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Several people have asked me to review the documentary film What the Health, and it was available via my Netflix subscription, so I watched it and took notes. Its thesis is that meat and dairy are killing us and that all the major diseases can be prevented and cured by adopting a plants-only diet (claims we have seen before). It features emotional testimonials and selected scientific studies; and it suggests that major health organizations and government agencies have been “bought” by Big Food and Big Pharma and are conspiring to hide the truth from the public.

It starts with Hippocrates’ aphorism “Let food be your medicine and medicine your food.” Hippocrates died in 370 B.C., before there was much in the way of effective medicine and before science had learned much about food (like the existence of vitamins). So Hippocrates is hardly a credible authority; and even if he were, the appeal to authority is a logical fallacy. The film tries to convince viewers that food is medicine, and indeed is all the medicine we need to prevent and cure obesity, diabetes, heart disease, cancer, and a host of other chronic diseases. It failed to convince me.

The filmmaker, Kip Andersen, describes himself as a former hypochondriac who once assumed that he was destined by his genetics to develop heart disease, cancer, and diabetes like others in his family. At some point in his life, he was exposed to the belief that healthy eating could prevent and cure those diseases. This was a complete revelation, and he felt betrayed. He says, “it felt like this information had been practically withheld.” He proceeded to interview doctors and others who subscribed to that belief, and to find supporting information on Google. Confirmation bias worked well, as it always does. He failed to obey my SkepDoc’s Rule: before you accept a claim, try to find out who disagrees with it and why. Most of us don’t believe all those diseases can be prevented and cured by diet, because the evidence just isn’t there.

Processed meat

He cites a summary of epidemiologic studies showing that eating a single serving of processed meat a day increases colon cancer risk by 18%. In the first place, epidemiologic studies can only show correlation, not causation. In the second place, that 18% increase is in relative risk, not absolute risk. In the third place, it doesn’t take the baseline rate of colon cancer into account. By one estimate, your risk of developing colon cancer by age 65 is 2.9% if you eat no processed meat, and 3.4% if you eat one serving a day. So out of 100 people who avoid processed meat, 2.9 will develop colon cancer, and out of 100 people who eat one serving a day, 3.4 will develop colon cancer: the difference in absolute risk is one more case of cancer out of every 200 people, which sounds much less alarming than the 18% figure. And there could be many confounding factors that would influence a person’s actual risk like genetics, salt consumption (processed meats like bacon have a high salt content), smoking, other lifestyle factors that might happen to be more common in people who eat a lot of processed meats, etc.

He makes a big deal of the IARC classification of processed meat as a Group 1 carcinogen, the same group as cigarettes, asbestos, and plutonium. The film interprets this to mean that hot dogs and bacon could be as dangerous as cigarettes, but that is simply not true. Cigarettes raise the risk of lung cancer by 1,900%! The WHO information page clearly states that classification in Group 1 is based on the strength of evidence that it causes cancer, not on the level of risk. It does NOT mean that everything in that group is equally dangerous. They concluded that processed meats cause cancer, and that there was inconclusive evidence of an association with stomach cancer.

But they did NOT recommend people stop eating meat. They explain, “Eating meat has known health benefits. Many national health recommendations advise people to limit intake of processed meat and red meat, which are linked to increased risks of death from heart disease, diabetes, and other illnesses.”

Red meat

The IARC classified red meat as a Group 2 carcinogen, but that only means that there is limited evidence for an association with colorectal cancer and possibly pancreatic and prostate cancers. They explain:

Limited evidence means that a positive association has been observed between exposure to the agent and cancer but that other explanations for the observations (technically termed chance, bias, or confounding) could not be ruled out.

Reality check: the movie presents an alarmist version of information that has been widely accepted for decades and is incorporated into nutritional guidelines. The consensus is that processed meats should be limited; but the data on unprocessed red meat is unclear. Only vegans recommend total elimination of meat.

Preventable deaths

It claims that food is the cause of most diseases, and 70% of deaths are preventable with lifestyle changes. They call obesity a “death sentence” that will certainly lead to diabetes and frequently to cancer. A recent study looked at the association between dietary factors and mortality from cardiovascular disease and diabetes. As a whole, ten dietary factors accounted for 45.4% of deaths. Only 0.4% of these deaths were associated with a high intake of unprocessed red meats, and 8.2% with a high intake of processed meats. Low intake of fruits and vegetables were associated with 7.5% and 7.6% of deaths respectively. According to the CDC, somewhere between 20% and 40% of the top five causes of death could be prevented by lifestyle changes, but not just dietary changes. Tobacco is the leading preventable cause of death, not improper diet; other important lifestyle factors are alcohol use, lack of exercise, sun exposure, and failure to use seatbelts and motorcycle helmets. The 70% estimate is an exaggeration; the true proportion of lifestyle-preventable deaths is probably less than 50%. And diet has a relatively small impact when compared to other lifestyle factors. The movie tells us dietary factors trump smoking, but that is demonstrably not true. It tells us plant-based diets will stop and reverse heart disease, and breast cancer can be prevented by diet; I wish!

Diabetes

We are in the midst of a (type II/adult-onset) diabetes epidemic. The movie tells us diabetes is not caused by sugar: meat and fat cause diabetes. It says carbs can’t make you fat; only fat can. It says the body can’t turn carbs into fat (yes, it can!). They cite a Harvard study showing that one serving of processed meats a day raises the risk of diabetes by 51%, but this 2017 systematic review says it raises the risk by 19%. And remember, this is relative risk, not absolute risk.

They say the risk of Type 1 diabetes is increased by exposure to dairy at a young age, but this study says just the opposite. Early exposure is not a risk factor, and it may actually decrease the risk. These are just two of many examples of how the movie cherry-picks studies that support its beliefs and ignores contradictory information.

Chicken

Is chicken better than meat? They say, “It’s a question of whether you’d rather be shot or hung.” They say chicken is the number one source of cholesterol in the American diet and it’s the leading source of sodium because chicken is injected with salt water. They tell us the risk of prostate cancer is four times greater with chicken. (Not true: this meta-analysis found no association.) A comedian walked out of an ADA event where they served chicken, saying it was like serving alcohol at an AA function. They say chicken is carcinogenic and fast food restaurants should be required to post that warning. But guess what? Fruits and vegetables contain carcinogens too! And they don’t recommend warning vegans about the carcinogens they are getting from plants. An obvious double standard.

Eggs

They tell us egg yolks are pure fat and cholesterol (not true; they contain half the egg’s protein along with vitamins, essential fatty acids, and other nutrients). One “expert” tells us egg yolk coats our red blood cells (!?), makes our blood thicker, and alters hormone levels. They claim that eating one egg decreases longevity as much as smoking 5 cigarettes. I doubt that.

Cheese

They tell us cheese is one of the worst foods; they describe it as “coagulated cow pus.” It is addictive, metabolizing to a compound that attaches to heroin receptors in the brain. It may cause SIDS and autism. 450 drugs are given to animals, and companies hide information about what is in their products.

Fish

They claim that diet guidelines are wrong to suggest replacing meat with fish. Fish is full of mercury, PCBs, cholesterol, pesticides, herbicides, and hormone disruptors. Farmed fish contains antibiotics and antifungals.

Milk

They claim that cow’s milk is “terrifying.” It’s full of bad things like saturated fat, cholesterol, and pus. A pediatrician tells us it gives children eczema, acne, constipation, acid reflux, and iron deficiency anemia. He calls it the most allergenic food. Dairy is linked to many types of cancer, as well as asthma, MS, type I diabetes, mucous, and autoimmune and rheumatologic diseases. Milk doesn’t build strong bones: people who drink milk have more fractures and don’t live as long. We are not supposed to drink milk: lactose intolerance is the norm for adults. African Americans have a high prevalence of lactose intolerance. The government encourages them to drink milk knowing it will make them sick; this amounts to “institutionalized racism.” They also mention racism in conjunction with runoff and spraying on pig farms, claiming the pollution is greater where there are African American communities.

Miscellaneous other questionable claims

Eating “dead meat bacteria toxins” causes an immediate burst of inflammation, causing immediate damage within minutes, stiffening our arteries and reducing their ability to relax by half (?!). Meat eating causes brain damage that is misdiagnosed as Alzheimer’s. Mad cow disease is killing people and the government won’t admit it. Many studies are funded by the dairy, egg, and meat industries in order to deliberately create doubt as the tobacco industry did when it said “doubt is our product.” Government diet recommendations come from a panel stacked with industry representatives. The government imprisons people who go against them, and even criminalizes people for simply taking a picture or recording what goes on in the animal industry. Whistleblowers are silenced by “ag-gag” laws. Apparently, the government is in collusion with Big Pharma, Big Food, and organizations like the ADA and the ACA; they’re all motivated by making money, not by keeping people healthy. We are anatomically frugivores (fruit eaters), not omnivores: you can tell because we don’t have the kind of teeth required for a carnivore to rip, tear, and bite its prey to death. (They forget that we have brains and tools that equip us to hunt, kill, and cook meat without any need for fangs or claws.) Further proof that we are frugivores is that we find fruit smoothies more palatable than blenderized meat!

Doctor-bashing

They are very critical of conventional medicine. They bring up the same lame doctor-bashing tropes we have debunked so many times. Doctors aren’t interested in prevention (nonsense! They invented prevention). Doctors don’t consider the underlying causes of disease (they always do, whenever there is evidence for an underlying cause). Doctors condemn patients to lifelong medication; if you take their advice, you’ll never get well (if you take their advice, you may not be cured from an incurable disease, but you’ll live longer). People who take statins still get heart attacks (true, but they get fewer of them). Doctors don’t learn about nutrition (nonsense, they understand the principles but they leave individual diet advice to the dietitians). Big Pharma and doctors have a vested interest in keeping people sick (but even if they didn’t care about their patients, surely they would have a vested interest in staying healthy themselves and keeping their loved ones healthy).

Phoning the American Cancer Society and others

In the first of several phone call vignettes, the filmmaker, Kip Andersen, calls the American Cancer Society to ask why they don’t warn about the dangers of meat on their home page. He is put on hold, but is eventually granted an interview. The interview is cancelled and the ACA stops responding when they realize he only wants to argue with them about diet and cancer. I’m not surprised. Their recommendations are based on expert evaluation of all the published evidence and they are not likely to change their minds because a single nonscientist with an agenda walks in off the street to argue with them.

The phone call gimmick is repeated for the American Diabetes Association. He wants to know why they don’t clearly state on their home page that meat causes diabetes, and how dare they include a recipe for bacon-wrapped shrimp! He eventually is able to interview an ADA spokesman who very reasonably tells him there is insufficient evidence that diet can cure diabetes, and says “We recommend a healthy diet.” He acknowledges that there are studies, but points out that many of them have never been replicated or are wrong; that’s why we do peer review. Andersen keeps bringing up individual studies until the spokesman loses patience and stops the interview, saying he doesn’t want to get into an argument. Andersen interprets this to mean that the ADA is not interested in prevention or cure.

Then he calls the American Heart Association to ask why they include beef and egg recipes. He gets a similar response. He interprets these failed phone call inquiries as stonewalling and an organized effort to conceal the truth. He discovers that the ACA, ADA, AHA and other mainstream organizations are funded in part by food manufacturers like Dannon, Kraft, Tyson, and fast food restaurant chains like KFC. He says we can’t trust them because they’re taking money from the companies that are causing the very diseases they are trying to prevent.

As an analogy, I couldn’t help wondering how the American Academy of Pediatrics would respond to a random phone call demanding that their home page warn that vaccines may cause autism and complaining that doctors can’t be trusted because they are paid by the Big Pharma companies that sell vaccines. I wouldn’t blame them for hanging up.

Benefits of a vegan diet

The American Dietetic Association issued a statement on vegetarian/vegan diets, listing a number of health benefits, but pointing out the variability of dietary practices and the need to individually assess nutritional adequacy.

The movie claims that patients crippled with rheumatoid arthritis can go off their meds, but this systematic review concluded that the effects of dietary interventions for RA were uncertain

Many of the arguments for veganism are not health-related but moral. Animals suffer from being confined, conditions are unsanitary, they produce greenhouse gases and are bad for the environment.

Testimonials

They interview people who have gone vegan and whose testimonials I find simply unbelievable. An obese woman saw her doctor for asthma; after a CRP test (not indicated!) her doctor supposedly told her she was “on the verge of a heart attack in 30 days.” I find it hard to believe any doctor would make that prediction. She allegedly experienced complete relief of her asthma and chronic pain after only two weeks on a plant-based diet; she was able to go off all her meds for asthma, pain, heart disease, and depression.

Elite athletes who go vegan report improved healing of injuries and “100% better” performance. A patient claims a plant-based diet cured her thyroid cancer in a year. A patient scheduled for bilateral hip replacement says she was able to walk pain-free and stop all her meds after just two weeks. I am skeptical.

The filmmaker provides his own testimonial that “within a few days I could feel my blood running though my veins with a new vitality.” (I can’t feel the blood running through my veins; can you?) He refuses to eat even a little animal food, not for health reasons but because he “can’t support an industry that is causing so much suffering to communities, families, and all life on the planet.” He rejects the “everything in moderation” argument because the evidence doesn’t show that eating small amounts of animal-based foods is healthy (but the evidence doesn’t show that it’s unhealthy either!).

Conclusion: Spectacle, not science

There are undisputed health advantages to a plant-based diet, but the evidence is insufficient to recommend that everyone adopt a vegan diet. The What the Health movie is not a balanced documentary, but an alarmist, biased polemic. It cherry-picks scientific studies, exaggerates, makes claims that are untrue, relies on testimonials and interviews with questionable “experts,” and fails to put the evidence into perspective. It presents no evidence to support the claim that a vegan diet can prevent and cure all the major diseases. It is simply not a reliable source of health information.

The consensus of scientists, doctors, and dietitians is that a vegan diet can be a healthy diet but is not the only healthy diet. We as a society should eat more plant foods, but we needn’t entirely reject all animal foods. A healthy diet can include eggs, milk, cheese, fish, shellfish, some red meat, and even a small amount of processed meats. There’s certainly no clear-cut evidence that would persuade us that everyone should completely forgo animal-based foods. We needn’t give up eggs, or bacon, or an occasional steak. There are risks to almost everything we do (even carcinogens in a vegan diet!), and many of us would rather accept a small hypothetical risk than give up the foods we love. Pending better evidence, I think “moderation in all things” is a very reasonable approach.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.