Opinionista Ivo Vegter 14 February 2018

What the Health: How two filmmakers have created a scare-fest through lies, laziness and silly claims about eggs

Described by its makers as a “documentary”, this propagandist film makes a lot of sensational claims but is weak on facts. By IVO VEGTER.

Filmmakers Kip Andersen and Keegan Kuhn are at it again. Last time around, they crowdfunded “the film that environmental organisations don’t want you to see”, about the dangers of animal husbandry and the need to go vegan. They got almost every major fact wrong, so I’m not sure environmental organisations cared all that much.

A few of my readers asked for an opinion on their latest attempt at a documentary, entitled What the Health. To them, I’d like to say thanks for wasting 92 minutes of my life. But now that I’ve seen it, I might as well rip the rug from under it.

This film is billed as “the health film that health organisations don’t want you to see”. Again, however, I don’t think any health organisations particularly care. The filmmakers’ only evidence for their conspiracy theory is that some such organisations get funding from the food industry, and few such organisations were interested in justifying why they didn’t feature this or that cherry-picked study on their website, giving credence to outlandish claims about diet. As we will see, they probably thought the filmmakers were neither arguing in good faith, nor sufficiently well-informed, to grant extensive interviews.

Andersen opens the film by saying he has a family history of heart disease, diabetes and cancer. In evidence of that history, he cites his father, who has heart disease, a grandfather who died young of diabetes complications and two grandparents who died of cancer. In other words, he has a perfectly normal family in which people die of various causes and leave behind anecdotal evidence of having done so.

In the rich world where Andersen and Kuhn live, the biggest threat to life and limb is no longer infectious diseases such as smallpox, rabies, measles, typhus, chickenpox, malaria, whooping cough, leprosy, syphilis, cholera, polio, tuberculosis, typhoid fever, infections and the common flu. Those have all been conquered by the health organisations the filmmakers so despise. As a result, life expectancy has roughly doubled over the last century or so. People now live long enough to die of degenerative conditions such as heart disease, diabetes, pulmonary disease, dementia, stroke and cancer.

Despite this dramatic progress in human health and his family’s perfect fit to this trend, Andersen was a neurotic wreck. He confesses to being “a recovering hypochondriac” who took preventative aspirins, laxatives and “every multi-vitamin I could get my hands on” since his teenage years. He was also big on self-diagnosis books (because who trusts qualified doctors, right?), and considered the WebMD symptoms checker to be “essentially my browser’s homepage”. He was paranoid that he, too, would die of the diseases that claimed his grandparents.

I have news for him: unless he is unlucky and an infectious disease or accident cuts short his life, he almost certainly will die of a degenerative disease, just like his grandparents did. Everyone dies of something, and that is how people with decent hygiene and healthcare tend to die.

He was shocked to learn of the World Health Organisation’s (WHO’s) finding that processed meat might increase cancer rates and uncritically quotes a Fox News presenter saying that “hot dogs and bacon could be just as dangerous as smoking cigarettes”. The film duly cuts to pictures of a mother frying up cigarettes for her children’s breakfast.

This is, of course, pure fearmongering. It simply is not true that processed meat is as dangerous as smoking cigarettes. I’ve debunked the hysteria before, but in brief, the WHO report stated that if you eat a 50g portion of processed meat every day, your risk of colorectal cancer increases by 18%. But that’s relative risk, which is often a big scary number. The real question is what the absolute risk is before and after the increase.

According to one study, the lifetime risk for an otherwise healthy 50-year-old individual with no family history of colorectal cancer is 1.8%. An 18% increase would make that 2.1%. That means instead of six out of 300 people developing colorectal cancer, it might now be seven out of 300. In other words, the risk is small to begin with, and remains small even after a lifetime of eating processed meat every day.

By comparison, smoking does not increase your risk of lung cancer by only a small, incremental amount. It increases your risk by a factor of about 42 (4,233%), assuming moderate smoking and averaging between the sexes. So the relative risk of eating processed meat (an increase in colorectal cancer incidence of 18%) is much, much less than the relative risk of smoking (an increase in lung cancers of 4,233%). The absolute additional risk of developing colorectal cancer when eating processed meat (0.3%) is much, much less than that of moderate smoking (12.4%). The two are simply not comparable, and to do so is either ignorant or dishonest.

The WHO ranks potentially carcinogenic substances not by the level of risk they pose but by the strength of the evidence that they are carcinogenic in some (potentially tiny) degree. The Atlantic magazine has a good explainer, but here is the WHO itself, in its Q&A document about the processed meat finding:

Processed meat was classified as carcinogenic to humans (Group 1). Tobacco smoking and asbestos are also both classified as carcinogenic to humans (Group 1). Does it mean that consumption of processed meat is as carcinogenic as tobacco smoking and asbestos?

No, processed meat has been classified in the same category as causes of cancer such as tobacco smoking and asbestos (IARC [International Agency for Research on Cancer] Group 1, carcinogenic to humans), but this does NOT mean that they are all equally dangerous. The IARC classifications describe the strength of the scientific evidence about an agent being a cause of cancer, rather than assessing the level of risk.”

Apparently, this confuses the hell out of uninformed people, such as Fox News presenters and the makers of What the Health, who truly believe a total absurdity: that bacon for breakfast is as dangerous as carrying radioactive plutonium in your pocket.

Many other foods also contain carcinogens. Wine and beer increase your risk of cancer. Food that is browned, such as stir-fried vegetables, produces carcinogenic compounds. In fact, many fruits and vegetables naturally contain carcinogenic compounds, even when raw. One example is acetaldehyde, a volatile organic compound. It pollutes the air when produced by burning fossil fuels, such as in cars. It is one of the main carcinogenic agents produced by both smoking and drinking alcohol. It is a Group I carcinogen, just like processed meat, smoking, asbestos and plutonium.

Acetaldehyde also occurs in broccoli, garlic, cucumber, carrots, wheat and rye bread, vinegar, melons, oranges, strawberries, pineapples, peaches, plums, apples, pears, mushrooms, tea, coffee and green tea. In some of them, it occurs at levels comparable with alcoholic drinks. Put that in your vegan pipe and smoke it.

Conversely, although it is widely believed that moderate fruit and vegetable consumption reduces the incidence of a variety of cancers, “no protective effects have been firmly established” by 30 years of research. Studies on the subject have been inconsistent and inconclusive.

If they were consistent, this would be enough evidence to lead the filmmakers to conclude that fruit and vegetables are bad for you. That would be an absurd conclusion, of course, but no more absurd than the conclusion that any meat at all is bad for you. As the WHO says, eating meat has known health benefits, but it is reasonable to advise people to limit intake of processed meat and red meat.

Andersen claims not to have known that “processed meat includes hot dogs, bacon, sausages, salami, ham, pepperoni, cold cuts and deli slices”. Presumably he thought salami grew on salami trees, before he learned astonishing new things while Googling stuff for his film. So, three minutes into the movie, the moderately well-read viewer (who knows ham is not like potato) already has formed an impression of the auteur as neurotic and ignorant.

He says: “Government and media almost exclusively blame lack of exercise and sugary foods as a cause of diabetes.”

But this is not true. Hardly anyone blames sugary foods. The Mayo Clinic says the causes are genetic and environmental, and being overweight is strongly linked to type 2 diabetes (the most common form of diabetes, also known as diabetes mellitus or adult-onset diabetes).

The National Institute of Diabetes and Digestive and Kidney Diseases says diabetes is caused by several genetic and lifestyle factors, including being overweight and inactive. It also lists other diseases and some medicines as possible causes.

The filmmaker’s own favourite website, WebMD, says “obesity and lack of physical activity are two of the most common causes of this form of diabetes”, accounting for 90% to 95% of cases in the US.

Risk factors listed on these three sites are age, family history, race, high blood pressure, low HDL (“good”) cholesterol levels, high triglyceride levels, a high-fat diet, high alcohol intake, a history of gestational diabetes, physical inactivity, a history of heart disease or stroke, depression, polycystic ovary syndrome, acanthosis nigricans and being overweight. Not one of them says a word about dietary sugar.

EndocrineWeb says diabetes is caused by genetic factors and lifestyle choices such as physical inactivity and being overweight, and adds: “A meal plan filled with high-fat foods and lacking in fibre (which you can get from grains, vegetables and fruits) increases the likelihood of type 2.” Not a word about sugar.

The Diabetes Research Institute Foundation (sic) says type 2 diabetes “is tied to people who are overweight, with a sedentary lifestyle”. Nothing about sugar.

The American Diabetes Foundation says: “Myth: Eating too much sugar causes diabetes.” It adds, however, that calories from any source, including sugar, can contribute to weight gain, which is a cause of diabetes. It also adds that there is research that links sugary beverages to type 2 diabetes.

The Centers for Disease Control and Prevention say risk factors for type 2 diabetes include older age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and race or ethnicity. No mention of sugar.

So the claim that lack of exercise and sugary foods are the causal factors for diabetes “almost exclusively” is – again – either ignorant or dishonest. Sugar is rarely blamed, although a few recent studies suggest it probably is a risk factor. This stands to reason, since too much sugar makes you fat.

Andersen goes on to quote a doctor who denies that carbohydrates or sugar cause diabetes (despite the available research about sugary drinks and high-glycemic index carbohydrates), and instead simplistically attributes it to “a diet that builds up the amount of fat into the blood”. He adds: “I’m talking about a typical meat-based, animal-based diet.”

Besides the fact that the term “fat” is far too vague to be useful in this context, this doesn’t contradict anyone. Everyone says high levels of saturated fats and trans-fats are a risk factor in diabetes. Everyone says high triglyceride levels are a risk factor.

To Andersen, it’s a revelation, however. He was always told differently. But then, he didn’t know that cheese grillers were processed meat either, so it can’t be very hard to surprise him.

This isn’t to say diet does not affect your health, including the development of chronic diseases. Of course it does. But acting like doctors or government officials do not recognise diet as a factor in these diseases is, quite simply, nonsense.

He quotes another doctor who says that carbohydrates cannot make you fat, because the body can’t turn carbohydrates into fat. This is patently false, since the mechanism by which carbohydrates are metabolised into fat is well established.

There is a lot of contradictory research on whether carbs or fat are bigger culprits in obesity, and which to focus on if you’re aiming to lose weight. Randomised controlled trials suggest a low-carbohydrate diet leads to better weight-loss results. Others say reducing dietary fat is the key. Some say you need lots of mono-unsaturated fats, which can be found in red meat, animal fats, dairy products, high-fat fruits such as avocados, peanuts, cashews, sunflower seeds and olives (and their oils), as well as cereals, including whole-grain wheat. Still other studies say it makes no difference: reduced-calorie diets work no matter which macronutrients they emphasise. Conversely, excess calories make people gain weight no matter whether they’re from fat or carbs.

This means that if our dear doctor based his opinion on medical research, he was cherry-picking, at best, and ignorant at worst. And so was our filmmaker.

Just 15 minutes into the movie and the entire premise is already falling apart. Almost everything the filmmakers say turns out to be untrue, exaggerated or misunderstood. They cherry-pick research that suits their conclusion and ignore research that doesn’t. They confuse correlation with causation in clinical trials. They produce anecdotal evidence from amateur interviewees, which are emotionally gripping but scientifically meaningless.

Let’s spot-check just a few other points. The film draws a comparison between egg consumption and smoking cigarettes, citing an unnamed study that said eating one egg a day is as bad as smoking five cigarettes a day. A study that made such a comparison didn’t actually say that and, more importantly, it has been roundly criticised for methodological errors and presenting data that does not support its conclusions. It’s garbage, in other words.

The filmmakers claim that eating dairy products increases cancer risk. They say women who eat dairy products are much more likely to die of breast cancer, although the actual evidence for this claim is “blurry and partially contradictory and equivocal”. One study found a reduced risk of cancer in women who consumed the most dairy. Another found “no consistent association between milk consumption and all-cause or cause-specific mortality”. Yet another found the consumption of dairy products such as yoghurt had significant benefits, such as a lower risk of obesity and cardiovascular disease. The idea that moderate dairy consumption is bad for your health, again, is nonsense.

The pair quote a doctor saying: “The data is crystal-clear, that you can stop and reverse heart disease with plant-based diets.” That stands to reason, if you suppose that heart-disease patients are also likely to eat meat and fat to excess. But the data is also crystal-clear that any other diet can stop and reverse heart disease, including low-fat diets with moderate amounts of meat and low-carb diets with significant meat consumption. The key is lower blood pressure induced by weight loss, and weight loss is not dependent on going vegan.

The film claims you shouldn’t be eating fish because of pollutants, saturated fat and cholesterol. But nutrition research says otherwise: “Fish is a very important part of a healthy diet. Fish and other seafood are the major sources of healthful long-chain omega-3 fats and are also rich in other nutrients such as vitamin D and selenium, high in protein and low in saturated fat. There is strong evidence that eating fish or taking fish oil is good for the heart and blood vessels. An analysis of 20 studies involving hundreds of thousands of participants indicates that eating approximately one to two three-ounce (85-gram) servings of fatty fish a week – salmon, herring, mackerel, anchovies or sardines – reduces the risk of dying from heart disease by 36 percent.”

More generally, the film argues that chronic diseases are caused by eating meat and dairy and, conversely, that the right food (vegan food) is all the medicine you need to cure heart disease, cancer, diabetes and obesity. Right at the start, they quote Hippocrates: “Let food be your medicine and medicine your food.” Citing an authority who lived 2,400 years ago, before humanity had any scientific knowledge about either food or medicine, shows just how laughable this extreme claim is.

It was refreshing to read the reaction of a vegan dietician, Virginia Messina: “As a vegan health professional, I am sometimes mortified to be associated with the junk science that permeates our community. And as an animal rights activist, I’m disheartened by advocacy efforts that can make us look scientifically illiterate, dishonest and occasionally like a cult of conspiracy theorists… I wish What the Health had stuck to … an informed discussion of the evidence. Instead, it cherry-picked the research, misinterpreted and over-stated the data, highlighted dubious stories of miraculous healing, and focused on faulty observations about nutrition science.”

Her detailed critique is worth reading in its entirety even if you don’t buy her arguments about veganism and animal rights. In it, she remarks that Andersen’s claim to have resisted switching to a vegan diet upon making the discoveries he documented in the film are contradicted by his own partner in the film, Kuhn, who says he’s been a vegan for years. That alone convicts him of manipulative dishonesty.

It grabs headlines to advocate simplistic extremes, such as a low-fat diet, a low-sugar diet, a low-carb high-fat diet, or an all-vegan diet. However, most reputable nutritionists and dieticians advise a balanced diet with a wide variety of foods eaten in moderation.

What this film should have concluded from the evidence is that some people could benefit from reducing their meat consumption and eating more fruits and vegetables. That is obviously true. It would also be consistent with the complex, incomplete and sometimes contradictory nature of the evidence on diet and nutrition. The best diet for any particular individual is a far more complex and nuanced affair than simply eliminating entire food groups from the menu.

Documentaries contain occasional facts and at least a little lightweight reasoning. By this definition, What the Health cannot be called a documentary. From start to finish, it is delusional, extremist vegan propaganda based on ignorance, misunderstanding, exaggeration, logical fallacies and outright lies. It is impossible to take seriously. DM

Gallery

While we have your attention...

An increasingly rare commodity, quality independent journalism costs money - though not nearly as much as its absence.

Every article, every day, is our contribution to Defending Truth in South Africa. If you would like to join us on this mission, you could do much worse than support Daily Maverick's quest by becoming a Maverick Insider.

Click here to become a Maverick Insider and get a closer look at the Truth.


Days of Zondo

Ajay Gupta tackles Jonas testimony from his Dubai safe haven

By Jessica Bezuidenhout

Towns near Fukushima are now being plagued by hordes of rampaging radioactive wild boars. Where are Asterix and Obelix when you need them?