“What the Health”: Half a Star

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“What the Health” claims to be “the health film that health organizations don’t want you to see.” My opinion: it’s a movie that isn’t worth the time it takes to see it, and I’d rate it at half a star. The movie is directed by Kip Anderson, the narrator and star of the movie, and Keeghan Kune; it’s supposed to be about Andersen’s journey to health. It’s more like a movie to nowhere due to a lack of skill in directing and research.

The obvious thing a movie is supposed to do is to tell a story; this one doesn’t. We don’t really get to understand why Andersen begins his quest. He wasn’t sick. He wasn’t overweight. He was already exercising. Why did he want to begin this journey? What we see are his questions about a healthy diet and the answers he gets from experts that explain why a vegan diet is the only healthy diet.

Those health organizations he’s talking about are the American Diabetes Association, the American Cancer Society, and just about every other national health association. He reviews their websites, sees that they recommend diets that are other than vegan, and thus he deems them unhealthy. Then he tries to interview dietary experts from the organization about why the organizations advocate these unhealthy diets. Alas, no one wanted to talk with him. The theme of the movie is that every organization takes money from meat, dairy, and refined food producers; therefore the organizations are corrupt because they don’t advocate a vegan diet.

The direction and writing are poor, but the real problem is the science that the film’s experts try to sell us. I’ll cover two primary issues in the next two Memos, but I don’t have the space to give a complete evaluation of all the claims made in this film. If you want to know more, I’m recording a Straight Talk on Health for Members and Insiders that will be posted later this week.

What are you prepared to do today?

Dr. Chet

 

Reference: What the Health. Directed by K. Andersen and K. Kune. 2017.

 

The Ignorant Vegan

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Before you write me an indignant email, remember this: the definition of ignorant is lacking awareness or uneducated. While being a vegan is a great way to eat, it can also be done poorly and thus can create health issues over time if vegans haven’t bothered to educate themselves. The issue is the foods people choose to include in their vegan diet.

Start with white: pasta, rice, bread, potatoes. Those are all vegan choices and can be prepared with some excellent recipes. The problem is the same as it would be for anyone, vegan or not: too many starches lead to an exaggerated insulin response. Calories still count: those extra calories can be converted to fat and actually increase cholesterol levels. You don’t get to overeat just because you’re vegan.

 

Nutrient Deficiencies

The problem doesn’t end there. Focusing on starches can limit the amino acids necessary to make complete proteins, at least in enough quantities to keep the body healthy. Isoleucine, leucine, and lysine are all deficient in those white starchy foods. The white foods have to be balanced with legumes which have high amounts of those amino acids.

Another potential issue can be iron. Because vegans do not eat seafood or meat, they can become iron deficient over time—and I’m talking six months or more. Yes, green vegetables such as spinach and kale do have iron, but a person has to be diligent in knowing the sources so they get those vegetables every day or at least several times per weak. In addition, soy products, sometimes a staple of a vegan diet, can interfere with iron absorption.

Last is vitamin B12. It’s sparse in plant-based products so unless you eat brewer’s yeast or the English staple marmite, vegans must take a B12 supplement.

 

Learning to Be a Vegan

Being a vegan is a healthy approach to improving your health but you have to be informed. It takes work for a while, until it becomes second nature. The one thing you can’t afford to be is an ignorant vegan. It can be dangerous to your health—the last thing you want.

Next week, I’m going to review the movie “What the Health” so make sure you see it this weekend. We’re going to answer the one question posed by the movie: does the science show that a vegan diet is the only path to optimal health?

What are you prepared to do today?

Dr. Chet

 

What Do Vegans Eat?

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The simplest way to describe a vegan diet is that it includes everything—except any food that comes from animals. If it comes from a plant, you can eat it. That includes all vegetables, all fruits, all grains, all legumes, and all nuts.

Peanut butter and jelly? Yes, if the bread is vegan. Baked sweet potato with brown sugar? Yep. A glass of wine or beer? Absolutely. Vegan pasta with marinara sauce? Ditto, but don’t add the Parmesan. I could go on and on, but you can see that it’s more than just salads and raw vegetables. And yes, you should eat plenty of those as well.

What should you eliminate? Meat from any animal; fish is also off limits. Fat from any animal. Anything cooked in or containing animal fats. Those biscuits you love? They’re made with lard, which comes from beef. The butter that goes on those biscuits? Nope, it comes from milk. Your favorite cake? No, it’s made with eggs. How about Jell-O; certainly Jell-O has to be okay! Not that either. It contains gelatin which comes from an animal. You can still eat those deep-fried foods as long as the oil is all vegetable.

The animal sourcing can extend to supplements as well. Gelcaps and capsules are made from animal or fish gelatin, although there are good vegan choices today. But don’t skip the supplements; they’re important because one nutrient that’s not easily accessible from plants is vitamin B12.

Just as there are vegan supplements, there are vegan versions of almost any food you can think of: eggs, milk, cheese, bread, burgers, even steak. I don’t know how good they taste, but they exist.

Seems pretty straightforward, doesn’t it? I’ll tell you how people can get it wrong on Saturday. Don’t forget to catch the documentary “What the Health” so you can follow along my review of the movie next week.

What are you prepared to do today?

Dr. Chet

 

All Signs Lead to Vegetables

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In the past couple of weeks, I’ve had many questions about vegan diets. Coincidentally Paula recommended a couple of HuffPost articles on rising CO2 levels and the effect on crops. Then someone asked me what I thought about the movie “What the Health” available on Netflix or online; it’s purported to be a documentary on the food industry and why a vegan diet is the best. When this confluence of events happens—when the universe gives me this many signs—it’s time to write about it.

I’ve spent the better part of two weeks researching the background on the movie and the articles. This was not easy reading, but I wanted to provide the most recent information so you can make an informed decision. Coming Memos are going to be related to issues surrounding vegan and vegetarian diets that were covered in the movie and the articles.

To get things started, I recommend that you watch the movie. When I review the movie next week, I want you to watch what they said and then what the research says. You can watch it on Netflix; if you don’t subscribe to Netflix, you can take advantage of their free trial, which is what we did. If you don’t like those options, you can watch it on your computer, tablet, or phone. That will cost you $9.99 but you can stream it any time. www.whatthehealthfilm.com.

On Thursday, we look at exactly what a vegan diet is. Reminder for Insiders: conference call is tonight!

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Veggies and Carbs

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Go ahead and finish your oatmeal and drink your protein-kale smoothie—you do need those veggies. Meanwhile I’ll put the PURE study in perspective.

This is a large study that looks at the economics of food as well as the health benefits. In a separate publication, the analysis of the data focused on the cost of fruit and vegetable intake as a percentage of monthly income. They specifically collected data from low-, middle-, and high-income communities from 18 different countries. Researchers actually went to grocery markets in those countries to collect the cost data. As you might expect, the lower the income, the higher the percentage of monthly revenue spent on vegetables and fruits.

I think that explains part of the reason the second study on vegetable intake and mortality said there was no additional benefit beyond three or four servings per day: if people can’t afford more, it’s wrong to teach them that more is better if it might not be. But that doesn’t justify the headlines because the message that Americans hear is “I don’t have to eat those darn vegetables!”

Yes, you do. Here are the issues with each of the studies.

 

Do Carbs Kill?

In the first study on carbohydrate intake and mortality, researchers used a simple percentage of caloric intake in their analysis. Basically we have a math problem: if someone in a poor country eats 80% of their diet as carbohydrates from root vegetables but they only get 1,000 calories per day that’s a completely different situation from a person who eats 3,000 calories per day but 50% of their calories are from refined carbohydrates and sugars.

As I’ve said many times, while we should eat fewer refined carbohydrates, carbohydrates are not inherently bad; it is the overconsumption that’s the problem. If researchers didn’t analyze the total caloric intake from carbohydrates, protein, and fats, we don’t have the complete answer. The PURE study used a food frequency questionnaire. I’ll leave it at that because I rant too much about the FFQs.

Finally, the researchers simply jumped the gun by recommending that health education should now focus on increasing fat intake while reducing carbohydrates. All types of vegetables and fruits are carbohydrates. Because researchers did not parse out different sources of carbohydrates in their analysis, their recommendations are meaningless.

 

Don’t Bother with More Veggies?

PURE is an observational study; it cannot determine cause and effect. Also it can tell you a lot about a large group of people but nothing about an individual.

The lead researcher actually provided the perspective on vegetables and fruit during an interview: if the research shows that the benefit of eating more plant-based food is a 20% reduction in mortality, and the mortality rate of the population is just 1%, that means the reduction goes from 10 out of 1,000 to 8 out of 1,000. It’s virtually meaningless to an individual.

The researchers hesitated to tell people with very low incomes to spend more on additional servings of plant-based food if there was not a meaningful benefit. But for most of you, the cost of fruit and vegetables is not a hardship, so buy ’em and eat ’em.

 

The Bottom Line

These will not be the last headlines we hear from the PURE study because the data continues to be analyzed. One issue for me is that there’s no data from the U.S. included so the ability to generalize to the U.S. population is very limited. We lead the world in obesity and overweight and our food consumption patterns are different even from other Westernized countries.

One thing remains clear to me: we should all eat more vegetables and fruit and reduce refined carbohydrates. The recommendation never changes: eat less, eat better, move more.

What are you prepared to do today?

Dr. Chet

Reminder to Insiders: The next Insider Conference Call will be Tuesday at 9 p.m. Not an Insider? Join now to participate in this call and get your questions answered.

 

References:
1. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32252-3.
2. DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8.

 

PURE Headline 2: Don’t Bother with More Veggies?

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Using the same data base of subjects in the PURE Study, researchers examined the vegetable, fruit, and legume intake on total mortality, mortality, and major cardiac events such as heart attacks.

The most important finding was that higher vegetable, fruit, and legume intake was associated with a reduced risk of mortality and morbidity. Simply put, the more plant-based the diet, the better off you are from an overall health perspective.

But that’s not what the headline messages said. They focused on the part of the study that said there appeared to be no additional benefits if subjects ate more than a few servings of vegetables, fruits, and legumes. That seems to fly in the face of the “more is better” results that previous research has shown.

Have all the prior studies been wrong? Have you been eating kale for no good reason? No, and I’ll explain why the headlines are wrong on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/S0140-6736(17)32253-5.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8

 

The Bottom Line on E-Cigarettes

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Vaping e-cigarettes is supposed to be better than smoking cigarettes because the toxic chemicals will be gone. That may be true for the chemicals released from tobacco and paper, but the third area of concern is the e-liquids that make up the flavor component of e-cigarettes. The marketing tactic often focuses on the variety of flavors available. The question is this: are they safe or do they contain chemicals that could negatively impact the lungs?

Researchers obtained a random sample of e-cigarette liquids from the most popular brands on sale in Greece, Spain, Germany, the Netherlands, the UK, Hungary, Romania, Poland, and France. The samples included a variety of different flavors and nicotine strengths. They analyzed each sample to find out exactly which chemicals were present and in what quantities.

Every liquid container that they tested contained at least one substance that has some level of health risk according to the United Nations classification system. The chemicals, with long complex names, can cause respiratory irritation, allergy or asthma symptoms, or breathing difficulties if inhaled. What they might do when heated is still to be determined.

There were several more research papers presented that also illustrated that e-cigarettes are not problem free. The belief is that they are not as harmful as conventional cigarettes, but the fact is we really don’t know because the components haven’t been tested.
 

Meanwhile There’s the FDA

And they probably never will be tested, at least in the U.S. This past July, the new head of the FDA Dr. Scott Gottlieb announced that he was suspending laws that govern e-cigarettes for five years. In the last administration, the governance over e-cigarettes was turned over to the FDA where they enacted restrictions that insisted the products be tested for safety before being brought to market. Those rules have been suspended so the industry could have time to set standards and comply with tobacco regulations.

I read Dr. Gottlieb’s ruling. As a physician who has treated cancer patients, he has seen what cigarettes do first hand. His belief is that nicotine addiction is the primary issue and that vaping, while not as good as not smoking, may help people quit smoking by using these products to help reduce reliance on nicotine. Gottlieb seems to believe that nicotine, while still addictive, does not kill people; it’s the 5,000 other chemicals in cigarettes that do.

I simply do not understand his reasoning. There are hazards to nicotine, as the research this week has shown. There are chemicals in the e-liquids that have not been identified, have not been tested, and we have no history with their use to investigate. How do we know what health issues we’re facing without finding answers to those questions?

One more thing. Dr. Gottlieb is an investor in a vaping products company called Kure. He has said that he will divest his interest and recuse himself from decisions on vaping for one year. I guess physician years are like dog years; he seems to have made a big decision on vaping after being in office just a few months.
 

The Bottom Line

As a former smoker, I understand the addiction. If vaping products had been available when I quit, maybe I would have used them. As a healthcare professional today, there is not a chance. We’re talking about inhaling substances that have never been subjected to any form of safety or toxicity testing. It’s unreasonable to do that. The studies I reviewed this week clearly show there is doubt. We know how long it took the tobacco industry to finally admit that tobacco was addictive when they had the data all along. The e-cigarette industry has no data at all.

You are a free-living human being. It’s your body, and what you choose to put in it is your choice. I just hope none of it comes from tobacco or e-cigarette products.

What are you prepared to do today?

Dr. Chet

 

Reference: European Respiratory Society. 2017. Abstract OA1978.

 

Update: E-Cigarettes Put Lungs at Risk

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The second study presented at the European Respiratory Conference on e-cigarettes that caught my attention was a study done in Sweden. Researchers questioned over 30,000 people, randomly selected from the Swedish population. The purpose was to ask the subjects about smoking: did they smoke, what did they smoke, and what type of respiratory symptoms did they have? Here’s what they found.

Only 12.6% of those surveyed said they smoked, and the numbers broke down this way: 11% smoked only conventional cigarettes, 0.6% vaped only, and 1.2% said they used both. Researchers speculated they smoked cigarettes when allowed and vaped in public or other settings.

What about respiratory conditions? As you might expect, the highest percentage of respiratory issues came from those subjects who smoked both conventional and e-cigarettes at 56%; 46% of those who smoked only cigarettes had respiratory issues, and 34% of those who exclusively used e-cigarettes. How many non-smokers had respiratory conditions? Only 24%. The results clearly show that vaping causes the same respiratory issues such as wheezing or productive coughs as might be found in tobacco cigarettes.

What might be contributing to the issues with e-cigarettes? I’ll cover that on Saturday. One thing is clear so far: vaping is not innocuous as has been sold to consumers.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017. Abstract PA4485

 

Update: E-Cigarette Safety

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As the European Respiratory Society held their annual convention, several research studies made the health news, including e-cigarettes and vaping. The appeal of e-cigarettes is that they seem to be safe–you’re not actually burning tobacco with its associated chemicals and inhaling that into your lungs. E-cigarettes remove all that bad stuff and associated negative health effects. Or do they?

In the first study, researchers recruited 15 subjects who had smoked cigarettes occasionally, fewer then 10 per month; subjects had also never used e-cigarettes. They were asked to smoke e-cigarettes for 30 minutes in a random order on different days; once with nicotine, the other without. The researchers measured blood pressure, heart rate, and arterial stiffness immediately after smoking the e-cigarettes and then two and four hours later.

In the first 30 minutes after smoking e-cigarettes with nicotine, there was a significant increase in blood pressure, heart rate, and arterial stiffness. That didn’t happen after the e-cigarettes without nicotine. While this is a small pilot study, it seems that vaping nicotine can impact the cardiovascular system in the same way regular cigarettes do.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017; Abstract OA1979.