole food plant based diet since plants are most associated with health and longevity such as low heart disease and cancer rates.  If a person does not want to be a vegan, he suggests we get about 10% of our food from healthy animal sources such as eggs, meat and fish with low levels of toxicity.

His information and recommendations are put into a “longevity staircase” of four steps.  The first step is to Avoid Deficiencies.  Here he focuses on the micronutrients (vitamins and minerals) that may be deficient in many modern foods.  These include magnesium, B vitamins, vitamin D, vitamin K, selenium and potassium.  He reviews how to get these micronutrients mostly from food, supplementing as necessary.

The second step is to Stimulate Hormesis.  This is a very interesting concept. Hormesis is where something in small amounts is healthy but larger amounts are toxic.  Even water if taken too much can be lethal.  Verburgh goes into detail how diet and exercise are beneficial in the right amounts, even when they stress the body.  Nietzsche is famous for saying “what doesn’t kill you makes you stronger”.  There are wonderful such examples in this book of hormesis at work.

The third step is to Reduce Growth Stimulation.  Here anyone interested in body building and the use of growth hormone should pay attention.  Stimulating growth shortens your life span.  This applies to overweight and obesity also.  I find it fascinating how some people who were prisoners of war or experienced some other deprivation end up living over 90 years with a clear mind.  This section of the book describes why.  

The final step on the staircase is to Reverse the Aging Process.  Here Verburgh takes us through the latest science including how we might clean up protein debris and sugar-links that come with aging.  He sees a future where we will be able to repair our diseased tissues using stem cells and gene editing. 

I recommend this highly readable book for its science that is not hard to understand, and to reinforce a healthy lifestyle, especially healthy nutrition.  Whether you are interested in living beyond the current life expectancies, this book will help you increase your “heatlhspan”, the number of years that you are vibrant and healthy.

The End of Type 2 Diabetes

Joseph E. Scherger, MD, MPH

Jason Fung, MD of the University of Toronto has taken “Ockham’s razor” to simply the management of Type 2 Diabetes.  William of Ockham (1287-1347) was an English Friar and philosopher.  He is famous for postulating that with complex problems, the hypothesis with the fewest assumptions is usually correct.  

Dr. Fung reformulated our understanding of obesity (The Obesity Code, 2016) by arguing persuasively that obesity is a hormonal illness of excess insulin.  Whenever we eat, especially carbohydrates, we secrete the hormone insulin to drive blood sugar into cells.  Insulin is more importantly a fat storage hormone that blocks the burning of fat and causes excess sugar to be turned into fat through lipogenesis (the making of fat in the body).  Repeatedly eating carbohydrates causes chronically high insulin levels and the steady accumulation of fat.  

Besides the benefits of a low carbohydrate diet, Dr. Fung stresses the importance of fasting to lower the insulin level enough to begin burning off body fat.  Dr. Fung points out that we have been focused only on what we eat and not enough on how often we eat.  Humans have spent most of their time on earth eating just one meal a day.  Eating three meals a day is cultural and contributes to the epidemic of overweight and obesity, especially with our increased intake of refined carbohydrates.

In The Diabetes Code Dr. Fung furthers this same argument to show that Type 2 Diabetes is caused by insulin resistance.   Doctors have known this for a long time, but Fung elucidates how insulin resistance occurs.  The repeated secretion of insulin that causes obesity next leads to fatty liver and our body’s protective mechanism over time is to become resistant to insulin. This results in the high blood sugar of Type 2 Diabetes (Type 1 Diabetes, a completely different illness, comes from the body losing all its ability to secrete insulin).

Dr. Fung describes how many of the drugs used to treat Type 2 Diabetes, while they lower the blood sugar, make the underlying disease worse by increasing body fat and increasing insulin resistance.  They biggest culprit here is the use of insulin injections. In the US we spend over 23 billion dollars on drugs for Type 2 Diabetes, more than the total revenues of professional football, baseball and basketball combined.  In Dr. Fung’s clinic most of the patients with this diabetes have complete reversal off of medications by three months.

The approach to preventing and reversing diabetes described in The Diabetes Code is simple. The nutrition is healthy fats, low carbohydrates and intermittent fasting.  Dr. Fung will often use fasting periods of three days or longer to get insulin levels low allowing the body to recover from insulin resistance.  Healthy nutrition continues for life with healthy fats: nuts, seeds, fatty vegetables such as avocado, quality fish and meat.  All refined carbohydrates and sugars are avoided. 12-16 hour fasting periods are built into the daily routine (stay hydrated and coffee or tea are allowed).  Adults should eat only 1-2 meals a day.  Any snacks should be healthy fat and low carbohydrates such as raw nuts.

With The Diabetes Code Jason Fung MD has provided a simple lifestyle approach to preventing and avoiding what has become the most expensive of all chronic diseases.  The food industry and the drug industry will not be excited by his method, but it is long overdue for the public to become healthier and lower the costs of medical care.  If taken seriously and universally, this lifestyle could mean the end of Type 2 Diabetes.

Comments on Food: What the Heck Should I Eat? By Mark Hyman MD

Joseph E. Scherger MD, MPH

It is important news for the healthy nutrition world when Mark Hyman comes out with a new book. Dr. Hyman is the director of the Cleveland Clinic Center for Functional Medicine and is chairman of the board of the Institute for Functional Medicine. He practices and directs the Ultra-Wellness Center in Massachusetts. He served as a personal physician to President Bill Clinton.  He has 17 previous books, most notably the best-selling Eat Fat, Get Thin (2016).

In Food: What the Heck Should I Eat? Dr. Hyman surveys the latest science on all different types of food.  He focuses on food itself more than the macro- and micronutrients, although these are discussed in detail.  He promotes a “Pegan diet”, a term he coined as a cross between the Vegan and Paleo diets.  While he states we should eat mostly plants, he begins the book by discussing meat, poultry and eggs.

After meat, poultry and eggs, he surveys dairy, seafood, vegetables, fruit, fats and oils, beans, grains, nuts and seeds, sugar and sweeteners, and beverages.  I did not find any new information here but having the latest nutrition science all in one place is very helpful.  Dr. Hyman then discusses what things you should keep out of your food such as processing and additives.  He makes a strong argument for eating only organic foods when possible. He then discusses what you can add to your diet such as spices (mostly good), salt (in moderation), and what condiments, dressings, vinegars and sauces are healthy and which are not.

Dr. Hyman discusses supplements and those that should be considered, but he rightfully puts them in a minor perspective compared with eating healthy food. The healthiest people on earth, who live in the Blue Zones, do not require supplements and eat only the food of nature.

The book ends with a description of the Pegan Diet and how to eat for a healthy life.  He covers how to detox from sugars and other high glycemic carbohydrates that are addicting.  He provides lots of recipes and more are available on the book’s website: 

My only criticism of the book is that he starts out discussing meat, poultry and dairy and that sends an implied message of priority.  Since we should eat mostly plants, I think it would have been more appropriate to start with plant based foods.  Since all the information is there, that is a minor criticism.

This has been an incredible decade of new understanding and change in what constitutes healthy nutrition.  Food: What the Heck Should I Eat? provides an excellent review of where we are at today.  I am eager to find out what is next!

Is It Food Addiction?

Joseph E. Scherger MD, MPH

I recently read the 2012 book by Dr. Pamela Peake titled The Hunger Fix (Rodale).  Here Dr. Peake presents detailed advice for how to get over your “false fixes” to unhealthy foods and replace them with a “healthy fix” to better nutrition and greater well-being.  If you feel that you are addicted to sweets and other foods, this book is uplifting and provides lots of good advice.

My comment, not meant to be a criticism of her book, is that we know what foods are truly addicting and what are not.  The problem is not “food addiction” but rather addiction to sugar and other high glycemic carbohydrates.  These are the foods that trigger the addiction receptors in our brain, much like alcohol and drugs, and get us hooked.  The detox is to sugar and other carbs and once you get beyond that, you no longer crave these unhealthy foods and can enjoy the pleasures of feeling healthy.

I have yet to meet a person addicted to broccoli and other healthy foods such as nuts and seeds.  However these foods are satisfying and you feel good the rest of the day if you eat them, as long as you do not ingest the sweets or grains.  Eating healthy requires discipline since the temptations for unhealthy foods are all around us.  Dr. Peake rightfully points out that getting over food addiction may be the hardest of all because of our culture and the omnipresent advertising for sweets, breads and other flour based foods.  Here is where getting a “healthy fix” becomes important.

Thank you Dr. Peake.

We Finally Understand Overweight and Obesity

Joseph E. Scherger, MD, MPH

Jason Fung, MD taught me how not to eat.  I never realized I could skip meals and have greater mentally clarity and plenty of energy.

In his book, The Obesity Code  (Greystone, 2016), Fung, a nephrologist turned obesity physician, describes with great clarity and solid science that obesity is a hormonal illness.  The central hormone is insulin.

In medical school we are taught that insulin is the hormone that allows sugar to enter cells for energy.  Type 1 diabetics lose their capacity for making insulin in the pancreas and will die unless they get insulin.  Curiously Type 2 diabetics, currently over 90 % of those with diabetes, have excessive insulin and what is called insulin resistance, that is the insulin does not work well in lowering blood sugar.

More importantly, as Dr. Fung points out, insulin is a fat storage hormone.  When we stress our body with excess carbohydrates, insulin pours out and “locks the door” for burning fat. Any excess carbohydrates we do not burn for energy become fat through lipogenesis. The actual biochemistry is more complicated but the general principle as stated is true.  When we expose ourselves to a daily ample amount of carbohydrates, our daily high insulin level results in insulin resistance, overweight or obesity, type 2 diabetes and even high blood pressure and high cholesterol.

Our bodies did not evolve to eat carbohydrates like we do today, being over 60% of our daily food intake in calories.  When we ate the foods of nature, root vegetables, whole fruit, nuts, wild meat, eggs and fish, the dominant nutrient was fat followed by protein and then carbohydrates, only about 15% of calories.  That is the evolutionary human diet and what we eat today with processed foods is not what our body wants and excess insulin with its high blood sugar are a stress response that causes poor health, even dementia.

The key to reducing fat is to get your insulin level low.  Fasting insulin is now regarded as an important lab test that should be part of any routine check-up.  Fasting blood sugar roughly correlates but the fasting insulin reflects more time in the body than a spot blood sugar.

The current normal range for fasting insulin is silly, being 2.5 to 26, a whooping difference.  Normal ranges come from what the current public has in their blood.  In order to lose weight, the fasting insulin should be below 10.  Without that diets and exercise are a waste of time and effort.  To avoid dementia, the fasting insulin be below 5 or 4.5 per Dr. Dale Bredesen, author of the The End of Alzheimer’s (Penguin, 2017).

Any time we eat, no matter what we eat, insulin in the blood goes up.  Obviously with carbs it goes up higher.  Fung points out that we have been focused only on what we eat and not focused on the equally important when we eat.  We did not evolve to eat three meals a day, and even snack between.  More natural in the history of our species is to eat 1-2 times a day, and drink only water in between.  

Fasting has been part of our history for thousands of years.  Judaism, Christianity, and Islam all honor fasting, even for days at a time.  All report mental clarity, inspiration and other health benefits from fasting.  Fasting even just 12 or more hours in a day may lower insulin levels.

Fung is the founding director of the Intensive Dietary Management Program at the University of Toronto. There he uses fasting as a core modality and is successful in reversing obesity and type 2 diabetes.  A variety of fasting programs are used depending on the person, from part of a day to as long as three weeks.  The recorded record for a medically supervised fast is 382 days in a male weighing over 400 lbs.  With exercise all muscle is preserved during a fast.  Besides water, minerals and electrolytes are consumed such as in bone broth.

Our cultural eating pattern of three meals a day is more psychological than physical.  We think we are hungry and need to eat but we do not.  Carbohydrates drive hunger through blood sugar fluctuations so fasting is much easier with a low carbohydrate diet.

I have started recommending intermittent fasting to patients and many have lost weight where they failed on just a low carb diet.  I do this myself, eliminating  snacks and skipping lunch.  The method of eating two meals a day in one eight hour period, for example from 11 AM to 7 PM gives 16 hours of fasting daily and is very effective a lowering insulin levels, fasting sugar and burning fat.  Staying hydrated with water is vitally important during a fast and helps to suppress hunger.

Thanks to Jason Fung, MD and others we have a much clearer physiologic understanding of overweight, obesity and type 2 diabetes.  Fasting is a powerful tool to add to any diet program for better health.

Reversing Cognitive Decline – The End of Alzheimer’s Disease?

Joseph E. Scherger, MD, MPH

Fifty per cent of Americans will have dementia by age 85.  This is a growing epidemic.  Cognitive decline starts much earlier.  We now know the cause.  Too much sugar and other carbs in our diet and an unhealthy lifestyle with too much stress, not enough exercise, not enough sleep and a lack of the right brain stimulation.

Two books came out in the summer of 2017 by leading academic neurologists who are able to reverse cognitive decline and even early and middle stage Alzheimer’s disease.  Their protocols are similar, based on major nutrition and lifestyle change.  These results for a disease that was considered untreatable are a game changer.

Dale Bredesen, MD is professor of neurology at UCLA and founding president of the Buck Institute for Research on Aging.  His protocol for preventing and reversing cognitive decline is called ReCODE (reverse cognitive decline).  His book is The End of Alzheimer’s (Avery, 2017).  ReCODE uses at least 12 hours of daily fasting to achieve nutritional ketosis and a healthy Mediterranean diet of nuts, seeds, vegetables including avocado, olive oil and wild caught fish.  The book covers foods in detail, along with the supplements he recommends.  Other parts of the protocol are exercise, sleep and stress reduction.  Dr. Bredesen’s research findings reversing Alzheimer’s disease have been published since “patient zero” in 2014. 

Dale Sherzai, MD and Ayesha Sherzai, MD are husband and wife neurologists at Loma Linda University.  They are co-directors of the Brain Health and Alzheimer’s Prevention Program at Loma Linda University Medical Center.  Their new book is The Alzheimer’s Solution (Harper One, 2017). Their NEURO protocol is very similar to ReCODE and uses Nutrition, Exercise, stress reduction (Unwind), Restorative sleep, and Optimize brain function through multiple cognitive exercises.  Their nutrition plan differs from ReCODE in that it is a whole food plant based diet (vegan or vegetarian).  Their results are amazingly similar so anyone could use ReCODE, NEURO or a combination of each.

Dale Bredesen is a basic scientist who worked in a lab studying the biology of Alzheimer’s disease for over 20 years.  Like many, he was hoping to find a single biochemical solution to the debilitating disease.  In his book he explains why that is not possible.  Having Alzheimer’s disease is like having a leaky roof with 36 holes.  Fixing one will not solve the problem.  Fortuitously his wife is a family physician trained and practicing Functional Medicine.  She told him the only solution to fixing Alzheimer’s disease is to fix the lifestyle.  Turns out she was right.

A remarkable difference between the books by Dr. Bredesen and Drs. Sherzai is the recommended supplements.  Dr. Bredesen recommends more than 20 for most people, something that would be very expensive.  His diagnostic evaluation, which is called a cognoscopy, would also be expensive for tests not covered by most health insurance.  By contrast Drs. Sherzai recommend just two supplements, fish oil and vitamin B12, getting the rest of your vitamins and minerals in foods.  The diagnostic work-up is simpler and more likely covered by insurance.  This contrast reflects the current difference between a comprehensive Functional Medicine approach and a vegan Seventh Day Adventist approach to health.  Take your choice or follow a combination of the two approaches.  Both protocols eliminate toxic sugars and processed foods.  I suggest you consider a combination of the two approaches until more is known.

One of my favorite chapters in The End of Alzheimer’s is “How to Give Yourself Alzheimer’s: A Primer”.  All you need to do is to eat a standard American diet and live a standard American frenetic lifestyle.  No wonder 50% of us will have Alzheimer’s by age 85!  It does not need to be that way.  Alzheimer’s disease is very rare in the healthiest communities on earth who eat only real local food and live a low stress life with good sleep and good family and community relationships.  Such a life is always within our grasp.  Start living this way today.  It is never too late to change.

Comments on Perfect Health Diet by Paul and Shou-Ching Jaminet

Joseph E. Scherger, MD, MPH

A Stanford student interested in nutrition told me that Perfect Health Diet by Paul and Shou-Ching Jaminet of Cambridge, MA influenced her to eat healthy.  This book was published in 2012 by Scribner and the Jaminets have a large following on their website and hold frequent events.  They are both PhD scientists in other fields but chose to dive deeply into food science.  Their approach most resembles a Paleo diet and is 65% plant based and 35% from meat and oils.

The Perfect Health Diet (PHD) is summarized in this apple diagram:


While I agree that this diet is very healthy by avoiding processed foods, grains and sweets, I find the PHD less than perfect.  The Jaminets heavily promote “safe starches” including white rice and white potatoes.  These are mentioned much more often than green vegetables.  No mention is made of cruciferous vegetables such as broccoli.  The science behind their promotion of these starches is weak. They criticize low carb diets and ketogenic diets even though their diet is a lighter version of these. Many of their case examples are people who followed very low carb and ketogenic diets but felt better on the PHD.

Their discussion of athletic performance is still carb based and ignores the science behind nutritional ketosis such as the work of Jeff Volek, Stephen Phinney and Eric Westman (see my previous Blogs and Suggested Reading on my website, 

The Jaminets do not accurately describe the causes of obesity, more focused on omega 6 processed oils rather than the abundance of carbohydrates that drives hunger, overweight, obesity and type 2 diabetes.

Their treatment of cancer prevention is weak and ignores the role of a more vegan diet for preventing and even reversing cancers, especially the cruciferous vegetables. 

Most importantly the Jaminets do not address the problem that much of our meat and other animal products are inflammatory to our bodies due to the modern practice of feeding animals corn and other grains rather than their natural foods.  They do not emphasize the importance of grass fed meat and wild caught fish.  They do not address the issues of arsenic contamination in rice and mercury contamination in fish.

In general the PHD is healthy but far from perfect. Given all the factors today in our modern food supply, I suggest a diet that is closer to 80-90% plant based would be healthier.  The natural fats from nuts, seeds, healthy oils, and wild fish should be promoted as daily foods.  I agree with the PHD recommendation of about 15% protein in the diet but I would also recommend that carbohydrates from whole fruit and vegetables be about 15% of the calories.

Like most nutrition book authors today, the Jaminets believe that their diet is right and all others are wrong.  This is unfortunate and prevents the community of healthy nutrition authors from coming together and to have an honest sharing of ideas. We still have much to learn and no one could know a “perfect health diet” even if there will ever be such a thing.  The leaders of the Institute for Functional Medicine ( are doing a good job of monitoring the science and revising their diet recommendations based on new knowledge.  There is no room for arrogance and the healthy nutrition community should be one of humility and sharing.

Comments on How Not to Die by Michael Greger, MD, Flatiron Books, 2015

Joseph E. Scherger, MD, MPH

I am thankful to an Eisenhower Medical Center Internal Medicine resident urging me to read this book.  The resident follows a whole food plant based diet as advocated by Dr. Greger, who is also the founder of the website,  Dr. Greger follows in the tradition of Nathan Pritikin and Dean Ornish, MD, all champions of eating only foods from plants and very low in fat.

When I was a medical student at UCLA in the early 1970s, I was curious about the work of Nathan Pritikin and often wondered what went on in the Pritikin Center in Venice, CA.  I knew he was achieving amazing results through eating only whole plant foods very low in fat.  I became a runner in the late 1970s and remember when the editor of Runner’s World magazine declared that marathon runners could eat anything they want.  When the famous runner Jim Fixx dropped dead of a heart attack in his 50s this was blamed on his family history (genetics).  Nathan Pritikin proved that wrong in his book, Diet for Runners (1985), where he chronicled many runners who died of heart disease in their prime by eating unhealthy fatty foods.

Dr. Dean Ornish in the 1980s gave academic proof to the work of Nathan Pritikin by showing that a very low fat whole food plant based diet reversed coronary heart disease, the first time that this was demonstrated.  I used his Reversing Heart Disease book (1990) with many patients.

In the late 1990s, Dr. Walter Willet at Harvard, and principle investigator of the Nurses’ Health Study, began to show that healthy oils such as olive oil gave added benefit by improving the serum lipids, a major factor in heart disease.  Dr. Ornish recommended against all oils stating that they were 100% fat. However the evidence became clear that healthy oils in modest amounts gave added benefit and the dietary guidelines changed to put them on the top of the new food pyramid. 

After 2000 it became clear that a Mediterranean diet was exceptionally heart healthy and those who followed it lived the longest and the healthiest.  The fats in this diet were expanded to include tree nuts, avocado and wild caught fish such as salmon.  The Blue Zones are the healthiest and most long lived people on earth and most follow this type of diet that includes healthy fats even from animal products in small amount (Dan Buettner, The Blue Zones, 2008).  However, the great majority of the diet is whole food and plant based, and free of the processed foods and sugars that we Americans consume in our Western diet.

I found some weakness and bias in How Not to Die.  The UC Berkeley science philosopher Thomas Kuhn, in The Structure of Scientific Revolutions (1962), observed that scientists tend to ignore data that does not fit in to their scientific paradigm.  This is the case with Dr. Greger.  His book would be more accurately called How Not to Diet from Foods from Animals.  All his How Not to Die… chapters speak only about animal based foods.  For example his How Not to Die from Infections covers all the toxins that can be found in animal foods, not addressing that many plant foods have been contaminated with E. coli and other dangerous bacteria, and that some plant foods like unwashed or uncooked beans have lectins that cause serious disease.

The weakest part of How Not to Die addresses overweight, obesity and type 2 diabetes.  Americans have been eating meats for many decades yet these health problems are more recent.  Dr. Greger tries to blame animal meats and fats for obesity and diabetes, barely mentioning the role of the high glycemic carbohydrates such as sugars and grains that make up so much of processed fast foods.

For a clear academic look at the predominant cause of overweight, obesity and type 2 diabetes, I recommend books by Harvard internist David Ludwig, MD Always Hungry (2016) and UC San Francisco pediatric endocrinologist Robert Lustig, MD Fat Chance (2012).  High glycemic carbohydrates, all derived from plants through processing, are the biggest health threat in the Western diet.

Since carbohydrates should be limited to what is in whole foods only, and Dr. Greger agrees that protein intake should be modest and only what the body needs (about 15 % of calories), it becomes clear that healthy fats from healthy foods are part of a healthy diet.  Aversion to fat caused us to create unhealthy foods such as margarine and vegetable oils high in the inflammatory omega 6 fats polyunsaturated fatty acids (PUFAs) that should be avoided.

Dr. Greger does not have a section on How Not to Die from Autoimmune Disease.  It is becoming clear that much autoimmune disease comes from small intestinal bacterial overgrown (SIBO or “leaky gut”) causing proteins to enter our blood stream that we develop antibodies to and then cross react out tissues.  The worst offenders here are the grains such as wheat, oats, barley, rye and corn, products that make up much of our diet directly or in animal and fish feed.  Eating such grains result in an unhealthy intestinal microbiome (dysbiosis) and is the basis for GI disease and autoimmunity. 

I have no doubt that Dr. Greger is healthy and those who eat his diet to the letter will be too.  He recommends only whole foods and to avoid processed foods and sugars.  Since as Paracelsus said, the poison is in the dose, Dr. Greger’s recommendation of three small servings of grains a day (one slice of bread or one half bagel is a serving) may be tolerated by most patients.  However these foods are still inflammatory and care health risks.  Dr. Gerger’s aversion to fat causes him to recommend only ¼ cup of tree nuts and only 1 tablespoon of ground flaxseed, two of the healthiest foods.  The evidence is clearly showing that both saturated fats and monounsaturated fats from real wild foods are healthy and may be consumed liberally.

I benefitted from Dr. Greger’s book and will recommend it to cancer patients since the evidence for reversing cancer is the strongest for eating a whole food plant based diet.  I eat and recommend an 80-90% plant based diet to prevent cancer and stay healthy, and am not concerned about the fats in healthy plants such as nuts, seeds and avocados. Thanks to Dr. Greger I am now consuming a ¼ teaspoon of organic curry powder with my breakfast for the turmeric and black pepper.

Nutrition science is evolving and that is very exciting.  I gain much from every book I read, being careful to read only authors who are science based and do not have a commercial bias.  We are what we eat and it is very rewarding to learn more and keep open to new possibilities.  Dean Ornish is recommending wild caught salmon in his most recent book, The Spectrum (2007).  I hope Dr. Greger will expand his science to look honestly at healthy fats and healthy foods from all sources.

The Great Food Debate – Mark Hyman vs Joel Fuhrman

Joseph E. Scherger, MD, MPH


Doctors Mark Hyman (Eat Fat, Get Thin) and Joel Fuhrman (Eat To Live) are champions of healthy nutrition.  Both doctors achieve amazing results with patients becoming lean and fit, and reversing problems such high blood pressure, high cholesterol, high blood sugar and diabetes.  Both doctors advocate for eating the real foods of nature and avoiding foods with sugar and refined carbohydrates.  Both advocate for avoiding inflammatory foods such as in vegetable oils and some grains. Both advocate for limiting total protein to meet the body’s needs. So they must espouse the same nutrition.  Not quite, and their differences are striking.

Mark Hyman recommends a diet high in healthy fats such as from nuts, seeds, fatty vegetables such as avocado, eggs, grass fed meat and wild fed seafood.  Hyman recommends a very low carbohydrate diet to keep insulin levels low and a steady blood sugar.  His diet would result in people being in nutritional ketosis most of the time (see my Blog on that).

Joel Fuhrman is almost a Vegan promoting a 90% plant based diet (he prefers 100%).  He recommends against the consumption of much fat even from healthy sources such as olive oil, nuts and seeds. Fuhrman holds on to the notion that eating fat makes you fat and raises blood sugar.  As smart as he is, I am surprised that he holds to these ideas that have been disproven by the latest nutrition science. Like other Vegans, he is so passionate about eating plants that he uses arguments based on belief against foods from animal sources, even eggs.  Moreover Fuhrman promotes whole grains as healthy, not acknowledging the carbohydrate load and inflammatory proteins.

To Fuhrman’s credit, his diet carries very low cancer risk.  I love these statements in his book, “The American diet is designed for disease”, “The salad is the main dish”, “Cancer is a fruit and vegetable deficiency disease”.  Vegans and other vegetarians have the lowest cancer rates in America, and very low rates of heart disease and stroke.  Hyman argues that animal foods have key nutrients that complete healthy nutrition for humans, and agrees we should eat mostly plants.  Fuhrman leaves the door open for people to have 10% animal based food.  Not everyone is willing to eat a “greens and beans” diet every day.

So take your choice and follow your passion with food, as long as it is healthy.  Just eat the foods of nature, no label of ingredients needed, and you will be well along with healthy nutrition and being lean and fit.

In Praise of Michael Pollan, and a Criticism

Joseph E. Scherger, MD, MPH

August 7, 2017

Michael Pollan is a journalist who has focused on food and nutrition for two decades.  His work is so scholarly that he became a professor of journalism at the University of California, Berkeley.  His groundbreaking book, The Omnivore’s Dilemma (2006), explored how the food industry mass produces our food in ways far removed from just eating the foods of nature.  Even the large organic food producers are guilty of alliterating our food for a mass market.  Pollan calls for getting as much of our food as possible from local farmers who produce real food in time honored natural ways. Since this book was published, the number of Farmer’s Markets has increased greatly and “eating local” became a movement.

His second book, In Defense of Food (2008) goes into specifics as to what a person should eat.  Here he distinguishes real food from what he calls “food like substances”.  This book goes into great detail based on his summary recommendation, “Eat food, not too much, mostly plants”.

Other Michael Pollan books I have read and enjoyed are Food Rules (2009) and Cooked (2013).  His “rules” begin with “Eat Food” and “Don’t eat anything your great-grandmother would not recognize as food”.  After laying out in simple but specific rules what we should eat, Pollan finishes with the rule, “It’s okay to break the rules once in a while”.

In Cooked Pollan explores the ways we transform the food of nature through cooking, with both good and bad consequences.  He divides this analysis by breaking down cooking into four core elements of nature: fire, air, water and earth.  He praises traditional methods with their wisdom handed down through generations and is critical of mass produced processed foods.  The book gives remarkable insights through his travels to the source of the best of cooking methods.

My only criticism of Michael Pollan is that he loves bread.  He honors the making of bread through traditional means of using yeast and carefully pressing the dough.  He visits a bread maker in San Francisco who makes only 250 loaves a day and sells these out quickly. He also visits pasta makers who use traditional methods, and points how these are better than most commercially available products.  However Pollan seems unaware of our evolutionary biology of not eating bread until recently in our existence, and the problems caused by excess carbohydrates and inflammatory proteins.  Bread causes us to have an unhealthy microbiome with the problems of acid reflux and inflammatory bowel disease, only to name the local bodily impacts of eating and other flour based foods from grains. 

To use Michael Pollan’s own expression here, bread and other flour foods from grains are “food like substances” in our human diet.  Hence they are not eating the foods of nature that we thrive on and are to be avoided.  Otherwise, read Michael Pollan and learn much about food.

Getting Over GI Problems is Not Difficult

I recently read a medical journal article on managing irritable bowel syndrome (IBS), a common gastrointestinal (GI) disorder.  IBS, along with gastroesophageal reflux (GERD), are the most common GI disorders adults suffer from.  The article made it sound very complicated!  

There are the ROME IV criteria for types of IBS, to IBS with diarrhea, IBS with constipation, and IBS with mixed diarrhea and constipation.  These types of IBS all have their own new and expensive drugs to treat them, none of which go to the root cause of the problems.  They only manage the symptoms, with a number of side effects to deal with.  The same can be said about the drugs for GERD.  Yesterday a report came out that the long term use of the PPI drugs like Prilosec and Nexium are associated with early death!

These GI problems are a reflection of dysbiosis, or an unhealthy gut microbiome.  The one hundred trillion bacteria in our GI tract largely determine our health in ways still untold, but especially our GI health.  If you have chronic acid reflux or any type of IBS, you have a disorder of your gut microbiome.

Your gut microbiome complete depends on what you eat!  It is our responsibility to feed it, and feed it well.  Eat unhealthy foods and you will have dysbiosis!  Science better understood just this decade shows that the inflammatory proteins of grains (especially wheat, barley and rye) cause dysbiosis.  Processed vegetable oils and excess sweets and alcohol do the same thing.  Many people are stopping these inflammatory foods and soon they have a healthy gut with no more GERD, no more IBS, and no more drugs that are not healthy in the long term.

Getting over common GI problems is a simple as eating a healthy diet!

For more information read my book, Lean and Fit, and the books in the Suggested Reading section of this website for more information on just what constitutes a healthy diet for good GI health.

High Blood Sugar is Carbohydrate Overload

High blood sugar is common.  Most Americans have it by being a prediabetic or having diabetes.  This goes along with being overweight or obese.  Your genes have something to do with how high your blood sugar is relative to your weight and age, but everyone will get high blood sugar if they consume too many carbohydrates and develop too much body fat.

It is important to remember that our bodies do not need carbohydrates.  The Inuit living in the Artic regions are able to get all of their nutrition including vitamins and minerals from eating a caribou and no carbohydrates.  The same is true for the Samburu and Maasai tribes in Africa.  Our bodies are perfectly able to develop blood sugar from both protein and fat. When we get our blood sugar that way the level stays steady and normal.  No spikes in blood sugar or the drops of hypoglycemia.  No bouts of hunger pains unless we are truly starving.

The body fat we accumulate, especially around the waist, comes from eating too many carbohydrates, from grains, sweets and excess alcohol.  Fat is stored energy and carbohydrates are nothing more than a rapid energy food we can actually do without.  Many high performance athletes do well on diets of fat and protein and become fat burners with a steady blood sugar. That is a great formula for endurance and the ability to fast, all part of being lean and fit.

Since eating too many carbohydrates is one of the biggest problems with our Western diet, we should rethink how we describe the common health problems of overweight, obesity, prediabetes and type 2 diabetes.  Becoming overweight is from eating an excess of carbohydrates, and becoming obese is a more extreme version of that.  Prediabetes and type 2 diabetes are from chronic carbohydrate intoxication.  Think of these problems that way and it will be easier to say no to bread, cookies and cakes, ice cream and other sweets, and that second and third drink you do not really need.

Intermittent Fasting – A Great Way to Right Your Metabolism, Lose Weight, Control Blood Sugar and Increase your Mental Alertness

Joseph E. Scherger, MD MPH

Amazon sells more than 5000 books on fasting, and many were written during this decade!  Fasting has exploded in popularity, and for good reason.  Fasting is a very healthy thing to do.

We can live for weeks, some of us for months, on no food if we have adequate water intake.  Prolonged fasting, more than three days, is not to be advised since that will cause some breakdown of your body other than fat. Intermittent fasting up to three days can be a very healthy thing to do.  When we fast, and drink water, we live off our body fat.  Even thin people with less than 10% body fat have enough fat energy to sustain themselves for days.  When you burn fat for energy, ketone bodies form, the breakdown product of fat.  This is also called nutritional ketosis. This is not to be confused with the state of ketoacidosis that happens in type one diabetics when there is no insulin to metabolize sugar.  The ketone bodies formed from burning fats are healthy and have great anti-oxidant properties.

I wrote about the ketogenic diet in my previous Blog so I will not repeat that here.  The ketogenic diet is regularly eating very low carbohydrates and foods rich in fat and protein.  Fasting is a nice complement to this and can jumpstart blood sugar control and jumpstart the body into burning fats for fuel.

There are several methods of intermittent fasting, and I regularly practice the first method.  I got some of this material from a self-published (on Amazon) short book by Steve Blum, Intermittent Fasting. Remember that ability to fast comfortably is enhanced by eating plenty of fat and protein form natural foods and avoiding the grains and sweets that drive hunger.  Remember to drink water! Coffee or tea without sugar (light cream is OK) may be included.

1.     12 hour intermittent fasting – This is the easiest method of fasting and fits into any lifestyle.  We normally fast while we sleep, but that is typically 6-8 hours.  The 12 hour fast means that you do not snack after dinner and you may delay breakfast some.  For example, finish eating at 7 PM and do not eat again until 7 AM.  If you have a later dinner for social reasons, delay breakfast until 12 hours later.  You may or may not lose weight with this method depending on what you eat during the other 12 hours.  Also, if you consumed a lot of carbs, including alcohol, at dinner, you may not go into a state of ketosis during the 12 hours so be mindful of that and avoid overeating and drinking.


2.     16 hour intermittent fasting – This is more serious fasting and may be done regularly or occasionally as a “cleanse”.  Here you reduce your food intake to two meals a day in one eight hour period.  For example you start eating at 11 AM or Noon and finish eating at 7 or 8 PM.  Blum suggests that women have a tendency to require more frequent eating and should strive for a 14 hour fast.


3.     5:2 Diet or The Fast Diet – This approach to intermittent fasting has you eating whatever you want 5 days a week and only eating about 500 calories 2 days a week.  It became popular in the UK by health journalist Michael Mosley in 2012 after his  documentary on the BBC called Eat, Fast & Live Longer. The diet quickly spread in Europe and the US.  Several books including cookbooks have been written about the 5:2 diet.  There is nothing special about this ratio, only that if you fast two days a week you will definitely get the benefit of intermittent fasting.  To fully benefit you should eat healthy foods all week, rich in fats and moderate protein.  If you eat too many carbs, your hunger will interfere with sticking to this diet and receiving the benefits.


4.     One to three days of intermittent fasting – Fasting for 24 hours or longer can be safely done up to three days, and the benefits are the same as listed for the ketogenic diet.  This length of fasting requires fortitude and limits how much physical activity you can do during this time.  I have not tried this but David Perlmuter MD (Grain Brain and Brain Maker) does this every three months. 

Whatever method of intermittent fasting appeals to you, I highly recommend you build this into your nutrition lifestyle.  It is a great way to rapidly return to a healthy state, especially after a period where you diet may not have been as good due to holidays or travel.