Thoughts On "What The Health"

[Aaron52101]

Hi Jeff,

I know this might be a bit off topic from the usual discussion on this board, but I was wondering if you had the chance to watch the the documentary "What the Health" on Netflix yet? With its recent release it has been getting a lot of attention both good and bad about plant based diets and the dangers of animal products to our health. I don't have anything too specific I wanted to ask you, but I always value your insights and thoughts on these issues, and since it relates to your field so much, I was of wondering if you had seen, if you had any thoughts about the information presented, the way it was presented, etc. Obviously we all know where you stand about your view on diet and lifestyle, but as an expert in this field I was just kind of interested in your critique of this documentary because of the overlap it has with your own personal beliefs.

Again I understand this is a tad off-topic, but I figured if you had seen it you certainly would have some commentary on it.

Thank you,
Aaron

[JeffN]

Hi Jeff,

I know this might be a bit off topic from the usual discussion on this board, but I was wondering if you had the chance to watch the the documentary "What the Health" on Netflix yet? With its recent release it has been getting a lot of attention both good and bad about plant based diets and the dangers of animal products to our health. I don't have anything too specific I wanted to ask you, but I always value your insights and thoughts on these issues, and since it relates to your field so much, I was of wondering if you had seen, if you had any thoughts about the information presented, the way it was presented, etc. Obviously we all know where you stand about your view on diet and lifestyle, but as an expert in this field I was just kind of interested in your critique of this documentary because of the overlap it has with your own personal beliefs.

Again I understand this is a tad off-topic, but I figured if you had seen it you certainly would have some commentary on it.

Thank you,
Aaron

I am assuming you have seen it and have some thoughts about it, which spurred your post. I would be curious as to what your thoughts are, good and/or bad, in regard to the film.

Thanks

In Health
Jeff

[Aaron52101]

Hi Jeff,

I know this might be a bit off topic from the usual discussion on this board, but I was wondering if you had the chance to watch the the documentary "What the Health" on Netflix yet? With its recent release it has been getting a lot of attention both good and bad about plant based diets and the dangers of animal products to our health. I don't have anything too specific I wanted to ask you, but I always value your insights and thoughts on these issues, and since it relates to your field so much, I was of wondering if you had seen, if you had any thoughts about the information presented, the way it was presented, etc. Obviously we all know where you stand about your view on diet and lifestyle, but as an expert in this field I was just kind of interested in your critique of this documentary because of the overlap it has with your own personal beliefs.

Again I understand this is a tad off-topic, but I figured if you had seen it you certainly would have some commentary on it.

Thank you,
Aaron

I am assuming you have seen it and have some thoughts about it, which spurred your post. I would be curious as to what your thoughts are, good and/or bad, in regard to the film.

Thanks

In Health
Jeff

Sure! So just a little background about myself, I am currently a dietetics student finishing my degree with and currently also planning on taking my Masters in Human Nutritional Science. After years of research before I even started working towards my degree I was pretty convinced that the majority of evidence in the field of nutrition pointed towards a plant based diet being optimal for human health and that that the less we could incorporate animal products into our diet the better. I have been vegan for over 5 years for not just health, but also ethical and environmental reasons. I'm the only vegan among a few other vegetarians in my program, and probably the only who really believes in the actual power of following an optimal diet on the prevention of chronic disease, even among my teachers. I usually keep my beliefs about nutrition somewhat guarded and don't talk to openly about anything that I think might be grounds for coming off biased or like a conspiracy nut. Most people know I'm vegan, but I tend to just kind of go with the flow in my program and try not to ruffle any feathers. I've had many friends in my program have a few things to say about the documentary, which I don't really debate as I believe it never really goes anywhere. I've even seen a few blog posts that have made made by popular science skeptics already that have already called out the documentary for being unscientific.

That being said, I would say I found about 90% of the content to be something I agreed with for the most part. There were always plenty of things that got a little sensationalized or taken out of context, but for the most part having known the majority of the people interviewed and respect their work I found most of it to be well stated. The problem I find is that when you take all this information that takes years to research properly and just throw it together into 90 minutes, it is going to be difficult for it to really be convincing. It's very easy to simply say information was cherry picked and that these "professionals" are not really credible. I kind of tried to think that if I were an outsider watching this documentary would I be convinced? And I kept thinking the natural skeptic in me would have probably thought a lot of the information could have been debunked, especially considering how against the grain a lot of the information is or sensationalized it feels. As someone in this field there were also a few claims made that I probably wouldn't have felt comfortable making myself that might not have the scientific backing (at least not at this point). I feel like there will be some people that will be inspired by watching it to make healthier changes, but like most the people I know who are in my field it will probably continue to have a lot of people calling it extreme/propaganda/cherry-picked/biased/unscientific, etc, which is likely due to a number of reasons. Partly due to people finding excuses to feed their bad habits, others who just simply don't really have a good understanding of the science of nutrition, and others who feel that if any of this stuff was as true as they say it is then we would know it by now and it wouldn't be such a big conspiracy to just have people eat this way.

Overall, I did enjoy it, but I think this documentary is still going to be a tough pill to swallow (no pun intended) for a lot of people. The directors previous documentary, Cowspiracy may have done a better job at selling a plant based diet for environmental reasons than this one did at doing it for health reasons.

[JeffN]

Sure! So just a little background about myself, I am currently a dietetics student finishing my degree with and currently also planning on taking my Masters in Human Nutritional Science.

Congratulations! We need more people like you.

After years of research before I even started working towards my degree I was pretty convinced that the majority of evidence in the field of nutrition pointed towards a plant based diet being optimal for human health and that that the less we could incorporate animal products into our diet the better. I have been vegan for over 5 years for not just health, but also ethical and environmental reasons. I'm the only vegan among a few other vegetarians in my program, and probably the only who really believes in the actual power of following an optimal diet on the prevention of chronic disease, even among my teachers.

I felt the same way.

I usually keep my beliefs about nutrition somewhat guarded and don't talk to openly about anything that I think might be grounds for coming off biased or like a conspiracy nut. Most people know I'm vegan, but I tend to just kind of go with the flow in my program and try not to ruffle any feathers.

That is the same approach I used and the one I recommend. However, when the opportunity presented itself, I gave several presentations on related topics like Vitamin B12, Vegan/Vegetarian Nutrition, Can Heart Disease Be Reversed. I presented the existing data as a topic for discussion, not with a sledge hammer of arrogance. Then as a graduate student, an opoortunity presented itself to create a WPFB nutrition curriculum for MD's.

I've had many friends in my program have a few things to say about the documentary, which I don't really debate as I believe it never really goes anywhere. I've even seen a few blog posts that have made made by popular science skeptics already that have already called out the documentary for being unscientific.

The "science" being discussed today by the masses, and even many health care professionals, is not science in its truest highest form. It's debate over headlines and misunderstood, misrepresented and misapplied data. It's not worth it.

That being said, I would say I found about 90% of the content to be something I agreed with for the most part. There were always plenty of things that got a little sensationalized or taken out of context, but for the most part having known the majority of the people interviewed and respect their work I found most of it to be well stated. The problem I find is that when you take all this information that takes years to research properly and just throw it together into 90 minutes, it is going to be difficult for it to really be convincing. It's very easy to simply say information was cherry picked and that these "professionals" are not really credible. I kind of tried to think that if I were an outsider watching this documentary would I be convinced? And I kept thinking the natural skeptic in me would have probably thought a lot of the information could have been debunked, especially considering how against the grain a lot of the information is or sensationalized it feels. As someone in this field there were also a few claims made that I probably wouldn't have felt comfortable making myself that might not have the scientific backing (at least not at this point).

I agree with your points. Especially about trying to explain what we do in 90 minutes.

I have asked several people to do an experiment, and I invite anyone else to do it too, because many of us are under the belief that if people just knew about this and had some individual support, they would do it. So, pick about 20-25 people you know really well who are not doing this. Bring them together and hand them each a copy of the FOK DVD and The China Study. Ask them to watch the movie and read the book over the next week. Then, bring them back and let them know that for the next 3 months, offer them as much individual (and group) support so you can to help them adapt what they learned. Then, see how many have a) watched the video and read the book b) became willing to do the experiment for 90 days, c) are left at the end of 90 days and d) of those, who are actually doing it.

The only one that seems to have had any impact from a true health perspective was Forks Over Knives. I think it was released at a time that there was a "perfect storm" going on. Several other events were happening at the same time that helped to get its message out. Outside of that, and I can show you all the tracking/trend data, all the others are like blips on the radar. Something like this happens every 25 years or so but then, rarely lasts as what we do is such a challenge to the combination of human nature and the toxic food environment we live in. (Diet for a New America was first published 30 years ago in 1987 and covered the same topics as FOK and Conspiracy and even had some of the same health care professionals in it).

This is why surveys have consistently found over the last few decades that only about 3-5% of our population follows a healthy lifestyle and only about .1% follow a health diet and the numbers have not changed. And, during this same time, diet and obesity have increased as a leading (if not top) cause of morbidity and mortality. This is covered in my Triage Your Health thread and also the thread in the Lounge on Are Americans Eating Healthier. It also discussed whether the amount of actual vegans has grown.

I feel like there will be some people that will be inspired by watching it to make healthier changes, but like most the people I know who are in my field it will probably continue to have a lot of people calling it extreme/propaganda/cherry-picked/biased/unscientific, etc, which is likely due to a number of reasons. Partly due to people finding excuses to feed their bad habits, others who just simply don't really have a good understanding of the science of nutrition, and others who feel that if any of this stuff was as true as they say it is then we would know it by now and it wouldn't be such a big conspiracy to just have people eat this way.

Correct. I have yet to see convincing evidence that the influx rate is higher than the fallout rate, so only a small percent remain in the pool. I worked with a company in NYC for about 2 decades offering similar programs. When the programs were initiated, we saw a steady growth till it hit a certain percent of the population we worked with. Then, for the next 20 years, that percent never budged, as more came in but an equal amount would fall away.

Overall, I did enjoy it, but I think this documentary is still going to be a tough pill to swallow (no pun intended) for a lot of people. The directors previous documentary, Cowspiracy may have done a better job at selling a plant based diet for environmental reasons than this one did at doing it for health reasons.

Agreed. Cowspiracy came close to hitting the trend numbers that FOK did. I think was because it came out in the same period, focused on a different aspect and really hit the emotional chord in many people that then felt like being vegan (healthy or not) was enough to make a difference for the environment and the animals. And to do that, you don't have to worry about being strict in regard to the health aspects. Hence, the huge rise (and popularity) in Vegan CRAP over the least 5-6 years.

However, even this trend may have peaked.

In Health
Jeff

[JeffN]

I think this review of the movie, What The Health, by Daivd Katz, MD, makes some of the exact same points you made and I agreed with.

Two Diet Wrongs Don’t Make a Diet Right
By David L. Katz, MD,
Senior Medical Advisor, Verywell
Updated July 24, 2017
David Katz, RD

https://www.verywell.com/two-diet-wrong ... ht-4147158

While I don't agree with all of his perspectives or writings, I think he makes some great points, similar to what I have written on I'm many threads. What we do is based on really good evidence and we don't need to exaggerate it, or make it something it is not.

This recently came up in this thread on plant vs animal sources of saturated fats and also animal fat vs animal protein.

viewtopic.php?f=22&t=56104&p=566882

Also, while it is no secret that I take a completely different perspective on "WFPB/Vegan" nutrition than my colleague Ginny Messina, RD, her review of "What The Health" makes some of these same points.

I mention this, because both of these reviews will get far reaching attention, not only in the WFBP world, but also the Vegan world and the whole Lifestyle Medicine world.

I am going to make a separate post that will link to all my discussions on some of these issues that I have addressed.

In Health
Jeff

[Aaron52101]

I think this review of the movie, What The Health, by Daivd Katz, MD, makes some of the exact same points you made and I agreed with.

Two Diet Wrongs Don’t Make a Diet Right
By David L. Katz, MD,
Senior Medical Advisor, Verywell
Updated July 24, 2017
David Katz, RD

https://www.verywell.com/two-diet-wrong ... ht-4147158

While I don't agree with all of his perspectives or writings, I think he makes some great points, similar to what I have written on I'm many threads. What we do is based on really good evidence and we don't need to exaggerate it, or make it something it is not.

This recently came up in this thread on plant vs animal sources of saturated fats and also animal fat vs animal protein.

viewtopic.php?f=22&t=56104&p=566882

Also, while it is no secret that I take a completely different perspective on "WFPB/Vegan" nutrition than my colleague Ginny Messina, RD, her review of "What The Health" makes some of these same points.

I mention this, because both of these reviews will get far reaching attention, not only in the WFBP world, but also the Vegan world and the whole Lifestyle Medicine world.

I am going to make a separate post that will link to all my discussions on some of these issues that I have addressed.

In Health
Jeff

Thank you Jeff for your comments; I always wish I had more time to review this forum and make comments because in a world where even most of the individuals in my own profession have very little regard for health and nutrition (as I'm sure you are well aware) it's always refreshing to see like minded people on the same page over here

Since this documentary has come out I've definitely had a few people who have seen it and know I'm plant based continually ask for my opinions of some of the articles critiquing it such as Ginny Messina's and the one posted by Harriet Hall (https://sciencebasedmedicine.org/what-t ... an-agenda/). Both of which I think made good points on the shortcomings of the documentary, and rightfully so as there were blatant issues with some of the facts and presentation of its content, but between both of these reviews I also had numerous critiques (More so in Hall's who really just tried to throw away science on meat and eggs for example by simply saying "doubt it" and not actually really use much real science to debunk the documentary).

I hand't actually read what Dr. Katz wrote, and I did find his article to be the best written critique I have read so far. Though personally I didn't find the documentary come off as pro-sugar as much as Katz did, I think it goes without saying we can all be in agreement that high amounts in our diet can be harmful, but I do think it is a scapegoat sometimes for larger issues. Some of the comments specifically that I know Dr. Garth made in the documentary that I think dealt with this issue that people have criticized he has now clarified after the release of the documentary on his FB page, which I think was more the fault of the specific sound bites they chose to utilize in the documentary than his own viewpoints. It is perhaps this reason though FOK was a better documentary because it tried to focus on eat a whole foods plant based diet, while WTH tried to push veganism.

[JeffN]

I keep getting links to articles or videos responding to the critics. I haven't found one yet that I thought made any great response that would negate the above comments. Today I was sent a video clip of Dr Greger saying that in regard to reversing heart disease, there was no cherry picking of data as there is only one diet shown to reverse heart disease.

Hmmm, if the implication is that it was vegan, that's not correct. If the implication is that it was WFPB, that's correct, but as I explained in my article, The Continuum of Health, that is not a diet, but a dietary pattern.

http://jeffnovick.com/RD/Articles/Entri ... _Pt_1.html

A diet that is (1) based predominately on a variety of minimally processed fruits, vegetables, starchy vegetables, roots/tubers, whole grains and legumes, (2) low in fat, saturated fat, calorie density, and (3) low in added sugars, oils and salt, has been documented to prevent and/or reverse disease - even for those who are seriously ill - in many published studies over the last 60 years. The results from these studies, which use differing specific diets in them, documents the importance and the effectiveness of this overall dietary pattern over any one specific version of this diet. This dietary pattern is commonly referred to as the Whole Food, Plant-Based Low/No SOS diet or simply the WFPB SOS or just WFPB.

When discussing the WFPB diet, it is important to understand that there is no one single program but there are some common denominators among all of the successful programs. While the programs are all very similar, they are not identical. Not all of the programs are vegetarian or vegan. Some of the programs allow for a small amount of certain animal products and some don't. Some allow for a small amount of non-fat dairy and some don't. Some allow for a small amount of oil and some don't.

And, there are two diets documented to reverse heart disease (and approved by medicare for ICR), one is vegetarian (Ornish) and included non fat dairy and egg whites. The other wasn't even vegetarian (Pritikin) and included non fat dairy, egg whites and fish & chicken. While these were not huge parts of the dietary pattern, the point is, these diets can't be used to make a vegan argument.

If you are wondering, the diet used in Dr Esselstyn's original patients during the 12 years, as described in the published papers, was the Ornish diet. He didn't change his program to much later, after the patients reversal had happened.

In Health
Jeff

[JeffN]

I was reminded of one other, that doesn't quite get the attention of the first two I mentioned.

His name is Dr Lance Gould and you can see his bio here.

http://www.uth.tmc.edu/pet/about-dr-gould.htm

As far as I understand, he and Nathan Pritikin communicated with each other extensively in the late 1970's. At that time, both had grants from the VA and were working with heart patient vets - Nathan Pritikin in Long Beach, CA, and Lance Gould in Seattle.

He co-authored 5 of Ornish's original papers which you can see here...

https://www.ncbi.nlm.nih.gov/pubmed/?te ... BAuthor%5D

Here is the full text of one of the published papers on his program, which he runs at the McGovern Medical School at The University of Texas Health Science Center in Houston. I think it is a fairly well done paper using 3 diet groups, the typical American diet, the AHA diet and his program and used PET Scans to document reversal.

http://www.sciencedirect.com/science/ar ... Dihub#BIB1

Here is his dietary recommendations used in the study

1) 10 to 20 g of fat/day;

2) 60 to 80 g of protein from non-fat or low-fat dairy products, egg whites, vegetable protein burgers or protein supplements, fish, skinned chicken breast or turkey breast, extra lean pork or beans, all baked or grilled, not fried;

3) whatever caloric-carbohydrate restriction was required to achieve ideal weight;

4) unlimited vegetables and salads;

5) exercise 30 min or more, 4 to 5 days/week, doing whatever activity maintained adherence;

6) one or more lipid active drugs dosed to goals of low-density lipoproteins (LDL) <2.3 mmol/l (90 mg/dl), high-density lipoproteins (HDL) >1.2 mmol/l (45 mg/dl), and triglycerides <1.1 mmol/l (100 mg/dl);

7) aspirin daily;

8 ) monthly follow-up for detailed food history, lifestyle review, and medication adjustment until the aforementioned goals were reached; and

9) antianginal and/or blood pressure medications as needed, including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and nitrates.

Here is his free PDF for patients
http://www.uth.tmc.edu/pet/Assets/pdf/g ... elines.pdf

His work is even referenced in one (or a few) of Dr Esseslstyn's publications and he is still active and practicing.

While these dietary recommendations are somewhat different then the first two ( more lenient on animal product use, more aggressive on medication, not as liberal on carbs), there are many common denominators. Without knowing more specifics, I ran some numbers to meet the above guidelines and it came very close to the Pritikin maintenance diet.

If you read the study closely, he really had 4 diet groups and I wish he looked at it that way and analyzed it as such. I would have liked to seen..

1) poor health group

2) AHA diet group (moderate)

3) low fat diet group with no medication (extreme)

4) low fat diet group with medication (extreme with medication)

i think grouping 2 & 3 together as he did was a mistake and don't get why he did it. Remember, in Pritikin & Essy, there was no seperate group 3 either, just a 1 &/or 4 as most patients were kept on or put on medications and included with any who were medication free. Ornish’s intervention group was the equivalent to #3 but he had no #4 and the control group was equivalent to #2.

Group 3 should have been separated out, if there was enough of them, and analyzed as a separate group.

I also wish there was much more detailed analysis of the actual diet.

In Health
Jeff