Forks Over Knives is a 2011 American film that purports to show that "most, if not all, of the degenerative diseases that afflict us," such as cancer and heart disease, can be controlled or eliminated through a vegan diet. The movie is a presentation by documentarian Lee Fulkerson of the claims of Dr. T Colin Campbell (author of The China Study) and Dr. Caldwell Esselstyn.
The primary claim in Forks over Knives is that a diet including animal products not only leads to obesity and obesity-related conditions, but also to cancer.
On the subject of obesity, the documentary details the works of diet-based doctors, such as Dr. Esselstyn, that claim they can reverse obesity, type II diabetes, and heart disease simply by switching a patient to a 'whole-food, plant-based' diet, which is illustrated to be a very specific vegan diet. The documentary supports this claim with data from The China Study, a detailed but often challenged study done by Dr. Campbell that examined population data in China to demonstrate a correlation between animal products consumed and "western-type diseases" such as heart disease, diabetes, and other afflictions. There are supplemental studies, such as a 2009 study at Some Goddamn Place that indicated that rats that were fed the milk protein casein later displayed higher cancer rates. The China Study, however, forms the bulk of the film's proof for its claims. The study paves the way for a recurring theme of how the consumption of animal products is a "western" idea, while plant-based diets are an "eastern" idea; the glamour of the mysterious and magical Orient will cure what ails you!
The documentary dips into historical investigation, as in its discussion of Germany's WW2 occupation of Norway. During this period, the Nazis seized much of Norway's food assets, such as livestock, butter, and cheese. Dr. Esselstyn maintains that local incidence of heart disease dipped drastically, due to the removal of animal products from the Norwegian diet. The possibility that there were simply fewer Norwegians after the depredations of the Nazis, or that a higher percentage of Norwegians died from getting shot or gassed during this period before they were old enough to develop heart disease, is not addressed.
All our problems can be solved by becoming vegans! Rejoice!
Usage of the term "animal products."
- Not all animal products are the same. It is sloppy to lump all animal products into one big category, encompassing both the KFC "Double Down" and plain egg whites in one group. It would be similarly useless, for example, to claim that "plant products" are unhealthy for children because nightshade is poisonous.
Plant products are healthy, look at these beautiful happy endings where veganism saved the lives of these people!
- What this documentary doesn't mention is that these people didn't go on just any plant-based diet. They went on very specific diets, ones that eliminated not only animal products but also all oils, including vegetable oils such as olive oil. Further, the restrictive nature of this diet eliminates all of the junk that they were eating before. It's hard to tell if weight loss, reduced diabetes and heart disease correlate with a plant-only diet - or with the simple elimination of junk food.
Animal-based diets are western, and plant-based diets are eastern.
- This is a disguised appeal to "ancient, foreign wisdom" instead of common sense. Vegetarianism as a conscious lifestyle choice is relatively rare in China, for example. While there is a global distinction in eating habits, it is almost solely one rooted in disparate levels of wealth and industry; producing enough meat, at affordable prices, and making it available to the general population requires not only a relatively rich country, but one with a firmly established meat industry that is able to deliver the goods. In many meat-eating countries and regions, agriculture of animal products as well as plant products is subsidized to a degree. In areas that still rely on substisence farming or have poor agriculture support systems, animals are very time, labor, and resource-intensive to care for and as a result diets contain more plants.
Usage of the term "western diet".
- If this sounds exactly the same as the usage of 'western medicine' in alt-med discussions, that's because it is. This documentary, despite its support by actual representing doctors, is a promotion of a kind of alternative medicine: the idea that serious diseases not only spring from dietary causes but can also be resolved by them. Most medical practice accepts diet as one factor among several others when it comes to heart disease and diabetes. Diets that are high in saturated fat and salt, for example, can help cause serious cardiovascular problems. However, Forks Over Knives goes a step further than medical science can credibly support, claiming that the promoted vegan diets can actually cure "western-type diseases."
Poor anecdotal evidence.
- A major claim in Forks Over Knives is that diet is the key factor in cancer, type-II diabetes, and heart disease cases. Yet the anecdotes provided as evidence for this claim are misleading. In several of these anecdotes, the individuals didn't simply change their diets: the patients in question changed their whole lifestyle.
- It is not mysterious that a man who stopped eating junk food and began to exercise more would have more energy and lower his cholesterol. Nor is it unheard of that type-II diabetes, which can result from poor health habits, might improve with a significant change in lifestyle. But in Forks Over Knives, the shift away from animal products is the decisive factor.
The China Study.
- Dr. Campbell's China Study faces stern criticism from low-carb blogger Denise Minger for omitting key data and results for the sake of its conclusion. She claims "correlation not being causation" is a major issue with it and that Campbell ignores many other correlations discovered for the sake of the ones that display evidence for a meat-cancer link. Minger being a non-expert with no background in epidemiology dramatically misses the boat by using unadjusted correlations, making her results completely worthless. Minger was openly challenged by Dr. Campbell to submit her findings to a peer reviewed journal for publication, so as to launch a formal critique in the scientific arena where it can be discussed openly by the scientific community. Minger has not done so, as her work would be eviscerated by just about any scientific review for being laughably terrible. She is however publishing her own book, and claims to follow a diet very similar to the one suggested by the film.
There are no serious scientific criticisms of the China Study or its results. Campbell's conclusions from the study, and suggestion to avoid all animal protein are scientifically validated by many other studies, even if there are some debates about how much is a safe upper limit. Public health experts remain hesitant to suggest people switch to vegan diets, even when their research suggests that that may be the proper conclusion of their work. (see statements made by Walter Willet, Frank B. Hu and especially their colleague Eric Rimm, who was quoted saying “Well, we could tell people to become vegetarians,”...“If we were truly basing this only on science, we would, but it is a bit extreme.” - Eric Rimm, nutritional epidemiologist, Harvard School of Public Health). This is likely due to industry pressure, and the personal dietary preferences of these scientists. Similar issues with smoking were seen when it was definitively shown by large epidemiological studies that smoking causes lung cancer.
- Although it is true that Norway's livestock was requisitioned in WWII, Forks over Knives leaves out the black market trade of such goods in a wartime country, as well as wholesale substitutions in the diet. For example, fish was much more widely consumed, to the point of fish roe being dried and ground up as a stretcher to add to rationed flour in bread, and people experimented with eating moss and seagull. The removal of livestock does not instantly indicate a shift to a vegan diet. Nor should it, because correlation does not equal causation. It does however directly indicate a dramatic decrease in the availability of the high saturated fat, and high cholesterol products that were a staple part of the diet. The post WWII reduction in chronic disease throughout Europe due to rationing and occupation was studied and formed the basis of the Senate Select Committee on Nutrition's findings implicating saturated fat and cholesterol in chronic disease.
Casein and Rats.
- Regardless of the findings, it is somewhat questionable that the effects of isolated casein ingested by rats might apply to the effects of hundreds of different animal proteins ingested by humans, especially when many of those proteins are accompanied by other substances found in animal products that may alter the effect on the body, such as whey which is usually found alongside casein in milk and has reported anti-cancer properties.
If you don't disregard these published peer-reviewed findings, the caesin-rat study showed that 100% of cancer occurrence in the liver in the presence of aflatoxin (a known carcinogen) could be turned on and off by adjusting the protein intake of rats. This study was repeated and published multiple times, by multiple groups of researchers, and presents a startling implication that caesin may have a causal role in carcinogenisis. Campbell's belief that this is due to the protein itself may be flawed, but many possible reasons for this association exist, including high sulfur content of animal proteins, IGF-1, and other tumor promoting hormones found in animal foods, and the bio-accumulation of toxic chemicals in fatty animal tissue.
This documentary is loaded with weasel words when it comes to veganism. Although they don't call it a vegan diet. Instead, they call it a "whole-food, plant-based diet." Presumably this is to avoid the loaded term of veganism, which invokes images of dirty hippies, PETA, and environmentalism issues to some.
In addition, it uses many heartstrings-tugging anecdotes of how people went onto very strict vegan diets and ended up losing weight, solving their health problems, diabetes, heart disease, etc. Although the stories are valid, they are a very clear show of pathos. Even the most critical reviewer had to admit she liked the feel-good stories, even if they added nothing to the credibility of the claims.
And finally, this documentary plays upon a modern American fear of poor health and body angst to sell its ideas.
 The possible aim
While the film repeatedly slams money-obsessed business practices and attempts to cast suspicion on the good will of conventional medicine, it is not a pure-intentioned messenger of wisdom, truth, and broccoli. While a few approved recipes appeared on their site, the exact details of the magic diet(s) are unknown... unless you buy some of the advertised books!
The "FoK Diet" page is helpful enough to prominently link to many of these titles, and even offers a convenient 'book packaging' service to make it even easier to buy multiple books.
There's nothing wrong with pointing consumers to these books and commercial diet programs, of course. But this is a program that has been presented as an ostensible public service, because the public needs to change their diets. But the proposed alternate diet - so heavily emphasized in the film - seems to actually be several different diets. Some of these diets are not strictly vegan, and include items such as honey, and each is the brainchild of different doctors. And while they have some common traits, their most prominent aspect is that they all want your money.
 See also
- ↑ 1.0 1.1 Forks Over Knives official website
- ↑ IMDB entry for Forks Over Knives
- ↑ 0.32% less Norwegians
- ↑ Q&A about Dr. Caldwell B. Esselstyn's "heart-attack-proof diet."
- ↑ The China Study: A Formal Analysis and Response
- ↑ Food rationing during World War two: a special case of sustainable consumption?
- ↑ Whey proteins in cancer prevention.
- ↑ The FoK diet