Friday, December 23, 2011

Forks over Knives

Maybe you've heard of Forks over Knives; maybe you've seen this movie. Perhaps you've heard of the China Study, which is the research that underpins the whole foods, plant-based diet (the kinder, gentler way of saying vegan) that Forks over Knives encourages.

If I hadn't already read Denise Minger's excellent review and critique of the movie, and in particular, the science behind it, I think I might have been left wondering whether I had my own nutritional belief system all wrong.  As it turns out, there was enough that I didn't buy, and I don't think I'll be changing my mind any time soon.  Let me explain.

Like Denise, I'll start with what I loved about the movie.  I'm in total agreement that the industrialized food system lies at the heart of the problem.  From the way animals are treated in CAFOs, the environmental impacts of factory farms, to the way the Standard American Diet undermines the health of millions, if not billions, of people, I can say we're on the same page entirely.

Like Drs Esselstyn and Campbell, there is no doubt in my mind that if you're serious about treating health issues with diet, a critical component is eating whole foods, and never touching anything processed or manufactured.

I also thought the presentation of the whole foods in the movie was inspiring.  The variety of colours and textures was infinitely more appealing than the gooey pink sludge we saw employees processing into ground beef in the meat plant (I shouldn't have to mention that I don't eat any of that disgusting stuff myself).  I find the idea of competitive eating off-putting.  And I didn't think the many shots of meat on the barbecue to be attractive, even though I do enjoy barbecued steak from time to time.

I also have no argument with the people interviewed in the movie, who all claim a variety of health benefits from their whole foods plant based diet.  The athletes among them were all much fitter than I am, without a doubt.  If these people's medical issues cleared up after following a vegan diet, then it must be working for them.  It made me wonder whether perhaps both paleo and plant-based diets can be right - if both can result in perfect health, as their proponents claim, then we might be wasting our time looking to trip up each other's science.  It is more productive to find points of commonality.

So what did I not like about the film?  Well, a couple of things struck me:

Both in the movie and in the accompanying book, we are told that: "Over time, as people ingest dietary fat and cholesterol, the endothelial cells become "sticky" and plaque begins accumulating" (direct quote from page 11).  It bothers me no end when dietary fat and cholesterol are implicated like this without mentioning the role of carbohydrates.  The science just doesn't support it.  The fact is that dietary cholesterol is not very relevant to the cholesterol in your bloodwork - it's not the cholesterol you eat, but the cholesterol your body producesIt's your carbohydrate intake, rather than how much cholesterol you eat, that is relevant to the plaque build-up in your arteries.

Something else that irks me whenever I see it (admittedly it's not just in this movie, but all over the media, and the major nutrition sites do this all the time), and which I'm beginning to obsess about, is the focus on total cholesterol and LDL, which is always accompanied by the irritating little "the bad cholesterol".  In the movie, we saw one of the patients discussing his improved bloodwork with Dr. Lederman, and I scanned the relevant section from page 29 of the book below:

Do you see any mention of his HDL?  I don't either.  Nor is its relevance mentioned in the movie.  That HDL is a better predictor of coronary heart disease than LDL or total cholesterol isn't discussed at all.  That not all LDL is bad, is of course not mentioned either.

While I know moviemakers have to be careful not to get too scientific on their audience, who might not be spending as much time thinking about the ins and outs of cholesterol as I do, I get really irritated every time I see this omission.

The third issue I have with the movie lies in its absolute non-mention of the effects of wheat.  It's not listed in the index of the book, and I don't recall hearing it mentioned once in the movie, though I may be mistaken.  Yet I firmly believe it deserves some discussion when it comes to cardiovascular disease.  Even if you're not in Dr. Davis' Wheat Belly camp as I am, it should be mentioned that wheat is one of the most inflammatory whole foods available.

You'll be extremely interested to see this table Denise Minger posted from the China Study:

Correlations with death from heart disease, ages 35 to 69.

I don't claim to know much if anything about the statistical accuracy of this data or the way it was collected, but I think it's highly relevant to note that wheat enjoys the #1 spot when it comes to positive correlations with death from heart disease. Note too that animal fat enjoys a hefty negative correlation in the same table.   But Dr. Campbell, the western researcher behind the China Study, is the same Dr. Campbell behind Forks over Knives.  To me this completely undermines the credibility of the premise of his plant-based diet.

Finally, I'd like to mention that as much as the above-mentioned aspects of this movie bother me, it also leaves me wondering whether there is more to Campbell and Esselstyn's dietary plan than what is specifically mentioned.  For example, though I didn't notice any discussion about the harmful effects of wheat, I didn't see it on the table displays, and the book only lists one bread recipe.  Could it be that, like me, Campbell and Esselstyn consider bread to be a processed food?  Perhaps they don't encourage gluten consumption, even though this wasn't the focus of Forks over Knives?

Either way, I didn't find that the film provided a sufficiently strong argument for me to change the way I eat.  If anything, what I learned from Minger's review of the data in the China Study, and how these relate to Forks over Knives, reinforced my resolve to stay away from wheat in particular, most carbohydrates in general, and to continue to consume animal proteins and fats from pastured sources.  And of course, what we have in common is the belief that a whole food diet is a must for good health.

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