A physician’s take on “What the Health”

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Jonathan Kaplan, MD, MPH, a board-certified plasic surgeon based in San Francisco, California. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Become a vegan! That's the message of the recent documentary from Netflix, What the Health.

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This is a purposely incendiary documentary in the same vein as Super Size Me, the documentary claiming-wait for it-that McDonald's food is bad for you! In other words, What the Health tells us some things we already knew (like processed meats are bad) and uses inaccurate comparisons, detailed below, as well as editing interviews in a way to purposely take comments out of context-all in an effort to make us angry and emotional. But look past that. Don't get caught up only on the issue of Veganism. While there are some frustrating aspects of this documentary and assertions that shouldn’t be taken as fact, there are several other messages worth focusing on in this documentary.

Processed meats and dairy

Now, on to the film. We're presented with the fact that the World Health Organization considers processed meats (deli meat, bacon, hot dogs, etc.) as class 1 carcinogens, in the same category as cigarettes and plutonium. They also claim that eating one egg a day is similar to smoking 5 cigarettes per day. While the fact that processed meats are considered bad for you, and certainly not news, the comparison between eggs and cigarettes is outlandish.

Dr. Kaplan

For completeness, what's the reasoning behind the eggs and cigarettes comparison? The claim is that the saturated fat in egg yolks can increase cholesterol and lead to cardiovascular disease in the same way cigarettes can. But according to this study, this claim is not supported. As a physician-viewer, you immediately feel insulted as to the false drama in these claims and presenting old news as if it's hot off the press.

With the help of several experts, we're told how what we eat affects our health-also something we already knew. In the process, they shatter some supposed myths about how sugar isn't really the culprit to a bad diet, but that meat and dairy are the underlying cause of our diseased human state.

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As they promote conspiracy theories and debunk "myths," you quickly realize you don't know what to believe anymore. For example, they claim that carbs and sugar aren't really that bad. The problem is fat.

However, this NY Times story provides evidence that the sugar industry paid researchers in the 1960s to write a paper refuting the concerning link between sugar and heart disease, and instead shifted the blame to fat. But now, most reputable organizations and studies show the risk of heart disease is in fact due to sugars and fat.

Next: "The most fascinating discovery in this documentary"

Everything in moderation

At this point of the documentary, in my vulnerable state of uncertainty, I just fall back to the common mantra that, “all things are good in moderation.” But apparently that's not true either. One of the "experts” in the documentary, Michelle McMacken, MD, says moderation isn't a good rule of thumb (quotes added because I don't know if she really is an expert. They may know more about this topic than me, but that doesn't necessarily make them an expert). According to the interviewee, there isn't a study that shows eating meat and eggs in moderation can turn your heart disease around. But that doesn't mean we shouldn't try and eat healthier, even if we don't accept the vegan diet.

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A bariatric surgeon featured prominently in the documentary made an excellent point regarding diet, obesity and disease. He pointed out that in our current society, we're sensitive to the idea of fat shaming other individuals. But the pendulum has swung too far. In the process of encouraging people to be comfortable with their bodies, we're unwittingly encouraging people to be comfortable with being sick by not at least attempting to slim down and living a healthier lifestyle.

The bigger message: Corporate influence on healthcare organizations

The most fascinating discovery in this documentary is unveiled 48 minutes and 6 seconds into the documentary: the influence of the food industry on organizations like the American Diabetes Association, the American Cancer Society, the Susan G. Komen Breast Cancer Foundation and the American Heart Association.

Companies like Dannon (maker of Dannon yogurt) and Kraft (makers of Velveeta, Oscar Mayer weiners, Lunchables) are corporate sponsors of the American Diabetes Association. The American Cancer Society takes money from Tyson chicken, one of the biggest makers of processed chicken, and Yum! Brands (Pizza Hut, KFC, Taco Bell).

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The Susan G. Komen breast cancer foundation partners and receives money from KFC, Dietz Watson processed meats. The American Heart Association takes hundreds of thousands of dollars from the beef industry, poultry and dairy producers, and millions from fast food and processed food manufacturers.

In other words, all of these health organizations are taking money from companies that produce foodstuffs that are associated with the very diseases these organizations are supposedly fighting. The documentary makes the analogy that this conflict of interest would be like the American Lung Association taking money from the tobacco industry. Hard to argue with this observation.

Next: Taking everything one step further

Taking it one step further, the documentary shows how major pharmaceutical companies donate money to these healthcare organizations. While it may appear they're on the same side-both are trying to end disease-the truth may actually be the treatment, not the elimination of the disease. In other words, they're not addressing the underlying cause of disease-what we eat. The suggestion is that ending the disease doesn't financially benefit pharma or these healthcare organizations.

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Even the U.S. Department of Agriculture (USDA) receives money from these industries, which supports the Federal checkoff programs. Checkoff programs are responsible for the messages we see on TV and billboards. Messages like "Milk, it does a body good," the "Incredible edible egg," or "Beef, it's what's for dinner." The USDA is there to protect the consumer and the producer, but that protection isn't always balanced.

In essence, the USDA is helping the food industry market their questionable products to consumers in ever more effective ways.

Animal Agriculture: A focus on community health

The other major message of this documentary, bringing into focus an issue I did not fully appreciate, is bioaccumulation and the pollution caused by animal agriculture.

The amount of animal waste from beef, pork, poultry and dairy farms is staggering. According to the film, feces from pig farms in North Carolina alone is equal to the amount of feces from the entire human population in the eastern portion of the United States. Unfortunately, all of this animal waste is not treated in sewage plants in the same way human waste is. That means much of the waste eventually finds its way to rivers and ground water.

But it's not just bacteria or viruses that can be passed on to humans. Many of the animals, including the fish in fish farms that are raised in close quarters, are susceptible to infection. To reduce the chance of an entire farm of animals becoming sick, they're treated with antibiotics. This in turn can result in antibiotic-resistant bacteria which can then affect humans.

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Additionally, the typical airborne pollutants and toxins from coal or manufacturing plants can enter the food chain. It's not hard to see how these noxious chemicals can move from the grass the cow eats, to their muscle, to the meat we eat or the milk passed on to a nursing baby. How many parts per million of these toxins pass along the food chain and how they affect humans is up for debate, but it does occur.

Next: My conclusions

Miraculous Recovery

Throughout the documentary, we meet three very unhealthy, generally sick and overweight individuals. By the end of the film, once the case for a plant-based diet has been made, these three people switch to a vegan diet. Low and behold, they're transformed into healthier, happier, more mobile versions of themselves.

The not so subtle suggestion is that they have a vegan lifestyle to thank for this turnaround. However, judging by the unhealthy lifestyle they were leading, any diet low in sugar and fat was likely to be beneficial.

Conclusion

In a study cited toward the end of the film, 99.4% of study participants who adhered to a plant-based diet avoided any major cardiac event, including heart attack, stroke and death. The message by the study's author, Caldwell B. Esselstyn, Jr., MD, of the Cleveland Clinic, is that a plant-based diet will reduce many of the ills known to humans including GERD, hypertension, diabetes, strokes, heart attacks, autoimmune disease, lupus, asthma, osteoporosis and rheumatoid arthritis. That's the primary takeaway from this documentary.

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However, even if you feel like there's too much conflicting information out there to switch to a vegan diet or recommend one for your patients, or you don't appreciate the heavy-handedness that is this documentary, there's still much to consider.

Over the years, there have been many mainstream and fad diets. Whether it's Atkin's, Whole 30, vegan or any diet out there, the pros and cons are too overwhelming to process. Try to focus on some of the more unequivocal messages here.

For example, even if we can't decide on veganism as the diet du jour, I think many of us can agree that corporate influence on healthcare organizations that are supposedly fighting the diseases these corporate giants cause, is very disturbing. Additionally, the potential damage to the environment from animal agriculture should not be overlooked either.

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This is a multi-faceted issue. Yes, of course, genetics is a factor but it doesn't have to be a death sentence. Regardless of the confusion surrounding this topic, eating healthy still means a diet low in fat and carbs, coupled with exercise and common sense. The rest is just details. Now go and do your own research.

Jonathan Kaplan, MD, is a board-certified plastic surgeon based in San Francisco, California, and founder/CEO of BuildMyBod Health, an online marketplace for healthcare services that allows consumers to determine cost on out-of-pocket procedures, purchase non-surgical services, and in exchange, the healthcare providers receive consumer contact info-a lead, for follow up.