Summary Of Forks Over Knives

Forks over Knives is a documentary detailing the global illnesses and obesity crises due to the “Western diet”. 40% of Americans are obese and over half are taking some form of prescription drug. Lipitor, a statin drug, is the most prescribed drug in the world, although there are genetic mutations many people have that are linked to statin sensitivity (1). More than 2.2 trillion dollars a year are spent on healthcare. More per person is paid on healthcare than any other industrialized country. Heart disease and cancer kill over one million Americans every year. Also chronic fatigue is an epidemic in this country. It is masked by overuse of sugar, caffeine and similar stimulants such that people are unaware of their health conditions.
Researchers are proposing elimination of refined, processed and animal based foods will prevent and reverse several of our worst diseases. They recommend adopting a whole foods, plant based diet. The narrator, Lee Fulkerson underwent a diet analysis under the care of two physicians in Los Angeles, Dr. Matt Letterman and Dr. Alona Pulde, in an effort to learn more about the link between food and health. These physicians incorporate a plant foods nutrition plan t=into the treatment of their patients. He underwent a twelve week nutrition program to treat an elevated CRP number. This is a measure of C - reactive protein, as a marker of the level of systemic inflammation.
The efforts of Dr. Colin Campbell and Dr. Caldwell Esselstien are described in this film. These doctors have made groundbreaking efforts in identifying the link between meat and processed foods to cancer and obesity. Both doctors grew up on farms, but didn’t know each other until late in life. Dr. Campbell’s family owned a dairy farm in rural Virginia. Growing up, milk was considered to be Nature’s perfect food. The Esselstien farm is in upstate New York. They raised both beef and dairy cattle. During their lifetimes, the American diet has changed considerably. Milk, processed food (including sugar) intake has nearly doubled in the past 100 years. Convenience food was popularized during the 1950’s, during the post WWII era. TV dinners, pastries, and convenience foods emerged which were devised to make our lives easier.
Dr. Colin Campbell was in graduate school at Cornell University, a place with one of the most prestigious nutritional science departments in the country. He specialized in animal nutrition and biochemistry. His research was on animal feeding as they are able to produce protein containing products including milk, meat and eggs. Protein was considered to be the vital nutrient, “the vital force” and is always synonymous with animal based foods. It wasn’t until the early 1900’s that the fact plant foods also have proteins came into play. In the early 1900’s the view in the nutrition community was to increase worldwide protein consumption in order to feed starving communities all over the world. At this time, Dr. Esselstien was beginning his career at the Cleveland Clinic in the 1960’s. Coronary artery disease was on the rise at this time. This disease forms due to buildup of cholesterol in the heart’s arteries. Cholesterol is a natural substance produced by all animals, and a part of cell walls. When cholesterol is consumed as a part of a diet, it remains in the bloodstream, and builds up in the arteries as plaque (2). It was a colleague of Dr. Esselstien's who successfully performed the first bypass graft in 1967. Today, over 500,000 Americans undergo coronary bypass surgery annually due to the rise in coronary artery disease. Each operation costs around 100,000 dollars.
Joey Acoin was one of the participants in this documentary. In the beginning he had a dangerously high cholesterol level of 320 mg/dL, and a blood sugar level of 480. He took 6 medications every day for the past four years before this study. Working with Doctors Letterman and Pulde he lost 29 pounds and eliminated 4 out of the 6 medications.
In the 1960’s Dr.
Campbell was in the Philippines trying to get protein to malnourished children. In order to keep costs down he and his colleagues decided against using animal based protein. Then Dr. Campbell discovered the more affluent families that were eating high amounts of animal based foods had children that were more susceptible to getting liver cancer. He found research supporting the effect of dietary protein on the carcinogenesis of Aflatoxin. This research conducted in India measured the carcinogenesis developing in lab rats after being fed daily doses of Aflatoxin, while being kept on a diet in high in protein and low in protein, respectively. This research paper showed a low level of milk (casein) protein to have a protective effect against liver tumors. Aflatoxins are naturally occurring mycotoxins that are produced by the species Aspergillus. Aflatoxin has a known ability to produce hepatocellular carcinoma and is one of the most carcinogenic compounds in nature (2). They are also found abundantly in plant derived foods that have been contaminated, especially in the economically developing world (2). Additionally, foods high in Glutathione help to clear the body of carcinogens (4).In a paper by Dr. Campbell, he states that AFb conjugates with GSH at the surface of a transferase (glutathione-s-transferase) in the liver, and with transferase B (ligandin) (4). Increased binding of AFb with liganin has been associated with decreased hepatocyte carcinoma
(4, 5)). I was unable to find any further studies linking casein protein to liver cancer, however there is research linking thermalized casein (ultra-heated) with colonic cancer by increasing protein fermentation in the colon(3,5). Dr. Campbell stated animal protein is excellent at turning on cancer; however it is surprising he didn’t mention Aflatoxin as being a potent carcinogen, and how it is easily found on plant products that are not properly handled before consumption.
The movie also focused on the “Western diet”, and the increasing consumption of high fats, processed foods, and meats with little or no vegetables and fresh foods. There is extensive research connecting the western diet with numerous health ailments, including diabetes, obesity, heart disease, and cancer (6). Researchers have correlated a diet high in fat, but lower in calcium, vitamin D, and fiber to be a cause for intestinal cancer (6).
During the 1970’s the war on cancer was initiated by President Nixon, however the western diet only increased in proportions. By 1978 Dr. Esselstien was the chairman of the breast cancer task force at the Cleveland Clinic. He began researching breast cancer and found that the incidence of breast cancer in Kenya was far lower than the United States. Also Prostate Cancer was found to be significantly lower in Japan than in the Unites States. He found a correlation between the lower incidence of breast and prostate cancers, and heart disease. He also found that “Western diet” components to be nonexistent in their diets. Additionally he mentioned the correlation of German occupation in Norway with the lowering of cardiovascular disease do to the unavailability of meat and dairy products during the occupation.
Dr. John MacDougal began practicing medicine on a sugar plantation in Hawaii in the 1970’s. He found immigrants of Japan and the Philippines were trim and fully functional into their 80’s and 90’s. First generation children of these immigrants became heavier, and when the second generation was born (the grandchildren of the immigrants); they were just as obese as average Americans. The main difference was the diet. Second generation children had completely abandoned their traditional foods, and adopted the “western diet”.
Dr.’s Campbell and Esselstien had come independently to the conclusion that many diseases could be eradicated by eating a whole foods plant based diet. They promote a diet that is high in minimally processes vegetables, fruits, grains, and legumes. They also recommend avoiding foods such as bleached flour, refined sugar and oil. Dr. Campbell states that a diet consisting of 20% plant protein did not promote tumor growth or cancer. He described how cancer begins in the genes which become oncogenes. This may be inherited or through a mutation. Poor nutrition promotes many genes to turn into oncogenes, which then progress to form tumors. He found processed foods promote cancer via the “symphony: of chemicals they contain and a lack of nutritional elements.
In 1973 a farm subsidy bill which included incentives to farm owners to massively increase corn production was formed. The increased production in corn also created the byproduct of high fructose corn syrup. This is an unnaturally rich food which fools stretch and density receptors in the stomach. Unnaturally rich foods fool a person into thinking they are not full. A person will believe they have to eat more as they don’t sense they are satisfied. Evolutionary biologist Dr. Doug Lisle, PhD., also discusses the motivational triad for food. This trio of biological mechanism exists in every creature. It is a way to pass genes on from one generation to the next. The motivational triad consists of three legs. The first leg involves food and sex. The other two legs involve avoiding pain and getting things done with the least amount of effort, (energy conservation). Rich foods excite human senses in that they provide a high amount of dietary reward with the least amount of effort. Evolutionarily this reward system helped our ancestors find highest amount of calorie rich foods available. Today, the calorie rich artificial foods provide a hyper-activation of the brains pleasure center, leading a person into the “pleasure trap”, according to Dr. Lisle. Additionally PET scans and fMRI imaging studies have found irregularities in response to food cues in regions of the brain implicated in reward, including the striatum, orbitofrontal cortex, and insula (7). Dr. Lisle has provided a similar example of the brain’s pleasure center being hijacked through drug addiction. Highly concentrated processed foods are thus giving drug like effects to our neural circuits. In another study, researchers correlated stress related food reward behavior to be dependent on the hormone ghrelin (8). Dr. Terry Mason MD of Chicago contends that the less affluent sectors of society or those that have a lower socioeconomic status have difficulty making the best food choices due to less food availability in their neighborhoods. This community also has higher levels of stress and depression due to their lower SES, which is increases their ghrelin levels (8).
Dr. Esselstien works with patients to teach them how to incorporate a plant based diet and eliminate heart disease symptoms. He lectures all over the United States. His wife is often present providing instruction and demonstrating how to prepare plant based foods.
In 1973 Zhou En Lai, the Premier of the People’s Republic of China was diagnosed with bladder cancer. He initiated a large scale scientific study on cancer. Researchers cataloged the mortality patterns of specific cancers between the years of 1973 and 1975. He died before the study was complete but this study became the capstone of Dr. Campbell’s research. He works alongside Dr. Jung Shi Chen who is with the Center for Disease Control and Prevention. Their research found different cancers clustered in various hotspots. They found Chinese people who are genetically all the same have big variations, regionally in different forms of cancers. They both attributed these cancers to environmental influence, particularly diet and tobacco (9). They found at least 96,000 correlations between diet and disease.
Dr. Esselstien began a study with 24 patients on mostly plant based foods, minimal milk protein and minimal medication. He was sent patients that were literally on their last leg, those that had failed their first or second bypass and angiogram. He began this study in 1985. 6 patients dropped out initially, leaving him 18. 4 of these patients showed signs of reversal of heart disease. Researchers found endothelial cells generate nitric oxide, which keeps blood flowing, dilates constricted arteries, and inhibits plaque formation. Dr. Campbell also found that nitric oxide is a powerful force eliminating inflammation that accompanies the formation of plaque. The “Western diet” damages endothelial cells. This has been found in several studies indicating a high fat diet enhances cardiac abnormalities (10). High fat foods slowly create dysfunction in endothelial cells via systemic inflammation and oxidative stress (10). Dr. Esselstien found that eating a whole foods plant based diet stops damage to endothelial cells as well as reverses it. Researchers have now found that plant polyphenols are naturally occurring compounds in fruits, vegetables, and cereals (11). These are secondary metabolites of plants and function as antioxidants which help defend against the development of cancer, osteoporosis, obesity and cardiovascular disease among others (11). Five years into the study, Dr. Esselstien removed dairy products from his patient’s diet after learning about Dr. Campbell’s studies and meeting with him. Dr. Joseph Crowe MD was a participant in Dr. Esselstien’s study as well as his colleague. He had suffered a nearly fatal heart attack despite having “healthy” cholesterol levels. Dr. Esselstien’s original 18 patients all survived the initial 12 year study. Erectile dysfunction is one of the first signs of generalized cardiovascular disease. This symptom tells of significant endothelial or vascular disease much earlier than a heart attack.
Ultimate fighter champion Matt Danzig follows a plant based diet exclusively. He finds a better recovery period and more strength eliminating dairy and meat from his diet.
The milk industry recommends the consumption of half a pint of milk daily for calcium and riboflavin. This is a false assumption. In the past fifty years milk has been marketed towards people even more, and the current recommendation is up to three glasses a day. Claims made by the milk industry include strong bones, and reduction of belly fat. Dr. Campbell found that high milk consumption and meat consumption lead to an increased incidence of osteoporosis. This condition is metabolic acidosis. The body draws on its most readily available acid buffer which is calcium from the bones. Bones become weaker as the acid is neutralized. I was unable to find further research on this condition, but I did find an interesting correlation between obesity and osteoporosis. A high BMI imposes greater mechanical loading on the bone, as well as increased adipocytes are a source of increased estrogen production. Estrogen inhibits bone resorption by osteoclasts (12). Dr. Campbell explains how skim milk contains a higher level of protein as the fat is taken out. Researchers have found that as the skim milk is produced, it contains a higher level of IGF-1 and the amino acid Leucine in comparison to full fat milk (13). The amino acid Leucine hyper-activates a signaling pathway mTORC-1 (13). This pathway is a master regulator of dietary synthesis (13). Researchers have found a correlation of high milk consumption and prostate cancer (13).
Dr. David Klurfeld PhD., is a nutritional scientist and national program leader at the USDA. He discusses the changing dietary recommendations as science progresses. Despite these changes, three servings of dairy products a day are recommended as well as meat being a main source of protein. The current USDA recommendations are leading to childhood obesity, according to Dr. Neil Bernard. He gives an example of school lunches including meat products topped with milk and heavily subsidized milk. He states these are government policies in effect, and have nothing to do with the health of the children. The food setup is more of a means to maintain the financial health of the big agribusiness companies. Dr. Bernard found that six of the eleven members on the panel overseeing dietary guidelines had financial relations with the food industry. His group sued the USDA for violating laws on what they are supposed to be doing and the transparency of those laws. His group won the lawsuit. David Klurfeld does not see a problem with having an industry connection with the scientists at the USDA.
Dr. Campbell has been marginalized by key administrators of his own university for changing his views about animal protein. This was after he had secured millions of dollars in research grants for Cornell University’s Nutritional Sciences department. His nutrition class was unjustly cancelled by the division director. The director was a longstanding advisor to the milk industry. Dr. Campbell cites the National Academy of Scientists as being under corporate control. More and more corporate money is funding the scientist panels in recent years. More corporate people are becoming chairs on the NAS committee than ever before.
The food choices we make also have profound global effects. Since the 1970’s, 20% of the Amazon’s rain forest has been cleared. 80% of this is occupied by livestock. It takes 10 times the energy from fossil fuels to produce a calorie of animal based food compared to plant based food. The livestock industry is one of the greatest contributors to global warming, much more than even the transportation industry. Heart disease is still the number one killer in the United States. Stents and bypass surgeries are best used in an emergency and are in no way a means to treat heart disease. Dr. Esselstien also mentioned that stents and bypass surgeries are useful to treat large blockage in the heart, but most heart attacks are caused by the numerous smaller plaques which cause inflammation that leads to blockages.
The narrator lost twenty pounds, had a normalized blood pressure and pulse rate, and his total cholesterol lowered almost 100 mg/dL. His LDL numbers reduced by half simply by following a plant based diet for 13 weeks. He significantly reduced his chances of getting a heart attack without any medication.
Dr.’s Campbell and Esselstien are still vital and active well into their 70’s. This film has been very motivating to me. After watching this film twice I have decided to try a vegan diet for the next 12 weeks. My diet will consist of whole foods which consist of vegetables, fruits, grains and legumes. I am also motivated to change my daughter’s diet as well.

References:
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2. Kensler, T., Roebuck, B., Wogan, G., & Groopman, J. (2010). Aflatoxin: A 50-year odyssey of mechanistic and translational toxicology. Oxford Journals, 120(Suppl1), s28-s48. doi: 10.1093/toxsci/kfq283
3. Corpet, D., Yin, Y., Zhang, X. M., Remesey, C., Stamp, D., Medline, A., Thompson, L. U., & Archer, M. C. (1995). Colonic protein fermentation and promotion of colon carcinogenesis by thermolyzed casein. Nutrition and Cancer, 23(3), 271-281. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/01635589509514381
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