The Five Most Important Dietary Tweaks

Image Credit: Sally Plank

The Five Most Important Dietary Tweaks

Generally, adherence to healthy lifestyle patterns has decreased during the last 18 years. Obesity is up, exercise is down, and the number of people eating just five servings of fruits and veggies a day dropped like a rock. And we didn’t start out that great to begin with.

Only 3% of Americans at the turn of the 21st century had the following four healthy lifestyle characteristics: not smoking, not overweight, five daily servings of fruits and vegetables, and exercising a half hour a day at least five days a week. Whether people were wealthy or college-educated didn’t matter; no sub-group even remotely met clinical or public health recommendations.

Where are people falling down the most? You can see in my video What Percent of Americans Lead Healthy Lifestyles?. If you look at heart disease risk factors, for example, most people don’t smoke and about half are exercising. But if we look at the healthy diet score–which is based on things like drinking less than four cups of soda a week–a scale of zero to five, only about 1% of Americans score a four or five. The American Heart Association’s aggressive 2020 target to improve that by 20% would bring us up to 1.2%.

Since we’ve known for decades that advanced coronary artery disease may be present by age 20—with atherosclerosis often even present in young children—it is particularly disturbing that healthy lifestyle choices are declining rather than improving in the U.S.

In terms of life expectancy, the U.S. is down around 27 or 28 out of the 34 OECD free-market democracies. The people of Slovenia live a year longer than citizens of the United States. Why? According to the most rigorous analysis of risk factors ever published, the number one cause of death and disability in the United States is our diet.

It’s the food.

According to the Global Burden of Disease study, the worst five things about our diet are: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

Studies that have looked at diet quality and chronic disease mortality risk found that those scoring higher (e.g. more whole plant foods), reduced the risk of dying prematurely from heart disease, cancer, and all causes of death combined. There is now an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.

Why do we eat so poorly? Aren’t we scared of dying from these horrible chronic diseases? It’s almost as if we’re eating as though our future didn’t matter. And there’s actually data to back that up, from a study entitled Death Row Nutrition.

The growing macabre fascination with speculating about one’s ‘‘last meal’’ offers a window into one’s true consumption desires when one’s value of the future is discounted close to zero. In contrast to pop culture anecdotes, a group of Cornell researchers created a catalog of actual last meals–the final food requests of 247 individuals executed in the United States during a recent five-year period. Meat was the most common request. The researchers go out of their way to note that tofu never made the list, and no one asked for a vegetarian meal. In fact, if you compare the last meals to what Americans normally eat, there’s not much difference.

If we continue to eat as though they were our last meals, eventually, they will be.

A few years ago I did a video called Nation’s Diet in Crisis. It’s sad that it doesn’t seem like much has changed. How Many Meet the Simple Seven? is another video in which you can see how your own habits stack up.

For more on fruits and veggies and living longer, see Fruits and Longevity: How Many Minutes per Mouthful? Surprised that nuts made the longevity list? See Nuts May Help Prevent Death. What about legumes? See Increased Lifespan from Beans.

The reason public health professionals are so keen on measuring lifestyle characteristics is because modest improvements may have extraordinary effects. See, for example:

Didn’t know the beginnings of heart disease may already be present in children? See my video Heart Disease Starts in Childhood. Think that’s tragic? Check out Heart Disease May Start in the Womb. Is it too late if we’ve been eating poorly most of our lives? It’s Never Too Late to Start Eating Healthier.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

61 responses to “The Five Most Important Dietary Tweaks

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    1. They are there you didnt read it!

      we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

        1. I believe this, and other similar articles, on Nutrition facts are more aimed at people eating the standard American diet.

        1. 6 Years ago I stopped drinking alcohol, taking any drugs whatsoever, I exercise a lot more than I used to, and having happy thoughts all day long. Those may or may ot be tweaks, but I have found them welcome additions to the WFPB diet.

    2. “According to the Global Burden of Disease study, the worst five things about our diet are: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.”

      Based on this paragraph, I am thinking that the five dietary tweaks are to eat enough fruit, eat enough vegetables, eat enough nuts and seeds, eat less salt and eat less processed meat.

      The prevailing recommendation is that we ought to eat at least five servings of fruit and vegetables per day. (See

      Dr. Greger recommends a quarter cup of nuts and seeds per day in his Daily Dozen App. Here is more information:

      Here are the American Heart Association’s guidelines on salt intake: “Choose foods with less sodium and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,400 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. If you can’t meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure.” (Source:

      A 2007 comprehensive study from the World Cancer Research Fund concluded that processed meat are a convincing cause of cancer and should be totally avoided. (Source:

  1. Great work as always! Just one little wondering though. I’m seeing all the challenges set forth in the Standard American Diet – up until “the last meal.” But I never could locate the Five Tweaks. I suppose I could pull them all out. Of course we know about needing fruits and veggies, avoiding soda, and animal products. But I love those lists, and I was looking for those five.

    1. Five Tweaks: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables

    2. Thanks for your question Pat.

      It is written on the 7th paragraph:

      According to the Global Burden of Disease study, the worst five things about our diet are: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

      Hope this answer helps.

      1. That’s not a tweak. Those are things we do too much of. Based on the headline, I was looking for 5 *positive* recommendations…new actions I can take to improve my health.

  2. I think the answer to your question is in this paragraph:
    According to the Global Burden of Disease study, the worst five things about our diet are: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.

  3. Although there is enough culpability to go around and not enough personal responsibility …. The American cooking shows don’t help. Phenomenal summary of America’s nutritional health THANKS Dr. G

  4. My wife and I have been doing all of this for years. Mostly vegetarian diet, organic, excercise, maintaining very healthy weights, supplements, ayurvedic practices, stress management. We are extremely picky about eating out because we want control of what is going into our and our children’s bodies. This even causes tensions at time when eating with family that don’t “appreciate” our lifestyle. In any event my wife was diagnosed with breast cancer last week at age 36. At this point we can only guess that genetic factors are at play but when I look back on all of the times I’ve read diet can overcome these factors I am now quite skeptical.

    1. Sorry to hear about your wide Matthew, I wish her the best of recoveries.

      I highly suggest you to read the NF summary on breast health.

      At PCRM, Dr Neal Barnard talks about how a plant based diet can help breast cancer with the basis of a 2015 study (see here).

      I hope that stories at the McDougall Programme of incredible women who have overcome breast cancer through a plant based diet can inspire you and help you continue on the diet that you are following (see here).

      Please let me know if I can provide any further help.

      Best wishes.

    2. Matthew, – I am so sorry to hear this news of yours. I, too, have had cancer in my family and its very frightening. Let me start with words of encouragement (as I understand the fear). My Mother had breast cancer twice, two separate initial events. First was Pagets disease, a very aggressive breast cancer. Ten years later carcinoma of the breast, a different cancer. Both resulted in mastectomy. But let me also say she survived both cancers and went on to live a full life. So please know there are good outcomes for breast cancer.
      Secondly, I don’t know if your vegetarian lifestyle includes dairy or not, but there is a very high association between dairy and breast and prostate cancer (whose development begins from the same cells in the embryo). Dairy is also highly linked to fibroid tumors in women. My Mother was a very heavy milk drinker and dairy consumer all her life. She had fibroids and a hysterectomy from them as well as her breast cancer. I eliminated milk when I was a teen and then later on eliminated the rest of dairy. At 64, I’ve had none of the dairy associated problem that my Mother had all her life and by the same age as I am now. As well, it may or may not comfort you to know that some breast cancer is now associated with bovine leukemia virus that is present in virtuallly all cows milk. Please see this research published less than a year ago:
      Although causation has not yet been firmly proven, I believe it is just a matter of time before it is and this team is working on it.
      Hope this is helpful.

    3. Matthew Svirida, I, too, couldn’t understand why I developed an aggressive breast cancer seven years ago. The two other women I knew who had the same (triple negative, meaning no hormone connection and no her 2 neu) cancer did the standard treatments along with a lot of nutritional support, though still eating meat, and, in fact, using a ketogenic diet. Both only lived about 18 months, and both were younger than me – one only in her 30s.

      I had been eating a lot of “clean” meat, eggs, and making cheese, yogurt, etc from “properly raised” cows in the two years prior to diagnosis.

      It was later that I learned of Colin Campbell’s work and how he discovered that all animal protein, but especially dairy protein, stimulates cancer growth, and cutting it down to 5% of the diet, or none at all, causes cancer to stop growing.

      My cousin, who has been vegetarian for over 50 years, has had three separate primary breast cancers. She uses a lot of milk in making chi as it’s made in India, and still hasn’t given that up, though she has cut it back quite a bit.

      Whatever treatments your wife decides on, I wish her well, and I suggest she not eat ANY more animal protein, ever! Good nutrition will help her through treatments. Also, there are many people who have cured cancers with diet alone. If you go to you’ll get lots of encouragement. Also go to for more stories of people who used WFPB nutrition to cure or help cure cancers. Ruth Heidrich’s interview is amazing. She cured stage 4 breast cancer through nutrition alone.

      If I had cancer again I’d start by going to TrueNorth Health Center and fasting – an amazingly healing therapy – to begin the treatment process. I wish I’d known about that seven years ago.

    4. Sorry to hear that. Certainly nobody is immune, the best we can do is control the known harms. Keep in mind that most cancers have been multiplying for 10 years before they are detectable and sometimes we die with our cancers instead of from them, so perhaps she is still helping her outcome. Good luck!

  5. The 5 Tweaks?? – Lots of writers use this ploy. Dr. Mercola is notorious for it. Catchy title – lengthy article ….with no direct information to answer the question posed in the title. I think the writer feels this will force the reader to “dig” for the answer and not just skim to the list of tweaks (which doesn’t exist)…. It’s understandable, the writer wants you to read the whole article. But it is infuriating when you don’t have a lot of time to go through all your emails before work, etc.

  6. All of these make great sense, but I’m still confused about salt. First, who could ever measure how much salt we take in? Not sure how on earth you figure that out! And second, is it still important to cut down on salt if I have a very healthy blood pressure? I’m in my 60s, but blood pressure is usually about 100/60, and I do love my salt! (But not from processed foods as much as salty, crunchy snacks and salting food at table)

    1. Thanks for your question Carrie.

      I understand your question, it usually is a bit difficult to measure salt and not many of us are paying attention to how much salt we are consuming. To accurately calculate how much salt you are taking, this could be done with the help of a dietitian, which could help determine that by using tools such as your diet history and USDA Food List.

      According to the chart provided by Blood Pressure UK, you seem to have ideal BP levels and I am happy for that (see video by NF here). I cannot tell if you are having an adequate diet, but if you are not consuming much of processed foods, fish or meat, then you have automatically eliminated the major sources of salt in diet.

      Please note that according to the NHS, adults should eat no more than 6g of salt a day – that’s around one teaspoon. Therefore, if you are not exceeding this amount, you are on the right track.

      Hope this answer helps.

    2. Carrie,
      Cronometer has an easy to use food diary which can track individual minerals
      If you are not eating processed foods, your salt intake may not be excessive.
      Potassium, magnesium, and sodium intake should be balanced. After tracking your intake for a couple of weeks, you may find that you need to increase foods rich in potassium or magnesium, or take supplements.

    1. Thanks for your question Thomas.

      According to the Global Burden of Disease study:

      1) we don’t eat enough fruit
      2) we don’t eat enough nuts and seeds
      3) we eat too much salt
      4) too much processed meat
      5) not enough vegetables.

      Hope this answer helps.

  7. I am looking for help to lose weight and lower my blood pressure.

    After years of unhealthy lifestyle im looking to turn things around the problem is I feel awful all the time and my doctors are a waste of time.

    Anyone got any good advice, support or help.

    It would be greatly appreciated.


    1. Thanks for your question Julian.

      Given that I do not have any information regarding your lifestyle and diet, it is hard to give out personalised advice. However, here is what I can tell you.

      A whole food plant based diet is one of the most effective ways to lose weight in the short term and medium term when compared to other regimens (see here and here). This has been confirmed in a 2015 meta-analysis that includes studies of the highest quality (see here).

      Good news is that this type of diet (whole food plant based diet) may also help in having a healthy BP (see here.

      NF has created summaries on both these topics and I highly recommend you to read them here and here.

      How do you get started on a plant based diet?

      Dr Greger has a useful article here and you can find many healthy recipes here.

      Hope this answer helps.

    2. hi Julian Jenkins, just a brief note to add to Darchiterd’s wonderful response. I would like to suggest you check in daily for Dr Greger’s articles and videos. There are so many contributors to the comments section that are working on similar issues you will be sure to get great ideas and support. Also, this is an older video of Dr Greger that is my absolute favorite. Its a lot of fun to watch and will show you how easy it is to get started.

      1. Thanks for your reply. I was mainly interested with why the over-consumption of sugar in its various forms was not 1 of the 5 tweaks in the global study.

        1. mvbuddha: I do not have any inside information on your question, but I have some speculation that makes sense to me.

          As I understand it, you want to know why reducing sugar would not have been right up there with suggestions such as increasing fruits, veggies, and nuts and cutting back on the salt and meats. I would suggest that the more one focuses on eating the healthy foods such as fruits and veggies, the more one doesn’t have room for the junk food like added sugars.

          However, more than that, I don’t think sugar is as big a problem as many people make it out to be. Sure, sugar is unhealthy. However, sugar is not quite the devil that people make it out to be either. Consider: A doctor named Kempner used a white rice, fruit juice and *sugar* diet to reverse eye sight loss caused by diabetes at a time when no thought such a thing was possible. Sugar is empty calories, but it is less than half the empty calories of the same volume of oils/fat.

          Also, consider that sugar is not as big a problem as other foods in terms of the volume in our diet. I’m in the middle of reading Dr. Barnard’s new book, “The Cheese Trap”. Pages 31 and 32 talk about how sugar consumption in America has actually gone *down* since the late 1990s. But obesity continues to rise–along with the rise in our consumption of fatty, salty and literally addictive foods like cheese.

          For all those reasons, I can totally see why reducing sugar intake would not be in the top 5 diet tweaks needed for the average person. What do you think?

  8. Uh, re.:
    “…Cornell researchers created a catalog of actual last meals–the final food requests of 247 individuals executed in the United States during a recent five-year period…”
    Maybe a sample skewed somewhat on the impulsive/deliberative scale ? Wait a few years and as we become great again and people are put on death row for not having the will to power re. an acceptable income, we may get a more representative population. E.g. as I’ve developed an aversion to meat, I don’t anticipate trying to get a little animal suffering in at the last minute just because we humans are idiots.

    1. Karl Young – I can’t figure out the meaning of your post. I’m feeling the sarcasm vibe, but I can tell I “don’t get it”. So sorry if this is redundant and obvious. The point of the study was: the general population’s food choices are the SAME as even the most impulsive population in a situation guaranteed to be immune from consequences. The conclusion is that the general population (which includes those who in general are NOT as impulsive as criminals are and who WILL live long enough to endure consequences) – the general population is no better at impulse control than criminals (known for low impulse control) WHEN IT COMES TO FOOD CHOICES. So while they control their impulse to, say, kill someone in a rage, they do not control their impulse to live an unhealthy lifestyle.

  9. Does deception add to or detract from a healthy lifestyle? You promised “the five most important dietary tweaks” in this article. I took time from my busy day to read it, but could not find what you promised. Instead, I found pitches for your videos. This make you seem no better than all the other scam artists out there.

    1. That was unkind. This is a forum for serious learning, not a place for derogatory comments. While you are not alone in not seeing the 5 tweaks right off, it is clearly present in the text. Please try again. And please do view some of the other videos so that you can become more informed about the latest nutritional science.

  10. A lot of the thing about diet – and the tweaks we could make – assumes that people are actually motivated to live longer. I think there is a psychological/emotional/spiritual crisis. So many turn to drugs, take crazy risks on the roads, are depressed, bored etc. etc. The will to live has gone. I know smokers who want to ‘enjoy now’ even if it means they die young.

    1. guest: I have had similar thoughts and experiences. This is why I think it is important to communicate the situation clearly to people. It is not just about length of life. It is about suffering. Some people die instantly of say a heart attack. But many people live years of suffering before dying. Ask those people who are in the middle of their suffering if it is was worth it, and I believe I read about a study where the resounding answer was “no”.

      I think part of the education our society needs to go through is the living sicker and suffering part, not just the length of life part. There’s an old video on NutritionFacts that showed some study that showed Americans were living longer, but it was longer sick years. In other words, we had fewer healthy years, even if the overall length of life was longer. (Something like that: )

      Just sharing a thought that your post triggered for me.

      1. Thea and Guest, you both have made excellent points. The terrible diet/food environment of the west as a whole seems to be a path leading to certain personal health destruction. Used to be smokers garnering the evil eye, but with over 15 cancers , diabetes, heart disease, kidney failure etc associated with obesity, it appears a good proportion of society is ignoring the warnings. There is a self centeredness in it all…. would appear the ‘food’ and the eating patterns are just a symptom of deeper ills.

      2. Good point on healthspan. I’ve noticed many of these people claim that they ‘don’t want to be a burden’, but of course their lifestyle choices mean they wind up doing just that.

        My belief is that suicide is sometimes a rational choice, but if I’m going to do it, I’ll pick a method that’s quick, relatively painless, and not a big mess to clean up.

  11. Some comments today made me laugh. Laughter is supposed to be good for you. Is laughter to be listed under fruit or vegetables? Perhaps it is a byproduct or an outcome of a plant based diet?

  12. perhaps its a reading comprehension issue. How many times can one ask what are the “five tweaks”?
    until it comes in a pill that can be placed in any open orifice, a large part of the population just refuses to take responsibility for their own healthy lifestyle. and dont forget to get up off your duff and do something.

    You can lead a horse to drink, But you cant make him water, but there’s a pill for that too…

  13. Very sad to look through the whole article, and then reread it because I couldn’t find the damn Five Tweaks I was promised!! Very bad form!! You will lose credibility and readers if you continue this style and scam people to read your videos promos instead of what you offered in the title! Super annoying! Learn the lesson.

    1. Patrick: I’m not sure if you are saying that you never found the 5 tweaks even after reading the article twice or if you think it is a scam that a title of an article made you have to actually read the article instead of just scanning it? Or something else? Your reaction is interesting because the following statement has it’s own paragraph in the article:

      “According to the Global Burden of Disease study, the worst five things about our diet are: we don’t eat enough fruit, we don’t eat enough nuts and seeds, we eat too much salt, too much processed meat, and not enough vegetables.”

      Can you clarify what do you think is missing from the article? Or is wrong about the title?

    2. Patrick, this is a website for serious learning. That kind of demeaning comment is not appropriate here. This is a non-profit effort with the sole purpose of educating YOU about your nutritional health. There is no “lesson” to learn, other than a little respect for those who spend their time and effort to give us the latest science in layman’s terms so that you and the general (non-scientist) population can understand it. If they failed in their mission to be clear enough for you, a simple, polite inquiry would have sufficed. You are not the only one who missed the five points, but you are one of the very few who were rude when you missed it. Bad form, my friend.

  14. Look at the bigger picture. The reason so many of you followers level off weight wise, even on a WFPB diet is that they arent active enough. I know because I was that guy. Being active means being to busy to eat. If you are parked behind a computer or tv you will not lose weight mostly because you little mean brain thing will convince you to eat something, even too much healthy food makes you fat.

  15. Fantastic article! Thank you for dedicating your time and energy to translating the latest dietary findings for your audience, Dr. Greger. You are truly making a world of a difference in the lives of countless individuals!

    Time magazine recently released an article that seems to oversimplify the role of sugar and fails to differentiate between natural and refined sugar. Thank goodness we have informed and experienced Doctors and researchers such as yourself to debunk and elaborate upon such gross scientific misrepresentations.

    If you are interested in referencing the article, it is titled “8 Things That Happen to Your Body When You Eat Sugar” and can be found here. Wishing you a wonderful rest of your day!

  16. I wonder something. From all 20+ countris that have better life expectancy than the USA, how did you manage to mention Slovenia, the country I live in :)

    Also heard it from your audiobook. Surprised me.

  17. Hi,

    I would kindly ask what do you mean by “The people of Slovenia live a year longer than citizens of the United States.”?
    Is this bad? Should people of Slovenia not live longer because of some reason or why this comparison?
    Maybe because we are central Europe?


    1. Hi Tom, as Christine mentioned above, Slovenia is one of the countries in the research Dr. Greger referenced, so he’s just using it as example compared to the health of US citizens. Hope that helps clarify!

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