“The whole problem with the world today is that fools and fanatics are always so certain of themselves, and wiser people are so full of doubts,” Bertrand Russell.
Now that the film “What the Health” is on Netflix, I went back and watched this film again to refresh my memory as to why I rolled my eyes so many times the first time I watched it. I think it was shortened a bit because one scene, that stood out in my mind, I didn’t see again. Regardless, “What the Health” is the second film by the filmmakers who made the film Cowspiracy (which I reviewed back in 2014 click here to read that review).
First, major spoiler alerts….so you may want to watch the film and then read my review.
The first part of the film basically states that meat unequivocally is the cause of cancer, diabetes and cardiovascular disease [CVD]. The middle parts of the film deal with environmental bioconcentration of toxins in meat, factory farming, and the influence of funding on research outcomes. While the end of the film gets into humans being frugivores, and having no nutritional need for meat. (This portion includes a discussion of the “rice diet”). The movie ends with how easy and cheap it is to follow a vegan diet with patients claiming how quickly they cured themselves of all modern illnesses and got off all their drugs by just “going vegan.” During the different parts of this film, Kip speaks to a virtual who’s who of vegan doctors (Greger, Kahn, Barnard, Mills, Esselstyn, etc). He doesn’t seek out any contrary or other points of view.
Before discussing some of the film’s many shortcomings, the few parts of the film that do make some sense are its segments on factory farming and on the overuse use of subtherapeutic levels of antibiotics with factory farmed livestock. Environmental pollution from pig CAFO’s in North Carolina is something Nicolette Hahn Niman discussed at length in her first book Righteous Porkchop. While working as an environmental attorney for Robert Kennedy Jr’s group Waterkeeper Alliance, Niman dealt with many of the issues raised in What the Health particularly regarding pollution from manure lagoons and the environmental racism of locating these CAFO’s near poor communities of people of color. These are all salient issues as is the issue of using sub therapeutic levels of antibiotics due to the crowded and unnatural conditions of such confined operations. Though unlike, What the Health, Niman does realize that there are alternatives to these factory type operations, and highlights these options. Whereas the film doesn’t try to make any such distinctions, since the film’s goal is to explicitly promote veganism.
Another segment of the film pointing out the influence of industrial/corporate funding on research outcomes is pertinent as well. But it is also a bit ironic, since vegan doctors also rely upon such research to affirm their beliefs (e.g. early and ongoing lipid and diet heart hypothesis research scapegoating saturated fat and cholesterol were funded by the sugar industry and continue to be funded by the pharmaceutical industry). These vegan [plant based] doctors do this while simultaneously and quickly dismissing any research as corporate funded that contradicts their points of view, even when that research wasn’t corporate funded. Coincidently, how many vegan doctors recently challenged the recent American Heart Association [AHA] position paper on coconut oil, saturated and polyunsaturated fats even though the AHA received and continues to receive a lot of funding from soybean oil , pharmaceutical and processed food companies? Nope, vegan doctor Joel Kahn reaffirmed the AHA’s findings because those findings further and conveniently reinforce his beliefs. So to say the least, it’s a bit disingenuous for vegan doctors to rail against the “Big Egg” and this sector’s supposed influence on the 2015 USDA food guidelines removal of cholesterol as an item of concern while not acknowledging that “Big Pharma” made a lot more money off of statins over the past 30 or so years demonizing cholesterol.
Anyway moving on to some of the film’s many faults, for cancer Kip cites the recent World Health Organization [WHO] report. Kip proclaims after reading this, he changed his diet, even though obviously he was already vegan long before this report came out in 2015. So to say the least, Kip is being a bit disingenuous.
The WHO report was the report that classified processed meat as a type 1 carcinogen (along with sunshine) and unprocessed meat as a type 2A carcinogen (along with heated beverages like coffee and tea). The report was a meta-analysis meaning, the WHO group did a keyword search and identified 800 studies related to the topic of processed meat, meat and cancer. Kip doesn’t understand how meta-analysis works. He asserts that 800 studies proved meat causes cancer. The reality was that for the form of cancer most ASSOCIATED with eating processed meat, colorectal cancer, WHO used 7 studies (out of the 800) to reach their conclusion (1). All seven of these studies were epidemiology studies meaning that the studies were observational studies. The WHO panel excluded other studies that contradicted their conclusion. Did any of these studies look at how the meat was processed, what other ingredients beside meat were included in the processed meats, or where any of the meat was sourced from? No of course not, none of the seven observational studies they cited did this.
Kip then highlights the report’s findings that eating a daily portion of processed meat increases colorectal cancer risk 18%. Sounds scary right? He then goes on to assert that eating processed meat is as bad as smoking cigarettes, and that children should be forbidden from eating processed meats- quite the melodrama.
Well, Kip (like many other people including doctors and science writers) doesn’t understand the difference between relative and absolute risk or, for that matter, how relative risk is actually determined. To begin with the 18% number Kip cited is relative risk NOT absolute risk. And to get an idea of how absurd the comparison of risk is to smoking, the relative risk for smoking is 2300%. Meaning people who smoke have a 23 times greater chance of getting cancer than those that don’t (2). Relative risk is a ratio derived from comparing a group with a control group. So for the relative risk in the case of processed meat, if you have one group of 100 people who ate meat and another 100 who didn’t, 6 out of 100 that ate meat got colorectal cancer whereas only 5 people in the control group that didn’t eat meat got colorectal cancer (6/5 = 1.18 or 18% increase). The actual ABSOLUTE risk is less than half a percent (6% – 5% = 1.0%). Not so scary any more, is it?
Remember too that this is an ASSOCIATION based on observational studies that don’t really isolate confounding factors (variables). Association doesn’t equal causation especially when absolute risk is so small. For example, it’s quite possible that the high fructose corn syrup in hot dogs is what causes cancer rather the meat in hot dogs. Or, for that matter, the French fries fried in soybean oil that were consumed with the hot dog rather than the hot dog itself (3) that cause the cancer. Again epidemiology can’t make any such distinctions. Nutritional science, in general, is very vague and difficult to do. As Bertrand Russell noted, “The whole problem with the world today is that fools and fanatics are always so certain of themselves, and wiser people are so full of doubts.”
Relying on observational studies and not understanding the difference between relative risk and absolute risk are reoccurring themes in this film. In general, these are reoccurring problems with media coverage of such studies, since stating relative risk is more sensational and generates more eyeballs and click throughs than actually understanding how the studies are done and whether or not the absolute risk warrants as much concern.
Moving on to diabetes, here Kip and his so-called experts proclaim that meat, not sugar, causes type 2 diabetes. To hammer this point, “diabetes expert” and PCRM doctor Neal Barnard (Board Certified in psychiatry not in internal medicine nephrology or endocrinology) provides the free fatty acids [FFA] gunking up the insulin receptor site hypothesis that’s popular in the vegan community. Type 1 diabetes is caused by not having enough insulin whereas type 2 is caused by insulin résistance. The issue with type 2 is that the insulin isn’t working as well to get glucose into cells, so more and more insulin is needed to reduce blood glucose levels. The gunk up theory of insulin résistance is that free fatty acids block insulin receptor sites so glucose can’t get into the cells. The vegan argument is that all of these free fatty acids come from the saturated fats (meat) a person consumes.
Well, there are some major problems with this “gunking up receptor site” hypothesis. First is that high fat ketogenic diets have been shown to reduce triglyceride levels (4). So it is hard to have more free fatty acids with lower triglyceride levels since free fatty acids are fats detached from the their glyceride backbones. Or, in other words, lower triglycerides means lower free fatty acid levels. Additionally, there’s the whole issue of fatty acid synthesis (5) by one’s liver, a process called de novo lipogenesis [DNL]. The liver converts excess carbs to saturated fats (mainly palmitic and palmitolec fatty acids to be exact) (6). This DNL process occurs when the level of sugar (glucose and fructose) exceeds the glycogen storage capacity of the liver. Fructose is especially problematic for DNL since fructose can only be processed by the liver, whereas glucose can be utilized by cells throughout the body. So after DNL takes place, there are three sources of FFA’s that get into the bloodstream: From excess carbs converted to fats, from stored fat reserves (adipose tissue) and from food. Of the three, the third from food is the least consequential. There is a postprandial (after eating) rise in fat levels in the blood, but the levels are lower in the fasting state.
(Note there’s a claim by Dr. Davis as well as an article by Dr. McDougall that sugar doesn’t easily convert to fat via DNL. This assertion is based mainly on “a study” with only nine people. The only problem is that there have been better designed studies, including this one, that show the exact opposite namely: “..This study supports the hypothesis that hepatic DNL is one of the mechanisms by which low-fat, high-carbohydrate diets induce hypertriglyceridemia in human subjects. Furthermore, hepatic DNL may also be a determining factor in inducing hypertriglyceridemia in insulin-resistant subjects, irrespective of their diets…” But then again cherry picking data is used to confirm biases, and vegan doctors LOVE to cherry pick).
Since the source of FFA’s is from DNL and adipose tissue, not consumed saturated fats, even using this hypothetical mechanism of gunked up receptor sites, the cause of diabetes is still excess carbs, especially fructose, even though fructose doesn’t spike blood glucose levels- see non-alcoholic fatty liver disease [NAFLD]. If you look at the dietary protocols of many of the whole food plant based doctor’s diets like Greger, they also are reducing refined carbs (in addition to eliminating meat) while also increasing fiber. Fiber slows down the rate at which fructose is released to be processed by the liver. So bottom-line is eat less soda, processed foods with HFCS, highly refined carbs, and fruit juices. As diabetes doctors like kidney specialist Dr. Jason Fung have demonstrated (7), type 2 diabetes can also be reversed using ketogenic high fat diets. So it’s not the fats, it’s the sugars, especially fructose causing fatty liver disease, DNL and FFA’s into the blood stream. Cut these fast simple carbs, and you can reverse type 2 whether you eat meat or don’t eat meat.
Okay this is just the first twelve or so minutes of the film. The argument against meat continues with the argument that meat causes cardiovascular disease [CVD]. This argument is based on the lipid hypothesis and diet-heart hypothesis. Ironically in this YouTube video, 40 Year Vegan Dies of a Heart Attack, Greger himself argues that arteriosclerosis is due to inflammation from high Omega 6 to 3 ratios and oxidized polyunsaturated fats. In this video, while Greger grossly oversimplified the fatty acid profiles of the foods he cites, he still argued for the oxidative stress theory of arteriosclerosis rather than the lipid hypothesis. So CVD is caused by inflammation and not the consumption of fats. High anti-oxidants plants are good since these antioxidants help mitigate free radicals. Note too since the 1960’s in the US that as consumption of saturated fats has gone down, consumption of highly processed polyunsaturated fatty acids have gone up way up as have the rates of heart disease, diabetes and obesity. Yes, as recent animal studies have demonstrated, soybean oil is also obesogenic (8). So as the late lipidologist Fred Kummerow noted, “Oxidized lipids contribute to heart disease both by increasing deposition of calcium on the arterial wall, a major hallmark of atherosclerosis, and by interrupting blood flow, a major contributor to heart attack and sudden death.”(9).
Rather than go on and on regarding the films many structural flaws and biases, let me just note a few further egregiously misinformed points the film gets wrong regarding the rice diet, B12 and human evolution.
Regarding the rice diet, as Dr. Jason Fong points out in this essay, Thoughts on the Kempner Rice Diet, the effectiveness of the diet had little to do with it being low fat or high carb. The diet was low calorie so there were no excess carbs, and there especially wasn’t excess fructose in the form of high fructose corn syrup. So using this diet as a justification for sugar not causing diabetes, as Greger did, is more than a bit misguided. Note too Fung is a nephrologist (kidney specialist and Board Certified in internal medicine) with a clinical practice whereas Greger’s background is in zoonotic disease without any clinical practice (Greger is not Board Certified in anything related to internal medicine) .
Greger is equally misinformed on B12 (cobalamin) synthesis since this occurs when cobalt is converted to B12 by gut bacteria. Yes B12 is synthesized by anaerobic bacteria, but those bacteria reside in the microflora of animals rather than in the soil. Remember too that in the natural world the distinction between an animal’s gut flora and the soil’s rhizosphere isn’t as distinct as it is in urban environments with waste treatment facilities. Animals, including humans, poop out different bacteria so gut microbes end up in soil, and soil microbes end up being consumed. Human guts actually contain the bacteria to synthesize B12 (10), however since we’re hindgut fermenters, we poop out this B12. Gorillas and chimps get their B12 by eating their own poop (coprophagia – see gorilla eating his own poop video here) With foregut fermenters like ruminants, the conversion happens in the four part stomach BEFORE the intestines, so the cobalamin is then absorbed in the intestines before being pooped out. As long as ruminants can get sufficient cobalt from their forages, they can make B12 in their guts which is then distributed to all their tissues. B12 is most bio-concentrated in the liver.
Contrary to the assertions in the film, vegans tend also to be deficient in DHA, unless they supplement with algae pills, as well as fat soluble vitamins A, D, and K2. Certain essential amino acids too, since plant protein aren’t as complete or as concentrated as animal sources of proteins. plus mineral absorption can be problematic since plant oxalates may block uptake of iron, etc. Potential deficiencies also have a lot to do with genotype (SNP) differences meaning different people convert ALA to EPA to DHA and beta carotene to retinal and varying degrees of efficiency. Taste can come into play with K2 since plant based sources of K2 like natto aren’t very appealing to a lot of people. There are simply many more palatable options to get K2 from animal sources than plant sources, and no, human K2 manufactured by gut bacteria isn’t accessible. K2 must be obtained through food or supplementation. So, needless to say, some people are better suited to vegan diets than others. There is no one size fits all diet.
As for human evolution, it’s also pretty funny that the PCRM and ER doctor Milton Mills’ 1987 paper on comparative physiology has become the basis of the vegan argument that humans are frugivores instead of omnivores. This is so amusing because Mills is a creationist who doesn’t even believe in evolution. He’s also an emergency room doctor without any background whatsoever in paleoanthropology. The silly teeth meme bantered around social media and presented here in the film ignores the simple fact that humans and our hominid ancestors have used crude tools as far back as 2.6 million years to pre-process food (including meat and root vegetables) outside our mouths so we lost the need for large jaws, teeth, and claws. With smaller jaws, hominids were also able to develop more of an aptitude for speech. All of these fine points and many more are detailed in Harvard professor of paleoanthropology David Lieberman’s book The Story of the Human Body. Here too is a brief article noting how slicing meat made us humans, How Sliced Meat Drove Human Evolution. Hominids also later started cooking with fire which further tenderized meats and other foods including starches. So how many dogs, bears, and lions does one see using tools and cooking with fire? Sometimes vegan reasoning is just plain inane. And as for human guts, human digestive tracts are quite distinct as well. Humans do have stomachs with strong acids to break down proteins, Plus unlike other primates, humans have very short colons so humans can’t really digest or utilize cellulose like other apes do and thus get only a small portion (10% +/-) of energy from short chained fatty acids [SCFA]. Gorillas get around 60% of their energy from SCFA’s.
Needless to say, What the Health, is just more vegan propaganda from the creators of Cowspiracy. Kip is obviously too scientifically illiterate to understand any scientific studies he reads, and he is only really interested in finding so called ‘experts” who will reinforce his vegan beliefs. So just like with Cowspiracy, there’s no effort at balance as the fanatically foolish Kip pursues his white whale.