August 2012

Volume 11 Issue 8

The Diet Wars: The Time for Unification Is Now

Recent disagreements posted on my discussion board have left the public asking, “Why can’t you experts agree?” Three giants in the field of plant-based nutrition, T. Colin Campbell, PhD, Caldwell B. Esselstyn, Jr., MD, and Joel Fuhrman, MD have recently been involved in discussions over matters of nutritional advice and business. (See below for the discussions.) This is just one of many examples of disagreements involving strong personalities that overshadow efforts to accomplish a greater good: saving the world and its inhabitants. Billions of people are sickened by the Western diet, the American healthcare system nears collapse, and the environment is becoming as hot as hell. Yet “Nero fiddles while Rome is burning.” It is time for all of us experts to sacrifice personal goals and needs for the greater good. With mutual support we can stand strong against the real enemy: those recommending and profiting from an animal-food based diet.

Good Versus Evil

The experts advocating meat-eating are identified by terms such as low-carb, Paleo, Primal, Zone, Wheat Belly, Atkins, etc. They want people to eat fat and protein (animals) for energy and to avoid carbohydrates (starches). Their messages support many profitable conglomerates, including the meat, poultry, fish, egg, and dairy industries. As a direct result of their sales, secondary businesses like medical doctors, hospitals, and pharmaceutical companies reap huge profits. All of these industries share an ideology with coal and oil companies: Profits override the welfare of planet Earth and its inhabitants.

In terms of making money, arguments among us are small potatoes. Our closed circle of vegan friends amounts to only a few customers. Setting our sites on the real enemy means going after the minds and hearts of billions of people. Let’s go for the big win.

 

Healthy diets based on plants foods have been advocated for millenniums. Here are a few of the important players (please note the lack of originality, in other words, the commonality):   

Barnard Diet (by Neal Barnard, MD, founder of Physicians Committee for Responsible Medicine): Based on starches, vegetables and fruits. Diet is low-fat. Emphasis is on no animal foods, ever.

Biblical Daniel Diet: More than 2500 years ago a diet of vegetables and water was found to improve the health of men in 10 days, compared to men eating meat (the king’s food).

China Study Diet (by T. Colin Campbell, PhD): Based on starches, vegetables, and fruits. Animal foods may account for 10% or fewer of foods consumed.

CHIP Program (The Complete Health Improvement Program by Dr. Hans Diehl): Based on starches, vegetables, and fruits. Emphasis is on eating low-fat.

Esselstyn Diet (by Caldwell Esselstyn, MD): Based on starches, vegetables, and fruits. No nuts, seeds, avocados, or other fatty plant foods are allowed. Emphasis is on eating very low-fat.

Engine 2 Diet (by Rip Esselstyn): Based on starches, vegetables, and fruits. Emphasis is on eating very low-fat.

Fuhrman Diet (by Joel Fuhrman, MD): Based on green and yellow vegetables, beans, nuts, and seeds. Not always low in fat. Small amounts of animal foods allowed. Emphasis is on eating “nutrient-dense” greens.

Hallelujah Diet (by Rev. George Malkmus): Consists of 85% raw, uncooked, and unprocessed plant-based food, and 15% cooked, plant-based foods.

Kempner Rice Diet (by Walter Kempner, MD): Based on rice and fruits. More plant foods and a few animal foods are allowed after recovery. Emphasis is on eating very low sodium.

Macrobiotic Diet: Based on grains (rice) and vegetables. Fish, seafood, seeds, and nuts may be eaten occasionally.

McDougall Diet (by John McDougall, MD): Based on starches, vegetables, and fruits. Healthy, trim people can eat some nuts, seeds, and avocados. Animal foods for holidays, at most. Emphasis is on eating starches.

Natural Hygiene Diet (by Herbert M. Shelton, ND): Advocates a raw food diet of vegetables, fruits, and nuts; and also periodic fasting and food combining.

Ornish Diet (by Dean Ornish, MD): Based on starches, vegetables and fruits. Low-fat dairy, some fish, and fish oils are used at times. Emphasis is on eating very low-fat.

Popper Diet (by Pam Popper, PhD): Based on starches, vegetables, and fruits. Emphasis is on eating very low-fat.

Pritikin Diet (by Nathan Pritikin): The original diet was based on starches, vegetables and fruits. Small amounts of meat, poultry, fish, and low-fat dairy are allowed. Emphasis is on eating very low-fat.

*This list is incomplete

 

Arguments by T. Colin Campbell, PhD, Joel Fuhrman, MD, and Caldwell Esselstyn, Jr. MD from the free McDougall Discussion Board. Contributions from other board members on this topic make intersecting reading and provide context for the isolated statements below.

Background: Posts on the McDougall Discussion Board, and other boards, have for years brought up disagreements between Joel Fuhrman, MD’s nutritional advice and other medical doctors, such as Caldwell Esselstyn Jr., MD. Both men recommend a diet of plant foods and warn against eating animal-based and processed foods. Dr. Fuhrman recommends limiting starches and to instead get more of your calories from nuts and seeds. Dr. Esselstyn recommends against using nuts and seeds, and instead recommends starches for calories. Both experts enthusiastically recommend non-starchy green and yellow vegetables, such as broccoli and kale. Disagreements between Drs. Esselstyn and Fuhrman are focused on a claim that a very low fat diet is harmful to some patients, especially those with heart disease. Dr. Campbell became involved in the discussion because of a scientific paper published by Dr. Fuhrman: Sarter BS, Fuhrman J. Effect of a high nutrient density diet on long-term weight loss: a retrospective chart review. Alternative Therapies 2008;14(3):48-53. This paper, when originally published, included Dr. Campbell as the first author. Reading through my discussion board will clarify any misunderstanding you have after reading the following comments and put the author’s thoughts into proper context.

 

The Doctors:

T. Colin Campbell, PhD is Professor Emeritus of Nutritional Biochemistry at Cornell University and has authored more than 300 research papers. He is coauthor of the bestselling the book, The China Study: Startling Implications for Diet, Weight Loss and Long-term Health.

Caldwell B. Essesltyn, Jr., M.D is the author of Prevent and Reverse Heart Disease. President Clinton credits his transformation to a vegan diet to Dr. Esselstyn. He is the past president of the American Association of Endocrine Surgeons and spent much of his professional life as a surgeon at Cleveland Clinic.

Joel Fuhrman, MD is the author of seven bestselling books and is a frequent guest on national television shows. His work has focused the public’s attention on the importance of “nutrient dense” vegetables. He has helped thousands of patients reverse serious illnesses.

 

Dr. Campbell’s First Response

Wed Aug 22, 2012 1:34 pm

I only recently learned of this post and it is accurate, except for one thing. I did not proactively publish Dr. Fuhrman’s paper as this might suggest.

About 5-8 years ago, I was expressing general interest in Dr. Joel Fuhrman’s work, as I did with a few other clinicians, inviting him to Cornell to give a lecture (as I did for 32 others) and including him in a group of seven to consider a research proposal on how to advance this field. He then asked that I help him publish in a peer-reviewed journal some case histories of his patients and their body weight loss. He thought that my long years of publishing over 350 experimental research papers might help (he had no such papers). I did so because I thought that he had something that needed airing in the professional literature. I agreed for him to use my name as a co-author (but in a secondary place in the list, although later it was mysteriously changed in the journal’s archives to my being first author—leading others to falsely believe that I had done the study).

His manuscript, submitted to two lead journals, was turned down. A couple years later, I became curious and asked him what had become of the manuscript. He replied that it had been submitted to yet another journal, albeit much lower quality, and was being published (in May 2008). Fast forward to the Fall of 2011, when I was reminded by a friend who had used those results and who informed me that something was amiss in the way that Dr. Fuhrman was promoting the findings.

With some difficulty I retrieved a copy of the raw data. Previously, Drs. Sarter and Fuhrman had only provided a summary table of these data—it is rare for secondary authors and reviewers to actually see the raw data. Not only were those data badly miscalculated and misinterpreted but, much worse, Dr. Fuhrman exaggerated in a very public place that this study resulted in "the most sustained weight loss ever recorded in a medical study” (or “in medical history"). This is not factual. Even though Fuhrman was claiming that all of the 56 subjects had lost weight and had kept it off for two years, only 4 had done so. He also said that average weight loss for these subjects was 53 pounds, but upon my calculation of the raw data, it was 34 pounds, and then this was only for the individuals who complied. His very public claim that there were 65 patients is false; there were 56 patients. On another very public occasion, he said that there were 100 patients, not the 56 or even the 65 (he was NOT referring to some additional patients beyond the study, as he once claimed).

I decided to submit a letter to the journal (in Sept 2011) withdrawing my support and shared it with Dr. Fuhrman. But to this day, he has refused to acknowledge anything wrong with the paper that I co-authored. Indeed, he continued to use this paper (his only paper) to raise funding from the public for his research. He continues to falsely highlight in a prominent place an average 53-pound weight loss.

More recently, I learned that he also allowed my name to be used in a widely viewed documentary (Fat, Sick and Nearly Dead), claiming that I supported his work. My name is placed alongside an image of his food pyramid used to support his work, which I never saw and which I cannot support. Worse, he prominently identifies my institution, Cornell University, in this film (now seen by three million viewers according to the producer), creating a serious professional embarrassment for me.

There is much more to this ongoing nightmare, but this is enough. Destroying the evidence of Fuhrman’s misdeeds, as one of his friends wants to do, does not solve the problem. I simply want it known that I can no longer support anything Dr. Fuhrman says or does. Some have advised that my making this public may hurt this important area of work. But I disagree. Behavior like this only runs the risk of turning this idea into one more food fad for personal gain, a practice that has long plagued the public narrative on food and health. We can do things better and it begins by making a special effort to tell the truth.

Dr. Fuhrman’s Response

Sat Aug 25, 2012 6:19 pm

It is good to see people interested in the fascinating nuances of nutritional science, and while I do not post to these boards, I do feel the need to set the record straight here. I am fine with disagreements based on science, but there is no need for personal insults and distortions with the purpose to demean. We are a community with shared interests facing many challenges in getting the word out. These attacks serve no one.

I never stated that one of Dr. Esselstyn’s patients died because he did not eat nuts. That claim is not true and I was never aware of that page on Dr. Esselstyn’s site before now. The potential contributory causes of death in such cases are not just difficult, but likely impossible to ascertain. I did say that there is evidence in the scientific literature that addition of seeds/nuts to a diet was shown to reduce the incidence of cardiac arrhythmias and the risk of sudden cardiac death. Therefore, I mentioned the lack of nuts and seeds in the diet may increase such a risk in the fragile cardiac patient. I did represent, on that occasion in a lecture to my Getaway audience (over 6 years ago) that my vast experience with thousands of vegan patients included a few who came to me after developing arrhythmias on an extremely low-fat vegan diet (without nuts and seeds). I have also reported a case where a man who developed cardiac arrhythmias resolved it when I adjusted his diet accordingly. I am concerned that if thousands of cardiac patients with advanced disease adopt an extremely low-fat protocol (without any seeds/nuts) we might see some deaths from cardiac arrhythmias, and we have no certainly that such a death has not already occurred. Dr. Ornish, Dr. Gregor, and other nutritional scientists and researchers I communicate with have had similar concerns about the issue of fatty acid deficiency in some vegans, that could be more susceptible to this, potentially promoting arrhythmias; but this is a complicated subject, not appropriate to be argued here now. Certainly I do not think patients should fear eating a few walnuts if they have heart disease, and I have the right and obligation to explain my dietary recommendations and the reasons for them. For many years, I have had extremely successful results reversing heart disease with cardiac patients adopting vegan diets. This is a scientific discussion of interest and a disagreement of interpretation of science, not a personal attack on anyone. It should not be twisted into a personal attack against me either. There is a huge difference between questioning the potential risk of a dietary recommendation and stating emphatically someone died because of it.

My nutritional advice may differ from others posting here, and differ from other professionals in this community, but this is not the appropriate place for me post my view, defend or elaborate on my case histories and years of clinical experience; however, I think that before these attacks continue, an effort should be made to clarify the facts rather than perpetuate personal attacks, especially when they are not accurate.

My paper on vegan athletes was written and published years before I added taurine to my supplement. The insinuation that my recommendations for competitive athletes are based on anything other than the performance value for the athlete is ridiculous.

These attacks on my character are not uncommon in these forums, and I have chosen not to respond to them; but this thread goes way too far. Notably, Dr. Campbell’s battle of words with me is very unfair. I have offered to discuss his concerns and correct his erroneous misinterpretation of events many times. Many others in our community have offered to the same, and open a healing dialog. Unfortunately Dr. Campbell has refused all of us and has persisted in personally attacking me. The study in question was a collection of patient’s charts from my office many years ago. The initial number of consecutive charts I transferred to the researchers was 100, then they narrowed them down first to 62, and then to 56 using various inclusion criteria; so the numbers change, and then even fewer than that continued for the full two years. Not only did I have nothing to do with the data collection and statistical tabulation of those results, but Dr. Campbell had the access to and maybe even an obligation to confirm those numbers and calculations, not me. That was certainly not my role in the study. When an error in the criteria for inclusion came up, many years later, it changed from the n of 19 to 18; at the two-year follow up, it still showed all but one person had significant weight loss, with a mean weight loss of 37.6. The lead researcher from the University of San Diego took responsibility for the error and wrote a correction to the journal and also stated, “Therefore the conclusions of the article remain as originally stated, being that the high nutrient density diet has the potential for leading to significant and sustained weight loss and reduction in cardiac risk.” Dr. Campbell then removed his name from the study. My report of an average 53 pounds of weight loss was consistent with the results of the study, until the error was found, and since that calculation error was reported I have never made such a claim again and removed all reference to it in my control. Dr Campbell’s inflammatory statements insinuating academic fraud are 100 percent unjustified and wrong. I was not involved in the calculations and numerical data and had nothing to do with them (I only supplied my patient charts to the researchers). I also had nothing to do with Dr. Campbell’s name being used in the movie mentioned and did not even know that his name was visible there until reading it here now. I was not consulted on what they used or did not use in that movie, I just did my part. He is incorrect on numerous other points above as well. Certainly, I did not intend to offend him or anyone else.

Character assassination has no place on these boards. I hope Dr. McDougall does not support this here. It is fine to disagree, on interpretation of science, but we should stick to logic and science, and refrain from the personal vendettas and judgmental distortions. Certainly, I have no interest in continuing to post here and think the personal attacks against me should stop. Certainly there is nothing wrong with continuing to question the logic behind my interpretation of nutritional science and my experience and disagree. Remember though, we are all fighting a similar battle and trying to help and motivate others to eat healthier and get healthier.

Joel Fuhrman, MD

Dr. Esselstyn’s Response

Tue Aug 28, 2012 12:22 pm 

The present Fuhrman flap is an embarrassing and distasteful chapter in the journey to healthy plant-based nutrition, brought on entirely by Dr. Fuhrman himself, who has a compulsion to denigrate his colleagues and/or their science. The repetitious nature of his attacks indicates he is insensitive to his own behavior and unaware of what he is doing to hurt himself in the eyes of his colleagues or the public.

By way of contrast, when the chairman of a leading corporation was questioned on how he had become so successful and the recipient of so many awards, he replied, "There are no limits to how far and how high you can go, if you are willing to give credits to others."

Caldwell B. Essesltyn, Jr., MD

Dr. Campbell’s Second Response

Wed Aug 29, 2012 6:46 am 

Mark Simon’s commentary on Dr. Fuhrman’s misdeeds is excellent. There’s not much else to say, except perhaps to remind ourselves that the proposition of using a whole food, plant-based diet, with little or no added oil, sugar and salt, is an amazingly productive story that has so much to offer.

I must add, however, one additional comment to my own post on Dr. Fuhrman. This concerns my “take” on the matter of trust in science, especially as it applies to the publication of research results in professional peer-reviewed journals. It is a process that is poorly understood by most people.

When manuscripts are submitted for publication, reviewers of the manuscripts rarely if ever see the raw data. They only see the summaries of these raw data. Thus they are compelled to trust the authors who compile the data into tables and graphs. If any of these raw data are not included, this must be explained. This process is a matter of trust that is so fundamental to science. If and when this trust is broken, penalties can be severe. At least this is the way that science is supposed to work, and I am confident that it does for the vast majority of researchers who publish papers. Our reputations in science rest on this trust, and without it our reputations--and our careers--can be quickly destroyed.

I accepted Dr. Fuhrman’s request to help him publish a peer-reviewed paper by lending my name as a secondary author. I did so because I believed his claim that he had something important to say. In effect, he wanted to use my reputation because of my half-century of publishing about 350 papers, my serving on the editorial review boards of five journals, and my serving on several grant review panels of NIH, the American Society and other organizations.

Fuhrman’s manuscript really was not a study. It was a summary of case histories from his practice. As project director his name was listed last, as is customary. Dr. Sarter was the person who tabulated the data. Her name was listed first, as is customary. They are the authors who assembled the data, wrote the manuscript and submitted the paper. My name was in the middle, as is customary for people who have a secondary part in the project.

The paper was submitted to two respectable journals. Both rejected the manuscript. About two years later, I inquired of Dr. Fuhrman what had become of the manuscript and he informed me that it was being published in a journal with a much lesser reputation (May 2008).

Three years later (2011) I learned that the findings of this paper were being questioned. I was urged to get a copy of the raw data to see for myself. Initially, Dr. Sarter who I have never met, denied giving me a copy. My second request succeeded, thus giving me my first opportunity to see her compilation of the data, in the form of an Excel sheet. I did my own compilation and it was flawed, as initially suspected by the person who brought this to my attention. But, importantly, this is only Dr. Sarter’s and Dr. Fuhrman’s compilation of the data. To this day, I have never seen the real raw data as presented in the case histories.

I also learned (in 2011) that my name, three years earlier (2008), had been changed to my being listed first in the journal’s archives. This is a serious misrepresentation, although I do not know who did this and why it was done. In any event, it incorrectly gave the impression to others that I was main author of this so-called study.

Like I have done hundreds of times for reviews of other manuscripts, I had trusted Drs. Fuhrman and Sarter to honestly summarize the data--a huge mistake on my part, as it turned out.

But, unbelievably, this flawed summary of data was only the beginning of the problem. Dr. Fuhrman then grossly exaggerated these flawed findings even further, in very public places.

I therefore had to withdraw my name by submitting to the journal a proposed retraction letter. I shared a copy of my letter with Dr. Fuhrman, assuming that he would want to do the same, as is customary in matters of this sort. He failed to take advantage of this opportunity and continued to go forward with the same exaggerations. Indeed, he began using this study, with my name intact, to raise public funding for his version of research.

He made it clear to me that he had no intention of acknowledging his culpability or of changing course in making false public claims. Instead, he and one of his colleagues began accusing me of “personal attack,” among other charges. Finally, about six months later my retraction letter was published but only after the editor eliminated the substance of my reason for submitting the letter.

Aside from Fuhrman’s serious misrepresentations, this affair reveals how important is this matter of trust in science. It is literally impossible for reviewers and secondary authors of studies to examine the details of raw data. They must trust those who assemble these data in a form that can be properly reviewed, analyzed and interpreted. When that trust is broken, science fails, and severe penalties can be the consequence. In this case, based on what I have experienced, I can no longer trust anything that Dr. Fuhrman does or says, as I said in my previous post. Were he to have been a member of a professional society, I am confident that he would by now have been put out to pasture.

And finally, returning to my initial point, although we must clean up messes when they occur, we also must not lose sight of the extraordinary possibilities that this dietary lifestyle offers for solving so many of our problems. We also must acknowledge the exceptional work and courage shown by the majority--and growing number--of professionals working in this area for these past 2-3 decades.

Dr. McDougall’s Comment: The Dust Has Settled

Disagreements on these particular matters have been going on behind the scenes for years. Now all is out in the open. From my viewpoint there is nothing more to say. (The threads on these discussions have been locked.) You can take your side in the arguments, if you choose. Rather, I would like you to join me in recognizing and commending the efforts of all three men for effectively communicating to the world’s population the importance of eating a primarily plant foods diet. Now it is time for our common goals to be recognized and our differences to be set aside.


 

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