nutrition

what the hell(th)

I’ve had a few patients and dietitian friends ask me if I’d see the documentary “What the Health,” and while I knew the basic premise promoting a plant-based, vegan diet, I finally had some time to watch it this weekend.  And I watched it while eating eggs, somewhat defiantly. When I didn’t have a mouthful of eggs chances were pretty good I was shouting expletives at my laptop and explaining to Peanut what the research the filmmaker was attempting to interpret actually meant. She was confused, much like most of the public, probably, after watching this film.

egg and cheese… friend or foe?

so let’s talk about the research
the filmmaker was big on citing research studies, which is a great way to sound like you know what you’re talking about, even if you don’t. The studies he talked about were cherry -picked to be easily manipulated into what he wanted them to say. Maybe because I’m used to reading and interpreting research, but it was so clear to me he didn’t actually read the studies and didn’t know how to interpret the data. He basically took key words – like “dairy” and “death” or “saturated fat” and “plaque” – and ran with them. The study on breast cancer and dairy, for example, is one I am very familiar with. This is an epidemiological study on a little less than 2,000 women with breast cancer who answered food frequency questionnaires, which is not the most reliable study design. What the data actually says is that high intake of high fat dairy products was potentially linked to a higher risk of mortality after breast cancer diagnosis. Not intake of all dairy, period. And the study also failed to account for dietary patterns and lifestyle factors of the high fat dairy intake group. This is HUGELY important. To date, the majority of the literature has found no overall association between dairy intake and breast cancer recurrence or survival, and this is an actual fact.

not done yet
it should also be noted that NONE of the studies cited in the entire film are randomized, controlled trials (RCTs), and these are the GOLD standard in the research world. Oversight much? It’s also extremely hard to draw definitive conclusions from nutrition-related studies in general because of inaccurate methodologies (the food frequency questionnaires or 24 hour diet recalls), self-report bias and confounding variables like other lifestyle factors. There is no mention of this in the documentary, of course.

fear mongering at its finest
I’m pretty sure at one point, the filmmaker compared eating eggs to smoking cigarettes. Um, what? He also claimed that meat directly causes diabetes (not really) and proceeded to ask why the ADA had recipes with animal-based products on their websites. The recipes also contained a lot of vegetables, but that doesn’t make for good discussion. Plus, any diabetes specialist or dietitian would logically conclude that the recipes on the ADA website are geared toward people who already have diabetes, and therefore a bit lower in carbohydrates to help them manage their blood sugar. The fear mongering continued for most chronic diseases, likening the intake of chicken to a death sentence or milk to a guaranteed cancer diagnosis. That. Is. Not. A. Thing. No chronic disease is caused by any one food. Period.

more delicious eggs from stone barns, and a cookie made with plenty of butter

the film was entirely one-sided
not a second was spared to discuss the “con” side of the filmmaker’s argument, and every MD he interviewed was drinking his kool-aid 100 percent. That’s convenient and again, makes for good TV, but is not reality. Had he asked, I’m sure experts would have lined up around the block to dispute the claims he was trying to make, myself included. Another pet peeve of mine is that he interviewed a “certified nutritionist,” which is such a BS term and I believe only requires you to have taken a handful of nutrition classes and pass a very general exam.  No advanced degree, clinical training, research applications, counseling experience, internship/field work (etc.) required. THESE THINGS ARE IMPORTANT. The “nutritionist” of course adamantly agreed with what he had to say and sounded like she found her main talking points on Google minutes before her interview.*

Also, I should mention that Steve-O (the stoner dude from that old show Jackass) was interviewed in this documentary in support of the filmmaker’s claims. Because that’s legit?

plant-based diets
while I’m not a fan of this documentary, I am a fan of plant-based diets and there is a reason they are so popular these days. There are a few different definitions of the actual term, vegan being one of them. I’m not against veganism, but I am against promoting it for completely unresearched reasons. My definition of a plant-based diet, and the one I teach to patients, is not exclusive and I don’t think it has to be. Yes, the majority of the foods you eat should ideally come from plants. But there is absolutely room for animal products too, if you enjoy eating them. With every meal, even! Remember, it’s dietary patterns as a whole that are going to affect our overall health in the long-term, not eating eggs instead of tofu at brunch this past Sunday.

final thoughts
there is always going to be a new book, movie, news article, ridiculous wellness summit and the like promoting new life-changing foods or diets, many of which were vilified just a few years ago or vice versa. That’s what sells. The problem is that people not knee deep in nutrition research are easily influenced by things like this, which often leads to unnecessary dietary restrictions and a whole lot of fear. Remember, fear + dietary restrictions = stress. And stress will hurt you long before your full fat Greek yogurt will.

 

*I really don’t like to dis on those in the health and wellness field, but things like this really make my blood boil.

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6 thoughts on “what the hell(th)

  1. Excellent post. I was actually eyeing up that doc on my netflix and hoping it would present something, somewhat well-rounded. . . Guess I should know better by now.

    The internet is an excellent tool and we all have access to knowledge we never had before but we really need to stop taking what is said at face value. Studies can be manipulated. Pictures can be paired with misleading descriptions. Anyone can write lengthy paragraphs about a deficiency in B17 being the single cause of all cancers and we lap it up and believe it because it’s an easy, cut and dried solution to some seriously scary or frustrating situations.

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    1. thank you! I love this comment. studies and research can be taken out of context so easily, whether you mean well or not, and people just run with it. and i think if you are faced with a scary situation or diagnosis, it’s easier to believe whatever someone says *may* help. i wish i had a solution to this, but it really is the new normal that we have to manage!

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  2. Thank you for sharing your thoughts! With research studies (especially on nutrition) it’s so important to read the fine print. So many are observational (as you note), small sample sizes, large limitations etc etc. And yet so frequently we just get a news headline “X is good/bad for you” Signed, a fellow research reader 🙂

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