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REVIEW: “WHAT THE HEALTH?”

Sorting out the TRUE Nutrition Claims

If you haven’t watched this documentary, you don’t have to in order to gain some insight from this article.  In fact, it isn’t necessarily a documentary I would recommend.  They do make some interesting and thought provoking points throughout, however, they do it with an underlying sense of extremism, fear mongering, and they do it all with an emotional twist.  This is the point of the movie: A vegan diet is the most healthful and least problematic for the environment and our society in general.  There is also a slight undertone that we should NEVER trust organizations such as the American Cancer Society, Susan G Komen, the American Diabetes Association, or the Academy of Nutrition and Dietetics because they are not in business to prevent diseases like cancer or diabetes, but rather they exist for some other reason (not directly stated by the producer of this movie).  I hope you caught the sarcasm there.

Keep in mind my credentials as you are reading this.  I am a Registered Dietitian (RD) and a Certified Diabetes Educator (CDE).  I am going to focus this review in my area of expertise.  This means I am not going to comment on the environmental impact, politics, or other areas that do not fit in the scope of nutritional science.  I hope to give you some perspective and show you how some of these extremists twist the truth just slightly so that you hang on their every word.  If it was done in a “research study”, it must be true, right?  Let’s take a look at some of the main points.

#1 The Claim: Processed meats are linked to cancer, coronary artery disease (CAD), and diabetes.  TRUE.

Let’s review briefly what “types” of meats we are talking about.  Red meat is considered beef, pork, and lamb.  The white meats include chicken, turkey, and rabbit.  Each of these types of meat can also be preserved, typically by the addition of high levels of salt and/or chemical preservatives (referred to as “processed meat”), or consumed without such preservatives (referred to as “unprocessed meat”).

The claim in the movie is that processed meats are linked to cancer.  This is TRUE! There might be a couple of reasons that processed meats are linked to cancer including the nitrates they contain and/or the sodium.  Nitrates are used to preserve meats and are found in deli meats, hot dogs, and some sausages.  The movie cites a meta-analysis published in 2012.  In this analysis, they conclude that processed meats consumption of 50 grams daily does increase risk for Coronary Artery Disease (CAD) by about 42%, and for Type 2 Diabetes by about 51%.  50 grams is equal to about 2 oz, which is typically the amount of turkey you would put in your sandwich.  100 grams daily of red meat will give you a 19% higher risk of CAD, and a 19% increased chance of type 2 diabetes.  Since many of these original research studies were pooled together for a conclusion, we can confidently say that it is likely to be accurate.  In the “discussion” section of this publication, you can read about how the investigators caution that it may be a component of the processing such as the nitrates or the sodium that may be at fault for increasing risk of these diseases.  We should however, consider that it is hard to “control” these studies since processed meats are associated with other risky health behaviors such as smoking, and low activity level.  We cannot be 100% sure that the risk in these ill health effects is increased simply by the processed meats.  This shows us another ASSOCIATION.  It does not provide a cause and effect relationship.  This would be like claiming that when people smoke it causes them to eat processed meat, which is simply not the case.  Many research studies will show associations, but are not designed to provide cause and effect relationship.  Here is the link to the publication if you want to read about it further:

https://www.ncbi.nlm.nih.gov/pubmed/23001745

Unprocessed Red and Processed Meats and Risk of CAD and Type 2 Diabetes.  Micha, R, et al. Curr Atheroscler Rep. 2012 Dec;14(6):515-24.

Where it gets a little off track:

After citing this study the producer, Kip Andersen, goes on to broaden the category and say that all meats increase the risk of CAD and type 2 diabetes.  While there is a strong ASSOCIATION with processed meats and heart disease and diabetes, this is not necessarily true for other animal products like chicken, turkey, dairy, or eggs.  Also, remember the definition of processed meats above.  This does not include fresh or frozen meats.

#2  The Claim: Diabetes is not caused by high carbohydrate and sugar intake, it is caused by a typical meat and animal based diet.  Sort of True.

Type 2 diabetes starts with insulin resistance.  What this means is that you have plenty of insulin, but it doesn’t work right.  The insulin in your body takes the sugar from your bloodstream and takes it into muscle and fat cells.  When we eat too many calories, our body sends it into fat cells.  As the fat builds up around the muscle cells, it prevents the insulin from getting the sugar into the fat or muscle cells like it needs to.  The sugar stays in the bloodstream and that is what makes the blood sugars high.  Eating too much carbohydrate, protein OR fat, will cause this to happen.

Dr. Neal Barnard says, “Carbs do not make you fat”.  This is also sort of true.  Excess Caloriesmake you fat.  Then he goes onto say, “Unless you are really overdoing it”.  I would argue, that most people really do overdo carbs!

Later, in an interview with Dr. Robert Ratner (from the American Diabetes Association) says that we can’t prevent type 2 diabetes in everyone.  That is also sort of true.  In MOST people we can prevent it, but in some, the genes are too strong and as they get older it may happen anyway regardless of how “healthy” their diet is.  Kip ruffles Dr. Ratner’s feathers by trying to discuss a study that looked at a vegan diet versus a conventional diabetes diet.  The vegan diet group (49 people) was counseled to consume vegetables, fruits, grains, and legumes.  The vegan diet group was high carbohydrate (75%), low-fat (10%), and low-moderate protein (15%).  33 people out of 49 in this group, completed this study.  The conventional diet group (50 people) was counseled to consume moderate carbohydrate and monounsaturated fats (60-70%), low saturated fat (<7%), and moderate protein (15-20%).  This was considered a “conventional diabetes diet”.  24 out of 50 of this group completed this study.  The results show that both groups lost weight and lowered their cholesterol.  Both groups also lowered their HbA1c (a three month average of blood sugars).  The movie boasts that the vegan group lowered their HbA1c a lot more.  Well, it was more, but not a lot more.  Also, the completion rates were really low in both groups.  This typically shows that results may not be valid.  You can look at this study here:

http://ajcn.nutrition.org/content/89/5/1588S.full

A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial.  Neal D Barnard, et al. Am J Clin Nutr May 2009 vol. 89 no. 5 1588S-1596S.

Dr. Ratner later says that “any diet works if people follow it”.  I am not sure why he gets so flustered!  He poorly represents the ADA in this situation.  He should have taken a little time to discuss more vegetables and fruits, healthy fats, lean meats, lowering processed foods and sugars, etc.  He could have easily looked at the above study and seen that there was really not much difference in the HbA1c among the two groups.  This interview was disappointing.

Another claim about Diabetes:  Type 1 diabetes risk is higher with milk consumption.  Mostly False.

The study they talk about here was looking at introducing cow’s milk between 6 months and 1 year old.  This is not the recommendation for infants in this age group anyway.  The conclusion of this study was that children consuming cow’s milk during this age range were almost 4 times more likely to develop type 1 diabetes as adolescents.  This study has many flaws, but one take away: Do not give cow’s milk to your child who under 1 year old.  The results from this research really don’t apply outside of this age range, but the claims in this movie make it appear as if it is true across all ages.

You can read this study for yourself:

http://www.aulamedica.es/nh/pdf/9247.pdf

Introduction of pasteurized/raw cow’s milk during the second semester of life as a risk factor of type 1 diabetes mellitus in school children and adolescents.  Villagrán-García, Edna F., et al.

#3  Chicken is the number one source of dietary cholesterol and sodium, and increases risk of prostate cancer.  Sort of true.

We do eat a lot of chicken, and so I would not be surprised if this is where most of our dietary cholesterol and sodium comes from.

But let’s look at the claim that there is increased risk of prostate cancer with consumption of chicken.

The conclusion from the study they cite is this: Results suggest that after diagnosis with prostate cancer, the consumption of processed or unprocessed red meat, fish, or skinless poultry is not associated with prostate cancer recurrence or progression, whereas consumption of eggs and poultry with skin may increase the risk.  So, it sounds like the skin of chicken and eggs are positively associated with increased risk of recurrence or progression.  Remember this is an association, not a cause and effect. But, it does appear that there may be some relationship between chicken with its skin and increased risk of cancer recurrence or progression.  It is probably a good idea to limit the skin of poultry and possibly eggs, if you have been diagnosed with prostate cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132069/

Intakes of meat, fish, poultry, and eggs and risk of prostate cadairyfishncer progression.  Richman, Erin L, et al. Am J Clin Nutr. 2010 Mar; 91(3): 712–721.

#4  The claim: 1 egg per day could be just as bad as smoking 5 cigarettes per day.  False.

The claim in the movie “1 egg per day could be just as bad as smoking 5 cigarette per day”.  He fails to cite his research.  I am skeptical of this data.  The research I found did show increased plaque in people who ate more than 3 eggs weekly, but it did not compare risk to smoking, it simply also assessed smoking.  They concluded that plaque formation in the arteries increases exponentially with smoking and egg yolks.  If you have any risk for heart disease, it may be a good idea to avoid eating excessive egg yolks.

http://www.atherosclerosis-journal.com/article/S0021-9150%2812%2900504-7/abstract

Egg yolk consumption and carotid plaque.  J David Spencer, et al.  Atherosclerosis.  Oct 2012. Volume 224, Issue 2, Pages 469–473.

Where it gets off track:

This study didn’t compare people eating egg yolks to smoking cigarettes.  It simply looked at plaque formation in both groups.

#5  Fish have become mercury sponges.  Sort of true.

Many fish do have high mercury content.  We do have to be careful in what types of fish we eat and where we get them.  If you are curious to read more about this:

https://www.nutritionaction.com/daily/what-to-eat/the-best-fish-for-your-health/

#6 Dairy products increase risk of fractures and breast cancer, and they have a lot of hormones in them.

The producers use the “gross factor” in pretty much all of their illustrations here when they discuss puss and hormones and show you some disturbing images throughout this section of the documentary.  While it is true that there is some research showing a link between dairy and inflammation, many of the claims they make are not true.   I am only going to tackle a couple of the most important things they discuss when it comes to dairy.

Milk drinkers had 0% protection from fractures.  TRUE.

Current research shows that there is not necessarily a protection factor from increased intake of calcium, however, there is also no increased risk of fracture.

“Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.”

http://www.bmj.com/content/351/bmj.h4580

Calcium intake and risk of fracture: systematic review. Mark J Bolland, et al.  BMJ 2015;351:h4580.

 Consuming 1 serving of whole dairy increases risk of breast cancer 49%.  FALSE.

In the movie, Kip talks about how this study clearly shows that there is increased risk of dying if you consume dairy products after you have been diagnosed with breast cancer.  What this study ACTUALLY looked at was risk of cancer recurrence in women who consumed high fat dairy vs low fat dairy.  1893 women were included.  Low fat dairy was associated with no change in outcomes, where high fat dairy produced a 50% higher risk of mortality. So in this study we are actually talking about the fat content of dairy, not just dairy in general.  So what was considered “high-fat”?  High-fat items included cream, whole milk, condensed or evaporated milk, other cheese, other yogurt, pudding, ice cream, custard, and flan.  “Low-fat” dairy was considered to be the “lowered fat” options for these foods.  So likely, the fat consumed was more of a factor in risk of dying rather than just dairy in general.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639864/

High- and Low-Fat Dairy Intake, Recurrence, and Mortality After Breast Cancer Diagnosis. Candyce H. Kroenke, et al.  J Natl Cancer Inst. 2013 May 1; 105(9): 616–623.

In this section of the movie the Registered Dietitian says you can prevent breast cancer with diet, but we aren’t.  We are putting so much money into finding a cure instead of focusing on prevention.  He sticks this quote right in the middle of talking about dairy, although, this RD, is not specifically talking about dairy, she is simply stating that breast cancer can sometimes be prevented with a healthy diet.

There is a problem with all of the hormones in milk.  MAYBE.

This hypothesis article (link below) explains that hormones present in the milk from pregnant cows is increasing the risk of hormone related cancers.  In this study they simply looked at countries with the highest rates of these cancers and saw that these are the countries that also consume the most milk and cheese.  There seems to be some relationship here, but there are so many other factors that contribute to this increased risk such as genes and also overall fat intake, or even other dietary considerations.  Again, this is purely an ASSOCIATION study, it cannot determine cause and effect.

http://www.sciencedirect.com/science/article/pii/S0306987705003543

The possible role of female sex hormones in milk from pregnant cows in the development of breast, ovarian and corpus uteri cancers.  Davaasumbuu, Ganmaa, et al. Medical Hypotheses.  2005. Vol 65, 6:1028-1037.

#7 The MyPlate and Food Guide Pyramid is recommending the foods that are making us sick.  FALSE.

This is a point they do not spend much time developing, but I thought it was noteworthy because there is actually many good concepts in MyPlate.  The concepts include eating more veggies, fruits, and whole grains.  Included on the plate are smaller portions of the meats, fats, and sugars.  Actually, with the exception of dairy being on the plate, the MyPlate can easily be adapted to fit a vegan diet.  Kip’s argument about the MyPlate encouraging foods that make us sick really just isn’t true.  In practice, I use a personalized version of the plate to accommodate client preferences.  It can be a great tool!

You can visit http://www.choosemyplate.gov to see the plate for yourself.

#8 You can get enough protein with rice and broccoli only.  Sort of TRUE.

To get to this protein goal while eating plant based, you have to eat about 2,000 Calories, and you must also be aware of incomplete proteins and complementary proteins.  There are 9 essential amino acids (meaning our bodies cannot make these), and you can find them all in plant based foods, but you cannot find all 9 in a single plant based food.  That is what makes it “incomplete”.  The only plant protein that contains all 9 is soy.  So, if you decide to follow a plant based diet, you must “pair” foods to make complementary proteins.  For example, eating beans with rice will give you a complementary protein because beans lack the amino acid that rice has and vice versa.

Another consideration is that when you trying to lose weight, you need to supplement with a higher protein food in order to get enough protein while lowering your Calories.  This can be done through a plant based protein shake or bar.   Furthermore, if you are trying to build muscle the research states that you need more protein than what is being recommended in this movie.  For specific recommendations and application tips on how to get an appropriate amount of protein, you should visit with a Registered Dietitian.  RDA (Recommended Daily Allowance) is 0.8 grams of protein per Kg. Optimal amounts for building muscle are 1.2 grams per Kg.

Lastly, with a purely plant based diet, you will need a B12 supplement.  They discuss this very briefly in the movie, but do not emphasize the importance of it, and my guess is that you missed it.  If you decide to change your diet drastically like is recommended in this movie, you must be aware of the amounts of nutrients you need to be healthy.  When cutting out major food groups, it is easy to become less healthy.  B12 is not present in any plant based foods and it must be taken as an additional supplement, or in a fortified food.

#9 Doctors are not taught much about nutrition in medical school.  TRUE.

This statement comes at the end of the movie.  It is true that most people go to their doctor first with the hope that their doctor will help them lose weight.  First of all, many doctors don’t have sufficient time in their appointments to tackle weight loss.  It is really complex!  I have heard many responses from clients who have asked their doctor for help.  The doctor may say: “Don’t eat anything white.”  Or, “Start a food journal.”  Or, “Come in every week to weigh in.”  Then the patient walks away with no direction or concrete steps in how to actually change their eating habits to lose weight.  For many people losing weight and changing your eating habits is much more complicated than simply eating less or changing the type of foods they are eating.  This is why Registered Dietitians (RD’s) are helpful!  RD’s who specialize in weight management and other disease specific diets have specific nutrition knowledge related to these areas in order to help their clients be successful.  Part of this includes counseling in areas of behavior change so that the client can be successful with changing the diet long term.  Changing habits is hard, and a qualified RD has just the right tools to help a client continue in motivation and success for the rest of their life!

So what can we learn from all of this?

It is still true that processed meats, high fat meats (like beef and pork) are not the healthiest options.  It is true that most Americans eat too many animal products.  It is still true that eating more vegetables, fruits, and whole grains is good for you.   It is still true that your diet may be the single most important thing affecting your health.  It would benefit so many people who are struggling with health issues to consult an RD who specializes in areas they need help with.  Lastly, it is still true that most documentaries like this one, don’t tell you the whole story.

YOU REALLY ARE WHAT YOU EAT, so eat well!

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