Forks Over Knives

Forks over Knives, a movie whose theme is in the title: food will replace surgical scalpels for cancer, heart disease, obesity, type 2 diabetes, and others.  Their answer is a “plant based” diet (Vegan).  The movie provides three live anecdotes to prove this, and star T. Colin Campbell and  Caldwell Esselstyn, Jr whose careers intersected with both having come to the same conclusion that a vegan lifestyle would eliminate heart disease, perhaps cancer, obesity, and other chronic illness.

The two stars of the movie, answering questions at its opening

The movie started with lots of video of obese people, and the movie ended with most of the people in the movie sitting down having a friendly, plant-based meal: great cinematic contrast as this small band of people fighting diseases by eating plants.

Some consider this movie  a documentary, especially those who advocate the whole plant (Vegan) lifestyle. It is not a documentary, a documentary is non-fiction, this is a movie, it is a hope, it is an unproven hypothesis.  As much as we (physicians) would love food to solve medical problems, and there is no doubt food can cause problems, but food, as medicine is another matter.

We are introduced to the narrator, Lee Fulkerson, who presents himself to a clinic while smoking a cigarette and having left behind two empty cans of an energy drink, and stating he earlier drank  a large cup of coffee.  The clinic is a family owned clinic  where the physicians, Drs. Matthew Lederman and Alona Pulde, promote a vegan lifestyle and will shop with the patients, cook with the patients, and watch their laboratory values improve. By the end of the film the narrator has lost weight, improved cholesterol, and improved his cardiac risk factors (they don’t tell you that the main reason for that improvement is he stopped smoking).

Lee Fulkerson looking over his lab results with Dr. Lederman

Much like the narrator doesn’t tell you that removing cigarettes, and weight loss were the primary improvement, the entire movie has a tendency to gloss over points, data, and misrepresent biology.

The good points of the movie are:

(1)  The doctors

It is great to see the physicians who take time with patients to change and impact their lives. Drs. Esselstyn, Matthew Lederman, and Alona Pulde whose fundamental belief in prevention is to impact what a patient eats. If you believe that food makes that fundamental impact on health, these physicians make a tremendous investment in their time to helping these patients. Many of us are teaching patients how to cook, and what to cook and more physicians are taking the course at Culinary Institute/Harvard to learn to these skills.  Changing lifestyle, spending time with patients, and having a positive impact is the ideal of primary care medicine.

 

Dr. Lederman and Pulde are a great team in this movie

(2)  Eating Healthier

Eating healthier is better than eating junk. No doubt the lady who ate her share of donuts into a heart attack helped herself by avoiding donuts. Whether she would have done just as well following a paleolithic diet as a vegan diet is debatable

Told she had to go to a rocker, Ms. Oswick found Dr. Esselstyn, and now lives without her donuts and chocolate

(3)   Feel Good Story

Watching a heartfelt good story: seeing people’s health improves, feeling better, and being more fit is a great story. Seeing physicians working to that end, as well as advocates of that position

The Incomplete Data
Cholesterol: The notions of cholesterol were not only out of date, but incorrect.  Early on the narrator states that cholesterol is what forms the plaques in the arteries of the body. To quote, “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.” This is not how plaque forms, and dietary cholesterol is far less important.  It may be that both T. Colin Campbell and Esselstyn were both trained in the era when cholesterol was thought to be the cause of the arterial plaques.  It isn’t and there are more discussions about this here.  Some people,  who have minor elevations of lipids,  can lower their lipid level (I avoid saying cholesterol because that is just not what we need to be talking about here)  through diet, exercise, and weight loss alone, but before throwing away medications and eating plants they should be  carefully monitored by their physician.

This is not a “minor slip up” in the movie- this is the first tenant of a plant based diet. It is also dangerously incorrect. Dietary cholesterol is avoided in a plant based diet, but a plant based diet does not avoid plaque in arteries.

The now clean arterial plaque:
One of Dr. Esselstyn associates had a heart attack- and they show the angiogram of his coronary arteries after the heart attack. You see the smooth arteries around this and then the ragged artery that caused the heart attack. After time on the plant based diet another angiogram was taken- and behold the artery is now clean.

Left is a clot, the artery on the right is free of clot - it is NOT reversed disease

This is misdirection to the viewers.  What they are seeing in that ragged artery is the remains of the clot in the artery that caused the heart attack. If a person survives, within a few days on aspirin that clot will disappear.  The associate credits Dr. Esselstyn with saving his life, by putting him on the plant based diet. But the misdirection is egregious, planned, and is often replicated on many websites that advocate a plant based diet — they will either show an artery of someone who had a heart attack with remaining clot, and then show a clean artery- or they will give you a slightly different two dimensional view of the artery that is more favorable.

The Norway Data
Dr. Esselstyn then shows the data of mortality from heart attacks and strokes of World War 2 Norway, which drops dramatically after the Nazi take over, and confiscate the meat supply.

The death rate dropped before the Nazi's took the Norwegians meats

The first question one would ask — if this is true, if by removing meat you immediately see a drop in strokes and heart attacks?  That is the implication. The problem is that Dr. Esselstyn’s conclusion about the data is missing a few points that might clarify the data:

The decrease in wartime heart disease and strokes was replaced with an increase in mortality from infectious disease, trauma (in war people tend to fire more bullets) – and in particular outbreaks of TB. The meats from the livestock were not taken by the Nazis until after this graph showed the dramatic decline (hence the drop was not because of less meat being consumed, in fact during this drop Norwegians consumed more meat  because the Nazis had told the Norwegians they were going to confiscate their livestock, so many Norwegians simply slaughtered their animals and didn’t raise new ones the following year. Meat consumption during this “fall in the graph” was almost double what it was during normal times.

The fish consumption during these times doubled. Not that eating more fish will decrease coronary disease (except in large population series this is a trend).

While others have pointed out that sugar consumption decreased, wheat consumption decreased and thus they became a paleo society with an emphasis on fish (thought Norwegians were Lutherans and turned out they were Pescatarians) – it is a long stretch that any single change in a diet would cause a single year dramatic decrease in cardiac mortality and strokes (but would be great if it did). It fits the theme of the movie that the change to a Vegan diet will, within a year, dramatically alter years of coronary artery accumulation of plaque – it won’t.

Dr. Campbell’s cancer study:
Rats given more milk protein have more “foci” of cancer than rats fed less milk protein. Several issues with this study, and those conclusions.  First, it wasn’t that the rats lived longer- they didn’t.  The rats died from being a part of an experiment, and some rats died before they were suppose to– those rats all were the rats getting less of “mothers milk protein.”

Campbell takes the one milk protein  and generalizes it to all animal proteins. Why? Proteins are chains of amino acids, and there is some magic about how a plant puts the amino acids together than an animal?  Casein is a bio-active group of proteins found in milk- it stimulates tissues to grow, which is what you want mother’s milk to do- it is not just a source of nutrition but is a “bioactive protein” meaning it helps to turn on certain proteins.  Take a rat liver, put it with a super high concentration of a protein that turns on proteins, and then add a cancer causing agent –well, it makes sense. But remember, these rats had better looking livers than the low protein rats (who died faster). Also  whey protein, another milk protein, has been demonstrated to have some opposite effect with tumor.  Some proteins are bio-active, and have effects when given in super concentrated form and isolated from their natural counter parts – like whey, they behave in not natural ways. Then to use this to make global conclusions about animal proteins is not science, it is prejudice. I discussed Dr. Campbell’s assumptions here.

Dr. Esselstyn’s patients:
Dr. Esselstyn took a bunch of patients with heart disease, convinced them to go on a Vegan diet (initially the group was allowed to have dairy til he met Dr Campbell then no dairy). Of this small group, six people dropped out. You can see more about his works on my previous post regarding him and this study.

While the study seems great, and they bring out two individuals who were a part of the original study (I think- they don’t really say that, and since the movie tends to gloss over details quite a bit one cannot make assumptions).

What is remarkable is that Dr. Esselstyn met with these patients every couple of weeks in his home. One sweet lady who had two heart attacks before 59 while eating a diet of chocolate and “every donut I could get my hands on and lots of gravy.” She also noted that Dr. Esselstyn, in spite of his “kind eyes” was quite strict “there’s the door.” That may explain why 6 of the original 24 dropped out.  Of the remaining 18 the math gets a bit fuzzy. 6 had “evidence of regression of disease” 11 stabilized.  But it turns out that Dr. Esselstyn’s math as presented was off, and not surprising, the data in this movie is driven by making a point, and not by precise details.

Esselstyn’s publication states he started with 22 patients, five dropped out, and six stayed on the diet but never came back for data collection—leaving Esselstyn with only 11 people in the study. The data from the  11 had  stabilization of their heart disease, but four people  had lesions that slightly progressed. The paper then looks at the method of regression of plaque, and these methods are now considered out-dated and of no use.

The high drop out rate could mean people either could not tolerate the diet, or died, or were asked to leave. The other issue is these patients had other interventions, such as statin agents that really do reduce arterial plaque formation. Esselstyn’s paper that does not rise to the evidence based medicine for major research. It is quite small, highly selective of the patients, not controlled for other interventions with heart disease (some patients had angioplasties, heart surgeries, and etc) – thus we cannot determine which intervention for this small group of individuals worked, if any. Why Esselstyn didn’t keep the other drop-outs on to serve as a control is deeply flawed.  Throughout the years on this diet variables changed – such as removing dairy products, and even if there was a dietary answer to heart disease, it would be lost in the details.

As a personal anecdote, my father had a heart attack in 1979, was forced to retire at age 55, did not have angioplasty (not available then) and loves sugar, ice cream, peanut butter, meat,  cheese, but he stopped smoking, retired, and 33 years later (and a few stents and an implantable defibrillator later). Looking at his previous angiograms- his disease has regressed (in spite of not being on a plant based diet, not being on a paleo diet, and not probably eating things that most diet zealots would shun). That is a series of 1, not 11 – but has as much validity as Esselstyn’s work.  The question is, was it diet that did this for these 11 people? What happened to the others? What does this mean? The answer is that this is as much of an anecdote as my dad is.

The China Project
T. Collin Campbell, a physiologist, calls this massive study the highlight of his career.  With his Chinese counterpart, Dr. Chen,  they took the simple hypothesis: diet effects disease rate.  By choosing rural villages with stable diets, and known health and mortality statistics assumptions could be made about how diet effects health.

Campbell and Chen with their monograph

The film shows the proud researchers, with reams of data, and the NY Times Jane Brody column (Brody is not an authority figure but the implication that the NY Times said this was a good study is another logical fallacy called “appeal to authority.”).

There are major problems with the China Study – the blood samples of all individuals was pooled and studied – avoiding individual variation. The statistics for heart disease in rural villages in the 1970’s (they used this data for their study) was imperfect at best, and if you ask Chinese cardiologists today the current statistics – 30 years later – are poor.  Heart disease is underestimated now, and even more 30 years ago. The same with cancer statistics, and most rural Chinese statistics.

The China Study has been uniquely reviewed and dissected by  Denise Menger of rawfoodsos.com.  She points out how the data sometimes shows the opposite of what is stated (much like this movie).  For example, the meat eaters of one village had lower levels of the diseases.

OVERALL
This is a movie, and not a documentary. This is a movie that advocates a plant based (Vegan) diet will solve heart disease, cancer, and other ailments- and presents inadequate and skewed data to that end. To be clear, there is no substantial data that proves their point, and the data they use is skewed if not outright incorrect.  It is a warm, feel good movie with some great people.

IF you wish to have a whole plant diet – then do so..  If you think you can throw your medicine away and just eat plants, do not do this without medical supervision – and by that I mean the MD or DO who prescribed the medication for you, or a physician that will monitor your blood levels of lipids, glucose, etc.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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  1. LafinGuy says:

    We enjoyed your review. Great points made throughout. We’ve been conducting our own little experiment inspired in part by this film as well as other documentaries & our motivation to live a fresher, healthier lifestyle: improving our quality of life.

    Both MoniQue & I have been moving toward healthier eating habits over the past year: shopping farmers markets, eliminating processed & package foods, purchasing grass fed beef & free range chicken. However, we decided 12 days ago to see what would happen if we completely eliminated animal-based foods from our diet over a 2-month period.

    I was diagnosed with type 2 diabetes a couple months ago, and I’ve had a history of high cholesterol. I’ve been on 850mg of Metformin & 5mg of Crestor, a day, for the past 2 months. Although I was not terribly overweight, I have dropped 15lbs over the same period. My blood lab results this week showed my cholesterol levels drop from 289 to 145. My blood sugar numbers are down from the high 200’s to low 100’s and my blood pressure reading, which was 140 over 90 the first two visits to my physician, was 130 over 85 this week. I credit the medication for the majority of my improvement, but also feel that the total lifestyle change is also having an impact, as I know you agree. I am hopeful that with continued commitment, I will find myself medication-free within the year.

    MoniQue has had her own health issues as well. We know that diet & exercise will produce results, but we’re curious as to whether or not dramatic changes occur over the next couple months. Both feeling better overall & improvements in medical condition are important. We believe that you can heal through food but not with food alone.

    As with anything, this film included, you take away what you like from it & incorporate it (or not) in your own life. We’ve decided to re-introduce fish into our diet a couple times a week, as of yesterday. But, we’ve agreed to continue keeping dairy & meat out. We aren’t preaching or advocating this to anyone else, as this is our own journey, but we are curious as to how we’ll feel over time. As a result, we’ve been vlogging about it weekly, updating our progress, talking about our meals, & joking about our relationship (humor is the best medicine, eh?). You may have already visited MoniQue’s blog, but if you haven’t, it’s lafingal.wordpress.com. I know we’d both enjoy some snarky comments & professional insight.

    Cheers!

  2. The Doc says:

    Always good to test things – and it is not a bad thing to eat whole foods. Good luck with your experiment – keep us informed of your results. As you see we had great results with Evo on the beer and sausage diet. He lost 15 pounds in a month- dropped his cholesterol and triglycerides – all on a diet of processed meats and beer. Almost the anti- everything diet, but it shows something simple: what we don’t know about diets is legion. Fish is good- of all the studies, people who eat fish tend to live the longest- of course, they have a lot of exercise running away from polar bears.

  3. Lynn says:

    I bought Esselstyns book but not because I want to be a vegan. The recipes are low in fat and lower in calories than conventional recipes. We keep kosher and kosher meat is expensive so having some vegan meals once in awhile is frugal. I don’t want my grandkids to develop weight problems so if I can get them interested in some whole wheat chocolate cake with some vegetables hiding in it, that might help. My mother died of type 2 diabetes, kidney failure and heart disease (she did not keep kosher and ate fast foods). I am very weight conscious and don’t weigh much but I like healthy stuff.
    I personally would wonder if it would be safe for person with occluded coronary arteries to opt out of cardiac surgery and embark on a vegan diet as a substitute. I could see a person getting the verdict from the cardiologist that surgery was his only hope and then this person books a flight to Ohio to see this vegan doctor. It does not seem realistic to me. Such sick people also would need someone to cook for them in order to stick to such a diet. I can’t imagine the sick person himself making that big kitchen mess.
    I do feel that probably most Americans are overweight but that does not automatically make them sick. It seems that for some, obesity is mostly a cosmetic issue but others develop backaches and diabetes. Despite all the fast food and obesity, the average American lives to be 84. I have seen skinny, seemingly healthy people, have heart attacks. I do wonder though, if Alzheimers is related at all to diet. I also wonder why certain hormonally driven cancers seem to be hitting more Americans at an earlier age.

  4. The Doc says:

    Think about heart disease this way: once the plaque has built up it takes a lot for it to regress- and the best agents we have are the statin drug therapies. The evidence that a vegan diet reverses heart plaque is poor quality evidence, and not reproduced by anybody else. If you need heart surgery, then get heart surgery – because the vegan diet won’t help you that quickly. I wish it did. A friend of mine, fellow surgeon, had two previous heart bypass operations and was told he couldn’t get another. He went on a strict Ornish diet. Thankfully he got his third bypass operation, because the Ornish diet didn’t reverse his disease.
    Nothing wrong with a plant based diet- however, there is something wrong if people think you can eat your way out of disease – especially if they have no real proof.

  5. Sugel says:

    These discoveries inspired Campbell and Esselstyn, who didn’t know each other yet, to conduct several groundbreaking studies. One of them took place in China and is still among the most comprehensive health-related investigations ever undertaken. Their research led them to a startling conclusion: degenerative diseases like heart disease, type 2 diabetes, and even several forms of cancer, could almost always be prevented—and in many cases reversed—by adopting a whole-foods, plant-based diet. Despite the profound implications of their findings, their work has remained relatively unknown to the public.

  6. thedoc says:

    Their work showed nothing of the kind, and is far from groundbreaking. The China Project you allude to was poorly done, and had errors in it that are innumerable and one reason it is not cited by scientists today. There was no case of a cancer being reversed, and no case of heart disease being reversed. Type 2 diabetes with weight loss can be managed with less or no medications – that is not startling at all. Esselstyn’s study was anecdotal at best, and how they calculated “reversal” is not at all. Campbell’s study in China was an observational study- and he has yet to explain how the villages with the highest meat consumption have the lowest chronic disease.

  7. Debbie Lucas says:

    So impressed!! My huband and I are going to try this .Sick and tired of not feeling well..also oreded the cookbook. not sure how to cook this way..But what about soy milk? isn’t this plant based?? Thanks..Debbie

  8. David says:

    Um, might I add that your website too is filled with completely incorrect information?

    You stated that aspirin will remove the blood clot, which is true. However, blood clots usually occur because of atherosclerosis, which are ultimately caused by plaque build up within the artery which the aspirin will have no effect on. Is that supposed to save the patient from the next heart attack? Probably not.

    Furthermore, you said that Esselstyne’s patients were also on statin agents which reduced the plaque… This is true, but the agents did nothing previous to the visits with Esselstyne, and it was only after the visits were they able to stop using them. Perhaps the statin prevented them from another heart attack, but it allowed them to continue to live unhealthily.

    You also said that the plaque was not made from cholesterol… well, that’s just plain incorrect. Not just a “minor slip-up,” but outright wrong. Unless you’d like to take on Mayo Clinic, a world renowned research centre, the plaque is formed by low-density cholesterol which is commonly found in ANIMAL products. The low density cholesterol is found in the fats in the blood, but when the amount of cholesterol increases the fatty substances accumulate, causing the atherosclerosis.

    The thing I liked about the movie was that it made the point (with mostly factual information, although I will agree that not all of it is completely accurate) that health is in our own hands and that our bodies have the ability to heal themselves if we feed them the right fuel.

    And to finish off, coronary heart disease is the number one killer in the U.S. (and commonly worldwide), and is based off of mostly avoidable circumstances. And what do I people eating? Animal products. Everywhere. Just a point, and I know lack of exercise is a huge part of it but let’s face the facts: vegans have nine times less of a chance of being obese than meat eaters. Whew, what a rant. Challenges on my claims accepted.

  9. thedoc says:

    It is not that platelets build up on a stable plaque, but an unstable one that ruptures. And, yes, the science is clear that people who take aspirin have less cardiac events. You can have minimal plaque and develop a blood clot on it.

    They continued to use statins.

    The plaques are not made from cholesterol – no- they are an intimal hypertrophy – and low density lipoprotein, is not a cholesterol, it is a carrier of cholesterol as well as other products. So- learn some biochemistry- cholesterol is not LDL, or HDL. And it is not that the lipoproteins themselves cause the change- that is somewhat uncertain.

    We cannot heal with food- we can kill with it. We can eat better and stop killing ourselves.

    Coronary artery disease is the number one killer- and became the number one killer after America started to live longer and smoke more. And Vegans do not live as long as others. Glad they are less obese- but I do have a few in my practice.

    One final assertion- in spite of all the papers examining saturated fat in the diet- there is not one that shows that it increases heart disease – just one of those inconvenient truths

  10. John Ammerman says:

    Next month it will be a year since I began eating the whole food vegan diet recommended by Colin Campbell and Caldwell Esselstyn. I came across their work indirectly through a CNN story by Dr. Sanjay Gupta entitled “The Last Heart Attack”. What grabbed my attention in the piece was the interview with Bill Clinton (a man famous for his large appetites and weak ability to resist many kinds of temptations). At the time I weighed in at 295 pounds, and at forty-six, I was at the same age my father had been when he died of a heart attack. Figuring that if Clinton could stick with it, so could I, I took the plunge, and eleven months later I weigh 198, my blood pressure is better than my 16 year-old son’s, and it’s been five months since my doctor took me off statins.

    All this, and still, I’m not a true believer.

    As you have pointed out Doctor, just about any diet out there, followed religiously will yield weight loss. Some of my friends follow a paleo diet and have had similar results in weight and blood cholesterol as I have. This has led me to suspect that the things these two eating styles have in common MAY be why they are both successful. These are: eliminating all processed simple carbohydrates (sugar and white flour), eating plenty of fresh fruits and veggies, not consuming any processed foods, and becoming physically active.

    So, suspecting as I do that the whole “animal protein is bad” angle is overstated, will I modify my diet, allowing myself the “luxury” of steak and chicken? No. The truth is I’ve become fond of eating this way. The food is delicious, and preparing it with my wife has strengthened our marriage. Moreover, what if they’re right? But even if they’re wrong, continuing down this path is surely far healthier than how I was eating before.

    Thanks for reminding us not to drink the Cool-aid.

  11. Laura says:

    Hello,

    My husband and I have recently started eating vegan and cutting out all oils. We love the forks over knives cook book and have found ourselves feeling so much better in a short amount of time. My question to you is, I have found it difficult to eat out. It is something we rarely do anyway, but every now and then a friend wants us to eat out and I just don’t know what to order. Most everything is made with oil, the only thing I know is not is a salad with only vinegar as the dressing which is not very appetizing. What do you suggest?

  12. thedoc says:

    Most people who change their lifestyle feel better – and I mean change for the good- as in eating healthier. Here is a tip about oils: you cannot cut them all out, because the body does not make Omega 3 or Omega 6 fatty acids. You do need some in your diet. The second tip is that even food that is made with oil – the amount of oil that actually gets into the food is less than 10 per cent. So, if a tablespoon of olive oil is used to fry some Okra, in that entire bit of Okra, only ten per cent of the oil used gets in. Many restaurants have great vegetarian options, and don’t be afraid of a little oil. In terms of salad – arg- probably the largest source of food borne illness in most restaurants- stick with the vegetables.

  13. Mark McManus says:

    Perhaps you could provide some much needed advice. I am a 68 year old man diagnosed with advanced atherosclerosis with a total coronary artery calcium score of 749 five years ago and stents placed in my LAD in 2006. I have never had a heart attack, but currently have moderate regurgitation in the aortic valve. In December of 2011, I began to experience cramping in my left calf when retiring in the evening and during the night. Subsequently, on January 1, 2012 after reading Dr. Esselstyn’s book, I began my journey into the plant based/no oil lifestyle. My pain disappeared and my energy level sky rocketed, my thinking was clearer, my total cholesterol reading dropped below 150, my blood pressure dropped and I have been able to eliminate all medication except for Red Yeast Rice supplements. Here’s my question, I am 5’9″ tall and in December 2011, I weighed 163 lbs. and after 9 months on a plant bases/no oil diet, today (10/9/2012) I weigh 144 lbs. I dislike the plant based lifestyle and I am afraid that this loss of weight, especially if it continues, will be more of a danger to my longevity than a potential future heart attack. Do you believe I can return to a more moderate nutrition plan that would include some oils and occasional meats to allow me to gain back much needed weight? I believe I am at a critical point where any further loss of body mass would be dangerous.

  14. thedoc says:

    Great weight loss, and a good result- although the red yeast rice supplements can be iffy- they are a lower dose form of lovastatin, and sometimes there is no lovastatin in them and sometimes there is some in them.
    IN terms of longevity – can’t answer what would work for that. A heart attack would not be good for your longevity.
    In terms of weight – you can gain weight on any diet, it is always a matter of calories. Your weight now, however, is within normal limits.
    My suggestion is to see your physician, specifically your cardiologist, who can check you and determine if they should send you for further work up regarding the weight loss, or for further nutrition.
    Remember, the eskimo population has the lowest heart disease rate and they have a diet almost all fats – but it is hard to get good seal in the lower 48

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