Review of "How Not to Age"
This review is based on an advance copy of How Not to Age. I did not have full access to the videos and citations that have now been released.
Looking for a single pill or procedure to extend your life? If so, Dr. Michael Greger’s How Not to Age is not for you. In this 600+-page book, with additional materials posted online, Dr. Greger explains the current scientific consensus on aging and makes meticulous connections to nutritional research, resulting in an original and powerful set of recommendations for slowing the aging process.
Lengthen your health span
Dr. Greger is interested in exploring ways to decelerate the aging process, given that age is a major risk factor for many deadly conditions, including heart disease, cancer, stroke, diabetes, Alzheimer’s, and dementia. He emphasizes “health span”—living in health—as well as lifespan. As he puts it, “What’s the point of living longer if you can’t enjoy it vibrantly?” He notes that genetics appears to account for only about 15-30% of how long we live. Lifestyle can significantly influence our lifespan and vitality.
Multi-media format
How Not to Age is more technical than Dr. Greger’s previous two best-sellers, How Not to Die and How Not to Diet. Sharing solutions that work, but also explaining why they work—down to the molecular level—Dr. Greger does not simplify the science as much as some of his readers might hope.
All this scientific detail demands space. Dr. Greger uses a novel combination of formats to share his work. Dozens of short videos on Nutritionfacts.org supplement the book and delve into individual topics with detailed explanations. All of his citations (around 13,000 sources) are available on his site with links to the original articles. The book features almost no graphs, charts, or figures, which could have assisted visually oriented learners; I assume the page constraints prohibited more. The videos do feature visuals, although even more charts and graphs would have been welcome.
Four parts
The book is organized into four parts. Part 1 is about how to block the eleven “essential pathways of aging,” that is, the main biological processes in our bodies that make us age. Some of the eleven processes, like inflammation and telomeres, will be familiar to most readers. Others may be new, like glycation, cellular senescence, and autophagy. In each section, Dr. Greger explains what the process is, how it causes aging, and what foods and behaviors may be able to slow it down.
Part 2 describes the eating, drinking, exercise, sleep, and other habits that are common to “Blue Zone” regions, areas of the world with the longest average longevity. Blue Zone centenarians eat almost exclusively plants, especially beans, and avoid processed foods. Dr. Greger also touches on the other lifestyle habits that are associated with healthy long lifespans, including exercise, weight control, sleep, and stress management.
Part 3 offers practical research-based advice for preserving your hair, bones, hearing, skin, and other important body parts and functions. The longest section in this part is “Preserving Your Mind.” Dr. Michael Greger reviews the major contributors to dementia and Alzheimer’s and shows what works (and doesn’t work) to minimize the risk or slow the progression of these conditions.
Part 4, called “Dr. Greger’s Anti-Aging Eight,” promises to be an actionable checklist of specific foods, supplements, and habits that can slow the aging process. I found it challenging to extract recommendations from some of the sections. Nuts, greens, berries, and “Protein Restriction” are clear enough. “Xenohormesis and MicroRNA Manipulation,” on the other hand, takes very carefully reading to extract actionable habits. The remaining categories, “Probiotics and Postbiotics,” “Caloric Restriction,” and “NAD+,” fell somewhere in between for me.
Calling out fake pills, potions, and procedures
Much more than in his two previous books, Dr. Greger addresses interventions that don’t work as well as those that do. This approach contributes to the length of the book and the somewhat choppy feel of some of the chapters, which sometimes move from one possible intervention to another without an obvious unifying flow. But this information is vitally needed, given how many supplements and procedures are marketed to older adults with claims of extraordinary results.
Dr. Greger has arrived at a mostly skeptical view of supplements. He notes in several places that, given the lack of oversight of the supplement industry, there is no guarantee that producers have gathered evidence of a product’s effectiveness or even that what’s listed on a supplement’s label is contained in the product.
In addition, sometimes pills and supplements provide too much of a good thing. In a section on “hormesis,” he explains research results that show that certain nutrients such as resveratrol and flavonoids are effective at levels attainable from diet, but they decrease in effectiveness at the higher levels found in many supplements. More is not always better. In addition, he notes that pills and supplements cannot give you the “symphony” of nutrition that whole plant foods provide, including vitamins, minerals, phytonutrients, protein, and fiber.
My take on how to read the book
I read the book cover to cover and would recommend that approach only to those who have a good grounding in biology. For laypeople, I would recommend starting with more approachable sections, like Part 2 about the Blue Zones, or chapters that appeal to you in Part 3 (I admit I couldn’t resist sneaking a peek at “Preserving Our Skin” when the book arrived). Don’t skip Part 1 entirely, though, the most technical section of the book, because understanding that multiple processes are constantly aging our bodies can be quite motivating for pursuing a healthy lifestyle for the long term.
I also recommend watching videos when they are referenced in the text. They definitely clarify important topics and provide interesting examples.
Applying the recommendations
The recommendations in How Not to Age are more numerous and complex than the “Daily Dozen” from How Not to Die and the “Twenty-One Tweaks” from How Not to Diet. While Dr. Greger reiterates that the foundation for a long, vital life consists of a healthy (whole-food plant-based or mostly plant-based) diet, regular exercise, and no smoking, he mentions dozens and dozens of possible dietary and exercise solutions across the four parts of the book, in many cases without formatting them in a way that stands out.
At times I felt the need to create a spreadsheet with all the recommendations I was reading about, and I wondered how I could possibly incorporate them all into my life every day. The simple answer is that I can’t—for example, there no way to drink in a single day all the helpful beverages he mentions throughout the book in the quantities that research suggests. I have chosen a few new habits to start (full-body moisturizing, homemade L-ascorbic acid serum, hibiscus tea, and decreasing salt), and I will add on from there once those are fully in place.
Lasting impact
This book is certainly a tour de force, a masterful synthesis of a huge body of scientific literature with evidence-based solutions offered wherever possible to assist us in living longer and in health. I definitely recommend getting a copy or borrowing it from your local library. Medical professionals may find much to consider for their own lifestyle as well as advice they can give to patients. Non-scientists interested in slowing down the aging process will learn a lot and discover ample steps that they can take.
Dr. Greger’s distinctive dry sense of humor is on display throughout the book and provides a welcome pick-me-up in the midst of technical description. While what’s in How Not to Age will not fit on a refrigerator magnet, as some might have hoped, Dr. Greger does justice to his complex and fascinating subject matter and roots his advice in evidence so that we have the best possible chance of living vigorously into decades we may never have imagined seeing for ourselves.