Sept. 11, 2023 – It’s been more than a decade since the documentary Forks Over Knives was released, in which people were shown to reverse the signs of heart disease while eating a whole-foods, plant-based diet.
This past summer, yet another medical journal published a confirmation of the eating plan’s health benefits, and a University of Oxford research team found that diets low in animal-based foods could have far-reaching environmental benefits as well.
The creator and executive producer of Forks Over Knives, Brian Wendel, said he was compelled to make the documentary despite having no background in filmmaking. The project became one of the first mainstream depictions of the plant-based movement outside of books and medical journals. Wendel, now 51, said his goal was to visually present the science and stories of how plant-based eating affected people's personal health.
“I just realized there’s a powerful case to be made that our most prevalent, chronic diseases, like heart disease and type 2 diabetes, are largely preventable and often reversible with this lifestyle. If there was a pill as effective as a plant-based diet, it would be a headline story,” he said.
The former real estate executive considers himself vegan, but he focused the film on the whole-food, plant-based diet plan, which calls for eating vegetables, fruit, beans, grains, and nuts, and avoiding meat, dairy, and fish. (Veganism, on the other hand, involves abstaining from all animal products, including non-food products, and typically also involves not using products tested on animals.)
A comprehensive review published in July in JAMA Network Open showed that 20 studies confirmed the significant impact plant-based diets have on lowering the risk of heart disease and a host of health indicators like cholesterol, blood sugar levels, blood pressure, and weight. The review combined data from more than 1,800 people who followed plant-based diets for at least 6 months.
The findings echo the groundbreaking results of The China Study, which was a key part of the science presented in Forks Over Knives. Led by Cornell University biochemist Colin Campbell, PhD, this study showed that people who lived in rural China ate a vastly different diet than Americans and also had life-and-death differences in their health. Compared to Americans, people living in rural China:
- Ate food that had half the fat, one-tenth the animal protein, and three times the fiber content
- Had cholesterol levels nearly 80 points lower, averaging 127 milligrams per deciliter total, which is well within the healthy range
- Drastically lower rates of many health problems, particularly coronary artery disease.
Empowering People to Change
Forks Over Knives also brought the science to life, featuring many of the patients of plant-based advocate Caldwell Esselstyn Jr., MD, who has personally counseled more than 1,500 people on plant-based nutrition. He’s now 89 with no plans to retire. Formerly a breast cancer surgeon, he began examining the relationship of diet and major diseases, including heart disease. In the early 2000s, he began nutrition counseling of people at his home and tracking their health.
“The thing that is exciting is, here are patients with potentially lethal disease and, with all due respect to my cardiovascular colleagues, none of the stents, drugs, or bypass surgeries have one thing to do with the cause of the illness,” Esselstyn said. “The disease’s causation is not being treated. The reason we have the results we have – quite frankly, the reason we will succeed where others fail – is we are treating the root cause.”
People in his nutrition counseling program attend a nearly 6-hour seminar, and each receives a personal phone call from him a couple of weeks ahead of time.
For comparison, “the usual cardiologist will spend between 10 and 12 minutes with their patient,” Esselstyn noted.
He keeps in touch with his newly indoctrinated plant-based followers afterward, too, although less formally. His phone is clearly busy, because he will pepper scientific explanations with anecdotes about his patients, often with the phrase, “I just talked to her on the phone the other day.”
For about a decade after Forks Over Knives was released, people sought Esselstyn’s guidance after seeing that most of his clients had rapid turnarounds in their health problems, sometimes in a matter of days.
Richard DuBois, 72, of Horseheads, NY, was among Esselstyn’s early clients – back when he still counseled people out of his home. (DuBois wasn’t featured in the documentary.) An avid marathoner (he ran more than 20), DuBois began having chest pain called angina when he exercised, and a diagnostic procedure called an angiogram revealed he had two major blockages of blood flow in his heart, one blocking 80% and another blocking 60%. He was scheduled for bypass surgery, but he first drove 6 hours with his wife to see Esselstyn after reading about him in a book on The China Study.
“We spent probably an hour or more with him discussing the science behind what he’s doing, and then [his wife] Ann, who is very much a part of the team, came in with a big bag of goodies and showed us how make it happen – how to eat, how to read nutrition labels, how to stay away from processed food – and then they fed us an incredible meal,” DuBois recalled of his 2005 visit with the couple.
He decided to try the diet for “a week or two” and began feeling better and losing weight, so he extended the trial to a month. His cholesterol and lipid levels dropped within that month, and he postponed and then canceled the surgery. He dropped about 50 pounds, going from around 190 to 140 pounds in 6 months. When he turned 70, he celebrated with a 70-mile triathlon – something his angina would have prevented him from doing even when he was much younger.
“A lot of people say, ‘Oh, I couldn’t give up cheese or I couldn’t give up meat.’ The situation with me was, I knew I had a serious problem, and if I was going to not do the surgery, I was going to have to be very serious about the diet,” DuBois said. “I was going to try it for a week, for 2 weeks, then a month, and it kept getting easier and easier to do. I made the decision early on that I couldn’t fail.”
Plant-Based Goes Mainstream
In the 10-plus years since Forks Over Knives was released, “the world is now totally interested,” said Ann Esselstyn. Her son, Rip Esselstyn, who was also featured in the film, eventually launched a plant-based business called PlantStrong that includes offering educational events and conferences. At first, the conferences were held at the family’s farm in New York.
“When Forks Over Knives first came out, an umbrella would have been enough to shelter all of them,” Ann Esselstyn recalled. “Today, when there’s a plant-based event, it’s 500 people. Rip had to move the event from the farm because it got so big.”
To date, Rip Esselstyn has published 230 episodes of his PlantStrong podcast, tallying 9 million downloads, and has a line of foods available online and in Whole Foods Markets. He jokes that plant-based products are so popular that he wouldn’t be surprised if a company tried to market “plant-based water.”
But many plant-based advocates caution that in some ways, the widespread interest in plant-based eating has made nutrition- and ingredient-label reading more important than ever.
“I think there’s been a lot of confusion in the last few years because the marketing types have gotten in there and are promoting junk foods as plant-based health foods,” said Wendel. “This idea that people can switch to highly processed fake meats and cheeses has kind of thrown up some hurdles into the momentum that whole foods, plant-based had because they don’t make people feel that much better.”
Wendel said he still follows mainly the same eating plan as when he first became a vegan. Like DuBois, he committed to the diet at first for only a matter of days as an experiment, and he never went back.
“I’m still doing the same old thing – lots of fruit and basically starch at the center,” Wendel said. “Whole foods, it doesn’t change over time.”