Forks Over Knives is a 2011 American advocacy film and documentary that advocates a low-fat, whole-food, plant-based diet as a way to avoid or reverse several chronic diseases. The film stresses that processed foods and all oils should be avoided. This is sometimes confused with a vegan diet, which in practice can be very different. The whole-food, plant-based diet promotes eating whole, unrefined or minimally refined plant-based foods. Those who adapt the lifestyle will base their diets around foods such as whole grains, legumes, tubers, vegetables, and fruits. It seeks to exclude or minimize any sources of animal-based protein and highly refined foods such as refined sugars, bleached flours, and oils.

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The statements expressed in this film
are not intended to be a substitute
for professional medical advice

Viewers should seek their own
professional counsel for any
medical condition or before starting
or altering any exercise or dietary plan.

The average American now carries 23 extra pounds.

Heart disease and stroke will claim the lives of 460,000 American women.

69 grams of fat. You could actually save 12 grams of the fat and half the calories if you simply ate an entire stick of butter.

We’re talking about diabetes and hypertension and bone diseases, osteoporosis.

Prostate cancer is now the most common cancer in American men.

Doctors say we really need to eat less red and processed meat.

And arterial sclerosis and cancer and autoimmune disease.

We have unprecedented amount of type 2 diabetes in our children, and we’re starting to see hypertension in our children in grammar school.

In case you’re wondering, 2,120 calories.

Clearly the Western diet is taking a toll. This should serve as a wake-up call. We have a growing problem, and the ones who are growing are us.

Food! It’s central to our lives and traditions. Every special occasion seems to involve food and feasting. But could some of these same foods, including several that we think are good for our health, also be causing many of our most serious health problems? Indeed, we’re facing a massive health crisis. No less than 40% of Americans today are obese, and about half of us are taking some form of prescription drug.

The best known statin drug, Lipitor, is the most prescribed drug ever in the world.

Almost one in five American four-year-olds are now considered to be obese.

Though Mexican-Americans and African-American children are still more likely to be overweight.

This could be the first generation of children in the United States that lives less than its parents.

We spend 2.2 trillion dollars a year on health care, over five times more than the defense budget. In fact, we pay more per person for health care than any industrialized country in the world, yet we’re sicker than ever.

Bill Maher: You see, there’s no money in healthy people, and there’s no money in dead people. The money is in the middle: People who are alive, sort of, but with one or more chronic conditions.

Michelle Obama: Obesity, diabetes, heart disease, high blood pressure are all diet-related health issues that cost this country more than $120 billion each year.

Every minute, a person in the U.S. is killed by heart disease. 1500 people a day die from cancer. Combined, these two diseases kill over 1 million Americans every year. Cases of diabetes are skyrocketing, particularly among our younger population.

Diabetes.

Diabetes.

Life-threatening diabetes.

One out of three people born in the U.S. today will develop this crippling condition during their lifetime. Millions of others suffer from a host of degenerative diseases. Millions more of us are so stimulated by sugar, coffee, and energy drinks that we’ve masked our chronic fatigue. But could there be a single solution to all of these problems? A solution so comprehensive, yet so straightforward, that it’s mind-boggling that more of us haven’t taken it seriously?

Bill Maher: Someone has to stand up and say that the answer isn’t another pill. The answer is spinach.

A growing number of researchers claim that if we eliminate, or greatly reduce, refined, processed, and animal-based foods, we can prevent and, in certain cases, even reverse several of our worst diseases. They say all we need to do is adopt a whole foods, plant-based diet. It sounds almost too simple to be true.

Forks Over Knives

You might not expect someone like me to explore the connection between diet and disease.

Lee Fulkerson: On my way over, I drank these two Red Bulls. I also had a 12-ounce Coke and another half of a 12-ounce Coke.

I haven’t always lived the healthiest lifestyle. And I’ve eaten more than my share of fast food. But as part of my effort to learn more about the link between food and health, I visited two physicians in Los Angeles, Dr. Matt Lederman and Dr. Alona Pulde.

Fulkerson: Hi.

Matt Lederman, M.D.: How you doin’?

Fulkerson: Lee Fulkerson.

Lederman: Lee, nice to meet you.

Fulkerson: Nice to meet you too.

Lederman: This is Dr. Pulde.

Lederman: Hi, Dr. Pulde. Pleasure to meet you too.

Both are M.Ds. Dr. Lederman was trained in internal medicine and Dr. Pulde in family practice. They incorporate a whole plant foods nutrition plan into the treatment of their patients.

Lederman: So let’s get started on that, and then we’ll do some talking. 142/82.

I found out a lot more than I expected. Like a lot of Americans, I thought my health was pretty good. I had no major diseases that I knew of. But I hadn’t had a thorough check-up in a while, so I decided to get one. When Dr. Lederman gave me the results, it was a real wake-up call.

Fulkerson: I gotta say I’m kinda shocked. I’m really worried about my blood work numbers. 240 and 241 for my cholesterol is way higher than it’s ever been. I got this six number. That, to me, is the most worrying number I got.

The six number was the result of something called a CRP test, which measures the inflammation in my heart and blood vessels. This put me in the high-risk category for a heart attack. So I committed to a 12-week nutrition program under Dr. Lederman’s supervision. The plan was to treat my health problems by eating a whole foods, plant-based diet.

Let food be thy medicine
—Hippocrates

The idea of using nutrition to promote good health is nothing new. Indeed, Hippocrates, the ancient Greek father of Western medicine, said, “let food be thy medicine,” over 2,000 years ago. Yet it wasn’t until more recently that the science behind this observation was systematically probed and applied. Two researchers who’ve made groundbreaking contributions to this effort are Dr. Colin Campbell and Dr. Caldwell Esselstyn. Born just a few months apart in 1933 and ’34, they each grew up on farms. Campbell’s childhood farm is in rural Virginia, where his family raised dairy cattle and milked cows.

Colin Campbell, Ph.D.: My dad and mother moved here in 1943 when I was nine years old. And during that time, we had a dairy of about somewheres between 20 and 30 cows, which in those days was a modest, medium-sized dairy.

At the time, milk was believed to be nature’s perfect food. So perfect, in fact, that this U.S. government film from the early 20th century recommended that infants who have just been weaned from their mother’s milk should be switched immediately to cow’s milk.

Campbell: That was the excitement of doing something, producing nature’s perfect food, if you will.

Established in 1675, the Esselstyn’s farm is in upstate New York. On these rolling hillsides, they grazed both beef and dairy cattle.

Fulkerson: This was sort of like the nerve center of the operation in a way?

Caldwell Esselstyn, M.D.: More or less, absolutely. This is sort of the epicenter, around these barns. This is the way farming was done in that era.

Fulkerson: And so this is sort of where you learned the craft… the trade. The trade of farming. How old were you when you moved here?

Esselstyn: Seven. I didn’t start driving the tractor till I was eight years old.

Fulkerson: A late bloomer, right?

Esselstyn: Yeah, exactly. But I enjoyed it, and I really got a great kick out of doing the farm work.

Although they didn’t know each other yet, farm life had a deep and lasting influence on both Campbell and Esselstyn.

Esselstyn: To make it successful, you had to have persistence, staying power, and tenacity of purpose.

Campbell: I guess it’s ironic in the sense that we’re both now advocating not consuming the products that we were busy actually producing with our families.

During Campbell and Esselstyn’s lifetimes, the American diet has changed dramatically.
Near the beginning of the 20th century, Americans each ate about 120 pounds of meat annually. By 2007, that figure had exploded to no less than 222 pounds.
In 1913, we ate about 40 pounds of processed sugar each per year. However by 1999, our consumption of all refined sweeteners had risen to over 147 pounds.
In 1909, Americans consumed around 294 pounds of dairy products apiece. But by 2006, our yearly intake of dairy had more than doubled to 605 pounds.

By the early 1950s, Campbell was off to college at Penn State while Esselstyn went to Yale. As part of Yale’s rowing team, Esselstyn won an olympic gold medal in 1956. During this same decade, the pace of American life was accelerating, even with our food. The late ’50s was the heyday of the drive-in burger joint. The supermarket was just beginning to thrive in the newly built, post-World War II suburbs. This was when the so-called convenience foods were born, like the legendary foil-wrapped TV dinner, not to mention a host of other tasty processed delicacies devised to make our lives easier and better.

By now, Colin Campbell was in graduate school at Cornell university, which had one of the most prestigious nutritional science departments in the country. His research was on animal nutrition and biochemistry.

Campbell: But it was focused more on feeding animals for their ability to be able to produce meat, milk, and eggs, protein containing. And so my own research was focused on protein, making sure we got enough. It was considered to be the vital nutrient. It was one of the first nutrients discovered and without protein, the animal would die, so it was a life force. In fact, in the even early 1900s, there were statements made that this is the stuff of civilization itself.

Protein was also nearly synonymous with animal-based foods like meat. It still is today all over America.

Why do you think meat is important in our diet?

Protein.

Protein.

Protein.

Protein.

Protein.

Protein.

Protein.

Protein.

A lot of protein in it.

We need protein, don’t we? You can’t live without protein.

Campbell: The idea that plants had protein also didn’t come into play until maybe the late 1800s, early 1900s, and then it struggled through the years.

No matter what source the protein came from, in the late 1950s, most scientists believed the world needed a lot more of it.

Campbell: We had a lot of starving and malnourished children in the world. And so in my community, in the nutrition community, there were discussions about why so. You know, what could be done? And one of the prominent thoughts was to make sure they get enough protein. I certainly went along with this view.

At about the same time, Dr. Caldwell Esselstyn was just beginning his medical career at the world famous Cleveland Clinic in Cleveland, Ohio. Surgery soon became his specialty.

Esselstyn: There’s something awfully satisfying about if you can remove the disease. For instance, if a patient had gallstones you could remove them. If it was a gastric ulcer or a stomach ulcer, you directly could take care of that. If it’s a hernia, the same thing.

During the 1960s, heart disease was on the rise in the U.S. What doctors commonly call “coronary artery disease” is usually caused by a condition of the arteries that supply the heart with blood. What happens is that over time, a fatty substance in the bloodstream called cholesterol builds up in the coronary arteries, restricting the blood flow to the heart. This can ultimately cause several problems, from severe chest pain, called angina, to heart attacks. Cholesterol is a natural substance produced by all animals, including humans, and it’s an essential component of our cells’ walls. But when we consume dietary cholesterol, which is only found in animal foods like meat, eggs, and dairy products, it tends to stay in the bloodstream. This so-called plaque is what collects on the inside of our blood vessels and is the major cause of coronary artery disease. In the late 1960s, a colleague of Dr. Esselstyn’s at the Cleveland Clinic made a major breakthrough in the treatment of this condition. In fact, Esselstyn shared space with him in the clinic’s surgical locker room. His name was Dr. Rene Favaloro.

Esselstyn: Rene really sparkled in the operating room. And in 1967, he did this first bypass graft at the clinic… coronary artery bypass graft.

This revolutionary new procedure was accomplished by removing a vein from the patient’s leg, then stitching it on the heart’s blocked coronary artery to allow the blood to flow around, or bypass, the blockage. Today, over 500,000 Americans go under the knife annually for heart bypass surgery. Costing around $100,000 apiece, these operations alone constitute a staggering total of nearly $50 billion.

Tampa, Florida

Joey Aucoin lives in Tampa, Florida, where he owns and operates a landscaping company.

Joey Aucoin: I tell everybody… the joke with everybody with me is: I don’t eat to live, I live to eat. And I… my whole life, I ate whatever I wanted.

In 2004, doctors discovered Joey had a dangerously high cholesterol level of 320 and a hazardous blood sugar level of 480. This not only made him a type 2 diabetic, but a prime candidate for a heart attack and a stroke.

Aucoin: This is my daily pill regiment. Um, I got two pills I take for my diabetes. Then I got one for cholesterol, one for high blood pressure, and then I take Byetta, which is an injectable medicine, every morning before breakfast and every night before dinner. And that’s what I’ve been doing for almost four years now. And I know it makes me tired, and I just… I just don’t feel normal. I only sleep four hours a night or so. I just hate takin’ ’em.

In the mid 1960s, Dr. Campbell was in the Philippines, trying to get more protein to millions of malnourished children. To keep costs down, he and his colleagues decided not to use animal-based protein. The program was beginning to show success. But then, Dr. Campbell stumbled onto a piece of information that was extremely important. It centered on the more affluent families in the Philippines, who were eating relatively high amounts of animal-based foods.

Campbell: But at the same time, they were the ones most likely to have the children who were susceptible to getting liver cancer. This was very unusual, since liver cancers are mainly found in adults. But just the mere fact that they occurred in children said, you know, there’s something here. This is pretty significant.

Shortly afterward, Dr. Campbell came across a scientific paper published in a little-known Indian medical journal. It detailed work that had been done on a population of experimental rats that were first exposed to a carcinogen called aflatoxin, then fed a diet of casein, the main protein found in milk.

Campbell: They were testing the effect of protein on the development of liver cancer. They used two different levels of protein. They used 20% of total calories, and then they used a much lower level, 5%. 20% turned on cancer, 5% turned it off.

This Indian paper, together with what Dr. Campbell had learned about increased liver cancers in children eating animal-based foods, combined to create a decisive moment in his work and his life.

Campbell: Because we learned that animal protein was really good in turning on cancer.

During this same time, the way Americans ate was changing, again. The number of fast-food franchises was exploding, as more and more overscheduled Americans began using them as a convenient way to feed themselves and their families. While the fast-food revolution was sweeping the nation, the rate of cancer deaths in America was continuing to rise.

As a result, in 1971, president Richard Nixon initiated a program that was dubbed “The War on Cancer.”

Richard Nixon: We are here today for the purpose of signing the Cancer Act of 1971. And I hope that in the years ahead that we may look back on this day and this action as being the most significant action taken during this administration.

On the front lines of this new war was Caldwell Esselstyn. By 1978, he was chairman of the Breast Cancer Task Force at the Cleveland clinic. Yet he soon began to doubt the medical procedures he was using.

Esselstyn: No matter how many of these operations I was doing for women for breast cancer, I wasn’t doing one single thing for the next unsuspecting victim.

So Dr. Esselstyn started investigating the global statistics on breast cancer. One of the facts he discovered was that the incidence of breast cancer in Kenya was far lower than it was in the United States. In fact, in 1978, the chances of a woman getting breast cancer in Kenya were 82 times lower than in the U.S. Dr. Esselstyn was even more surprised by the numbers he discovered for some other types of cancer.

Esselstyn: In the entire nation of Japan in 1958, how many autopsy-proven deaths were there from cancer of the prostate? 18. 18 in the entire nation. That, to me, was about the most mind-boggling public health figure that I think I’d ever encountered.

In the same year, the U.S. population was only about twice the size of Japan’s, yet the number of prostate cancer deaths exceeded 14,000. Dr. Esselstyn also discovered that in the early 1970s, the risk for heart disease in rural China was 12 times lower than it was in the U.S. And in the highlands of Papua New Guinea, heart disease was rarely encountered. The link he noted between all the areas he studied was simple.

Esselstyn: Virtually, the Western diet was nonexistent. They had no animal products. They had no dairy, no meat.

Even more compelling to Esselstyn was some historical data that had long been overlooked. In World War II, the Germans occupied Norway. Among the first things they did was confiscate all the livestock and farm animals to provide supplies for their own troops. So the Norwegians were forced to eat mainly plant-based foods.

Esselstyn: Now we look at the deaths in Norway, just antecedent to this period, from heart attack and stroke. 1927, 1930, ’35. Look at right up here. Right at the very top, 1939. Bingo! In come the Germans. Immediately, 1940, wow. ’41, ’42, ’43, ’44, ’45. Have we ever seen a population have their cardiovascular disease plummet like this from statins, from bypass surgery, or from stents? No. But look what immediately happened. With the cessation of hostilities in 1945, back comes the meat, back comes the dairy, back comes the strokes and heart attacks. I mean, it’s such an absolute, powerful lesson. But, uh, we didn’t get it.

Because of evidence like this, Dr. Esselstyn was making the same assessment that Dr. Campbell was due to his work in the Philippines, seeing a causal link between animal-based foods and some of our most deadly diseases. But they weren’t the only researchers coming to this conclusion. Another was Dr. John McDougall. In the mid 1970s, he began practicing on a sugar plantation in Hawaii.

John McDougall, M.D.: What I observed there was the health of the people differed dramatically depending upon how long they’d been in Hawaii. People who were raised in Japan, the Philippines, Korea, China, first generation who had moved from their native land, were always trim, never had heart disease, prostate cancer, colon cancer, breast cancer, rheumatoid arthritis, multiple sclerosis, never overweight. They were in their 80s and 90s and fully functional. Their kids got a little fatter, a little sicker. Their grandkids in the next generation were just as fat and sick as anybody I’d ever seen. And what came through clearly was the diet was the difference. The first generation had learned a diet of rice and vegetables in their native land. But the kids, they started to give up the rice and replace it with the animal foods, the dairy products, the meats, and the results were obvious. They got fat and sick. So I knew at that point what caused most diseases.

At the time, however, Campbell and Esselstyn knew virtually nothing about this other information. Even so, they ultimately reached a revolutionary conclusion… that many of our most crippling conditions could be greatly reduced, if not completely eradicated, simply by eating what they call a whole foods, plant-based diet. This means consuming foods that come mainly from whole, minimally refined plants such as fruits, vegetables, grains, and legumes. It also means avoiding animal-based foods such as meat, dairy, and eggs, as well as processed foods like bleached flour, refined sugars, and oil. Campbell and Esselstyn’s research in this field would change their lives forever.

“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition ”
― Thomas A. Edison

Matt Lederman, M.D.: So, I went through your preliminary form. The goals that I have… tell me if I missing any… from you were: Eliminate your shots and medicines. You want to get off this stuff. You want to sleep well at night. You’re not doing that. You want to stop feeling tired and run down. You want to lose weight.

Joey Aucoin: That’s it. You got it.

Lederman: So those are your goals. The other complaints: You had low energy, ringing in the ears, sinus problems, post nasal drip, shortness of breath, wheezing, coughs, indigestion, and reflux, loose stool, diarrhea, bloating, black and bloody mucousy stool with meat consumption, and difficulty walking, getting around, trouble losing weight, chronic and unpleasant hunger feelings, groggy after meals, strong food cravings, and anxiety about food in general. All of that stuff…

Aucoin: Sounds like I’m dead.

Lederman: So I don’t mean to, you know, harp on the bad stuff, but, you know, that will all… most of that should get better. My goals, I’m adding in.

Aucoin: Which goals do you have?

Lederman: I want you to reverse all your medical diseases, the ones that we can reverse, and most of yours, we could. I told you all the risk and benefits. Based on what I told you, I would stop all these meds. And I would stop these, on top of all these risks.

Aucoin: Okay, that’s what I’m gonna try. You’re gonna get my best… my best effort. I can tell you that.

Lederman: You’ll do good. You’ll do well.

By 1975, Dr. Campbell was at Cornell University, investigating what he’d discovered in the Philippines.

Campbell: Our work from the beginning was designed, in a sense, to do two main things. One, I wanted to replicate, if possible, the Indian work, because it was so provocative. Secondly, if this was really true, I wanted to study how does it work?

Just like the Indian researchers, Campbell fed half the rats in his study a diet of 20% casein, the main protein in dairy products. The other half was fed only 5% casein. Over the 12 weeks of the study, the rats eating the higher protein diet had a greatly enhanced level of early liver cancer tumor growth. On the other hand, all of the rats eating only 5% protein had no evidence of cancer whatsoever. But Dr. Campbell decided to take these findings a step further. This time, instead of keeping his test rats on the same diet throughout the study, he kept them in one group and switched their diets back and forth between 5% and 20% dairy protein, doing so at three-week intervals. The results were astonishing. Whenever the rats were fed 20% protein, early liver tumor growth exploded. But when the same rats were given 5% protein, tumor growth actually went down.

Campbell: I mean, this is so provocative, this information. We could turn on and turn off cancer growth just by adjusting the level of intake of that protein. Going from 5% to 20% is within the range of American experience. The typical studies on chemical carcinogens causing cancer are testing chemicals at levels maybe three or four orders of magnitude higher than we experience.

Even more surprisingly, Dr. Campbell discovered that a 20% diet of plant proteins from soy beans and wheat did not promote cancer. However, there’s a longstanding belief among the public that animal protein is important for human health. Connie Diekman supports this position. Ms. Diekman is director of nutrition at Washington University in St. Louis, Missouri. She’s the past President of the American Dietetic Association, and an advisor to the National Dairy Council.

Connie Diekman, M.Ed., Washington University: When you eliminate animal foods from your eating plan, you run the risk of inadequate protein content. Animal proteins provide all the amino acids that we need for cell growth, tissue repair, and overall health.

Campbell: Eating whole foods, it’s virtually impossible to be protein deficient without being calorie deficient. Because even if you take the foods that have the least amount of protein in it, let’s say potatoes, for example, or rice. You know, 8%, 9%. Well, that’s the figure we more or less need.

Dr. Campbell’s research led him to a conclusion about the way genes, chemicals, and nutrition interact to promote cancer.

Campbell: Cancer starts with genes. It might be genes we’re born with, it might be genes that are actually changed by a chemical, so those genes become capable of producing cancer cells. Whether we do or don’t get cancer is primarily related to how we promote those cancer cells to grow over time. That’s where nutrition comes into play. They grow much more rapidly when they were fed animal protein.

Dr. Campbell and other nutritional scientists have found that only a small percentage of cancer cases are caused solely by genes.

Campbell: I think the general consensus in my field is that probably not more than 1% or 2% at most is attributed to the genes we may or may not have.

Pam Popper, N.D.: And that’s the most helpful and hopeful information I give people. Because if you go through life thinking that what happens to you from a health perspective is based on your genes, you’re a helpless victim.
My diet was pretty abominable. I thought the two principal food groups were caffeine and sugar.

Dr. Pam Popper is executive director of the Wellness Forum in Columbus, Ohio, and an expert in the areas of health and nutrition.

Popper: The women in my family are all overweight. I’m not. I don’t eat and live like they do, you know. So, I’ve changed my health destiny by not engaging in the same habits.

Over the next several years, Dr. Campbell initiated more extensive lab studies using various animal and plant nutrients. The results were consistent: Nutrients from animal foods promoted cancer growth, while nutrients from plant foods decreased cancer growth. Yet Campbell hadn’t identified a specific biological mechanism that caused the effects he observed.

Campbell: And it finally occurred to me that there is no such thing as the mechanism. What we are looking at was a symphony of mechanisms. We think that nutrition is attributed to individual nutrients. And that’s the way it gets marketed and that’s the way the companies tell us, so forth. When, in fact, nutrition, all of it working together to create this symphony, the hundreds of thousands of different kinds of chemicals in food, all kind of working together nicely. I mean, the complexity is total. That’s a holistic concept. And I had to say to myself, that’s a very exciting idea.

Dr. Campbell realized that his discoveries in the laboratory were significant, but limited. How were these findings relevant in people? How do different types of foods affect cancer and other diseases? Campbell needed a large-scale population study. He would soon find a perfect opportunity.

Lederman: So mangoes are really good. They flavor things really nicely.

Okay.

Lederman: That’s something… you wanna get a riper one.

Dr. Matt Lederman and his wife, Dr. Alona Pulde, are among a small but growing number of physicians who use a whole foods, plant-based diet as a primary treatment for their patients. From shopping with patients to teach them how to read nutrition labels…

Lederman: And I don’t care what it says on the front, the back, or the sides… both: Look at the ingredients. And that’s all I care about.

To showing patients how to prepare meals, they are not your typical M.D.s Doctors Lederman and Pulde use food as treatment because they feel it’s the best medicine available… medicine that not only makes their patients feel better but that truly improves their health.

In 1973, the U.S. congress passed a new farm subsidy bill. Among other things, it included incentives that encouraged a massive increase in corn production. One of the major byproducts of this enormous corn surplus was a low-cost sweetener called “high fructose corn syrup”. Companies could add this sweetener to anything from soda pop to hot dogs, and then make these products widely available at low prices. Processed sugars and other refined foods are far more calorie-dense than the whole plants they’re made from. The dramatic increase in their use is a major reason why our food has become richer.

To evolutionary psychologist and author Dr. Doug Lisle, the consumption of unnaturally dense foods is the main cause for the epidemic of obesity in America.

Doug Lisle, Ph.D.: It isn’t that people have become more self-indulgent. It isn’t because they’re lazier than they ever were. What’s happening is that their mechanisms of satiation are being fooled.

The process starts with a range of receptors in our stomachs that help us gauge how much food we’ve eaten. These include stretch receptors to help measure the sheer volume of food in our stomachs. We also have density receptors, to help determine the caloric density, or what we more commonly call the richness of our food. For instance, 500 calories of natural plant food fills the stomach completely, triggering both our stretch and density receptors to signal our brain that we’ve had enough to eat. But 500 calories of unnaturally rich or processed food fills the stomach far less, deceiving these receptors into telling our brain that we need to eat more. Even worse is 500 calories of oil, which is almost pure fat and barely triggers any response at all.

Lisle: The problem with weight management in humans is that if you make these foods completely artificial, which we do today, you wind up with a problem that people have to overeat just to be satisfied.

But why do these concentrated foods that are so harmful to us give us so much pleasure? Dr. Lisle says the answer is related to a system called the motivational triad. This is a trio of biological mechanisms that nature has designed into every creature on earth so they can survive to pass their genes on to the next generation. The first leg of the motivational triad is pleasure seeking.

Lisle: And, primarily, two things are the cause of that, and those two things are food and sex. So in the case of a great white shark, its basically got a neon sign flashing across its forehead saying, “food, sex, food, sex, food, sex.” Unless it’s a male, then it says, “sex, food, sex, food,” but it’s pretty much the same thing.

The other two legs of the motivational triad are avoiding pain and doing everything with the least amount of effort.

Lisle: Pleasure seeking, pain avoidance, and energy conservation, that really sums up animal behavior, whether we’re talking about a paramecium under a microscope or a great white shark.

Richer foods naturally excite our senses because it’s nature’s way of telling us they will provide the highest amount of dietary reward with the least amount of effort. This helped our ancestors find the most calorie-dense and ripe foods available, which contributed to our survival. But in today’s environment, we can artificially increase calorie density well beyond what our ancestors would have found in nature. The resulting foods give us a hyper-normal amount of pleasure, leading us into something Dr. Lisle calls the pleasure trap.

Lisle: What the pleasure trap is is an interaction between our natural instincts, which are trying to tell us the right thing to do, and some kind of artificial, modern stimulation that is piggybacking or hijacking that process. So the classic example of the pleasure trap would be drugs and drug addiction. The way drugs work is they hijack the existing pleasure circuits. When certain chemicals hit those areas, they cause feelings of euphoria and excitement.

The same drug-like effect happens when we eat highly concentrated, processed foods.

Lisle: We’ve removed the fiber, we’ve removed the water, we’ve removed the minerals. We’ve done everything that we can to hyper-concentrate sugar and fat and add a bunch of salt as well into the food, and now what the food has become is it’s become a low-grade addiction.

Terry Mason, M.D., City of Chicago: These things are drugs. They have other deleterious side effects, not the least of which is adding a lot of empty calories.

Dr. Terry Mason is commissioner of health for the city of Chicago. He’s one of the few public officials in America who openly supports a plant-based diet.

Mason: If it walked, hopped, swam, crawled, slithered, had eyes, a mom and a dad… don’t eat it.

Dr. Mason contends that the less affluent segments of our population have difficulty making the best food choices.

Mason: Well, first of all, the diets are calorie-rich and nutrient-poor. This is the real problem. And, unfortunately, poor people are poor in everything. They’re poor in health, they’re poor in food choices, they’re poor in almost every aspect that you could think of.

This makes the less prosperous particularly vulnerable to the low-grade addiction of highly processed foods.

Mason: People want stuff that’s fast, people want stuff that’s quick, and they like the stuff that’s salty, and they like the taste of something fried. And so those are the kinds of things that you see in our community.

* * *

San’dera Nation lives in a quiet suburb in Cleveland, Ohio, with her five children. In October 2008, she was stricken by a strange illness.

San’dera Nation: I wanna say something, but it’s not coming out. I’m getting really shaky and sweats, and then I’m cold and I’m sick and I’m fatigued, and my stomach hurts and everything. So I went to the doctor, and that’s when he diagnosed me with hypertension and diabetes.

Like Joey Aucoin, San’dera was treated with expensive prescription drugs.

Nation: I was in denial for a while. I heard what they said, but I was in denial, like, mmm. I still ate things I shouldn’t have. I didn’t really get the education that I needed to know, so I really depended on that pill to save me.

Then San’dera met with Dr. Esselstyn, who recommended that she treat her illnesses with a whole foods, plant-based diet.

Esselstyn: Come on in, and we’ll get to work.

Nation: I was a little nervous, but he made it real easy for me. I was real interested in what he had to say and what he was going to teach me and the new journey that I would be taking with him.

He that takes medicine and neglects diet, wastes the time of his doctor.
—Ancient Chinese Proverb

* * *

Between China and the United States…

In 1974, Chinese premier Zhou Enlai was hospitalized with bladder cancer. Knowing that his disease was terminal, he decided to give his country a more complete understanding of cancer. So he initiated what would become one of the largest and most thorough scientific studies in history. 650,000 researchers catalogued the mortality patterns caused by several types of cancer for the years between 1973 and 1975. The study encompassed every county in China and over 880 million people. Zhou died in 1976, years before his study was complete.

Okay, and you’ll need how many shirts? Probably three?

Yeah.

Okay.

Zhou enlai’s cancer study would ultimately have a major impact on what Dr. Campbell himself has called the capstone of his research.

Beijing, China

Campbell: Early 1980. And you were there for two or three months?

Dr. Junshi Chen is now senior research Professor with the Chinese center for disease control and prevention. He first met Dr. Campbell at Cornell in 1980, when he was a member of the Chinese Institute of Food and Nutrition Science. The cold war was just beginning to thaw, and Dr. Chen was among the first senior scientists from China to visit the United States. By then, Dr. Campbell had become one of the most distinguished nutritional biochemists in the world. When they discovered this book, a significant collaboration was born.

Junshi Chen, Ph.D.: This is the atlas of cancer mortality in China.

Published in 1981, the cancer atlas was the result of Zhou Enlai’s nationwide study. It showed a highly unusual geographical distribution of different types of cancer in China, which tended to be clustered in certain hot spots. The same was true with cancer after cancer. And the counties with the highest levels were often far greater than the counties with the lowest levels.

Chen: So, for example, esophageal cancer, according to this cancer map, the mortality has a 400-fold difference among different counties in China.

Campbell: That’s huge.

Chen: Yeah. And in… I understood, in the United States, only several-fold difference.

Campbell: Not even… maybe twofold or so, we see.

Chen: Yeah, yeah. So that caught our attention in term of, so, why? Because they’re all Chinese. Genetically, they are all the same. And the why they have so much difference in single cancer mortality? So we believe it has to be related to the environment. The bigger environment. And from our professional perspective, of course, it’s diet and nutrition.

Campbell: Dr. Chen and I said, you know, “why don’t we just go there and do a study?”

For Dr. Campbell, it was the opportunity he’d been looking for. Among other things, he could examine how his observations about liver cancer in Filipino children and the findings from his lab studies applied to a large human population. The project would consider 367 diet and health-related variables, making it one of the most ambitious nutritional studies ever conceived. Dr. Campbell and his associates carefully chose 65 counties scattered across China. These counties were mainly located in rural or semi-rural areas.

Chen: We used the rural counties because they are stable in their residents, and they have been in this lifestyle for at least 20 to 30 years.

More than 350 workers were trained. They carefully surveyed the diet and lifestyle of 6,500 people in the chosen counties. Urine and blood samples were also taken. In 1983, doctors Campbell, Chen, and their collaborators began to analyze the vast amount of information that had been collected. The job would take years.

* * *

After eight weeks eating plant-based foods, Joey Aucoin was still off all his medications.

Aucoin: When I started this, I had all these side effects from medication and from my being so unhealthy. But now I’m getting in better and better shape every day. I feel more healthy. I very seldom get tired during the day. I just feel so good all the time. This… this is the scale that I weigh myself on. And it started about eight weeks ago way up here around 218, 220. And now it’s bouncing between 180 and 185. None of my belts fit. This one here, I actually had to have two new holes punched in, ’cause I liked the belt so much. Nothing fits. I gotta go shopping. It’s just everything, all my clothes. A good problem to have.

Cammie Aucoin: It’s been fun for him, because I think he’s learned in addition to the fact that he’s seeing such great results, that it’s…He loves it.

Jason Aucoin: I don’t think he’ll go back to his old ways. He feels too good, and he likes… even if he started to go off a little bit, he feels too good, his energy’s too good, he looks younger.

Cammie Aucoin: And the fact that he would have to go back on all the meds, you know, if he did, I think that that’s a huge motivation for him to maintain the lifestyle.

* * *

In the mid-1980s, Dr. Caldwell Esselstyn was struggling to organize a study on coronary artery disease. His plan was to put a group of patients on a diet of low-fat plant-based foods, along with small quantities of low-fat dairy products and minimal amounts of cholesterol reducing drugs.

Esselstyn: And slowly over the next, uh, 18 months, I got the 24 patients that I had asked for. But the ones they sent me were a little bit sicker than I had thought. These were patients who had failed their first or second bypass operation. They had failed their first or second angioplasty. And there were five who were told by their expert cardiologists they would not live out the year.

One of the most gravely ill patients was a 59-year-old speech and communications teacher, Evelyn Oswick.

Evelyn Oswick: Ate all the chocolate candy I could eat, ate every doughnut I could put my hands on. Oh, I just love things like that, a lot of gravy. And then, um, I had my… I have had two heart attacks before I met Dr. Esselstyn. When I had the second heart attack, the doctor said that I should prepare for death, really is what he said. And I looked at him and I said, “do you really mean that what you want me to do “is buy a rocking chair and just sit there and rock away and wait?” And he just looked at me and he said, “yes, that’s just exactly what I’m saying.”

Anthony Yen was born and raised in China.

Anthony Yen: And we were eating a typical Chinese cultural diet. A very small piece of meat. But they sliced it, and so it was cooked for flavor rather than your American style, when you eat, you eat a large, great, big piece of meat, which you could easily fed the whole family in China. And we eat a lot of vegetables in China. And we had soup. But once I came to the United States, you find beginning to experience fast food. The hamburgers and cheeseburgers, pizza. And I noticed my weight beginning to gain.

When Mr. Yen was 56 years old, he suddenly experienced severe chest pains.

Yen: At that point in time, I had a open heart surgery. I have five bypass… five. But it was very interesting. About a week later, uh, I felt my chest tighten up again. So myself and my wife went to see Dr. Esselstyn.

Esselstyn: I saw every one of these patients myself every two weeks for the first five years. And at that visit, we would get a full cholesterol lipid profile. We would get blood pressure, weight, and I would go over every morsel they ate.

By using simple foods as the main treatment for his patients, Dr. Esselstyn was bucking a high-tech, high-cost system that was deeply entrenched in both big medicine and big government.

Esselstyn: You know, behind my back, I got to be known as Dr. Sprouts. But I guess I’ve always liked a challenge.

We preheated the oven, got the water going. I just added some seasonings. And then we add the onions and the spinach.

Fulkerson: I’ve never been a morning person, my whole life. And, uh, but previous to this experience, um, it had probably been worse than ever. And that entailed needing to get up in the morning and caffeinate myself with cokes and red bulls and stuff like that, uh, before I could even think or start to work.

We didn’t make the rice noodles, but you can just boil them real quick and then throw this on top of them.

Right, right.

Debbie Lowe: He’s actually eating more often, but he’s eating the right foods, and he lost weight. So he certainly feels much better that way. And you can tell it in his face, in his neck, you know, in his belly. It’s all… he’s lost a lot of weight there. He also has a better energy. Um, he’s waking up earlier now. That’s great, because we have then some morning time together.

I don’t have to carry anything.

Fulkerson: You’re the doctor.

* * *

1990. Following nearly a decade of intense effort, Dr. Campbell and his colleagues finally publish their China study. It identified no less than 94,000 correlations between diet and disease.

Campbell: Those are big numbers for any study. And in the end of the day, when we did all these correlations in this book here, and we looked at the number of them that were statistically significant, it was between about 8,000 to 9,000. When you have that large number of correlations then you start analyzing each one, if it works out as statistically significant, this means that if 19 out of 20 are pointing in the same direction, it’s highly significant and likely to be true.

Hundreds of detailed tables and charts were included in the study. Each one presented the raw data that was collected. Then this information was cross-referenced in multiple ways to demonstrate its reliability and to show how it linked with the 367 variables the study examined.

Chen: I think the major message we got out of all these correlation analyses is only one message. The plant food-based diet, mainly cereal grains, vegetables, and fruits, and very little animal food is always associated with lower mortality of certain cancers, stroke, and coronary heart disease.

The New York Times called it “the most comprehensive large study ever undertaken “of the relationship between diet and the risk of developing disease.” For Dr. Campbell, he finally had large-scale data on people, and it was remarkably consistent with his earlier discoveries. Together, he found that the scientific evidence was clear: Whole, plant-based foods were beneficial to human health, while animal-based foods were not.

* * *

San’dera Nation’s journey to better health wasn’t easy at first.

Nation: It was a little hard, ’cause I’d been eating fatty foods and grease and everything for 38 years, you know, as long as I can remember, so it was kinda hard to go from that to changing the next day completely. I started a journal for maybe the first three weeks, write down my feelings and emotions, what I felt like… So that other people could know it’s okay to feel that way.

Along the way, San’dera had strong support from Dr. Esselstyn and his wife Ann.

Nation: They keep in touch, and they’re like, “we haven’t forgotten about you,” and I know they haven’t. I really feel here that they haven’t. “I went to Wal-Mart this day. “I had wanted a subway sandwich, “and I said I’m gonna get me that meatball sub. “I then received a call while I was at Wal-Mart “from Mrs. Esselstyn, “as if they knew I was weak at this moment. “She stated, ‘promise me “you will not eat anything from Wal-Mart.’ “it gave me chills to know that she called at that moment. “Therefore I left the store without getting that meatball sub.” What do you see?

While Dr. Campbell was publishing his China study, Dr. Esselstyn was getting some powerful data from the research he’d started in 1985. He began with 24 patients, but 6 had dropped out in the first year, leaving him with a total of 18.

Esselstyn: At the end of five years, we had follow-up angiograms, and 11 of the group had halted their disease. There was no progression. And there were four where we had rather exciting evidence of regression of disease.

These results were astonishing. The diet produced something that medication and surgery never had before: Actual reversals of heart disease. The biological mechanism that caused these reversals centers on the lining of our veins and arteries… the endothelial cells.

Esselstyn: They are the absolute life jackets of our blood vessels. You’re young, and you’re a teenager, you’re healthy, you could spread those out one layer thick, and you’d have something that would cover six or eight tennis courts.

In 1988, scientists discovered that endothelial cells manufactured the gas nitric oxide.

Esselstyn: Well, what did nitric oxide do? Nitric oxide keeps our blood flowing smoothly without being sticky.

It also helps to dilate constricted blood vessels during physical activity and inhibits the formation of plaque.

Esselstyn: And most importantly, nitric oxide is a powerful force for eliminating the inflammation that seems to go with this plaque.

However, scientific tests have demonstrated that when we start eating the typical Western diet, our endothelial cells are damaged.

Esselstyn: When you’re getting to be in your 40s and 50s and 60s, and you’ve been slaughtering your endothelial cells, you don’t have those six or eight tennis courts. You may be down to one and a half or two, and they can’t protect you.

Yet according to Dr. Esselstyn, when we begin eating a whole foods, plant-based diet, the damage to our endothelial cells not only stops, it starts to reverse.

About five years into his study, Esselstyn made a small but significant change in his patients’ menu. It started in 1990, when he read the glowing review of Dr. Campbell’s China study in the New York Times.

Campbell: Dr. Esselstyn saw that, and he invited me to come to a conference he was organizing in Arizona.

These two revolutionaries, who, up until then, had been on similar but separate paths finally met face-to-face.

Campbell: On the one hand, I’m coming from the scientific group, getting some ideas. He’s coming from the clinical route and doing some dramatic research. Here’s the science, here’s the clinical evidence. Put the two together, it’s amazing.

When he learned of Campbell’s research, Esselstyn removed dairy products from his patients’ diet. The results of his ongoing study continued to be impressive, and in 1995, he published a paper detailing them in a noted scientific journal.

Yet one of Esselstyn’s most remarkable success stories involved a colleague of his at the Cleveland clinic, Dr. Joseph Crowe.

Joseph Crowe, M.D.: Actually I was, um, active, healthy, very busy, uh, mid-40s, absolutely, um, no risk factors at all for any heart problem.

But Dr. Crowe, even with what was considered to be a healthy cholesterol level, was actually ravaged by heart disease. This angiogram, taken after his first nearly fatal heart attack in 1996, shows how badly damaged one of his coronary arteries was. This angiogram was done after less than three years of entirely dietary treatment. Dr. Crowe was fortunate. In 25% of cases, sudden death is the first and only sign of coronary artery disease.

Of Dr. Esselstyn’s original 18 patients, all survived the initial 12 years of the study. Today, 14 patients are still alive over two decades after the study began.

Oswick: The thing about Essy, although he’s always very pleasant, when you said, “I’m going to be on this program and I’m going to stay with this diet,” you stayed with the diet, or there was the door. You had no choice. I mean, his smiles are wonderful, but he is very stern. You know, that’s why I’m still living. But, you know, he’s just… He’s just a wonderful man.

Yen: And I look at the pictures… Some of my pictures years ago, 20 years ago actually looks older than today. The only thing is I lost more hair, you know?

Anthony and the other male patients also noted another change.

Yen: When you’re young, when you were teenager, you see a female or so on, it gets kind of excited. And the first reaction physically, you know, it gets attention, you know? Raise the flag, I call it. This happened to us, all the other, uh, Dr. Esselstyn’s, uh, I call ’em all the Guinea pigs. The flag still rises.

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Mason: I’m a practicing urologist and have been so for the last 25 years. And erectile dysfunction is actually the first clinical indicator of generalized cardiovascular disease. It’s the canary in the coal mine. It’s the thing that lets you know that you have some significant endothelial and vascular disease, much earlier than will a heart attack or something like that. We have to stop thinking of the body like it’s compartmentalized. It really isn’t. The blood goes everywhere in the body. And so if you have vascular disease anywhere, you have it everywhere.

Despite the apparent success of the dietary approach, some critics say eating this way is extreme.

Esselstyn: Now, with the Western diet, this guarantees there are gonna be what? A half a million people in this country this year who will have to have the front half of their body divided, their heart exposed, then veins will be taken from their leg and sewed on their heart. Some people would call that extreme.

Dr. Esselstyn has now successfully treated over 250 patients with heart disease, using almost exclusively a whole foods, plant-based diet.

Esselstyn: Heart disease, as far as I’m concerned, is an absolutely toothless paper tiger that need never, ever exist. And if it does exist, it need never, ever progress.

* * *

Las Vegas, Nevada. At the extreme couture gym, we found an extraordinary plant-based athlete… ultimate fighter champion Mac Danzig. In the mixed martial arts world, strength, toughness, and endurance are of paramount importance, and Mac has them all.

Mac Danzig, Ultimate Fighter Champion: I had cut dairy out of my diet when I was about 18 years old, um, because I had a, uh… Ear, nose, and throat allergy to dairy, and I was getting a lot of ear infections and things like that. So when I cut that out, really the only thing that was separating me from having a vegan diet was chicken and fish. So I was just eating that for years, and I was eating it because I thought that I needed to, because everyone tells you, you know, if you’re an athlete, you need, you know, at least chicken and fish in your diet for protein. You know, something that’s just one of the myths that’s been perpetuated for a while. All it took was me cutting the chicken and fish out, and I did it cold Turkey. I think a lot of people, stereotypically speaking, think someone that’s a vegan is, like, some skinny hippie type of person, and, uh, you know, I’m not necessarily trying to break the stereotype. I just… I tried the diet for my own personal reasons, and it worked for me. I feel like I have more energy now that I don’t eat the meat products. And I also feel like I recover better in between my workouts. I’m not trying to be part of some exclusive club or anything like that. I’m just doing my thing, and, um, you know, don’t plan on eating meat or dairy or anything like that for the rest of my life.

* * *

This, uh, guide is called the type “a” planning guide. Now, it includes foods that are found in the basic four food groups, because we are concerned about the total daily needs, and this is a part of it.
We must serve 1/2 pint of fresh fluid milk to provide calcium, riboflavin, and the other nutrients that are needed for our children.

For decades, the dairy industry and U. S. government have been saying that milk is good for our bones. While all whole foods contain calcium, an essential nutrient for bone health, it is argued that we need the higher amounts found in dairy. Children and aging women in particular have been singled out to drink more and more and more milk.

What do you think the most important nutrient we get from dairy products is, like milk?

Calcium.

Calcium.

Calcium.

Calcium.

Calcium.

Calcium.

Calcium. Calcium. Calcium.

Diekman: The science in terms of dairy’s role in healthy bones is pretty strong, and, in fact, the national osteoporosis foundation, of course, utilizes that science in their recommendations.

Osteoporosis is a degenerative bone disease, which has been widely linked to a lack of calcium. If this is true, nations with a high intake of dairy products, which are a major source of calcium in a westernized diet, should have low levels of osteoporosis. But according to a study done by a distinguished Harvard researcher, nations with high levels of calcium intake tend to have high levels of hip fractures, which is a key indicator for osteoporosis.

Campbell: And so, in fact, the higher the dairy consumption, the higher the rate of osteoporosis… exactly the opposite of what the dairy industry has been telling us for so long. One of the primary mechanisms for that is that animal protein tends to create an acid-like condition in the body called metabolic acidosis.

To combat this condition, the body draws upon its most readily available acid buffer, namely calcium in our bones. As the calcium is extracted to neutralize the excess acid, our bones are weakened. In defending the health benefits of milk, many national health organizations now recommend that we consume low-fat dairy products.

Diekman: It can be milk, it can be yogurt, it can be cheese, it can be anything made from milk. But again, the important message, it’s a message that comes from the American Dietetic Association, the National Osteoporosis Foundation, Cancer, Heart, we’re all on the same page. It needs to be low-fat or fat-free.

Campbell: So as the fat’s taken out, the protein becomes a larger proportion of the total. So they become higher in protein, lower in fat. And when we compare these high-protein, low-fat milk products, for example, with prostate cancer, the relationship is as strong as it is for cigarette smoking and lung cancer.

Campbell: Most of these animals here are what we call heifers.

Fulkerson: Uh-huh.

Campbell: They’re the young females, not yet cows.

Fulkerson: So they haven’t had their first calf yet.

Campbell: Haven’t had their first calf.

Fulkerson: So they have to have their first calf before they can lactate.

Campbell: And once they come into lactation, they almost keep them, these days, they keep them pregnant continuously for three of four years.

Fulkerson: Why are they eating grass now?

Campbell: Well, this is the last time, in their lifetime, they’re going to see grass. After that they’re in the barn, they’re standing up for the rest of their life.
When I was young, we defended our product, promoted our product, because it was nature’s most perfect food. And, uh, so I believed that. But it took a slightly different twist as time passed. I mean, it’s the most perfect food for calves. And trying to switch the milk of one species to another species doesn’t make a lotta sense.

Only two months into her treatment, San’dera was experiencing dramatic effects on her type 2 diabetes and hypertension.

Nation: Since I’ve been on a plant-based diet, blood pressure’s been wonderful. My blood sugars are in the 80s. It shocks me, 70s. So I was alarmed when it was 60. I’m like, “aah! Isn’t that bad? It’s 60?” You know, and I talked to the diabetes educator, which is wonderful. She’s like, “no, that’s a normal blood sugar.” You’re pancreas is working, it’s reversing.”

Ironically, San’dera works at an outpatient facility for diabetics. Yet the treatment that was achieving success with her diabetes came from outside the established medical system. The positive results went far beyond San’dera’s chronic diseases.

Nation: Mentally, not having the sluggishness, the fear of the disease progressing. Because I feel I’m in control and have power of taking it back the right way now. So, mentally, I feel great. I’m eating the things I should eat. The one thing that is true that Ann said to me, “you really start tasting the real taste of what you’re eating,” cause I’d eat a peach, and you’d think… I was in heaven with my white peaches. I get to eat, and that feels good to be able to eat, bringing the sugar down, you’re losing the weight, your whole everything changes. You know, I think we’re a little dependent on, you know, our doctors and the medications. We should take a little bit more responsibility and check it out for ourselves.

And speaking of doctors and medications, how does San’dera’s regular physician feel about her new lifestyle?

Nation: When I recently approached her about my blood sugars being so great, my question was, “should I not take my medication?” She said, “no, you still take your medications.” And she said, “what is that doctor trying to do? Take you off your medications?” And I’m looking like, “yeah, I’m hoping that’s the… The goal.” So there’s still people we have to make believers, yeah.

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The key agency that sets nutritional guidelines for Americans is the United States department of agriculture. The U.S.D.A. helps determine what foods are served to everyone from our soldiers in the field to our kids in their school cafeterias. These guidelines are also taught in our schools, influencing what our children will eat for the rest of their lives. Dr. David Klurfeld is a nutritional scientist and national program leader for human nutrition with the U.S.D.A.’s agricultural research service.

David Klurfeld, Ph.D., USDA: We’ve made dietary recommendations since the 1890s, from U.S.D.A. and that was before we knew about vitamins and minerals. Subsequently, we’ve had different food groups, and we had the basic 4 and 5 and 7 and 12, and it varied as the science changed.

Perhaps the best known of the food groups was the “basic four”, introduced in 1956 in a leaflet called “food for fitness.” The mainstay of nutrition education for over 30 years, the basic four defined what an entire generation of Americans believed was healthy to eat. The four food groups was replaced in 1992 by the “food pyramid,” then updated by “my pyramid.” These guidelines recommend three servings of dairy products per day, and meat is still a primary source of protein. In following “my pyramid ,” a 15-year-old girl can eat a daily menu consisting of a bowl of lucky charms with low-fat milk and a glass of orange juice from concentrate for breakfast, cheese-flavored crackers for a morning snack, a cheeseburger on a whole-grain bun with French-fries and a coke for lunch, chocolate pudding and grapes for an afternoon snack, and chicken nuggets with a biscuit and canned green beans for dinner with low-fat ice cream for dessert.

Mason: I see now what’s happening with the way that we feed many of our children in our school systems. We shouldn’t be surprised that we’re seeing childhood obesity at the rates that we’re seeing it.

Dr. Neal Barnard is a medical researcher and president of the physicians committee for responsible medicine.

Neal Barnard, M.D.: Well, the problem is, when a kid is pulling his tray down the school lunch line, you see federal policies in action. There are burgers topped with cheese, the milk is heavily subsidized. But the vegetables and fruits, a little bit harder to find. And this is because the government contracts are going to particularly the meat producers and other producers as well. It has nothing to do with the health of the children. It has all to do with the financial health of the big agribusiness entities.

Pam Popper, ND.: What we have with the U.S.D.A. Is it’s really a farmers advocacy organization. And, okay let’s have one, but that same group cannot advocate for farmers, help subsidize their operations, manage commodity foods, subsidize the price of growing things, and then turn around and say, “okay, we’re going to tell people what to eat.” They’re going to tell people what to eat based on their constituents, which are the farmers, not the American public.

In 1998, Barnard’s group sued the U.S.D.A. Every five years, the government reformulates the dietary guidelines for Americans. That’s the blueprint of what Americans are supposed to eat to be healthy. And we looked at the panel that pulled it together… 11 people. 6 of the 11 had financial relationships with the food industry. So we said, hey, wait a minute. There are laws about what they’re supposed to do and how transparent they are supposed to be. They violated those. And we brought them to court, and it was a long trial, but we won. But that doesn’t change the fact that the policies they came up with continued to favor industry as they always have.

Klurfeld: I don’t think there really is a problem with industry connections between scientists and the food industry, primarily because if the beef industry has a question about their products, shouldn’t they go to the best scientists? And if the best scientists are consulting for the food industry, I still want the best scientists on these committees that make nutritional recommendations. Financial conflict of interest is only one conflict of interest. You know, there are people who’ve spent their entire careers trying to prove that a vegetarian diet is good for you or that red meat is bad for you. Now, they may not have industry ties, but they too have a conflict of interest.

Campbell: You know, we do develop biases personally. I had those biases, too. But I got to a point in my career that I was getting results that went against what I had thought was true. So I had to self-reflect, criticize my own bias, look at it really carefully, and I changed my views.

Dr. Campbell paid a price for changing his views. He’s been marginalized by key administrators of his own university, this after being a lead scientist and securing millions of dollars in research grants for Cornell’s nutritional sciences division. He had a popular nutrition course canceled by the division director who had long been a major consultant to the dairy industry. Numerous observers feel this was an arbitrary decision that violated the standards of academic freedom. Dr. Campbell has also witnessed serious corporate influence over research that is used to develop the government’s nutrition policy. One example he cites centers on the prestigious National Academy of Sciences.

Campbell: The building behind me here is perhaps the single most important building in the area of science in the country. This is where scientists participate in deliberations about issues of the day and determine how that science can be used to affect policy. In the early days when I was involved, those panels were mostly funded by public money. But on the other hand, in more recent years, I have seen more and more corporate money coming in to support these activities and more and more people being allowed on the committees, especially the chairs of the committee. And, of course, they can pick the kind of people they want to pick in order to get a certain kind of conclusion. It’s not the way it should be, and I’m sure that if the public were to know how powerful is this influence, they would be surely upset.

* * *

One-quarter of what you eat keeps you alive. The other three-quarters keeps your doctor alive.
—Ancient Egyptian Proverb

Vancouver, Canada

Ruth Heidrich: I had been a runner for 14 years, in fact, a marathoner. 47 years old, the top of my game.

In 1982, Ruth Heidrich’s running career came to a sudden stop when she was diagnosed with breast cancer. After a mastectomy, her doctors recommended chemotherapy and radiation to treat the cancer that had by then spread to her lungs and bones. Ruth decided to visit Dr. John McDougall instead.

John McDougall, M.D.: And I said, “Ruth, I spent my residency “collecting information on diet and breast cancer. “It’s all in these files right here. “Sit in my office and read through it and see what you think.”

Heidrich: He said, “these are the studies that show… “what I’m trying to prove is that diet can reverse breast cancer.”

McDougall: And she read it, and she comes out and she says “okay, I’ve changed my diet.” She changed her diet.

Heidrich: So he showed me how to eat. No added oils, lots of fruits and vegetables, whole grains.

Ruth then started training for the ironman triathlon in Hawaii, which combines running a marathon with long-distance biking and swimming.

Heidrich: I became obsessed. Kept up the running, of course, never stopped, and then added swimming, biking, and, for good measure, lifted weights. And people were saying, “you’re crazy. You’re a cancer patient. You should be resting.” Doctors told me this. I felt so good. I felt fit, and I wanted to maintain that level of fitness. And I felt sure that if I had a healthy body and I was putting the right food into it that I could beat this cancer.

At the ironman triathlon, Ruth won a gold medal in her age group.

Heidrich: Stuck with the diet. Found out my arthritis disappeared. My constipation disappeared. My dandruff disappeared. No sign of depression, which you might expect with a cancer diagnosis. I felt renewed, invigorated, and out to show that diet is so much more important than anybody ever thought. Mmm!

McDougall: Other women get over breast cancer, colon cancer, prostate cancer. There are people who’ve had metastatic prostate cancer all over their body who have gone through what we call spontaneous remission. In other words, they’ve been cured. And it’s not the end of the world when you get this diagnosis. Some people get over it. Ruth did.

Heidrich: So I’m still racing. Still daily training. Now how many people in their 70s are doing triathlons? Not very many. So that gives hope for all of us as we age that not only will you stay healthy and beat the degenerative diseases that most people get, but you can start collecting medals.

* * *

The food choices we make have profound global effects. It takes over ten times the amount of energy from fossil fuels to produce a calorie of animal-based food than it does to produce a calorie of plant food. Since the 1970s, 20% of the Amazon’s rainforest has been destroyed. That’s an area the size of California. 80% of this cleared land is now occupied by livestock. The world’s cattle alone eat enough grain to feed 8.7 billion people, nearly 2 billion more than the population on earth. With almost a billion malnourished people across the globe, redirecting even a portion of the grain used to fatten cattle could feed every hungry mouth on the planet.

For Gene Baur, factors like these, combined with a deep respect for animals, helped convince him to adopt a plant-based diet. Mr. Baur is president and co-founder of farm sanctuary near Watkins Glen, New York. It provides a safe haven for animals that have been abandoned or abused.

Gene Baur: I grew up eating animals like most people in our country, but once I started considering my food choices I recognized that I didn’t want to eat animals. And the more I learned, the more I saw that I was healthier if I didn’t eat animals and that I had a much lighter footprint on our planet. The livestock industry is a greater contributor to global warming than the entire transportation industry according to the United Nations. So by eating meat, milk, and eggs the way we are, we’re harming our own health, we’re slaughtering 10 billion innocent animals every year in the U.S., and we’re destroying the planet.

Statistics compiled from the United Nations and the World Health Organization demonstrate the profound global effect that diet has on health. These are the estimated amounts of animal foods produced in nine countries, a figure that’s closely related to animal food consumption. These are the numbers of deaths due to heart disease and cancer in the same countries. In the United States, the very same diseases continue to have a grave impact. Even with the billions of dollars spent on cardiac treatment, heart disease is still the number one cause of death, killing over 600,000 people a year.

Esselstyn: And the elephant in the room, when we talk about stents and heart bypass surgery, is the fact that while it’s no question in an emergency, these procedures are absolutely lifesaving. But when they’re done electively, these procedures do not protect from new heart attacks.

Stents and bypass operations are used mainly to treat large arterial blockages. Yet according to many research studies, only a small percentage of heart attacks are caused by the largest build-ups of plaque. The rest are caused by the more numerous, newer blockages that are far more inflamed and much more likely to rupture than the larger, older, more stable plaques.

Esselstyn: And so this is why those procedures don’t treat the disease. They are treating symptoms.

Doctor Esselstyn has been eating the same foods that he has recommended to his patients for over 25 years. One of his sons, Rip Esselstyn, used a plant-based diet to fuel a successful ten-year career as a professional tri-athlete. When Rip turned 34, he was ready for a career change and trained to become a firefighter. Rip was assigned to engine company number 2 in Austin, Texas.

Rip Esselstyn: We’re incredibly competitive here at the fire station, and we love making bets. So we were out on the porch one night, and we kind of made this little bar bet to see who had the lowest cholesterol level. So the next morning, we drove to a lab, got tested, and the results came back. And it lead to a discovery that J.R., James Ray, our resident redneck, had a cholesterol of 344. Pretty much means you’re knocking at death’s door. And so what we did, in an act of solidarity, is the next day we went about eating a plant-strong diet, to basically save his life and save his arteries.

The men agreed to change their firehouse diet. But in Texas, old eating habits die hard.

Meat’s almost a sport in Texas. I have several good friends that, they’re barbeque teams. That’s what they do. That’s their sport on weekends.

Rip Esselstyn: Texans are serious about their barbeque.

Texas, Kansas.

Rip Esselstyn: Well, guys associate being manly with eating meat. And if you’re a firefighter, it’s exponentially so. Last year, for example, there were 133 firefighter fatalities in the United States. 52% were from heart disease. Our number one killer of in-the-line-of-duty deaths for firefighters is heart disease.

After just three weeks on his new diet, J.R. Tested his blood cholesterol, and it dropped 148 points, a decrease of 43%. His results inspired the others, who also saw their cholesterol drop and their energy levels rise. As firemen, they were not only helping themselves, they were in better shape to assist others.

Rip Esselstyn: One of the things about being a firefighter is you don’t have any idea what your next call could be. We may have a high-rise alarm, where we have to go up 20 flights of stairs with air packs on, with all of our bunker gear on, with a high rise pack on our backs. Anybody can go down the poll, but not everybody can go up, especially without their legs. And right there you’re talking about an additional 75 to 100 pounds that you have to carry up 20 flights of stairs. You have to have an amazing aerobic capacity and strength in order to do that.
Real…Men…Eat…Plants. Real…Men…Eat…Plants.
You know what, as firefighters, everybody thinks that we fight fire, and we do. But over 70% of our calls are medical emergencies where we are responding to heart disease, hypertension, type 2 diabetes, rampant obesity. And so we see, up close and personal, basically the destruction that’s being caused by the standard American diet. To me, the answer is just absolutely so simple, it’s criminal. It’s just people starting to take responsibility for their health and starting to eat more plant-based foods. It’s that simple.

* * *

After 13 weeks on a whole foods, plant-based diet, it was time to get my results from Dr. Lederman.

Lederman: When you started, your weight was 231, 231 pounds, now 211 pounds.

Fulkerson: Okay, that’s good.

Lederman: It’s a 20-pound drop there.

Fulkerson: Wow.

Lederman: Your blood pressure was 142 over 82 when you started. It’s now 112 over 70.

Fulkerson: Wow. That’s a big drop.

Lederman: That’s a nice drop. Oh, yeah, that’s… that’s great, and, uh, it’ll just keep getting… It’ll keep dropping as you continue to do this. Your pulse was resting at 92 when you started. It’s now down to 60, resting.

Fulkerson: Okay, cool.

Lederman: Your total cholesterol though went from 241 down to 154.

Fulkerson: What?

Lederman: Yeah, that was pretty amazing. 241 down to 154.

Fulkerson: 154?

Lederman: 154, yeah, that’s really… and your LDL, which is your bad cholesterol… um, I think this is the most impressive… went from 157 down to 80.

Fulkerson: No way!

Lederman: Yeah. That’s amazing that it dropped almost in half. Uh, we did C.R.P. last time, which is sort of the marker of the inflammation in the heart and the blood vessels. And that went from 6.0 down to 2.8.

Without using any medications, I significantly reduced my chances of getting a heart attack and many other diseases.

Nation: Tomorrow marks 20 weeks on the program. I’ve lost 45 pounds. I’ve reversed the diabetes.

Esselstyn: You have to know that everybody is so incredibly proud of what you’ve done.

Nation: I don’t have to rely on the medication. I have a lot of energy that I didn’t have before. My children love it. They’re so proud of me, and they tell me all the time. I had a little saying that I’ve carried around for maybe the last two years. And it’s “win the war. “Do not let one lost battle end the war. “If you do break down and give into temptation, do not quit. “Just get right back on track. Not tomorrow, but right now.” The diabetes is not coming back. I’m not gonna let it come back, nor the weight. The message is, you’re in control of your life.

Joey Aucoin had over two dozen health problems, including type 2 diabetes. But after 22 weeks eating plant-based foods, his condition had changed dramatically.

Lederman: Hey, how you doin’?

Joey Aucoin: Back again.

Lederman: And you’re getting healthier. Your weight is down 28 pounds. You feel better than you have. 26 out of 27 complaints are gone completely. Your marker of inflammation in the vessels is down to that of a normal person. Uh, your blood sugars are coming down. They continue to come down even on a daily basis, which are gonna get better. Your cholesterol is significantly lower than it was when you first started, before you ever started taking any pills. Your blood pressure is normal now, compared to how it was before while on pills. It was still elevated. And you just… you know, you just said you’ve never felt like this before. You look… look at how you look in the pictures. You look healthier. So, you know, like I told you before, I explained how the numbers can affect… can affect our judgment of what real health is. And it’s not just the numbers. It’s overall the entire picture, and your picture looks fantastic.

Joey Aucoin: I was takin’ nine pills a day and two shots. I was spending almost a 150 to 200 a month on medication, above my insurance. Just think about that: I’ve been doin’ it five months. I’ve saved, you know, $800 to a $1000 already, ’cause I haven’t taken one pill, one shot. So think about what that saved me… not just me, the insurance company.

McDougall: The U.S. government will give you figures that 75% of the dollars spent in health care are due to chronic illnesses, and these are due to diet and lifestyle. Let’s get rid of the problem, which is the sickness which is caused by the food.

Now well into their 70s, doctors Campbell and Esselstyn are both vital and active. They also continue to spread their message.

Esselstyn: If you carefully look at our school children, already the arteries to their brain, their carotid artery, is getting some intimal medial thickening.

Dr. Esselstyn lectures about his research all over the United States and abroad. His wife Ann frequently accompanies him to help council patients and to demonstrate the preparation of plant-based foods. Dr. Esselstyn is also director of the cardiovascular disease prevention and reversal program at the Cleveland clinic’s Wellness Institute. Like Dr. Esselstyn, Dr. Campbell continues to lecture throughout America and beyond.

Larry King: Dr. Campbell, you believe that even if animal-based proteins, meat, dairy, et cetera… are free from contamination, you don’t think people should eat them?

Campbell: No, I don’t. I think the closer we get to a plant-based diet… I should say a whole-foods, plant-based diet, the healthier we’re going to be for all of us.

In China, where Dr. Campbell did his large study a generation ago, the population has experienced dramatic increases in the amount of meat, dairy, and processed foods the average person consumes. At the same time, the rates of degenerative diseases are skyrocketing. Many Chinese now share some of the same beliefs Americans have about nutrition.

Eating meat gives us protein and has many benefits to our health.

Drinking a glass of milk in the morning is good.

Dr. Campbell’s message is resonating with growing numbers of concerned people around the world.

Thank you. Thank you. Thank you.

Thanks to the efforts of both these pioneers and their colleagues, thousands of people are realizing that profound improvements in health and quality of life are within reach.

Mason: You have two choices: You can eat yourself into poor health and early death, or you can eat yourself into good health and a long, healthy life. And that road is on a plant-centered dietary pattern.

Campbell: You know, I know of nothing else in medicine that can come close to what a plant-based diet can do. I can say this with a great deal of confidence, that our national authorities are simply excluding this concept of nutrition from the debate and the discussion in order to protect the status quo. In theory, if everyone were to adopt this, I really believe we could cut health care costs by 70% to 80%. That’s amazing. And it all comes from understanding nutrition, applying nutrition, and just watchin’ the results.

Esselstyn: The greatest gift that you could possibly give to yourself and your family, not only those in your generation, but your children and your grandchildren, if you can make them be aware of the incredible power that resides within each of them to avoid life’s most poignantly tragic and painful events, you just don’t have to have those kinds of events.

Yen: I believe that with all my heart, if anyone listen to this, and they really should look at their refrigerator, and look at their diet, and give a try. You lose weight, and you’ll be healthier. Nothing could lose if you just take few weeks and try. You could see how easy it is.

Oswick: I’m not gonna say it was difficult. Again, I made up my mind, this is what I’m going to do. I never felt like I wasn’t getting what I wanted. So I didn’t have ice cream, so I didn’t have the doughnuts, so I ate something else.

Aucoin: I can thank them in every way I can think possible, and my doctor, especially Matt, and they just can’t understand what it’s done to change my life. And it really has. Not just mine, my family’s, everybody’s. It gives me shivers talking about it, because it’s so serious. It’s a life-changing experience.

Nation: You can be in control, and I stress this, ’cause there’s so many things going on in my life that I’m not in control of. And that’s my message. You can control your outcome of your body. Eat to live and don’t live to eat. You better get that. You better get the recipe. This is good.

♪ sleep, don’t visit ♪
♪ so I choke on the sun ♪
♪ and the days burn into one ♪
♪ backs of my eyes ♪
♪ of the things I’ve never done ♪
♪ sheets are swayin’ ♪
♪ from the old clothesline ♪
♪ like a row of captured ghosts ♪
♪ over dead grass ♪
♪ was never much but we made the most ♪
♪ welcome ho oh oh ah ah home ♪
♪ ah ah oh ah ah home ♪
♪ ah ah ha ha ha ha home ♪
♪ ha ha oh ah ah ah home ♪
♪ ships ♪ ♪ are launching ♪
♪ from my chest ♪
♪ some have names but most do not ♪
♪ if you find one, please ♪
♪ let me know what piece I’ve lost ♪
♪ peel the scars from ♪
♪ off my back ♪
♪ I don’t need them anymore ♪
♪ you can throw them out ♪
♪ keep them in your Mason jars ♪
♪ I’ve come ho oh oh ah ah home ♪
♪ ah ah oh ah ah home ♪
♪ ah ah ha ha ha ha home ♪
♪ ha ha oh ah ah ah home ♪
♪ ooh ooh ooh ooh ♪
♪ ooh ooh ooh ooh ooh ♪
♪ ah ah, ah ah ♪
♪ ah ah ah ♪

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