This past summer, I got a chance to watch the 2017 documentary What The Health. It about negative health impacts of animal product consumption and the role of the leaders in the health and pharmaceutical industries in supporting such consumption by allowing animal product food companies to influence their decisions. In general, the film supports a vegan diet for good health.
The film has been praised by some and criticized by others, including doctors, dietitians and journalists, especially towards the research.
The critiques of What The Health include:
cherry picking biased scientific research studies
interpreting those studies wrong
using weak unsupported data to make conclusions
making those conclusions based on correlations rather than causations
Support of those critiques would require a more in-depth analysis of the studies that the film referred to. I will not go as in-depth, but rather reflect on the main points from my viewpoint as someone with research experience and an interest in becoming a dietitian. I am plant-based vegan, but approach the film from a more neutral viewpoint, because I understand that dietetic research has limitations and that healthy eating means something different to everyone often regardless of that research.
Cherry Picking and Bias
Just like any other documentary, this film did cherry pick by selecting information that best fits the specific topic and what messages it is trying to get across.
On the surface, the sources actually look pretty strong, many coming from peer-reviewed journals and publications, not the more popular media sources (internet, magazine, etc.) which may often not have the most accurate information.
For more than a decade, it has been known that nutrition studies can have bias, particularly those funded by food industry companies resulting in favorable results: Researchers Find Bias in Nutrition Studies – NPR
The film highlights this and the role of funding in influencing the decisions of health organizations too.
Interpretation and Correlation
Anyone can interpret the same study and results differently. Think of this analogy:
You follow a recipe to make cookies. The result is that the cookie dough spreads to form cookies. You then wonder what made the cookies spread. Assume no one in the world knows that it’s mainly the baking soda. You say it’s the flour. You ask other people. One person says it’s the oil and another says it’s the baking soda.
Those are all individual interpretations of the same result, in this case correlations because you have not identified a single variable as a cause. Neither person is necessarily wrong until the definite cause is discovered. The only way to do so is to study each variable individually:
It could be one of the ingredients, the temperature, the mixing method and anything else that can possibly cause the cookies to spread or sometimes it could be a combination of different variables.
Imagine this scenario in a study on the effects of a certain diet or food on health. There are so many variables that can influence a result.
A major issue of the film is not that it interpreted studies bad, but that it used many correlation studies, for example the eggs are as bad as cigarettes for diabetes and cancer study, to make too-early conclusions and health claims. These type of studies stop short and there is more in-depth lab research needing to be done.
If there is a correlatative link between egg consumption and the development of the diseases associated with cigarette use, I propose that scientists have to dig deeper to find if maybe there is a certain compound in the eggs that directly or indirectly causes the formation of those diseases. This applies to other similar studies.
Why are Health Claims so Contradicting?
I’ve always wondered the same! Why is it that at one point we hear a food is bad and at another point we hear that the same food is good? It can be due to the update of new information as more research is published or due to the funding issue previously mentioned and conflicts of interest. But perhaps it is more likely due to the medium through which the information is passed on from the research site to the public.
Assuming that all studies follow scientific methodology and are thoroughly reviewed prior to being accessible to the media (fingers crossed), contradicting information from media sources may likely be due to the selection and the interpretation of studies.
The media can choose what it wants to share. Not every published study or journal is selected from and most information may never be known or as widely shared. Study results can be interpreted and worded differently, simplified to spare out most of the details and headlined in a certain way that grabs the most public attention.
The scientific studies themselves (methods, experiments, data, etc.) are often not wrong in practice, but their applications can can be problematic as each study method has its limitations. Results of lab experiments involving cells or model organisms can’t be directly applied to humans. Results from human studies can be limited in their application to all humans too, unless the right design and methods are used.
The Good in the Film
Highlights role of animal product companies in funding and influencing health organizations and research, which may be a big shocker to others who were unaware. It would be great to possibly find out to what extent the funding has an influence.
Highlights the nutritional completeness of a plant-based vegan diet and addresses the carb fear and protein craze. I think it’s an important message to get across, because many people are discouraged from trying a more plant-based diet due to fear of getting enough protein or eating too many carbs.
The Bad in the Film
Did not specify a whole food plant-based diet. It does not differentiate between refined and unrefined carbs or whole plant fats and the saturated or refined fats and oils it must be referring to. Some people may get the idea that all sugar, even refined white sugar, is okay to eat without care and that all fat is bad and should be limited. The truth is that any food, regardless of the food source and whether containing carbs, protein and/or fat, can be unhealthy if you overconsume it. In general, unrefined whole forms of food are preferable, because they can be more nutrient dense and filling so you consume less.
Focuses mostly on the negatives of eating animal products, rather than on the positives of eating more plant-based foods. People may respond better to positive information and consider information that focuses too much on the negatives to push them to one side as fear-mongering. The film may have missed a chance to educate the public on how and why they should introduce more plant-based foods in place of the animal products.
Highlights that the vegan diet is the “healthiest” diet everyone should follow. “Healthy” is a subjective term and can only be used when comparing one thing to another. There is no doubt that eating more whole or less processed plant foods can be healthier compared to eating less plants. The effects of meat and other animal products on health merits further research or review. Some of the healthier traditional cultures in the world include some small amounts of animal products. Likewise, there is a growing population of people just as healthy without animal products.
So…What The Health Do I Eat Now?
The key interview in the film was when Kip Anderson interviewed the Chief Scientific & Medical Officer of the American Diabetes Association Dr. Robert Ratner, M.D. Upon being asked why the ADA has beef recipes on its website despite it being classified as a cause of diabetes according to a study, Dr. Ratner replied (quote):
“Any diet works if people follow it. I can’t tell you what a proper diet is.”
As many other reviews pointed out, this scene may suggest that the American Diabetes Association, and the other organizations asked to be interviewed in the film, are hiding something. What I additionally got from this scene is that he actually has a point.
Doctors do not receive much nutrition education and are not able to give much advice about a proper diet so maybe he is not the right person to ask the question. But more importantly, it is true that any diet works as long as it is sustainable, it fits your preferences and values and you are getting everything you need nutritionally from it. The best diet is the one that works for you.
Across the globe, people follow so many different kinds of diets and no one follows the exact same diet or has the same reactions to the same diet, due to differences in unique biology, personal preferences, values, location, culture and more. Dietitians know and apply this when counseling individual clients or patients, not only follow research, but also their professional judgement and client or patient experiences and preferences.
I follow a plant-based vegan diet due to personal moral reasons, knowing that I can still obtain everything I need nutritionally and making it work for my body. I have also noticed an improvement in my digestive system and my performance as an athlete. Although not from a study, each day there is more and more observable evidence of people adopting a more plant-based way of eating and experiencing improvements in their health too.
As much I stand behind my dietary choices, I am also accepting of all dietary choices without discrimination. I think everyone could benefit from including more whole plant-based foods in their diet, but to what extent is their personal choice and I would never force someone to do so if they choose not to. I transitioned to a more plant-based diet after unintentionally watching a similar flawed video that led me to curiously search for more accurate information from nutritional resources and dietitians and discover that it’s more than health. Maybe this film encourages others to do the same.