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Review: Forks over Knives, the movie

Published 2.24.2017
This review of the 2011 movie Forks over Knives was inspired by the recent online vegan diabetes summit, which I "attended" and took notes during which I then wrote up (if you're interested, check out the Mastering Diabetes series on the Archive page. At the time of this writing, I haven't quite finished writing up all my notes and commentary, but since Forks over Knives was mentioned so often during the summit, I rewatched it to review here.

I first watch Forks over Knives when it first come out, so these are my thoughts after the second viewing— and after I have spent six more years reading and learning about diets and health. I watched the film on Netflix, but if you don't have Netflix, you can purchase or rent your own copy here: Forks Over Knives
The movie (as all movies related to diet and health) starts with dire statistics and footage of headless fatties. A number of the doctors who presented in the vegan diabetes summit also show up as talking heads in this movie. The movie is based on the research of T Colin Campbell that he published in the book, The China Study.
The movie is advocating the diet in The China Study, and thus is not an unbiased presentation. Lee Pulkerson, the host, found out in a check up that a number of his biomarkers were less than healthy, and so did a 12 week program based on a whole food plant based diet (WFPBD)— in other words a vegan diet.

In The China Study, Campbell looked at eating pattern data from across China, and claimed to find an association between eating less meat and lower rates of heart disease. In addition, he studied the effects of casein on rats, which he claimed showed the danger of eating dairy products. Dairy is true enemy of vegans. I base that statement on my personal observations, so it's wroth every penny you just paid to read it. However, cheese, in particular, seems to be the last animal product for people to give up. Cows aren't killed in the collection of milk, just as chickens and bees aren't killed in the collection of eggs and honey. That lack of killing for many people is enough.

Vegans, of course, would argue vociferously (and even aggressively) that even though the cows and chickens aren't killed, they are mistreated in the processing. Certainly in the construct of industrial farming, they likely have a point. However, they would not be mollified by more humane farming techniques (as can happen on smaller farms). I'm getting a bit far afield here, but the I broach the subject to introduce the fact that Colin Campbell's results and conclusions from The China Study are controversial in many quarters.

To Campbell's credit, he published all the data from his study to allow others to analyze the data. Unfortunately for Campbell (and vegans) the re-analysis demonstrated that Campbell didn't have the data to make the claims he was making. Campbell himself, in this New York Times interview, admitted that he didn't have the data for asserting that a 100% animal free diet was best. That's because he did not find any completely vegan societies in China. He found groups eating 5-10% of their calories in animal products, but that's not zero.

No, Campbell extrapolated that if 5-10% animal products was healthiest (and even that assertion was called into question based on the raw data) diet he came across then 0% animal product must be even better. That simply doesn't follow, and it's certainly not the conclusion that an ethical researcher would arrive it. It can be a new hypothesis to test— but it shouldn't be the conclusion of this study. But I digress, so back to the film.


Caldwell Esselstyn figures prominently in the movie too. It was the China Study that convinced Esselstyn to go vegan and make his diet treatment vegan. Prior to that he had gotten great results with just a little bit of animal products. Also, as and aside, prior to Campbell and Esselstyn meeting in the movie, Esselstyn talks about endothelial cells and nitric oxide and how important it it. And yet in 2016, Malcom Kendrick wrote about the topic as though this was something new and different. You'll have to google to understand that reference, as I have not yet gotten to Dr Kendrick and his brand of shenanigans. But again, I digress.

The primary thing I learned in re-watching this movie is why Esselstyn excludes meat in his treatment. I've said often recently (in my coverage of the vegan diabetes summit) that until and unless vegans can explain why Nathan Pritikin's protocol resulted in the same benefits as their diet, I don't think the case they make is strong or ultimately convincing. Pritikin didn't just reverse heart disease for clients, (Pritikin was not a medical doctor) he reversed type two diabetes as well. The Pritikin Plan was not/is no vegan. It is a very low fat diet that limits meat consumption and emphasizes vegetables— and more importantly— it works.

So now I know. Colin Campbell made an unsupported extrapolation for the data that he collected in China, and Caldwell Esselstyn was convinced that he was right. That closes an open loop for me, so if for no other reason, I'm glad I rewatched. For the record, neither Campbell nor Eselstyn talk about ethical reasons for not eating animals. Theirs is solely a health argument.

Something else I learned is that Dr Esselstyn commands complete compliance, or the patient is bounced from the program. That's straight from one of his (admittedly very grateful) patient's mouth. This woman is still alive 20 years after traditional cardiology had given up on her. She is a true believer in "Essi's" plant. But she doesn't pretend it's easy or not extreme. To be fair, Esselstyn doesn't pretend that either. His is an extreme plan offered to patients facing death.

The movie also discusses osteoporosis as a way to bash dairy intake again. And the fact is that high levels of dairy are not protective. But hold the phone, then they go into the dairy is acidic deal. However, I thought this was disproved. Low fat milk is higher in protein (because the fat is removed) and it's even worse than whole milk, so maybe it is the additional processing and removal of fat? My personal hypothesis is that milk isn't protective as expected because it doesn’t have the correct ratio of calcium/phosphorus/potassium unlike say… BEANS, which have Ca/P/K content ratio that is closer to human bones. Again, that's worth every penny you just paid to read it.

So at the end of the movie, they show Ann Esselstyn serving up salad. But folks… the set up is to make the food look like it’s this bounty that can’t be beaten, but the bottom line is: if you are used to eating calorie dense animal products… this does NOT look satiating. On. Any. Level. She was serving up moderate sized bowls of lettuce leaves… literally less than 50 calories per bowl (there was only leaves, and we know the Esselstyns don’t use oil) The volumetrics idea only goes so far. A human body needs enough calories to function. A tiny bowl of lettuce ain't going to cut it.

Bottom line: The movie is well done and even interesting but in the end amounts to vegan propaganda. Should people (American in particular) eat less animal products? Yes, absolutely, but does that mean that we should all become vegan? No, I don't think the evidence and data in hand supports that conclusion— for health.

Why that last minute proviso? Look, if someone is vegan because they do not want to kill or exploit animals (collecting eggs and milk is definitely exploiting hens and cows), I get it. I'm not going to argue with them, except to insist they acknowledge that their choice mandates supplementation or food fortification to be healthy. My definition of a healthy diet is one that does not require supplementation. I recognize and respect that others disagree, but that's my bottom line. I like Michael Pollan's "eat real food, not too much, mostly plants," line. It's how I strive to eat.

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