“Forks Over Knives”: Is the Science Legit? (A Review and Critique)

Welcome to my “Forks Over Knives” analysis, AKA the longest movie review you’ll ever attempt to read. Thanks for stopping by! In case you aren’t yet convinced that I’ve made it my life’s mission to critique everything related to T. Colin Campbell, this should seal the deal.

As most of you probably know, a documentary called “Forks Over Knives” recently hit the theaters after months of private screenings. Vegans everywhere are swooning, giddy that their message is now animated, narrated, and on sale for $14.99. Proud meat-eaters are less enthused, sometimes hilariously so. The film’s producers call it a movie that “examines the profound claim that most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods.” Roger Ebert calls it “a movie that could save your life.” I call it a movie that deftly blends fact and fiction, and has lots of pictures of vegetables.

Vilification of animal products aside, “Forks Over Knives” highlights something I strongly believe in—the power of diet and lifestyle to trump illness. When I first heard about this movie, I thought the title described a salad fork conquering a steak knife, but it turns out the imagery actually refers to diet (fork) and medicine (knife, or scalpel). Forks over knives. Food over medicine. Hey, I can get on board with that!

And along those lines, I have a weird confession. I kind of loved this movie. Not because of its scientific accuracy (which was sketchy) or because of its riveting narrative (it’s no Brave Little Toaster), but because I’m a sap when it comes to seeing sick people get healthy. “Forks Over Knives” had no shortage of personal stories from folks who, with a tearful glimmer in their eye, recounted how they evaded death by ditching their pill-popping, fast-food-noshing, insulin-injecting lifestyles. Toss in some animated graphs and gross surgery pictures, and I’m in 96 minutes of nerd heaven.

But there’s a reason I’m a health blogger and not a film critic, and I realize not everyone likes to see coronary arteries slashed open or a hear slew of personal stories intended to pluck at our heartstrings. So this won’t be your standard movie review. In fact, it isn’t a “review” so much as a chronological critique of the scientific claims made throughout the movie. My criticisms are limited to the stuff presented as evidence rather than those weepy personal stories, the filming quality, or other features I’ve got no talent in reviewing.

Why am I doing this? Am I evil?

For the record, I’m not dissecting this movie because I think everything in it is terrible. Quite the opposite, in fact. I believe the “plant-based diet doctors” got a lot of things right, and a diet of whole, unprocessed plant foods (i.e., Real Food) can bring tremendous health improvements for people who were formerly eating a low-nutrient, high-crap diet. Especially short term. But I also believe this type of diet achieves some of its success by accident, and that the perks of eliminating processed junk are inaccurately attributed to eliminating all animal foods. So the goal of this critique is to shed light on the areas where the “plant-based science” is a little, um, wilted.

Some other observations about the movie, both positive and negative, before we dive into the real critique:

  • Word choice. This film was very careful about avoiding the term “vegan” and using “plant-based diet” instead—and frankly, it was a smart move. Even though the movie made it clear that no animal foods are good for you ever, the phrase “plant-based diet” sounds flexible, non-dogmatic, and limited to the realm of edible things. “Vegan,” on the other hand, is loaded with ethical and political connotations—evoking images of pamphlet-pushing PETA members, rubbery soy cheese, and Walter Bond.
  • You’re good men, Charlie Browns. I’ve written (and spoken) about the “plant-based diet doctor squad” in the past—our enthusiastic Team Asparagus comprised of Dean Ornish, John McDougall, Neal Barnard, Caldwell Esselstyn, and Joel Fuhrman (although he’s a bit of a rebel, eschewing grains and allowing more fat than the rest). In this movie, Esselstyn and McDougall get plenty of camera time, and I’ve got to say, I really like these guys. No joke. They’re sincere, they’re well-intentioned, and they’re passionate about what they do. The world needs more doctors who want their patients to get off their medication, who prescribe food instead of drugs, and who have a sincere interest in changing lives. Way to go, dudes.
  • Hey, fatty. A major component of Esselstyn’s heart-disease-reversal diet is the massive reduction in fat—not just from animal sources, but also the elimination of nuts, seeds, avocado, olives, olive oil, canola oil, coconut, and any other forms of concentrated plant fat. Unless I dozed off for something important, this movie barely mentioned this part of Esselstyn’s program, which I think is critical one. By keeping fat under 10% of total calories (which we also see in the disease-fighting programs of McDougall, Ornish, Pritikin, and Barnard), omega-6 intake—particularly the problematic linoleic acid—sinks like a gondola shot with a machine gun. Although these plant-based-diet doctors have a different view of fat than I do (Esselstyn, for instance, believes that any dietary fat damages the endothelial cells and promotes heart disease), it still would’ve been useful to hear about this in the movie, if only for the sake of full disclosure. I almost wonder if the movie’s creators dodged the “uber low fat” message to avoid freaking out the audience. What? We can’t even put olive oil on that ten-pound salad?!
  • Go fish. As we’ll see later in this critique, some of the anecdotes used to support a plant-based diet (such as Norway’s war-time cuisine and the traditional Japanese diet) actually point to marine foods being a great addition to your menu. For some reason, no one in the movie says a gosh darn thing about fish. Are they lumping fish into the same “meat” category as Oscar Mayer Weiners? Have they forgotten that fish exists in the food supply? Are they ignoring the health benefits of marine foods that nearly everyone—even the folks who swear on their momma’s grave that red meat will kill you—agrees on? What’s going on here? I sure don’t know, but it seems awfully… fishy. (You totally saw that coming.)
  • Welcome to False Dichotomyville—population: you. According to this movie, “plant-based diet” and “Standard American diet” are the only two ways you can possibly eat, and an egg is exactly the same as a bag of Cheetos. A recent pingback led me to this review at DoingSpeed.com (it’s not what you think), which nicely sums up the movie’s flip-flopping description of America’s cuisine: “the definition of the Western diet changes suddenly, one second referring to cake and donuts and the next [to] animal products.” Animal foods, it seems, are synonymous with the Western diet, and meat exists only in industrialized countries. Non-Westernized populations like the Masai, traditional Inuit, Australian aborigines, and countless hunter-gatherers have conveniently vanished for the duration of this movie. It must be awesome to selectively choose reality like that!
  • Fast forward. For me, the most interesting part of this movie happened around the 30 minute mark. First, the film discusses a 1973 corn subsidy bill that encouraged a massive increase in corn production—which pretty much explains why so many foods these days are injected full of high-fructose corn syrup or other cheap, corn-based ingredients. It’s all about the money. Shortly after that, the movie gives some camera time to evolutionary psychologist Dr. Doug Lisle, who tells us about a concept called the Pleasure Trap—a motivational triad of “seeking pleasure, avoiding pain, and conserving energy” that all our years of evolution have hardwired us for. Because our modern, processed foods are so rich in calories and easy to access, they provide a high degree of dietary reward with almost no effort. Our bodies freakin’ love this. So much, in fact, that our brains say “eat eat eat!” in the presence of such foods and our natural hunger signals get overridden. That worked well in the wild, when periods of food abundance were interrupted with periods of famine. But these days, it just makes it easy to get fat. And the Pleasure Trap applies to much more than just food. Indeed, we’re biologically driven to seek the easy way out, to avoid pain, and to pursue things that make us feel good.

Critique time!

After a collage of soundbites about how awful and unhealthy Americans are (ya think?), the fun begins around the 13-minute mark, when we get a brief biology lesson on the C-word: cholesterol. Props to the scriptwriter for at least noting that cholesterol is a “natural and essential substance” (per some descriptions, you’d think the stuff was toxic sludge), but the narration goes downhill from there. After outlining cholesterol’s important biological functions, the movie states:

13:06—But when we consume dietary cholesterol, which is only found in animal foods like meat, eggs, and dairy products, it tends to stay in the bloodstream. This so-called plaque is what collects on the inside of our blood vessels and is the major cause of coronary artery disease.

Yikes! Did we slip and fall back into the ’80s?

For starters, cholesterol from animal foods does not have some magical ability to set up permanent camp in your bloodstream and turn into plaque, just by sheer virtue of its animal-foodness. This was a common line of thought decades ago, but as research progressed, we figured out that the body is actually pretty awesome at regulating cholesterol production in response to what we ingest from food. As this paper from 2009 explains, the supposed link between dietary and serum cholesterol stems from studies that had fundamental design flaws, failed to separate the effects of cholesterol different types of fat intake, or were performed on animals that are obligate herbivores (hey there, rabbits!). The doctors in “Forks Over Knives,” it seems, are among the few stragglers who still believe dietary cholesterol is harmful.

Most people (about 70% of the population) are “hypo-responders” when it comes to cholesterol intake—meaning the cholesterol they eat from food has a negligible effect on the total cholesterol in their blood. A smaller slice of the population (“hyper-responders”) see a greater rise in blood cholesterol after eating high-cholesterol foods, but the change is because both LDL and HDL increase proportionally, preserving the cholesterol ratio and leaving heart disease risk the same as what it was before. (As more evidence, a similar study (PDF) found no change in LDL/HDL ratio in either they hypo-responders or hyper-responders, even when feeding folks an extra 640 mg of cholesterol per day.)

Not only that, but some cholesterol-rich foods like eggs have actually been shown to make LDL (the so-called “bad” cholesterol) less atherogenic by increasing its particle size. And in one study of diabetics, a high-protein, high-cholesterol diet improved HDL more than a similar high-protein diet with a low cholesterol content (though it was likely other components of the foods involved, rather than the dietary cholesterol itself, that caused this). It’s a weird, wobbly stretch to paint animal foods as a death knell because they contain cholesterol.

Enter: T. Colin Campbell

Minute 17:01—”We learned that animal protein was really good in turning on cancer.” There’s an inappropriate joke buried somewhere in there.

Now we’re talkin’! To anyone who’s read (or is moderately familiar with) the book “The China Study,” the next part of the movie is a trip down memory lane. We learn about Campbell’s work in the Philippines, where he was trying to improve the lives of malnourished children by filling their diets with more protein. It was here that the trajectory of his career made its first wild turn:

Minute 15:42—But then Dr. Campbell stumbled upon a piece of information that was extremely important. … The more affluent families in the Philippines … were eating relatively high amounts of animal-based foods. But at the same time, they were the ones who were most likely to have children susceptible to getting liver cancer.

(Gasp! Shock! Horror! Let me insert the requisite “correlation isn’t causation” warning before we continue.)

Minute 16:10—Shortly afterward, Dr. Campbell came across a scientific paper published in a little-known Indian medical journal. It detailed work that had been done on a population of experimental rats that were first exposed to a carcinogen called aflatoxin, then fed a diet of casein, the main protein found in milk. [Campbell:] “They were testing the effect of protein on the development of liver cancer. They used two different levels of protein: They used 20% of total calories, and then they used a much lower level, 5%. Twenty percent turned on cancer; 5% turned it off.”

Although the above is true, it’s only one (misleading) part of the story. We’ll explore exactly what’s wrong with this summary later on, when Campbell’s own research comes to the fore in the film. But for now, let’s just look at one spot where the film lets a figurative cat (err, rat?) out of the bag.

The paper from India that Campbell found is called The Effect of Dietary Protein on Carcinogenesis of Aflatoxin, which appeared in the Archives of Pathology in 1968. Indeed, the researchers discovered that rats fed 5% of their diet as casein were generally free from cancerous growths, whereas the rats fed 20% casein were riddled with ‘em. But at the 16:37-minute mark, we get to see a snippet of this paper that shows us something equally important:

Don’t get distracted by those red letters! What we’re interested in is the sentence near the bottom, which the film’s producers apparently didn’t notice: “In all, 30 rats on the high-protein diet and 12 on the low-protein diet survived for more than a year.”

Let that sink in for a moment. Maybe it’ll hit a little harder if I told you that in the “high protein vs. low protein” experiments discussed in this paper, 10 low-protein rats died prematurely while all the high-protein rats stayed alive. In other words, the overall survival rate for the 20% casein group was much better than for the 5% casein group, despite the fact they had liver tumors. The low-protein rats were dying rapidly—just not from liver cancer. And as we’ll see later, the reason the non-dead, low-protein rats didn’t get tumors was partly because their liver cells were committing mass suicide. 

In his article “The Curious Case of Campbell’s Rats: Does Protein Deficiency Prevent Cancer?“, Chris Masterjohn explores this oddity further by plowing through the Indian research Campbell talked about. If you haven’t seen this article yet, you owe it yourself to read it now, because it’s kind of mind-blowing—both for Chris’s analysis of the Indian research and his takedown of Campbell’s own rat studies. (And for anyone who’s going to gripe about this article being posted on the Weston A. Price Foundation site (I know you gripers are out there), I encourage you to read it anyway, use your noggin, and check the references for yourself rather than dismissing it sight unseen.)

Regarding that paper from India that sparked Campbell’s “aha protein evil!” moment, Chris notes that “Campbell never tells us … that these Indian researchers actually published this paper as part of a two-paper set, one showing that low-casein diets make aflatoxin much more acutely toxic to rats.” This second paper is called The Effect of Dietary Protein on Liver Injury in Weanling Rats, and indeed, it shows that rats on low-protein diets experience much more actual liver damage than rats on high-protein diets when they’re exposed to aflatoxin. They don’t get cancer, but they’re sicker overall because they’re less capable of detoxifying aflatxoin—leading to fun stuff like fatty liver, liver necrosis (cell death), proliferation of bile duct tissue, and early death. As Chris puts it:

Somehow, I doubt many people would read this study and shout “sign me up!” for a low-protein, plant-based diet if it is going to save them from cancer at the expense of killing them in their youth.

Indeed! As we’ll see later in this critique, Campbell’s own low-protein rats weren’t a rosy picture of health, either. Even more exciting, we’ll look at some more studies conducted in India showing that low-casein diets—but not high-casein diets—promote cancer when aflatoxin dosage is at a lower, real-world-applicable level. Fun times ahead! (If you’re impatient, you can skip to that section right now by clicking here.)

Esselstyn: From operating table to kitchen table

Next up, we get a bigger peek into the life of one seriously cool cat: Dr. Caldwell Esselstyn, physician at the Cleveland Clinic. Although Esselstyn noted—in an earlier segment of the movie—that he loved surgery for its ability to neatly remove a problem from the body, he faced some disillusionment as his career progressed. In 1978, when Esselstyn was chairman of Breast Cancer Task Force at Cleveland Clinic, he was unhappy that he was only treating people who were already ill and doing diddly squat for the “next unsuspecting victim.” He wanted to focus on prevention. So he put on his sleuth cap and set off to investigate—first by shoveling through global statistics for cancer.

Only YOU can prevent forest fires. And heart disease.

For the next few minutes, we get to hear about the alarming discoveries this investigation uncovered. Don’t want breast cancer? Then move to Kenya, where the rates are 82 times lower than in the US (well, at least they were in 1978). Got prostate cancer? Japan doesn’t: In 1958, there were only 18 autopsy-proven deaths from prostate cancer in the whole country. Compare that to the 14,000 in the US for the same year. Heart disease, too, was lower outside of America:

Minute 19:21—Dr. Esselstyn also discovered that in the 1970s, the risk for heart disease in rural China was 12 times lower than it was in the US. And in the highlands of Papau New Guinea, heart disease was rarely encountered. The link he noticed between all the areas he studied was simple. [Esselstyn:] “Virtually the Western diet was nonexistant. They had no animal products. No dairy, they had no meat.”

…And there it is. Again, we have the conflating of “Western diet” with “animal products,” as if meat and dairy are the major dietary difference between Westernized and non-Westernized populations. Oy! (By the way, here’s a friendly reminder that in rural China—at least based on the China Study data—heart disease mortality was actually inversely associated with meat intake, meaning the folks eating the least meat actually died more frequently of heart disease. It doesn’t mean too much as a lowly correlation, but it does fly against the assumption that animal foods are always linked with heart disease.)

Next is where it really gets interesting. About 20 minutes into the movie, we get a fascinating historical tidbit about diet and heart disease in war-time Norway:

Minute 19:50—In World War II, the Germans occupied Norway. Among the first things they did was confiscate all the livestock and farm animals to provide supplies for their own troops. So the Norwegians were forced to eat mainly plant-based foods.

In the movie, Esselstyn eagerly explains how cardiovascular disease went kerplunk when the Germans invaded in 1939, only to zip back up as soon as the war was over—perfectly coinciding with their supposed near-vegan period. How obvious it is! The Norwegians went veggie and healthied up; they returned to their lamb and gjetost and re-clogged their arteries. As Esselstyn puts it: “With the cessation of hostilities in 1945, back comes the meat, back comes the dairy, back comes the strokes and heart attacks.”

Here’s the graph the movie walks us through. The Nazi flag marks the arrival of the Germans; 1945 is when they left. (Right below it is a similar graph from a 1951 issue of “The Lancet” that’s even more dramatic. After adjusting for an unequal age distribution (and unrealistically low mortality in the ’20s and ’30s), we can see that death from cardiovascular disease really did nosedive to a lower rate than Norway had seen in the past few decades.)

War! What is it good for? Reversing heart disease, apparently.

Oh, Norway; how close you were to cardiovascular salvation! Nice job screwing it up.

The intended point, of course, is that the dip in mortality was from giving up animal foods. When the Germans swiped all sentient creatures from the food supply, Norwegian hearts pumped with atherosclerosis-free ease—proving that going “plant based” will save your ticker. It sounds convincing enough, and the graph is compelling*… but is there more to the story than meets the eye?

*Note: If you look at the numbers on the right side of the graph, you’ll see mortality dropped from 30 to 24 deaths per 10,000—a difference of only six people per 10,000. That’s still nothing to sneeze at (especially if one of the saved was your great-grandpa Bjørn who helped you exist), but the graph gives an exaggerated view of the actual change in mortality.

Luckily, there are a few resources out there that track the war-time diet changes in more detail. One is a paper discussing how nutrition affected Norwegian youngsters during the war, which you can read as a PDF here (spoiler: the kids were shorties). But the part we’re interested in is the table estimating how food intake changed during the war. The numbers represent how much each food increased or decreased during the war (percentage wise) compared to the pre-war values.

Did meat and milk intake go down? Fo’ sho’ (although clearly not to zero). But look what else happened. Sugar consumption was chopped in half. Both butter and margarine intake decreased significantly. Veggie intake shot up. And perhaps most significantly, fish consumption increased by a whopping 200%, a bigger change than seen with any other single food item. Need I mention the eighty gazillion studies showing the benefits of fish, DHA, and an improved omega-3/omega-6 ratio for cardiovascular health?

The paper also notes that total calorie intake decreased by about 20% compared to pre-war levels and weight loss was common. Did calorie restriction and sinking body mass play a role in mortality changes? Definitely maybe.

Oh, but it gets better. There’s a section in a super old issue of “Proceedings of the Nutrition Society” called “Food Conditions in Norway During the War, 1939-45” with even juicier details. I couldn’t find any free copies to link to, so I’ll type out the relevant bits. But first, take another look at that “circulatory disease” graph from the movie and verify with your own eyes that the first (and biggest) drop in mortality happened in 1941.

Now read this:

During the first year [starting in spring of 1940] the rationing included all imported foods, bread, fats, sugar, coffee, cocoa, syrup, and coffee substitute. In the second year [starting in late 1941] all kinds of meat and pork, eggs, milk and dairy products were rationed

See the problem?

Animal foods didn’t really dwindle from Norwegian kitchens until the end of 1941. Even if we ignore the fact that changes in mortality would naturally lag behind changes in diet, it’s hard to blame the 1941 drop in cardiovascular disease on something that mostly happened in 1942! D’oh. Time-wise, there’s a stronger link between the mortality tailspin and the previous year of food rationing: “imported foods, bread, fats, sugar, coffee, cocoa, syrup, and coffee substitute.” (Or maybe it was just the anticipation of ditching meat that made everyone healthier.)

Despite the dismal record keeping, a few studies were “secretly performed” in Oslo to track changes in food intake during the war. Between 30 and 50 families were surveyed three times annually from 1941 to 1945, giving us a nice little diet portrait encompassing not only rationed food, but also the “black market” items people were eating. Although it’s hard to say how accurately this represents the food intake of Norway’s whole population, it’s at least a place to start. And unlike the last table, it breaks down food consumption year by year, rather comparing only war-time and pre-war values. (Note that the top row is for the years 1936-7 and the next is for 1941—it seems there isn’t any data for the gap between.)

I pity da fool who doesn’t enlarge this image.

From “Proceedings of the Nutrition Society,” 1947. Volume 5, issue 4, page 264.

Numbers, numbers, everywhere! Let’s distill the major stuff from that chart so you don’t have to squint at it forever:

  • Cod liver oil became a standard addition to war-time diets. (Interestingly, the paper later notes a huge improvement in Norwegian dental health between 1940 and 1945: By the end of the war, the average number of cavities was less than half of what it was before the war. Vitamin A and D, anyone?)
  • As we saw earlier, fish intake increased massively. So did ‘taters, roots, and vegetables, particularly in 1942 and 1943.
  • Intake of whole milk was actually higher in 1941 compared to before the war, but then gradually diminished.
  • Intake of skim milk was higher throughout the war than before it.
  • Cheese, cream, and condensed milk started dropping off the radar at the end of 1941.
  • Meat hit a major low in 1943 and 1944.
  • Added fats like margarine and butter declined, particularly in 1942 and 1943.
  • Flour, meal, groats, and bread intake went up slightly, mainly from black-market sources.
  • Intake of sugar, coffee, and chocolate declined significantly.
  • Fruit also declined significantly, and as we’ll see later, mainly came in the form of locally picked berries.
That’s a lot of stuff all happening at once, eh? Since we’re mainly looking at the “Forks Over Knives” claim that the mortality drop came from eliminating animal foods, let’s take a gander at dairy and meat. First up, here’s a graph of daily dairy consumption (in grams) for each year, for an typical Norwegian man. I averaged the three values given for each year to give annual data points; that way we stay consistent with the mortality graph from the movie.

There’s no doubt about it: In 1941, when cardiovascular disease started plummeting, Norwegians were eating more total dairy (light blue line) than they were before the war, when the death rate was higher.

How about flesh foods? Again, this is in grams per day for your average Norwegian man:

For the families surveyed in Oslo, fish and meat consumption were almost exactly inverse: Fish intake rose in perfect step with the decline of meat. And at its peak, the average man was consuming almost three-quarters of a pound of fish a day! That’s a decent chunk o’ seafood. Because meat and fish intake were so tightly correlated, it’s hard—maybe impossible, given the sparse data available—to separate any mortality effects of meat reduction from the huge spike in marine foods.

[Edit 8/22/2012: A reader recently pointed out two errors in the protein graph that once lived in this spot. I’m taking it down until I have a chance to fix it, and apologize for not catching the inaccuracies sooner.]

 

One more thing before we emigrate from Norway. After poking around the interwebs, I found a gem of a paper called Food rationing during World War two: a special case of sustainable consumption? The whole thing’s pretty interesting, but the best nuggets are the details about actual foods eaten in Norway during the war (and the reiteration that “sugar rations [were] restricted to 3 kilos per household per year,” which is less than 2% of what a four-person Norwegian family consumes today.)

In a similar attempt to reduce the waste of food resources in Norway, the home economics institutes focused on how to exploit the local resources from the sea and from wild plants in a more efficient manner. This involved exploring the boundaries for what was commonly perceived as food, by experimenting with uncommon ingredients such as wild sea birds (including sea gull) and wild plants including moss.

Who needs Lean Cuisines when you can have seagulls and moss for dinner?

This paper also remarks that “herring and potatoes represented the mainstay of the Norwegian crisis diet,” which certainly agrees with the graphs and tables we looked at earlier. But those rascally Scandinavians took their herring consumption one step further. Fish eggs, or “roe,” also became a staple:

For instance, the food labs tried to find new uses for the nutritious and plentiful fish roe. … The institutes created a number of recipes using fish roe as a substitute for flour. … The most basic recipe simply recommended using equal amounts of roe and flour, then mix with water and some yeast to bake bread or rolls. But there was nothing wrong with using roe in finer foods either; for instance in waffles mixed with milk, sugar, some regular flour and essence of vanilla and cardamom.

We’ve got to give those Norwegians props for being resourceful. Substituting fish eggs for flour? Serving herring roe waffles? Who would’a thunk it? (This actually makes me wonder if, despite bread consumption going up during the war, actual flour intake could have gone down due to substitution with other ingredients. But maybe that’s just my suspicious-of-wheat bias creeping in.) Apparently, a popular dessert was also “herring roe bread pudding,” made mostly from fish eggs and potatoes*:

350 g. herring roe; 1 tbs potato flour; 1 tbs bread flour; 5 tbs breadcrumbs; 4 boiled potatoes; 4 dl. milk; 1 tsp currants (made of dried blueberries); 2-3 tbs sugar; essence of almond; Served with sweet red sauce (saftsaus).

*Hey ancestral-eating folks, this is totally tweakable to be paleo. The first person to modify this recipe and actually eat it will earn my lifelong respect.

Lastly, some cool info on the fruits and vegetables Norwegians were eating. By the end of 1942, most fruits and veggies were done near gone from the markets and tremendously hard to get through rationing. So the government gave housewives throughout the country a list of “valuable wild plant supplements” to use for vegetables, which included “nettles, goutweed, and dandelions … as excellent sources of iron and vitamin C.” Foraging for wild edibles became common. And even before that, Norwegians earned their stripes as deft berry-pickers:

Already in August 1940, the public provisions office in Oslo [Forsyningsutvalget] launched a publicity campaign to get the city dwellers out in the forests surrounding the capital picking berries. The simple slogan “Pick berries! There is plenty in the forests!” printed on a poster of a girl carrying a big basket of berries was meant to tempt the city consumers to supplement their own supplies of food. As the war progressed, berries became an increasingly treasured resource. By 1943, the authorities had introduced a limit for when one was allowed to start picking different sorts of berries, and there are accounts of masses of consumers spending the night in the forests waiting for the official start date for when the berries were ripe.

How cute! Like rabid fans camping outside the theater for Harry Potter, Norwegians would line up in the forest, waiting for berry season to commence.

But back to the point of this thing. In “Forks Over Knives,” Esselstyn cites Norway’s war experience as a remarkable example of a plant-based diet leading to rapid improvements in cardiovascular disease. But as we can see from the exhaustive (and probably excessive; sorry) information above, the real Norwegian war-time diet was:

  • Based on marine foods, particularly omega-3-rich herring and its eggs (which are super high in cholesterol… just sayin’)
  • Supplemented with a variety of foraged foods, including berries, moss, and wild greens—which tend to be much higher in antioxidants and nutrients than their commercial counterparts
  • Based on potatoes as the main source of starch
  • Remarkably low in sugar and added fats, including vegetable oils/margarine

Those are a lot of positive changes—and as we saw earlier, the increase in fish intake more than made up for the drop in meat and dairy, in terms of total animal product consumption. Plant based? Only if fish is a vegetable.

…And now that I’ve stolen a big chunk of your day yapping about war-time Norway, I’ll add a warning that everything above may be moot. The apparent decline in cardiovascular disease could easily be confounded by the major rise in infectious disease that happened during the war, including a full doubling of pneumonia deaths. Just because cardiovascular disease mortality drops doesn’t prove cardiovascular disease itself has truly declined. Sometimes, it just means faster-acting diseases are snatching lives before heart attacks or strokes have a chance to claim their victims.

Hat tip to Chris Masterjohn for passing along this snippet from Broda Barnes’ book, “Solved: The Riddle of Heart Attacks.” Barnes reviewed 70,000 Austrian autopsy protocols from the years 1930 to 1970, and found—just like in Norway—that cardiovascular disease mortality dropped significantly during World War II. But instead of ascribing the change to diet, Barnes had a different hypothesis. He writes (emphasis mine):

At Graz, heart attacks dropped 75 percent between 1939 and 1945, and it is true that people were not eating cholesterol foods during the war. … A look at the arteries of the entire series of 2000 autopsies in 1945 revealed that the number of the individuals with damage to their coronary arteries (arteries to the heart) was approximately doubled in 1945 compared to 1939, and the degree of damage to each one affected was about twice as great. … Adult patients, dying from tuberculosis during the war, had a very severe degree of damage to the arteries of their hearts. … Two years later the conditions were reversed. The antibiotics against tuberculosis had become available, and deaths from this disease fell like a lead pipe. Immediately deaths from heart attacks started to rise. The autopsies gave us the answer: the adult dying from a heart attack had healing tuberculosis in his lungs. (Pages 2 and 3)

In contrast to Esselstyn’s theory, Barnes found that actual arterial damage was about twice as great by the end of the war as it was before the war, at least in Austria. But because infectious diseases shot up during the war years, a person’s official cause of death was more likely to be tuberculosis, pneumonia, or another acute illness, even in folks who actually did have cardiovascular disease. For Austria, the decline in cardiovascular disease mortality didn’t reflect the true state of Austria’s heart health. (And it’s possible the infections themselves, with accompanying inflammation, actually helped worsen cardiovascular disease.)

This doesn’t mean that Norway’s war-time diet had no impact on mortality, of course—just that we ought to look at death statistics in the context of total mortality.

Whew! How was that for a long discussion of something that only took one minute and fifteen seconds in the film? Let’s move on.

MC Hammer Dougall time

Next up, Dr. John McDougall makes an appearance to remind us once more that animal foods are terrible. We hear exactly how the McDougall of yore evolved into his current pro-plant, anti-animal-foods position.

The story goes like this. In the 1970s, McDougall was working as a doctor on a sugar plantation in Hawaii. He noticed that the older generations of Japanese (and other Asian) immigrants were free from modern diseases—they were slim, active into old age, didn’t get heart disease or arthritis or breast cancer or diabetes, and generally evaded the maladies plaguing most Westerners. McDougall attributes this to the fact that the older generation “learned a diet of rice and vegetables in their native lands,” and carried this diet with them when they set sail for the US. Their kids and grandkids, on the other hand, were a different story: They started getting fat and suffering from the same diseases other Americans do—and according to McDougall, the reason was simple:

Minute 21:56—[McDougall:] Their kids, they started to give up the rice and replace it with the animal foods, the dairy products, the meats… and the results were obvious. They got fat and sick. I knew, at that point, what causes most diseases.
“It had nothing to do with the sugar cane they snuck on their lunch breaks.”
As much as I love unreferenced anecdotes, it’d be nice to see if this observation holds up to reality. Were the Americanized Asians doing nothing but replacing rice with animal foods in the ’70s? Can we ascribe their downward health spiral to the lack of a plant-based diet? Maybe this little ditty, published in the American Journal of Clinical Nutrition in 1973, will offer some clues. Indeed, the paper remarks that “Dietary information … reveals striking differences in dietary patterns as the Japanese men have migrated to areas where American culture prevails.”

Among other things, this paper records the differences in eating habits between native Japanese and Japanese who moved to Hawaii—and provides us with my favorite thing ever: graphs. I’m posting copies of the relevant ones below. The black bars represent Japanese who moved to Hawaii; the white bars represent Japanese who still lived in Japan when the data was recorded (a few years before McDougall was working on the sugar plantation). The three sets of bars for each graph show what percent of the population ate that particular food for the specified frequency (in most cases: less than two times a week, two to four times a week, and seven or more times per week). If that’s a little confusing, don’t worry—we’ll discuss what these graphs show in a moment.

(FYI: Each row of graphs is a separate image. I made them huge on account of the spotty, barely-readable text, which was even spottier and more barely-readable when the pictures were normal sized.)


What’s it all mean?!

For starters, look at the middle row with three graphs. See how the center and right-hand graph have black and white bars that follow a similar distribution? That means the intake of those foods wasn’t massively different between the native Japanese and the Hawaii-dwelling Japanese. Now look at the labels on those particular graphs: Meat and Ham, Bacon, Sausage. As you can see, the majority of both native and Hawaii-dwelling Japanese were eating regular meat two to four times per week, and ate processed meats less than twice per week. Out of all the foods documented, the ones with the smallest difference of intake between native and Hawaiian Japanese populations were flesh foods.

How ’bout that.

Now look at the bottom left graph that says Fish. The white bars, representing the native Japanese, show that about 40% of Japan’s population ate fish at least seven times per week—compared to only about 8% of Japanese living in Hawaii, who were apparently unaware of their islands’ marine bounty. In sharp contrast to their native diet, over half of the Hawaiian Japanese ate fish a maximum of once per week.

The tally so far: the native Japanese on their “traditional” diets ate a lot more fish (which, c’mon, is totally an animal product) than Hawaiian Japanese, and ate slightly less meat, ham, bacon, and sausage… but the difference wasn’t huge.

Now for the fun stuff. Check out that top row of graphs. The Hawaiian Japanese didn’t swap out rice for animal foods—they swapped out rice for bread! Whereas the native Japanese almost all ate rice two to three times per day (and most ate bread less than twice a week), the vast majority—almost 90%—of Hawaiian Japanese ate bread more than seven times per week. As we saw in an earlier blog post, wheat-based diets seem to have different effects than rice-based diets in at least one other Asian country.

The other major change, along with a drop in traditional soy intake, was “butter, cheese, and margarine.” I’ll definitely agree with McDougall that Hawaiian Japanese seem to be eating more dairy than their native counterparts, although throwing margarine into the mix makes it difficult to determine just how much.

At least based on this data, the “Americanization” of Japanese immigrants in Hawaii didn’t involve a newfound guzzling of flesh foods: it involved picking up America’s wheat habit and abandoning the native staples of fish and rice. If “sugar” had been included in the above graphs, I have no doubt we’d see major changes with that, too. The only animal food that did strongly increase among the immigrants was dairy, although in this paper, it was pooled together with margarine (which no one considered bad yet back in the groovy ’70s).

Does this invalidate McDougall’s observations? Not necessarily. Maybe the patients he treated on the sugar plantation were skewering wild pigs and snacking on bacon all day.

Do you smell a rat? I do… and it has hepatocyte necrosis

After the tale of sickly Hawaiians, “Forks Over Knives” segues back into the research Campbell embarks on after his experience in the Philippines. In ’75, Campbell was working at Cornell University, conducting a battery of experiments on dietary protein and aflatoxin-induced liver cancer in rats. I’ll let the movie sum it up:

Minute 25:03—Just like the Indian researchers, Campbell fed half the rats in his study a diet of 20% casein, the main protein in dairy products. The other half was fed only 5% casein. Over the 12 weeks of the study, the rats eating the higher protein diet had a greatly enhanced level of early liver cancer tumor growth. On the other hand, all of the rats eating only 5% animal protein* had no evidence of cancer whatsoever.

*Notice the sneaky interchange of “casein” with “animal protein”? Rest assured, folks, that casein is an animal protein, but not all animal proteins are casein. This movie falls into the same trap I mentioned in my “China Study” critique last year, and that many other people (Dr. Harriet HallChris Masterjohn, and Anthony Colpo, to name a few) have taken issue with as well: extrapolating the effects of casein to all forms of animal protein. As I discussed in that critique, casein seems to be the strongest cancer-promoter among the isolated proteins (with whey, the other major protein in milk, being decidedly anti-cancer). Not only that, but the effect of specific protein sources on tumor growth can vary dramatically depending on the types of fat and carbohydrate also included in the lab diet. Both in the movie and in his book “The China Study,” Campbell makes an unjustified leap from “isolated casein in rat studies” to “any animal protein in a real-world human diet. Shazam!”

But those are small potatoes compared to what’s coming next. First, take a look at something Campbell himself noted in the movie (emphasis mine):

Minute 26:05—[Campbell:] “This was so provocative, this information. We could turn on and turn off cancer growth, just by adjusting the level of intake of that protein. Going from 5% to 20% protein is within the range of American experience. The typical studies on chemical carcinogens causing cancer are testing chemicals at levels maybe three or four orders of magnitude higher than we experience.”

Although Campbell is trying to explain why his rat studies have relevance for humans, this statement actually highlights why they usually don’t. In Campbell’s experiments—as well as the Indian study that inspired him all those years ago—the rats received very high doses of aflatoxin to initiate cancer in the first place. Protein only appeared to work as a cancer promoter in his studies, not an independent carcinogen. And even though the range of protein was reasonable for a real-life situation, the amount of aflatoxin exposure would be really hard to replicate unless you had a death wish and a bottomless stomach. Quoting Chris Masterjohn’s “Curious Case” article again, to get the sort of aflatoxin exposure that caused even a “barely detectable” response in Campbell’s rats, you’d have to eat about 1,125,000 contaminated peanut butter* sandwiches over the course of four days. I don’t know about you, but I doubt I could eat a lick over 900,000. More than that is just gluttony!

*Contaminated with aflatoxin at a level of 20 parts per billion—the maximum allowed by the FDA.

So what would happen if the animals were exposed to lower, more realistic levels of aflatoxin? Would different levels of protein still have the same effect?

Luckily, we have an answer to that question. In the late 1980s, more researchers from India were conducting experiments with casein and cancer—but this time used different doses of aflatoxin, and studied rhesus monkeys instead of rats. In one intriguing paper titled “Effect of Low Protein Diet on Chronic Aflatoxin B1-induced Liver Injury in Rhesus Monkeys,” the researchers describe something that undermines the conclusions Campbell drew from his own research.

I’ll let the paper speak for itself. Here are the first three paragraphs:

And a bit later:

Okay, I’ll speak too. Let’s decode the science jargon.

Basically, the researchers are talking about an experiment they conducted feeding monkeys diets that had either 5% or 20% casein. These monkeys were given a hefty dose of aflatoxin each day—1 part per million. Just like in the rat studies, the monkeys in the low-protein group suffered from massive cell death (but no cancer), while the monkeys in the high-protein group got pre-cancerous growths called “preneoplastic lesions.” So far, this is consistent with everything Campbell found.

But here’s where it gets interesting.

The researchers reference an earlier study they did with the same setup—rhesus monkeys, aflatoxin exposure, and either 5% or 20% casein in each diet. But in that study, they used a much more moderate dose of aflatoxin: 0.16 parts per million. And guess what happened? In this situation, it was the low-protein group that grew tumors, while the high-protein group was perfectly healthy and cancer-free! Oh, snap.

The results of this earlier experiment were published in a paper called “Effect of Low Protein Diet on Low Dose Chronic Aflatoxin B1 Induced Hepatic Injury in Rhesus Monkeys” in 1989. Indeed, the researchers weren’t pulling our legs: This study really did show that a low-protein diet was both more “cancer promoting” and more deadly than a high-protein diet when the dose of aflatoxin was lower. When the dose was 0.16 parts per million, the low-protein monkeys were stricken with liver lesions while the high-protein monkeys were fine. When the dose was raised to 0.5 parts per million, the low-protein rats didn’t get tumors—mainly because every single one of them died when they were less than one-and-a-half years old! And I quote:

Monkeys on low protein diet [with 0.16 ppm aflatoxin] surviving for 90 weeks or more show foci of preneoplastic lesions, whereas those on high protein diet reveal no such alterations at the corresponding time interval.

(Translation: The low-protein monkeys on a low dose of aflatoxin had pre-cancerous growths in their livers (at least, the ones that weren’t already dead did). The high-protein monkeys were A-OK.)

The hepatic injury again is more accentuated in the low protein group as compared with the high protein group [with 0.5 ppm aflatoxin]. No preneoplastic lesions are observed, possibly due to a poor survival (less than 70 weeks) in the low protein animals with this dose. The animals in the high protein group surviving even beyond 90 weeks do not show any preneoplastic/neoplastic lesions. It appears that in the simian model used by us, the liver injury caused by AFB1 is accentuated by simultaneous restriction of dietary protein and in animals on such combined regimen preneoplastic lesions appear around 90 weeks of experiment.

(Translation: When the aflatoxin dose was raised a bit, the low-protein monkeys still suffered from a lot more liver injury than the high-protein monkeys. They all died too soon to develop any precancerous tumors—in contrast to the high-protein monkeys, who had a better survival rate and still didn’t have any tumors growing at the 90-week mark.)

And here’s the researchers’ (perhaps more digestible) discussion of it all; emphasis mine:

In contrast to innumerable studies on aflatoxin induced hepatotoxicity in rats, very few studies have been done in monkeys and in most of these studies large doses of aflatoxin have been used. The important feature of the present study is the low level of intoxication ingested as contaminated meal, a situation more likely to be encountered in natural exposure to human and animals.

(In other words, this study—at least in theory—has more real-world relevance than Campbell’s rat experiments.)

The study shows that small doses of aflatoxin (0.16 and 0.5 ppm) on chronic administration induce injury in the liver. However at both the dose levels and at all time intervals the injury is more severe in animals on low intake of proteins.

(Whether the aflatoxin dose is low or moderate, the low-protein monkeys are worse off than the high-protein monkeys.)

Rhesus pieces: A picture of a cute monkey to make us feel bad about vivisection.

And finally:

These observations suggest a synergism between protein calorie malnutrition and aflatoxin induced hepatocarcinogenesis and may explain the higher incidence of hepatocellular carcinoma in certain areas of the world where contamination of foods with aflatoxin and malnutrition are prevalent.

Remember when Campbell was talking about how, in the Philippines, it seemed to be the well-nourished affluent folks who were getting liver cancer? This paper presents the opposite perspective. Here, the researchers are noting that liver cancer tends to be higher where there’s aflatoxin contamination and malnutrition (most notably protein-calorie malnutrition), rather than affluence and high animal food consumption like Campbell observed. According to the researchers, their experiments suggest that malnutrition increases the liver damage and cancerous growths associated with aflatoxin exposure—explaining why liver cancer, for instance, is highest in areas where malnutrition runs rampant.

But enough of this monkey business. When we compare the above study to the ones using an extremely high aflatoxin dose, it’s clear we’ve got a paradox. In this study, it was the low-protein monkeys getting tumors. In the other studies, it was the high-protein monkeys (or rats) getting tumors. So what’s going on here? Why would a low-protein diet protect against cancer at high doses of aflatoxin, but promote cancer at low doses of aflatoxin?

The answer, it seems, lies in protein’s effects on both growth and detoxification.

Although this isn’t discussed in “Forks Over Knives,” Campbell spends a few pages of “The China Study” talking about an enzyme responsible for metabolizing aflatoxin—a lil’ somethin’ called “mixed function oxidase.” This enzyme is key for turning aflatoxin into metabolites that can mess up DNA and initiate cancer. And as Campbell discovered through his research, a diet of 5% casein can turn this enzyme down faster than you can say “hepatocellular carcinoma.” Here’s how he describes the process on page 52 of his book:

Decreasing protein intake like that done in the original research in India (20% to 5%) not only greatly decreased enzyme activity, but did so very quickly. What does this mean? Decreasing enzyme activity via low-protein diets implied that less aflatoxin was being transformed into the dangerous aflatoxin metabolite that had the potential to bind and to mutate the DNA. … We now had impressive evidence that low protein intake could markedly decrease enzyme activity and prevent dangerous carcinogen binding to DNA. These were very impressive findings, to be sure. It might even be enough information to “explain” how consuming less protein leads to less cancer.

This is a strangely happy portrait of something that’s actually deadly.

Why does your body want to detoxify aflatoxin in the first place? How ’bout because it’s… well… a toxin? Even though slashing enzyme activity does reduce cancer-causing metabolites, it also leaves more aflatoxin in its original, toxic form—which can damage organs and start to promote cancer in another way, which is exactly what happened with the low-protein monkeys. Here’s how.

In aflatoxin studies, we’ve seen that low-protein diets cause some unfortunate problems for lab animals—one being an increased toxicity of aflatoxin. That’s because the reduced enzyme activity from low-protein diets prevents the body from properly detoxifying stuff. (Campbell even acknowledges in some of his earlier papers that a low-protein diet makes rats more susceptible to liver injury from aflatoxin, even when they don’t get cancer from it.) So what happens when aflatoxin toxicity goes up? Apparently, it makes liver cells start dying like crazy in a process called necrosis. At low levels of aflatoxin, the necrosis only occurs in low-protein animals, because the high-protein animals still have their detoxifying enzymes in working order.

Here’s where the trouble starts for our low-protein friends. Because their liver cells are facing mass genocide, their bodies rush to make new cells to help the liver regenerate. According to the authors of the monkey studies, this rapid death/proliferation cycle is one of the very things that encourages pre-cancerous lesions to form—especially when cells are proliferating at the time of aflatoxin exposure (which is what would happen to a malnourished human eating aflatoxin-contaminated food). At mild aflatoxin doses, the low-protein monkeys still had enough dietary building blocks to regenerate their liver cells and feed early tumors—hence why they began developing lesions. (The authors also note that low-protein diets slow down the cell cycle, causing more cells to hang out in the “S phase” where their replicating DNA is vulnerable to attack—another potential pathway to cancer.)

Once the aflatoxin dose is raised, though, something new happens. Cell death increases even further for the low-protein animals, so much that their poor bodies can’t keep up with it all. The result is that the liver starts facing major injury—gettin’ fatty, exhibiting bile duct proliferation—but avoids developing tumors because there’s just not enough construction material (protein) to build a bunch of new cells. Healthy cells are dying left and right, and pre-cancerous ones don’t even stand a chance. It’s at this point that a lot of lab animals—both in Campbell’s studies and with the monkeys—keel over and die, despite having tumor-free corpses.

For the high-protein animals, not much happens until aflatoxin dosing is raised through the roof. At lower doses, their bodies do a fine job of detoxifying the aflatoxin, cell death isn’t increased, and there apparently aren’t enough cancer-causing metabolites yet to do much harm. It’s only when aflatoxin exposure gets cranked way up that the high-protein animals experience the same liver necrosis that plagued their low-protein counterparts. Although the extra protein improves the animals’ ability to detoxify aflatoxin and regenerate their livers, it also provides more tissue building-blocks—giving both healthy cells and pre-cancerous lesions the stuff they need to proliferate. The protein that prevents high-protein animals from dying from necrosis overload is the same thing that lets them develop tumors. Quite the catch-22, huh?

At least, that’s the explanation suggested by the authors of the monkey papers over two decades ago. I haven’t done an exhaustive search of the literature, so it’s possible there’s more current research explaining the paradox of low-protein diets increasing tumor growth at low doses of a carcinogen, but preventing tumor growth at higher doses.

As much as Campbell condemns “reductionism”—which refers to looking at a singular nutrient or pathway instead of how various components work in harmony—Campbell’s interpretation of his protein research falls into this very trap. By looking at only the positive effects low-protein diets seem to have on cancer, he misses out on the many detrimental effects they have on other aspects of health, including the fact that they seem to invite early death.

Important note: One important difference between Campbell’s rat studies and the monkey studies above is the use of continuous versus acute dosing. In the monkey studies, the animals got small, daily doses of aflatoxin throughout the experiment. That’s like what would happen if you lived in a humid climate where some of the food supply was growing aflatoxin-containing mold. By contrast, in Campbell’s studies, the rats got a giant dose of aflatoxin at the beginning of the experiments. That’s like what would happen if you accidentally ate 80,000 jars of aflatoxin-contaminated Jif in one sitting (oops!).

With all that said, let’s return to “Forks Over Knives” and see what else Campbell has to say.

Minute 26:29—Even more surprising, Dr. Campbell found that a diet of 20% plant proteins from soybeans and wheat did not promote cancer.

The movie goes on to explain that animal protein has some mystical, inexplicable, yet very real ability to promote disease—a property that plant protein lacks. Referencing Campbell’s rat studies, we’re told that “the results were consistent: Nutrients from animal foods promoted cancer growth, while nutrients from plant foods decreased cancer growth.” And yet…

Minute 29:20—Campbell hadn’t identified a specific biological mechanism that caused the effects he observed. “It finally occurred to me that there was no such thing as the mechanism. What we were looking at was a symphony of mechanisms,” he said.

Out of all the moments in the movie, this might have been the biggest face-palmer for me.

It just so happens that Campbell did identify exactly why casein behaved differently than plant proteins in his rat studies. Decades ago. In 1989. The discovery emerged from a study he conducted on “protein quality” and liver tumor growth, which you can find here. Although regular wheat protein didn’t spur tumor growth like casein did,* wheat protein behaved exactly like casein as soon as Campbell added lysine, the amino acid wheat is low in. Basically, any complete set of amino acids—whether from the animal kingdom or plant kingdom—is going to have the same cancer-promoting effects. (At least when aflatoxin dosing is very high. At lower aflatoxin dosing, that same complete protein will protect against oft-deadly liver damage. In fact, in the paper cited above, Campbell notes that the unsupplemented gluten groups and low-casein group—despite getting fewer “foci” that mark the start of cancer—had far worse liver injury than the high-casein group. He writes: “All animals developed bile duct proliferation, which characterizes the acutely toxic response to aflatoxin B1 (data not presented). The most severe lesions occurred in the experimental groups with the lowest response of foci [5% casein and 20% unsupplemented gluten].”)

*Note: Campbell actually used casein diets that were supplemented with methionine (test diet PDF here), an amino acid that casein is low in. This made the casein a more “complete” protein and may have influenced the cancer-promoting abilities of the casein diets. If we’re going to compare apples and apples, we could look at the casein-supplemented-with-methionine diet right next to the gluten-supplemented-with-lysine diet. And when we do that, we find that both are equally powerful at promoting tumor growth.

The reason this finding is so important is that it shows, fairly convincingly, that Campbell’s findings only apply in a lab setting—where rats are fed a single source of protein for their entire lives. The rats that stayed cancer-free on an unsupplemented gluten diet were the equivalent of a human eating nothing but wheat, every single day, from the moment they’re weaned off Momma’s teat until the day they die. A vegan eating a mixture of plant foods will naturally end up consuming complementary amino acids, and their body will synthesize the “complete protein” that Campbell says is cancer-promoting. For instance, in the common combination of rice and beans, beans supply extra lysine that rice is low in—the same effect as supplementing gluten with this amino acid.

It’s not like Campbell forgot about his discovery, either. In his 2009 response to a critique by Joseph Mercola, Campbell wrote:

The adverse effects of animal protein, as illustrated in our laboratory by the effects of casein, are related to their amino acid composition. … There have been many different kinds of studies for well over a half century showing that the nutritional responses of different proteins are attributed to their differing amino acid compositions. … These differences in nutritional response disappear when any limiting amino acids are restored.

Wheat protein, unlike casein for example, did not stimulate cancer development but when its limiting amino acid, lysine, was restored, it acted just like casein. There have been literally thousands of studies going back many decades showing a similar effect on body growth and other events associated with body growth—all resulting from differences in amino acid composition of different proteins.

Enough said. Let’s look at one more snippet from this segment before we move on:

Minute 29:00—Over the next several years, Campbell initiated more extensive lab studies using various animal and plant nutrients. The results were consistent. Nutrients from animal foods promoted cancer growth, while nutrients from plant foods decreased cancer growth.

Beep! False. Campbell actually discovered that certain animal fats are superior to certain plant fats in terms of cancer protection. In a study published in 1985, he found that fish oil tends to inhibit cancer, and in a couple other studies, found that corn oil appears to promote it (such as here).

Esselstyn: The study cogs start turnin’

But enough about rats and vegetable protein. Next up, the movie returns to one of our movie’s shining (human) stars, Caldwell Esselstyn. In the 1980s, with “prevention!” flashing relentlessly in his mind’s eye, Esselstyn finally got the chance to do what his years of surgery never allowed: Fix heart disease with food instead of scalpels.

Minute 44:11—In the mid-1980s, Dr. Caldwell Esselstyn was struggling to organize a study on coronary artery disease. His plan was to put a group of patients on a diet of low-fat, plant-based foods along with small quantities of low-fat dairy products and minimal amounts of cholesterol-reducing drugs.

Indeed, that’s the gist of it: a low-fat, plant-based diet with a scoop of statins for dessert. But since the film doesn’t dive into the finer details of the diet, let’s look at how Esselstyn describes his program in his book, “Prevent and Reverse Heart Disease.” From pages 5, 6, and 72, we  can see that the diet eliminates:

  • Anything with a “mother or a face,” including meat, fish, and poultry
  • All dairy*
  • All nuts and avocados
  • All oils, such as soybean oil, olive oil, corn oil, cottonseed oil, canola oil, and anything else with “oil” in the name
  • All solid fats like margarine and butter
  • All foods—whether pre-made or prepared at home—that contain even a drop of added fat
  • Any grains that aren’t cross-your-heart, swear-on-your-grandmomma’s-grave, 100% whole. According to Esselstyn, this includes eliminating items that have healthy-sounding ingredients like “multigrain, cracked wheat, seven-grain, stone-ground, 100 percent wheat, enriched flour, or degerminated cornmeal”
*In both “Forks Over Knives” and his book, Esselstyn notes that his diet initially contained low-fat milk and yogurt, much like Dean Ornish’s program. It wasn’t until years later, when he learned about Campbell’s research, that he decided animal protein wasn’t conducive to health and yanked dairy off his patients’ menus.

On the flip side, the diet allows:

  • All vegetables, including leafy greens, root veggies, and other veggies encompassing all the beautiful colors of the rainbow
  • Legumes such as lentils, peas, and beans
  • Whole grains ranging from the commonplace (whole wheat, corn, wild rice) to the exotic (quinoa, millet, amaranth, teff, kamut, spelt, rye)—but only if they contain no added fat, high-fructose corn syrup, or even a smidgen of refined grain
  • All fruit

And if you think this diet is flexible and allows some cheat-meal wiggle room, you’re sadly mistaken. Esselstyn is a self-admitted stickler, and insists that a fundamental rule of his program is that “it contains not a single item of any food known to cause or promote the development of vascular disease.” Which, to him, means a life permanently devoid of pot roast, Nutty Buddies, or butter on your endless bowls of steamed kale.

Although his program doesn’t specifically forbid processed foods, adhering to his rules pretty much ensures everything you eat will be Real Food. For instance, his diet manages to eliminate even the “fat free” replacement products we’ve all seen at the store:

If you see any of the following words or phrases on a label—glycerin, hydrogenated, partially hydrogenated, mono or diglycerides—avoid the product. These are all sneaky forms of fat. Snackwell’s devil’s food “fat-free” cookies* list 0 grams of fat on the nutritional chart required on all packages. But if you read the ingredients, you notice that glycerin is listed fifth among them. Similarly, Kraft’s zesty Italian fat-free dressing and Wishbone’s fat-free ranch both list soybean oil and dairy products among their ingredients. But because the portion sizes are small, these products can still be called “fat-free,” under the government’s standard. Read the ingredients. (Page 124)

*Forget glycerin! How ’bout avoiding this junk because the first four ingredients are sugar, refined flour, high-fructose corn syrup, and corn syrup?

Indeed, Esselstyn’s diet categorically eliminates most “fat-free” Frankenfoods—many of which were wildly popular when he conducted his study in the ’80s and ’90s. Apparently, he nixes them not because they contain ingredients so awful they’d make a billygoat puke, but because their microscopic amount of fat is still too much. In a lipid-phobic era when dieters swapped fat for refined carbs, Esselstyn accidentally ‘rescued’ his patients from junk-filled replacement foods, which we now know are often worse than the originals. He got it right for the wrong reasons.

And lastly, despite what it may seem, Esselstyn’s diet is not a whole-grain free-for-all. His book describes the diet as decidedly vegetable-based, and notes that you may need to scale down on the starches to avoid unwanted pounds:

If you are eating a plant-based, no-oil, whole-grain diet filled with leafy greens and all the colorful vegetables, you don’t need to worry about weight. … However, if you let whole grains, starchy vegetables, and desserts dominate, weight can begin to creep back. If that happens, simply cut back on grains and starches, increase your consumption of leafy greens and colorful vegetables, and cut out desserts. (Page 126)

As we can see, Esselstyn’s program entails a lot more than a simple shift to plant foods. Here are the likely culprits behind his success:

  • By completely eliminating oils, Esselstyn’s diet causes a massive reduction in the omega-6 fats—particularly linoleic acid—running wild in Western diets. (And more broadly, it slashes intake of polyunsaturated fats, which are the type of fat most likely to promote LDL oxidation because of their unstable chemical structure.) Boom! Down goes polyunsaturated fat intake, down goes omega-6 intake, down goes inflammation, down goes some major components of heart disease. Although Esselstyn achieves this by giving the boot to all fats, the same thing could be achieved by just eliminating foods and oils high in polyunsaturated fats, particularly industrial seed oils like soybean oil and corn oil. (If you’re thinking, “But those are the types of oils the government tells us are healthy,” please read this.)
  • Due to its strict no-added-fat rule, Esselstyn’s program eliminates 99% of what you’d find in a gas-station convenience store, a vending machine, or a crinkly silver Frito-Lay bag. In other words, this is a no-junk diet. Sure, animal foods are out—but so are the even wider range of low-nutrient snacks, processed desserts, convenience foods, and other manufactured items that usually fill American kitchens.
  • By allowing only 100% whole-grain foods with no added fat or sugars, Esselstyn makes it pretty tough to eat processed wheat products like bread, pasta, cereal, bagels, pastries, crackers, and other grainy goodies. In his book, Esselstyn acknowledges how hard it is to find bread that fits into his diet plan, and endorses sprouted grain products by companies like Ezekiel. As a result, the main starches in this diet are likely to be from roots, starchy vegetables, legumes, squash, and grains that still look like they did when they came off the plant—like corn or wild rice. The movie showed the following display as an example of an Esselstyn-approved feast.

Behold: plants.

Now that we have a better idea of what Esselstyn’s diet entails, let’s hop back into the movie.

Minute 44:32—[Esselstyn:] “Slowly, over the next 18 months, I got the patients that I’d asked for. But the ones they sent me were a little bit sicker than I’d thought! These were patients who had failed their first or second bypass operation, they had failed their first or second angioplasty, and there were five who were told by their expert cardiologist that they would not live out the year.”

We then get to meet one of those so-called lost causes: Evelyn Oswick, who’d been one of Esselstyn’s most “gravely ill” patients. Not only had she already suffered from two heart attacks by the age of 59, but her doctors thought her situation was so hopeless that they told her—quite literally—to go home, sit in a rocking chair, and wait to die. But as evidenced by the fact she appeared in “Forks Over Knives,” she’s not only alive, but quite the bright-eyed and bushy-tailed survivor. Woohoo, Evelyn! Woohoo, Dr. Esselstyn! Woohoo, plant-based diet!

Although we don’t have enough data to really analyze her success, I’ve got to wonder if ditching meat—or even the fat—was really the thing that helped. Here’s how she describes her previous diet:

Minute 45:00—[Oswick:] “I ate all the chocolate I could eat, I ate every doughnut I could get my hands on… oh, I just loved things like that. A lot of gravy.”

“It was that drop of glycerin in the candy that did me in.”

Esselstyn then describes how his study was performed. For a full five years, he met with his patients once every two weeks to draw blood, take their blood pressure, measure their weight, and endure the nickname “Dr. Sprouts.” We know Mrs. Oswick is alive, but what happened to the other 23 study subjects? Did they end up back on the operating table, wads of carrots lodged in their veins? Did they miraculously heal? We’ll have to wait to find out, because now it’s time to learn about…

The China Study

I’ll admit it: I was pretty excited to see what “Forks Over Knives” had to say about the China Study—a massive epidemiological project and namesake for Campbell’s bestselling book. Would we get an elaborate, attempted indictment of animal foods by blaming all woes of the human body on high cholesterol? Would the producers sacrifice accuracy for simplicity and just say “animal foods made bad things happen?” Would Campbell warn the audience not to Google around for critiques of his study, because they’re all written by shills for the meat industry, or—worse—liberal arts majors?

Finally, we get to find out. After nearly 50 minutes of nail-biting anticipation for our China Study segment, we see T. Colin Campbell and his colleague, Junshi Chen, thumbing through a copy of “Diet, Life-style, and Mortality in China“—the 900-page tome showcasing the data they spent so many years gathering. Oh, sweet reminiscence! This is the same book that sat on my desk for three months last year, collecting blood, sweat, and sticky-notes.

“Orange you glad I didn’t say banana?”

Campbell briefly explains how this study generated a whopping 8,000 to 9,000 statistically significant correlations. “This means that if 19 out of 20 are pointing in the same direction, it’s highly significant, and likely to be true,” he says. (I’d add that “true” isn’t the same as “meaningful”—variables can be strongly and legitimately correlated, but not actually have a cause-and-effect relationship.) After learning a bit more about how the data was presented in that giant book, we get to the good stuff. The summary of it all. The fruit of international labor. The culmination of those 9,000 statistically significant correlations. Are you ready?

Minute 49:30—[Chen:] “I think the major message we got out of this correlation analysis is only one message: The plant-food based diet—mainly cereal grains, vegetables, and fruits, and very little animal food—is always associated with lower mortality of certain cancers, stroke, and coronary heart disease.”

That’s a pretty simple message to get from such a big, complicated study! Too bad it’s baloney.

What Campbell and Chen imply in this movie clip is that all those correlations are, serendipitously, singing the same tune: That plant foods offer protection against diseases, while animal foods tend to promote them. Alas, the trends in this study are anything but straightforward—and as Campbell himself has pointed out, the unadjusted correlations can be quite misleading:

“Use of these correlations … should only be done with caution, that is, being careful not to infer one-to-one causal associations. … First, a variable may reflect the effects of other factors that change along with the variable under study. Therefore, this requires adjustment for confounding factors.”

Agreed, good sir. But since we’ve just been told in “Forks Over Knives” that these correlations generally point in the same direction (and reinforce the idea that animal foods cause disease), let’s put relevance aside and see if that claim is up to snuff.

Note for anyone needing a math catch-up: A correlation is basically a relationship between two things—meaning they both go up at the same time (a positive correlation) or one goes up while the other goes down (a negative or “inverse” correlation). For example, your age is positively correlated with the number of wrinkles on your face, but your age is negatively correlated with the amount of time you spend Googling “Justin Bieber.” Correlations are usually expressed as numbers between 1 and -1, with zero indicating that there’s absolutely no relationship between the variables. The farther away the number is from zero, the stronger the relationship—so a value of 0.54, for instance, would be stronger than a value of 0.12. In the case of our China Study data, strong positive numbers indicate that a certain food is associated with more of a certain disease, while strong negative numbers indicate the food is associated with less of that disease.

Get it? Got it? Good!

In my China Study critique last year, I pulled a bunch of data directly from “Diet, Life-style, and Mortality in China”—the same book Campbell and Chen are huddled around in that last picture—showing just how inconsistent the “plant-based diet is healthier” message really is. For instance, we’ve got peculiar things like this:

  • Plant protein has a correlation of 0.21 with heart disease (positive)
  • Non-fish animal protein has a correlation of 0.01 with heart disease (neutral)
  • Fish protein has a correlation of -0.11 with heart disease (inverse)
  • Meat intake has a correlation of -0.28 with heart disease (strongly inverse)
  • Fish intake has a correlation of -0.15 with heart disease (inverse)
  • Egg intake has a correlation of -0.13 with heart disease (inverse)
  • Wheat has a correlation of 0.67 with heart disease (really flippin’ high!)—which is not only the strongest association between any food and heart disease, but remained sky-high even when I tried adjusting for anything that might be confounding it.*

*Our grain-happy “conventional wisdom” might scoff at the idea of wheat being atherogenic, but there’s at least one cardiologist out there who has great success treating his patients’ heart disease by eliminating wheat (and not going low-fat)—and he recently published a fantastic book showing why modern wheat is so problematic.

Why isn’t that nasty meat congealing in China’s collective aortas? Why does wheat seem like a less-than-heart-healthy grain? Why are we told that a plant-based diet “is always associated with lower mortality of … coronary heart disease” in the China Study data, when it’s the folks eating the most animal foods who get less heart disease? It’s quite a mystery. (And in case you’re wondering, it’s not because the animal-eaters were croaking from strokes instead: Non-fish animal protein correlates at only 0.05 with stroke mortality; fish protein correlates at -0.11, and plant protein correlates at 0.12.)

Of course, in the vast sea of potential ways to die, cardiovascular disease is only one tiny, plaque-bound droplet. We’ve still got cancer to think about! And indeed, a cursory glance at the China Study data makes the animal food-cancer relationship seem massively confusing: Meat and dairy have zero statistically significant positive correlations with any form of cancer, eggs are associated only with colorectal cancers, but fish—which we’re usually told is healthy for us—is strongly associated with a number of major cancers, including leukemia and liver cancer. What gives?

This, my friends, is why correlations can lead us astray.

closer analysis of the fishy data shows us that the “cancer clusters” mostly occur in prosperous coastal areas, where more people are eating refined starch and sugar, drinking beer, eating refined vegetable oil, smoking manufactured cigarettes, working at indoor industry jobs instead of doing manual farm labor, and experiencing other aspects of urbanization. In fact, the variable “percentage of employed population who are in industry” is highly associated with nearly every common cancer, including male lung cancer (0.62), female lung cancer (0.47), leukemia (0.53), liver cancer (0.47), colon cancer (0.41), stomach cancer (0.25), breast cancer (0.24), brain cancer (0.21), and death from all cancers (0.31). It just so happens that the more industrialized counties are near bodies of water, where fish consumption is frequent. (Incidentally, humid coastal regions also have a higher prevalence of both aflatoxin and the hepatitis B virus, which are major risk factors for liver cancer.)

Unless there’s something uniquely cancer-promoting about fish protein in comparison to other meat protein, it seems likely that the fish/cancer links are confounded by other elements of industrial lifestyles. Indeed, when we look at the variable “non-fish animal protein intake,” the correlation with “death from all cancers” is a measly 0.03, which is even less than the correlation with plant protein (0.12).

Feel free to peruse my full China Study critique for more details about the lack of straightforward correlation between animal foods and disease (or plant foods and good health). You can also check out some earlier posts on individual animal foods and their correlations in the China Study:

That should cover it, right? Moving on…

Just kidding. How could I be done with this section when I haven’t posted a single graph, table, Bigfoot photo, or liberally-screen-shotted article excerpt? We’re far from finished here, folks.

Although Diet, Life-style, and Mortality in China is crazy-expensive and out of print (and I returned my library copy long ago, so I can’t scan pages), I still want to post some direct charts* to prove I’m not just making stuff up. Lucky for us, the results of China Study II are posted online as a series of PDFs. The China Study II is basically a follow-up to the first China Study, except the researchers plopped 20 more counties onto the list and recorded even more variables than they did for the first round. Because China Study II includes regions with a much greater degree of urbanization than the first China Study, some of the correlations are a little different. Meat, for instance, is now more popular in industrialized coastal counties instead of mainly pastoral areas, and as a result, has some of the same disease associations that fish did in the first China Study. Even though the data between the two studies aren’t identical, China Study II is still useful for a couple things I’m going to show you.

*I realize I can overdo it with the graphs and tables. It isn’t because I want to bore you or turn your eyes into blurry, computer-screen-induced globes of pixelation—but rather, because I suffer from Liberal Arts Complex.

lib•er•al arts com•plex: n. Subconscious desire to compensate for poor choice of collegiate studies by over-explaining, over-referencing, and over-graphing material in attempt to gain credibility; form of mild neurosis.

So let’s take a look at some pages straight out of the second China Study monograph—more specifically, the mortality section. (If you’re worried the meat industry bribed me to Photoshop the following images to make them look anti-vegan, by all means, download the full PDF straight from Oxford’s website by clicking here.)

First, let’s look at how various foods correlate with “death from all medical causes” for adults age 35 to 69. This variable is more interesting to me than “all-cause mortality” because it excludes things like drowning, car accidents, getting mauled by a pack of rabid wolves, and other modes of death that have nothing to do with diet (unless the wolves found you because they smelled your nitrate-free liverwurst).

Correlations with death from all medical causes, ages 35 to 69.

All aboard the Abbreviation Train! Choo-choo. For reference, PLNT =  plant, ANIM = animal, PROT = protein, and CHOL = dietary cholesterol. The variables preceded by the letter “M” are mortality statistics; the ones preceded by “P” are plasma measurements; the ones preceded by “U” are urine measurements; the ones preceded by “D” are foods from the diet survey; and the ones preceded by “Q” are from a questionnaire.

I’ve highlighted the food variables specific to either the plant or animal kingdom, so let’s take a gander at how they correlate with “all medical deaths.” Total plant food, percent of diet as plant protein, and wheat? All strongly positively associated with death from all medical causes, meaning that as intake of these things goes up, so does the risk of keeling over from something body-related. Total animal protein intake, percent of total calories as animal protein, egg intake, meat intake, red meat intake, fish intake, and consumption of dietary cholesterol? All strongly negatively associated with death from all medical causes, meaning that as intake of these foods goes up, medical mortality rates decline. Again, many of these associations may be—and probably are—totally meaningless, but they describe an important trend: For whatever reason, in China, the animal-food-eaters are living longer than their more plant-based counterparts.

…Which brings us to another problem. As we saw with heart disease in Norway, high rates of infectious disease can sometimes obscure the true prevalence of chronic disease—because folks are getting wiped out by short-term illness before they have a chance to die from things like cancer, strokes, or heart attacks. Even if their arteries are plaqued up the wazoo or their bodies riddled with tumors, it’ll be the tuberculosis, or the pneumonia, or the other infectious disease that shows up on the death certificate (and, subsequently, in the data). In the China Study, low animal food intake tends to be associated more with poor counties where malnutrition, unsanitary conditions, less education, and acute “diseases of poverty” prevail. For instance, here are some charts for three mortality variables associated with lower quality of living: death from all respiratory disease, death from all digestive disease, and death from pregnancy and childbirth complications. In each case, you can see the strong inverse associations with animal foods (except milk), and strong positive associations with a greater portion of the diet as plant foods. (For a complete key to all the variable abbreviations, check here.)

Correlations with death from all respiratory diseases, ages 35 to 69.

Correlations with death from all digestive diseases, ages 35 to 69.

Correlations with death from pregnancy and childbirth, women aged 34 and under.

Based on the above, we’d actually expect to see areas with higher animal food consumption also experience higher mortality from long-term diseases. Not because they actually have more of those diseases, but because there are fewer “diseases of poverty” to kill them off prematurely. Again, it’s all about what the death certificate says. And to quote a paper Campbell himself co-authored: “it is the largely vegetarian, inland communities who have the greatest all-risk mortalities and morbidities and who have the lowest LDL cholesterols.”

While we’re at it, here are some other relevant pages from the China Study II monograph—some “diseases of affluence.” If you’re sick of these charts, just keep scrolling ’til it’s over. I won’t be offended! Once again, correlations really don’t mean diddly squat here, but they do paint an interesting picture of how diet and mortality patterns interact… and again, it’s far from damning of animal foods.

Correlations with “death from all cancers.” Strong inverse associations with animal fat (ANIMFAT) and saturated fat (%SATFA); strong positive associations with millet and eggs:

Correlations with death from all cancers, ages 35 to 69.

Correlations with “death from heart disease.” Strong inverse associations with animal fat, rice, legumes, and green vegetables; strong positive associations with wheat flour, light-colored vegetables, fruit, and eggs:

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

Correlations with “death from stroke.” Strong inverse associations with percent of diet as animal protein, rice, poultry, fish, dietary cholesterol, legumes, and green vegetables; strong positive associations with wheat, percent of diet as plant protein, and percent of total calories from plant food:

Correlations with death from stroke, ages 35 to 69.

Correlations with “death from diabetes.” Strong inverse associations with milk, meat, red meat, and animal fat; strong positive associations with fruit and eggs:

Correlations with death from diabetes, ages 35 to 69.

And lastly (no, seriously, this is the last thing): Since we already know collections of plain-jane correlations can be totally misleading, here are some of the findings from researchers who analyzed the China Study data beyond the raw correlations—including adjustments for confounders. I wrote about these studies in greater depth in my one-year China Study Anniversary post, but here’s the Reader’s Digest version.

From “Erythrocyte fatty acids, plasma lipids, and cardiovascular disease in rural China” (PDF):

  • “Within China neither plasma total cholesterol nor LDL cholesterol was associated with cardiovascular disease”
  • “There were no significant correlations between the various cholesterol fractions and the three mortality rates [coronary heart disease, hypertensive heart disease, and stroke]”
  • “The consumption of wheat flour and salt … was positively correlated with all three diseases [cardiovascular disease, hypertensive heart disease, and stroke]”
  • “Red blood cell total polyunsaturated fats, especially the n-6 fatty acids, were positively correlated with coronary heart disease and hypertensive heart disease”
  • Meat, fish, and green vegetables are associated with higher levels of sex hormone-binding globulin, indicating greater insulin sensitivity/less insulin resistance
  • Wheat has the strongest positive association with insulin resistance out of any food
  • “The results strongly indicated that dietary calcium, especially from dairy sources, increased bone mass in middle-aged and elderly women by facilitating optimal peak bone mass earlier in life”
  • “Comparison of results in Table 7 reveal that calcium from dairy sources was correlated with bone variables to a higher degree than was calcium from the nondairy sources, probably resulting from the higher bioavailability of dairy calcium”
  • Even after adjusting for other factors, animal foods are negatively associated with death from cervical cancer
  • “Our finding that the highest blood cholesterol levels in the Chinese were associated with … the lowest risk [of heart disease] is also a contradiction of what might be expected”
  • “Consumption of green vegetables, rice, meat, and fish was associated with reduced mortality [from stomach cancer]”
And finally, here’s what famous researchers Walter Willet and Frank B. Hu had to say about the China Study data:
  • “A survey of 65 counties in rural China, however, did not find a clear association between animal product consumption and risk of heart disease or major cancers.”

Just because.

Esselstyn: It’s a plant-based miracle!

Now that we have The One Message from the China Study neatly tucked into our brains, we turn our attention back to Dr. Esselstyn and his revolutionary research.

Minute 52:00—While Dr. Campbell was publishing his China Study, Dr. Esselstyn was getting some powerful data from the research he’d started in 1985. He began with 24 patients. But six had dropped out in the first year, leaving him with a total of 18. [Esselstyn:] “At the end of five years, we had follow-up angiograms, and 11 of the group had halted their disease. There was no progression. And there were four where we had rather exciting evidence of regression of disease.”

As the movie notes, this is pretty darn exciting. Even the most experienced, uber-credentialed doctors often believe that heart disease progression can only be slowed down—not stopped, and certainly not reversed. I salute you, O mighty broccoli!

But there’s something majorly funky with the movie’s description of this study. We’re told that Esselstyn ultimately ended up with 18 patients, 11 of whom halted their disease. Four folks regressed their disease, but we don’t know if these people are included in the 11 who didn’t get worse. And at any rate, 11 plus 4 doesn’t equal 18, so some folks have mysteriously vanished from the head-count. What’s up with the weird math?

After poking around for more detailed results of Esselstyn’s study, I found that—quite fortuitously—he posted the full text his papers right on his website. The five-year results are discussed here: A Strategy to Arrest and Reverse Coronary Artery Disease: A 5-Year Longitudinal Study of a Single Physician’s Practice. (Note the line of links near the top of the article for the full description of methods, results, discussion, and conclusion.)

In contrast to what we’re told in “Forks Over Knives,” Esselstyn’s paper says that he started with 22 patients, five dropped out, and six stayed on the diet but never came back for data collection—leaving Esselstyn with only 11 people in the study. (We’ll talk about why this is a problem in a moment.) Of those 11 folks, all had an “overall” stabilization of their heart disease, although four people did have lesions that slightly progressed. Depending on the method of analysis used (“mean percent stenosis” or “minimal lumen diameter”), either eight people or five people had evidence of regression in some of their arterial lesions. Aye, numbers!

No disrespect to Dr. Esselstyn and his work, but right off the bat, we can see there are some big problems with this study:

  1. The drop-out rate was crazy high! Since the initial 22 patients got slashed down to 11, we have to consider why the other half of the group slipped off the radar. Was it because they were feeling bad on Esselstyn’s program? Did they experience repercussions from a plant-based diet that they perceived were even worse than heart disease? Were they sick of getting celery strings stuck between their teeth? When studies have a significant drop-out rate, the folks who stick around tend to be the ones having the most success, while the failures slink away—which ends up skewing the results to make the intervention look more effective than it may have truly been.
  2. It was an uncontrolled intervention trial. That means there was a no control group to compare against the folks who got dietary and statin intervention, so we can’t estimate how many of their health changes were due to Esselstyn’s program and how many were due to chance.
  3. It was a non-randomized study. The patients volunteered rather than being randomly assigned to treatment, creating a problem called “selection bias.” In this type of research, we know that folks who elect themselves for study may have different characteristics than the rest of the population, which is why many researchers use randomization to choose study subjects instead of letting people choose themselves.
  4. A whole bunch of variables changed. This wasn’t a study that examined the effects of one component of diet; it did a complete menu overhaul, changing total fat intake, animal food intake, processed food intake, sugar intake, vegetable oil intake, and about ninety gazillion other things. Combined with that lack of a control group, it’s impossible to determine exactly which diet components had an effect on heart disease, and which were neutral (or even negative).

In addition, some effects of Esselstyn’s diet are a little alarming. In the “results” section of his paper, he displays the following table, which shows how his study subjects’ blood values changed during the intervention.

Let’s ignore the fact that those super-low total cholesterol levels are associated with higher rates of cancer, mental illness, infection, and other fun stuff (yes, your cholesterol can be too low) and focus instead on the other values. Holy triglycerides, Batman! Although Esselstyn’s diet helped lower most of his patients’ triglycerides, a couple still have values in the major danger zone (362?). Some of those HDL numbers are looking pretty sorry as well.

All in all, Esselstyn’s study shows that a whole-foods, plant-based diet is probably infinitely better for cardiovascular health than the junky cuisine many folks eat. But it’s far from conclusive evidence that this diet is the best we can do for reversing heart disease, or that it would generally be effective in a population beyond his 11 self-selected subjects. A diet that reduces triglycerides and increases HDL more than his did, for instance, might have an even better outcome.

That’s all, folks

For sure, “Forks Over Knives” has some other areas I could nitpick, such as Campbell’s statement that “animal protein tends to create an acid-like condition in the body called metabolic acidosis” and leads to osteoporosis (minute 1:03:20)—an unfounded belief that I already debunked in the “dairy” section of this post. But I think this critique covers the meatiest points. (Pun definitely intended.) And if you made it this far, hats off to you!

Now if you’ll excuse me, I have to go tend to my feedlot cows and cash my Meat Industry checks. Oops, did I say that out loud?

2,421 comments

    1. It WAS amazing and I enjoyed the documentary very much. EXCEPT… I am a scientist and can unequivocally state this was not information presented scientifically. The problem is the number of doctors associated with it lends it more credibility than it should. Doctors are NOT scientists. Drs can have gone to school to be scientists but they are not the same things. A scientist works from a hypothesis, develops theories and then runs experiments.during which there must be some sort of control and some sorts of challenge and a scientist must start at the most “pure” unassailable point, ideas in his premise.

      That last point is the problem. We learn at the very beginning of the movie that 5% casein does not cause or promote cancer but 20% does. But we are what we eat. It applies to animals and people. In India we can safely assume the milk (casein is a milk protein) came from water buffaloe because cows are sacred and no part of them is consumed. BEFORE we ever decide of a causative factor from casein, we must look at the breakdown of the ingredients, minerals, trace elements, chemicals, pesticides, herbicides, etc that might be in that milk. WHY? Because whatever that cow ate will be in its milk and therefore in the protein.

      If a cow eats mercury, lead, malthion (pesticide) benzene, ddt, salt grass, wheat, derivatives, etc–it ALL effects the meat AND the milk. Same thing with chickens and ALL other animals.

      This is why if you travel and come home and try to recreate a dish from abroad –even with a recipe–it will NEVER test the same as it did overseas. It can’t–your food was not grown in the same soil, with the same kind of fertilizers and macro nutrients…your beef did not eat the same food, breathe the same air or eat the same grasses or grains as it does stateside.

      EVERYTHING matters. Things to know:

      1. India (where the casein test was run) has a very high ratio of pesticide pollutants due to a noncontrolled mfg environment. What trace chemicals could be in the grass or water or in the air that could ultimately affect the buffalo and then the meat and milk? Were those particular factors eliminated?

      2. India has also been the site of numerous and vast chemical disasters such as the Union Carbide disasters–what is the proximity of the site to the tests? To the grazing areas of cows?

      3. Diet–the diet of both cows and domesticated herbivores in the US are very poor and rife with chemicals, pesticides, herbicides, food additives, genetically altered vegetable and meat products (yes cows in the US are often given derivatives of meat including other cow products in their diet) were these potential OUTLIERS eliminated before coming to conclusions?

      4. Unless from organic cows, the repeated experiment later performed by Esselman also would be suspect due to the diet of the cows, the treatment of them with antibiotics, growth hormones and vaccines, and a diet high in genetically modified grains and animal by products not to mention residiual pesticides and herbicides and whatever is in our ground water….(in that particular region where the cows grazed and drank and where the grain grew) same type of OUTLIERS–therefore the same skewed data.

      FYI–to be truly scientific, all potential outliers must be eliminated or nullified through identification, efficacy tests, etc–in other words we have to prove they have no bearing on the results BEFORE proceeding with the experiment on people. Scientists know this. Medical Doctors who usually are the beneficiaries of science not normally the practitioners of science may or may not know this.

      I could write tons more, but here is the most interesting, diets high in animal protein (ketogenic diets) but LOW in carbohydrates also greatly reduce or eliminate the need for diabetes meds, cholesterol and High blood pressure, etc but yet those two diets are diametrically opposed and the numbers for successful treatment ranges into the thousands–how can that be? If both are right then something that is not being examined is the key.

      There is a lot of passion in this movie but very little science. It is like an infomercial for vegans.

      And why is it not called vegetarianism any more? Whole food plant based diet? Really? Plant based does not mean to the exclusion of animal products–but since this diet DOES intent to exclude all animal products, what is wrong with it being called a vegan’s argument for not eating meat? Not PC? Been done and not successful?

      I enjoyed this movie for the same reason I enjoy most documentaries–because the passion of the director and producer finds a way to bring a rather dry and esoteric subject to the forefront and into the homes of a generation raised on video games and sound bites. I found some points intriguing but not revelatory or even necessarily true/correct.

      The danger (and there IS a danger) in this idea and doc is that it seeks to take data and cherry pick what it wants to make its point ignoring too much else–that is not science it is propaganda. Consider this–an entire nation dying of some disease and a new antibiotic being discovered. The antibiotic is made into a blue pill and Esselstyn and Campbell see it being administered at their hospital and clinic….then they both rush out and tell the world that pills that are blue will cure the epidemic.

      The clarion call goes out and soon, people are popping blue pills. But most pills are not the antibiotic. Some are diet pills, some are saccharin pills or placebos, some are benedryl or another drug some are just water pills or even pills for PMS. Now–how many people will get well? Under these circumstances, natural mortality for that disease will kick in–but the public will not know or understand this–they will think that the ones who lived took the right blue pill, they will try to ferret out which blue pill those who survived took, they will not look at natural survival rates nor will they look too deeply at the assay or what is in the actual pill–they won’t because they are laymen. They understand a blue pill can save them. What they do not understand is that it NEVER was a color that could save anything or anyone –it is the ingredients and they do not get that information.

      Similarly, we all do not want to die from cancer, or heart disease or hbp or diabetes…this sounds like a healthy plan…some of us do not want animals eaten though they fail to realize the animals we domesticate would be killed anyway because they would be competing with humans for places to grow the agricultural crops needed to feed billions. Predators would take care of the rest. It never will be the panacea or utopia wished for by some and believed in by others. NEVER. LIfe is not set up to be a place of harmony–it is a place of competition, survival and lots and lots of maiming, killing, eating, and death. Then again, with the world going towards less viable water–what happens or would happen if all diets depended solely on veggies and we experienced the predicted 75% of the world in drought scenario?

      Most ideas like this are idealistic but also very, very short sighted. The point is conversion and like any other kind of conversion–religious or otherwise, the point is not to iron out the details of look or think to deeply–sheer bodies on one side or the other is the goal–preferably as mindless and automatic as the disciples in charge can get them.

      1. Wow! Two great ‘group’ posters in a raw, first (non-Smith) Lisa, now thqueenbee. Thanks people. These fantastic posts totally couterbalance the recent insane drift in the discussion.

        Some people here have both the knowledge and the writing skills to run their own blog. I’d certainly visit them on a regular basis.

        Welcome thqueenbee :-) Please please keep on posting!

        @anna: I’m still investigating the matter. I’ll get back when I’m done. Unlike someone I know, in these matters I take the time to be sure that I’m not juding a book by its cover… and I NEVER go by hearsay.

      2. @thqueenbee. You are wrong about your assumption that in India only buffalo milk is used. Both cow and buffalo is equally consumed. Go to any Indian/ethnic store and ask for ghee (clarified butter) or paneer (cottage cheese) and you’ll see cow written over it (mostly). I am from India btw and I eat all kinds of meat. (goat, pork, chicken, beef, fish, shrimp, lobster, etc).

      3. How is the conclusion drawn that there were EQUAL amounts of rats in the experiment for High and Low Protein – what if there were only 13 rats in the second set

        1. why would a scientist use 30 rats in one set and 13 in another? that’s half the amount of animals. Usually, one tries to keep the number of animals within treatment groups the same. They can be off, by usually by one or two animals. Not half the group. I suggest you read the original scientific article for yourself. It should state how many animals were in each treatment group at the beginning, and how many died during the study.

      4. Several incredibly naive assumptions in your post, makes me question your scientific universalism.

        1. Indians don’t eat any part of the cow – actually not all Indians are vegetarian and some do eat any and all parts of the cow.

        2. Therefore…they don’t eat cow dairy. Wrong! Cow dairy is widely consumed in India by the majority of Indians including ghee, yogurt and paneer cheese.

        3. India has a high ratio of pesticide pollutants. Not in the 60’s when this study was taking place! India did not have open trade at that time and did not use modern production methods. Their farms were largely organic, more so than in today’s standards of what organic means.

        4. Chemical disasters such as Union Carbide may have contaminated the milk production. No! This study was in the 60’s and there were no Union Carbides are any other foreign chemical factories at that time in India (due to Gandhi’s ideas of isolation and using traditional methods whenever possible).

        If you can claim to know so much about India and get it wrong, what does this say for your other opinions?

        1. Simply in the spirit of truly illuminating the truth, I appreciate International Correspondent’s comment. I know that Denise is inquisitive like that and would want to really get the information right, so I’m hoping that she has read this comment and can respond to it fully.

      5. What a witty little critique! I thoroughly enjoyed that. I wish I lived my life according to which ever direction the wind is blowing. Sometime you should spend an afternoon on Medline and Pubmed. Do a search regarding the correlation between dietary animal proteins and cancer and see what you get. Bring your coffee because you’re going to be a busy girl. This movie wasn’t made because three or four guys found some interesting correlations. You crack me up!

          1. I thought he intended to be demeaning. He was angered by a different opinion, a sign of an insult to faith rather than a disagreement over science. I find this useful, there are so many worthwhile opinions to consider its nice to be able to sieve out the worthless ones after the first line and move on.

            1. Too easy. This wasn’t necessarily meant to be demeaning. And most importantly, a mysogenistic person can know much more about nutrition than someone who isn’t. If you’d stop reading the text above at the first sign of error. I hope you stopped very early. What I mean is that someone can be wrong on somrthing and right on the other.

          2. Um Are you suggesting a woman is a man? Or maybe a girl cant be a women? Please stay with the subject and stop with your speech restricting political correctness.

          3. Dear Dr. Mason – not necessarily – it’s really dependent on the intention of the speaker/writer. As a 65 y.o. woman, I use “girl” all the time when talking to peers. I love the mantra: “you go, girl”, but it can be meant as demeaning I suppose, like the use of “boy, do this or that” when speaking to a man servant, etc.

            Guess what I’m saying here is that it is presumptuous to assume that a writer mean the term to be demeaning. Let’s giv’em the benefit of the doubt and not present a reply that can be confrontative.

        1. “Do a search regarding the correlation between dietary animal proteins and cancer and see what you get.”

          OK, done.

          Conclusion: On the basis of the results of this quantitative assessment, the available epidemiologic evidence does not appear to support an independent association between animal fat intake or animal protein intake and colorectal cancer.

          http://www.ajcn.org/content/89/5/1402.full

          1. For the record, I don’t yet have an informed opinion on this topic, … but it’s at least worth noting that the paper to which you refer was funded by The National Cattlemen’s Beef Association and the National Pork Board.

          2. From the study you cite: “DDA, CAC, KAL, and BS received partial funding from the Cattlemen’s Beef Board, through the National Cattlemen’s Beef Association, and the National Pork Board. MAR received no research funding for this work.”

            You think that may have had some influence on its conclusion?

      6. I think it a mistake to say that physicians are not scientists, as they most certainly are. Unfortunately, as with far too many scientists, they don’t always practice good science!

          1. Being a clinician significantly limits the freedom to always practice good science becuae a clinician must follow protocls which were once based upon what might have been good science at the time but may now be obsolete or even contrary to current good sceince.

        1. To R Kugel: gager is right on this – physicians are not scientists, but more appropriately categorized as practitioners or technicians. Technically, an MD is an undergraduate degree and does not include training in research methodology.

      7. I believe the doctors would have seen the same result from their patients from just losing weight. Not just because if was plant based.

      8. First, my credentials, such as they are. My mother opened a health food when I was 15, and I’ve worked there mostly ever since. I went to school originally for journalism, but finished Bio/Pre-Med with a concentration in Immunology. I’ve written and lectured on a variety of health topics, including frequently to grad students at the university level. And while I use and celebrate a lot of traditional herbalism, I’m most grounded in research-driven, methodologically sound healthcare. I’m a skeptic of all things, so I make a habit of seeking out primary sources.

        I write all this to establish my credentials mostly so the following statement will carry as much weight as it can: good job! Great job! Meticulous, great, great job. What you’re doing shouldn’t be necessary. But, sadly, it is. Great job!!! Respectfully, with gratitude and admiration, Adam Stark

      9. Small note as I was skimming your response. There is a significant difference between plant-based and vegan. Oreos are vegan. Tofurky is vegan. Bread is vegan. Vegans try to avoid foods with any animal products, but that still leaves for a ton of crap. Yes, being vegan comes with its own set of stereotypes, but the distinction is on purpose. Plant-based, whole food diets focus on eating as much of the original sources of energy as possible, without eating the sun, of course. It is a diet less based on animal rights and more on human health. Plant-based basically cuts out a lot of the crap vegans still eat.

        1. brightyellowjello,

          There is a significant difference between plant-based and vegan. Oreos are vegan. Tofurky is vegan. Bread is vegan. Vegans try to avoid foods with any animal products, but that still leaves for a ton of crap.

          No, not really. Veganism speaks to ethics, but a significant number of vegans eat a whole food diet. There is no significant difference. The difference lies between whole food and processed food, and not even “plant based” is specifically defined as processed-food free. The S.A.D is plant based, getting between 2/3 and 3/4 of its calories from plants. But it’s refreshing to meet a wf/pb person who recognizes the significant impact that eating whole foods makes over processed foods. I would hope this distinction applies to diets that include animal foods as well. A whole-food, omni diet is optimum for most people. The issues are created with processing. When the wf/pb community can begin looking at data that compares wf/pb diets to wf/omni diets (as opposed to the SAD), and recognizing that pb doesn’t improve on it, the reality will dawn.

          base: verb  to make or form a base or foundation for. plant·based: adj the arrogant label for the diets of a pious community that refuses to acknowledge that most diets, including the S.A.D., get the majority of their calories from plants. criticisms and comparisons generally label all other diets as “meat based”, or “carnivorous” even though these diets are also generally based on plant foods as well. a more accurate label would be whole-food vegetarian.

          ________________________________

    2. Good Analysis.
      After reading most of it, I’m now coming back to each point a bit more in depth. I only started with reviewing this work so I’m down to only the first 2 things I came back to:
      1)First: Cholesterol (referring to the study you found showing ingesting diet cholesterol reduce serum cholesterol). I came across that one (or a very similar one) a long time ago. This kind of conclusion happens often with “studies”, that’s why life should be all about data (as in units, like grams and moles). I believe these results are indeed accurate i.e. if you start with someone with relatively high Total Cholesterol like 180 or 220 (yes both these figures are very high in reality, the 180 also), consuming certain animal products an even straight pure diet cholesterol in a glass may bring you serum cholesterol levels closer to where you want them. If you try this with a more “normal” serum cholesterol level (like mine for example: Total Cholesterol=104 – you guessed right I’m vegan) that’s not going to work. Consuming diet cholesterol will increase my Total Cholesterol for example. It will likely upset my LDL/HDL as well. The problem with these studies is they start with the paradigm that consuming animal product is normal so they all start with “high” cholesterol subjects. Shifting paradigms and trying these things on a “normal” “low” cholesterol subject (one that is not fed no animal protein and no diet cholesterol at the beginning of the experiment so his cholesterol level is really low to start with) and the results you describe no longer apply. Refer to the ton of research conducted by guys like Kritchevsky (father of cholesterol research) or Funch along with their research teams and then think again. These guys converged away from cholesterol and ended up on animal protein pretty early in the game (back in the 1960’s I believe).
      2)Second: Cancer and animal protein. Looking at your comments on more dead animals with the 5% protein than with 20%… I think Campbell will be the first one to agree with you. Just go back to the China Study and you’ll see that he is the first one to say that 10% protein is required for adequate growth/health. So nothing unexpected or that could justify your indignation.

      I’ll try to get back to your work and look at the other items further. Maybe one general comment on all this. You make a lot of negative comments about Collin Campbell, almost every paragraph is pointing to the fact that he’s basically lying or confused. You have your hands on a fraction of his work, mostly the conclusions with some data and what you see does not impress you. Campbell was much closer to the work than you. I guess where I’m going is that your information is much more partial than his. I conduct a lot of scientific experiments in my professional life and I deal with situations like this all the time. How many times do we find that the data is confusing or reversed or seems to prove the opposite of the principle at hand. Than we redo the experiments not one more time but 10 times. We then develop a feel for that theory we started with. After enough experimentation it’s pretty solid. The technicians can still prove us wrong on a number of experiments but in reality, if they were to conduct it enough time ($$), they would get to the same conclusion as us and our math/science. You can only break yourself against principles. I hope you look at all these with an open heart as much as an open mind. I hope one day you join us (vegans) as John Lenon once said. Here is a true (pure) scientific principle: Only herbivores (includes granivores and frugivores) get atherosclerosis, it is not possible to produce it in omnivores or carnvivores (unless you chemically destroy their thyroid). Since humans are subject to atherosclerosis they have to be herbivores too (William Roberts, Baylor University, Executive Director of the Cardiology Institute at Baylor, he wrote more than 1300 articles on atherosclerosis).
      All the best – I love your approach and your work – this world needs more people like you ready to take the time and conduct real science (or at least analysis in your case) !

          1. Yeah read it carefully. That idiot contradicts himself. He’s trying to disprove that humans are herbivores then makes a statement that supports exactly what he’s trying to disprove. It’s hilarious.

            1. I failed to see contradictions. Cholesterol is necessary for good health. And cholesterol does not cause blockage in humans. Eating animal fat does not cause blockage in humans. Some of my vegan friends would probably agree with you if they hadn’t died of cancer.

              1. If you failed to see contradictions, maybe you should go back and read it again. Or maybe you don’t see it because you don’t want to see it. Yes cholesterol is necessary, but not in our diet. Our bodies produce all the cholesterol we need. Yes I realize dietary cholesterol doesn’t necessarily cause high cholesterol levels. And your last sentence doesn’t really prove anything.

                1. Here is the conclusion. ” Dr Roberts’ and other data simply do not support an argument that only herbivores get atherosclerosis; they also do not support his assertion that carnivores don’t get atherosclerosis; they do not support the myth that raised cholesterol is the sole cause of atherosclerosis; and they do not support his contention that humans must be natural herbivores. ”
                  No where in is critique did he contradict himself. You should not use your ass as a hat. You read again.

                2. I did see where the author agreed with the doctor the carnivores do not develop atherosclerosis except when carnivores are fed grain products.

              2. I live in Santa Cruz, CA – tons of vegans out here, and I don’t know of single one who has, had, or died of cancer or heart disease.

    3. Wow that’s what you call a film review! Congratulations on such a well-written and well-thought out piece. After watching Forks Over Knives I have changed to a mainly’plant-based’ diet and I think the name is apt because there are people like me who want to follow it and yet are uncomfortable with the image that goes with ‘vegan’. Plus the fact I do not have to be too rigid about it, and I still use leather shoes (although I do have concerns about the animal cruelty involved in some countries with the leather trade) and if I am out for a family dinner I do not sit there not being able to order anything and I might order fish. I do my best to continue to advocate humane farming methods, as I think the factory farming is not only inhumane but not doing much for the safety of our food supply. However I am a realist and you cannot change things overnight and I am not ready to chain myself to railings. To summarise I think some of the points in this article are valid and I will look again at the movie, and I think the way to go for most people would be far less meat, far less milk, no processed trash which has hardly any food value. It is clear we are all addicted to fat and sugar, its just like an addiction. I might point out that since changing to the mainly plant-based diet I have never felt fitter or had more energy, it is like being on a permanent high and people ask me why I am almost skipping down the corridor (in pants I haven’t been able to get into for years!)

      1. Yes, I’ve been thinking a lot about the so-called “French Paradox” – they eat a lot of meat and dairy, but have relatively small numbers of heart disease. I think it’s because they tend to eat whole-foods, very little processed garbage.

        1. It’s interesting you bring up the French – I find that EU’s Walk A Lot, tend to eat smaller portions (well, maybe not Italians) and drink a lot of fine wines… I don’t know what that all means in terms of overall health/disease but I LIKE the part about drinking nice wines at lunch and dinner.

          As I’m reading this blog’s comments, it’s fascinating to see how many strong opinions there are around food. As a retired doc who specialized in reproductive endocrinology and nutrition, I’d like to prescribe about 90% of these responders: “drink more wine” and “chill” more with laughter.

          O – BTW, I don’t know of a single culture that has reproduced for generations that are fat-free, fish-free, meat-free, dairy-free vegans (or as the movie likes to call’em – plant based). Not One culture.

          1. I’m reading as many of the strong opinions as I can, and I very much appreciated a couple of Claudia’s points.

            I have little exposure to continental Italians, but my Sicilian grandmother served the largest portions of food I’ve ever seen and she never, ever let me walk away from the table until my plate was empty.

            At a local cafe, I stood in a serving line behind a man who was utterly unable to make a food choice. His facial expressions, speech and behavior were all increasingly anxious/agitated as he attempted to identify something, anything that was compatible with his diet. I was in no hurry and, as a retired psychologist, was even a little intrigued by the situation (i.e., not part of the chorus shouting at him to make up his mind or move on). At one point, he turned to me and asked me what I was going to order. With a smile and the best cheerful tone I could muster, I replied, “three bottles of wine, one for me and two for you.” Too bad he didn’t even crack a smile. Clearly, this man’s anxiety about food is going to kill him long before his food choices will.

            A larger issue. The clinical endpoints for most research seem arbitrary and/or irrelevant. I’m a 105-pound, 55-year-old woman with a recent nonfasting total cholesterol of 169, HDL 70 and triglycerides 47. I do not have diabetes (HgA1c 6x normal and transaminases 3-4x normal). This is despite myriad off-label medications (and combinations thereof), currently including prednisone, hydroxychloroquine and mycophenolate. I eat mostly fruits, vegetables, whole grains and legumes with occasional meat, dairy and added oil (olive, grandma, I promise). And yet my food choices are pretty random–whatever’s in season or on sale or happens to “sound good” when I’m in the store. I started “reading up” on nutrition to see if I could help myself via improved nutrition. So far, though, my takeaway is that there are a lot of strong opinions that can’t all be true and, with all the focus on endpoints like cholesterol and blood sugar (for which my values are consistently good), I have no idea which direction to go. I have reviewed Dr. Weil’s antiinflammatory diet and noted that some of his recommendations are outdated (boo), so who knows? Maybe my best choice is just to maintain the status quo…cheers!

      2. I eat a plant based diet and reversed arthritis, morbid obesity and pre-diabetes. In all, I have lost over 150 pounds by doing Fuhrman’s Eat to Live and variations of it. I started out thinking I was a vegan but now realize that “veganism” is a smokescreen. As Michael Pollan points out, modern food production kills animals. There is no getting around to it. I recently had to leave a couple of vegan groups on Facebook because their worldview is that vegans are morally superior to vegetarians who eat their own humanely produced dairy products.

        I think much of the blow back against FOK is coming from people who resent these authoritarian vegans and PETA types. I did not read Denise’s critique as I do not believe she is qualified to accurately critique the science and really, after debating with some of these “vegan” types on other sites, it really comes down to which studies one wants to believe and FOK is a MOVIE, folks!

        In closing , I believe I owe my life and presumed (barring an accident) longevity on folks like Caldwell, Ornish and Joel Fuhrman. Yes, I know a sample size of one does not make a study but whole foods plant-based works for me and is now working for thousands of people (just on Facebook, look at the numbers of people who follow just Fuhrman’s program on FB, it is in, at least, the tens of thousands.)

        1. “I did not read Denise’s critique…”

          And yet you feel compelled to comment on it. Interesting. You do know what the definition of ignorance is, I presume? It sounds to me as though you are a shill for the Fuhrman diet. BTW, Fuhrman’s an interesting case study. He selects 20 nutrients, and omits some rather critical ones (D-3, K-2, all essential fatty acids, etc.). And then he compounds this by multiplying the amount found per calorie of food times twice the ORAC score.

          Yes, the same ORAC that the USDA dropped because they felt it was too unreliable and unscientific.

          It’s rather odd that fiber, which provides no nutrition to humans, fits Fuhrman’s criteria for inclusion, but vitamin D-3, essential to so many biological functions, is excluded. Perhaps the good doctor knew which way he wanted his results to skew a priori, and devised the list of critical nutrients based on that?

          But hey, if it worked for you, who cares if the underlying science is shoddy, right?

          1. Finnegans,
            why do you feel a need to be condescending to others on a public forum. What happened to the respect? I have read Dr. Fuhrman’s Eat to Live, Super Immunity, and Disease-proof Your Child. And I wont be labeled as a “shill” for the Fuhrman diet, either. But I will say that he absolutely addresses vitamin D-3 in Super Immunity, since it has been one of the sources for boosting the body’s natural defenses (vitamins and minerals act as important coenzymes and cofactors in metabolism, which is recognized). In Disease-proof your child, early on he addresses the essential fatty acids and highlights the importance of dietary DHA and EPA (which is the result of conversion of alpha-linolenic acid). With all that said, I commend Denise for her detailed work and getting into some hardcore science material! Not an easy task without a science background.

            1. Why should I respect someone who did not even bother to read the critique and (being disrespectful herself) decides that Ms. Minger is not qualified to make such a critique (again, without having read a word of it). Sorry, I don’t suffer fools lightly.

              It’s clear the poster was just promoting the plant-based diet gurus, and I made an accurate critique of Fuhrman’s ANDI scoring system. But let’s not take my word for it, let’s go to Fuhrman’s own website:

              http://www.drfuhrman.com/library/what-is-a-nutritarian-diet.aspx

              “Though micronutrient density is critically important, it is not the only factor that determines health. For example Vitamin D levels, B12, and proper omega-3 intake are important for optimal long-term health as well as avoidance of sodium and other toxic excesses. These concerns are not addressed in the H = N/C equation.”

              OK, so vitamin D3 and B12 and omega-3s are important for optimal health… but let’s not make that part of the food scoring system? How does that even make sense? Oh wait, let’s look at the best food sources for these nutrients:

              D3: Fish and fish liver oils, egg, beef liver.
              B12: Beef, turkey, liver, oysters, clams, chicken giblets, beef, eggs, yogurt, milk, chicken.
              Omega-3s: Fish, oysters, eggs.

              And of course Fuhrman omits vitamin K2, which works synergistically with D3 and calcium to promote bone strength and arterial health. Why?

              K2: Liver, cheese, butter, eggs, chicken, goose, beef, liver (and even bacon!).

              Why, it’s almost as though if he included these important nutrients in his scoring system, meat, dairy, fish and eggs would be an important part of the diet, and we can’t have that, can we? Nooooo, it doesn’t fit Fuhrman’s preconceived narrative!

              But what about the antioxidant ability of the majority of Fuhrman’s list of foods? It’s based on those foods’ ORAC score, squared. But wait, isn’t ORAC discredited? Could it be? From Wiki:

              “A wide variety of foods has been tested using this method, with certain spices, berries and legumes rated highly in extensive tables once published byA wide variety of foods has been tested using this method, with certain spices, berries and legumes rated highly in extensive tables once published by the United States Department of Agriculture (USDA), but withdrawn in 2012 as biologically invalid,[3] stating that no physiological proof in vivo existed in support of the free-radical theory. Consequently, the ORAC method, derived only in in vitro experiments, is no longer considered relevant to human diets or biology by the USDA.

              Oh noes!

              It looks like Fuhrman is peddling propaganda! He has a preconceived bias towards some foods and against others. How very scientific. But if you want to eat foods that contain ALA, remember that only 8-20% of ALA is converted to EPA in humans, and less than 10% converted to DHA. Did Fuhrman mention that as well, I hope?

              At least Fuhrman sounds science-y. And to be honest, following his dietary recommendations would remove some problem foods: refined foods, fast foods, processed foods. That’s all well and good, but he throws the baby out with the bathwater, so to speak, by throwing aside scientific rigor in favor of his biases.

              I am all for respect. Seriously. But I am reminded of the quote from Isaac Asimov:

              “Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.'”

              1. I’ve read a number of Denise Minger’s articles. It’s a great pleasure to read such thoughtful, well researched and delightfully written discourse.

                Went to the website posted above for Dr. Fuhrman: http://www.drfuhrman.com/library/what-is-a-nutritarian-diet.aspx

                It says that Dr. Fuhrman has his own system, ANDI not ORAC. I followed the link for ANDI. The scoring is revised based on what looks like significant additional research. The links are on the page posted.

                Both the food pyramid and food plate there differ from the USDA’s, but they do include animal meat and products. He does recommend limiting their consumption, and eliminating those cooked in certain ways and those rife with toxins.

                BTW, veggies, fruits and grains can also have toxins. Organics reduce but do not eliminate all toxins. Waxing may make them hard to wash off. Others are sucked into the roots or through the skin or are GMO’d in every cell and cannot be washed off.

                These toxic foods are also fed to animals, who in turn concentrate them, as humans do, for example, in a mother’s milk.

                I went and read more of his website. There are many articles, all loaded with references. Those I read were definitely biased to his point of view, but also his point of view seemed based on the references, and those I followed were excellent IMHO.

              2. You ROCK Finnegan…When you replied to Jessica: “Why should I respect someone who did not even bother to read the critique and (being disrespectful herself) decides that Ms. Minger is not qualified to make such a critique (again, without having read a word of it). Sorry, I don’t suffer fools lightly.” I just cracked up – you said it so much better than I could have… I, too was thinking WTF, this woman wants to comment on Minger’s in depth review of CC in FOK docu but she can’t READ it! Yet she can sneak her agenda to promote Fuhrman because “it worked for her”.

                I mean there are a jillion ways to lose weight in regardless of the method used (unless it’s drugs of course) it’s likely to result in lessening disease, pain, etc. at least in the short term.

                Thanks for taking the time to point out some of the short-comings of Fuhrman. ANY diet that eliminates sugar and processed foods is going to show benefits… period. But I think what will sustain us in the long run is a traditionally balanced diet and of course, a nice glass or wine or ale.

        2. Nicole,
          I am trying to go to a plant based diet but it’s the rabid vegans who keep turning me away. They keep saying that I must give up things like my boots and that killing and eating pigs is the same thing as killing and eating babies.

          PETA are their own worst enemy.

          Mike

    4. Why is the dropout rate surprising? I’ve known people with emphysema who continued to smoke and people with liver damage who continued to drink. Is it that shocking that people who have been eating foods loaded with saturated fat and cholesterol their whole lives would have difficulty giving them up?

      1. People don’t like changing. It’s AMAZING what rationalizations people go through so they don’t change.

    5. Reading this article makes me actually laugh. I put it right up there with all the “healthy” diet plans and lose weight supplements. Hey was Dr. Oz consulted?? You can be critical of Colin Campbell’s work or FOK but you can’t attack the proof of what has occurred in many of us on WFPB diets. I myself have lost 70 lbs eating more than ever. My labs have gone from scary to NORMAL. I have more energy than ever and all my aches and pains and other problems are GONE!. I eat nothing with a mother or a face, no dairy etc. So why do people want to cast negativity on a way of eating that would save so many lives? My answer.. because they are closed minded morons who have nothing better to do with their lives but be critical. If you want to be healthier than ever. Not die of heart disease, diabetes, etc then go plant based. If you want to shorten your life and keep your families memories of you with them limited then go ahead follow the advice of people who know nothing. Keep eating meat, fish, dairy and fatten up you arteries, destroy your pancreas, feed those cancer cells. Your choice

      1. If you try to understood the scientific analysis which Ms. Minger has clearly laid out, and the points being made, you might learn something and be able to better understand why your diet changes helped you, and what future considerations to be aware of as you follow the “plant-based” diet. Unlike the creators of the movie, she has no dogmatic agenda, except to help people do their own critical thinking.

  1. I can’t believe I read the whole thing! >:D

    Now if you’ll excuse me, I’m going to go use both a fork and a knife (and some fish) to better my health….

    P.S. I don’t know what you’re on, but what would you consider bottling and selling it? I’m sure there is a market for “pure awesome.” ;)

    1. I know it’s not the Jif from the picture. Fun fact: it has hydrogenated fats in it. Little enough to slip past the FDA, but defs enough for a friend of mine to have a weird reaction to it. Took a few minutes reading the label, but yup, it’s in there. Probably for enhanced shelf stability… that stuff that’s ground at the supermarket separates. (My life is better without either one.)

      1. Quite, less than 0.5 grams per “serving” counts as none. However, the manufacturer defines, within very broad limits, what a serving is. For transfats produced by hydrogenation the safe limit is none, zero, nada.

    2. I AM noting that a diet in fish appears to be almost mandatory for complete health BUT I am also noting that the decline in fish sources devoid of pollution, toxins, or diet manipulation (fish farms which use the similar genetic modified additives as we use in cattle, pigs, and chickens) may mean that this “healthy protein source will soon be just as unhealthy and prone to possibly contributing to cancer and other diseases as red meat.

      We need to remember we are what we eat. This means cows are what they eat and so on. ergo–we eat meat that has eaten products contaminated with pollution, mercury, lead, toxins, growth hormones, vaccines,genetically altered grains, antibiotics, etc and we actually are eating pollution, mercury, lead toxins, growth hormones, etc too.

      This is especially important when you consider what growth hormones do–they cause cells to increase growth exponentially and in a shorter time span. A chicken that may have weighed 2 lbs and taken 6 months to mature now takes 3 weeks and is twice the size.

      It does not take a rocket science to ask the inconvenient question: what happens to the growth hormones when humans eat them? Do they have a treaty to stop working? Are they still contained residually in the cells of animals or plants? Well the last few generations have increased exponentially in height and girth following the adoption of these additives.

      Now add to that mix fake smell, colors, flavors as well as the hormones–just how does that play out in the human body? consider that cancer is unmitigated growth of cells…that cocktail regularly supplied in our foods certainly can cheerlead unmitigated growth–and lest health nuts feel superior–the run off from farms and landscaping and yards that contributes to all this cocktail can eventually get into the ground water–which means it becomes nutrients that can even find their ways onto organic farms. Think about that. I Love fish–but everytime I eat any of it no matter where I caught it or bought it–I wonder…..

      1. Your first point of this comment is the largest factor in why there is not any animal protein in my diet. I feel my options to achieve ideal health with a clear conscious are almost non-existent. I have been looking and looking for answers, but it is so frustrating to search and come up with little or no conclusions on how to construct a truly healthy diet, one that is healthy for my body and the planet. I keep coming to the idea that raising and growing my own food is the only way to achieve what I am trying to do and until then I am stuck wondering what I am actually eating and how it is affecting my body. Even then, as you mentioned, will simply the environment that I am raising my food in be contaminated as well.

        I apologize for the venting, but I think I recognized a similar frustration in your remarks.

        Thank you for being thorough and thoughtful with your comments.

        1. I share these concerns, I’m very environmental conscious.

          But personally after lots of research, I came to the conclusion that eating animal products from local, ‘natural’ farm practises (organic or otherwise), pastured animals, minimal grains use etc… had little negative impact, if any, on the environment. Eating eggs from free-range hens, for instance, is probably totally harmless.

          Besides, plant products are not automatically environment-friendly or health-friendly, far from it. Lots of plant products can be unhealthy and/or can have a huge negative impact on the environment…. heavily processed, contaminated with pesticides etc… si it’s not a clear cut.

          Eating mostly local products rather than imported ones, and organic rather than ‘standard’, IMO has probably a much more positive impact to the environment than simply avoiding some categories of food.

          BTW eating almost no grains makes the ‘local food’ practise much easier for me, since organic grains are almost always produced very far from my home.

          YMMV.

          1. There’s a guy they make fun of in this video for claiming that when you eat dead meat, you’re eating an animals fear. He advocates eating raw stuff, which I think is funny because do you think an animal sitting on your dinner plate is gonna be less scared? hehe But actually, I think the guy is right in a way about one thing. There is a giant adrenal hormone release right before death if the animal sees it coming. Whether this is bad for you or not, who knows.

            1. There is a really horrid ritual in some Parts of the Phillipines where a whole bunch of folks torture an animal before killing it because they swear the adrenalin and whatever else bestows healing and cuilinary perfection. not my thing but there ya go

        2. From the research data I’ve seen, we are all being exposed to high levels of contaminants. The good news is that eating a healthy, low-fat, whole plant based diet can mitigate the risk.

          Animal-based food like products tend to concentrate contaminants. The original research from India, replicated by Professor T. Colin Campbell, showed that caesin (cow milk protein) strongly correlates with cancer deaths induced with aflatoxin.

          The diet recommended by Professor Campbell and many others will help you live a longer and healthier life. If you can grow or find organically grown produce, so much the better.

          1. Another vegan drive-by.

            Tip to vegan commenters: you might want to actually read Denise’s articles before commenting on them, unless you enjoy looking like trolls.

          2. No, the good news is that if you actually care to educate yourself, you know, by reading the article, you can stop spreading the thoroughly debunked casein research you mention.

      2. Your take on the growth hormones secreted in so much of what we eat and drink is a very telling point! Those hormones have got to go somewhere and it is obvious that they are still active in our bodies encouraging a far greater activity level in the proliferation of cells. Guess the old problem of the inability to make money from ‘natural’ products restricts the enthusiasm to conduct ‘real’ research on this as prevention of cancers!

        1. Be cautious believing most scientific sounding information, most of it is based upon badly designed studies and incompetent statistics. Let me give an example in your area of concern. I eat fish from many sources at least once a day, not small amounts, sometimes like an Eskimo the only thing for lunch, I’ve looked into the data and found nothing to back up the warnings from the professional warners but for me this is not enough, So a while ago I decided to have a mercury test to determine actual mercury level in the body. When the test came back, while the mercury levels were one tenth of the concern level, the Doctor’s office was very concerned regarding the very high arsenic level so got back with the lab for a retest. The lab looked into it and determined they should have done an unusual test for a seafood eater. There are two types of tests, the second one rarely done. It took a long time to find someone to do it. When it came back it showed inorganic arsenic and organic arsenic both well within limits. There are two types of arsenic, one very poisonous, the other not. The problem is the standard heavy metals test will erroneously indicate a dangerous arsenic level for a a sea food eater. I believe organic arsenic is flushed out while inorganic accumulates so the data depends on how recently seafood was eaten. Since we evolved eating seafood its not a toxicity problem.
          I got far more out of this test then I’d hoped for. Not only was my danger of poisoning, particularly mercury poisoning, from fish eaten to excess non existent but its so non existent nobody apparently suffers from it because if it were a problem the lab surely would have performed the test on a sample from at least one patient with the living memory of the staff. Labs apparently are not doing tests on seafood eaters so if there is no testing where is the disease?
          Why not eat all the fish you want then have a test done for reassurance. But warn the Doctor if he asks for the standard test its going to look like someone is trying to poison you with arsenic.

          1. Get a stool mercury test and you’ll likely stop eating fish from the level you’ll likely register with. Further, make sure you test for pcb’s and other dioxins as well.

            1. Wait, so the levels of mercury in his body aren’t a concern, so you are telling him to get the levels of mercury that haven’t been absorbed by his body… to indicate how unhealthy his body is?

          2. You certainly should not be reassured because your levels are “within limits”. Those are so frequently very much too high, and they vary greatly from country to country… there is no good reason for that except corporate influence.

  2. I believe the statistics from Norway further underestimate the consumption of meat. The statistics measured official consumption of rationed foods sold through stores. A lot of food was obtained from other sources. I remember my parents and grandparents talking about how they had pigs and chickens in their gardens. People didn’t just go berry picking in the woods. Animal hunting for personal consumtion was widespread as was fishing. The stuff not easily obtainable was sugar, imported fruit and grains. Also, remember the winter is long in Norway with a very short season for vegetables and fruit. During WW2 the Norwegians in reality went back to a hunter-gatherer diet.

    1. Arild Eide,
      What a remarkable similarity between your assumptions and conclusions…
      There’s a quote from Denise’s article in regard to the data:

      “Between 30 and 50 families were surveyed three times annually from 1941 to 1945, giving us a nice little diet portrait encompassing not only rationed food, but also the “black market” items people were eating.”

      1. Given the country was occupied and failing to turn over meats and other products to the occupiers could be punishable by deportation or death–jsut WHO do you believe actually told the truth about what they had and or had eaten? People who would have been so stupid as to tell what they ate off the black market in 1941 probably never lived to tell what they would have eaten in 1942–if you knew anything about how the Nazis operated, then you’d know only a collaborator (and those would be known) could have bilked the German orders and gotten away with it. Read up.

  3. Wow! What an enormous post, but it was a very pleasant read. I feel the same way about your posts that you do about coronary artery bypass footage and 400 pound dudes drinking carrot juice. They’re avoiding their doom and you are avoiding a fate worse than death: being known only for being an English major! Go, Denise! You’re also somewhat prettier.

    Some of us just require a higher standard of evidence than others. There are going to be some people who have their hearts set on believing that a certain type of diet is best for everyone, and they are going to watch the movie and espouse all of its arguments without questioning them. But the way that you thoroughly evaluate the arguments and their weak points, and tie it all together with a firm understanding of epistemology and empirical data is admirable and the way it should be done. Many people simply don’t have the time to think for themselves, so they throw in with a paradigm, and it is blogs like yours that give them an alternative view in an comprehensible way.

    A lot of your posts dispute the notion that various animal products are necessarily harmful, but I am wondering if you ever intend to do a pro-meat post. I know you’re not an evangelist, but so many people are under the impression that even if meat isn’t death it still isn’t nutritionally valuable. But there are so many semi-essential compounds in meat, especially grass-fed meat that improve health – carnosine and beta-alanine, creatine, carnitine, lots of alpha-lipoic acid, taurine, CLA, etc. Vegetarian studies aren’t all sunshine and rainbows, and there is a good deal of clinical and epidemiological data that suggests that some animal products do improve health. Anyway, just a thought for the future.

    Cheers.

    1. Stabby,
      “semi-essential”? What’s that? A semi-scientific term to evade the unforgiving “non-essential”?

    1. walter bond and many other A.LF activists risk their lives and freedom to liberate animals from torture and murder. And to throw a major wrench in the murder industries machine.
      your comment is not only retarded, and irrelevant, it is also racist.
      you think white people havent caused animals to become extinct?

      try getting off your arse and doing something rather than being an annoying hippy.

      VEGAN ANIMAL RIGHTS ACTIVIST AND PROUD OF IT.

      1. xvx,
        where’s the racism?
        Do you really think a statement like “x did y” is racist when not immediately followed by a “but a, b, c, d, and e did too”?

        The problem with using such unfounded accusations of racism is that real racists get the opportunity to get away with their acts saying “O, you know how these political correctness people are: they shout racism every time somebody speaks up.”

        You’d be more effective promoting your cause if you’d be a bit more careful with your words.

        1. No but it is innapropriate to talk about the alledged reponsibility for extinction of an aboriginal people, when western culture is actually making approximatly 200 species disappear into oblivion every single day. It would be like talking of the racism of the Jews during World War II. It would be unfair and probably ill-intentioned.

    2. You are suffering from Racism in your brain.
      You could call it an “Unconscious bias” a phrase used by racists to get away.

      1. Cardinal Cacciatore have brought this to my attention; he shall be Holy Father after me–the Pope George Ringo I. Ah yes–to be canonized is long process, there are many steps, but death must precede them all, and before that, the miracle(s). Miss Minger, we pray, shall be not eligible (for consideration) for many many years.

        Still, in interim, steps can be taken in acknowledgement and gratitude. While we continue to study the literatures of which she has authored, It has been commented on the beauty of Miss Minger, and yes, we, having reviewed the evidence, a determination has been made that Miss Minger is Ea pulchrior Iesu infante est; how you say in English: “Cuter than Baby Jesus”. Should she deign to visit the papal residence within Vatican City, and indeed this would be most highly encouraged, she shall be recognized as Puella formosa in urbe, or as you say the American states, [a] “Hot Child in the City.” Indeed, this title applies to Miss Minger when she resides in any setting of urbanity.

  4. C’mon… all that and no mention of, uh, *clears throat*, “the flag still rises?”

    Great work! Exactly why I started taking notes at the 30-second mark and stopped at the 30-minute mark – I just wasn’t up to this task.

    1. hmm, i thought exactly the same thing, i sent it to all my friends WIVES, including my own… (ulterior motive there) but i doubt they will read it…

  5. Props to you for making an effort on writing this novel, I meant blog. I had the time to read all of it but not the patience so hopefully someday you will have resources to turn this blog into a documentary so maybe more people will be interested. I guess that’s always the case about documentaries being biased which makes me think, what would be their agenda? Would these doctors make more money participating in this documentary? Are these doctors also farmers thinking that if they reveal their studies to the people, they would buy more vegetables and fruits from them? I don’t think so.

    But maybe I’m the biased one. I’m a healthcare professional who see patients with the same diseases, morbidly obese patients who can’t even wipe their own butt.And I always ask them, what do you like to eat? They answer meat like burgers, hotdogs, chicken and lots of sweets. especially the processed one. And I’ve also been starting to notice that they’re getting younger and younger. I have a 39 yo patient with full blown tumor in his throat and guess what kind of diet he used to have? You know the answer to that.

    I watched this documentary and guess what, it didn’t make me want to be vegan or vegetarian. It just made me want to eat less meat and eat more fruits and vegetables. And it made me feel really good. I have more energy, i feel lighter and just healthier. I really could care less about their studies. But between you and these doctors, I would listen to the doctors. They made the real effort to help in terms of being healthy. All you did was question their studies. But like I said, there is always an opposition to everything good or bad. Hats off to you still.

    1. Burgers come with buns. Hot dogs come with buns. Chicken is often breaded and fried. Sweets don’t usually come from meat in the United States.

      All you’re seeing is the meat? Really?

      It is hard as heck to get a straight answer out of someone of what their typical diet is. We don’t remember after a day or so. We have to guesstimate. And that’s *before* measurement comes in. I do best with my weight loss when I track my food but I HATE tracking food. You would too, if you had to weigh everything before it went into your mouth. It’s supposed to be a temporary thing but it’s still a PITA. And most people filling out food-frequency questionnaires, or simply asking their doctor’s or dietician’s or nutritionist’s questions, won’t have measured.

      You basically have no idea of what your obese patients are eating. You zeroed in on a few foods because you have an axe to grind and you have about gotten down to the handle now. Put the handle down and next time you see an obese patient, ask them have they ever used SparkPeople. I’m sure you can figure out where to take it from there. I will be VERY surprised if you don’t find that these people get a good 500 grams of digestible carbohydrate from starch and sugar per day. That’s from plants, by the way, just in case you forgot.

      1. I would also add that when was the last time you ate a hamburger or hotdog without fries or chips? And most likely soda as well.

        You say you’re going to McDonalds for a BURGER, when the macro breakdown for the actual meal would have the processed carbs grossly overshadow the ‘meat’.

      2. The movie was about meat AND processed foods. It is widely known that the ‘western diet’ has gotten out of control- the average meat intake has increased, and it coincides with obesity and serious diseases. The average processed food intake has increased, and so has obesity and serious diseases. Isn’t it just common sense to see that the ‘western diet’s’ lack of an abundance of whole, unprocessed, plant based foods- and also the fact that meats and processed foods can be a source for synthetic ingredients, harmful chemicals, and hormones- is causing problems for a lot of people, and that eating healthier will help stop those diseases from occurring. Maybe the doctors were only commenting on the parts of their studies that related to the subject they were talking about (hmmmm- no surprise) with the hopes of getting ignorant people to pay attention. Maybe eating a diet with less meat and processed foods would cause the same, healthy result that they portrayed in the movie with the plant-based diet (they never said it wouldn’t, they just said they chose to promote a wholly plant-based diet), but it is indisputable that the current ‘western diet’ encourages consumption of way too much meat and processed foods than what the average American should be consuming. It’s been proven, whether meat is healthy or not. Anything in excess causes problems. You saw that part of the movie, right? about the evolution of the food pyramid? and how it recommends an overdose of animal proteins? I haven’t seen anyone say that they agree that eating excessive amounts of animal protein and processed foods are GOOD for you and PREVENT diseases. Is it really all just so that people don’t feel guilty eating their meaty and processed bun of a burger or processed breaded and just dunked in unhealthy processed oil fried chicken? Maybe that’s worth doing a study on.

        1. @Lisa:

          “the average meat intake has increased, and it coincides with obesity and serious diseases”

          Interesting. Care to provide some evidence to backup this blanket statement?

          @Jane:

          Up to this point, your posts have been interesting. Even though I mostly disagree with your points of view, I actually enjoyed reading most of your posts. I think it would be a pity to enter a different territory.

          @ Selena:

          “it all boils down to BIO-INDIVIDUALITY.”

          You could just as well say, it all boils down to chance. Or personal beliefs. You name it. When you start using relativism as the basis to approach nutrition, you can state anything you like, even the wildest claims (i.e. “SOME people can eat only carrots for years, and be healthy, you know..”). I personaly think it’s a receipe for baloney, and actually rather close to obscurantism.

            1. Respond to what? Your petty opinions? Your petty accusations? I can’t see any point in doing so. Bring something remotely interesting to the debate first. But… I smell the Troll scent.

              1. Scientific integrity and ethical business practices are a foreign concept to idiots. These are usually are the same people that think all corporations and businesses are evil.

                1. It is not about being evil as the devil. However, corporations are discouraged in every possible way of behaving ethically and compassionately. Add to that the fact that a corporation isn’t a living being in which no one trully feels responsible. And they better, caus if they do, they’ll lose their job. So you get something that certainly looks evil, while it’s simply people doing what they are encouraged to do. It is ludicrous to believe that the masses will go against the grain.

                  1. Corporations are not entities that can make decisions with feelings. The decision makers of corporations are no more evil that the population and your statement that corporations are discouraged from behaving ethically or without compassion is meaningless. Corporations are conceptual entities that share ownership of a business. The first corporation ever is the Catholic Church. The talent needed to successfully operate a large corporation is considerable and those people are rewarded generously. We all benefit from corporations with cheaper goods and services. If a corporation has suspicious business practices it will not prosper. It is popular to demonize corporations and business but where would we be without them? You can’t do better.

                    1. We all benefit from corporations with “We all benefit from corporations with cheaper goods and services. If a corporation has suspicious business practices it will not prosper.”

                      LOL! We “ALL” benefit. Tell that to the Chinese manufacture workers, or others in Mexico, Eastern Europe or elsewhere. Tell that to non-human animals. And your right, a cheap toaster from Wal-Mart makes me so happy. Maybe you should try questioning things rather than faking it to look smart and reassure yourself while not making significant changes in the way you see the world and/or act in it. I know what a business is. For example my father is a veterinarian. The city brings him stray dogs for euthnasia. At some point he decided this was unacceptable and tried having those pets adopted. He now loses money because they use space, cages that paying clients could be using, they require medical treatments, they need to be fed, employee time, plus time setting the adoptions up. There is no doubt he would make more money otherwise (their are only costs, no revenues) and/or could probably lower prices. That is the reality which every entrepreneur must face. And the problem is much exacerbated in a big company.

                    2. At first I was not going to respond to such a ridiculous post but I thought I should to challenge your miserable understanding of how business takes people out of the retched living conditions that exist in most of the world. When a corporation opens in the poor areas they are inundated with people looking for jobs to help take them away from the bare agrarian existence.
                      You should ask these people how they feel about the opportunity to get their fill of food everyday.
                      Here is how it was before the industrial revolution.

                      http://www.forbes.com/sites/objectivist/2013/02/25/capitalism-in-no-way-created-poverty-it-inherited-it/

    2. Oh and by the way? I told my doctor last year that I was trying to follow a grain-free diet. She was a good sport about it, but she looked at me like I’d grown a third eye on my forehead, and said she hadn’t heard of anyone doing such a thing. A doctor. An MD. In 2010.

      Just because someone’s a doctor doesn’t mean they know better. They get, what, one unit of nutritional training? Possibly not even a term in college? Maybe a couple weeks?

      I told her I have trouble converting beta carotene (as far as I can tell; the signs certainly point that way). She’d never heard of that either. Almost half the population does now, at least out of the healthy folks. If you count the diabetics, the folks with metabolic syndrome and the folks with slow thyroids then the number’s probably much larger. I fit into at least one of those categories. My labs were only as good as they were last year because I’d already cut so much (carby) crap out of my diet. There was still room for improvement. Nope, no use for beta carotene here. It’s fish liver oil for me.

      1. If you want to be cruel, next time ask her to look up your year over year triglyceride and HDL numbers and read them out to you. My Doctor put his head in his hands saying you always have a hole for me to fall into..

    3. Meaning no disrespect Jeanne, but you’ve decided to alter your eating patterns based on a biased documentary, but you don’t have the patience for slogging through a (albeit long) post that debunks the science it’s basing itself on. Don’t you think you owe it to yourself ? This sounds like a case of “Don’t confuse me with the facts”.

      Some of the doctors might be well meaning but they have a raging case of confirmation bias. Like, well you. You see what you want to see, and anything that doesn’t fit becomes invisible. A human trait, but one that needs to be guarded against, not embraced.

      1. I missed that one!

        “This sounds like a case of “Don’t confuse me with the facts”.

        Some of the doctors might be well meaning but they have a raging case of confirmation bias. Like, well you. You see what you want to see, and anything that doesn’t fit becomes invisible. A human trait, but one that needs to be guarded against, not embraced.”

        Beautiful, Angelyne, beautiful. :-)

        Wizzu

      2. Angelyne,
        “Meaning no disrespect Jeanne” but you’re uninformed, impatient, irresponsible, ignorant, biased, and lax?

        Meaning no disrespect Angelyne, but merely putting that phrase in front of a row of insults doesn’t take the respectlessness out of them.

        1. There’s a way to word things in a more respectful way, which is exactly what Angelyne did. Meaning no disrespect, but you’re just being a douche.

          (Just to be clear, yes, I know that saying you’re being a douche isn’t very respectful).

      3. “Some of the doctors might be well meaning but they have a raging case of confirmation bias.”

        How, exactly, is this article not doing the exact same thing? It leads with a statement saying the author has set out to disprove all works of Dr Campbell. It’s not possible to give this article any sort of credibility when it starts out saying it’s intentionally biased.

        1. “It leads with a statement saying the author has set out to disprove all works of Dr. Campbell?”

          Where exactly was that?

          1. The bias referred to is in the first paragraph of Denise’s paper: “In case you aren’t yet convinced that I’ve made it my life’s mission to critique everything related to T. Colin Campbell, this should seal the deal.”

              1. You can read those words quite literally and believe the critique could be positive, but the sentiment expressed there is clearly non-supportive…and anyone who thinks otherwise has serious delusions. Those words are reserved for finding fault.

              2. Technically speaking, a critique may indeed be positive or negative. However, a simple reading of Denise’s paper reveals that the critique is negative. Also, when someone makes it a ‘life’s mission’ to critique the life work of another, this suggests a bias.

                1. Not all biases are bad.

                  I find I am rather biased against climate change deniers, Miley Cyrus twerking, Jerry Bruckheimer movies, etc.

                  Given the lengths T. Colin has gone to in advancing an agenda, rather than having his conclusions follow the data, Ms. Minger’s bias seems well-founded.

            1. The thing that Kay and Brian are missing WRT the statement of Denise’s “life’s mission” is that Denise is again flashing her sense of humor. Perhaps you didn’t pick up on that, but she was being cheeky. It seems to me that when offering as thorough (and therefore prolix) analysis of FOK as Denise has, a little humor is a welcome leaven.

              As to the notion of criiques and criticism, a critique should be per se objective; it’s conclusions may be positive, or negative, or contain both positive and negative elements. I find nothing in the analysis and methodology Denise utilizes to indicate bias, and to say that this piece is somehow biased seems to indicate that the reader simply didn’t care for Ms. Minger’s conclusions.

              1. Perhaps in jest, but then again, many a true word is spoken in jest. As for not caring for Denise’s conclusions, this is true, but not because of vegan beliefs or practices on my part. In fact Denise is closer to vegan eating than I have ever ventured. I have a problem with her conclusions, simply because they are wrong.

                1. You don;t make a convincing argument just stating that Denise is wrong. Opinions are like *, as the saying goes.

                  1. Opinions like * – If it looks like, smells like, tastes like a turd, you need a convincing argument?? There were 4 blind guys feeling an elephant, one feels a leg and says…
                    LMAO

                    1. The only thing that smells like a turd are the posts like yours, criticizing this post in the most infantile ways without offering anything even remotely resembling a cogent counter-argument.

                      You need an olfactory re-alignment, because your sense of smell is obviously very bad.

                    2. Stll LMAO…Just like Denise’s; it’s just my sense of humor…please don’t misjudge me for it. What’s sauce for the goose is sauce for the gander.

      4. You pretend it has been debunked. This critique certainly is interesting and is worth investigating further but it has not, right off the bat, debunked anything. Just as the documentary did not seal the deal. I suggest most people here read the response of TC Campbell to Denise’s China Study critique, to which Ms. Minger graciously posted the link on this website. Their are serious scientific flaws to this critique which I think are unfair to Dr. Campbell. Furthermore, it is ridicule to tell someone they are hiding from the facts because they don’t read everything everyone has to say on a particuliar subject. We all have something, many other things to do, so while getting as much info as we can, we are obliged to rely on intuition in a general sense. And more practically, we might believe someone who has dedicated most of his life to nutritional research before a young blogger. This is not meant to be mean by the way.

        1. Many years ago, Time Magazine ran an ad campaign asking people to “consider the course.” I think of this ad slogan every time I run across yet another frustrated English Major (not even a journalism degree) setting herself up as a nutrition expert. — Nicole Anderson, Cal-Berkeley

          1. Nicole,

            Denise doesn’t give any advice and she doesn’t set herself up as an expert in anything. In fact, she says, ‘here’s the data, take a look at it yourself. You don’t have to be an expert to see that it doesn’t match what the so-called experts claim.’ It’s the same data that has been published for you to look at. Are YOU too ignorant to add a few numbers or calculate a percentage? Are doctors still thought of as Gods? They get about 25 hours of nutrition education in med school. It was generous of you to take the time to leave a comment that adds nothing to the discussion but snide derision. That far better resembles the mark of a frustrated English major, and it’s probably time for a little introspection on your motives.

            ________________________________

    4. Hi Jeanne! I’m an NP with a practice specializing in women’s health. I work with obese women a lot. All of my clients keep a diet log for 2 weeks prior to their first appt and they are asked to eat normally, to not make any dietary changes before their 1st appt. I have not yet reviewed a diet log of an obese client that was not filled with sugars/grains. Processed food intake is high for most. I recommend you also have your clients maintain a preappt. diet log. I guarantee that when you see the consistent carbohydrate abuse or high carb intake on their food logs your conclusion will change!

    5. This brings up a question I had…based on the remarks of both Esselstyn and Campbell, I’d expect that very few lifetime vegans have ever been diagnosed with Type II, diabetes, hbp, high cholesterol, heart disease or cancer. Even less would have died as a result of any of those illnesses. After all, they claimed that it appeared animal based protein was the impetus or appeared to be implicated in cancer . Anyone got the stats for the mortality rate of vegans for these diseases? It would be wonderful to have a followup documentary with the numbers then question these two doctors on what each vegan had done “wrong”. Or maybe it was genetic. :)

      1. There cannot be life long vegans, veganism is an insane experiment on diet. If infants from birth ate a vegan diet, they would fail to thrive, contrary to there belief, animal fat and protein are essential to our health and well being, If someone ate a Vegan diet without supplements for 30+ years they would have severe nutritional deficiencies….contrast that to an Inuit eating a diet completely based on animal fat and protein that will require no supplements over that same 30 year period and be in good health….veganism is a dead end….if children fail to thrive on this diet, why should adults be eating it…

        1. Hi Ryan,

          I read your comment about Forks & Knives, but i disagree with you that we need a diet full of animal protein and fats for infants or adults for growth and to survive.

          I have watched many health food videos and not just only forks & knives. Watch “food Matters” and read ” One Answer to Cancer” and you will realized that many healthy persons live on a very good nutritious plant based diet, and also and more importantly, where their overall health problems also mostly disappear or can stabilize to normal.

          Babies or infants the best source of food comes from mother milk, which has only around 5% protein and I do not see any babies not growing unhealthy, so they do not need to drink abnormal, processed cows milk.

          Yes! I do agree with you that on a plant based diet you do need to eat more vegetables and fruits, nuts and seeds, but thats the problem, as where people need to understand this.

          The best way to do this is to Juice your vegetables, which is the best source of getting into your body all the essential vitamins, minerals and the small amounts of protein you need for your body to function accordantly.

          I also take Super foods. Read “David Wolff” his book named “Super foods”
          Chorella, Spirullina, Maca and Raw chocolate with honey and flex seed oil can do wonders to your body.

          John from Malta

    6. Jeanne, you should never criticize someone for questioning someone’s study. I’m sure the doctor’s in these studies have very pure motives, but they are not necessarily unbiased. They are promoting an animal free diet because they believe it is healthier, and it would certainly be better for the planet and animal welfare if more people adopted the diet. It’s important to listen to what everyone has to say, though, and even better if you can get a counter argument from the doctors in response. You can’t take anything for granted, especially since the views in the documentary are not widely accepted in the scientific community. I guess if you don’t have any science background at all, it can be tough to discern fact from fiction. This should make you extra skeptical of everything. Always think, how might they be trying to trick me, and why would they? In this case, what motive would the doctors have? I don’t see any really harmful ones. Maybe they love animals and the planet. They seem like good people to me. After watching to FOK documentary, and reading this blog, I will replace more of my meat with fish, and cut down on wheat. I already eat my veggies. I’m cutting down on sugar, too, and added fats.

      1. Here is a post I really like. I don’t come to the same conclusions as yours (and thus I don’t follow the same diet), but I share your overall points of view and attitude towards ‘information’.

        “Minds are like parachutes… they only function when they’re open.”

  6. Denise, great research with exceptional validity. I think I have fallen in love with your mind :) It’s time academia got a good boot up the bum for poor thinking processes and making huge assumptions that are not supported by data.. PLEASE keep up the fantastic work.

  7. Thanks for this. I just made my husband watch the movie because I want to lower our meat intake and up our vegan meal intake. We rely too much on meat for our meals and it lowers the amount of vegetables, beans, and stuff that we eat.

    A lot of alarm bells went off while I watched the movie (and read all the books – Fuhrman’s, etc.), but I am trying to get a feel for all the different conclusions researchers have come to.
    For the movie, I figure they know most people won’t want in depth explanations, so I forgave their shallow explanations. I definitely had a real problem with both the Norway info and the casein diet extrapolations.

    Right now, I think a heavily plant based diet, while limiting table sugar and anything else processed and sticking to whole grains like rice is probably the healthiest. Meat should come from free range animals and I should try to find some safe fish. My gut feeling, though, is that meat should be a few high quality ounces a day only and not be eaten all day long. Balance is key. I’m not sure what to do about oil, though. I need to stir fry my veggies and use a bit of oil in the oven and I am completely baffled as to which sort to use. I have some pig fat in my freezer from a free range pig and I was going to make lard. ha ha ha. I remember reading somewhere that it holds up better for frying. I don’t know how true that is.

    And also, you don’t need to apologize for all the graphs, etc. I’ve had doctors tease me because I get so excited by all the “data, data, data” and always want to analyze my own blood tests and such. I definitely like to see what you used to come to your conclusions. Don’t apologize for the people who get annoyed by data… I doubt they’d be reading your blog if they didn’t <3 data.

    One thing, though. Where do the Chinese get their meat from for these studies? And how much meat are they eating? Are they eating factory farm meat or meat from cows in fields? Are they eating very small portions of meat when they do eat it?

    And the issues with wheat… Is it actually wheat, or is it the stuff we always combine with wheat before eating it? Everything we tend to eat with wheat in our house has sugar / milk / eggs / star trek ingredients in it. It is all pretty highly processed. I am going to go read your post on wheat next, though…

    Anyway, great job and thanks for posting this.

    1. Pastured lard is a great fat to use and very stable. So is coconut oil. Coconut oil is used by some for weight loss, you can google to find out more about it of course.

    2. @Bethany. I think you are spot on. Your diet sounds very close to a primal/paleo diet. You should investigate that. You’ll find a community of really smart people that blogs about the paleo/primal lifestyle.

      The fact that you saw this documentary and heard alarm bells, puts you in that rare category of critical thinkers. We need more people like that :)

      Talking about critical thinking skills, saturated fat has been unfairly vilified for decades for absolutely no reason. Despite decades of trying, scientists have never been able to show saturated fat to harmful.

      So that’s what you can use to fry. Lard, suet, duck/goose fat, bacon grease, coconut oil, butter/ghee. Plenty of choice to suit any type of dish you want to make.

    3. Forgot to add. It’s the wheat itself. Read “Wheat Belly” to see what I mean. And yeah, the sugar, and processed oil that more often than not accompanies wheat, just makes it all the worse. A perfect storm…

    4. Check out whfoods.com: He recommends doing a “healthy saute” for veggies with veggie broth. It works for most of my needs. Lard & coconut oil are other options & stable at high temps.

      For me, who has never had a major health issue or weight problem, I think everyone should FIRST aim for a REAL FOOD diet. From there you can tweak to your needs. From Paleo to Vegan I think we can all agree that preservatives, trans-fat, & HFC syrup are all bad, and eliminating Frankin-foods is the first step to health.

  8. I was totally with you until that last bit. Sounds like you’re dismissing plant based nutrition on the basis of the blood lipid profiles of 11 advanced heart-disease patients (I’d be happy to share my own blood lipid profile for contrast). Otherwise, fantastic post. Popular documentaries bug the crap outta me. There’s no wisdom in dumbed-down for the masses sound bites.

    1. She was dismissing the particular study, and for very good reasons as outlined, not plant based diets in general. She has already destroyed Campbell’s book in previous posts (she gives the super short version of that in this post), and the remaining evidence presented in the movie didn’t say what they said it did. Thus dismissal of the movie’s conclusions, but not necessarily plant based diets in general. In other words, she didn’t say all plant based diet research is flawed, just these bits of research presented in the movie. Basic logic dictates that you can’t automatically jump to the conclusion that all plant based diets are wrong just because the studies presented in this movie were highly flawed.

      It would be pretty ironic if Denise argued that a plant based was bad, considering that according to her “About Me” page she eats an almost entirely plant based diet herself. Notice the title of the blog? It’s there because she’s a raw foodist, which necessarily cuts out almost all animal products except milk (according to some definitions) and raw fish. In an older post or a comment somewhere here I believe she described her diet as something like 90-95% raw plant based, and the remainder raw fish.

      1. I wouldn’t say that a raw diet by definition precludes most animal products. If you work with pastured-fed, organically raised animals, there’s little reason to avoid eating the meat raw. Same goes for eggs. Raw foods, meats and eggs included, have vastly improved enzyme make-ups. Enzymes are destroyed and proteins denatured through heating.

        1. Enzymes are proteins. Besides by heat (cooking), enzymes are also denatured/destroyed by acidic environments–like the one in your stomach (pH anywhere from 1-5 depending on when and what you last ate). Whether consumed raw or cooked, the enzymes in the foods you consume are denatured and hydrolyzed before you absorb them into your blood stream.

  9. Very thorough! Love it. There’s a supposed doctor in the movie named Pam Popper…she happens to live in the same city as I do and owns a hot yoga studio (was called Bikram yoga, but she got in trouble for using the name Bikram). I attended her class once and she was a supreme B**** to her clients. She yelled about how dairy is a carcinogen and she should know because she’s a doctor. After about an hour of her miserable 108 degree yoga class with all the talking down to us, I left the studio, but I made sure to check her credentials on my way out. She had degrees from online universities that I had never heard of. If you look her up online, you will find no listing of the universities that she attended. And this is one of the very radical heroes of modern vegans. I know one vegan who chooses to be vegan because of her love for animals. The rest are radical, agenda-pushing wanna-be’s. They are no better than the radical tea party movement.

      1. Yeah..wanting the government to stop giving subsidy payments to industrial corn and soy producers (or at least the ones I know). Darn them radicals. :)

      2. Ya, those Tea Partiers who are backed by their corporate sponsors like the Koch brothers. They are not a grassroots movement but an attempt by radical libertarians-not traditional conservatives-to dismantle the New Deal, safety regulations, corporate regulations, and any financial regulations, and we know how that turned out in 2008. Where were they when the Constitution was being crapped on for 8 years? They only decided to get vocal when a black guy was elected.

        BTW I am paleo, don’t eat wheat or any processed food, and I hunt. The lobbies for the wheat and soy growers are two examples of powerful influences on government to the point where their lobbyists are part of the agencies that are supposed to ‘regulate’ these industries, and are often the ones deciding what is ‘healthy’ for Americans. The problem isn’t ‘big government’, but the collusion of government and big business. This is known as corporatism.

        1. 1) I am, by your definition, a “radical” (is there some other kind?) libertarian. Who is more supportive than not of the TP.
          2) The TP “originated” via Ron Paul’s 2008 campaign, which was as “grassroots” as any movement in modern political history.
          3) Suggesting contributions from the Koch Bros created this movement, or that this movement was lead by the Kochs is as disingenuous, or naive, as claiming McDonalds made Americans like meat and cheese.
          4) The demographics of the TP are interesting, and inherently unstable http://reason.com/poll/2011/09/26/is-half-the-tea-part-libertart with @2/5 being good, noble libertarians (or fellow travelers) like myself who want to “dismantle the New Deal, safety regulations, corporate regulations” (and bring back slavery, witch trials and thatched huts) and the remaining 3/5 being those “traditional conservatives” you mention, such as your hero Rick Perry, seen here: http://youtu.be/BhDhDRvHaGs

          1. So, do you get a medal for being the first tea partier? Oh yeah, I was there during the embryonic stage, too, when a dozen people picked Wall Street unsuccessfully during the winter of ’08/’09.

            Let’s face it, Dick Armey and Glenn Beck coopted the movement within three months of Santelli’s cri de coeur on live TV. I haven’t forgotten the day the scale tipped away. It was early in the spring of 2008 at a Florida Tea Party rally where a young speaker started talking about George Bush’s role in the 2008 bailout and the geriatric, anti-Obama crowd booed.

            Run the numbers: fiscally conservative libertarians with brains are handily outnumbered by the neo-Bircher crowd.

      3. Tea Party “Radicals” are not racist and could care less what color Obama is. Look at how many of them support Cain! Last I checked, he was black too! I am sick of people throwing in their hatred for our country’s past and the right side whenever they get the chance. Notice no one is talking about the organizers who are being arrested left and right? Whatever. And the big difference between the years of Bush vs Obama is that Bush was supportive of our country, our military and at least tried to stand up to other countries. Obama is bending over to them and look at China, Iran and Russia. They are developing nuclear weapons. Who holds all our debt? China. Who doesn’t like us? Iran. Wake up people.

        1. Actually, quite a few tea party people are extraordinarily racist. I’m an independent and often get courted by people from the tea party movement. They do not seem to be able to reference Obama except in racist or ethnographic terms (he’s Kenyan or he does not take care of blacks, or he is not a citizen, or he is not really black or…) that is part and parcel to the dialog. Cain was only acceptable because he was a counterbalance to Obama and therefore a “good ni…..” because he belonged to the GOP. It was about race, and it will always have a racial component. That may not be the only component, but I have been talked to and feted by tea partiers in Indiana , MO and KS–and they ALL bring up race–over and over again. That is one of the focus and like many said, their concerns about the budget (which I share) and government (which I share) fall flat when they speak of it in terms of basically getting their own way yet using the same government to control everyone not on board with their agenda. racist, sexist, genderist, myopic and selfish party if ever there was one.

      4. There is more to the tea party movement than that—we know this because of who is in the movement and what they proclaim. The movement is simply a holding cell for some conservatives, some radical right and some radical left, a lot of racists and then some people who cannot find a job and blame their local/state employment crisis on the federal government instead of their state/local government–but we digress. This is about vegans and a vegan dvd that was presented as “pseudo science” in much the same spirit as those commercials for the latest diet gimmick are on tv after 12 am . Dangerous only because so many in America don’t think and what ever is in the “spoon” they gratefully swill.

  10. Why the concern over those who disparage the Weston A. Price stand on traditional diets?

    The science presented by Weston A. Price Foundation proponents makes sense from the same standpoint. People, meat eaters or otherwise, were healthier before ANY of our main dietary staples were so unrecognizably processed by modern preparation and packaging. Where’s the dispute? I cannot understand why it isn’t obvious that no matter what we choose to eat, the processing is only doing us harm. I truly believe that heat processed oils, feedlot meats, and vegetables, grains, and beans sprayed with pesticides and genetically modified, are foods that are unrecognizable to our bodies as nutritional sustenance. Hence the development of disease, and the increasing proliferation of obesity and malnutrition. The body reacts to these foods by treating them as poisons, or storing them as fat.

    Where the Weston A. Price approach makes sense is in consideration of traditional foods being healthier, no matter where we come from on the globe. Comparing diets from one culture to another is fine, but somewhat moot, in my opinion. A negligible few of us are ever going to find it attractive or even practical to adopt the traditional diets of another culture. We would all be healthier, current diets or not, if the foods we ate were from meats fed the diets they evolved to eat, fats cold pressed or rendered in their whole state, and vegetables and grains grown organically and eaten in season. Period.

    With regard to over-eating and gluttony, we have found in our home that a traditional diet is more satisfying and we eat less overall. I believe this is because traditional meats and fats, and organically grown veggies, grains, and legumes are more nutritious and satisfying. They are foods our bodies recognize, and can process and utilize as the fuel they are meant to be.

    When considering a “plant-based diet” in comparison to a balanced diet inclusive of healthy proteins, Nina Planck, in her astounding book “Real Food, What to Eat and Why” makes a fascinating and obvious point when she says-

    “The simple truth is this: there are no traditional vegan societies. People everywhere search high and low for animal fat and protein because they are nutritionally indispensable.”

    and

    “Cooks know that gelatin-rich broth extends the poor or scant protein in plants. Even vegetarian societies prize either dairy or eggs.”

    and

    “The vegan diet is unnatural and rare because it’s risky, especially for babies, children, and pregnant and nursing women.”

    And, lastly,

    “Protein needs are unforgiving: when the diet lacks amino acids, the body ransacks it’s own tissue to find them.”

    I believe the Weston A. Price group has one thing right, and that is to stop eating processed foods, and we will all be healthier.

    Ann Griffin
    Not a professional, just an eater that does my homework!

    1. We could further explore and perhaps should explore the satiation factor. People simply have no idea now when to stop eating or when they are “full” . There is a diet out that I thought was amazingly irresponsible and ridiculous (fatloss4 idots) and has more negative reviews than positives online. I tried it on a lark. (why oh why?) and lost 16 lbs the first 2 weeks then 16 more the other. I got off because I did not need to lose any more weight AND I could not fathom the nutrient quality of the diet. working or not–it did not seem nutritionally sound to me. There was plenty of fresh fruit and meat but a meal consisting of merely scrambled eggs and boiled eggs?

      The lynchpin was to eat until you felt full–no minimums or maximums just eat less than full satiation. A lot of people can’t do that and so the diet failed them. I loved the graphics in the movie which showed what calorie dense food did and how it was perceived in the stomach. It made a lot of sense and was in a form people could understand. All in all, my takeaway from the movie was no to processed foods (totally agree with your post on that point) no to refined foods or minimize it and KNOW your body. I eat out a lot due to one of my jobs and so find I usually have a doggie bag with 2/3 of my dinner in it. I can eat on it for usually 2 meals. On the other hand, my dining companions usually are finished with plates pretty clean by the time I am ready to call for the check.

  11. I love your post. All I could think the entire time I was watching the movie was “this is such BAD science” or in some cases “this is such bad INTERPRETATION” of science. I followed watching this with a viewing of “FatHead” which was a “comedy” but had much better scientific interpretation!

  12. Awesome timing on this post Denise. I happened to watch Forks Over Knives on Netflix today after my husband came across it in the new movies section and said it looked like something I would like from its description:

    “Focusing on the research of two food scientists, this earnest documentary reveals that despite broad advances in medical technology, the popularity of modern processed foods has led to epidemic rates of obesity, diabetes and other diseases.”

    I spent the movie taking mental notes of things that I disagreed with, and it was awesome to see them all written out here. Thanks!

  13. Cod liver oil and fish roe in Norway? No wonder their teeth got better and their heart disease decreased. CLO = vitamins A and D, as you accurately pointed out, and fish roe = vitamin K2. What you’ve got here is the holy trifecta of fat-soluble vitamin supplementation. The fact that so much of their milk was skim would have increased their mineral intake, too–and while under ordinary circumstances they couldn’t have absorbed much of it due to a decreased fat intake, perhaps the CLO and the fish eggs helped?

    The more I learn about what’s in meat, the less impressed I am with the culture’s (ours) insistence that a plant-based diet will save us all. We keep speaking of meat as though it is only useful for obtaining protein and fat in the diet. But animal foods have the best forms of A and D (you can’t find D in high amounts in many foods, but for D3 all the food sources are animal) and K2, they’re the best sources of several (if not all) of the B vitamins, they’re the best source of sulfur which may turn out to be quite important in carbohydrate metabolism along with all its other functions, they provide a more bioavailable form of all the bone minerals, etc.

    And get this? Animal proteins come with their own buffering agent. It’s called glutamine. That is, l-glutamine, and not to be confused with glutamic acid or the glutamates (which are also important in the body, and NOT the same as MSG, which is a protein salt, but still not the same as glutamine). It assists in the process of turning excess hydrogen and nitrogen into ammonia in the kidneys. Now, your body must do this for ALL proteins you eat. Plant proteins are not exempt. But plant proteins are for the most part noticeably deficient in glutamine. Two exceptions I’ve heard of are wheat and spinach–and nobody in their right mind would rely on either of those foods for their main protein source. Lectins and phytates and oxalates! Yum yum! I can feel my bones dissolving already!

    I am *so* unsurprised that Lierre Keith and other ex-vegans tell stories of bone loss suffered during their vegan years. We’re already seeing too many women getting osteoporosis on an *omnivorous* diet who didn’t have to, and I suspect this heavy emphasis on a “plant-based diet” is to blame. Women have already historically gotten the short end of the drumstick when it came to meat rations in far too many cultures throughout human history and now, the weight loss and dietary health industries seem determined to drive that final nail in. Y’all, if you want to still have all your teeth and bones into your elder years and you want to have grandchildren to spoil, stop listening to the wannabe herbivores. Please.

  14. Wow….you sure do great research! In your honor, I would say the word ‘minger’ should mean ‘to deftly skewer folks by analyzing and explosing their blatantly distorted or incorrect facts.

  15. “The cause of atherosclerosis”, by William Roberts, the chief editor of American Journal of Cardiology, it’s all well 2000’s.

    All about cholesterol…

    “atherosclerosis is one of the easiest diseases to produce experimentally, but the experimental animal must be an herbivore. It is not possible to produce atherosclerosis in a carnivore but with one exception, and that is in carnivores that have hypothyroidism due to thyroidectomy”

    http://ncp.sagepub.com/content/23/5/464.full

    Jenkins, the inventor GI-concept, all about cholesterol and the flawed science and dairy sponsored “research” behind the “cholesterol is not bad”-frenzy

    Dietary cholesterol and egg yolks: not for patients at risk of vascular disease.
    Can J Cardiol. 2010 Nov;26(9):e336-9.

    http://www.ncbi.nlm.nih.gov/pubmed/21076725

    1. Hi Richard,

      I don’t think anyone’s arguing that humans are carnivores, so I’m not sure how your first quote is relevant. Scientists have induced atherosclerosis not only in herbivores, but in omnivores as well (like dogs, pigs, and chimps).

      As for your second link: Did you read the full-text? The authors try to use observational studies to “prove” eggs increase heart disease risk, and cite studies that have the very flaws I mentioned in this blog post — particularly failure to separate the effects of increased saturated fat intake from increased cholesterol intake. They also try to claim dietary cholesterol increases LDL oxidation by citing in vitro experiments, which often fail to reflect what actually happens in the human body.

      The study’s authors aren’t exactly unbiased, either. As mentioned in the “conflict of interest” section of that article, two of ‘em have vested interest in making cholesterol look bad:

      “Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs, and Dr Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium; his research has been funded in part by Pfizer Canada, AstraZeneca Canada Inc and Merck Frosst Canada Ltd.”

      1. Don’t worry, William Roberts just uses bit of an unclear vocabulary. Essentially what he means that since atherosclerosis is only a disease of herbivores, then humans must be herbivores. Atherosclerosis cannot be experimentally initiated to animals who biologically flesh-eaters. He elaborates that biologically the optimal diet for humans is that of plant-based, vegetables, fruits and cereals. There’s no talk of humans being omnivores, period!

        Your meat-eating Masai tribe, even the young blokes have arteries of an old middle-aged, Western men, plagued by atherosclerosis, although they seem to get away with with their 30km daily walks.

        “Atherosclerosis in the Masai”

        http://aje.oxfordjournals.org/content/95/1/26.short

        The inuits are well known for their poor cardiovascular health, (along with women who at the age of 19 look like 45)

        “Low incidence of cardiovascular disease among the Inuit—what is the evidence?”

        “The evidence for a low mortality from IHD among the Inuit is fragile and rests on unreliable mortality statistics. Mortality from stroke, however, is higher among the Inuit than among other western populations”

        http://www.sciencedirect.com/science/article/pii/S0021915002003647

        So, no the doctors of Forks Over Knives are long from the only ones believing animal products, let alone cholesterol, are harmful.

        1. Denise Minger wrote:

          “Scientists have induced atherosclerosis not only in herbivores, but in omnivores as well (like dogs, pigs, and chimps)”.

          Yes, we have the exception, you are right!

          “These studies initially were done by some Russian physiologists beginning in 1908. And atherosclerosis was not produced in a minority of rats fed these diets, it was produced in 100% of the animals! Indeed, atherosclerosis is one of the easiest diseases to produce experimentally, but the experimental animal must be an herbivore. It is not possible to produce atherosclerosis in a carnivore but with one exception, and that is in carnivores that have hypothyroidism due to thyroidectomy”

          William Roberts, 2008

          1. Sorry, not meaning to hijack your blog, however I missed this:

            “so I’m not sure how your first quote is relevant”

            It’s relevant because Williams is saying that cholesterol is the sole cause of atherosclerosis! He said this in 2008, so the Fork Over Knives crew is long from being unique.

            1. Hi again Richard,

              Based on what you’ve written, I’m disinclined to read Roberts, so forgive me if I’m misunderstanding anything by relying on your summaries. But the statement “cholesterol is the sole cause of atherosclerosis” has to be false because injecting cholesterol into rabbits does not produce atherosclerosis, as Nikolai Anitchkov had noted.

              Chris

              1. Hey, Chris.

                Rabbits are herbivores, and indeed get atherosclerosis incase fed animal products. Ain’t working with dogs, cats and omnivores such as bears. I suggest you actually read what Robers says, after all together with Jenkins he is one of the most leading authorities in cardiovascular issues.

          2. Hi Richard,

            I don’t see where William Roberts has addressed the occurrence of atherosclerosis in omnivores. He seems to only be speaking of carnivores vs. herbivores, which is a false dichotomy. In at least one omnivore (pigs), researchers are able to induce atherosclerosis without the presence of hypothyroidism, which indicates that atherosclerosis isn’t exclusive to species classified as herbivores.

            1. Just catching up now. I want to also just throw in that dogs aren’t omnivores – they’re carnivores who are commonly fed an omnivore diet. So it strikes me that if induced in dogs – that it is more of a reflection on diet and less on species. The same experiment should be run again on dogs fed a carnivore diet.

          1. Hey Fredric,

            I have no suspicions over that in regards to dairy-eating vegetarians, out of whom most of in the Western world just compensate the meat with dairy, however do you any evidence of dairy-free vegetarians, vegans having atherosclerosis or poor heart?

        2. Hi Richard,

          This post explains the emergence of atherosclerosis in the Masai. Their arteries are actually the healthiest during the Muran period, when they’re eating mostly milk, meat, and blood; their atherosclerotic lesions skyrocket after age 40 or so once they have more dietary freedom and start eating sugar, flour, and vegetable oils:

          http://wholehealthsource.blogspot.com/2008/06/masai-and-atherosclerosis.html

          The problem with the Inuit is that they haven’t been eating their true traditional diet for over a century, and any mortality statistics from the 1900s onward reflect the inclusion of Western foods. If you look at their diet in the ’80s, for example, some of the most commonly consumed foods are sugar, white bread, rolls, crackers, Kool-aid, soft drinks, and coffee: http://www.ajcn.org/content/55/5/1024.full.pdf+html

          Even so, I’d say even their pre-Westernized traditional diets (as well as living conditions) are far from ideal for those seeking optimum health. What they ate before the influx of Western foods was out of geographical necessity, not a quest for longevity.

          1. Are you serious?

            The fact that young Masai guys have arteries that of old American men is very illustrating, don’t tell me that American males are oil-free vegans, and never consume sugars and vegetable oils. If the wild theory of Stephan was to have some credibility, the least he could is to show that Masai eat more vegetable oils and other crap as opposed to West. I doubt that very, very much. Stephens theory makes as much of sense as a claim that Atkins secretly consumed vegetable oils and sugary cakes as much as typical American or even more since he had progressed coronary heart disease already in his 60’s.

            It takes a lot to get your arteries in worse condition than that of typical Americans have them. So, if anything you ought to be writing a lot about importance of physical, endurance exercise.

            The inuit source I wired you was from Greenland were the amount of American junk food is not the pronounced as in Alaska. Also, pay attention that the Inuits in Greenland suffer more strokes than Western populations, and the Westerners eat plenty of crap. So looks like the typical Inuit diet still looms in the background explaining the difference.

            So Basically your great meat-eating native populations are all in much worse situation than even typical Westerners, if these studies would match with Westerners with similar exercise habits the difference would be staggering.

            Denise, it looks like you cannot even master the art of cherry picking.

            1. Richard,
              I’d like to see you write a masterpiece like Denise has done instead of being so accusatory–first you’ll need to learn how to use correct spelling and grammar.

            2. Hi Richard,

              Stephan was just making the same point that George Mann made in the paper; it’s not Stephan’s theory. Mann made the point that serum cholesterol and atherosclerosis declined in the moran even compared to children, which is proof of nothing but certainly quite interesting. The age comparison is seriously confounded by the fact that the moran consume copious amounts of stimulant herbs, engage in ritual lion hunts, and otherwise live completely different lifestyles than the rest of the Maasai. It’s the among the poorer points that Mann made, but Mann did not make a big deal out of it.

              I do think, however, that you missed the central point of Mann’s work. He investigated hundreds of living Maasai for ECG evidence of previous MI and did not find any. Based on the age structure of the population he studied, his sample size, and the incidence of ECG evidence for MI among Americans, he should have observed a number of cases with evidence for MI if Maasai had similar age-adjusted risk of heart disease as Americans and he did not.

              The central theme of his autopsy paper is the striking absence of complex lesions, healthy luminal diameter, and again, complete absence of evidence for MI.

              I think you are generating a lot of confusion by suggesting they had lots of atherosclerosis, or as much as Americans, judging this by total thickness of plaque burden. Especially in this day and age, we know full well that the mean size of a plaque has nothing to do with predicting heart disease risk, but rather its composition is predictive. Lipid-rich, collagen-poor plaques are likely to rupture, which is the primary cause of ischemia. Less commonly, protruding plaques that themselves block a coronary artery are a cause, and likewise calcified or eroding plaques. The Maasai were essentially free this kind of plaque development.

              The point here is not that the Maasai had perfect heart health, but they did have strikingly better heart health than typical Americans. For a population with a high burden of infectious diseases and exposure to copious amounts of smoke, this is impressive. If you are going to argue that their heart health was poor, I think you at least need to show that there are whole populations of vegetarians or vegans who do not have the degree of atherosclerosis that the Maasai had at similar ages.

              Chris

            3. Of course the inuit and masai have worse health on a western diet! They have had even less time to adapt to these foods than westerners. Why is it that american indians, pacific islanders, etc. all have much higher rights of diabesity than white americans?

              Also, Atkins heart disease was caused by a viral infection. Who said he secretly consumed vegetable oils and cakes?

              1. Careful with adaptation. What many people fail to understand is that for natural selection to operate their must be significant difference in the reproductive success of those would be better suited to a certain diet in this particular case. This hasn’t really been the case for a very long time. People don’t presumably make less children because they have atherosclerosis. Even if they die of a stroke at 50, a very vast majority has already had children and couldn’t have had more. Erectile dysfunction does not prevent someone from procreating, particularly since Viagra exists.

                Lol viral infection! No his heart attack was not because he ate a lot of meat and fat. lol

        3. I reversed my heart disease and got off insulin by cutting out most plant matter from my diet. My HDL has gone up, my LDL changed from pattern B to pattern A. This on a mostly carnivorous diet. That is the best evidence I could ever have. No one will ever convince me that we are supposed to be vegetarians.

        4. Richard,

          Atherosclerosis has been induced using diet in normal domestic cats: http://cat.inist.fr/?aModele=afficheN&cpsidt=2092420

          I’ve met PETA members who feed their cats tuna because they know that cats are obligate carnivores, so I’m sure you recognize that fact.

          This line of reasoning is, of course, quite silly. If in fact it were true (and it’s not) that only herbivores develop atherosclerosis by means other than thyroid inhibition, then the fact that humans develop atherosclerosis could as easily be used to show that this generalization is false, because humans are not herbivores, as it could be used to show that because the generalization is true, humans must be herbivores. Thus it cannot serve as proof in either case.

          Even in the rabbit, there are resistant strains, and the difference largely amounts to thyroid status. By your logic, then, the resistant strains must be carnivores.

          Note also that another interpretation here would be that humans are a carnivore whose thyroid status has been disrupted. One could support this, for example, with research showing that thyroid supplementation prevents atherosclerosis in humans: http://blog.cholesterol-and-health.com/2011/08/central-role-of-thyroid-hormone-in.html

          Given these multiple interpretations of the same evidence, it seems to me that this evidence is not very useful in supporting any of these arguments.

          Chris

        5. In other words….if you see a patient getting cured from a disease and the drug used is blue…then the extrapolation that “blue pills cure disease” makes sense to you. The association is not conclusive, and what neisy states is correct, once omnivores are included in the analysis, the same ALS also is readily produced in omnivores. Understand where we fall on the eating chain scientifically is based on what our bodies can get nutrients from NOT based on what we decide to eat. Most ruminants or herbivores cannot readily digest meat–so they are called herbivores because their bodies cannot readily derive nutrients from animal protein. Carnivores are called carnivores because their systems cannot readily derive nutrients from grass or vegetables sources. Omnivores have evolved with the ability to eat AND transform both animal and plant sourced products into nutrients. Nothing suggests humans should only be herbivores. NOTHING. An omnivorous animal is actually more optimal because evolutionary-wise it is adaptable to what ever is available in the environment. Sensibly speaking, omnivores are the next evolutionary step in natural selection because that ability increases adaptability. The only way your argument and extrapolation makes sense is if science finds out there is a vestigial ruminant apparatus in humans.

          Let us know when you find that.

          1. First SOMETHINGS do point to the fact that we are herbivores (I’m not saying we are I do not know, and I don’t think anyone does). Second, it is truly ridicule to say that an omnivorous animal is more optimal, the omnivore, or herbivore, or carnivore, is simply adapted, albeit imperfectly, to his particular ecological niche. You need to realise that being an omnivore comes with a certain tradeoff, presumably in digestion efficiency of a particular foodstuff. To talk about “the next evolutionary step” is even more ridicule; that’s just not the nature nature works. If a species exists it his adapted, and so none is “better” from an evolutionary perspective. From a selfish gene point of vue, maybe you could say the most populous species could be considered the most successful. Those are obviously necessarily herbivores, that’s the way a foodweb works, must work. The energy transfer being quite innefficient (in absolute terms), their will necessarily be much less individuals as you go up the foodweb. Lets remember also that an omnivore is not simply an animal who can eat either animal products or plant products; to be healthy this particular animal must eat a particular combination of foods which happens to come from each of those 2 broad categories.

            Lastly, an herbivore is not necessarily a ruminant, quite the contrary. And to respond to some earlier posts, chimps and dogs are not omnivores, they are respectively herbivores and carnivores. It is not because an animal eats something exceptionnally that he is an omnivore, or almost all animals would be omnivores. Thats just not what those categories mean.

            1. Plant based diet works. Actual living humans – many – have tried it with wonderful success. Why all the chatter? To avoid “losing” your meat?

              Just try it for 6 months. Check your blood numbers, blood pressure, how you feel, and make a decision. It won’t kill you.

              Enough of the chatter. Discover the true “silver bullet” of good health and get on with your life.

    1. This is just a video about the paper you linked in your other comment, where two of the three authors are funded by statin manufacturers. No anti-cholesterol bias there, right? ;)

      1. LOL…

        pot calling the kettle black….

        Dr Jenkins, the inventor of “GI”-concept has been very keen on promoting dietary intervention to tackle disease. No, tell me, how would an advice to stay away from cholesterol rich animal foods contribute to statin sales?

        I find it ridiculous how you dare to refer your blog as health-blog, your blog is nothing but a sales pitch for animal-products with the ever present “you’ll be screwed for staying on plant-based diet on the long-run”-pitch.

          1. ^ Well, that’s the message the Western medical literature has been repeating for about 70 years, and looking at Loren Cordain fat belly, I think the “you’ll be screwed for including any animal products” -pitch is spot on…okay jokes aside, the point was that there’s no chance in a million year that blog is something what would be referred as “health blog”, this is more like some kind of a Lierre Keith-style, anti-vegan blog which tries to be scientific.

            Check this out, about dozen latest articles screencaptured…narrated by Michael Greger MD, Denise & Atkins/Paleo folks ain’t telling you this stuff…meat is sickness-inducing toxic…I tell you that

            http://nutritionfacts.org/videos/industrial-carcinogens-in-animal-fat-2/

            Another claim which caught my attention was the claim that cholesterol can be too low….phew…I am too lazy these days, so you’ll get narrated screencaptures.

            “Can cholesterol be too low”

            http://nutritionfacts.org/videos/can-cholesterol-be-too-low/

            1. *Yawns* Please Richard. I believe you to be an intelligent guy. Surely you can put together more dots than that. They’ve been telling us to load up on wheat and vegetable oils during that time too.

              I’d advise you to hold your tongue a little bit and keep an open mind. Doesn’t mean you “have to” start eating animal products or quit promoting plants. However, some day you may have problems (like Denise did ie..the whole reason for starting this blog) and have to sit down to dine on a plate of crow.

              1. Grok, nice blog you have, just checked it out.

                I don’t see any evidence of long-term vegans supplied with b-12 having any health problems. I think it’s utmost ridiculous to start preaching something like that in the face of an ecologic catastrophy created by the meat-eating society. 65% of all grains cultivated in the world goes into feeding animals (98% of the annual 225 million soy production). Animal husbandry takes about 2/3 of world’s land-surface. 99% of the American poultry comes from factories.

                “UN urges global move to meat and dairy-free diet”

                http://www.guardian.co.uk/environment/2010/jun/02/un-report-meat-free-diet

                So, if something the shift should be in emphasizing the health and ecologic problems of meat for the sake collective well-being. If you like your ridiculously expensive organic, “ethical” wild-game then go ahead and eat it but make sure you shut your mouth up. Propagating for animal-products is outward irresponsible….. Okay, enough with the “vegan propaganda”, I am sure I made my point.

                I love objective information. Since we don’t have any evidence of long-term vegans having health issues, in fact the opposite is true compared to omnivores, this should tell us that it might be good to take advice from long-term vegans instead of short-term vegans. We never get to hear objective information of Mingers vegan fare, therefore I give my two cents over the issue. Most likely it went like this: her raw-food diet consisted about 1000 kalories per day, out of which heavy abuse of nuts and olive oils made the intake of fat around 60-70%. In fact when you do this, screw up, you start a blog and maybe write a book about the dangers of veganism. That’s the usual story with short-term fad diet vegans. So, no, vegan per se, does not equal health. Fatty foods and low-calory regime does the trick.

                Keep up the good work of bringing enlightment to the paleo-crew.

                1. Richard, if you want to piss, please move it over to my blog. I’ll respond as time permits. There’s a whole lot wrong with the second 1/2 of your comment.

                  That said… I will :)

                  1. Alright,

                    just a quick note. I love this new study which destroyes Mingers grand idea of vegans getting good grade in epimologic studies conducted in the Western sphere for the sake of being just more health conscious than the overall animal-eating population. Well, now we have data from the third-world where assumptions being associated to veganism in the West do not bear similar merit.

                    Yang SY, Zhang HJ, Sun SY, et al. Relationship of carotid intima-media thickness and duration of vegetarian diet in Chinese male vegetarians. Nutr Metab. 2011;8:63.

                  2. hi
                    whats the deal with the hate on eggwhites
                    Esselstyn says that,”But when we consume dietary cholesterol, which is only found in animal foods like meat, eggs, and dairy products, it tends to stay in the bloodstream. This so-called plaque is what collects on the inside of our blood vessels and is the major cause of coronary artery disease.” but EGGWWHITES HAVE NO FAT OR CHOLESTROL…so whats the deal?

                2. Richard–I’m not a vegan–or a foodist. But I do care about my health. when you get snarky or need to rebut everything that is said–it’s a turn off. If you are so unsure of your own diet that you need to justify it by rebutting anything/everything you see–then have at it but understand most will either ignore you or put you in a certain box. If you are wishing to convert–then the tactics you are taking will fail. Total turnoff, You don’t need to rebut everything, I doubt few posters here are going to rush to read anything you give a link to because you do not appear entirely lucid..and people tend to not seek out brainwashing sources. lest your behavior and mindset be catching. Just saying ;)

                  1. “If you are so unsure of your own diet that you need to justify it by rebutting anything/everything you see–then have at it but understand most will either ignore you or put you in a certain box” Hahahhahahah!! Wow, because this WHOLE article & website isn’t someone questioning EVERYTHING about the vegan diet? I agree there are holes in the science of FOK, but this article (with it’s shoddy resources to back up it’s claims) & it’s commenters just proves how backward minded 99% of the population is. It’s so pathetic how defensive MEAT EATERS are to a whole food plant based diet.

                3. @Richard
                  I think Minger was on 80/10/10 in the end. Had you done your research, her video is easy to find. You may want to see what happened to the RawBrahs, who are also in the video. They had a lot of issues.

                  Minger is not here because she just decided to trash all the vegans, fruities, and all the mixes in between. She is here because she did their diet and had health issues.

                  The vegans and raw foodies are a CULT. No matter how bad things get for them, they never blame the diet.

                  I am on a ketogenics diet. I am the one that abuses fats and oils. :)))) I don’t eat meat, because I don’t like it. I take amino acids. That and because in the USA

                  And the problems with Cults is that their solution is the end all and be all of health. Go look at 30 Bananas A Day. They are claiming that Bananas will get rid of Candida/Yeast. There is no yeast /candida elimination book on the planet that says that. What they all say is that you can have 1 or 2 fruits a day. What they are experiencing at 30BAD is the difference between soluble and un-soluble fiber and maybe colitis.

                  In the end, Minger CLEARLY points out that the Raw/Green world makes endless “Correlation is Causation” claims to justify their diet. She also CLEARLY points out that anybody getting off CANE SUGAR and other junk is going to feel better, and get better.

                  LAST. You may what to go and look at the BANANA crop. It is the most TOXIC crop on the planet. The banana’s panama disease is back, a fungus that lives in the soil and is killing whole banana plantations in a matter of years. Since the fungus lives in the soil, it is VERY HARD to kill. So they have to make new banana plantations in a new area, clearing more jungle. Bananas are a big crop. So they are having to clear more and more jungle to plant more, plants. Most banana plantations spray the crops, by airplanes, 3 times a MONTH, with pesticides and fungicides. That is a LOT OF FREAKING SPRAY IN THE AIR. It gets in the water supply, and the villages nearby have endless health problems. Not to mention what it is doing to the wild life.

                  What I find this that most of the raws, vegans, veggies, and fruities are so busy defending their diet, they don’t even look at other evidence.

                  -Trent

            2. Your first video only highlights the anti-meat findings of those studies. The very first study referenced clearly states that chicken with skin, hot dogs, and hamburgers all had no association with bladder cancer. But I guess your veggie/vegan folks ain’t telling you that stuff.

            3. That’s one of the more amusing things about the Paleo diet, how bad most of its proponents look. Mark Sisson and our beautiful hostess excluded.

        1. Hi Richard,

          Dr. Jenkins was only one of three authors for that article. Do you think it’s irrelevant that the other two were heavily funded and supported by statins manufacturers?

          I’m sorry you feel that way about this blog. If you read through some of my other entries, you’d see that I actually eat mostly plant foods myself and am careful to never recommend a particular eating style to anyone. I write a lot about animal products because I feel they’re unfairly vilified, although I sometimes try to redeem some plant foods as well (ie, see my fruit post a few entries back). Like you, I used to believe anything animal-derived would promote disease, which is part of why I was vegetarian and vegan for a decade. When I started reading research outside of what the vegan community was regurgitating, I had to revise my long-standing perspective on animal foods because the science just didn’t support it.

          1. “Dr. Jenkins was only one of three authors for that article. Do you think it’s irrelevant that the other two were heavily funded and supported by statins manufacturers?”

            No, not at all. As I tried to hint already, despite majoring in economics, I cannot see the connection between the advice to avoid cholesterol-rich animal foods and increased statin sales, in fact, I see the contrary, plummeting statin sales following from advices such as that.

            The fact the Jenkins, one of the biggest authorities in cardiovascular diseases, has his name on the paper definitely legitimizes it in my eyes. The biggest authorities in cardiovascular business, Jenkins, Williams and many others make an advice against cholesterol, so it’s not an a thingy of the 80’s, I am sure we can both agree to that.

            Anyways, I love your manipulative skills, your above post certainly comes out very polite and almost convincing. But not exactly! Had you have a sincere interest in health you’d be 100% dedicated to encouraging people to avoid factory farm animals and since 99% of US poultry comes from the factories and over 90% of the pork and other meats, it would mean that you’d courage people who have no contact to wild game (the overwhelming majority) to follow mostly vegan diet pattern. It’s also very cute from you to try us make believe you’d be doing sincere research, beg me to laugh. Now you try to give the bullshit that we should not be vegans because your fad, raw diet failed. Unfortunately your advices makes you as part of problem, not the solution.

            We are all much better when keeping the animal products in minimium, exactly as UN has been touting for a decade, whether they should limited 100% or not, is another issue, but that’s not your concern as long as people are filled by animals you are “careful to never recommend a particular eating style to anyone”, when this is not the case a hell brakes loose as we all can witness.

            “because the science just didn’t support it”

            LOL…..

            http://nutritionfacts.org/videos/industrial-carcinogens-in-animal-fat-2/

            Whether Campbells study is flawed or not is completely irrevelant, the same message has been echoed the Western medical literature for centuries, we have literally hundreds of meat/dairy/fish = sickness papers. In fact, the notion of animal foods making us sick was was already observed by Plato two thousands years ago.

            anyway, thumbs up for you having the courage to keep the conversation rollin’.

            1. I would like to see the “…literally hundreds of meat/dairy/fish = sickness papers…”” that is …scientific, randomized, double blind etc. and peer reviewed.. And Plato is now a nutritionist too?
              “…. plummeting statin sales following from advices such as that….” How come you cannot stick to the known science . The intake of cholesterol has next to no relation to serum cholesterol, the liver just produces the levels needed. High inflammation- high LDL. And as we all know among the high inflammatory foods wheat products star as the absolute numero uno.. Please Denise don’t waste too much time on the fanatics who keep screaming don’t confuse with the facts, because I know what I have decided to know.

            2. I’m thinking of the projection that within the next 20 years the most deficient resource and most expensive on the planet will be …WATER. I am wondering with such constraints and theoretically a diet heavily dependent solely on produce–what the actual famine situation would then be like? Any comments, besides suggesting we can a lot in preparation? :)

              1. The thing about water is, it will never be anything but water even when contaminated, unless it goes through some kind of nuclear reaction which is very unlikely here on earth. The production and harvest of food will always be dependent on water through climate. This is largely out of our control but as the population increases it will grow to a state of non sustainability because of land or water requirements.

            3. I came across this blog today and find it fascinating in the extent of the dialogue pro and con for various diets. I am not a medical doctor, though I did study biochemistry and molecular biology, and grew up on a dairy farm where we raised most of the food fed to our cows, and a few pigs and chickens. My question to the community as a whole is are there studies that can definitively prove beyond doubt that a diet low or devoid of animal protein/fat is superior to one that includes animal proteins and fat? Or, are most studies not large enough in sample size to be meaningful statiscally if applied to the human population and disese as a whole? My general sense is that many studies, papers, diets or books espoused here are small in nature, and / or anecdotal in nature. One has to be careful to draw conclusions from small samples as meaningful to human life span and health in general. For instance, I grew up drinking raw cow milk and cream, eating plenty of animal protein and lots of vegetables. My parents even more so and both are 87yr old, my mother has Alzheimers and hbp, my father has joints worn out from labor, otherwise healthy. My grandmothers both born on farms eating similar dairy and meat laden diets lived into their 90’s, my grandfathers died of one by tentanus, the other bacterial infection of an abcessed tooth. The point being, maybe genetics plays a large role that is only beginning to be understood within the context of diets. A population living on a subsistance diet my die of disease other than heart related, while another living on a heavy meat and dairy dies of other disease. The point being, does any one group statistically live longer than any other group? In the end I agree we are what we eat but i know from current research that we all have slight mutations in our DNA that enable/ or not for us to metabolize some compounds/foods but not others. In the end we all die, and seemlying at around a similar age if given access to adequate amounts of a variety of food types.

              One last note to a comment about growth hormones in animal foodstuffs, for those eating animals that may have been given recombinant growth hormones, once you ingest that food (milk, meat, whatever,) any growth hormone present, being an enzyme thus a protein, will be broken down in the digestion process to constituent amino acids as any other protein, it will not be biologically active.

  16. You certainly are a strong argument for giving scientists a liberal arts education! While extremely rigorous, you have a superb gift for explaining potentially complex matters in a way that makes them seem almost obvious.

    Then again, maybe you’re just very, very intelligent.

  17. and again… laughing, snickering and being wowed all the way through! – i can only thank you for your diligence – but then again – you are clearly doing what you are passionate about and exceptionally (yes… awesomely) good at.

    upon moving to switzerland 2 months ago, my ancestral-noshing partner and child and i are getting serious about a website and perhaps workshops for all these “poor” affluent swiss/german/european people that look at us like we have grown 2 eyes in our foreheads (nod to Dana) not to mention the brain oozing out of our ears.

    I thought the US was bad – but EU is horrid in just as many diet-fail ways – just to see the stream of addicts at 7 am pouring out of the bakeries with their (admittedly great smelling) crescent-shaped space-cakes of pure wheat (even space cakes just have a bit of hemp…)! and you try it – say “stop eating bread” to a swiss person and they quietly slide away smiling that “WTF was that?” kinda smile, happy they got away from you alive and unscathed.

    i think we’ll start David-ing the Goliath here and see what happens (deportation probably…)

    thanks lots Denise – you’ll be at the top of our references for those who can do the english (maybe we even translate you to deutsch!)

  18. Ouh yes,

    fresh new date from China (2011) Check it out, lady.

    Vegetarian, not even vegan, at significantly lower risk for heart disease in China

    Yang SY, Zhang HJ, Sun SY, et al. Relationship of carotid intima-media thickness and duration of vegetarian diet in Chinese male vegetarians. Nutr Metab. 2011;8:63.

  19. Wonderful post Denise. I wish I’d had it, or something like it, to hand out to folks who came to see this film at the theater where I work. We were showing it the same week as AHS, so I was pretty much constantly biting my tongue to keep from having “discussions” with my customers.
    Regards

  20. It really is puzzling how Esselstyn still believes that stuff about wartime Norway. It looks like the improvement in dental health, at least, was due to reduced consumption of refined carbohydrate. ‘Dental caries in Norwegian children during and after the last World War’ says:

    ‘The cause of the decrease in caries frequency during the war and the cause of the increase after the war is discussed. Based on the rationing of the various food articles our tentative conclusion is that the decrease may be attributed to the lowering in consumption of refined carbohydrate and the increase in consumption of more natural foods . …’

  21. I thoroughly enjoyed this post. I laughed out loud several times. It was as gripping as an Academy-award-winning courtroom drama.

    Considering that you are writing about dry scientific papers and data, you’ve got a real knack for making the information accessible, engaging, and extremely entertaining. This is incredibly rare; I hope you know what a gift you are to the planet. I’ll continue to read your blog with pleasure and I’d be thrilled to read any book you write (hopefully one day).

    I’m now obsessed with the idea of testing this recipe for herring roe bread pudding. I’ll use almond flour and/or coconut flour and coconut milk. I’ve already found a recipe for the saft saus.

    I’ll let you know how it turns out!

    Ann Marie

    1. I have not read the post yet but will asap.

      About a book… as far as I know, Mark Sisson is working with Denise on a book! I think it will be published in 2012. It will teach us all how to disect any study – just never as good as Denise!

  22. This was an amazing review, I love it how much of the boring graph reading and combing through studies you do so we don’t have to! Thank you so much! I gave up wheat a few months ago and after reading this I am so glad I did!

  23. Absolutely amazing, I hate how I love scientific data so much. I believe plant base diets do have their time and place and definitely not for everyone. I really enjoyed how you pointed out all the pieces that were conveniently missed in the movie.

    1. Translation:
      […] mostly. However, I got stuck on a super long article by Denise Minger on Raw Food SOS: “Forks Over Knives”: Is the Science Legit? (A Review and Critique). She is too good for a cursory glance. The article is about a new movie: Forks over Knives, and […]

  24. Well done Denise. I find your style of writing to be light and refreshingly lacking in dogma. Combined with your gift for disseminating research and breaking it down, you pack quite a punch. The world could use a few more of you.
    Ben

  25. Denise, you are amazing! I recently watched “Forks Over Knives” and left feeling so frustrated. You are a brilliant researcher and a wonderful writer. I just shared this on Facebook. Thank you!!!

  26. Denise, another wonderful blog–you really are an amazing one person show. However, a couple of comments, focused more on Esselstyn than on Campbell. You point out quite correctly that there was a rather high drop out rate, but then assume it might have been due to poor results. I suspect it might well have been due to either difficulty keeping to the diet, or such good results that they felt able to quit the discipline of those frequent visits and blood lettings.
    Also you comment that though the results were good, maybe even better ones are available with a somewhat different approach. Maybe yes, but remember his patients were an extreme bunch–much damage had already been done. Recall Ornish’s “Spectrum,” which offers a spectrum of degrees depending on the point from which you start. Would you not approve of that? (and not incidentally, he offers evidence for regression of prostate cancer too–not bad?). And you refer us to William Davis as an example of a better way. I go to his website and find lots of ads for expensive supplements, but no links to published or other hard data on results; am I missing something, or can you direct me to such data? Both Ornish and Esselstyn had the courage to submit their results to the public.
    So I am still thinking over the rich content of your blog, and feel profoundly grateful for all the intelligent hard work that went into it (and the light hearted tone too!) –but am still impressed by the real world results achieved by this vegan stuff.
    Please keep going, and I look forward to that book next year.
    Thanks and best wishes, Chris

  27. The Esselstyn family and Neal Barnard are pretty good walking advertisements for what they do. They have controlled weight and maintained health in themselves as models, and that is going to sell some program.

    Neal Barnard says everybody should supplement with B12, no matter what their diet. He also looks healthy and dynamic.

    The Weston A. Price photos are persuasive and data are impressive.

    In China, meat-eating has been associated with wealth, which could mean meat-eaters endured less stress and less job-related risk.

    The take-away for me as an individual is that one size does not fit all, and personalized medicine ought to already be here.

      1. Neal Barnard is 58, pushing for 60’s. You can surely find unrepresentable pictures out of everyone.

        Let say that compared to the chubby out-of-shape and obese low-carb crew, Cordain, Sears, Taubes, Jimmy Moore, Kendrich, etc, the vegan MDs come out looking like elite athletes.

        1. Tom Naughton, at AHS, did a nice job of shredding the gist of your “argument”–namely that many people on low-carb diets are overweight, therefore, low-carb diets caused their obesity.
          Tom’s talk: http://vimeo.com/27793037
          Incidentally, there are virtually no elite athletes in any highly competitive (read: where millions of dollars are at stake) sport who do not consume mass quantities of animal protein in some form. Oddly enough, the people who most resemble elite athletes ARE elite athletes.

          1. “Incidentally, there are virtually no elite athletes in any highly competitive (read: where millions of dollars are at stake) sport who do not consume mass quantities of animal protein in some form. Oddly enough, the people who most resemble elite athletes ARE elite athletes”

            Lol….is this what you call logic? There’s no society where rape and murders are not persistent, should this little notion tell us that rape and murders are clever acts?

            Besides, even in factual terms your remark is bull shit. And don’t worry I know all about the Taubes-style “If it wasn’t for the low-carb/high fat, I’d be much more fattier”-logic.

            “Vegetarian Crowned Germany’s Strongest Man” (2011)

            http://www.mfablog.org/2011/08/vegetarian-crowned-germanys-strongest-man.html

            1. I see you’ve failed to address my point.

              Let me remind you: vegetarian ≠ vegan. In fact, the highest quality proteins in terms of their anticatabolic/anabolic effects (Read: the best for gaining muscle/losing fat) are apparently various blends of proteins derived from milk and eggs.

              1. Following your logic the “best” protein in your terms would be human protein, do we need that “high-quality”, high-growth facilitating human protein, no. I’d rather to choose the protein which is kindest to my kidneys and liver, although drinking some isolated nutrients is nut cup of tea to begin with.

                1. Muscle meat proteins have lower biologic value than milk protein blends; even if nutritionally desirable human milk proteins are obviously not likely to become widely available for mass consumption by adults any time soon…Although this is interesting: http://www.npr.org/blogs/thetwo-way/2011/02/25/134056923/breast-milk-ice-cream-a-hit-at-london-store And there is no evidence to support avoiding high-quality proteins per se for kidney/organ health; if protein (or calories) needs to be limited for some reason, the emphasis on quality oughta go up, not down.

            2. Patrick Baboumian relied extremely heavily on quark (a type of cheese) and whey for his protein (which if you don’t know how weight lifting works, comprised the major component of his diet).

              He is apparently going vegan as of this month, however, so it will be extremely interesting to see how well he performs with all-plant sources of protein.

          2. Then again, low carb has taken many people from high cholesterol to low, from obesity to lower weight, from heart disease to some reversal and removed some people from the type II diabetes roster –go figure. The problem with pseudo science be it conducted by doctors or snake oil salesman or your latest magazine rag–it seldom is scientific except in the claims and throwing around a few studies or comparisons. That is all well and good but a true scientist will usually know the challenges (a component of any study that tries to be the devils advocate) as well as the criteria that must be considered before any position is either taken or bolstered. We are seeing a lot of “studies ” which either do not share the data they should (such as the results of their challenges and a control group–like maybe one fed casein but NOT using aflatoxin as a carcinogen/mutagen) without studies like this running side by side with the actual desired study or clinical trials–you have nada. Butkiss. Nothing. What is amazing is that this is passed off as science. But I also consider the venue. This is in a documentary , NOT because it defies the status quo, but because tthat in the vetting process for scientific study, this type of data does NOT pass muster because it fails to challenge or compare itself to the medical/scientific data of sources which may refute or contradict its own premise.

          3. Please, allow me to send people here instead for Tom’s excellent video “Science for Smart People”:

            The AHS video, alas, does NOT show the slides, and so a big chunk of Tom’s talk seems nonsensical.

        2. Richard, your responses are defensive. This defensiveness indicates that you have an emotional attachment to your chosen dietary style and feel attacked when exposed to new and differing information. Your responses indicate a desire to argue, not reasonably discuss. Nutrition is not religion and should not be based upon belief but understanding. In order to gain understanding you will need to be able to receive new information. Your overly-emotional defensive stance will disallow for receipt of new ideas.

      2. They look cadaverous because their diet does not provide the amino-acids, fats and nutrients their body need. They are living of the meat and fat from their own body, what it can cannibalize. The body is looking for what the supposed “plant based diet” can’t provide.

  28. Documentaries have long served as vehicles for propaganda (no surprises here). This one seems to be particularly flawed.

    This documentary contributes nothing regarding the value of a meat-free working hypothesis for optimal nutrition as it contributes nothing regarding the value of any other working hypotheses. It is inconsequential.

    And that is the reason why I appreciate this post, Denise. It is great that something as worthless as “Forks Over Knives” has prompted you to work out something as interesting as your post… regardless of its ultimate validity. You have made a contribution and this is always worth praise. Thank you.

  29. DM……might i suggest you write a book called the Broken China study? You method and mind are perfectly suited to this. There will always be vegans because of dogma. But as a doc i am sick of reciting patients who are slowly killing themselves with this dogma. Id love to just write the a Rx for your book. Im patiently awaiting your assistance. Great blog as usual. Dr. K

  30. Thanks, esp the part on Norway was awesome!

    Wartime disease rate drops are always very suspicable, as diminishing of available calories, the believability of statistics and wartime stress are as well major possibly confounding factors. Wartime stress might add to the injury as those autopsy studies you referred seem to show. THINCS guys like Kendrick and esp Colpo have built an excellent case for chronic stress and dysfunction of HPA-axis as major contributors on metabolic dysfuntions in heart disease. Post-wartime Finland has been used as an primary example – consuption of animal products went down faster in control areas where there was no intervention. Perhaps radical interventions ie North Carelia project added to post-war stress by rapid cease of smoking and subsequent demise of small farming in Carelia bc of health fascism?

    So far, the big picture on wartime coronary disease rates remains full of controversies and variables and seem next to useless other than wild hypotheses generating.

  31. It took me 3 days to get through it, but this is the most in depth analysis I’ve ever read. Your humor and witty writing style amazes me! You put all of these scientists to shame and just proved that everyone should get their liberal arts degree before pursuing the sciences.
    Thank you for this!

  32. My favorite line:

    Would Campbell warn the audience not to Google around for critiques of his study, because they’re all written by shills for the meat industry, or—worse—liberal arts majors?

    Keep writing Neisy – we all eagerly await to hear from you!

  33. I can not thank you enough for writing this critique. I just finished watching the documentary. It tries to back up its argument by citing scientific information, but what they present is as unscientific as it can be. You have done a wonderful job of cataloging it all. I am going to share your critique with the people who recommended me the documentary.

  34. great read, denise, with some real lol moments :o)

    perhaps you should create an iphone app called ‘can i cite this ?”, so people can use it to find out whether the study/book/author that they are about to cite still has any integrity :o)

    i do have some proper points/questions to save for when i have a little more time

  35. Denise,
    I just wanted to commend you for such an outstanding review. The level of detail you provide is simply brilliant! I recently watched the film and then for some reason remembered your blog. No surprise to see that you provided such an in-depth, comprehensive analysis here.
    It’s great that you provide the supporting science and help to fill some of the “gaps” omitted from the data that was provided in this movie.
    Again, absolutely brilliant review and thanks for so much for your sharing your knowledge and insight on this.
    Best Regards, Scott

  36. I shocked myself by reading most of this. I am a “scanner” more than a reader but I actually found myself reading and rereading the details that you gave. I think and process globally but there are times when details matter and your discection of the details were very telling. When I heard about the movie my first thought was “Did they eat organic, pastured animals/eggs, et al?” I was never more weak and undernourished than when I was on a macro-biotic diet…My mother is from Germany and we had healthy, hot delicious food every day, growing up in Michigan. Despite our possible good genes (though 3 of the 7 of us died from cancer and one survived skin cancer) we ate a lot of meat and butter but my mom was very concious of health and good nutrition read Adele Davis books from early on. She made her own bread from the best ingredients she could find (and she bought rye bread from Canada that we ate with butter and honey while we played Euchre) I credit this diet with my health today since unfortunately in my early 20’s I got caught up in bulemia and anorexia because my then husband wanted me bone thin and put me on a low-fat diet. I got terribly malnourished and nearly died several times. Long story short, in the past 5 years or so I’ve seriously worked on my health. In the last year is when I went on the high fat/protien along with (more recently) bone broth and coconut oil with kefired raw milk and Cod LIver Oil and liquid Co-Q10 and I’m losing fat like crazy and I feel my back, shoulders and psosas “unfreezing” and my short term memory is coming back. I will be 50 next year and people think I am in my late 30’s even with all of the damage that my body sustained in the past. I credit it with the diet my mom gave us, lots of fat, meat and vegetables. We ate very little sugar, no soda and our treats were apples and sometimes pretzels (in moderation) and we could sometimes have a 7-up since it had no caffene, if we really begged. My poor mom, when McDoanlds came to town we begged her relentlessly for it and we maybe had it once a week after our Christian meeting on Sundays but not that often. My life course shows that the research for “Forks over Knives” is bunk. I’ve done every “diet’ known to man and they all fail in comparison to what I am doing now. The Chronic fatigue, (though I had the virus killed by an electro-something or other machine and that was a huge help) fibro-myalgia, depression etc. that I once had are all gone and my ex-husband possess them all instead. He continues his low-fat diet, “knowing that his arthirits “came from too much weight lifting when I was young” bull…he is a sugar/bread/donut hound, duh! Thank you for the lovely information and the time it took you to make it available to other souls. I don’t have to thank you for your passion because I know you can’t help that! Best.

  37. Wow. Even if you only post every couple of weeks, you put out more quality information than almost anyone. I really don’t know how you do it!

    You should write a book or something…after all, 2 or 3 of these monster posts would probably fill one up :)

  38. Taking a Trip Down Memory Lane, Fishing for Our Good Friend Glutathione in the Waters of the Memory Hole: How T. Colin Campbell Helped Prove That Protein Protects Us | Mother Nature Obeyed – Weston A Price Foundation
    I wish this link would have worked!!!

  39. Hi Denise, What a tour de force that was, well done! I don’t know how you have the time or energy to do such thorough analysis and demolition on something like this! I could understand where you came from on the China Study and am only grateful that you took the time and applied the same rigour to this. I think most folk will take the film at face value – much easier that way – which is why we’re where we are now with the whole ‘grain’ (pun intended) debate. Tanks again.

  40. Even if all of the Esselstyn patients fared well, a study shortcoming is that it is a highly selective sample and there is no evidence that these results are applicable to the general population.

    1. Also, regarding the Esselstyn study, your 4 numbered points – except for point 1 – are not very convincing. Points 2 and 3 relate to the study not being a randomized clinical trial. But randomized clinical trials are often biased as well. Case controlled retrospective studies (I realize this isn’t one) are underused. And point 4, that many variables were changed does not detract from the study. The purpose of the study was not to pinpoint a specific dietary factor.

      1. “The purpose of the study was not to pinpoint a specific dietary factor.”

        Then why is it being used to promote a specific dietary intervention in the film?

    2. I’m a 3 year old male stepping back from the precipice of metabolic syndrome. I have been on a very low fat vegan diet for a year – I’ve lost 40 lbs, my bp is down to a high normal – I’ve been able to get off 2 meds, my cholesterol is 75, and I eat a lot of food everyday. Inflamation of my joints is no more. The forks over knives diet has been a lifesaver for me. So you can do your double blind science studies, but if you’re in the same boat as I was I suggest you try the diet for two months and see if it doesn’t have a tremendous benefit for your health!!! I’m never going back…

      1. Good for you to take charge of your health. I would not presume to suggest you ought to change your diet or that there are potential pitfalls associated with it (you can operate Google, presumably).

        What I would note is that this sort of diet removes many potential causes of metabolic syndrome – so was it the fat? The red meat? The processed foods? The sweets? And it is entirely possible to remove both good and bad from one’s diet and achieve positive results, but not optimal results. In other words, some might suggest that you’ve thrown the baby out with the bathwater.

  41. What seems obvious here, and concurrent with my comment of earlier, is that what works for one isn’t necessarily going to work for all. Having said that, I agree with an earlier commenter who said that it’s the processing of the foods that renders it poison to our systems, causing disease.

    Richard, I believe that you “believe what you believe” pretty strongly, and I respect that, however it cannot be denied we evolved as omnivorous creatures, and thus our bodies need that mix of foods, including animal protein. Yes, I understand and realize that we do not live the same lifestyles as our predecessors, and that we are not living our lives in the same set of “drive to survive” parameters as they. However, an argument might be made that a different set of stresses is present in our lives today, causing a type of stress our ancestors didn’t face. I don’t think anyone can make the argument that we have evolved “beyond” the need for animal protein just yet….

    To my understanding, no vegetable, legume, or grain, or any combination thereof, can give us the complete amino acid profile that our bodies need, and that can be found in animal protein. It seems that I also read somewhere that even soy protein, as in tofu, tvp, etc, has an incomplete amino acid profile.

    It seems there’s no adequate substitution for animal protein when it comes to fueling the human body!

    To promote the idea that mankind needs to adopt an unnatural vegan diet for the sake of the planet is irresponsible, at best.

    1. Not to disparage you over much, but gluten (wheat protein) is only missing lysine in order to be a complete protein. Lysine is commonly found in legumes, so wheat + beans provides a complete amino acid profile.

      There are other combinations that provide complete proteins as well, but you have to know what plant proteins are missing what amino acids, and what other plant proteins fill the gap.

      This is actually in DM’s blog post in the section about Campbell’s casein studies, it’s just not laid out that way.

      The trouble vegans tend to have is it’s very hard to do the protein thing properly and consistently (seriously, wheat and beans at every meal?), even though it is entirely possible. My roommate, an ethical vegetarian, had to move away from pure veganism because he was unable to manage this, and he’s a pretty smart guy. It’s a whole lot easier to just eat meat, which always provides a complete protein.

      1. Never mind what wheat and beans will do in the small intestines of a susceptible person such as myself.

        And I was one who found this way of eating tasty. Just not sustainable.

      2. I’m replying to this post, but I would like to comment on this entire thread.
        It’s great that we’ve debunked everything from the china study to forks over knives.
        That doesn’t help me eat better.
        You wonder why people just throw in the towel….
        Feels like food tribes arguing….while the average American still goes to McDonald’s, eats turkey legs at Disney and is fat, sloppy and out of shape.
        We need simple advice, not “I’m smarter than everyone else” commentary. This is why everyone is confused.
        If my my cholesterol is 250+ and and I’m contemplating going on Lipitor, I don’t give a shit about the rat study in India.

        1. Chris,

          Your passive-aggression isn’t welcome here. I empathize with your situation as I’ve been in a similar one myself, but you don’t go into a forum about the color green and complain that you’re not learning about the color red. You are probably correct that you need to find another forum that gives actual dietary advice. Denise’s forum is designed to provide nutrition information and let people make up their own minds. Perhaps when you are further along on your journey, you will find you’re able to make use of the information she provides. In the meantime, let’s not criticize something for being what it is, instead of what you want it to be.

          Best of luck to you.

          ________________________________

          1. Maybe you’re mistaking my restraint with passive aggressiveness. I’m going to phrase this as a question: what’s the point of your article?

            Maybe FOK is right, maybe it’s wrong. You also seem to be all for eating well. We are both in total agreement on both fronts.

            However, it seems as though you’ve cracked the code all by yourself and seem solely focused on making your point that many folks who’ve spent careers researching this topic are either lying or aren’t competent. They almost pulled the wool over our eyes, didn’t they? A more balanced approach would have been helpful.

            My point is that I was disappointed to read a review that was an actual attack.

            Hope that was direct enough.

            Good luck to you as well and thanks for taking the time to respond.

            On Sat, Aug 31, 2013 at 12:15 PM, Raw Food SOS

            1. Hi Chris,

              This isn’t my article, this is Denise Minger’s article. (She usually comments as “neisy” but seeing as the entry in two years old, she doesn’t comment often any longer.)  I won’t pretend to speak for her, so I’ll say this instead, this is an extensive blog, and if you read over a few of the other entries, you’ll see that Denise provides the DATA and the discussion of it, but not dietary advice. If you need to be hand-held through a nutrition plan, this isn’t the place to get it. That approach is much more McDougall and Campbell’s styles, the “Just take my word for it.” style. What Denise has demonstrated is that their word can’t be trusted. As a former wf-vegan with sky-high cholesterol, I really do empathize– I was angry with all of nutrition science for a while. But when I took responsibility for reviewing the research myself and making up my own mind, it was very empowering (and I dropped 150 cholesterol points too in less than 10 months.)

              You don’t have to like Denise’s tone to see that you’ve been lied to. And she certainly isn’t the only thinking person to have looked more closely at the data the plant-based gurus claim supports their advice, only to realize it doesn’t. And it’s pretty normal to hate the messenger that brings this stark reality to you, when it’s your own dream you’re being woken from. It brings disillusionment and resentment along with it too. 

              Yes, many folks who’ve spent careers researching this topic are either lying or aren’t competent. They HAVE almost pulled the wool over our eyes. There is a good book out called, Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts It isn’t specifically about diet policy but it’s incredibly enlightening about why we stick to bad choices and giving advice we now know is wrong. The three main tenets it discusses are- 1.) Once we’ve taken a position publicly, it’s really hard to admit we were wrong. 2.) Emotionally, we need to believe we’re both good people and good decision-makers  3.) Our biases make us more than capable of fooling ourselves, even if that means ignoring evidence to the contrary.

              It’s OK to be disappointed that your expectations weren’t met, but criticizing the author for that is unwarranted. It isn’t her job to meet your expectations, and considering the title reads, “A Review and Critique“, it’s hard to understand why your expectations of a critique were not that it would be critical of the film’s content. I’m sure she’d welcome any debate of the science.

              Best!

              Huntress 

              ________________________________

  42. I am tired of fighting on a certain health forum countless variations of vegan/raw food diets. After I pour all my sarcasm (innate and quite impressive) on some promoter of a cold grass soup on a cold winter night, a defender of a warm hay (hay and hay only) stew shows up. I run to the mirror to check my look – no, I am still not a cow.

    1. I respect your sarcasm but no wonder you are tired.

      If you think there are only grass eaters and omnivores, and carnivores, you are rudely mistaken.

      Have you ever been outside of your home? Nature is not a farm. There is more than just grass in this world, than cows and pigs and dogs. There are billions of different kinds of plants in many different places with many different parts(roots, tubers, leaves, stems) and fruits and seeds. There are many different animals, many different creatures.

      There is sprouted, grinding, soaking, culturing, cooking.

      Grass is not the only herb, furthermore there are many different species on this planet with specific ways of eating, including eating earth and mineral licks, parrots eat clay, elephants for example consume clay.

      The diet recommended in this film is a starch based diet, not a cow diet.

      1. “The diet recommended in this film is a starch based diet, not a cow diet”
        Thank you, but thank you … I am pretty sure that starch isn’t good for me.
        I think I’ll have a roasted cow for dinner tonight. If it kills half of the world’s vegan/raw food population, I’ll send my condolences.

  43. Wow! I seriously would like to know where you get the concentration, focus, and critical mindset from, Denise.

    For other folks who read that: Could you seriously remain concentrated and critical of Denise’s article all the way through? I think I lost my concentration on the half way and just “busyread” until the end.

    The main thing I learned from this post is this: Everything that involves analyzing what people did in the past is speculation. Data collection is definitely not 100% accurate and neither is the thought-process of someone analyzing the data. It’s all, in my opinion, very subjective.

    1. I found it helpful to read Denise’s post over 3 days time. There’re so many interesting findings, you really don’t want to miss out by rushing through it.

    2. Subjective is not the right word. Analyzing data should involve rigorous critical thinking. Unfortunately for all of us, neither the researchers themselves nor those who report on and spread the conclusions of the research always think critically enough.

      Shrugging our shoulders and calling it all subjective is too lazy. It’s hard work to do what Denise has done, and it’s hard work for us to read it. But it’s what needs to be done if knowledge is ever to advance.

  44. Dear Ms. Minger,

    I can’t believe you have waged war against anyone who switches to a plant based diet to improve their overall health in this review.

    Forks Over Knives has a simple message: avoid dairy and meat products and over time, one can reverse/prevent heart disease, diabetes and in some cases cancer.

    You attack EVERYTHING in this film, it sounds like you really hate anyone who sticks to a vegan diet.

    I am extremely disappointed with your review. I have been able to lose nearly 10 pounds over the past 2 months since I switched to a plantbased diet, and I feel much better for. This is my simple truth, are you going to spend another 10 pages and attack that too?

    1. “Forks Over Knives has a simple message: avoid dairy and meat products and over time, one can reverse/prevent heart disease, diabetes and in some cases cancer. ”
      Except doesn’t do as described. Every vegan I know has cancer and they had it after going vegan.
      Are you reading Denise wearing blinders?

    2. Mary- in switching to a plant based diet, what else did you eliminate? Were you already eating clean and healthy with minimal processed foods, and clean meats (game, fish, or pastured/grass fed animal products)? Did you feel better after adjusting your protein from animal products to only plant products? If so- then that’s something to discuss, as it provides a direct comparison/contrast to the criticisms of the film.

      However, if you weren’t eating clean, if you were eating lots of pizza, burgers, fries, processed flours (mind you, I love all these foods myself, although I stick to whole grains now, and love me some wheat, so I’m not knocking you here)- was your diet extremely high in carbs but not dense in nutrients? Lots of sugar? I’m thinking average US consumer here. If you switch from eating average to eating clean, you are going to feel better, but you can’t say it was directly the elimination of all animal products, since you eliminated so much at once. That’s what this review, and a lot of Ms. Minger’s writing is about- you can’t, as a scientist, say “we threw out all the animal products in the diet, as well as all the sugar, carbs, processed foods and inflammatory fats- and the people got healthy! It must mean meat is bad!” There are too many variables to make that kind of a statement.

      Now- going back to the top of this- if the scientists had a good controlled study of healthy individuals who already ate clean (as defined above, or find your favorite paleo/primal site), and removed the meat, and they ended up even healthier, then you’re on to something. So far, the studies haven’t done that, or been designed around that. So we have a lot of badly created/correlated studies and statistics being bandied about to say ALL meat and animal products are bad.

      And in case you missed it- no one here is slamming or hating on a veg centered diet- look at most paleo sites, and you’ll find lots of discussion about veggies and how to cook them. Probably as many ways to make a tasty salad or use an avacado as you’ll find on any vegan site.

      You’ll also see a lot of meat eating paleos/primals/WAPs slamming industrial feed lots and grain fed cows and poorly fed animals who aren’t healthy themselves so aren’t really healthy for you either- which is vastly different from healthy, properly fed animals or wild game, which are healthy for you- and if you take the time to read further, you’ll find lots of discussion about the whys and hows, and what to look for in animals products, should you choose to include them in your diet again.

      I’ve yet to come across a paleo diet blog saying anything at all about veggies being bad- lots of discussion about grains, but not veggies. Now, there might not be friendly terms with most vegans, but that’s something other than hating vegetables. I’ve yet to read any discussion that says ‘meat good, veggies bad’. Again, look around, and read, and take the time to read the whole post- there are several lines talking about agreement with a veg-centered diet. The whole gist of the critique though, is that the evidence to say animal products are bad or damaging to you is not currently based on strong science from well developed studies.

      And if you pay careful attention, you’ll see it stated multiple times by Ms. Minger in multiple posts and comments- if you found a diet that makes you healthy and happy- good for you! Keep it up, and keep learning so that you can improve it more with time. Instead of getting upset, share what you have done- what are the actual changes you have made? What’s working for you, and what problems are you still having? That kind of thing.

    3. 10 pounds in 2 months?? If you went on a ketogenic diet you would lose 10 lbs in ten days!! After giving up all grains and legumes I lost 25 lbs in 2 months. amy GERD went away in 2 days and my Arthritis went away in ten days.

  45. “….avoid dairy and meat products and over time, one can reverse/prevent heart disease, diabetes and in some cases cancer….”
    Just wondering where you have found that, I would be really interested. As an independent scientific researcher I would certainly take any reference you can give under consideration.

    1. James,

      If you watched the film Forks Over Knives, this is the message.

      Wow, OMG!

      I can’t believe how hated, despised folks who advocate a plant based diet from this blog.

      It’s like if you eliminate dairy and meat, you’re a commie or something. it is unbelievable.

      Look all I care about is losing weight, and helping myself to reverse the damage done from decades of dairy and meat consumption.

      OK? is that a sin or something? Denise and company and most of the bloggers seem to eguate veganism with evil.

      1. Yeah Mary, did you actually read the review? Sure doesn’t look like it. Do you always over react like this when someone disagrees with you?

        Random boss “Mary, I don’t think those figures you quoted in your report are accurate”

        Mary, ” OMG, Did you just accuse me of being incompetent and EVIL ???”

      2. It wasn’t the meat and dairy that made you a cow. It was what you ate with the meat and dairy. There is only one thing that makes people insulin resistant and that is carbohydrates. Try giving up bread and potatoes and rice and anything white. It is a painless way to lose weight.

        1. There are millions of people currently living in rural South America, Central America, Asia, and Africa on diets of potatoes, corn, rice, millet, cassava, and other starch vegetables with complete freedom from IR.

          1. Citations, please.

            Millet is a goitrogen. Bitter cassava is implicated in causing paralysis in rural Africa. Corn-based diets caused pellagra in the American South and Northern Italy 100 years ago. Potatoes contain varying amounts of solenine, a potent toxin which can cause death. (In the United States, wheat products are fortified to prevent pellagra and were heavily promoted by the government. Solenine levels in potatoes are regulated and for this reasons some varieties may not legally be sold. Therefore in the US the worst reaction seen is stomach upset and vomiting. It is unclear what level of millet consumption is safe, but in the US it is minimal. Most cassava available in the US is processed, sweet cassava, and much of the corn consumed is nixtamalized.)

            It’s weird–you could have picked better banners, such as sweet potato, taro root, plantain, and, for northern climes, buckwheat and turnip. Of your list, only rice is fairly innocuous (and I’d be surprised if rice isn’t implicated in dental caries).

  46. My perception was not that anyone was attacked, nor was “war waged” on anything. I believe the intent of this review was simply to call into question the faulty “science” behind the low-fat and vegan/vegetarian diets being pushed as the only true answer to good health.

    You state yourself that your switch to a plant-based diet was only recent. Do you really want to weigh in on the long-term benefits of such a diet after being on it such a short time? Is that really your “final answer??”

    1. I agree with you Ann. I didn’t see where Denise was attacking anyone. I know Denise and she eats mainly a raw food plant based diet. She had been raw food vegan for 7 of her 24 years. She loves animals and detests the inhumane treatment of factory farmed animals. I found this analysis completely subjective and written with good humor. She was merely stating where the movie lacked in scientific evidence. That’s all.

  47. The movie doesn’t give a lot of scientific information, most is anecdotal. Limiting your intake of meat and dairy certainly is not a wrong approach, however if you do it to limit or reduce your weight, you’re going to be disappointed. Most of you weight is carb related and in particular wheat related. We are in still in the process of discovering how unbelievably unhealthy wheat in any shape or form is.
    You will come across William Davis MD, cardiologist in many news releases in the next little while because of his book Wheat Belly.
    The link gives the first part of an interview Tom Naughton had with dr. Davis:

    http://www.fathead-movie.com/index.php/2011/09/12/interview-with-wheat-belly-author-dr-william-davis/

    The second is about the dark side of wheat: http://www.greenmedinfo.com/page/dark-side-wheat-new-perspectives-celiac-disease-wheat-intolerance-sayer-ji

      1. Oh, I can think of a better one than that. How ’bout “It’s all rhetoric!” Or Keynes: “In the long run, we are all dead.” You might also think of responding to Neisy’s posts with a simple “So you claim.”
        Here–Your hero: You’re either for him, or you hate Jesus and want the terrorists to win.

        1. Are you responding to me?

          Daniel Kirsner said: “Oh, I can think of a better one than that.”

          A better what?

          Daniel Kirsner said: “You might also think of responding to Neisy’s posts with a simple “So you claim.”.

          I wasn’t responding to Denise’s post, I was responding to James comment.

    1. It is troubling most of this diet discussion takes place in an absence of talk about exercise. Exercise and diet are the Ying and Yang of all health. Talking about one by itself is like explaining planet earth without mentioning it’s part of a solar system and a universe. Things work together and you’ve got to understand that togetherness to come to truth.

  48. “Opposition is True Friendship”–William Blake, The Marriage of Heaven and Hell

    Denise, I love your blogs, and have immense respect for your precocious erudition and skill in handling statistics, but am going to question some of what you say in this “review,” while taking the liberty of bringing Dean Ornish into the discussion though he was not included in the film, since I think he belongs in the overall argument being pursued.

    I will focus on Esselstyn, and the evidence for the success of his program, and largely stay out of your war against Campbell ( I agree that you really got him on the wheat issue–you definitely won that round on my score card.) However, though Esselstyn began his work without knowing about Campbell, he made some modifications in it after learning about Campbell, and the two are now working from the same page, so that I think we can read Esselstyn’s results as confirmation of the basic soundness of Campbell’s work. So I think you have a problem; you find many faults with the science behind the program, but are faced with evidence that seems to show that it works–and indeed, that it works spectacularly well. So you dismiss much of what it shows (“weepy personal stories”), and focus on things like Esselstyn’s now rather old published paper.

    You begin by giving them all a pretty good mark–“I believe the ‘plant-based doctors’ got a lot of things right, and a diet of whole unprocessed plant foods…can bring tremendous health improvements for people who were formerly eating a low-nutrient, high-crap diet.” But then the qualifiers: “ Especially short term.” ( Short term? we see people who have had over 20 years of happy, healthy life after having been given up as virtually dead–short term??) And you believe that “the perks of eliminating processed junk are inaccurately attributed to eliminating all animal foods.” You are right that the movie focuses on the plants and not on low-fat or junky carbs, but you can’t get everything into one shortish movie–this ain’t a 300 page book. And you are right it does not mention fish–but McDougall has a DVD that talks about fish, and in fact much of the good news about fish can be reinterpreted as “not as bad as meat” rather than as “positively good,” and much of the research on even those omega-3s shows that benefits peak on rather small doses, and some of that benefit may diminish as you bring down the omega-6s, since the ratio seems as important as the absolute amounts.

    But on to your critique of Esselstyn’s paper–which is not central to the movie, but I can see why you want to deal with it. In my previous reply I commented on your asssumption that “when studies have a significant drop-out rate, the folks who stick around tend to be the ones having the most success, while the failures slink away”–and suggested that this might well not be true of this group, for a whole variety of reasons, one of which is hinted at by the woman who joined recently, lost weight, cured her diabetes, and comments that you have to follow pretty rigorously or you leave the program. There was no control group–partly because there was no money ( that raises costs quite a bit) and on the other hand, in a sense there was a huge control group–the general American public. It was a “non-randomized study.” Quite true; Esselstyn is not a cardiologist, and could only get either volunteers or referrals from cardiologists who saw their patients as virtually dead, and gave them this last chance to grasp at some more life. And as you say, it changed a whole bunch of variables–it was a complete dietary overhaul–and that was central to the aims of the study.

    You then go on to look with alarm at the published results. You acknowledge “super-low total cholesterol levels,” but associate them with “higher rates of cancer, mental illness, infection, and other fun stuff”; but these patients, and the docs (Ph.D. and M.D.) themselves seem remarkably free of such things, though many are well advanced in years. Then a few of the triglycerides are still high, and some of the HDL numbers “are looking pretty sorry as well.” Well, maybe, but Dean Ornish, after considerable experience of this sort of program, says this: “Vegetarians have low levels of total cholesterol, very low LDL levels, and very low rates of coronary heart disease, even though their HDL levels tend to be low and their triglyceride levels tend to be high.” ( Dr. Dean Ornish’s Program for Reversing Heart Disease, 1996 p/b, p. 261). So these figures may not be as dire as you suggest; it is the end result that counts, not the surrogate markers.

    Your critique ends with a pat on the back, a B+ for effort in effect, “useful work, but could do better if he really tried”: “All in all, Essesstyn’s study shows that a whole-foods, plant-based diet is probably (why the qualifier?) infinitely better for cardiovascular health than the junky cuisine many people eat. But it’s far from conclusive evidence that this diet is the best we can do for reversing heart disease, or that it would be generally effective in a population beyond his 11 self-selected subjects. A diet that reduces triglycerides and increases HDL more than his did, for instance, might have an even better outcome.” Well, one extra subject did turn up–the maker of the movie, who had no intention originally of being involved in this way, but saw a doctor who applies the C/E program, got tested, was alarmed, began the program, and very quickly improved his vital statistics substantially. And a good many patients have now followed this kind of program with success; Esselstyn mentions that he has now had 250+ patients in his program, and more doctors are getting involved, like Joel Fuhrman and those in the movie, and, of course, Ornish, whose program is now followed in several centers, and accepted by several insurance companies because it produces results and saves them money. No, more than 11 subjects, please; you are ducking plain facts.

    Perhaps a diet that reduces TG and increases HDL more would produce an even better outcome–and I look forward to your book to supply some specifics, and some real life evidence, that this is indeed so. But while waiting for that, I am going to take a quick look at the paper that William Davis published, since he is a doctor of whose work you seem to approve, and the paper addresses these desiderata. Unfortunately I can access only the abstract, and we both know that there can be many a slip between an abstract and the full text of a paper. But here goes anyway.
    Davis gathered a group of 45 male and female subjects with coronary calcium calcification scores of greater than 50, “without symptoms of heart disease,” and treated them with “statin therapy, niacin, and omega-3 fatty acid supplementation to achieve LDL and TG or=60, and Vit D supplementation to achieve serum levels of > or =50, in addition to diet advice.” After “a mean of 18 months” (meaning?) 20 experienced decrease in CCS of 12% average; 22 experienced no change or slow progression, and 3 experienced progression exceeding 29%. I do not find these statistics very compelling; his group was in no way comparable to the groups that either Ornish or Esselstyn worked with–this group was symptom free, and only beginning the long trek towards serious heart disease; even with this level of intervention, only 44% were improved, though for many progression was stopped or helped. Let us compare that with figures given by Ornstein, using no anti-cholesterol drugs: “After only one year, the majority (82%) … demonstrated some measurable average reversal of their coronary artery blockages.” (Program for Reversing Heart Disease, p. 17). Not bad after one year?

    And about these statistics; one of the things that Ornish learned during many years of applying his program was that the correlation between lipid statistics and actual progress was much looser than he expected. He had assumed that total cholesterol would have to be below 150 for reversal to happen, but found that it was not so (pp. 19-21). What count are results and the cost of achieving them.

    You worry about the low total cholesterol in Esselstyn’s group (would that not apply also to Davis’s group?), and about high TGL and low HDL; I worry about high statin doses and their combination with niacin in Davis’s group (I am going to assume that getting LDL below 60 involved fairly high dosage; please correct me if I am wrong). Some years ago there was a good deal of discussion about the dangers of combining the two–it seemed that this considerably raised the % of significant muscle damage. Now that there is an FDA approved drug that combines the two, it must of course be safe… but is it? We are learning that muscle damage is much more prevalent with statin use than used to be thought, even when patients make no complaints of pain or weakness or fatigue. Such damage involves the mitochondria, those tiny energy producing organelles within nearly all the cells of the body, and particularly dense in heart muscle–the heart has in fact been called “one giant mitochondrion.” Some years ago P. Langsjoen published several papers linking statin use to diastolic dysfunction or heart failure, showing that the latter improved with discontinuation of statins. There has been a good deal of work since then, including a paper by Owan in 2005 (PMID: 16003647) that used data from the Mayo Clinic to show that the ratio of diastolic to systolic heart failure had climbed rapidly since the early 1980s, and was now over 50% of hospital admissions for heart failure, a fact that many doctors have not yet taken on board. Diastolic heart failure is a problem for cardiologists, because they do not know how to handle it; Langsjoen’s suggestion that it is due to statins is clearly not welcome, butchimes perfectly with the spreading use of statins, and may very well be true. Stephanie Seneff in a series of blogs details how it might work (see a series of papers with full refs at http://stephanie-on-health.blogspot.com ). There is also a recent article by B.A. Golomb, “Statin adverse effects: a review of the literature and evidence for a mitochondrial mechanism”, PMID: 19159124, with a very full bibliography.

    In view of this, I consider that any therapy that involves substantial long term statin doses to achieve some degree of improvement of the state of the cardiac arteries may in the long term be sacrificing the heart muscle itself to achieve that end. In addition, there is a good deal of evidence that statins increase rates of both cancer and diabetes. Diet based therapies are safer than drug based therapies, and even if Davis’s program does lead to long term improvement of those arteries, I would choose Ornish and Esselstyn, since they have demonstrated that also. And not just in those 11 patients: as many here have pointed out, the proponents make a very good case for the long term benefits of their program simply by the state in which they now are, though in their late 70s.

    Another point. You mentioned cancer as a possible consequence of too low cholesterol while critiquing Esselstyn. One of the “weepy” stories we hear in the movie is that of a woman who cured metastisized breast cancer by following Dr. McDougall’s advice. Ornstein in Spectrum gives some details of a study (with controls) on prostate cancer that shows slowing and even partial reversal of that cancer with his program, and expresses confidence that it could achieve the same results with breast cancer, though ethical issues prevent him from pursuing such a trial. Granted that Ornstein’s program involves more than diet alone, but diet is a or the major part of it; more evidence for the basic validity of the C/E approach?

    You suggest that there is possibly an even better path, and that may be true; even Ornish somewhere suggests that adding fish to his program may be compatible with reversal, though it has not been tested. As far as I know it still has not been tested; if there is ever good evidence for it, I shall rejoice; I love seafood, and live in coastal BC where local wild salmon, halibut, and prawns can all be freely obtained. I think that you, Denise, are as likely as anyone I know of to find a path that combines successfully much of the Campbell/ Esselstyn vegan approach with carefully chosen bits from the paleo doctrine, and I do look forwards very much to that book. But in the meantime, in between-time, I shall stay with what seems to me still the best and best tested regime.

    I have one final question: from your website I gather that you had been a vegetarian or vegan for some 10 years before embarking on this very intense and personal quest for the perfect diet. But you yourself seem a pefect product of that diet–slim and healthy of body, wonderfully active and playfully creative of mind. If being vegan can produce both you and the Campbells and Esselstyns of this world, what more can we hope for? Why seek to leave paradise?

    And one final word: Ornstein distinguishes between what he calls a “ prevention” diet and a reversal diet. Someone like you with already a long (at 24!) immersion in vegan and vegetarian diets may do just fine on his “prevention” diet, which does include some fish and so on. But most of us have not been so lucky, wise, or happy, and do need some version of his “reversal” diet. For most of us, damage has been done, and hard work will be needed to stop or partially reverse it. Whether that will include some animal protein remains for me a question, but for the time being I shall avoid it.

    All in all, Denise, I think you have seriously underestimated and undervalued the good news conveyed in this movie. But I continue to have faith in your good will and high intelligence; now, how about a “review” of Fat, Sick, and nearly Dead, behind which Dr. Joel Fuhrman stands as supporting figure? I have already bought a juicer….
    With best wishes, Chris Heppner

    1. Hi Chris,

      I really appreciate your comments. This is the kind of thing that moves our collective health dialogue forward — a calm, rational exchange of ideas focused on the science instead of personal attacks. Addressing some of your points:

      However, though Esselstyn began his work without knowing about Campbell, he made some modifications in it after learning about Campbell, and the two are now working from the same page, so that I think we can read Esselstyn’s results as confirmation of the basic soundness of Campbell’s work.

      Not necessarily. Esselstyn was achieving success with heart disease reversal when his patients were still eating animal protein (dairy), and as I understand it, the modifications he made based on Campbell’s work were more theoretical — not done because they visibly improved his patients’ health, but because he was persuaded by Campbell’s work that animal protein is harmful. Esselstyn’s program involves a lot more than what Campbell was espousing based on his research (particularly the dramatic reduction in not only animal fat but also plant fat), and the huge drop in omega 6 fats/linoleic acid is probably a large component of his program’s success.

      So I think you have a problem; you find many faults with the science behind the program, but are faced with evidence that seems to show that it works–and indeed, that it works spectacularly well. So you dismiss much of what it shows (“weepy personal stories”), and focus on things like Esselstyn’s now rather old published paper.

      I’ve offered explanations of why I think Esselstyn’s program works, and have never said his program is ineffective. Rather, I believe it’s effective for reasons other than the ones he gives. Esselstyn believes all fat causes endothelial cell damage, that dietary cholesterol is bad, and that reducing blood cholesterol to very low leves via diet and statins is necessary for preventing or reversing heart disease. I believe it’s only specific fats in excess levels that are pro-inflammatory and predispose LDL to oxidizing, and that his diet systematically reduces them by keeping all fat intake under 10% of total calories. That, combined with the elimination of processed food, should be enough to give nearly any program some success with treating heart disease. My concern is that animal foods are removed as part of a long list of dietary changes and their effect has never been isolated in the context of Esselstyn’s work. What if eating a whole-foods, low-PUFA/linoleic acid diet with no processed junk or refined grains is enough to achieve his results, without needing to go vegan? This is my concern, and given the fact that populations have remained heart-disease-free eating large amounts of saturated fat (but low PUFA) and animal products suggest that the elimination of these things might not be central in his program’s success.

      You begin by giving them all a pretty good mark–“I believe the ‘plant-based doctors’ got a lot of things right, and a diet of whole unprocessed plant foods…can bring tremendous health improvements for people who were formerly eating a low-nutrient, high-crap diet.” But then the qualifiers: “ Especially short term.” ( Short term? we see people who have had over 20 years of happy, healthy life after having been given up as virtually dead–short term??)

      Esselstyn has clinically documented the success of only 11 people. I’m thrilled those people had their lives changed and saved by Esselstyn’s program, and as I mentioned in this critique, found the personal stories quite touching. But 11 people, particularly 11 people who were self-selected and began the diet later in life while desperately ill, can’t be used to gauge the effects of the diet on the population at large. Perhaps I view this less optimistically because I routinely get emails from people on the McDougall program and other low-fat, plant-based diets who are facing health problems. The vegan “failure to thrive” phenomenon is very real, and the success of a handful of people in a unique situation isn’t enough to prove the diet will bring continued health for everyone who adheres to it.

      In my previous reply I commented on your asssumption that “when studies have a significant drop-out rate, the folks who stick around tend to be the ones having the most success, while the failures slink away”–and suggested that this might well not be true of this group, for a whole variety of reasons, one of which is hinted at by the woman who joined recently, lost weight, cured her diabetes, and comments that you have to follow pretty rigorously or you leave the program.

      It may or may not be true for this group, you’re right. There’s no way to know, and I have no doubt that the difficulty in adhering to Esselstyn’s program played a role in why some people left. But if even one or two of the folks who dropped out/didn’t complete the follow up did so because their health problems were worsening, it would change the picture of Esselstyn’s results. Any way you look at it, the 11 folks who stuck with the program were likely to be the ones having the best success on the diet and are not representative of the general public.

      Then a few of the triglycerides are still high, and some of the HDL numbers “are looking pretty sorry as well.” Well, maybe, but Dean Ornish, after considerable experience of this sort of program, says this: “Vegetarians have low levels of total cholesterol, very low LDL levels, and very low rates of coronary heart disease, even though their HDL levels tend to be low and their triglyceride levels tend to be high.”

      Seeing as a few of the patients did have lesions that worsened during the study, and some of the patients have lipid profiles that are almost definitely the atherosclerosis-producing “Pattern B” (high trigs, low HDL, small, dense LDL), my first thought is that the diet could benefit from further tweaking — particularly for those folks with sky-high triglycerides — to be fully effective and actually reverse (not just arrest) heart disease in all the patients.

      Perhaps a diet that reduces TG and increases HDL more would produce an even better outcome–and I look forward to your book to supply some specifics, and some real life evidence, that this is indeed so.

      The science behind this has to do with the etiology of heart disease and is already being written about in many places. Google “LDL pattern A and B,” “oxidized LDL,” etc. The goal is to prevent LDL oxidation by making LDL particles big/fluffy instead of small and dense, reduce endothelial injury, and reduce the formation of foam cells (lipid-loaded macrophages that have gobbled up oxidized LDL and contribute to plaque formation). Coupled with a diet and lifestyle that lowers inflammation, shifting the lipid profile to one with low trigs, high HDL, and large, fluffy LDL removes many of the steps involved in heart disease — without needing to keep total cholesterol under 150 like in Esselstyn’s program.

      RE: William Davis — I was unfamiliar with the study he published, but if you read his blog or his recently released book, the theme of his work is in treating heart disease by reducing small LDL via diet (particularly eliminating wheat and refined sugar). He frequently writes about the individual cases of his patients and their success. I guess you could write the unpublished results off as anecdotal, but if that’s the case, the 250+ patients Esselstyn mentioned would also have to be canned as evidence.

      And about these statistics; one of the things that Ornish learned during many years of applying his program was that the correlation between lipid statistics and actual progress was much looser than he expected. He had assumed that total cholesterol would have to be below 150 for reversal to happen, but found that it was not so (pp. 19-21). What count are results and the cost of achieving them.

      I agree. I also believe it’s possible to achieve those results on a non-vegan diet that preserves the other elements of Ornish and Esselstyn’s programs (linoleic acid/omega 6 reduction, elimination of processed food, etc.).

      In view of this, I consider that any therapy that involves substantial long term statin doses to achieve some degree of improvement of the state of the cardiac arteries may in the long term be sacrificing the heart muscle itself to achieve that end. In addition, there is a good deal of evidence that statins increase rates of both cancer and diabetes. Diet based therapies are safer than drug based therapies, and even if Davis’s program does lead to long term improvement of those arteries, I would choose Ornish and Esselstyn, since they have demonstrated that also. And not just in those 11 patients: as many here have pointed out, the proponents make a very good case for the long term benefits of their program simply by the state in which they now are, though in their late 70s.

      Esselstyn’s program specifically used statins, and Davis is actually staunchly opposed to them except in rare cases (for instance, read his blog post here: http://www.trackyourplaque.com/blog/2011/04/when-might-statins-be-helpful.html). I agree that statin use is generally a trade-off for worse problems.

      Another point. You mentioned cancer as a possible consequence of too low cholesterol while critiquing Esselstyn. One of the “weepy” stories we hear in the movie is that of a woman who cured metastisized breast cancer by following Dr. McDougall’s advice. Ornstein in Spectrum gives some details of a study (with controls) on prostate cancer that shows slowing and even partial reversal of that cancer with his program, and expresses confidence that it could achieve the same results with breast cancer, though ethical issues prevent him from pursuing such a trial. Granted that Ornstein’s program involves more than diet alone, but diet is a or the major part of it; more evidence for the basic validity of the C/E approach?

      I wrote that low cholesterol is associated with higher rates of some cancers, not that low cholesterol necessarily leads to cancer (the whole “correlation isn’t causation” thing) — sorry if that wasn’t clear! The point was to illustrate that low cholesterol levels are associated with their own set of problems and we shouldn’t assume lower is always better. There is a much more direct and causative connection between low cholesterol and mental illness, depression, hormonal problems, etc. since cholesterol plays a role in neuron signaling and is a precursor for hormone production.

      But in the meantime, in between-time, I shall stay with what seems to me still the best and best tested regime.

      Chris, the most I ever hope for is that folks find a way to be healthy and happy. If you’ve found something that’s bringing you the results you want, by all means, run with it and rejoice. :)

      I have one final question: from your website I gather that you had been a vegetarian or vegan for some 10 years before embarking on this very intense and personal quest for the perfect diet. But you yourself seem a pefect product of that diet–slim and healthy of body, wonderfully active and playfully creative of mind. If being vegan can produce both you and the Campbells and Esselstyns of this world, what more can we hope for? Why seek to leave paradise?

      I developed a large set of health problems as a vegan (mostly dental and cognitive) and was super unhealthy as a vegetarian (catching colds 2 – 3 times per month for basically my entire childhood, after going veggie at age 7… tons of ear infections, bronchitis, fatigue, etc.). Although my diet is still “plant strong,” it wasn’t until I added back some animal foods that my health truly improved.

      And one final word: Ornstein distinguishes between what he calls a “ prevention” diet and a reversal diet. Someone like you with already a long (at 24!) immersion in vegan and vegetarian diets may do just fine on his “prevention” diet, which does include some fish and so on. But most of us have not been so lucky, wise, or happy, and do need some version of his “reversal” diet. For most of us, damage has been done, and hard work will be needed to stop or partially reverse it. Whether that will include some animal protein remains for me a question, but for the time being I shall avoid it.

      This is a very good point — sometimes more aggressive measures are needed to reverse existing damage. I hope one day we’ll have more studies to shed light on the role of each specific change in programs like Esselstyn’s and Ornish’s.

      Chris, thanks again for your detailed and thoughtful comments. I appreciate your readership. :)

  49. I’d like to see a study where Dr. Esselstyn is given 100 people with advanced heart disease and Dr. Animal Fat (name your favorite doctor who thinks top sirloin doesn’t harm the human cardiovascular system) is given 100 people with advanced heart disease.

    One group follow Dr. Essy’s diet. The other group follows the diet high in dietary cholesterol and saturated fat (mostly from animal based foods).

    Then we all get to kick back and watch for the next year, the next 5 years and the next 12 years.

    I haven’t been to Las Vegas in quite some time. But I know where I would place my bet on a diet competition like that.

    1. I’d love to see more vegans/vegetarians present argument like the gentleman Chris did above (and the lovely people that commented in the AHS wrapup post). That was thought provoking and welcome to me, and I greatly enjoyed the discussion between him and Ms. Minger.

      Comments like yours and Richard’s basically give me a headache and make me want to write you and your opinions off, which is unfortunate if you are actually a thoughtful person with good reasoning skills. I’d also love for commentors like yourself to argue daily dietary practice theories separately from the treatment of acute disease and avoid creating strawman arguments. And while he’s kind of not thought about these days, before he went commercial, didn’t Atkins actually successfully use a ketosis diet high on animal protein and fat to treat acute heart disease (it’s been a long while, so I could be mistaken about the severity of those he treated)?

      Anyway…

      Does anyone know if there are any actual studies being conducted or planned to compare from a common baseline, such as healthy populations of primal/paleo to vegans or vegetarians? That’d be the interesting one to me.

      1. ChristopherD: I’d also love for commentors like yourself to argue daily dietary practice theories separately from the treatment of acute disease and avoid creating strawman arguments.

        Is it really a straw man argument to suggest that some think the Esselstyn diet could be improved by adding animal based foods, even “full fat” (not skim or non-fat) animal based foods?

        There’s a guy named Uffe Ravnskov who wrote a book titled, “Fat and Cholesterol Are Good For You.” Dr. Ravnskov’s previous book, “The Cholesterol Myths” was mentioned (in a positive way) in the DvD “Fathead.”

        So, let’s have an Esselstyn versus Ravnsov match up. Then we can find out if heart disease patients do as well with a diet high in (full fat) animal based foods as they did under Esselstyn’s program.

        1. A study like that (without the competition aspect – an actual controlled scientific study) would be spectacular.

          The vast majority of “high carb vs low carb” studies (I don’t know of any animal vs plant studies) tend to be not particularly low carb on the low carb side, or don’t control for potential confounding elements like PUFA’s. This means almost all of these studies must be taken with heavy caveats, and so they don’t leave you with a clear direction for what is healthy and what isn’t.

          Epidemiological studies, like The China Study, tend to have such complex and misleading raw figures that the ecology fallacy runs rampant, and you are again left wondering just how reliable and complete a given scientist’s conclusions are. Case in point, Denise’s destruction of Campbell’s arguments based on the study.

          A well-run study that specifically targeted the vegan health issue would be wonderful. As far as I know, it has never been done (else one side or the other of the debate would be quoting the snot out of it). In the mean time there is tons of anecdotal evidence that a pure vegan diet is, if nothing else, extremely difficult to maintain in a healthy manner.

  50. Hello,

    I just want to say that it has been a very interesting read, and I am not entirely sure what to make of all the information yet. But I do have one comment on protein quality. I will declare now that I am not an expert on any of this stuff, I am just going by the information you put in here, some basic high school biology, and a little help from wikipedia.

    Your statement below:

    “The rats that stayed cancer-free on an unsupplemented gluten diet were the equivalent of a human eating nothing but wheat, every single day, from the moment they’re weaned off Momma’s teat until the day they die. A vegan eating a mixture of plant foods will naturally end up consuming complementary amino acids, and their body will synthesize the “complete protein” that Campbell says is cancer-promoting. For instance, in the common combination of rice and beans, beans supply extra lysine that rice is low in—the same effect as supplementing gluten with this amino acid.”

    This on first glance seems to make sense, but I am nagged by that last statement regarding mixture of plant foods and implying that it is the same as supplementing gluten with an extra amino acid. Now, I have no idea how they supplemented the amino acids, but it seems to me the two could mean very different things.

    It may be true that in any given vegan meal, two food groups could provide incomplete proteins that strictly speaking, could added up to complete proteins if you only talk about numbers of amino acids and percentages. But such foods are not made of proteins alone correct? it is bound up together with all sorts of other stuff, like minerals, fiber, sugars…etc. The body may digest actual foods very differently than say supplemented amino acids.

    This is from Wiki on complete proteins:

    “Absorption of the amino acids and their derivatives into which dietary protein is degraded is done by the gastrointestinal tract. The absorption rates of individual amino acids are highly dependent on the protein source; for example, the digestibilities of many amino acids in humans, the difference between soy and milk proteins[9] and between individual milk proteins, beta-lactoglobulin and casein.[10] For milk proteins, about 50% of the ingested protein is absorbed between the stomach and the jejunum and 90% is absorbed by the time the digested food reaches the ileum.[11] Biological value (BV) is a measure of the proportion of absorbed protein from a food which becomes incorporated into the proteins of the organism’s body.”

    This sounds very complicated to me, but it looks to me like there is a possibility that two incomplete proteins from different food sources (which in amino acid counts and percentage may in theory add up to complete proteins) may not actually be broken down the same way by the body as an actual complete protein, or even the same time and therefore may have very different effect on cancer.

    Furthermore, even assume that what you say is true, that in a given vegan meal, two incomplete proteins adds to a complete protein. How likely is it I wonder? That two food sources and their incomplete proteins extracted at the same time, the same place, to give full amino acids in just the right percentage as a complete protein, what are the chances? It seems to me very difficult to say. Yet, if you eat animal proteins, which I understand to mean complete proteins almost always, you are guaranteed to have all the amino acids available which are more likely to promote cancer growth correct? This may sound just being over technical, but many people eat meat every single meal, and over a lifetime, doesn’t that risk really add up? I can’t even think of how to calculate that risk…perhaps you can, you seem really good at the math stuff.

    Thanks, I really enjoyed this piece, will continue to think more on the topic.

    1. The key is that all of the amino acids are absorbed into the bloodstream – the where is a bit of a red-herring. It all gets into the blood no matter which part of the intestine absorbs it (that is, in fact, why we have different parts of the intestine – to facilitate the digestion of different nutrients), and that is the important part.

      The way the body digests protein is to break it down into its constituent amino acids before absorption. So what you actually digest are the individual amino acids themselves, not the whole protein. Amino acids are also not used immediately, but stored until needed. There is no need to eat a complete protein at each meal to meet your amino acid requirements, so long as you are are averaging a complete protein.

      Therefore, there is no reason to think that supplementing wheat with beans, for example, would not result in the absorption of the entire amino acid profile. Something in the food would have to actively block the absorption of the amino acids for that to occur. Vegans who eat a varied mix of plant proteins probably don’t have a protein deficiency.

      With regards to protein, animal foods are simply easier. If you eat an animal, you get all of your amino acids. No planning necessary. Animal foods are also jam packed with key vitamins and minerals and fats that are either non existent or not very available from plant sources. In my opinion, the problems with cutting meat from your diet are likely more to do with vitamins and fats than protein specifically.

  51. For a liberal arts major – your grasp of epidemiology and statistics is pretty darn good!

    I agree about the difficulty with interpretation of correlational data. Don’t tell me the China study threw those those 9,000 variables into one gargantuan multivariate analysis to reach their vege verdict? Surely not.

    My favorite line
    “Do you smell a rat? I do… and it has hepatocyte necrosis” :)

    Your post was awesome. I’ll be spreading the word.

  52. Denise, could I ask please, when you were vegetarian and had all those health problems, were you eating any white flour, white rice, white sugar, or low-fat dairy?

    I realise this could be a difficult question since you were only 7 when you went veggie. Can you remember?

    1. Hi Jane,

      My diet shifted a lot between the time I was 7 and the time I was 17, when I reintroduced animal foods. From ages 7 to 11, I ate a semi-healthy vegetarian diet (my parents didn’t buy stuff like soda or sugary cereals), but I was still eating wheat, dairy, and sugar in desserts. When I was 11, I was diagnosed with a wheat allergy and stopped eating all wheat, both refined and whole. A couple years later, I stopped eating dairy and soy because I was sensitive to those foods as well. From 14 to 16 my diet was wheat-free, dairy-free, nearly sugar-free, and soy-free. I was still getting sick all the time. When I was 16, I became a raw vegan, and this was the first time in my life I actually had energy and a functioning immune system. By the end of one year as a raw vegan, though, I had over a dozen cavities, receding gums, hyperactivity mixed with lethargy, constant brain fog, sleeping problems, muscle loss, and a sharp decline in short-term memory (although on the bright side, I still wasn’t getting sick!).

      Hope that helps!

      1. Denise, thanks, that does indeed help a great deal. It sounds very much like Chris Masterjohn’s experience. No animal foods, terrible dental health. I suppose it’s the fat-soluble vitamins.

  53. James, is it really true that wheat is so unhealthy? I mean, whole wheat as opposed to white wheat flour? There is a whole industry devoted to wheat-bashing whose arguments are pretty suspect. Yes, doctors remove wheat from their patients’ diets and they get better. We don’t know what would have happened if they’d replaced all the white flour with wholemeal flour.

    1. Is whole wheat so unhealthy? Yes, it certainly is for some of us. I ate whole wheat breads, cereals, and other products (taboule, pilafs, pasta) heavily for most of my life (ages four to forty-four); my diet was centered around it. My consumption of white flour, in the occasional serving of noodles or dessert, was minimal.

      I gave up wheat entirely nearly two years ago, and suddenly a host of chronic health problems cleared up: depression, fibromyalgia, irritable bowel syndrome, eczema, asthma. So apparently all that “healthy whole wheat” wasn’t, for me. But I’m not alone — I hear the same thing from dozens of other people who’ve gone Primal or Paleo.

      So yes, the gluten, lectins, and phytates in whole wheat can cause real problems. For quick summaries, see http://www.marksdailyapple.com/why-grains-are-unhealthy/ or http://www.realfooduniversity.com/real-truth-healthy-grains/ .

  54. Denise, many thanks for your (swift!) and helpful reply. You are of course right that Davis says critical things about statins on his blog–which makes it all the more curious that he seems to give them such a central place in his published study. Maybe someone who has access to the full text could throw some light on just what his protocol was?

    And thanks for those notes on your early years–I am sorry they were so full of trouble. I, in contrast, despite all kinds of turmoil and difficulties in early and middle years, and varying dietary habits, remained in the best of active health until I was 70–and then got hit hard. So we do come at these questions from very different starting points! I will get back to you on some other points later.
    Best wishes, Chris H.

  55. Denise says: I’ve offered explanations of why I think Esselstyn’s program works, and have never said his program is ineffective. Rather, I believe it’s effective for reasons other than the ones he gives.

    Bingo!!! Then follow Esselstyn’s program if you want to be hear attack proof. period. If his program is so powerful that it works and can reverse the heart disease, then let him explain why it works rather than your version of why it is effective.

    Common sense: If Esselstyn’s program works and your program is diagonally opposite to his program then do you want me to draw conclusions for you?

    1. No, it’s not common sense. It’s wrong because now people are following a program and focusing on unnecessarily strict behaviors like completely avoiding meat for the next 70 years of their life, when they could be enjoying a larger variety of foods and getting the same results.

      I’ve got a program for making sure your car will start when you turn the key: keep your tires clean, change the oil regularly, follow the recommended maintenance schedule, and don’t ever, EVER listen to the radio while driving. The radio is the most important part; if you listen to it your car will slowly die. My program works, so let me explain why it works.

  56. Denise says: that his diet systematically reduces them by keeping all fat intake under 10% of total calories. That, combined with the elimination of processed food, should be enough to give nearly any program some success with treating heart disease.

    Sounds like you just need a cookie for splitting hair and nitpicking!!! You have criticized Campbell, Dr hammer MCDougall, Dr Esselstyn, Dr Ornish. Now you are on to, Esselstyn’s program is bound to work because on this program you don’t eat anything, so how you are going to get food born illness?

    You have made lot of twists and turns since your first Campbell hammering. Now the evidence is so compelling that you are forced to accept Esselstyn works with some ego.

    Esselstyn, McDougall, Ornish, Cambell …they all send pretty much the same message as opposed to yours. If you now accept one, doesn’t make any sense why would you lambaste others?

    If you think it is non refined/ unprocessed component of their diet which is the kicker, then it is these luminaries who preached that whole foods concept first which now you want to piggyback on. If it wasn’t for these men then we will still be doing high fat, high protein along with potato chips and french fries.

    You can write as many dessertations as you like, you have NO CASE in my opinion.

    1. So in other words, since they thought of it first we should just follow along and not make any improvements to their diet recommendations just because they happen to be better than the standard American diet, gotcha.

  57. Earlier this year, Dr. William Castelli did an interview on diet and disease. Castelli was the director for many years of the Framingham Heart Study. So, how do Castelli’s conclusions line up compared to those of Dr. Esselstyn and Dr. Cambpell?

    http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

    . . . . you know some of us knew you could shrink these deposits – I mean I learned you could shrink the deposits in people’s arteries when I was a medical student in Belgium working for a pathologist in the ’50s. When he did an autopsy he would call us over and say “Look at this coming back to Belgium at autopsy all these fat deposits in their arteries.” We said, “Well wait a minute if it’s coming back where did it go?” He said, “I don’t know where it went. Disappeared by 1942.” Well what happened in Belgium in the early ’40s, an army came and well right behind the army came the German trucks. They backed them up to all the farms in Belgium, northern France, Holland, Poland, all the countries the Germans invaded, the trucks showed up. All the meat and livestock went back to Germany and by 1942 in Belgium at autopsy all the fat deposits in the arteries had disappeared.

    . . . . .

    . . . . . . when we lower the cholesterol we lower the heart attack rate. So it’s a very important player. You know, we know that if I can get your total cholesterol down around let’s say 100 to 130 or so, and I have maybe not quite a billion people on the earth like that, and those people cannot get atherosclerosis. You know in the China Study, for example, when Chou En-lai was dying of cancer he started a study in China just like the Framingham Study. The only difference was it was in 880,000,000 people so it was a little larger than the Framingham Study. But you know they found these villages in China where you couldn’t get a heart attack or you couldn’t get diabetes and the women couldn’t get breast cancer and you know their total cholesterol were 127, but the chances we could ever get Americans down that low with diet and exercise are not good.

  58. Here we go again. Cholesterol is a symptom, an indication that something is not as it should be. Especially the so-called bad cholesterol, actually what am I saying. I mean the lipoproteins , the low density ones, they are the ones that your liver produces in quantity when they are needed to fix something. You can do two things here. Trying to prevent that something is in need of fixing and help the LDL with antioxidants that it does not get damaged, because when there is a war going on in your system the ‘medics’ get hurt.
    You want to lower your LDL? Try staying away from wheat and anything wheat related. see: http://www.greenmedinfo.com/page/dark-side-wheat-new-perspectives-celiac-disease-wheat-intolerance-sayer-ji.
    or get William Davis’ new book ‘Wheat Belly’

    1. James,

      Which is more important, staying away from wheat or staying away from eggs?

      Perhaps the leading Canadian stroke prevention expert, Dr. David Spence, says we should stay away from eggs.

      http://cnews.canoe.ca/CNEWS/Canada/2009/04/11/9083531-sun.html

      “The only Canadians who should eat eggs regularly are those with a terminal illness,” said Dr. David Spence, a Robarts Research Institute scientist and director of the Stroke Prevention and Atherosclerosis Research Centre in London, which treats more than 6,000 patients.

      “Who would you want to believe — the dietitian who works for the Egg Farmers of Canada or a doctor who has spent 30 years trying to prevent strokes? I don’t have any interest in this at all, but they certainly do. They are selling eggs, I am selling stroke prevention,” he said.

      http://zestzfulness.blogspot.com/2010/11/cholesterol-in-egg-yolks.html

      There’s been a widespread misconception developing among the public and even health practitioners, that consumption of dietary cholesterol and egg yolks is harmless. Much of this has to do with effective egg marketing.

      Diet is not just about fasting cholesterol; it is mainly about the postprandial effects of cholesterol, saturated fats, oxidative stress and inflammation. A misplaced focus on fasting lipids obscures three key issues. Dietary cholesterol increases the susceptibility of low-density lipoprotein to oxidation, increases postprandial lipemia and potentiates the adverse effects of dietary saturated fat. Dietary cholesterol, including egg yolks, is harmful to the arteries.

      Egg yolks are not something that should be eaten indiscriminately by adults without regard to their global cardiovascular risk, genetic predisposition to heart attacks and overall food habits.

        1. Sue,

          I agree. Let’s have Dr. David Spence of Canada and Chris Masterjohn debate this.

          By the way, Dr. Esselstyn uses the same argument when he tells people not to rely entirely on statins. Esselstyn says that although the statins will result in the liver producing less serum cholesterol, with every bite of steak, every drop of olive oil, you are still assaulting the endothelial lining of your arteries.

          In one lecture Dr. Esselstyn gave, he mentioned that Tim Russert was taking statin. But Russert continued to eat the steak, cheese and other endothelial assaulting foods. Then, bam. Fatal heart attack.

          Now, some have argued that it wasn’t the steak and cheese that killed Tim Russert. It was the Dr. Pepper and the Coco-puffs.

          That’s why we need Uffe Ravnskov (author of “Fat and Cholesterol are Good for You”) and Esselstyn to duke this one out in a study where they each get 100 people with really bad heart disease. We can see which do better.

          But Ravnskov can’t hold back. Ravnskov must have his heart disease patients choke down at least 8 ounces of either beef, chicken or pork each day, at least 1 egg each day and at least two ounces of cheese each day.

          This way, we will have isolated the variables, so to speak.

          1. Steel,

            The liver only makes about 15% of the body’s cholesterol and the primary way it governs plasma cholesterol is through its role in clearing LDL from plasma via the LDL receptor.

            I agree with you in principle that we should settle these questions with experimental evidence and that comparing different diets argued to be heart-healthy is important. I do no think, however, that it makes sense to use a dietary approach designed by Dr. Ravnskov’s since he seems to think that diet is irrelevant to heart disease and as such he doesn’t have a dietary prevention program. In any case, whoever’s approach would be chosen, it would be important to collect 200 people (or however many) and randomize them to treatments administered either by the same people, or by randomly selected people. Having someone be actually treated by Esselstyn or an “opponent” of his would seriously confound the interpretation of the study.

            I suppose if you can get Dr. Spence to comment on this blog, you can get me to respond. But I think the others were suggesting I respond to your comments, which I’ve attempted to do.

            Chris

      1. Yes, Chris would probably do a better job. Really I have no comment on this. 30 years trying to prevent stroke?? Guess that’s how he makes his money. Like my brother-law , a pediatric surgeon says, if all people would eat and live healthy we would be out of a job. I know it was tongue in cheek but still. And of course with eggs I mean real eggs from pastured chickens, same as with pork and beef.
        The rest is bull, or cascaded knowledge. I thought we were past this but apparently old lies die hard.

        1. James, I asked you a question further up the thread which I imagine you didn’t see. Here it is:

          James, is it really true that wheat is so unhealthy? I mean, whole wheat as opposed to white wheat flour? There is a whole industry devoted to wheat-bashing whose arguments are pretty suspect. Yes, doctors remove wheat from their patients’ diets and they get better. We don’t know what would have happened if they’d replaced all the white flour with wholemeal flour.

          1. See the recent book, “Wheat Belly” by William Davis.

            There are a variety of components in wheat that are known to cause various problems for certain segments of the population. However, there are also components that are known to cause deleterious effects for all humans. Whole wheat has a higher concentration of lectins (WGA) than white flour.

      2. Mr. Monkey, or if I may call you Steel,

        I think it is somewhat disingenuous of Dr. Spence to harp on the conflicts of interests that dietitians working for Egg Farmers of Candada have when he has his own. This is what the review cited in the blog you linked to says:

        =========
        Conflict of Interest: None of the authors receives funding from purveyors of margarine or eggs. Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs, and Dr Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium; his research has been funded in part by Pfizer Canada, AstraZeneca Canada Inc and Merck Frosst Canada Ltd.
        ===========

        I don’t think this invalidates their arguments, of course, but neither does funding from the Egg Board necessarily invalidate the findings those studies. It’s important to trace the money trail, but ultimately the scientific questions should stand on their own merit.

        I agree that heart disease is about oxidative stress, inflammation, and endothelial function. But this review provides no quality evidence that eating eggs hurts these parameters. He cites a study published in a cardiology journal showing that McDonald’s hash browns and Egg McMuffin worsen endothelial function whereas frosted flakes and orange juice do not. This was published in a cardiology journal and cardiology journal’s are notorious for providing useless dietary information. That manuscript would never been accepted as is in Journal of Nutrition or American Journal of Clinical Nutrition. There isn’t even a table providing basic nutrient breakdowns of the two meals. Is it possible that reused fryer oil caused the decrease in endothelial function, or that vitamin C in the orange juice protected against this decline in the other group? To Dr. Spence it is obvious that it was the cholesterol, but to me it’s not so obvious.

        He cites two studies purporting to show that eggs increase LDL oxidizability. I don’t accept in vitro LDL oxidizability as a useful measure because this does not necessarily reflect the actual oxidation taking place in vivo. Nevertheless, one study I only have access to in abstract and it doesn’t even mention a control group. The other fed four diets and didn’t randomize the order, so is useless on that basis. Randomization is an essential pre-requisite for cause-and-effect inferences in all scientific studies, and that study would have been rejected outright from the British Medical Journal or from many meta-analyses based on its illegitimate (non-randomized) method of assigning trial order alone.

        I don’t think we should always ignore these types of studies, but we should recognize them for what they are. It is disheartening that Dr. Spence spends no effort critiquing the strengths and limitations of the studies he cites. He just cites whatever is convenient.

        Maria-Luz Fernandez has conducted a number of randomized, placebo-controlled studies showing that egg consumption has little or no effect on blood lipids in some 70% of people and that in most of the rest it increases total cholesterol without altering the total-to-HDL-C ratio, and that it tends to increase LDL particle size (considered good) without altering LDL oxidation. She responded to Dr. Spence’s review, though Dr. Spence didn’t grapple with any of her research in his review, nor in his response to Fernandez in which he stated rather simply and dismissively, “It is curious how Dr Fernandez, like many others, simply doesn’t want to look at the evidence.”

        My curiosity is returned.

        Chris

        1. I guess what I find interesting is that whenever some doctor gets the idea into his head that he wants to treat or prevent a heart disease through nutrition rather than through bypass surgery, inevitably the doctor, whether its Ornish, Esselstyn or McDougall, always ends up pushing that plate of animal based food further and further away from the patient.

          And with Spence versus stroke we see the same thing. Just as Esselstyn had made a second career of defeating heart disease, Spence’s career seems devoted to preventing strokes.

          What does Spence say about eggs? Don’t eat ‘em, at least not the yolks.

          Ah, but eating eggs don’t raise serum cholesterol levels very much. Spence says that what happens between the time you eat and the time your blood is drawn is a bigger player. Esselstyn reaches similar conclusions. Esselstyn has explained why statins might reduce your cholestrol count in a blood draw but don’t do as good a job of protecting your arteries as does a low-fat, whole foods, plant based diet.

          Now, maybe there are clinicians out there in the universe who have dedicated their lives to stroke prevention and heart disease prevention who are using a diet that is high in eggs, cheese, chicken, pork and beef to prevent the next stroke or the next heart attack. Maybe such people exist. I just haven’t found them yet.

          So, what is the guy or gal who wants to avoid a stroke to do? Listen to the egg industry that says eggs yolks are healthy? Or listen to Dr. Spence, Dr. Esselstyn, Dr. Ornish, Dr. McDougall, Dr. Campbell who say that they are unhealthy?

          Assuming that this hypothetical guy or gal doesn’t want to try to become a clinical nutritionist on their own, following the lead of those doctors and rejecting the advise of the egg industry seems like the correct course. Don’t you think?

          1. Hi Steel,

            Dr. William Davis is a cardiologist practicing in Milwaukee and Medical Director of the “Track Your Plaque” program. He practices “preventive cardiology,” which I think is precisely what you are suggesting — using the food fork and other lifestyle changes to prevent the need for the medical knife. He advocates eating eggs with no restrictions other than appetite.

            Is he right about everything? Maybe, but probably not. He’s human like you and me. But if you haven’t found anyone practicing any type of preventive cardiology who doesn’t eschew eggs, I think you need to look just a little bit harder.

            I understand your point that Drs. Spence and Esselstyn think that the total exposure of the endothelium to lipids is what matters, and not simply exposure to fasting lipids. I think the evidence is very strong, however, that it is not exposure of the endothelium to lipids per se, but to oxidized lipids that promotes atherosclerosis. If you’d like my rationale for believing this, I described it here:

            http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html

            If you prefer audio, I also described it here:

            http://chriskresser.com/the-healthy-skeptic-podcast-episode-11

            http://chriskresser.com/episode-16-chris-masterjohn-on-cholesterol-heart-disease-part-2

            Or if you prefer video:

            http://blog.cholesterol-and-health.com/2011/08/my-ahs-presentation-is-now-online.html

            If you find good evidence that eating eggs over the long term increases lipid oxidation in plasma, I will be happy to discuss it with you.

            Chris

            1. Chris,

              [Dr. William Davis is a cardiologist practicing in Milwaukee and Medical Director of the “Track Your Plaque” program.” He practices “preventive cardiology,” which I think is precisely what you are suggesting — using the food fork and other lifestyle changes to prevent the need for the medical knife. He advocates eating eggs with no restrictions other than appetite.]

              Well, maybe the randomized trial featuring 200 heart disease patients should be an Esselstyn versus Davis matchup.

              Does Davis allow his patients to eat, say, 8 ounces of beef each day, as part of his preventative cardiology?

              If so, perhaps an Esselstyn versus Davis contest would get the issue of whether Esselstyn (and Ornish) got their results primarily by banning processed and refined plant foods (includling vegetable oils) or if their results were heavily dependent on telling their patients to stay away from (or limit) animal based foods.

              For the average guy or gal out there, all of these detailed discussions about whether this or that scientific experiment was an intervention trial or an observation trial is unimportant.

              The bottom line is: can I eat my top sirloin and avoid that heart attack?

              Esselstyn says no. What does Dr. William Davis say?

              1. By the way. I had a phone conversation with Dr. Esselstyn several months ago.

                I told him that I had read his book, “Prevent and Reverse Heart Disease,” read many of the information he provided on his web site and decided to adopt his diet.

                I also told him that some relatives of mine (aunt, uncle, 2 cousins) have adopted what I would call a Weston Price Foundation diet.

                Standard food at their house these days is:

                3 eggs and bacon for breakfast. Steak cooked with butter for lunch and dinner.

                Their food is purchased from local farmers, not from corporate farms. Also, the beef is grass fed.

                I told Dr. Esselstyn that my relatives eat grass fed beef. He chuckled and called it, “grass fed arsenic.”

                So, his position is clear, to say the least.

                1. Hi Steel,

                  Well I’m sure Dr. Esselstyn realizes that this is an enormous exaggeration. I hope this family is eating more than steak, eggs, and bacon. It’s worth noting that most of the groups Price studied did not eat steak every day.

                  Thanks for sharing,
                  Chris

              2. Hi Steel,

                I’m probably not the best person commenting to describe Davis’s position because I haven’t finished his book yet, but my understanding is that he does not place any limits on meat consumption because he believes that once you eliminate factors that disrupt appetite (among which he singles out wheat as particularly important) you will settle on a more instinctual eating pattern that provides what your body needs.

                I should emphasize that the only reason I brought up Dr. Davis was because you said you weren’t aware of anyone practicing a preventive approach to cardiology that did not eliminate eggs. So, now you are aware of Dr. Davis, who promotes eating eggs as part of his plan.

                I think it would be very valuable to test Esselstyn’s approach and Davis’s approach, but I think we should be careful of a few things.

                First, each of these is just one of many approaches. It isn’t as if Esselstyn’s approach should act as some sort of prototype for the vegetarian camp and Davis’s should act as a prototype for the omnivorous camp. So you might show that one outperforms the other but it might not provide the definitive answers you want to question such as, “should I eat steak?”

                Second, you might run into the problem that both are effective. If this is the case, you may miss out on any evidence for the efficacy of either if all you’ve done is compare the two. So you would instead want to randomize one large group of people to either approach or a control group that receives standard medical treatment.

                Third, you’d have to realize that either of these approaches may be difficult to comply with. I think the best way to address this would be to develop as rigorous as possible a measure of compliance, and then publish the results both with an intention-to-treat analysis and a per-protocol analysis. The intention-to-treat analysis includes results for everyone, even those who dropped out or complied poorly, and the per-procotol analysis includes results only for those who complied well. The former addresses the question, “what will be the effect in the general population if we recommend this approach?” while the per-protocol analysis makes some attempt to understand what the true effect of full compliance is, although it is nevertheless seriously confounded by the fact that those who comply well are not a random sample of the total.

                Incidentally, Esselstyn’s analysis of his own results violates basically every point contained in my outline of how to properly address these questions, which is why it constitutes rather weak evidence for the claims he makes.

                Chris

                1. Earlier, you posted, “I hope this family is eating more than steak, eggs, and bacon.”

                  If I had to choose between eating exclusively those or exclusively vegetables, I would choose the the meat and eggs.

                  Since, I value the phytonutrients, and antioxidants in vegetables, I eat those as well.

                  Again. If I had to choose between animal flesh and vegetables.

                  Dave

  59. In the Norway graphic it says ‘rate’ so the number 24 doesn’t mean there were 24 deaths, but that 24% of 10.000 people died of cardiovascular diseases (aka 2400 people) so if you’re talking about a percentage of 30% that lowers to 24% that’s about 600 less deaths, not six, which is quite impressive considering that it all happened in a lapse of 5 years or so.

    Be careful interpreting charts, specially if you intend to do so in a critical way.

    1. Hi Lau,

      The numbers are indeed actual deaths and not percentages. “Death rate” refers to the number of deaths per a certain number of people, usually 10,000 or 100,000 or another round figure.

      If the numbers in the Norway graphs referred to percentages, it would mean that over a quarter of the total population was dying each year from heart disease or stroke. If that were the case, Norway would run out of human citizens pretty fast. :)

      1. Regarding the Norway data and Dr. Esselstyn’s mention of it in Forks Over Knives. It is interesting that Dr. William Castelli reached a similar conclusion. Here’s an interview he gave back if February of 2011.

        http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

        Castelli:

        . . . . you know some of us knew you could shrink these deposits – I mean I learned you could shrink the deposits in people’s arteries when I was a medical student in Belgium working for a pathologist in the ’50s. When he did an autopsy he would call us over and say “Look at this coming back to Belgium at autopsy all these fat deposits in their arteries.” We said, “Well wait a minute if it’s coming back where did it go?” He said, “I don’t know where it went. Disappeared by 1942.” Well what happened in Belgium in the early ’40s, an army came and well right behind the army came the German trucks. They backed them up to all the farms in Belgium, northern France, Holland, Poland, all the countries the Germans invaded, the trucks showed up. All the meat and livestock went back to Germany and by 1942 in Belgium at autopsy all the fat deposits in the arteries had disappeared.

        Me:

        Now, apparently there were some others who thought that “livestock” was part of the cause of heart disease.

        Because in the 1950s a doctor named Lester Morrison, from Los Angeles, decided to do an experiment and put 50 heart disease patients on an “experimental” diet, a diet in which the amount of animal based foods was reduced (though not completely eliminated). On this experimental diet, the “banned foods” included egg yolks, butter, pork, animal fats, whole milk, cream and other foods made with such items.

        Another 50 heart disease patients just ate like “normal.”

        Dr. Lester Morrison tracked these two groups over the years.

        After 8 years only 12 of the “normals” were still living and breathing. But in the “experimentals,” those backing away from that fatty animal based foods, 28 were still alive.

        After 12 years, none of the “normals” were alive. But 19 of the “experimentals” were still alive.

        So, maybe Dr Campbell, Dr Esselstyn, Dr McDougall and others are correct in steering people away from the pork and beef.

  60. Dr. William Willett has this to say about milk and protate cancer.

    “A diet high in dairy products has been implicated as a risk factor for prostate cancer. In nine separate studies, the strongest and most consistent dietary factor linked with prostate cancer was high consumption of milk or dairy products. In the largest of these, the Health Professionals Follow-up Study conducted by the Harvard School of Public Health, men who drank two or more glasses of milk a day were almost twice as likely to develop advanced or metastatic (spreading) prostate cancer as those who didnt drink milk at all.”

    Seems like Dr. T. Colin Campbell is right. You can turn on and turn off cancer growth, simply by adjusting the level of that milk protein.

    1. What about the effect on overall mortality? That is a much more relevant number than the response of a specific disease to diet.

    2. Uh, if you read the VERY NEXT PARAGRAPH in Willett’s book Eat Drink and Be Heathy (the quote you did not attribute), you will see that dairy risk mirrors an excess calcium intake risk and Willett associates prostate cancer risk in men with excess calcium, not casein.

  61. Thank you Denise for your review of this film. Recommendations and “shares” about it have begun to abound on Facebook. I am leery of things that are popular on FB, just on general principles. I appreciate your exhaustive review of this movie; I have felt that the ideas that we as humans are better off eating only one sort of thing and only that thing, whatever that thing is, are based in pseudoscience at best.

    I became very interested in the information about wheat that comes across over and over in the graphs. I wonder whether it is the refined enriched wheat flour that is the problem, and also whether eating whole grain organically grown wheat produces the same problems.

    I, for one, have been following a balanced diet comprised of vegetables, fruits, fish, dairy and meat for many years. When I say balanced, I mean I try to get approximately equal amounts of calories from fats, carbs, and proteins. The real difference in my intake as opposed to many other folks’ is that I have been committed to eating NON-PROCESSED food for almost my entire lifetime. And, within the limits of my budget and availability, I choose organic food over non-organic.

    I also stay away from all dyes and artificial fragrances and known carcinogens in personal products, cleaning products, and household products.

    Additionally, I get lots of fresh air and exercise working in my organic gardens and walking my dog.

    I know I am not a statistically significant population, being only one person, but I am almost 59 years old and I am pain free, disease free, full of energy and for the most part do not “look my age”. I’m not sure whether it is my diet, exercise habtis, or my avoidance of known carcinogens and artificial scents and dyes that is responsible for my good health; perhaps a combination of all of the above.

    At any rate, I applaud your blog post and intend to post a link to it on my Facebook page in response to the recommendations that I watch the documentary.

    Finally, I suggest this as a maxim for people to live by: “Moderation in all things, even moderation”

  62. I have been primarily vegetarian for 40 years. Some dairy throughout this time, recently some white flesh included for social purposes and even the willingness to try blood meat (here, taste this. OK, a taste.). The one overriding factor that is not even addressed in all of this vegan vs animal products hoopla is the suggestion of moderation in the amount of food we consume. Most people eat way, way too much. The completely plant-based or completely meat-based argument is ridiculous. Our dental make-up even indicates we are omnivorous. There is something inherently unintelligent in fanaticism. Moderate the amount of animal products in your diet. That is smart. Moderate the amount of food you consume. That is brilliant.

    1. Jon,

      Sounds very reasonable, I suppose.

      But again, this is what seems to go against this “moderation” concept.

      If someone goes to see a doctor and gets diagnosed with hypertension, heart disease and diabetes, a large majority of doctors reach for the medications and surgeries.

      You know. Maybe bypass surgery or a stent for the heart disease. Maybe Lipitor for the high cholesterol, Maybe Glucophage for the diabetes. Blah. Blah. Blah.

      But then the patients complain about the drug’s side effects. Or maybe there’s some brain damage done to the patient during the coronary bypass operation. Or maybe the stent fails and there is a need for yet anothe surgery.

      So, you have some exceptional doctors. Doctors like Esselstyn, Ornish, Campbell, McDougall, Barnard.

      These doctors say, “Hey, guys. Rather than giving people more pills, giving people more coronary bypass operations, more stents, why don’t we get to the root cause of these diseases, the meaty, fatty, toxic American diet?”

      At that point, the drug companies, the food industry, the hospitals and cardiology departments are not thrilled with doctors Esselstyn, Ornish, Campbell, McDougall and Barnard.

      After all, there is a lot of money to be lost if people stop buying the T-bone steaks, the bacon, the Lipitor, the Glucophage, the coronary bypass surgeries, the stents.

      Nobody wins excepts the people who grow rice or corn. But even the corn growers stand to lose because, currently, most corn isn’t fed to human beings as corn. It’s fed to animals, which will then be fed to human beings.

      Are those doctors who appeared in “Forks Over Knives” different than your usual, “moderate” doctors? Yes. But that’s a good thing. Not a bad thing.

      Moderation is okay. But that doesn’t mean you should smoke a moderate amount of cigarettes.

      1. I agree with you completely.
        Nobody says that a “moderate consumption” of crack, heroin etc. is OK. You don’t neccesarily die right away but it is unhealthy nonetheless.

  63. This is something I found at Pubmed that I think applies to the whole Diet-Heart hypothesis.

    http://www.ncbi.nlm.nih.gov/pubmed/8252690

    Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox.

    CONCLUSIONS:

    Over the years, France and Finland, with similar intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follows. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat were associated with increased CHD mortality, possibly through their effects on thrombosis as well as on atherosclerosis.

    1. You left out the best part, and I know you didn’t miss it because it is right at the beginning of the abstract:

      For decades, the coronary heart disease (CHD) mortality rate has been four or more times higher in Finland than in France despite comparable intakes of dietary cholesterol and saturated fat. A potential answer to this paradox is provided by this study of 40 countries and the analyses of other nutrients in the diets besides cholesterol and saturated fat.

  64. There is quite the discussion here on eggs. Would you consider yolk and white part the same? Do they both raise bad cholesterol and or damage endothelial lining and cause atherosclerosis?

    1. I would consider the egg white less harmful than the egg yolk. I think that is why Dr. Lester Morrison, back in the 1950s, banned the egg yolks but didn’t ban the egg whites.

      Dr. Dean Ornish, in his late 1980s book, “Program for Reversing Heart Disease,” bans egg yolks but allows egg whites on his “reversal” diet.

      The other plant based doctors (McDougall, Esselstyn, Barnard, Campbell) ban the whole egg.

      When you get right down to the nub of it, just about every food item you eat on the plant based diets recommened by those guys have two features:

      (1) Vitamin C

      (2) Fiber

      Generally speaking, that’s what tends to separate a plant based food from an animal based food. And it also tends to separate the “whole” plant based food from the “highly processed and refined” plant based food.

      Imagine how different the whole “plants versus animals” diet debate would look if human beings were like cats and didn’t need to consume Vitamin C or fiber in their diets.

      Right?

      1. Oh. But grains don’t have Vitamin C. They do have fiber though.

        One of the reasons I decided to go on the Esselstyn-McDougall diet is the issue of diverticulitus.

        My father, when he was in his 50s, had to have a significant section of his colon removed. It was infected or diseased or something. At the time of the surgery, there was a concern that the whole dang colon might have to go bye bye and he would have to carry around, in his rib cage, a bag full of poop. It didn’t get that bad, thank goodness.

        But in addition to reducing my risk of heart disease and prostate cancer (Dr. Campbell’s “China Study” and Dr. Walter Willett’s “Reconsidering Calcium”), I was also impressed by Dr. Campbell’s discussion of Dr. Burkett’s work on fiber in “The China Study.”

        It seems that when a nation moves away from the whole foods plant based diet as eaten in less developed nations, you start seeing these digestive system related diseases.

        That was the great thing about “The China Study.” Chapter 4, “Lessons from China,” is interesting. But the chapters that follow it, the ones where Campbell talks about heart disease, diabetes, auto immune disease and how the food industry manipulates what the public learns about nutrition. That’s Campbell’s huge contribution.

        And even on the issue of “The China Study” itself (the Cornell-Oxford-China Project). I have a hard time believing that Dr. Chen and Dr. Campbell messed up the interpretation and somebody with no background in epidemiology just fell into the correct interpretation of the data.

        Also, if Dr. Campbell had really “cooked the books” on the China Study, why would Dr. Esselstyn, in 1990, decide to use the China Study as the basis for changing the diet he would recommend to his patients? And then there’s the issue of “if the plant based diet isn’t based on correct interpretations of research, why does it seem to cure or alleviate so many western diseases?”

        1. “why would Dr. Esselstyn, in 1990, decide to use the China Study as the basis for changing the diet”

          Because he was duped. People like Denise and Chris Masterjohn who can crunch data with the use of computers were toddlers and grade school students. Esselstyn still gets the results he wants, so no need to change and eat crow. Limiting the available palette of foods for people with a history of food abuse (the reason they’re diseased) during his program may not be such a bad thing. Seems to be his M.O. anyway.

          “no background in epidemiology just fell into the correct interpretation”

          Pretty sure they were saying that about Einstein when he started busting up the big dog’s work. I know a lot of dipshits who have “backgrounds” or are “credentialed” in subjects that I wouldn’t listen to for a moment.

          1. Grok: “Pretty sure they were saying that about Einstein when he started busting up the big dog’s work.”

            Um. Before we conclude that Denise Minger or Chris Masterjohn is another Einstein, wouldn’t it be smart to wait until they develop and make public a dietary pattern? One that can achieve results equal to or superior to the results achieved by Dr. Esselstyn and the other plant based doctors?

            It’s one thing to talk and blog about nutrition. It’s quite another to put ones ideas about nutrition in a very difficult rigorous clinical setting.

            1. I’m sorry, you’re right. Einstein’s ideas were just chicken scratch nonsense on a notepad up until the day before they were published and practiced.

    2. They are diiferent, I’m allergic to yolks, like volitile… but I use those whites as I please with no problems. I’m thinking its sulfur related from the bad experiences I’ve had.

    3. Hi Mark,

      Our discussion was primarily concerning the yolk, which is the part that contains cholesterol and thus the target of Dr. Spence’s criticisms. The placebo used in Fernandez’s studies was cholesterol- and fat-free eggs. I’m not sure exactly how they are produced but I imagine they are based on egg whites. As I indicated earlier, I don’t believe that the yolks cause endothelial dysfunction, but so far I don’t think anyone has targeted that accusation at the whites at all.

      Chris

  65. Awe man…i just watched Forks over Knives and now I stumble on this. I did read the whole thing (including the links)…now my eyes hurt (must be the carrots) and even more confused. At least we can count on one thing in america…half of the truth. I was sold on the movie and I felt dumb when you pointed out the Norway graph…I figured it was to good to be true but I wanted to open up my pill bottle no more. I was just diagnosed with Lupus out of the blue…and I was looking for a cure (lol) now dashed with a dash of truth. I will read the fine print next time…great blog.

  66. I get that that there was a vegan agenda in the movie, but what I got from it, was to eat better food and consider how my food choices affect my carbon footprint.
    I can’t imagine I’ll ever live my life as a vegan or even a vegetarian (animals are so tasty), but attacking this movie for its flaws in a ridiculously long article was just annoying.

    1. It’s such a shame that someone held a gun to your head and forced you, against your will, to come here and read a thorough analysis of the movie. The annoyance must have been excruciating. My heart goes out to you.

  67. Thanks for the focused energy needed to comprehend the plethora of info in this film. Much was said about the dietary aspects but little credit for supporting the well-constructed portrayal of the current lack of transparency prevailing in agribusiness relations. Without agribusiness/government transparency, what kind of grand scale credible statistics can we rely on for the future? It would after all, have saved you much of the time and effort you committed to cross referencing statistical data. So I’d have to say focus is great but perhaps hyper focusing on selective parts of a respectably professional work will lead to extraneous work. To further that statement, all of the people that read your critique might be a bit prompted to lose their head in the information rather focus their energy on where it matters, where it makes a difference. People who don’t know how to eat are at the mercy of their own help as eating (What, that is) is a teetering habitual act, and there aren’t enough of us to slap corn/soy eaters on the hand every time they stick a MAC nugget in their mouth like a half bitten fingernail, or the end of an apparently delicious eraser. I mean to say that this critique is really something beautiful but it probably comes out wrong because of my evident bias. I simply mean to suggest energy be focused in more productive ways. Other than that, too each his own and I’m glad to have the opportunity to contribute my ideas followed by the pillaging of them.

  68. Did a vegan sleep with your bf? You seem to have a lot of bias in your language. Most studies can be dissected and shown to have flaws if you look hard enough. Those flaws can be twisted in any direction.

  69. Maybe there are many flaws in this study but what we eat has a profound effect on our well being/lifespan. I’m on the Dr Dean Ornish diet for reversing heart disease and this is a peer reviewed, scientifically proven way to reverse heart disease ( actually the only way without pills, but I’m sure you already know this ) and follows closely to many of the conclusions that the China study has revealed. When it comes to food there will be endless points of view but looking at the current health of the industrialized world I see little benefit in endlessly protecting the status quo, so anyone that can help us to look at our present habits and make changes will potentially save countless others.
    I think more important than looking at flaws is looking at potential ways to better the health of everyone.

  70. What Denise is doing is just trying to be smart ass. She takes Esselstyn’s diet and then adds 1% – 5 % animal protein and tries to prove that it will achieve the same results. This is absolutely ridiculous. Just 2 decades ago when Ornish and Esselstyn ran plant based experiment, prior to that noone knew how to cure HD let alone reverse it. Reversing HD was unheard of. Only solutions available were pills, stents, and bypasses and then repeat of those till finally the person died.

    Now she is nitpicking their diet and trying to win brownie points.

    1. We have seen silly comments, stupid remarks, short sighted or ignorant. Sometimes you even wondered if these people were not reporting from an alternate universe. And then you have the special category of childishness. Grow up.

      1. James, I am still interested in the answer to my question. Here it is for the third time.

        James, is it really true that wheat is so unhealthy? I mean, whole wheat as opposed to white wheat flour? There is a whole industry devoted to wheat-bashing whose arguments are pretty suspect. Yes, doctors remove wheat from their patients’ diets and they get better. We don’t know what would have happened if they’d replaced all the white flour with wholemeal flour.

        1. Some the best analysis of wheat so far are on this very blog, if you would take ten seconds and look. There really aren’t a ton of blog posts here, and the ones on wheat have great big letters saying “WHEAT” in them. You’ve been asking the same question for days now, so there isn’t much excuse for not actually looking.

          The gist of the wheat issue that I get is that the jury is still out, but signs aren’t looking good for wheat. It is well known to be incredibly destructive for people with sensitive digestive systems, and there is even a serious disease specifically associated with the protein found in wheat (celiac disease). This disease is basically an “eat too much wheat and you’ll die” sort of serious disease. There are a number of studies that suggest gluten may be detrimental to even healthy digestive systems, though obviously not to the extent of a celiac sufferer.

          New studies seem to suggest wheat is a major player in a number of diseases (including ALL the diseases cholesterol is blamed for), though it is still a relatively recent avenue of study and we need more studies of various types before we can speak definitively about it.

          1. Thanks bigjeff. I have read it all, don’t worry. Yes, wheat is destructive to people with sensitive digestive systems, but what made them sensitive? The evidence is overwhelmingly in favour of white flour, white rice and white sugar being the culprits. Gluten etc can be dealt with provided the micronutrients are present that their digestion requires. If you have gluten intolerance it means the mechanism normally preventing it isn’t working, not that there is no such mechanism. Look up ‘oral tolerance’.

            1. Sorry to completely disagree Jane. You’re correct about the white flour being not healthy. Pure starch only one step removed from sugar. Actually it turns to glucose in your mouth if you mull over it a bit. The real problems are with the wheat germ agglutinins and the lectins.

              http://www.greenmedinfo.com/page/dark-side-wheat-new-perspectives-celiac-disease-wheat-intolerance-sayer-ji

              If you want to eat wheat take the white stuff and load it up with veggies for fibre.

              1. Hi James, wheat germ agglutinin is a lectin. It’s normally taken up into enterocytes where it gets degraded. Might not happen if your gut isn’t working properly.

                  1. Thanks Anon for mentioning Kurt’s blog. Yes, among the many others, Paleo, Neo-Paleo, Modified-Paleo, and many other like minded, Kurt Harris is clear level headed and easy to understand. He does not appear to have any agenda other than trying to get the truth out about a healthy diet and grains in any shape or form is not part of it according to him. As I have made clear I am of the same opinion and I have collected quite a data bank of scientific studies to back that up. And yes, Ancel Keyes was a fraud, but so was Fredrick Stare who ran the show at Harvard for many, many years during which time he was in a position to do even more harm. Even our dear Walter Willett is still only half convinced that they have been wrong all those years.

  71. I cannot tell you how much I appreciate your well-researched critique of this documentary. It is so easy to take films like this as gospel and not research further. I hope everyone that watches Forks Over Knives also reads this. I look forward to reading your blog regularly now!

  72. HDL has been thought of as the good cholesterol but as in everything there is more to the story. it is much more than just a number.

    The long lived Okinawans have a HDL in the 30s, and the “anti-atherogenic” diet of the Tarahumara Indians keeps their HDLs in the upper 20s.

    So, having a high HDL is not a prerequisite or a requirement for optimal heart health.

    There are subfractions of HDL and some are good, some not so good.

    In recently published research on men in a three-week low fat program, blood tests showed that on entry the men (typical high-fat American-style eaters) had normal amounts of HDL, but the HDL tended to be pro-inflammatory.

    Pro-inflammatory HDL promotes plaque build-up in the arteries. But after three weeks on a healthy low fat diet, exit blood tests showed the HDL had been converted from having pro-inflammatory qualities to having anti-inflammatory qualities despite the fact that total levels of HDL had on average gone down a little.

    Anti-inflammatory HDL is beneficial because it does a good job of removing LDL from the arterial system.

    The lead author Dr. Christian K Roberts and colleagues at UCLA concluded, “Pay attention to the quality of HDL, not the quantity, The function of HDL may be more important than the steady-state plasma [blood] levels.”

    Journal of Applied Physiology, 2006; 101: 1727.

    In addition other new research found that even one meal rich in saturated fat could interfere with the ability of “good” HDL cholesterol to protect against damage to arteries.

    In the study, scientists at the Heart Research Institute in Sydney, Australia fed subjects 2 different meals. One meal was high in saturated fat. Three and six hours after each meal, the scientists measured blood flow and assessed how well HDL was protecting arteries from inflammation. The saturated fat meal essentially turned “good” HDL cholesterol into “bad” HDL cholesterol particles. Instead of being anti-inflammatory, they become pro-inflammatory.

    Journal of the American College of Cardiology, 2006; 48: 715.

    Another study measured reverse cholesterol transport (RCT) which is the ability of HDL to remove cholesterol. When the subject were put in a healthy low fat diet, the level of HDL went down but the RCT stayed the same. This showed than while the absolute number may have dropped somewhat, the efficiency of the HDL went up.

    In other words, having a high HDL from a higher fat diet, may not be a good thing and may in fact, be a bad thing. Yet, having a lower HDL from a healthy lower fat diet, may not be a bad thing and in fact may be a good thing.

    The best way to raise HDL is to lose weight and exercise regularly.

  73. Interesting comments.

    My husband and I decided to go on a 15 day cleanse and basically followed Esselstyn’s program without knowing it. Since the cleanse (only fruits and vegetables) we have proceeded eating whole plant foods and added grains.

    Results:
    my total cholesterol dropped from 220 to 157; husband’s, after stopping Lipitor, dropped from 143 to 135. HDL up LDL down

    Blood pressure mine has been and still is fine; husband had to stop taking high blood pressure medications as his blood pressure was too low taking it.
    (monitors it 3 times a day)

    Weight loss: Me 16lbs over a month, husband 12lbs over same period. After bringing on grains our losses have slowed but are still occurring.

    Husband’s PAD has virtually disappeared.

    We’ve both increased our exercises both cardio and weights. Husband works out 1.5 to 2 hours each day and increased swimming from 40 laps to 70 and has a new PR of 100 laps. I have increased my running from 1.5 miles a day to 2.5. Weight lifting has been added. I’m 52, my husband is 68.

    We were meat loving carnivores, I personally was a cheese fanatic. The transition was easy, neither of us misses the meat, but figuring out new meals is a bit of a hassle.

    We are amazed at the variety of foods there are to eat that don’t crawl, swim, or walk and how great we feel. Indigestion is gone, we now can eat spicy foods and not have to pay the price. Sleep is better.

    You can argue correlations and philosophies and point out holes in the information of the movie but I’m more results oriented. I have tried to lose weight and lower my cholesterol using the eat less exercise more and all I saw was both keep creeping higher. My husband was resigned to having to take meds for the rest of his life. We now see a much different future.

    What if Esselstyn and Campbell et al. are right?

    1. The obvious question is: did you cut out processed foods along with the animal foods?

      I imagine you probably did, and if so, how do you know it was eliminating the animal foods specifically, rather than the processed foods, that is responsible for your improved health?

      Everyone recognizes that processed foods are extremely detrimental to our health. There is no debate, on either side of the vegan issue, that processed foods are bad for you. A vegan who primarily eats doughnuts and chocolate is probably going to be obese and die of a heart attack. This is no surprise, even though both of these are quite easily veganized.

      So is it the processed food, or animal foods that are the problem?

      You cannot eliminate both in one fell swoop and then claim it is animal foods that caused all the problems. This is why the conclusions of Esselstyn and those like him are unreliable, even if they ultimately see beneficial results. It is entirely possible that their results would be even better if they included animal foods in their diets.

      This is why we isolate variables in science – so that we actually know what is causing what.

      1. Define processed foods. Meat is processed through butchering and aging, milk is processed by being pasteurized and homogenized, cheese is processed, flour through milling, sugar, cereal and breads are all processed. If you mean fast food and bagged snacks and sugared drinks we were never fans. We like food too much to eat this tasteless crap.

        So, yes we did cut out the very few that we ate. We are semi-retired and work from home. We make most all of our food from scratch with little processed foods. No soda, no fast food. Occasionally a potato chip – medium-sized bag would last more than a week and usually have to be thrown out before all was consumed. Desserts were made by me but usually only once or twice a year – neither of us are sweet crazy. I would say the most processed food we regularly had in the house was cereal, cooking oils, and baking supplies and pasta – oh and my beloved cheese. I abhor long lists of ingredients on any food product and would not buy them.

        We thought overall we were eating quite healthily. Especially when compared to what we saw people eating when we where in public.

        I understand variables and scientific research. While not a controlled study we do have data before, during and ongoing throughout our transition. Since basic health is based on blood pressure, heart rate, cholesterol and weight, I cannot point to anything that changed all of these for the better other than our eliminating intake of animal protein and the increase of fruits and vegetables. Our consumption of and therefore our elimination of processed foods was negligible.

        That my husband was able to give up all medication within a two to three week period has our attention. No dieting, exercise or vitamin regimen has affected his need for meds in 13 years. After 10 years of my cholesterol increasing ever higher then to have it drop 63 points in 2 weeks is nothing short of amazing.

        Of course our changes might be attributable to giving up coffee ;)

        1. Hi Julie,
          I will be turning 60 on my next birthday. My diet sounds a lot like yours except I also eat eggs, chicken, fish and whole milk mozzarella. No processed foods, no wheat or gluten foods of any kind. I’ve been eating this way since I was in my 30’s when I was diagnosed with migraines. The neurologist put me on this migraine diet which includes the foods I mentioned above along with lots of fruits and veggies. But high protein is required for me
          since my body needs the seratonin that I don’t produce in large enough amounts.
          My cholesterol is 137 my HDLs are very high and my LDLs are low. I Jazzercise 5 times/week and I feel great.
          I’m just saying, it seems like it’s the processed foods that make people unhealthy.

          1. Hi Sue,
            I agree with you that processed foods are the dirth of Western diets. But that is my point, we really didn’t partake in eating the stuff and still have the precursors of potential (me) and sustaining (husband) coronary disease. These symptoms only dropped once we eliminated animal proteins and grains.

            I’m amazed we like eating this way now. We didn’t do this as a political or compassionate choice to save the earth and animals, we did it to rid ourselves of needing to be on prescription drugs for the rest of our lives and living with the side effects. I grew up on a dairy farm and my husband was, perhaps one of the best grill masters I have known. We LOVE animal protein in all shapes and types. We just don’t want to live with the effects.

            If you can hold your cholesterol that low and still imbibe in animal protein, that’s great. But my husband’s history was making his future look really short or bad.

            We will continue to track our health indicators and if they stay good we stay on this way of eating. If they go up we get rid of wheat. If that doesn’t work we go raw. If that doesn’t work we flip a coin, consider every medical professional an idiot and do what the heck we feel like :)

            1. Hi Julie,
              I know it’s difficult when you are genetically predisposed. There is so much information now linking wheat and grains to coronary heart disease. It will be interesting to see what your outcomes are. You should read Wheat Belly by William Davis.
              Good luck to you.

          2. Sue—one issue I would love to understand better is the issue of cholesterol and health…like yourself, I have very low total cholesterol (130-150, typically) with high HDL; however, I have struggled with health issues over the past decade am aware that there is a strong association between very low total cholesterol and health problems (http://en.wikipedia.org/wiki/Hypocholesterolemia ; http://lmgtfy.com/?q=low+cholesterol+mortality ). I don’t know if causation is involved, and _if_ raising total cholesterol would be a good thing, I have no idea how to achieve this–eating more fat, drinking alcohol in moderation, green tea, niacin, etc. have all been for naught, although I have yet to try everything this AHS presenter suggests: http://www.tripleyourhdl.com/
            It might be interesting to hear what Chris or Neisy have to say on this issue…

    2. My question is this- you say you were eating mostly healthy, but had animal products- what is ‘mostly healthy’ and did you go back to those foods just without the meat?

      You leave out a substantial amount of dietary information- and I’m only nitpicking because I’m interested, just to say, I am happy for you both and just wanting more detail as I’m contemplating changes in my own diet, and I know from prior experience that I can often make myself feel better mentally and physically by eating a steak (my own study of one)- so, I’m looking to compare/contrast.

      1) you did a cleanse of veggies and fruit- I’m assuming it was a dramatic shift- was it also a shift in total calories? I.e., did you adjust your total fruit and veggie uptake to make up for the calories, or did you end up with a pretty severe reduction as well? Do you have estimates for total calories before/after the shift?

      2) What was the shift in total fats?

      3) What was the shift in starch/carbs? You state you didn’t eat a lot of processed carbs, so what did you