Forks Over Knives: Can a Plant Based Diet Reverse Disease?

“Isn't it enough to see that a garden is beautiful without having to believe that there are fairies at the bottom of it too?” Douglas Adams

There’s no doubt in my mind that the western diet – characterized as highly processed, animal product rich, sugary, fatty and salty – is bad for our health. Its spread is closely followed by a huge rise in the incidence of obesity and several “western” chronic diseases such as heart disease, hypertension and type 2 diabetes.

Traditional diets and especially plant based diets are associated with much healthier populations and lower risk of many diseases. Ample amounts of evidence show that.

Since I know that a whole foods, plant based diet is the best nutrition advice we can come up with, and I’m a lifelong vegetarian (for a multitude of reasons, the main one being animal welfare) I expected Lee Fulkerson’s documentary “Forks Over Knives” to be music to my ears.

Forks Over Knives

Forks Over Knives follows the research and personal journeys of nutrition scientist Dr. T. Colin Campbell (The China Study) and surgeon Dr. Caldwell Esselstyn. Campbell and Esselstyn independently came to the conclusion that abandoning the American diet and maintaining cholesterol levels well below those historically recommended by health policy experts on a plant based diet can prevent and even reverse heart disease and other illnesses.

The movie is peppered with engaging personal tales of people whose lives were changed by a plant-based diet: A diabetic mother, a diabetic, hypercholesterolemic meat-loving landscaping company owner, a vegan mixed martial artist, and the film’s writer and director, Fulkerson, himself – his Red Bulls and soda habit led to less than stellar lab results. Vegans, we learned, not only are healthy, some of them are really cool and really strong.

The vibrancy on the 70 something year-old vegan doctors and their plant-eating patients and the beauty of the rainbow-colored veggie fruit and grain dishes are in sharp contrast to the footage of obese, sickly, tired people and greasy super-sized unappetizing meaty food.

Forks Over Knives advocates an idea I generally believe to be true. It is a rather entertaining film, and definitely good food for thought.

However, it falls short on nuance, balance and hard facts and pushes a strict vegan way of life beyond what the science presented can support. Here are a few of my qualms:

• Where are the nuts?

The first question that comes to mind when watching a movie about food-as-cure is what’s the recipe? Forks Over Knives isn’t very clear on what the various people shown in the movie are eating. Prominent in their visual absence are the nuts – a mainstay of many plant based diets. I suppose nuts and seeds aren’t mentioned because Dr. Esselstyn’s diet, which arrested and even reversed severe coronary disease, I found out when I pulled out his study, is a very low fat vegan diet, which eliminates not only all animal products including eggs and dairy (except non-fat milk and yogurt), but also nuts, avocados and all vegetable oils. No extra virgin olive oil in this one. Perhaps sharing these details would have made this food-cure less tenable and less of a no-brainer, and that’s why the details weren’t presented.

Dean Ornish’s study, not mentioned in the movie, is an interesting comparison. Ornish’s regimen, which includes stress reduction through yoga and meditation, a low-fat vegetarian diet, smoking cessation, and regular exercise, also not only stopped the progression of coronary artery disease in the 20 patients in the treatment group, but also reversed some of it. The Ornish diet is very similar to the Esselstyn diet, but allows for some nonfat dairy products -- skim milk, nonfat yogurt, nonfat cheeses, nonfat sour cream, and egg whites. (Nuts and oils are out in the Ornish regimen, too.)

What the Esselstyn and Ornish diets have in common is not only very low intake of animal products and lots of wholesome plants – they’re both very low fat diets.

• Could food be the only medicine we need?

Although it is not explicitly said, the movie gives the notion that a plant based diet is all you need to reach a cure. The patients depicted gladly abandon all their diabetes, hypertension and cholesterol lowering meds upon adopting the lifestyle. (Dr. Esselstyn does note that in acute cases a coronary bypass is necessary).

However, in Dr. Esselstyn long term study, on which much of the movie relies, the patients* with severe coronary artery disease were on cholesterol-reducing medications as well as on a plant-based diet. The combination of diet and drugs is what got Dr. Esselstyn’s patients to a blood cholesterol of 150 mg/dL and to no repeat heart events.

• If high amounts of animal food are bad, does it prove that we should eat none at all?

If a little is good, more isn’t necessarily better (think vitamin toxicity), and I don’t think it’s self-evident that if meat consumption is correlated with disease – which is what the China Study showed – consuming any amount of animal products is harmful.

And although Dr. Esselstyn had remarkable results in his study of 17 heart patients on a low fat vegan diet, since there was no non-vegan control group, we can't really conclude that veganism cured his patient’s arteries.

• Can a plant based diet cure metastatic breast cancer?

Perhaps the most disturbing bit in Forks Over Knives was the story of Ruth Heidrich, a breast cancer survivor now in her 70s, 30 years after the diagnosis of metastatic breast cancer. Ruth, a six-time Ironman Triathlon finisher, tells a story of miraculous healing through a vegan diet and exercise. This, unfortunately, is an anecdote – there are no studies showing that a vegan diet alone can treat breast cancer. Suggesting a vegan diet can cure cancer is dangerous and irresponsible, especially when the movie features several authoritative medical doctors and scientists.

Eat food. Not too much. Mostly plants

I was glad I came to Forks Over Knives already “sold” on a plant-based diet, because the movie oversold plant-based diets to the point in which those of us not already in the choir might not think of joining.

Michael Pollan’s less assured and more moderate recipe for healthy eating, summed succinctly in “Eat food. Not too much. Mostly plants”, has, I think, much more of a chance of changing people’s mind and behavior.

Between the convenience-foods/fast-food diet and the strict vegan diet there are many shades of green. Adopting a more wholesome plant-based diet isn’t an all or nothing choice, and you can definitely eat for pleasure – and not just for health – while eating mostly plants.

Forks Over Knives reminds us of the prevention and healing powers of a healthy diet – a power that can’t be denied. I’ll need lots more proof before I believe in fairies, but the garden sure is beautiful!

Dr. Ayala

*Dr. Esselstyn’s study group initially included 22 participants, 5 dropped out within 2 years, 11 completed 5.5 years of follow-up, and at 10 years 6 were still on the diet.

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!