We have all heard, at one time or another, that it is impolite to discuss religion or politics at the dinner table. Not discussing such evocative topics is a method of engineering a peaceful mealtime environment. But how about discussion of the meal itself – could that, too, be a source of strife?
Most people enjoy eating, and they enjoy eating their diet – which is not only cultural, but also extremely personal. Diet is necessarily universal, but the range of diets enjoyed by humans around the world is simply staggering. From Arctic Eskimos who in the 1920′s, were reported to rely on fish and mammalian foods for 80-100% of their calorific intake (although this has been disputed), to Mediterranean populations who eat an extremely high-plant diet, all seem, at first glance, to thrive. It is therefore unsurprising that dietary criticisms are often met with abrupt defence – not a relaxing topic for the dinner table.
The nutrition landscape is densely populated, and confusion is rife. Self-proclaimed experts jostle for position amongst researchers, health professionals, and industry representatives. There is also very significant overlap, as industry groups fund research and lobbying, and provide educational information. Industry funded organisations such as the Centre for Consumer Freedom espouse the notion that consumers should eat whatever they want, while simultaneously promoting the fast-food products of their supporters. Unsurprisingly, the message that it is okay to do whatever one wants is a popular one!
From this confusion, is it possible to draw any real conclusions about the health benefits of any specific diet? Certainly we are familiar with the claims of self-proclaimed diet experts, although these are usually intended for weight-loss rather than overall health benefits. Dr Robert Atkins created one of the first popular weight-loss programs, the Atkins Nutritional Approach. This low-carbohydrate programme may result in weight loss, but may also result in “complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities”. More recently, the South Beach Diet has become popular, even in the face of significant criticism. In the case of both the South Beach Diet, and the Atkins Nutritional Approach, the creators were cardiologists; doctors whom the public should be able to trust for nutritional information.
In a nutritional camp a great distance from the likes of Dr Atkins, a group of doctors and nutritionists suggest that the bulk of scientific evidence does point to single health-promoting diet. Among the best know of this group are T. Colin Campbell Ph.D, and doctors Dean Michael Ornish, John A. McDougall and Caldwell Blakeman Esselstyn. They conclude that a diet consisting of plant-based whole-foods, is health promoting, and the further from this diet one moves, the higher the risk of chronic diseases. To clarify, a plant-based whole-foods diet consists of plant-based foods which are minimally processed. This does not mean raw foods, it simply excludes or minimises highly refined food products, such as white bread, refined sugar and potato chips.
There is a large amount of evidence supporting claims that diet can have an enormous impact on heat disease. The plant-based whole-foods diet has been shown to prevent, halt, and even reverse heart disease. Much research surrounding diet and heat disease has been carried out, stretching back to the Framingham Study which began in 1948, and identified the common risk factors of heart disease. More recent epidemiological work, such as the China Study, supported the ‘risk factors’ view, but suggested that these risk factors were not simply predictors of heart disease, but themselves functions of diet.
Dr Caldwell Esselstyn worked as a cardiologist at the prestigious Cleveland Clinic, where he developed a programme of preventative cardiology. His programme was centred on a plant-based whole-foods diet, and successfully treated many patients. Dr Esselstyn wrote, in T. Colin Campbell’s 2006 book The China Study that the results achieved with the programme were consistently better than those achieved using conventional drug-based approaches. In 2000 Dr Esselstyn retired, but he continued to try to persuade the Cleveland Clinic to continue the programme he initiated.
I have now treated a number of senior staff with coronary disease at the [Cleveland] Clinic – senior staff physicians. I have also treated a number of senior staff trustees. One of the trustees knows about the frustrations we’ve had trying to get [the diet-based preventative programme] into the Clinic, and he says, “I think, if the word gets out that Esselstyn has this treatment that arrests and reverses this disease at the Cleveland Clinic, and it’s been used by senior staff and he’s treated senior trustees, but he’s not permitted to treat the common herd, we could be open for a lawsuit”.
It’s a strange state of affairs; a proven treatment, supported by research, is being passively shot down. There is an adherence to the status quo, a resistance to alternative ides, which is evident throughout the literature. One typical examples states that “in vegetarians, a decrease of ischemic heart disease mortality was observed probably due to lower total serum cholesterol levels, lower prevalence of obesity and higher consumption of antioxidants”. This statement implies that the lower serum cholesterol levels, lower obesity and higher consumption of antioxidants were unrelated to diet rather than, as appears more logical, a direct result of it. The tone of this article, particularly the conclusion, implies that vegetarian diets do not have an overall effect on health and mortality, while the data suggests the opposite.
The literature is full of such assumptions and misinterpretations. For a long time vegetarians, and in particular vegans have been told that they cannot obtain enough protein from their diet. Searching PubMed, ProQuest and Google Scholar, I was unable to find any reports of protein deficiency in vegans in developed countries. So the argument turned to amino acids – surely vegans cannot obtain all of the eight (or so) human-essential amino acids from plant-based foods. When presented with the well established evidence however, even the American Dietetic Association acknowledges that they can. The vegan community is quick to point to athletes and bodybuilders who eat no animal products, as a demonstration that ample protein can be obtained from plant sources.
Most of the epidemiological research comparing chronic disease in vegans/vegetarians with omnivores, focuses on the health claims of the vegetarian/vegan camp. While this is entirely understandable, it often leads the researchers to compare vegans and vegetarians only to the most ‘health conscious’ omnivores. This comparison relies on an enormous assumption – that all vegans/vegetarians follow their diets for health reasons. It seems likely that the two most common reasons for following a vegan/vegetarian diet are a belief in animal rights, and a particular cultural heritage. Put simply, the research compares omnivores who follow health-concious diets, exercise, and generally take care of themselves, with vegetarians/vegans who may not be health conscious. It is perfectly possible to be a vegetarian and eat nothing but cheese and potato chips. This is a significant flaw in methodology.
An additional problem encountered in research is the low number of vegans in the general population. Lacto-ovo vegetarians (those who eat dairy and eggs) may consume high levels of these animal products as a ‘substitute’ for meat. From the standpoint of the plant-based whole-foods diet, these products may have similar detrimental health effects to meat. Based on that speculation, the lacto-ovo vegetarians should perhaps be grouped with the omnivores, not the vegans.
These are but a few of the challenges facing research in this field, especially when it is carried out in westernised countries. It is for this reason that the China Study, comparing populations in rural China, and intervention studies, such as those conducted by Dr Esselstyn, are so valuable.
It is worth noting that the diet regimes, as well as the science conducted by the supporters of the plant-based whole-foods diet do not receive much professional criticism. Of course, fine points of research can be debated, and certain conclusions questioned, but on the whole, their interpretations have stood the test of peer-review. T. Colin Campbell’s book The China Study, which does much to summarise the science, has generally been well received by others in the field. Arguments agains the diet have been made based on evolutionary evidence which suggests humans evolved consuming a high animal-protein diet.
So what of other chronic diseases, can they too be mitigated by diet? The evidence regarding heart disease is the most compelling, however that is partly a function of the sheer volume that has been carried out. Other diseases for which there is compelling evidence are obesity (1 2 3 4 5 6) and type II diabetes (1 2 3 4 5). Risk of osteoporosis may be increased with consumption of animal products, particularly dairy products – this has been discussed previously. The risk of various cancers is believed to be related to diet. Certainly, obesity is a very strong risk factor, and consumption of ‘excessive’ red meat, and a lack of whole-foods, vegetables, fruits and grains, has been linked to various cancers. T. Colin Campbell and others believe that there is a fundamental link between animal products and cancer. In animal trials, his research group was able to demonstrate a remarkable correlation between liver cancer development and animal protein consumption – while plant protein consumption suppressed cancer growth and progression.
The term ‘balanced diet’ is widely used. It implies that all foods are okay in moderation; a healthy diet is one which is moderate in many things, and excessive in none. But this idea is not as intuitive as it as first sounds. We can see that high animal-product, high protein, high fat, low plant-product diets (such as the Atkins Nutritional Approach) are generally unhealthy. They have many potential side effects, including sudden death, and typically adherents are advised to take supplements to compensate for low intake of certain micronutrients. Intuitively, it seems that a diet consisting entirely of animal products would spell health disaster, while a diet consisting entirely of plant products, is demonstrably healthful. This does not support the concept of balance, rather it suggests – admittedly subjectively – a continuum from one extreme to the other. It may be that there is a ‘health optimum’ which involves some animal product consumption, but it is far closer to a plant-based diet than our typical western diet.
The research is not conclusive, and this is hardly surprising. We now consider smoking to be extremely detrimental to health, but it took a disturbingly long time for us to realise that it was detrimental at all. The endless variation of diet and the complexities of biological systems ensure that coming to any definitive conclusions will remain extremely difficult.
All we need is a large population of vegans, living an otherwise western diet, so we can research them for the next 80 years…
There is a multitude of reading material surrounding this topic, but probably the best place to start is T. Colin Campbell’s The China Study, and the critiques thereof, links are provided below. For those who would rather watch a movie, try the 2011 documentary Forks Over Knives.
On the pro plant-based whole-foods diet side
The China Study – T. Colin Campbell
Campbell summarises much research, and presents a case for the health benefits of the diet. While other books are perhaps a little more accessible, this provides the best summary of the science. It is not a scientific treatise; Campbell describes it as a documentation of his logical journey through disparate research which overwhelmingly drew a consistent picture.
For criticism of the plant-based whole-foods diet
The Protein Debate – Loren Cordain, PhD; T. Colin Campbell, PhD
This is an excellent debate, well reasoned and thought provoking. The evolutionary argument is intriguing, but may not apply to modern humans – after all, we all hope for a longer life-expectancy than our distant ancestors.
The China Study – A Formal Analysis and Response – Denise Minger
This is a poorly constructed criticism by a young woman with no scientific training. It serves to demonstrate the vigilance which one must use on the internet. The criticism is well written, but poorly reasoned and shows a poor understanding of the science involved. It is essential to also read Campbell’s first response and, more importantly his final response to Minger.
Reply to TC Campbell – Frank B Hu and Walter Willett
A well reasoned and argued criticism from scientists involved in the Nurses’ Health Study. Note Campbell’s criticism of the Nurses’ Health Study, and Hu and Willett’s criticism of Campbell’s international studies.