This Vegan Documentary is a Bait and Switch

Good morning everyone. This is going to be a sort of off-the-cuff response video to the new Netflix documentary "You Are What You Eat." I'll say up front, I was really resistant to do this response video, but the waterfall of requests for me to view it has been enough to push me over the edge. So maybe I'll regret doing this, but here I am feeling shitty about myself while I do a response video to a Netflix documentary. That's advocating for a particular way of eating. With that said, the concept behind the documentary I, I find quite appealing— to bring people along with the scientific process. This documentary was supposed to be wrapped around research out of Stanford looking at an 8-week randomized controlled trial using pairs of identical twins. 22 started the study, 21 completed, where the twins were randomized to either a vegan diet or an omnivorous diet, with health metrics tracked along the way and reported at the end of the study. With the first 4 weeks being a feeding portion where they actually got meals delivered to improve adherence to the diet plan, and then the following 4 weeks they were asked to make their own food along that plan. So the idea of wrapping a documentary around it, while being propaganda by definition, I don't think is actually bad. I love the concept of bringing people along with the science. If done correctly. Now, I just want to start off giving positive feedback as best I can. It was interesting to watch, especially the beginning of the documentary, the first episode, some of the framing, because a lot of the statements, even if coming out of the mouth of certain people with whom I don't really agree— and I'm not talking about the main scientific team, more supporting cast— but talking about how you know, our food culture is very problematic, how the standard American diet is terrible, how there are issues with the dietary guidelines. Things like that are actually messages I can get on board with. So if you were to watch it and you walk away with just the, you know, the core message, what we eat really matters to our health and we need to have an adult discussion about that, that's great. I think that's a good core message. The issues I have I have several, but I'm going to kind of focus on 3 we're going to walk through in this video. The first, and probably my biggest issue, is it really wasn't about the twin study. It's about, you know, you are what you eat. At the very beginning it says this, you know, Stanford twin study. And so I went to the documentary kind of hoping to see the data broken down throughout the 4 episodes. And I'm watching and I'm watching, and I get to episode 4 and they haven't talked about any of the data. It's not until a bit into the last episode that they even discuss some of the data. And even in the last episode, it's a small fraction. So over the entire documentary, which is like 4 45-minute to 1-hour episodes— I don't remember how long each episode was— but, you know, over the whole docuseries, only a small portion of one episode is devoted to the actual data. The rest is wrapped around other issues. Related to what we eat, which I think were presented in a kind of biased manner. I will say they're important discussions to have, things like sustainability, animal welfare, and these things aren't necessarily intermingled, but they do need to be talked about, I think, in buckets before we can intermingle them. And it's really important to not conflate them in a misleading manner, which I think was done in, uh, this documentary. Again, that's not to say anything about the paper behind it, but when you're pitching this as this is about Stanford research and a twin study, you want to talk about the results related to health. And actually, it was pretty alarming that in the last episode, one of the, the main figures said something to the effect of like, I, you know, I could get people to eat more plants if I didn't talk about the health aspects. That's a paraphrasing taken out of context, to be clear, but it just, for me, when I was watching it, resonated in a particular way after being like, well, where are the data? Where are the data? Where are the data related to health? I'm in episode 4 and I haven't seen any. And then to say, you know, well, this really is about making, you know, a compelling argument, but not necessarily one related to health was for me a little bit cutting. So, you know, criticism one, this documentary was not about health data primarily. It was about spreading a message that, you know, plant-based is good. For other reasons, which we can nitpick in another video. But here I wanted to respond, I came on to respond to the data, which really wasn't the focus. Um, so that kind of transitions into point 2, which this felt like a sales pitch to me, um, unfortunately. Now I don't discredit work just because of where funding comes from, especially with nutrition work that can be very expensive. It's really hard to get, you know, grants. So You know, in general, I think it's okay to have industry funding provided the study is done well. In this case, the funding part of it came from Beyond Meat. And so when you combine that with the fact that the documentary didn't actually talk about much data and that a lot of it actually had to do with trying to sell meat alternatives, um, I, I do find that suspicious, and for a particular reason that I'll get to at the end of this point. But just some examples There was one company CEO just talking about how, you know, their meat substitute was— the first thing, you know, without compromise, as like an equal. And they elevated to, so this is truly— our meat is truly a better cut of meat. I'm not sure how you make that argument. I mean, the ingredients are things like koji culture, yeast, water, natural flavors. The, you know, the protein and the carb counts are equal in the meat. Like, this is not bioidentical. And, you know, can lead to potentially, you know, nutrient deficiencies. You're eating more processed food if you're eating these processed, you know, meat alternatives. The point of actually the study was to eat more of a whole foods diet. So a lot of these meat alternatives I don't even think were being consumed, which is a point I'll get to in a minute. They were advertising products that the participants just didn't even eat. So again, separating the industry from what was actually done for the study, making this again more of a sales pitch because you're not saying, oh, these are products participants ate. And look, these were the health outcomes. Like, no, participants didn't eat these, and then these are the health outcomes. They're kind of like separate things. So it's a little bit weird for me. And again, these substitutes, these plant-based substitutes, are not equal. Another example was this Miyoko's, like, vegan mozzarella cheese, which they were showing and talking about, you know, its, its practical elements, talking about how it's an amazing vegan cheese. I mean, the ingredients are cashew milk, sunflower oil, tapioca starch. The macro breakdown, macros not necessarily reflecting the whole complex food that is cheese, but are like, you know, 11 grams of carbs, 2 grams of protein in a cheese, in a liquid cheese that looks like Hellmann's Mayo. It's just, it's not an equivalent product, so it's a little bit funny that they're trying to sell it as such. And again, these aren't necessarily foods that participants are eating. To hammer home that point, one of the foods that they were going over was an egg substitute. They were showing a video of some Stanford students from their alt meat lab making an egg substitute, which is I think a fine scientific endeavor. I think it's kind of fun, and I actually think it's kind of cool that major universities are having these food engineering courses. It's probably something I would've taken in college. But then you look again, you look back at the data. This study was all, this documentary was supposed to be about the study. Table E-12, how much egg substitute did the participants actually eat? Remember, they're advertising egg substitutes. How much did they eat? Zero. The participants didn't eat this food. And you'll see in the table as well, meat alternatives. When they say meat alternatives, they're actually including things like tempeh, tofu, soy. So this isn't like Beyond Meat, the alternative. This is just plant-based proteins, effectively, is how I read it. If you're just having like a slab of tempeh, which I think is great tasting at least, and actually a pretty decent source of protein. That counts in the meat alternatives. There's nothing wrong with that food, but don't conflate that with an Impossible Burger. And don't advertise— this is me providing my opinion, you can do whatever you want, you have the money and the funding— but don't advertise, you know, fake eggs when the participants in the study about which this documentary is supposed to be didn't eat that product. It just, to me again, is misleading. Now, and this is kind of more of an aside, but I found it humorous when I was looking through some of the supplements. It's all about vegan versus omnivore. The vegan diet wasn't actually vegan, um, if for the only reason that it included honey. Still, I mean, if vegans on social media are going to be doing victory laps, keep in mind they didn't really have a problem with including some animal products. So you can take this up with the bees. But anyway, the, the third point is actually trying to get to the little bit of data that they presented. First focusing on what was the main endpoint of the study, LDL cholesterol. They call it bad cholesterol. I think everybody knows now that— not everybody, but people should know that's a gross oversimplification. Nevertheless, this was the primary endpoint. It was strategically chosen, I'm sure, knowing that a vegan diet will lower LDL. That's not anything new. Um, and indeed it did. Of note, the omnivorous twins, albeit they were twins, had higher baseline LDL as well. That doesn't mean the change wasn't still significant, but they did have, um, higher LDL at baseline by 8 mg/dL. This was from the baseline data table, which actually didn't have any statistical significant values that I noted, which was a little bit odd. But nevertheless, vegan diet lowered LDL. Fine, I would expect that. Interestingly, the vegan diet lowered LDL to the same level I had on a standard American diet, mixed diet, eating a bunch of crap food. So I don't even know why I brought that up. I just found it personally humorous. But of note, they do kind of try to vilify saturated fat at a few points throughout the documentary. Um, and so one might argue, oh, the vegan diet was lower LDL cholesterol because they had less saturated fat. Therefore saturated fat is bad. Yada yada yada. I'll just point out saturated fat can have a little impact on LDL cholesterol. Um, fiber in this context I think probably had a larger impact. If you actually want to look at the saturated fat in the omnivorous group, remember because this wasn't a low-carb diet by any means, this was a high-carb diet, the saturated fat per meal was pretty low, 4 grams per meal. Like they weren't drinking butter. So the driver of the low saturated fats, probably fiber, and the driver of satur— uh, this— the driver of the low cholesterol, sorry, not saturated fat, was probably more fiber than the fat. And it's really important to highlight, this is really important, that drivers of LDL cholesterol changes with dietary shifts are multifactorial and differ based on other elements of dietary context. So if somebody goes low carb the driver is much more likely to be a low BMI. So there were a pair of twins in this study who had body fat starting at 11%. I bet you if you put them on a low-carb diet, even vegan, their LDL would have gone up. So the LDL topic is complicated. I'm not surprised it went down with the vegan diet. I expect that. I don't think the main driver here was saturated fat. You can draw your own conclusions. I've presented some of the data. But moving on from that, you know, other endpoints were interesting to look at. Things like, you know, HDL and triglycerides, they, in terms of just lipid markers, there were non-significant differences between the groups, but lower HDL trending and higher triglycerides trending in the vegan group. Insulin went down in the vegan group compared to the omnivore. Not entirely surprising given that the vegans were eating less in general. It wasn't a statistically significant difference. And of course, if your goal is to lower insulin and glucose, the best option would be a low carbohydrate diet, which You know, wasn't included and wasn't the focus of this trial. An interesting thing was, um, uh, TMAO, which is something that, um, you know, it's a, it's a compound of metabolite that can increase in the blood when you have more fish or meat in your diet. Again, fish or meat. It's questionably associated with cardiovascular disease. They even say that TMAO may be a bystander of disease. Um, I think that's even a strong statement. In the documentary, they say that there were differences. Um, in the paper, they clarified there weren't actually differences on the primary analysis. They had to exclude 3 participants to find a difference. Um, so you can take that as what you will. For me, it was kind of a soft endpoint that, you know, oh, if we cherry-pick out some outliers, then maybe we can find a difference. I don't think it's necessarily clinically relevant. I think the clinical relevance is questionable. So it's interesting they chose to highlight that in the documentary. The thing most people might be interested in was weight changes. Now, the vegan participants generally ate less and less protein. So what they reported in this study was, and this comes straight from the main study, the vegan participants lost more body weight, minus 1.9 kilograms, and the confidence interval, you know, it didn't cross zero. So the vegans lost more body weight. In the study, they do not report body composition. Not in the main study, not in the supplement. You can do a Ctrl+F for dexa, D-E-X-A, D-X-A, body composition. It's not there. It's interesting then that in the documentary they chose to highlight body composition, which was not that favorable for the vegan diet. So here's, you know, one set of twins, Michael and Charlie. What you find is that the vegan twin, vegan again, because he might have had some honey in his diet per protocol, lost 3.5 pounds. And the omnivorous twin only lost 0.1 pound. So that's what was reported in the study. That's the data, the main endpoint, one of the secondary endpoints actually, was the weight change. And it's like, oh, the vegan lost more weight. So that's what's reported in the study. It's interesting that they actually include body comp in the, um, documentary. And what you can clearly see here is, yeah, the omnivore lost less weight, but he gained 3.6 pounds of muscle and lost 3.8 pounds of fat. Whereas the vegan twin lost more weight, but he lost muscle and less fat. So again, just to highlight, the omnivorous twin gained more muscle and lost more fat. And the vegan twin lost less fat, but also lost muscle. So that's where the benefit, heavy quotes there, of the vegan diet on the weight was. Now the other twins had similarly, you know, results that just didn't necessarily resonate with what I read in the paper. I also found it interesting as an aside, again, this is with the like the change in the marketing and the framing with respect to the documentary versus the paper. They talk about in the study how it was an ad libitum protocol. People should just eat what they feel to, you know, get satiated. But then, you know, they're comparing twins and like one twin, this is another set of twins. I think it was Jevon and John. I might be getting those names incorrect, but the omnivorous twin gained a lot more muscle. And then the vegan twin did not gain as much muscle. And then the narrators and the trainers were like, well, that's because the vegan twin didn't do the vegan diet right. He didn't eat enough calories and protein. So it's like, you can't say in the paper, in the protocol, oh, this is ad libitum, we just want to, you know, tell people to eat as much as they want, and then tell the participants— and they said this in the documentary— they wanted the participants to eat— these particular participants who were trying to gain weight— more, and then blame the results on the fact that they didn't eat enough of the vegan diet to gain sufficient muscle mass, and that's why the omnivorous diet caused more muscle gain. It's just kind of, I think, a deceptive reframing in my opinion. And, you know, I could go on about other things like diet satisfaction. The omnivores ended up liking the diet more. Most of the vegan participants ended up including meat again later on after the study concluded, and they kind of highlight that in, um, in the documentary and in other sites. Eating out could have been a confounding factor. It looked like the omnivorous dieters were eating out more. So, you know, that's a variable because it is just easier to eat out on an omnivorous diet than on more restrictive diets, be it vegan or keto. And so that can be, you know, founder. These are all tiny— tiny— can't talk today— tiny side points. To review, you know, I was really disappointed more than anything in the fact that this wasn't about the study. This wasn't about the results. Only a tiny proportion talked about the results. This mostly was a sales pitch for vegan fake foods, which weren't the focus of the study. And they were, I think, you know, misrepresented in terms of their nutritional quality. And that topic was actually swept under the rug as a topic of the documentary in place of talking about, you know, non-nutritional potential benefits of eating plant-based. So again, conflating messaging. And then, you know, the results were a little bit underwhelming. I'm not surprised that a vegan diet lowered LDL a little bit. You know, there are other ways you can do that. Stay tuned for maybe my next paper. You'll be a little bit surprised about that. Not generalizing to people beyond myself, but nevertheless, stay tuned, you'll find it interesting. Um, and then things like the body weight change, which, I mean, there weren't really many changes. They reported mostly the LDL and the body weight change. In the paper, they say the vegan diet is beneficial and because it causes more, you know, weight loss. And then they're showing results in the documentary that are distinct from the paper where they're saying You know, yeah, the vegan diet caused more weight loss, and they're trying to put a positive spin on it, but then they're showing results from, again, 4 participants that were cherry-picked out of 21. So they could have chosen the best cases they could have, and they're still saying, yeah, for some of these guys, you know, the omnivorous diet caused more muscle gain and in some more fat loss. So I'm not really seeing what the benefit of the vegan approach is here and in a generalizable sense. That's not to say you can't have success on a plant-based diet, that you can't build muscle, you can't perform well athletically on a plant-based diet. I actually believe that you can if it's well formulated. But to try to engineer the message this is better for health from what was presented, I think is really a stretch. So those are my two cents.