Monday, July 3, 2017

What The Health: A Wolf’s Eye Review

So…I’ve had a lot of folks ask me for my thoughts on the Netflix documentary film “What The Health.” I’ll be honest, I drug my feet in doing this as these postmortems tend to be fairly painful, but the requests for some commentary has reached a bit of a fever pitch, so, here it is, with my usual preambles and caveats.

Some of my hesitation in digging into this is also that I’m just not sure if it matters. People generally make their decisions early and are seldom swayed by any future information. But, like that uplifting story about the person who throws starfish back into the ocean, if it matters to you, helps even a few people make better sense of all this, then it was likely worth it. Another not insignificant slice of my hesitation is that this is going to get me on the radar of the cranky (read crazy) vegan folks. One of the people featured in the movie did prison time for harassment and was the founder of an animal rights group that is known to have done everything from physical intimidation of people they disagree with, to firebombing houses of employees of the same.

Charming folks.

Not sure if you’ve noticed, but people are fucking crazy these days, so again, stoking the ire of the religiously militant vegans is not really an appealing thing to do. No one reading or commenting on this will have the degree of scrutiny and crosshairs (real or metaphorical) brought to bare on them that I will. I don’t want a big outpouring of emotion about this but I would appreciate some understanding that “you” get to read this, “I” get to deal with the aftermath of writing it.

I started this off attempting to be as professional as I could be, similar to this piece that I did.

In that piece I managed to largely keep it together until near the end of the presentation when I felt like the whole thing was a sham and I was just being messed with. With “What The Health” I did not make it very far before I came metaphorically unstitched and my professionalism fled me. I apologize in advance for that, this review would likely be taken more seriously if I’d managed to maintain a more clinical tone…but yea, even though I strive to have the emotional complexity of a Vulcan, I too can get squirrley at times. Some of the claims and tactics employed in the movie are just…well, I’ll let you decide what they are.

What I did-My Process man

I watched the movie and provided a time index for the various portions that I felt were particularly important to comment on. The time refers to the duration of the movie remaining. There are some things that I know I missed as there are sections of the movie in which claims are made in a rapid fire fashion and it would have made this already long piece literally 5x longer. Despite this I think you will notice that a lot IS covered and the way the “facts” are handled is remarkable. In some cases I just provide a name and time index, in other cases I dig into quite a lot of detail.

I introduce people as they appear and upon their first appearance I will generally mention a bit about their background and I also go out of my way to mention if they are vegan or not. Almost NO ONE featured in this film is not vegan. There is zero attempt to seek out contradictory views, this is a monochrome of political, nutritional and ecological ideology. That said, the film is remarkably well done and the folks producing it have spent a lot of time thinking about how to address the common counterpoints and concerns raised around the material they present. Without further ado, here is my review of “What The Health.”

First Spark Media– A film company focusing on activist related projects. Most of the material they have produced to date is vegan/animal liberation in nature.

1:31:23 Dr. Robert Ratner American Diabetes Assoc- Provides a long list of diabetes related problems. Asked what the relationship is between diet and diabetes. Response “I’m not going to get into that.” This section pops up later in the film.

Executive Producer: Joaquin Phoenix- Vegan, Filmmaker, Actor, Activist.

Directors Kip Andersen, Keegan Kuhn- Kip and Keegan produced an earlier film “Cowspiracy” which apparently had some input/backing from Leonardo DiCaprio. Both Kip and Keegan are Vegan.

1:30:06 Kip relates a story of his “previous hypochondriac past”  Made a point that he diligently followed all the major health org’s recs.

1:29:33 Kip shares ABC news report: “New information, meat causes cancer”

Soundbite: “Processed meat is clearly linked to an increase in cancer”. No mention of absolute vs relative risk. “Just as dangerous as smoking cigarettes.” 1:29:22 This all made the circuit a few years ago and was pretty soundly debunked. The takeaway from the “research” was that if one consumes processed meats, everyday, for one’s whole life, the absolute risk for developing say, colon cancer was estimated to be 6%. The background risk for colon cancer is 5%. Now, I talk about the massive limitations of the type of study mentioned here a bit later (not sure we can trust ANY element of these types of studies), but what biassed researchers, and the media do is then look at the change in relative risk. The difference between 5 and 6 percent is clearly 1 percent. But 1 is 20% of 5. So, this get’s reported as a “20% increase in cancer risk.” One need not be a statistician to see how shady this type of information handling is. The next photo provides a concise breakdown of relative vs. absolute risk. I do not know who put this together originally, but it’s outstanding.

1:28:47 Processed meats a Group 1 Carcinogen, just like cigarettes and Plutonium!! They then shift to some great imagery of moms cooking breakfasts of scrambled cigarettes for the kids. YUM! I get into the details of the carcinogen claims later.

1:26:30 Kip is in route to talk to an American Cancer Society Rep. When the rep understands the interview will be about diet and cancer, she cancels the interview.

1:26:00 Dr. Allan GoldHamer (Vegan), Founder TrueNorth Health Clinic-Relates statistic on poor health.

1:25:47 Dr. Joel Kahn (Vegan), Kahn Center for Cardiac Longevity relates a story of poor national health, largely lifestyle related and preventable. Yep.

1:25:32 Dr. Michael Greger (Vegan) Runs I’m not sure if there has ever been a less accurate URL vs site content in the history of the interwebz.

1:25:22 Dr. Milton Mills-Vegan

1:25:12 Dr. Michelle McMacken-Vegan- contends dietary choices trumps smoking for health. Maybe a stretch, but not too preposterous when we consider the Kitavans who smoke like chimneys, eat well and appear to suffer little if any ill effects.

1:23:54 Kip makes the point that the government blames lack of exercise and “sugary foods.” No source cited, is this really the message? The government has certainly pushed the exercise as medicine idea, in which one should not need to worry AT ALL about the food one consumes, one need only exercise more. This is a remarkable bit of cherry-picking and or telling a half truth which is a common theme throughout the movie. At a point later, it is stated that a focus on sugar has steered the story away from the real baddies, meat and animal fat. So, while the ACSM colludes to ban CrossFit (if this is news to you, read the aforementioned link) and make it largely illegal to say that diet matters (at all), we just need to exercise more, the real focus (According to Kip)  is that the blame should have “always” been on meat and animal fat.

1:23:44 Dr. Neal Barnard PCRM-Vegan, “Diabetes Expert” Diabetes is not caused by high-carb diet…with an exasperated lilt. Caused by accumulation of fat in the blood, like typical meat based diet” Insulin resistance is a build-up of fat, yes…but is that the whole story? And how best to fix this? Time and again low carb diets have proven superior in this regard. Many, many people have unpacked the insulin resistance story in remarkable detail elsewhere, so I’m not going to devote a ton of space to that here. I will mention that the low carb approach has proven to be incredibly powerful in reversing insulin resistance and the related co-morbidities. BUT…despite consistent positive results on low carb approaches like Atkins, there has still been a lot of handwringing about “all that fat and animal products.” The solution? EcoAtkins. This is an attempt to eat low carb, but with largely vegan foods. If this is how someone wants to roll, that’s fine, but when studied against the original Atkins plan it was no better, and in some ways worse with regards to improving various biomarkers. This really IS an inconvenient truth, as the film completely ignores the low carb approach, even when built from “plant based” sources. Let me say that again, in a different way: Low carb diets have consistently proven to reverse insulin resistance and type 2 diabetes better than high-carb, low fat approaches. There IS a “plant base” low carb approach which works well…this gets no airplay.

1:23:00 Dr. Garth Davis- Bariatric surgeon, vegan, author of Proteinaholic. Garth is a genuinely nice guy, and although a staunch vegan, he and I have had some decent interactions over the years. That said, Garth is being presented as an expert, but the critiques on his work, specifically his book, are pretty severe. Denise Minger’s thoughts on his book.

Garth’s reply…which spends the opening salvo largely trying to discredit Denise due to “lack of credential” (that’s what we generally call a Straw Man attack) while also playing the game of somehow acknowledging her brilliance?? It’s odd. Really odd. If you notice my interaction with people I have NEVER raised the question of “qualifications.” Does the person know the material, yes or no? In this day where there is easy access to any topic, I am not only un-impressed by the Appeal To Authority, I get immediately suspicious. This is a way of shutting down the heretics without ever addressing their message or content.

1:21:55 Dr. Neal Barnard- Talks about a cookie…sugar lures you in, but it’s the fat that “gets you.” Reasonably truthful, but really misses the point. Hyperpalatable foods are the issue. It’s the flavor combos at issue. No one would be fired up to eat sugar, flour, or butter in plain forms. Ok, I could nosh on a stick of butter, but mix those ingredients into a cookie? That’s pretty damn tasty. Tasty to a point there is no “off switch.” This is a remarkably unsophisticated handling of what is a highly complex process, the neuroregulation of appetite.

1:21:29 Dr. Garth Davis – “Sugar is not great, low in nutrients, but it “does not cause inflammation, can be stored as glycogen.” “The focus on sugar has taken the focus off meat, dairy, eggs, pork, turkey, chicken…”  I’m not even sure how to comment on this as the science is not remotely supportive of his dismissal of sugar:  Now, that is looking specifically at fructose, but table sugar is 50% fructose.

1:20:52 Related this paper: Unprocessed red and processed Meats and risk of coronary artery disease and type 2 diabetes—An updated review

From the abstract: “In meta-analyses of prospective cohorts, higher risk of CHD is seen with processed meat consumption (RR per 50 g: 1.42, 95 %CI = 1.07-1.89), but a smaller increase or no risk is seen with unprocessed meat consumption. Differences in sodium content (~400 % higher in processed meat) appear to account for about two-thirds of this risk difference. In similar analyses, both unprocessed red and processed meat consumption are associated with incident diabetes, with higher risk per g of processed (RR per 50 g: 1.51, 95 %CI = 1.25-1.83) versus unprocessed (RR per 100 g: 1.19, 95 % CI = 1.04-1.37) meats.”

Let’s unpack that:

1-Prospective cohort studies were the sole source of information. What the heck is that? From our good friend Wikipedia: “A prospective cohort study is a longitudinal cohort study that follows over time a group of similar individuals (cohorts) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome.“

Here is a short but interesting paper that looks at the limitations of cohort studies, in this case looking at OPIUM USERS and the risk of death. Arguably, opium use and risk of death is a much simpler story to unpack relative to complex dietary interactions…I don’t think anyone would argue that point. Despite this, the study is incredibly shaky due to:

Recall bias. Did people actually report what really happened (opium consumption in this case, meat consumption in the context of the papers being cited by What The Health). Recall bias is such an issue many people have called for the abolishment of this type of stuff entirely.  This due in no small part to the fact one cannot assign causation, just correlation, but correlation with perhaps more noise than signal. What I mean by that is that the data being looked at may be so fraught with error (noise) that any attempt at gain insight (signal) is literally impossible. The main study cited in the film is from a food frequency questionnaire, which again, have been found to be so fraught with error that many are calling for their abandonment.

Now, it might be worth asking, why are these folks relying on a dodgy methodology (A prospective cohort study, built entirely from a food frequency questionnaire). Here is an interesting snippet from the Red meat/processed meat paper: “ Similar to most other lifestyle risk factors (e.g., smoking, physical activity, obesity, consumption of salt, dietary cholesterol, fruits, vegetables, nuts, whole grains), the effects of meat consumption on cardiometabolic endpoints have not, to our knowledge, been investigated in any RCTs.”

Despite a complete lack of GOLD STANDARD testing (Randomized, Controlled Trials–RCT’s), public policy, bad documentaries and a never ending slew of media pieces are built from studies which are known, from the outset, to be incapable of showing causation. I cannot emphasize this enough, as the film presents this material as “proof” in the same way that a physicist would describe the properties of gravity.

2- Nearly 2/3 of the “risk” associated with processed meats is ascribed to the sodium content. There is SOME mechanistic plausibility here, particularly in the case of CVD, as a hyperinsulinemic individual tends to disproportionately retain sodium, and a high sodium intake MIGHT exacerbate this. But interestingly, trying to lower sodium intake in these folks also tends to do almost nothing, as the problem is upstream and due primarily to insulin.  Here is a great line from the abstract of that paper: “Similar to other areas in prevention, the controversy is likely to remain unresolved until large-scale definitive randomized controlled trials are conducted to determine the effect of low sodium intake (compared to moderate intake) on CVD incidence.” Seems to be a theme emerging here…Huge amounts of money and an iron-clad public healthy policy is being promulgated by “research” that is incapable of addressing causation, and that may have more signal than noise. Finally, the whole discussion of sodium is likely flawed, again from poor mechanistic understandings. I’ll be talking to the author of The Salt Fix in a future episode of the podcast, but this story looks remarkably like that we have seen for fat, animal products etc.

3-Based on the paper and the arguably flawed data, there appears to be little if any association between unprocessed meat intake and CVD, and only a modest relationship between unprocessed meat intake and type 2 diabetes. Now, I’m being pretty generous even mentioning this point as the whole paper, the whole investigative process, is built on “data” that as I said previously, likely has more error than signal. (Sorry to be redundant, but if you come away with ANYTHING I hope it’s an understanding of what is being claimed vs what this material can actually support.)

An important point to take away from all this is the What The Health documentary is building a story first that processed meat is bad (which is highly debatable, and the notion it’s “as bad as cigarettes is just preposterous). That is a monumental claim and the facts behind this claim fall flat. Which should then make one suspicious about ANY of the information shared by folks promulgating information like this. I’m working on a post to follow this that will look at the epidemiology of smoking and compare/contrast that with what happens in “nutritional science.”

1:17:41 Michael Greger Claims “dead meat bacteria toxins” immediately damage the endothelial lining of the circulatory system. There is no doubt endotoxemia is a huge issue, an overlooked issue. But Dr. Gregor is unique in assigning this only to animal products. There is abundant literature showing processed foods, with added processed oils increase endotoxemia (which can worsen insulin resistance and CVD risk) but if you ask Dr. Gregor and his ilk for any research showing whole foods doing the same thing, you will be waiting quite a long time. The main citation Dr. Gregor provides is an in vitro (petri dish style) study: In vitro studies should not be dismissed out of hand but they absolutely CANNOT be used as in vivo (in a living body) evidence. They are at best suggestive of potential mechanisms of causation and can inform future research. I can only describe tactics like this as “ham-handed” which is ironic given Dr. Gregor’s disdain for “the other white meat.”

Here is the post Dr. Gregor has produced to support his thoughts:

I agree with much of what Dr. Gregor is saying here with regards to intestinal permeability and health. I do not agree with his complete analysis of the cause (animal products) nor the best solution (a grain based vegan diet). And again, it is fascinating what is being left out of this discussion. This paper makes the mechanistic case for dense, processed carbs being the root cause for endotoxemia. Now, we can get in and debate the merits of one theory vs the other, but to completely ignore this contradictory information implies what can only be construed to be dodgy motives on the part of the filmmaker.

Worth a mention: some degree of inflammation and arterial stiffening occur after eating ANYTHING. Dr. Gregor does not mention this fairly important fact. If one reads between the lines, some kind of intermittent feeding vs grazing schedule is likely a good idea due to the inflammatory nature of just eating.

1:17:15 Dr. Michael Klaper

1:16:54 Dr. Caldwell Essltyn “It’s really quite clear that from the standpoint of cancer and CVD that animal protein plays an enormous role…” Question from Director: “is chicken better?” Dr. Essltyn’s response: “It’s a question of if you want to be shot or hung…”

Cancer rates are increasing, but due mainly to population increases and aging:

Meat consumption over time:

Total meat consumption in the US:

We seem to have largely swapped chicken for beef, and we appear to be overall below our previous historical highs in consumption. One could argue meat consumption has, over all, increased, yet cancer rates appear to be increasing largely as a factor of an aging population and an overall increase in population. That’s one part of the original claim that meat causes cancer, the other claim was that meat is at the heart of CVD. Take a look at this:

Despite a clearly sicker population with regards to obesity and type 2 diabetes, heart disease rates are declining, due mainly to decreased smoking (the smoking decrease is powerful enough to offset even the increases in diabetes, at least to some extent). If the claims about meat consumption contributing to heart disease and cancer were true we would NOT see trends like those depicted above. It is difficult to say whether Dr. Essltyn is outright lying or is just terrible at interpreting science. Either way, his claims are not supported by the evidence. I’ll have a few more thoughts on this at the end of this review.

1:16:13 Neal Barnard: “Heterocyclic amines are clear cut carcinogens and they can form when meat is cooked or heated.” True, but high temp cooking of ANYTHING produces a variety of potentially carcinogenic substances. Cooking at lower temps reduces all of these processes, and marinades with antioxidants dramatically reduces HCA formation

But wait, there is more.

Remember that study I mentioned above that looked at In vitro (not in vivo) effects? It appears the microbiome bioconverts substances such as HCA’s to largely benign substances. From the paper: “In conclusion, even if one would assume that 100% of the daily amount of PhIP ingested by a human being is converted into PhIP-M1 in the colon, this concentration most probably would not lead to cytotoxicity and/or carcinogenicity in the colorectal mucosa.” Some of the confusion in this arena stems from clear cytotoxicity and mutagenicity in animals fed HCA’s. What might be a problem with this? Yes, animals are not people, but more specifically, animals do not eat cooked food. Humans do, and have for perhaps 500 thousand years. Possibly longer. Famed evolutionary biologist Richard Wrangam makes the case in his book that humans are neither carnivore, herbivore or even omnivore, but rather “cookivore.” Give the book a read as this thing is turning into a monster and I do not have time to unpack all the details there, but I will make the point that if the medical and research community had even a bit of influence by the Ancestral Health/Evolutionary Medicine model, much of this goofy research and blind alleys would have never happened.

The take away form all this is despite the boogeyman Dr. Barnard tries to create with regards to HCA’s, he ignores entirely that there are mitigating steps one can take when prepping food, and those mitigating steps may in fact not matter all that much when one considers that these substances are largely inactivated by the action of the gut flora. NOW…I can make a case that if the gut flora is disturbed, if the gut is unhealthy, this could be a problem, but that’s a topic for another day. One final note: Barnard really goes after chicken as the main culprit in the HCA story. He cites research which I was unable to find or verify, but I do know this: people are eating, on average, more chicken than previously. The agenda here appears to be to tackle that shift and shut it down. Interestingly, I’d like to see folks eat much less chicken, but this is due to sustainability issues, not health.

1:15:03 Kip mentions a study (does not provide it) that eating one egg per day was equivalent to smoking 5 cigarettes. I can’t actually unpack this one as there is no citation for this claim, which spurred me to search “Research citations What The Health.” The best I can find is this, which is not remotely up to snuff for a works cited:  Again, these are remarkable claims, with at best paltry support.

1:14:31 Michael Greger “You know these saturated fat studies that are trying to vindicate saturated fat…they are all just funded by the dairy industry.” He has a point, some of these studies are indeed funded by the dairy or egg industry…but the story is a bit more complex than that. This just replays the tape on all the old Ancel keys stuff, not the least of which was the recent unearthing of research data that was “forgotten.” The research looked at mental patients fed two diets: One high and one low in saturated fat. The low saturated fat diet was enriched with corn oil…cholesterol levels were consistently lower in the low SF group, but cardiac death and all cause mortality were WORSE. This is a remarkable study in that we’d never get this past an ethical review board today AND it was close to metabolic ward standards. The rigor of a study like this as compared to cohort studies is difficult to properly describe. They are not on the same planet. The point being, the claims about saturated fat and cholesterol made in this movie are highly inconsistent with the best science we have, populations and history, yet these claims are regurgitated again and again with no regard for what the facts actually support.

1:12:18 A good section on epigenetics and that our genes are not our destiny…but clearly I’m not aligned with many of the recommendations being made.

1:10:41 Dr. Ken Williams president of the American college of cardiology: Paraphrasing: “ It is clear that increasing meat intake causes increased rates of CVD.” Kip asks “what about fish” to which Dr. Williams responds with the “4 worries,” PCB’s, mercury, saturated fat, cholesterol.” I think the first two concerns can be reasonably valid and are why it’s a good idea to eat fish that are lower down the food chain. As to the saturated fat and cholesterol “issues”…I think we’ve covered that.

Side Note:

This is a slick process overall. What the Health starts off with a fairly credible position (in most people’s eyes) of raising the question of the safety of processed meats and red meat in particular. Lots of people buy that, even if they still eat them. Then chicken, eggs and dairy are thrown in, all with the same specious claims of cancer, CVD, and diabetes being solely due to the consumption of animal products. But then they add fish. That gate-way product for vegans shifting back to animal products. Slick.

1:08:55 Mike Ewall, Energy Justice network “dioxins are the most toxic substances known to science.” Dioxins are nasty, no doubt about it, but Chris Masterjohn did a thorough unpacking of this topic here:

The movie goes on to make the point that the main input for dioxins is the grass that cows eat! But again, there is more to the story (said another way, this claim is patently false). From Chris’ article “A review published in 1995 suggested that pastured animal products would probably contain higher dioxin concentrations because of a higher rate of soil ingestion;3however, newer research has revealed the fact that the primary sources of above-average dioxin concentration in beef samples are feeding troughs constructed with pentachlorophenol-treated wood and the inclusion of incinerator waste as a feed additive.6 Grass-fed beef is not exposed to these sources of dioxins.” Mr. Ewal appears to be either very sloppy in his fact finding or he maybe, has an agenda. If I were not trying to be professional I’d say the man is “A Damn Liar.”

Again, I have to tip my hat to the What The Health folks, as one of the thorniest topics they deal with is the use of grazing animals in not just food production, but also habitat restoration, carbon sequestration…you know, “save the planet” stuff. The push for decentralized, grass centric processes is in direct opposition to the CAFO meat production just about anyone can hate. But, if a healthy, not-so-nasty alternative (pastured meat) were to gain traction (which it has) that could pose a problem for the folks who approach veganism as a religion. Is dioxin a concern? Yes. Is it a concern as presented in this documentary? Well, I’ll leave that up to you to decide. I do have to give them yet further props for wrapping up this section by relating the story that moms can pass dioxins to their offspring, both in utero and via breast feeding. This is true, but the whole context of this piece is at best questionable.

1:04:43 A section on the problems of dairy, many of which I agree with. There are interesting associations between dairy and autoimmune disease. But again, there is a lot of nuance and unpacking to get the full picture on that story.

1:02:29 Dr. Barnard comments that there is zero evidence that milk builds strong bones. Again, I largely agree with this. I have always put most dairy products into a “grey area” in that if you do not suffer any type of immunogenic reaction to dairy, fine, dig in. I do not handle bovine dairy, but do great with sheep and goat. This is one area of overlap between the vegan and paleo camps.

The movie goes on to cite research links between dairy consumption and cancer…again, this is all correlational work, BUT. There are some proposed mechanisms that could offer some insight in all this. Dairy is loaded with various growth factors, and promotes the production and release of growth factors from the liver. In the context of a chronically overfed westernized society, this could pose a problem. And in general, dairy consumption increases with industrialization. The only pesky problem here is traditional societies ranging from the Mongols to the Masai have consumed prodigious amounts of dairy but have been largely free of modern degenerative disease. This too is “anecdotal” but it’s interesting how the filmmakers appear to go out of their way to avoid mentioning any of these confounders.

1:00:38 Kip contacts the Susan Komen organization (the pink ribbon folks, whom I have serious issues, but again, topic for another day) and asks why they do not warn against dairy consumption, citing this paper which looks at high and low fat dairy consumption and cancer recurrence and mortality in breast cancer patients.  This was a food frequency questionnaire (garbage) but check this out from the paper: “Intake of high-fat dairy, but not low-fat dairy, was related to a higher risk of mortality after breast cancer diagnosis.”

Let’s unpack that:

1-As I said earlier, food frequency questionnaires are recognized to be so fraught with problems and inaccuracies that many researchers have called for their abandonment. This is unlikely to happen as a massive amount of infrastructure and funding is wrapped up in this hopelessly flawed process. This whole paper and it’s findings are questionable, but let’s put that fact aside for a moment and consider this:

2-How on earth does Kip ignore that lowfat dairy (according to the study) is NOT associated with increased cancer recurrence? I clearly have my own agenda here, I’m the “paleo guy”, right? But how many times can a filmmaker do stuff like ignoring what is simply in the abstract, lying directly or by omission, and still be taken seriously? I know a lot of folks reading this do not have science backgrounds…so you are taking things largely on faith whether you believe me or the folks in this film, but if this is an error on Kips part one must really question his ability to analyze information in this sphere. If it’s not an error it’s a manipulative lie by omission, which should call into question any and all claims and motives with this whole project. But, we will not drop the ball at this point with still an hour to go in this film, we will slog through.

3-As flawed as the basic research is, let’s look at how the confounders can add up in something like this. Now, why do folks choose lowfat dairy? In general, low fat is still perceived to be a healthier option. People who make one healthy lifestyle choice tend to make multiple lifestyle choices which are arguably, healthier. People who do not eat meat (for perceived health reasons) also tend not to smoke. Although researchers claim they can adjust for all these variables, critical analysis of this type of research makes a pretty strong case this is by and large false. These murky cofounders are difficult if not impossible to adjust for and are fantastic opportunities to offer up statistically hatched lies. So, despite the limitations of the research due to the food frequency piece, one could make a case that the low fat dairy folks DID in fact see benefits with regards to cancer recurrence, but this may have nothing to do with what dairy option they chose and everything to do with the overall mindset and choices that would drive these folks to make generally healthier choices in all aspects of their lives.

58:05 Christina Stella Center for Food Safety, staff attorney. Section on the drugs, particularly antibiotics, fed to feedlot animals. I agree with most all of this, it’s dangerous and appalling. But this is also all an outgrowth of the industrial food system. Options like Polyface Farms, holistic management, mobile slaughter can make CAFO food lots a thing of the past, which would essentially remove the need for the vast majority of the meds fed to these animals and the potential problems which will come from this method of food production.

54:42 Larry Baldwin Water Keeper Alliance Talks about the number of pigs raised in north Carolina (more than 10 million…approximately equal to the human population). The film makes a solid case about how damaging this centralization is to the environment, and also the disease potential of things like the H1N1 flu virus. This is all accurate and concerning information. This whole story would also change entirely with decentralized food production which effectively managed the waste products of this process. Consider this:

That’s the total amount of nitrogen fertilizer used in the us, 1965-2010. Although a small amount of this is used for backyard gardening, a main portion goes towards row crops and industrial agriculture. What is somewhat humorous about the vegan agenda of this film (stop eating/using animals in any way) is that the primary option for fertilizing the corn, wheat and rice that these folks recommend will fall in petrochemical derived nitrogen fertilizers produced by the Haber process. Various beans and legumes ARE nitrogen fixers and can and should play a role in better managing this whole mess, but what if we effectively used the waste from animal production to fertilize our agricultural crops instead of letting it poison water systems? What would this mean for antibiotic use in animals? Watershed contamination? A frustrating element to this film is that one solution and one solution only is being presented. Are all of the environmental, social and medical issues concerning? Yes, they are. But Planet of the Vegans is not the only way to address these issues, but it is the only solution offered in the film.

48:45 Dr. Robert Ratner chief Science officer, American Diabetes Assoc. Kip interviews Dr. Ratner (he finally gets his sit-down with the ADA) and Ratner describes the mission statement of the ADA, and mentions that there is no way to prevent type 2 diabetes in all people. Not sure how Dr. Ratner has missed all the anthropological data showing populations without DM2, but I guess we will let that pass. To Kips’ credit he mentions a study comparing a low fat vegan diet vs the ADA recommendations and how the vegan diet performed better. Dr. Ratner gets pissed and closes out the interview, and is visibly pretty cranky. Dr. Ratner makes the point that many dietary approaches can reverse type 2 diabetes, there are many studies showing this. The problem is getting people to comply. Kip does not mention that a low carb diet beat both the ADA and conventional low fat diets, but hey, details.

Low fat can work, so can low carb. I think LC works better (SEE MY ECOATKINS POINT ABOVE) and more consistently, but the important thing is “everything in moderation” is absolute bullocks when viewed through the lens of the neuroregulation of appetite and our modern world of hyperpalatable foods. Maybe I should write a book on that…wait…I did.

44:38 Kip mentions that dairy avoidance is associated with reduced incidence of type 1 diabetes. True, but also true for wheat, which again, he somehow neglects to mention:

Important points: Not everyone who eats dairy and wheat develop type 1 diabetes. Not everyone who avoids these foods will be spared development of type 1 diabetes. But it may be that eliminating/avoiding allergenic foods such as these will reduce the POTENTIAL for developing the condition. This is perhaps one of the most infuriating and potentially injurious features of the film: Information is presented in black/white absolutes.

43:36 Kip discovers, in the wee hours of the night, that the American Diabetes Association is sponsored by a bunch of multinational food conglomerates. He lists a number of products like Dannon yogurt (which I can find on the sponsor page) and a number of entities that I cannot FIND, like bumblebee tuna. There is also a long list a pharmaceutical companies and even those bastards at Wonderful Pistachios.

Just kidding, pistachios are amazing.

Yes, corporate money has despoiled the whole medical industry…this is why I push for decentralization and I’d love to see 5 American medical associations, not just one. Kip goes on to do this same search for entities like the American Cancer Society…he highlights the meat oriented sponsors, yet somehow neglects to mention the folks who produce refined grain products who are also sponsors. The selection bias here is remarkable.

41:10 Steve-O. Yes, the “comedian” quasi-famous for such cinematic masterpieces as helping his friends put Hot Wheels cars up their bum, mentions an American Diabetes Assoc event he attended that had BBQ chicken. He left. The horrors. The gravitas.

(Ok, yea, I’m getting pretty punchy)

40:01 Kip beats the dead horse of the governmental bodies tasked with stewarding our health being funded by food producers. Yep, that’s a problem.

38:48 Mark Kennedy, Lawyer, PCRM- Mark describes the “check off program” which is effectively a government backed program that aids fast food producers (and others) in figuring out ways of increasing the consumption of fast food. As usual, they focus only on the meat and dairy inputs, ignore the refined grains and sugar. I’m not sure what else to say other than “and why do people want MORE government at every level of their lives?” I have an answer for that: So long as “my” perceived political ideology is in office, yea baby, bring on ‘Das Gubmnt’. Then, when the political pendulum swings it’s “OH SHIT!! How did that lunatic make it into office?! The government has too much power!” I promise, that’ll likely be the only political rant I do in this thing. Probably.

34:53 Film talks about “cheeseburger laws” which are designed to prevent litigation on the part of people who feel certain foods have caused them health problems. Only meat and cheese are mentioned. No mention of grains and or sugar.

Ryan Shapiro, Historian of National Security, MIT- Ryan describes how the American Egg board produced internal documents describing the vegan mayonase alternative, Hampton Creek as a “Crisis and major threat to the future of the American egg industry.” Too bad the American Egg Council did not just sit back and wait for Hampton Creek to be exposed as shysters and frauds:

Clearly there are plenty of dirtbags who are also meat eaters, this is not a uniquely vegan thing, but when you consider the games played at Hampton Creek as well as the wunder gal Elizabeth Holmes (vegan), founder of the zero to $9billion valuation to zero Theranos, you kinda have to wonder.

I’ve done my best to keep this as factual as I can, but at some point the annoyance with this stuff bubbles over. The tech scene is so enamored with crap like Theranos, Soylent and vertical farming that it’s almost maddening. The whole vegan schtick is sexy in that “I’m morally superior…l’m woke…” it just sickens me at this point.

32:55 (or there about) The film shifts to the massive influence of the pharmaceutical industry, how those folks do not want to see stints and statins go away. Yep agree with the analysis, just not the solution.

30:09 Jake Conroy, Formerly Imprisoned Activist- At this point in the film Kip is making the case that the pharmaceutical industry effectively gets its own legislation passed and then claims that they are so powerful they have imprisoned activists. Jake is introduced as if he was imprisoned “fighting big pharma” but was in fact part of an animals rights group called Stop Huntingdon Animal Cruelty (SHAC).” Huntingdon Life Science is an animal testing facility (which I think a MASSIVE amount of animal testing is both unnecessary and unethical). SHAC (from Wikipedia) “used tactics ranging from non-violent protest to the alleged firebombing of houses owned by executives associated with HLS’s clients and investors. The Southern Poverty Law Center (SPLC), which monitors US domestic extremism, has described SHAC’s modus operandi as “frankly terroristic tactics similar to those of anti-abortion extremists,” Jake was imprisoned in 2006 after being found guilty of harassment.

I thought the lies by omission detailed above were bad…this…I’m not sure how to even couch the degree of bait and switch bullshit here. Yes, the guy was imprisoned. For harassment of the HLS employees. And the guy is the organizer of the SHAC which has responsibility for things perhaps as severe as firebombing houses. Who firebombs anything? I can think of religious zealots and drug dealers. It’s people like this guy and DurianRider that might ensure that veganism never goes mainstream. Thanks for that guys.

26:43 Dr. Milton Mills- Kip asks if we need to eat meat to get complete protein. There is a long list of docs that come on mentioning how if you eat 2,000 cals of brown rice and broccoli, you will be “fine”. I’m not really going to unpack this as this topic has been beat to death. A vegan diet is likely better than a SAD junk food diet, at least for a while. One can reasonably easily supplement and get the things missing in a vegan diet (DHA/EPA, choline, etc) but it’s not optimum.

23:40-Dr. Michale Klaper- Mentions that “all these Paleo people are going to die from heart attacks and diabetes.” Ok.

22:19 Kip gets into some comparative anatomy, specifically of the teeth and makes the point that since we do not have large canines, we are not designed to eat meat.It’s fascinating to me that Kip manages to ignore nearly 2 million years of human stone tool use, the role these tools played in our evolution, and how this all led to a massive die of of megafauna (big critters) at the hands of our ancient and more contemporary ancestors. Some people just dismiss this material out of hand…it’s the history of humanity!

There are a lot of claims that come from Vegan Land, but the “Humans evolved to be herbivore/frugivorous and “never ate meat” is on par with insisting the earth is flat. One can certainly believe these fairytales if one chooses, but it’s interesting what a disadvantage people experience when they insist on using an operating system or world view that is fundamentally flawed. The notion that humans did not hunt significant quantities of both large and small game is not supported by any of the evidence from anthropology and calls into question how humans could have lived in any pre-agriculture environment that is above the 40* latitude line. My own story around this is possibly valuable: I participated in a Discovery Channel show called “I-Cave Man” in which we were instructed on the basic use of stone tools and then tasked with living in a harsh, alpine environment in late spring. I was provided some basic instruction ins stone tool knapping, dead-fall traps and snares a few weeks before the show and I practiced like a madman. I also made and practiced with an atlatl (a hand thrown spear, in which the throwing velocity is increased using a wooden launcher) for hours every day. I was still a relative novice, but by the time of the show I could make cutting tools that worked better than surgical steel. I managed to take down a 650lb elk with this Atlatl and between myself and castmates, we butchered the whole animal and brought it back to camp. Although Billy Berger (one of the castmates) is considered to be an expert in stone tool manufacture, he has related that his skills are likely on par with that of a 4-5 year old CHILD who would have been raised in a hunter gatherer troupe. My point here is humans were very good at hunting, stone tools make up for a lack of horns, claws and ripping/tearing teeth.

Somewhat related: With a few weeks of practice I managed to develop the skills to make a fire kit and actually make a fire with a hand drill. It was a bastard, and we barely pulled off the fire as part of the show, but again, it illustrates that although many of these skills are quite complex, a relative amateur can attain enough technique to pull this off in fairly demanding situations. As I mentioned above with regards to Ricahrd Wrangham, fire was a critical part of human evolution, particularly as it relates to our nutrition:

19:47 Dr. Caldwell Esseltyn- Relates research showing improvements in patients consuming a plant based diet. Yes, any shift away from a hyperpalatable, highly processed diet is going to be a win.

The final 15 minutes of the film is a mix of rapid fire medical claims about veganism, several before and after transformations, interviews with vegan athletes and heartstring tugging cinematography. This is a slick, well done film and the whole vegan story is incredibly compelling: eat to be healthy for yourself, your world, and be a kind, spiritually superior person. Who doesn’t want that? The problem(s) arise when we ignore a few things: Veganism is not the only healthy way to eat. It’s arguable if veganism is actually healthy long term, but I’m all about folks experimenting, just be rational and honest about your experience. Some of the most compelling elements involve the notion that veganism is going to “save the planet” and it is morally superior. It’s outside the scope of this already long piece to unpack those topics properly, but myself and others are working to have a concise, well researched accounting of those topics. I will say this: the vegans are kicking our collective asses. It’s a religion, it’s a community, and identity. I’m not sure how to deal with that other than creating an alternate food religion, which honestly sounds horrifying to me. The problem is these folks are well organized, well-funded and they get massive traction in producing films like What The Health, Cowspiracy etc. Cowspiracy was crowd funded and raised more than $600K in 48 hours. We have no similar analog (with regards to scale and reach) for “ethical omnivores” that are working to address many of the issues raised in the film, including animal husbandry practices, environmental damage etc. As a movement we are remarkably fragmented and in general I’d say most folks are more concerned with getting abs than thinking about the knock-on effects of an industrial food system. Not slamming folks, just stating an observation.

Unpacking a topic like this involves shades of grey, and if I’ve learned anything about human behavior, it’s that we, as a species, do not do well in the grey. Black/White, Left/Right, Vegan/animal murderer.

BTW- I reached out to Kip via Facebook asking if I could interview him about some questions I have on the research. No response. Ironic given the tactics employed in the movie.


I hope you found this analysis helpful. Again, I tried to generally remain professional in my tone but clearly at some points became pretty frustrated. Now, I’d like to ask you a favor: If you do in fact care about this topic, please become a member of the Farm to Consumer Legal Defense Fund. These folks fight the legal battles that small farmers find themselves in when they end up in the crosshairs of a local health department, or a multinational like Monsanto. The FTCLDF is interesting in that they will help just about any farmer, at any time. One of my favorite people in the world, Joel Salatin, had an interesting response when asked how vegans could get along in a world that worked along his model of food production (which includes, but is not exclusively based on animal products). His (paraphrased) response “If the vegans will let me raise the food my family wants to eat, I’ll make sure to raise the food their family wants to eat.” We could all likely learn a lot from some contemplation on that sentiment.

I’ll close with a question of sorts: Based on my average site traffic this post will get far more than 6,000 readers who would identify as “ethical omnivores.” Way more. If someone (not me) were to produce a GOOD movie based around the practices of regenerative agriculture and the Ancestral Health model, how many of you would donate $100? $50? If you are game to help, please say “yes” in the comments (along with any other observations you care to share. If your answer is “no” I’d appreciate you tell me why you’d be unwilling to support a project like this.
















































from The Paleo Diet

Dear Mark: HDL, Probiotics for Acne, and Artificial Sweeteneners and Weight Gain

Inline_DM_07.03.17For today’s edition of Dear Mark, I’m answering three questions. First, is HDL all it’s cracked up to be? Is HDL always good? Is it the savior? Or is the story a bit more complicated? Next, what are some good probiotic options for treating acne? Do any exist? And last but not least, what’s the relationship of artificial sweeteners, insulin, appetite, and weight gain?

Let’s go:

Carine Dubois wondered:

I am slightly concerned about the age old acceptance of HDL as the good cholesterol in light of the recent failures of HDL potentiating drugs failure to decrease CVD. Could there be more to the story such as good and bad sub fractions as with LDL …. many more studies have to be done using up dated technology before accepting the AHA recommendations as dogma

Great insight, Carine. I feel very similarly. All the HDL-boosting drugs, like torcetrapib, have failed. And not just failed to protect against cardiovascular disease and death, but actively increased the risk of disease and death. They’ve been real disasters.

However, here’s why I think the coconut oil-induced HDL increase is different than the torcetrapib-induced increase:

HDL is “good” because the actions and behaviors and foods that increase it are “good” and the actions and behaviors and foods that decrease it are “bad.” The former include exercising, eating olive oil and avocados, losing weight, and lowering excess carb intake. The latter include smoking and gaining weight. These things aren’t good or bad because of the HDL effect. They’re good or bad for dozens of reasons. Thus, absent HDL-boosting pharmaceuticals, higher HDL is “good” because you have to do “good” things to raise it.

You’re also right that HDL isn’t just HDL. There are different ways to measure. And even with HDL particle number, there’s more to the story than “higher” or “lower.” For instance, small, dense HDL particles tend to be more protective and possess more antioxidative potential than large, buoyant HDL particles. While a pharma exec might take this to mean we should be pumping out drugs that make HDL particles smaller and denser, a person like Carine would take a more nuanced exploration.

Maybe a preponderance of small, dense HDL particles indicates a large inflammatory load that needs quelling. Maybe a shift toward larger, less dense HDL particles indicates an improvement in inflammatory status. After all, the body actively manufactures HDL particles to reduce oxidative damage.

David asked:

Hi Mark, in this article

How to Support Healthy Skin Bacteria

you mentioned that a lotion containing Enterococcus faecalis SL-5 was
shown to be effective against acne. Any idea where one could buy this
bacteria (or bacteria-containing lotion) on the web? My initial
searching was not encouraging. Thanks for all you do!

Unfortunately, I, too, have been unable to track down a good source of Enterococcus faecalis SL-5. I doubt anyone else has had any real luck. The mixture used in the study was made specifically for that study. They isolated E. faecalis from human feces (the bacteria is a normal resident of the human gut) and added it to a regular lotion. I’ve never seen it replicated or a commercial version released. Too bad. I’m sure something is coming down the pipe.

That’s not all you can do, however.

In 2012, topical application of a 5% Lactobacillus plantarum extract reduced acne lesion size. There are patents for topical L. plantarum extracts, but I haven’t seen any products.

A more recent study found that oral supplementation with a liquid probiotic containing Lactobacillus rhamnosus SP-1 reduced inflammation and adult acne. An Italian pharmaceutical company named Biodue SpA provided the materials. I can’t speak for the sourcing of course, but here’s some for sale on eBay. Also, here’s bulk Lactobacillus rhamnosus SP-1 for sale. I haven’t found any from regular sources (Amazon, etc).

AOBiome is currently running in-house trials to determine if their Mother Dirt probiotic skin spray can fight acne. Anecdotes are promising, if preliminary.

Stephen Schlepmo asked:

It’s known that artificial sweeteners don’t stimulate insulin (right?) but do they somehow stimulate appetite? Hence compromising fat reduction goals?

Let’s look at the various sweeteners.

Does aspartame induce an insulin response? No:

What about sucralose (Splenda)? Nope:

As for the others, a review of in vivo studies concluded that “low-energy sweeteners” do not have any effects on insulin or appetite hormones.

Yet, observational studies continue to find links between artificial sweeteners and obesity. Maybe it’s reverse causality—being overweight causes diet soda consumption. Overweight people are more likely to drink diet soda because they think it’ll help them lose weight, and intent to lose weight does predict artificial sweetener usage. But this 2016 study attempted to minimize the effect of reverse causality, and they still found strong links between artificial sweetener consumption and the risk of abdominal obesity. Those who drank the most diet soda had the biggest bellies.

And we know how bad Splenda can be for the gut biome, which plays its own role in the risk of obesity.

It’s hard to say, but I err on the side of “avoid”—even if the reason has nothing to do with insulin or appetite.

What’s easier to say is that the non-caloric-yet-natural sweeteners, like stevia or monk fruit, are better choices. Take stevia, for example. In one study where it was compared to sugar or Splenda, stevia actually reduced postprandial insulin levels, and those who ate the stevia didn’t increase calories to make up for the missing sugar calories.

All that said, there’s one surefire way non-caloric sweeteners—even natural ones—can compromise fat loss and and stimulate appetite: by compelling you to eat treats you’d otherwise shun.

Say you eat a good Primal dinner. You’re done. You’re quite full. You’d never consider tucking into a sugary bar of milk chocolate—unless it was sweetened by stevia or monk fruit or one of the sugar alcohols.

Before you know it, you’ve eaten an entire sugar-free chocolate bar that you would have ignored if it had sugar. You’ve just tacked on a few hundred calories to your total, all thanks to the stevia.

That’s it for today, folks. Take care and be well.

Let me know if you have anything to add or ask down below.


The post Dear Mark: HDL, Probiotics for Acne, and Artificial Sweeteneners and Weight Gain appeared first on Mark's Daily Apple.

from Mark's Daily Apple

Scenes of Summer

Lunch at The Fitzroy //

He beat us three times //

His first time eating ribs //

My 1,000th time eating fish tacos //

“I got the bill mommy” //

Late night grocery shopping //

The secret ingredient is jam and this egg poacher //

Overgrown! //

Still eating all the burgers //

This swing!!! //

*Heart eyes* //

#beerholder //

Best.Dog.Ever. //

Happy 4th!!!

The post Scenes of Summer appeared first on Kath Eats Real Food.

from Kath Eats Real Food

Clean Eating Frosty Coconut Sugar Virgin Margarita Recipe

Clean Eating Frosty Coconut Sugar Virgin Margarita Recipe

I’m a margarita girl. On the rare occasion that I do drink, nine times out of ten, I’ll be drinking a margarita. I love the refreshing cold and the varying types of flavors. But as I said, it’s… Read more →

from The Gracious Pantry