I wish people wouldn’t look at “What The Health” as doctors promoting a vegan agenda. There was no meeting of vegans where an agenda was planned for world domination.

Rather, we are physicians that, after years of research, reached the conclusion that Western medicine’s lack of emphasis on the importance of nutritional science has left the public at the mercy of industry and snake oil salesmen.

We are physicians that have realized, after ignoring the dogma we are fed, and after scrutinizing the science, that a plant-based diet is the best preventative medicine available.

Believe me, there is no money in this “vegan agenda.” None of the doctors in the film are profiting in any way. We are not getting paid by “Big Kale.” We weren’t paid to be in the movie, and our book sales are either donated or don’t amount to much at all.

This film should be looked at as physicians who have found a way to prevent the most common Western diseases and want to share it with the world. When I found out that I had high cholesterol, hypertension, and fatty liver, I decided to dive deeply into the research because I felt medicine couldn’t be the answer. What I found blew my mind. I thought I had come across some secret answer and all I needed to do was share it with the world. Little did I know that the world didn’t want to learn.

The strangest “insult” thrown our way is that we are vegan and therefore biased. We are vegan because we believe strongly what we say. We walk the talk.

In the end, a plant-based diet is the best diet to prevent and treat disease, and I can back that with tons of science. It also happens to be the best diet for protecting our environment from pollution and CO2. Finally, it has the added benefit of preventing the senseless torture of billions of sentient animals. If this is my secret agenda, then I guess I am guilty.

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You might be asking yourself how protein can be associated with weight gain when you have always been told to eat protein to lose weight. There are many possible answers to this very complex question. One comprehensive 2009 review considers mounting evidence that the chronic acid intake from high-protein diets may actually cause cellular dysfunction and eventual weight gain (Berkemeyer 2009). While this article is an interesting read (to me, at least), I think the answer is much more simple.

Volumetrics and Calorie Density
You may have heard of a term called “volumetrics.” Barbara Rolls, Ph.D., a nutritionist at Penn State, invented this term to describe a very simple idea: if you eat food with low-calorie density, then you will not gain weight. The idea is that the stomach has stretch receptors that feed back to the brain when our stomachs are full. If you eat food with lots of calories per weight, by the time your stretch receptors alert your brain that you’re full, you have already eaten too many calories. However, if you eat food with a low amount of calories [per weight], you can stuff your face until your stomach tells you that you’re full without overconsuming calories (Rolls 2000; Rolls and Bell 1999; Rolls, Ello-Martin, et al. 2004).

The Fiber Factor
Fruits, vegetables, and beans are high in fiber, which is not absorbed into our bloodstream. So some of the weight of these plant foods does not translate into calories absorbed. Likewise, the fiber holds water and obviously water won’t cause fat gain. So if you eat a giant 280 gram slice of watermelon, due to the fiber and water, you get only 85 calories. A 280 gram piece of chicken delivers almost six times the calories (480). If you could actually consume 280 grams of olive oil (20 tablespoons, in case you’re crazy), you’d take in a whopping 2,380 calories.

This is why I tell my patients they do not need to count calories when they eat a plant-based diet. I don’t care how many apples they eat, or how much kale they consume. I have never seen anybody get fat from broccoli or bananas. One patient didn’t believe me and tried to prove me wrong by eating six apples a day. She still lost weight. Even the most dedicated overeater will become full before eating too many calories.

As an added bonus, the fiber in fruits and vegetables acts as a binder to the sugar they contain. I don’t recommend drinking juices because they remove the fiber from the sugar. When you drink orange juice, the sugar goes into your system real fast. This doesn’t make you fat, but it does make you hungry in an hour or so. Eat an orange, on the other hand, and the fiber turns the sugar into a slow release pill so you don’t experience the same sugar rush. High fiber decreases the glycemic load of the food, and studies have shown that this really does decrease hunger (Lennerz, Alsop, et al. 2013). I believe this is why fiber is so well associated with weight loss. When you look at large studies, people eating the most fruits, veggies, and grains are eating the highest fiber and thereby eating lower calories and losing more weight than meat eaters (Mozaffarian, Hao, et al. 2011).

Plant-Based Diet for Weight Loss
I have been using plant-based diets for weight loss for many years with considerable success. My goal is not to make everybody vegan, but rather to greatly increase the amount of fruits, vegetables, grains, and legumes consumed, while decreasing our usual reliance on [animal] protein. I want my patients to turn their plate around. I tell them to dethrone the meat from its starring role in the center of the plate. I always hear that plant-based diets are hard to do, but it hasn’t been for my patients. It’s not just me; studies have found that vegetarian diets are very well tolerated in clinical settings (Berkow, Barnard, et al. 2010; Thedford and Raj 2011).

A plant-based diet liberates us from counting calories, but it goes further; I tell my patients not to count anything. Years of counting points and carbs, and weighing portions, has made them addicted to measuring. It is a huge relief for them to stop having to starve themselves and worrying about portions. I instruct them to eat the rainbow with a wide variety of fruits and veggies, without limits. If you are hungry, I tell them again and again, have an apple. Enjoy it fully and don’t worry. I provide them with delicious recipes that allow large portions but with low-calorie content. Time and again they tell me how easy it is to eat this way. They gush over how delicious the food is, how they are never hungry, and how they feel fantastic. Remember, my business is helping people lose weight. If they didn’t lose weight, I wouldn’t be successful. Thankfully, this diet is extremely successful, which is why I recommend it.

(Read More: Obesity—It’s Not About the Carbs)

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Can you believe people actually avoid fruit in an attempt to lose weight? There has never been a single credible study showing that fruit consumption leads to weight gain, and yet this concept is as prevalent as any nutrition dogma. I have treated people for obesity for years and I can tell you, nobody is coming to see me because they ate too many apples or grapes. Why do people think fruit leads to weight gain? The quick answer from my patients is because of the carbs.

When I ask my patients what their downfall is, when it comes to weight loss, they unanimously blame carbs. Their diet log will read: eggs-and-bacon breakfast sandwich, Subway sandwich and chips for lunch, and a pork roast with potatoes for dinner. When asked the part of that menu that is causing them to gain weight, they blame the bread from the sandwiches, the chips, and the potatoes. It is always the bun, never the hamburger. Now don’t get me wrong; there is nothing healthy about chips, loaded with fat. The sandwich bread is likely bleached flour with little, to no, nutrient value.

However, the vast majority of the calories are coming from fat and protein. Pizza and donuts are considered carbs despite the fact that they contain as many (or more) calories from fat as carbs.

Here are two examples. The first is for a Pizza Hut six-inch Personal Pan Meat Lover’s Pizza (admittedly one of their more calorically dense and fat-heavy options). Of the 850 total calories, 430 come from fat. That’s 51 percent. Another hundred calories come from protein, leaving 320 calories from carbs.

Second, a Krispy Kreme Original Glazed Donut. According to the company’s website (updated September 2014), a single donut delivers 190 calories, 100 of them from fat. That’s 53 percent. Carbs account for 84 calories (44%), while protein comprises another 6 calories (3%).

Widespread Misconceptions About Protein, Carbs, and Fat

Here’s a recent conversation with a patient, a woman from Ghana, that really highlights the misconceptions about diet and weight loss. She has lived in the United States for many years, and during much of that time, struggled mightily with obesity. She has seen endocrinologists, dietitians, and trainers. She has done the Atkins diet several times and most recently went to a doctor who prescribed Belviq (the newest prescription medication targeting obesity). She sees a registered dietitian and a trainer regularly. Despite the meds, the medical oversight, and her sincere and steadfast efforts, she still has a body mass index (BMI) of 40, which classifies her as morbidly obese.

And as you’ll see, she already knows everything she needs to make smarter decisions. It’s only the proteinaholism that blinds her to the truth:

ME: So what do you typically eat for breakfast?

PATIENT: Usually eggs of some sort and a protein.

ME: What do you mean by “protein”?

PATIENT: Well, it could be chicken or bacon or sausage.

ME: Hmm, those aren’t really protein. I mean, some of those choices have more calories from fat than protein. So really, you could just as well say, “I have eggs and some fat for breakfast.”

PATIENT: (Chuckles) Never thought about it like that.

ME: So what’s for lunch?

PATIENT: Usually salad with a pro-um,

I mean fish or chicken.

ME: OK, do you snack during the day?

PATIENT: No. My issues really are at night, when we eat more carbs from our traditional diet from Ghana. We eat lots of yams and stews. Lots of starches.

ME: Interesting that you view that as your bad meal when to me it’s your best. Have you visited Ghana recently?

PATIENT: Yes. Funny enough, whenever I visit Ghana I lose weight. That is the only place I lose weight.

ME: What do you eat there?

PATIENT: Lots of yams, yam stews, lots of maize (corn), fruit.

ME: Are there lots of obese people in Ghana?

PATIENT: Not at all. In fact, when I am there I am one of the biggest.

ME: So do you see what I’m getting at? In Ghana you eat lots of starches and fruits, and people are thin and you lose weight. But come to America and eat American “health food,” and you gain weight. As I look at your diet history, you have always tried diets that focus on high protein. You told me you try to eat lots of protein and it has never worked long for you. Yet you have completely avoided a diet that you enjoy and have lost weight on.

PATIENT: Well, I thought fruits and starches made you fat, and we need more protein. That is all I hear.

In Ghana, the obesity rate is 5.5 percent, slightly higher for women (7.9%) and slightly lower for men (2.8%), compared to America’s 34.9 percent rate of obesity. Higher rates of obesity were found among those who live in the more Westernized portions of Ghana and eat less fruit. Also, those who had not completed a secondary school education were much less likely to become obese than those who graduated from secondary school, high school, and college. This suggests that with higher earning power came the ability to buy meat and other rich Western fare. The Ghanian traditional diet was the one most closely correlated with normal weight and is high in beans and starches, including maize, yams, fruits, and cassava roots (Biritwum, Gyapong, et al. 2005)[1].

Traditional diets high in fruits, veggies and starches have worked for thousands of years, and continue to keep people slim and healthy. But our obsession with counting fat, carbs, and protein blinds us to this truth.

[1] Biritwum, R., Gyapong, J., & Mensah, G. (2005). The epidemiology of obesity in Ghana. Ghana Med J, 39(3), 82–85.

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