Eating can be a positive experience for your mouth- as well as your waist. You may know me as a surgeon, but what you don't know is that I spend more time teaching patients to cook than I do operating on them. I've always been a foodie, and for over 30 years I have eaten at some of the finest restaurants in the country. Now I'm going to share with you how to eat out, eat healthy, but eat well.
Wednesday, July 26, 2017
What The Health: A Movie of Pure Vegan Evangelism and Bad Science
What the Health: A Culinary Medicine Review
A vegan manifesto
Being a vegan
As you know, there are some militant vegans out there. They believe with passion, and the militants, of any food fad, will cherry pick their data better than most. This is a movie made for evangelical outreach – it mixes in some facts, leaves out a lot of others. So, if you want to be a vegan blindly, don’t read any more.
There are various reasons people choose to be a vegan, but to start with: it is not a healthier option than other methods of eating, it is not better for the planet, and it is not more ethical. If you can get past that, and be a vegan and supplement, you will, statistically, live as long as a heavy meat eater.
There is no information that will change the mind of a militant vegan. I have been in those “wars” before, and discussing diets is like talking religion or politics at the table. If you have friends over with certain dietary views, trying to change their mind with data is futile. That can be any diet.
That being said, here it a review from a Culinary Medical perspective. The good, the bad, and the very ugly. Many of these topics I have blogged about before, and the references will be in the other blog posts.
The Movie – it is not a documentary
The movie itself is well done. It is shot well, has a good story line, and presents its data with all the usual counterpoints addressed. It is made by First Spark Media, a vegan production house that is pro PETA. All the “authority” figures in the movie are vegan all the talking heads in the movie are vegan – and there is no attempt to see the “other side.”
The Executive Producer is Joaquin Phoenix – who is a vegan activist, filmmaker, and actor. Kip Andersen is also a vegan, although the movie seems to be about him stumbling his way into becoming one (good acting, by the way). Kip also calls various organizations to ask about their recommendations – nothing like calling an organization, getting the receptionist, and asking complex questions that should be asked of policy makers. The reason Kip doesn’t talk to the policy makers of those organizations is pretty simple: they would have wiped the floor with publications contrary to his views.
Meat Causes Cancer – but not really
The movie starts out with this theme. It is wrong, but that does not stop them from making the claim that it is as dangerous as smoking cigarettes. It isn’t. So let’s look at the actual data and see if we can make sense of it. The overall risk for colon cancer is about 2.24%, which increases as you age (get your colonoscopy at age 50) and if you have a relative with colon cancer the risk rises to about 7% .
Lets break down the evidence for “processed meat.” This is meat that has been salted, cured, smoked, or preserved (think hot dogs, sausages, salami, your basic charcuterie plate). If you don’t eat a lot of any meat then about 56 out of every 1000 people will develop colon cancer. If you eat a lot of processed meat (like two servings or more a day) for every 1000 people who do this 61 of them will develop colon and/or rectal cancer. (PMCID: PMC3108955)
The movie talks about a 20% increase in risk – but this is a “relative risk” which is a statistic that reflects the difference between non meat eaters (56 out of 100o will develop colon cancer) and heavy processed meat eats (66 out of 1000) – that is an increase of 10 or 17% (the movie rounds it up to 20%).
As you can see – it is a lot worse to have relatives who have colon cancer than to eat processed meats. Plus, we don’t know which processed meats do this – we think we have an idea, but not so much. We know if you live in Spain you have a higher incidence of colon cancer than Sweden, and in Spain there is a ham shop on every corner, but to put this in terms for every 100,000 people: in Spain 40 will get colon cancer, in Sweden 32 will get colon cancer, in the US 34 will get colon cancer.
Is that as dangerous as cigarettes? Not by a long shot. Consider this: if everyone in the United Kingdom stopped smoking there would be 64,500 fewer cases of cancer. If no one at processed meats there would be 8800 fewer cases of cancer. Lung cancer is something we do not have good treatment for. We can check for bowel cancer, and everyone should (remember, the bigger risk for bowel cancer is having a relative who has it, and getting older). Since bowel cancer starts as a polyp you can have a colonoscopy, have a polyp snipped off and prevent cancer – we cannot do that with lungs. So, when they say that the processed meats are as bad as smoking- they have gone way out on a limb and then sawed it off.
So what about red meat? Not processed meat, just the good old American steak. I blogged about this and did a video about this before called Meat and Mortality: Does Eating Meat Decrease Your Lifespan? You can see the citations in there but there was no association between red meat and cancer when a lot of great data was looked at.
When it comes to meat consumption in the United States, we have increased our total meat consumption (we eat more chicken than beef these days) so what has happened to cancer and heart disease? Their rates have gone down. The big decrease in heart disease and cancer happened because people stopped smoking – but the trend to increased meat (red meat, chicken, etc) did not give the rise in either heart disease or cancer that one would assume would happen if the horrors depicted in this movie were true. Consider that we have a more obese nation, with increasing diabetes, but most authorities find that association is with highly processed carbohydrates and not from meat.
Adding a rosemary Marinade reduces HCA - here some rack of lamb is in a marinade of fresh rosemary with garlic, dijon, and olive oil.
Dr. Barnard says, “… carcinogens can form when meat is cooked…” When meat is grilled over a high heat this happens. He fails to note that this happens with vegetables or any food cooked at high temperatures. From a culinary medicine perspective using a marinade that is rich in antioxidants such as fresh rosemary. John La Puma shared his favorite marinade for chicken and beef which is two tablespoons of olive oil (extra virgin), two tablespoons of balsamic vinegar, and 1/2 teaspoon of fresh cut rosemary. I also like his ginger sesame salmon where the marinade is 2 tablespoons of balsamic vinegar, 1/2 teaspoon of sesame oil, and a 2-inch piece of grated, peeled ginger in 1/4 cup of soy sauce (you can get gluten free if you need) – just 15 minutes is all you need. In addition, cooking at lower temperatures, such as using Sous Vide for the majority of cooking reduces that risk.
Eggs and Cigarettes
When one has extraordinary claims, they need extraordinary evidence. So when Kip talks about eggs and how one egg a day has the same effect as smoking 5 cigarettes, there is no great citation for this. There is a reason, because it isn’t true. I blogged about is Smoking as Bad As Eggs? Vegans don’t like the dairy industry, and they always want to find a way to scare you away from dairy (see vegetarians can eat dairy, vegans think it is cruel to do so).
Saturated Fats – or Butter isn’t better
Dr Greger, an ardent vegan, dismissed the studies about saturated fat stating that the studies that have vindicated saturated fat were funded by the dairy industry. There is some truth to this. In culinary medicine we find that olive oil, a monounsaturated fat, works better and is one point on the Mediterranean Diet. While saturated fats are clearly not the evil they once were, the vegans have dismissed an entire generation of studies.
When Kip calls the Susan Komen organization to ask why they don’t warn against dairy consumption he cites a paper that examines the risk of recurrence of cancer in breast cancer patients. The paper’s title is “Intake of high-fat dairy, but not low-fat dairy, was related to a higher risk of mortality after breast cancer diagnosis.” There you have it – but this paper has a lot of issues. For example, it is based on Food Frequency Questionnaires, which is based on a person’s recall of what they ate. Food Frequency Questionnaires do not make great data points. But the title of the paper shows that low-fat dairy isn’t an issue. Somehow Kip ignores this- again, pretty clear where the agenda of the movie takes you.
Diary, especially hard cheese and fermented dairy are a point in the Mediterranean Diet score – which again, has millions of people it has followed. Essentially, in the Mediterranean area they don’t eat a lot of dairy. I blogged about this in Mediterranean Diet Score: Dairy, Meats, Alcohol.
Kip talks about how avoiding dairy is associated with a reduced incidence of type 1 diabetes. This is pure correlation and not causation. There is a greater association with wheat (PMC 4185872) than with dairy – but consider that while the film brings this as an “all or nothing” with dairy, they neglect other information that is not great for vegans.
It was amusing when they brought up the American Egg board worried about vegan mayonnaise. For those who are not familiar with that product, Hampton Creek, who made the vegan mayo was involved in a major buy-back program from grocery stores to shore up their industry and get more investors. I guess vegans can be frauds too. On an even playing field there is no great substitute for mayonnaise, and the people who promoted investment in Hampton Creek are now lawyering up (Bloomberg article about this here).
What About Fish
This bear thinks the fish in this box is good for him
The former president of the American College of Cardiology, Dr Ken Williams, is an ardent vegan. So the softball from Kip about fish is responded to: “Four worries… PCB’s, mercury, saturated fat, cholesterol.” I blogged about this in Fish and Mercury: Causes, Symptoms, Fish you Can Eat.
So while some fish are a problem, with a bit of care, most are not. If you use the seafood guide from Monterey you will be fine. For that you can click here. They also have an app for your phone.
What Dr Williams fails to point out is that vegans do not have great sources of omega-3 fatty acids. Fish are the best source, and the data is quite clear that people who eat fish have less heart disease, longer lifespans than even vegans.
Williams also fails to note that The American Heart Association recommends people eat fish twice a week, because of the clear reduction in heart failure and lower incidence of fatal heart attacks.
Still, the purpose of this movie is to convince you should eat a plant diet. Using this bit of nonsense they have thrown fish out of the bus even though fish eaters live longer than anyone on the planet.
From a Culinary Medicine perspective there is data encompassing millions of people with the Mediterranean Diet. Fish is one of the solid points on the diet, and that leads to an overall reduction in cancer and heart disease. I have blogged about this before in Mediterranean Diet Score: Part One.
My friend, Robb Wolf points out fish is “That gate-way product for vegans shifting back to animal products.” Most vegans discover that they crave something in their diet, and often they find their way back to fish.
Diabetes and High Carb Diets
Part way into the film Dr Neal Barnard, a vegan who is president of the Physicians Committee for Responsible Medicine (sounds nice, but it is a vegan activist organization. They do have some great material, and I have their “Nutrition Guide for Clinicians” on my desk). In this bit he claims that diabetes is not caused by a high-carb diet and that it is caused by a build up of fat and that is found in a meat based diet.
What he fails to note is that many studies have shown that low-carbohydrate diets have been superior for people with diabetes. In fact the first way they were able to extend the lives of children with type 1 diabetes was to completely rid them of sugar and highly processed carbohydrates – thankfully Banting and Best discovered insulin and now type 1 diabetic patients can live quite a normal lifespan.
My friend, Garth Davis, a fellow bariatric surgeon, comes on board and states that “Sugar is not great… but does not cause inflammation and can be stored as glycogen.” He ignores that fructose, which is half of table sugar, is quite inflammatory, and is well known for the havoc it causes on the liver (fatty liver disease) and its role in heart disease and increasing low-density lipoprotein.
When toward the end of the movie Kip interviews Dr Robert Ratner he fails to mention that the low carbohydrate diets beat both ADA and conventional low fat diets for the treatment of diabetes. In fact, 7 out of 11 keto dieters were able to reduce their diabetic medications where only 2 out of 13 low fat dieters did. (PMID: 24717684 PMCID: PMC3981696 ) Nor does he mention the effect that the Mediterranean Diet has on diabetes. Both low fat and low carbohydrate diets work to reduce issues with diabetes, what doesn’t work are highly processed carbohydrates.
Factory Farming – Save the Planet
Factory farming has a lot of issues, and they are brought up in this movie. The overuse of antibiotics in animals is a problem. Many factory farms are ecologic disasters, but opting out as a vegan means you are not supporting those farms that actually raise animals with care, like Elysian Fields. The ability of “foodies” to put their dollars where the creatures are cared for, and they are in balance with nature is powerful. When I blogged about this,Vegans versus Foodies: Moral High Ground, I pointed out that the real moral high ground is putting your consumer dollars where it counts.
When they talk about the large number of pigs raised in North Carolina and the potential for Swine Flu, this is not hyperbole. Far better to have a system like Spain where the Iberico hogs are raised where they graze freely, eat plenty and produce the best tasting ham in the world.
To be clear, it would be an environmenta
l disaster to not have animals in the eco-system and this is known by most who have taken a basic biology course. Still, the doctors on this (who did take those courses) seem to have forgotten that an ecosystem on planet earth is best with animals, including humans.
Food Industry and Health
There is no doubt the food industry is a major lobbying agency and has not benefited the health of the US. Probably the greatest was when the Harvard Scientists were bought by the sugar industry and said fats were evil. This was ignored by the film, of course, but let us not let facts get in the way of this film.
Why Do They All Show Their Abdominal Muscles?
Ever notice that any diet, dietary product, protein powder, or supplement loves to show people flexing their biceps and showing their washboard abdominal muscles? The reason is this is powerful marketing, but poor. You don’t get those great muscles from protein powder, eating vegan, eating paleo. You get that through hard work, exercise, and hours dedicated to your body.
It is great if that is what you want to dedicate your life to, and people need to spend more time in the gym and less time in front of the computer. I think more people should spend time reading and learning critical thinking – or to quote Shakespeare, “I would challenge you to a battle of wits, but I see you are unarmed.”
Yes, you can obtain the protein you need without eating meat or fish. Legumes are a great source of protein, so is rice, so is broccoli. Of course, if you eat this way you will have to supplement to get the missing omega-3 fatty acids, choline, B12, etc. So if you have to supplement your diet, is it really that good for you?
I have written about Biotruths: What We Are Meant to Eat as a logical fallacy before. Some misinformed paleo diet folks love this argument, but so do vegans. They are both wrong- we are not “meant” to eat anything. We have evolved, and we can eat a wide variety of foods- going back to plants as a sole source of nutrition is not supported by this argument.Of course the movie couldn’t get by without mentioning the old biotruth about what man is suppose to eat. I would have been terribly disappointed if they missed this logical fallacy. A biotruth is a misstatement of biology or evolutionary biology stating that man was meant to eat this or that because of their teeth. They didn’t disappoint me.
Vegan Vs SAD
There is no doubt that the vegan diet is better than the Standard American Diet, but there is no proof it is better than any of the other diets mentioned. Getting rid of processed food, especially processed carbohydrates is a goal.
The problem with the Standard American Diet is not 25% Animal food in our diet (meat, eggs, dairy, fish). Nor is the answer in the 12% plant food, but we do need to eat more of that.
The problem with the Standard American Diet is that it is 63% processed foods, including sugars, refined grains, with added fats and oils. To be fair, over 70 percent of the diet that most Americans consume is “plant based.”
This movie tries to show that the animal based part of our diet is just wrong. It isn’t – the problem is the refined portion of the American Diet.
Beer and Sausage Diet
When my friend, Evo Terra, and I did a three year study about a beer and sausage diet, showing better markers for him with his liver, with inflammation, and with science – no one believed it. But alas, it was true. You can lose weight and feel better with any sort of diet. This was our extreme, but it was fun.