Response To Layne Norton’s Review of the Game Changers by Garth Davis, MD on November 21, 2019

Intro

The Game Changers Movie seems to have actually been a real Game Changer. It became the best selling I-Tunes pre-ordered movie and is trending like crazy on Netflix. Seems like you can’t turn on news or social media now without somebody talking about vegan diets. No doubt this is in part due to the involvement of renown film director/producer James Cameron and other famous athletes and actors. I think the popularity/infamy is also due to the fact that the movie challenges a very basic and antiquated notion that vegans cannot be athletes or build muscle at an elite level.

The backlash from the movie has been predictable. Every on line trainer/pseudoexpert has released their own review of the movie to assure their followers that the advice they gave them about eating animal protein was not misguided and this movie is nothing but vegan propaganda. Every article I read bemoans a vegan bias and states that the science is erroneous. Of course, most of the critiques of the science come from people who have not read the science and/or cannot understand the science because they have no expertise in the field. In fact, the vast majority of people criticizing the movie seem to have never seen the movie based on what I read in their critiques.

The fact that people are shocked by a vegan bias is dumbfounding to me. This is not a movie that sought to review the scientific details of performance on plant vs animal data. Can’t imagine a movie that comprehensively reviews the science behind plant based diets vs omnivorous diet, reviewing the statistical analysis and methodology in depth, would hold anybody’s attention. The movie is a story about an athlete who felt better on a plant based diet and sought out other athletes that chose a plant based diet either for other reasons, or because they felt like they performed better on a plant based diet.

For many, the idea of contributing money to an animal agriculture business that subjects animals to abhorrent conditions, is unthinkable. The fact that they can avoid animal agriculture and still be successful athletically is a huge relief. The subject of the show, James Wilks, tells a good story. He discovers the benefits of a plant based diet, experiences it himself, and seeks out others who have had similar experiences. He also makes a case for why he, and the other athletes, perform well on a plant based diet.

I am not sure what people were expecting. I did not watch the Magic Pill, a ketosis diet documentary, and expect anything but a biased view. It was a story about people that benefited from a ketosis diet, as billed. It made outrageous claims that go far beyond anything in Game Changers, but I did not go apoplectic, and start crying on line about bias. It was expected.

All that being said, people have been asking me to respond to the science aspects. I can’t respond to everybody so I will respond to Layne Norton. I chose to respond to Layne because he is a PhD in nutritional science who did his thesis on protein. He is not a dumb guy, and he is also an athlete. In addition, his reaction to Game Changers has been the most outrageous. You would think the movie was an all out assault on him. He has written a very long winded “debunking” of the film which shares many of the other critics’ main points. Layne is also somewhat of an on line bully. He yells loudly, and in this day and age, people think because you are aggressive and loud that you must be right.

I know this will sound disingenuous and unbelievable, BUT I really tried hard to give his critique a chance. I imagined I would go through it and agree with some things and disagree with others. Alas, with all due respect to Layne, I think his anger got in the way of his critical thinking. Keep in mind he criticized the movie in a post before it was even released, and his bias shows. Now, if you do not know a lot about science you may defer to Layne and figure whatever he says must be true. Who has time to check his references? I certainly don’t, but nevertheless I did.

What follows is a point by point critique of Layne’s “debunking”. This is long and I am not sure how many people want to go so deep into the science but in summary, Layne totally misrepresents the movie, cherry picks articles, misrepresents articles, and basically put together a story line that sounds credible to the lay person ear but truly misrepresents the movie and the science presented in the movie. His main hypothesis seems to be that the movie is saying that the only way to be a successful athlete is to be vegan, or if you become vegan you will definitely succeed. The movie doesn’t even come close to making those claims! This is not a critique about Layne. He is an intelligent guy. He is not a “Bro Scientist”. There is much that we agree on. He has criticized all the fad diets and I kinda like his brash argumentative nature. We have that in common, obviously. I am, however, more disappointed in his critique than I thought I would be. I am surprised that people refer to it at all as it is extremely weak review.

So let’s do this!

Bias

Layne starts off, as most all scientific presentations do, by dealing with bias. He admits his biases and states that he was funded by egg and dairy. In fact, the lab he trained in was heavily funded by animal agriculture. His preceptor was a main consultant for the National Cattleman’s Beef Association and all the articles I have read from his lab have had an industry sponsor. As you will see. most of the articles he cites in his review are industry funded.

Oddly, Layne goes into a narrative that seems to state that these animal ag biases don’t influence him, BUT he then goes on to look at people associated with the movie and lists their biases, which are mainly that they are vegan. There is an undertone in his, and many of the critiques, that their bias drives the statements in this movie more so than financial bias might drive a research study.

First off, bias is real, especially in research. This article did a great review of how industry bias affects results, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040005. Layne’s whole upbringing was in a lab funded by animal agriculture with the goal of determining protein needs. Findings of their research would most definitely affect industry. I am NOT saying he lied or cheated. Many biases live deep in psyche and can affect experimental design or result interpretation. The vast majority of the articles he cites in his piece have industry conflicts. Layne’s academic and personal life rest on the importance of animal protein in the diet. Secondly, he calls to question the doctors’ biases in the movie saying that their bias is that they are vegan.

Fair enough. Being vegan is definitely a bias. I try very hard to attend meetings and read papers that go against my beliefs. I actually do not tell my patients that they have to be vegan. Do I believe vegan diet is great for your health. Obviously I do and I can present you with tons of research, including randomized control trials, to prove my point. But can I say that you have to be vegan to be healthy? No. Can I say fish is bad for your health? No. I wish I could as commercial fishing is terrible for environmental health, but studies on personal health don’t show a relationship of fish with bad health. See, I am vegan not because I make money from being vegan. I don’t make a penny. There are no vegan ag firms paying scientists. No such thing as “Big Kale”.

I am vegan because after years of studying the research, going to scientific meetings, and treating patients, I believe a vegan diet is excellent for preventing, and in many cases, treating disease. I am also vegan because, as I will discuss, I believe it is the best diet for preventing pollution and climate change. Finally, I am vegan because I do not want to contribute a penny to an industry that flat out tortures animals to provide readily accessible meat when it is simply not necessary.

I think the famed anti aging researcher Luigi Fontana said it best in his excellent review article: “At the individual level, reducing the intake of calories by increasing the consumption of a variety of minimally processed plant foods and by significantly reducing the intake of animal foods will significantly increase health span and reduce health care costs, environmental pollution, soil erosion, water pollution and shortage, CO2 production and global warming, violent weather and associated planetary consequences.” https://f1000research.com/articles/2-101.

None of the mentioned doctors are getting rich off books or being vegan. Saying it is a bias that they contributed an article to Forks Over Knives website for free is odd. It is a cause they believe in, and in that way it is a bias, but certainly not a financial bias. Likewise, the implication that James Cameron created this movie in order to sell more plant protein products from a company he invests in is downright ludicrous. Cameron is a long time environmental advocate and turned vegan to lower his carbon footprint. https://www.mensjournal.com/health-fitness/james-cameron-why-i-eat-a-vegan-diet-20150915/. He now invests in projects that he thinks will benefit the environment, like plant based meat substitutes. He is worth $700,000,000 and is certainly not getting involved in Game Changers to make money. Even more importantly, he got involved well after the movie had already been completed in rough draft. He did not create this movie but just buffed it up and invested in it because he believes in plant based diets to help lower CO2, methane, and pollution.

Petty Start

Layne then starts with a very petty criticism to get this ordeal started. In passing, James mentions he was injured and tied up in bed and spent a thousand hours studying nutrition. When I heard this I did not imagine James had a stopwatch checking each hour he actually spent reading. It was an obvious hyperbolae/figure of speech anyone would use. Layne goes into a mathematical proof of available hours to read and questions the possibility of whether he could have actually spent a 1000 hours exactly on reading. Seriously?

The Gladiator Diet

The first part of the movie is something that seems to have pissed off the whole bro community as much as it did Layne. James discovers an article that shows that the Gladiators ate a mainly vegetarian diet. The article in question is by far the most definitive study on gladiators https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110489. Basically, they exhumed the bones at a cemetery and looked at the regular Romans and compared them to the gladiators. The paper points out that all Romans ate lots of plant food and legumes. The study, however, found a highly significant difference in the strontium/ca ratio in gladiators. In the movie and the paper the lead author explains that vegetarians have higher Sr/Ca levels suggesting that the gladiators were vegetarian, or at least heavy plant eaters.

There is NO mention in the article or in the movie that gladiators were vegan. That is a false and disingenuous accusation by Layne. The study results are confirmed by many ancient Roman texts that gladiators were referred to as the “Barley Eaters”. Note, the high Sr/ca ratio is indicative of strong bones due to good diet and strenuous exercise. SO, James is intrigued by the fact that these gladiators ate a mainly vegetarian diet and were still strong. Layne goes on to criticize the movie for not including a study that showed that gladiators ate seafood. His link doesn’t work and I can’t find this study, nor is it relevant. They ate a MAINLY VEGETARIAN diet. That is all that the movie is saying, and they were strong because of, not in spite of, consuming a predominately plant based diet.

Many critiques have stated absurd things like the gladiators were short. A trait that would have been determined in youth, not during the diet they ate as gladiator, AND all romans were short with average height 5’ 5”. Many have also said that the gladiators were fed prisoner food, or as Layne claims, whatever was available. This is somewhat erroneous. The key being there were different classes of gladiators.

The Ad Gladium were common prisoners that were sent into battle to die. They may have been fed cheap food. They died quickly and would likely not have received preferred burial. Then there were the Ad Ludum. These were prized fighters and were revered the way we revere athletes these days. They were also owned by different houses and would have been optimized for battle. They attended fighting schools and that is where they would have eaten the barley heavy, plant ash diet that made their bones so strong. The schools were so prized that many people volunteered to go to the schools and become gladiators. Regardless of why they ate a predominately plant based diet, the diet, as James discovered, made them strong.

Layne really goes off course here by citing a blog where one of the authors states that the gladiators were fat https://outofthiscentury.wordpress.com/2010/01/30/fat-gladiators-modern-misconceptions-regarding-the-dietary-practices-of-swordsmen-of-the-ancient-roman-arena/. The blog he referenced is actually DISPPROVING the assumption that the gladiators were fat. There is NO evidence whatsoever that gladiators were fat. This was an assumption by one guy who assumed that because they ate carbs they must be fat, as if carbs make you fat. Now I can write a whole book on the fact that carbs do not make you fat and that De Novo Lipogenesis, the conversion of carbs to fat, does not occur with much significance https://www.nature.com/articles/1600744, but that isn’t really part of this discussion. I think even Layne would agree that carbs don’t make you fat.

One simply needs to look at the frescoes from Pompeii or the carvings and paintings to see that the gladiators are depicted as strong and lean, not fat. There are no writings that ever mention they were fat. http://www.theguardian.com/world/2019/oct/11/pompeii-dig-unearths-fighting-fresco-gladiators-tavern.

http://www.vroma.org/images/mcmanus_images/bestiarii.jpg.

Here is an excellent review in a letter to the editor for the Journal of Sports Science that states that the best athletes of the Roman era were vegetarian: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761927/

Protein As Fuel

Layne next takes a bit of a tangent. He is surprised that James brings up that people think protein is a fuel, and dismisses even discussing this notion as he has never met anybody who thinks protein is a fuel. Meanwhile, just about every patient I meet thinks protein is a fuel. Can’t tell you how many times someone has said to me that they have no energy so they must be protein deficient. This is a very common misconception. Look at the Naked and Afraid TV show where they are constantly complaining about feeling weak because they cant find protein.

He then states that protein is used to increase lean body mass. The movie doesn’t really go into muscle protein synthesis but this is Layne’s real area of expertise. He starts with an article that was a cross sectional study where they called people and asked what they ate. Interestingly, if you read the study, the vegans had the healthiest food index scores (thanks Layne) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967195/. In the study the vegans got on average 83 grams of protein, which well exceeds the RDA.

Remember the RDA for protein is based on the mean protein needs plus 2 standard deviations. So, they determined that the average protein needs are much lower, but to be sure that the public gets enough protein they recommend 2 standard deviations higher which is 0.8gm/kg. 83 gm is even higher than that but Layne states that it is inadequate for muscle building.

OK so here is a huge mistake he makes. This study was on average people NOT athletes. He points out endurance athletes need more than this, and I will tell you most plant based athletes will work to get more than this. Assuming that because the average person eats 83 gm that the plant based athlete can’t then get more is absurd!!! Also note in this study that the omnivores got 111 gm, STILL below what Layne thinks is adequate.

He also seems to totally mess up what the movie is stating. The movie is NOT stating that you don’t need protein, it is saying you can get enough protein from plants!!! In fact, James clearly states that athletes need more protein. One of the bodybuilders in the movie, Nimai Delgado, has diet plans for clients that are 150 gm of protein a day. I have used them and easily achieved that amount of protein with meal planning and without needing to eat meat.

I would also like to add that Layne does some cherry picking here. He goes into the fact that the consensus for athletic protein needs are 1.2-1.4 gm/kg BUT he cites evidence from a paper he wrote that athletes need even more, 1.3-1.8, and possibly even more if they are trying to cut weight and maintain lean mass. Again, this can all be done by a plant based diet BUT it is a little misleading, or can at least be called into question. The typical method of determining protein needs uses nitrogen balance.

Layne has pointed out in his research that nitrogen balance may not be an accurate measure and it may be better to employ a nitrogen utilization and oxidation measures. Using this measure it shows that athletes may need more than the 1.2-1.4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913918/. The thing is, this is a lab test. Does increasing protein to increase amino acid oxidation actually lead to more muscle?

A randomized control trial of 12 men randomized to 2.6 vs 1.3 gm/kg for 1 month showed no change in strength or mass https://www.physiology.org/doi/abs/10.1152/jappl.1992.73.2.767. Likewise, adding protein shakes shows maybe a small increase in mass but not strength https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997282/#__ffn_sectitle. In average people, and especially in elderly as I wrote about in my book, increasing protein alone seems to not do much at all. In a large trial recently completed in elderly men 08.gm/kg of protein vs 1.3gm/kg showed no difference in fat free mass nor strength https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2673735

One of the biggest systematic reviews and meta-analysis of protein and muscle gain concluded that increasing protein up to 1.6 gm/kg did increase muscle mass but only in younger, trained individuals, and going higher doesn’t further increase mass or performance. In addition, between the control groups and the experimental groups, the higher protein up to 1.6 gm/kg/day, only amounted to about 11 oz added lean mass and only a 9% increase in strength https://bjsm.bmj.com/content/52/6/376.long. So if you take me for example, I am not interested in being “swole”. I compete in endurance sports but I am not trying to win the race. If I really wanted to do everything I could to be the absolute best I would need 113 gm of protein. I arrive at this by taking my weight (180 lbs) and my body fat% (13) to get my FFM= 71 kg and then multiply by 1.6. I can easily get 113 on plant based diet BUT I feel more comfortable at 1.2 gm/kg which is 84 gm, which I get easily without supplementation. I have noticed no difference in performance between 84 and upwards of 150 which I have tried in the past, but I am not an elite athlete. The point is, if I were, I could easily achieve those results on plant based diet.

So you may wonder, why if muscle protein synthesis is stimulated at higher protein intake, why does that not necessarily translate into mass and strength. So many possibilities and we are going off point. I have some theories but they are purely theory. First off, high animal based diets have high sulfur containing amino acids like methionine. In fact, many people like Layne criticize plant based protein because it is lower in methionine. In addition, if you are eating more protein you may be excluding other foods. In the low carb dominant mindset people prefer protein to fruits and veggies. This means lower electrolytes, especially potassium and magnesium. The net result is an increased acid load. There is a difference between acidosis and acidemia. Your body wont let your pH change much so you do not become acidemic, but if faced with acid load your body must buffer to maintain acid pH (acidosis). One of the key electrolytes it uses is calcium. If you look at urine in people on high protein diets you will find high calcium levels. It used to be thought that the calcium was leached from bones to provide buffer but it “may” be being leached by muscle. This is all just theory but the acidosis is real. http://www.ncbi.nlm.nih.gov/pubmed/21481501

http://www.ncbi.nlm.nih.gov/pubmed/12450898

http://www.ncbi.nlm.nih.gov/pubmed/11842945

Interestingly, in a study of adolescents fruit and vegetable consumption were correlated with strength http://www.ismni.org/jmni/pdf/57/15NEVILLE.pdf. Could it be that they provide a buffer. Food for thought.

In addition, when people say plant protein is inferior they often point to its lower leucine values. I look at that as an advantage. Now Layne may have a stroke if he reads this because his thesis was on the fact that leucine is the stimulator of IGF1 and muscle. The problem is that leucine also stimulates mTOR, a protein synthesis pathway that is a major player in aging. Momentary increases in mTOR may be beneficial but prolonged, constant increase leads to aging and possibly muscle issues. If you are trying to eat 150-200 gm of protein you will have to eat multiple high protein meals throughout the day, raising IGF1 and mTOR each time. https://www.cell.com/cell-metabolism/fulltext/S1550-4131(13)00119-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413113001198%3Fshowall%3Dtrue, https://onlinelibrary.wiley.com/doi/full/10.1111/j.1474-9726.2012.00798.x, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815731/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695616/, https://www.ncbi.nlm.nih.gov/pubmed/23325216.

I would also add that while IGF1 may have a role in muscle growth but it also has a role in cancer, especially breast and prostate, and aging. So you have to ask yourself, is the possible small benefit of over eating protein worth the increase in IGF1 and mTOR? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673798/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768517/, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)10384-1/fulltext, https://science.sciencemag.org/content/279/5350/563.abstract. This is a lot of speculation on my part and really not part of the movie. Just an aside since Layne brought up is the supposed inferiority of plant proteins and the need for leucine to build muscle

James Loomis and Glycogen

At this point Layne turns his attack on James Loomis, an internal medicine doctor who has been the team doctor for the St. Louis Rams and the ST. Louis Cardinals, and is the medical director at the Barnard Medical Center. He has also completed an Ironman triathlon. Loomis points out that the athletes he took care of thought that protein meant energy and would eat more protein food pre-game with the idea that they would perform better. Loomis states that by choosing protein foods over carbohydrate foods pre-game, they were therefore sacrificing vital energy. Layne shows data that you don’t completely deplete your glycogen stores on long term low carb diets, but that has nothing to do with what Loomis is discussing. Loomis is simply pointing out that carbs are important to pregame performance and athletes should seek to optimize glycogen stores. This point is often debated but I will refer you to this excellent experts panel where they really get into the science about carbs and performance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794245/. Bottom line being that while you may not deplete your glycogen, you will displace glycogen for protein and have less than you could have had you chosen a higher carb pregame meal.

Cherry Picking Athletes

Of course they cherry picked athletes!!!! Relative to omnivores there are few vegans. The movie is about succeeding on a plant based diet! There are MANY other plant based athletes, both professional and amateur. In fact, there is a whole other movie called “From The Ground Up” which is also an excellent documentary on plant based athletes, and has completely different athletes (only Jurek is in both movies).

Layne makes a huge deal about them focusing on the Diaz v McGreggor fight as being inappropriately used. He says that the movie “could have been used to demonstrate that someone can be vegan and still perform at a high level”. That is exactly what they did. How could they not have used this fight. Layne tries to shift things to say that Diaz was heavier and a bad match up for Macgreggor, yada yada. Diaz was not in training for this fight. He took the fight on 11 days notice. MacGreggor was HEAVILY favored by the odds makers, and if you look up major upsets in MMA history this fight always ends up on the list. MacGreggor made Diaz’s diet an issue. He mocked him for his diet. Called Diaz weak because of his diet, and went around bragging after eating multiple steaks. He seemed to concede after the fight that he may have eaten too much steak. There couldn’t be a more perfect story for this movie. You couldn’t have scripted this.

The issue Layne has is he somehow misinterprets the message to say that Diaz beat MacGreggor solely BECAUSE of his vegan diet. That is absurd. He points out that the movie focuses on boxer Brian Jennings who went toe to toe with Klitshko but lost, and Vladimir eats meat. He also brings up that Diaz lost the next fight with MacGreggor (though that was a knock down drag out fight that I think Nate won). These would be worthwhile arguments if the movie was trying to say that eating a plant based diet made you a superhero. Instead, the movie is simply showing, like Layne himself wanted, that you can be vegan and compete at a high level. Athletic success depends on training, genetics, diet, and many other variables. Being plant based makes some feel like they recover and perform better. Diaz says that he feels stronger on vegan diet and that is why he was ready to fight on 11 day notice. NOBODY is saying that if you eat a plant based diet you will immediately exceed your genetic potential. Bringing up Usain Bolt eating meat is irrelevant. That is not what the movie was about. They could have easily brought up Kipchoge who is the best marathoner ever and eats a plant based diet. https://www.sweatelite.co/eliud-kipchoge-diet/. The degree to which he misconstrues the intent of the film is amazing. He criticizes Kendrick Farris for only finishing eighth in the Olympics for weight lifting instead of noting the amazing feat of being the only American qualifying for the Olympics that year and proving you can be strong on a plant based diet.

Animal Protein Superiority

Here Layne launches into a diatribe on the superiority of animal protein to plant protein. Yes, animal protein has higher leucine but is that good or bad. As I pointed to above that may mean more IGF1 and mTOR which may not be beneficial for long term health. Yes, animal protein has more methionine but methionine is sulfur containing and contributes to acidosis and may feed cancer Studies in mice on low methionine diets have actually shown an increase in longevity https://www.ncbi.nlm.nih.gov/pubmed/8001743. In addition, there is evidence that high methionine may increase homocysteine which can increase heart disease and other diseases https://www.ncbi.nlm.nih.gov/pubmed/12611557. Interestingly, vegans and vegetarians have been found to have normal circulating blood levels of methionine despite what Layne thinks is a methionine deficient diet. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705437/.

In addition, Layne already admitted earlier that the average person gets enough protein from a plant based diet. I have NEVER seen a single study showing vegan diet creates any protein deficiency, and long term studies on long term vegans show excellent health and adequate protein intake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081456/. James actually says in the movie that “Athletes need more protein but you can get this with a plant based diet.” Layne goes on to admit to this though he says you need even more protein than a meat eater. There are no studies showing that vegan athletes need more protein than omnivorous athletes, and as I have shown above, more does not mean better.

Layne is then critical of Patrick Baboumian, first off stating that his record has been broken. This is true. Game Changers originally was shot many years ago. It took a long time to release. He also is critical of Patrick because he uses protein shakes. This is confusing to me? The movie doesn’t say protein isn’t necessary and it doesn’t say you shouldn’t supplement with a shake. To be a Strongaman you have to consume huge amounts of calories so shakes will be necessary. He points out that Brian Shaw lifted more than Patrick, and Brian eat meats, but Brian also consumes lots of shakes. It isn’t like Brian is eating meat and he therefore doesn’t need supplements https://www.businessinsider.com/brian-shaw-the-worlds-strongest-mans-daily-diet-has-12000-calories-2018-10.

In the movie James does say that a cup of Lentils or a peanut butter sandwich has “ABOUT” as much protein as 3 oz steak or 3 eggs. Layne focuses on the sandwich because the lentil part is true. 2 tbsp of peanut butter with two whole wheat pieces of bread gives you 15 gm vs eggs that would be about 18 and meat that would be about 20. A little off. May vary based on type of bread. He then goes on to criticize that the peanut butter comes with fat and is more calorie dense but that is NOT the point James was making. He was simply stating he could get enough protein with these substitutions.

The bottom line is that the movie is doing EXACTLY what Layne states he wanted to see from the movie. It is showing that you can compete at an elite level and can get enough protein without eating meat. These athletes state that they feel better on plant based diet. Diaz may be his best self on plant based diet. That doesn’t guarantee him a win, and nowhere in the movie do they state that it does. You can’t compare a meat eater to a plant eater and judge athletic performance. There are way too many variables. You would have to judge a person before and after switching to a plant based diet. That study hasn’t been done but this movie shows you athletes that have been on meat diet and switched to a plant based diet and feel that it improved their performance, or at least didn’t hurt it.

The Burrito Experiment

Layne, and many others, hate the burrito experiment. In the movie they have them eat different burritos and look at how cloudy their serum is afterwards. Layne is correct that Dr. Vogel did not actually measure the effect on their vessels and so this is misleading. I wish they would have because it turns out that Dr. Vogel was the key investigator showing that saturated fat causes problems with vasoconstriction https://www.ajconline.org/article/S0002-9149(96)00760-6/fulltext. The testing may be a little too involved for the movie. I do think looking at post prandial serum is important though. If you eat plant fats you could get cloudy serum but it doesn’t seem to affect endothelial function though some experts, like Caldwell Esselstyn, believe even plant fats affect endothelium and you should never have cloudy serum. Regardless, I think our system of measuring fasting labs misses the important effects that each meal has on our vessels.

Layne points out that lean meat can decrease endothelial function and cites this study http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.791.1943&rep=rep1&type=pdf. Several of the authors in this study received money from beef industry. In this study they compared people eating a “healthy American diet” vs variations of the DASH diet using meat. The key being that the experimental group with lean meat ate 6% saturated fat and 28% total fat vs the group that ate 33% fat and 12% saturated fat. Of course they had better vascular reactivity. If you spun their blood after their meals it would be less cloudy because, despite eating more meat, they were eating far less fat. His dairy study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726585/#__ffn_sectitle, likewise was industry funded. This one was strange. They looked at BP as their main measure of endolthelial function. The best measure of endothelial function is called flow mediated dilation, but BP can serve as proxy. The study is so simplistic and so full of confounders I am surprised it was ever accepted to a journal. They didn’t really change diet but at breakfast received low fat dairy or some non dairy food. The non dairy had higher salt. Seriously.

In the end it appears that fat is the main determinant of endothelial function if you use flow mediated dilation as the main measure of endothelial function. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864433/. We can go way off course here in looking at vasoconstriction and diet. It may be that heme iron in meat affects BH4, a cofactor in nitric oxide synthetase, thereby interfering with conversion of arginine to NO, and thereby causing vasoconstriction. May be that TMAO interferes with NO production. May be that the fat we eat gets oxidized and creates inflammation and interrupts NO production.

Regardless of mechanism, studies definitely show a link between meat consumption and hypertension in general https://www.ahajournals.org/doi/full/10.1161/01.hyp.0000016178.80811.d9?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed. And vegans certainly show a lower BP compared to meat eaters https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443300, https://www.ncbi.nlm.nih.gov/pubmed/12372158 . One of the largest studies looking at diet and hypertension showed plant proteins actually decreased BP https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593153/. This could be due to vasodilation due to improved conversion of arginine to nitric oxide or could be secondary to plant proteins having higher glutamic acid which is an amino acid found in higher quantities in plants. Glutamic acid converts to glutathione which is a powerful antioxidant which may further aid endothelial function https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048930/. In fact, there are multiple randomized control trials that show that putting someone on a plant based diet lowers blood pressure, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1342239/, https://www.ncbi.nlm.nih.gov/pubmed/6129380, https://www.ncbi.nlm.nih.gov/pubmed/12076551.

Regardless, I agree that the burrito test could be a bit misleading BUT it should make people at least pause as the increased postprandial fat may have an influence on vascular function. It is certainly clear that lower fat improves flow mediated dilation and plant based diets are low in fat and have the ability to lower blood pressure. Maybe that clear serum has something to do with the increased erections seen later in the movie.

Beetroot Bench Press

Layne really messes this one up. He thinks he has James here. James cites a review article that mentions that Beet juice was shown to increase TOTAL weight bench pressed. Layne of course heard this as increased bench press max weight but that is NOT what James says. Total weight is reps x weight. He finds this out himself but still says James was misrepresenting when clearly he wasn’t. He used the exact wording used in the review. Beet Root juice does increase the number of reps at a given weight and thereby can increase TOTAL weight bench pressed by 19%.

Animal Protein and Inflammation

Layne begins this with the typical statements of epidemiology being correlation not causation. This is so misread by the public. They somehow take this to mean that if it is correlated it can’t be causation. I’m serious. The ridiculous attacks on epidemiology by the lay public are baffling. We will never have a prospective randomized control trial that lasts 20 years. We need epidemiology to help develop hypothesis. Without epidemiology we would have never been able to say smoking causes lung cancer.

In Layne’s criticism of epidemiology he makes a very novice mistake. He suggests, using a graph, that epidemiology is like comparing spending on science to amount of suicides. They correlate but obviously are not related. THAT is NOT epidemiology. That is what is called a univariate analysis and no journal would ever accept something as ridiculous as this analogy. Epidemiologic data is subject to multivariate regression analysis to control for confounding factors which means that epidemiology looks at multiple factors and holds all but one constant among groups in order to determine a true correlation.

Layne goes on to say that the biggest driver of inflammation is weight gain and the reason vegans usually have better health outcomes is because vegans consume less calories than omnivores. Now pay attention here. EVERY single epidemiologic study I have cited in my book or my posts controls for weight. In other words, the study makes sure that if they are studying meat eaters vs vegans they pick people that weigh the same. He then goes on to cite yet another industry funded study. Does Layne not like NIH funded research? The study was a meta-analysis studying people eating more than 0.5 servings of meat vs less than 0.5. There was a significant difference in inflammation until you controlled for weight but there was still a trend afterwards. Regardless, this was a really bad study with not enough difference between the two study groups over so many different studies to really expect to see a difference. Typical of an industry funded study, if you make the 2 groups similar you are less likely to see a statistically significant difference.

Finally, Layne actually cites a non industry funded study. The study does show that meat’s negative effects may have to do with weight but the conclusion they came to was “Consistent with AICR/WCRF cancer prevention recommendations, the current findings suggest that dietary intakes of red and processed meats may be associated with adverse health effects such as cancer through an inflammatory pathway in some population groups.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540319/. He basically cites a study that proves my points.

I can’t argue too much with the next study he presents showing plant vs animal protein and inflammatory effect on isocaloric diet with decrease in inflammation. I do agree that losing weight, no matter how you do it, is an important determinant of inflammation. BUT there may be a whole other level of anti inflammatory effects with plant based diets. First off, diets high in animal fats seem to induce endotoxemia. This may be due to bacterial endotoxins left in the animal meat consumed, or it may be secondary to changes in microbiome by having meat based diet reduce butyrate production, which is food for enterocytes and may disrupt gap junctions allowing endotoxin from natural flora into bloodstream. https://academic.oup.com/ajcn/article/86/5/1286/4651083, https://www.ajconline.org/article/S0002-9149(96)00760-6/fulltext. In fact, there are many different ideas on how a plant based diet can be anti inflammatory ranging from phytochemicals and antioxidants to microbiome changes. https://econtent.hogrefe.com/doi/pdf/10.1024/0300-9831.78.6.293. Everything from tart cherries, to grape fruit juice, to ginger, to blue berries have shown an effect on tempering inflammation and helping recovery. https://www.ncbi.nlm.nih.gov/pubmed/27455316, https://www.ncbi.nlm.nih.gov/pubmed/26288392,

https://www.ncbi.nlm.nih.gov/pubmed/22111516. In addition, high protein diets have been shown to increase CRP and urinary cortisol https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564212/.

James Rope Battle

He implies that James rope session was re-enacted. I have no idea if this is true. If that is true I would have like to see that mentioned in the film. Layne implies that James may be lying about the whole event. James is a pretty bad ass athlete. I buy it but this is all speculation.

Animal Protein and CVD/Cancer

Interesting here that James seems to criticize epidemiology and yet utilizes epidemiology to make statements that support his view. He criticizes cherry picking throughout his rebuttal but appears to be a master of cherry picking articles for this section. He again seems to miss the fact that properly done epidemiology controls for weight, so when I present data showing vegans have less cancer or heart disease the articles I use have already accounted for the fact that vegans weigh less and have taken that out of consideration. If weight was not controlled for, the findings would be even more dramatic. Layne states that lean meat is part of a healthy overall diet, once again using a study that received funding from the beef checkoff program https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238465/. I would agree that beef can be healthier than a junk food diet. In this study nobody is vegan, and the lean beef group is consuming ½ the saturated fat. Of course they will do better. He does include one good RCT that was surprisingly not industry funded and showed equal weight loss with equal calorie deprivation comparing a meat to fiber group, and resulted in similar improvements in metabolic parameters. No big finding here. Doesn’t matter how you lose weight, numbers will improve.

Then Layne once again shows that he does not understand the science or just doesn’t understand the statements made in the film. He is critical of the movie for saying that a vegan diet is the only diet proven to reverse heart disease. He points out that a Mediterranean diet lowers MARKERS of heart disease, somehow believing that this equates to reversing heart disease. First off, he identifies Mediterranean diet being “high in lean proteins”. What is he talking about?????? I guess it depends on what he thinks “high” is, but the traditional Mediterranean diet is NOT high in protein. The article he references is THE review of the Mediterranean diet https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.118.313348. Please read it. They try to establish a Mediterranean index by which to judge whether a studied diet fits with a true Mediterranean diet. Meat counts AGAINST a Mediterranean score. First line of the article: “The Mediterranean diet (MedDiet), abundant in minimally processed plant-based foods, rich in monounsaturated fat from olive oil, but lower in saturated fat, meats, and dairy products, seems an ideal nutritional model for cardiovascular health.”

Secondly, Layne doesn’t seem to know the difference between preventing heart disease and treating heart disease. The Mediterranean diet does a good job of preventing heart disease, and the Predimed and Lyon studies showed “reduction” in cardiovascular mortality but they didn’t show disease reversal! (Interestingly, those who stuck to more plants in these studies score higher index of compliance with Med Diet and did better, read the article).

To show reversal of heart disease you actually have to show reversal of the plaque itself. Drs. Ornish and Esselstyn, have actually documented a reduction in plaque and an increase in flow to the heart with plant based diet, https://jamanetwork.com/journals/jama/fullarticle/188274, https://www.ajconline.org/article/S0002-9149(99)00290-8/fulltext, https://www.mdedge.com/familymedicine/article/83345/cardiology/way-reverse-cad.

While Dr. Fleming showed that a high protein diet worsened coronary perfusion https://journals.sagepub.com/doi/abs/10.1177/000331970005101003. These studies actually directly look at the disease itself, coronary perfusion. That is what the movie was referencing.

Now Layne gets into mTOR which I have already discussed above. He discusses that Rapamycin, a drug that blocks mTOR, may help with fighting cancer but says it is a big jump to hypothesize that stimulating mTOR may be risky. Hmmmm. See my references above. There is good evidence about mTOR. Layne seems to concede that mTOR could be a factor but only if it is chronically elevated. If it is episodically stimulated then it may be beneficial. On this we concur, but understand what he is saying. He is essentially admitting that chronic stimulation of mTOR is bad, and leucine stimulates mTOR, BUT earlier he was arguing that we need leucine and we need to get it from animal protein and we need to eat 1.6 gm/kg or more!!!! You aren’t going to eat all that protein in one meal. It will be spaced out throughout the day so you will be constantly consuming animal protein and thereby getting leucine through out the day and thereby chronically stimulating mTOR. How could he possibly NOT see this!?!?!?

Talk about cherry picking!!!! He then goes on to list this article as evidence that vegetarian diet is not protective if you compare to healthy meat eaters. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2352199/. He is right that if you control enough you limit degree of benefits because the 2 groups look similar. This study looked at vegetarian, NOT VEGAN. He calls them healthy but 46% smoked. This was the Oxford study and further studies showed that the vegetarians did not supplement B12, often didn’t get even 500 mg of calcium (which should be easy to do on plant based diet), and ate similar amounts of fiber as meat eaters, and less than 20 gm. In this study vegetarians who ate fruit did have a significant decrease in heart disease. They also note that the Oxford vegetarians did not do as well as vegetarians in other groups. This is likely due to a poor vegetarian diet.

Layne cherry picked an old article. Does he not know all the other studies that have looked at heart disease and vegetarians?? Lets look at a meta-analysis of the various studies that have been done. Keep in mind, all of these studies control for weight and any other factor that could independently affect results. This weakens associations and yet still, as this meta-analysis concludes, “Our results suggest that vegetarians have a significantly lower ischemic heart disease mortality (29%) and overall cancer incidence (18%) than nonvegetarians. “ https://www.karger.com/Article/FullText/337301.

As far as cancer is concerned, Layne leads you to believe that the movie is simply fear mongering when it lists a whole bunch of articles showing the relationship of meat to cancer. Remember, the American Institute of Cancer Research and the World Health Organization have listed processed meat as a type I carcinogen, and red meat as a 2a. This after experts poured through hundreds of articles.

Cancer is very difficult to study. There are multiple factors that play a role in carcinogenesis, of which food is just one part. We can never do a truly prospective randomized trial with food because cancer takes many years to form. Reviewing the literature for cancer is long and arduous. I will provide a link here to the cancer chapter in my book where I review many studies looking at the epidemiology and mechanistic data showing the correlation between meat and cancer http://proteinaholic.com/cancer/.

Bottom line is this, large population studies like the Adventist Health 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/, NIH AARP https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803089/, Harvard Nurses Health and Health Profession Study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712342/, Iowa Women’s Health Study https://academic.oup.com/aje/article/161/3/239/127005, show red and processed meat are definitely correlated with a shorter life. This meta-analysis sums it up perfectly: https://academic.oup.com/aje/article/179/3/282/103471. With this kind of data it isn’t fear mongering, it is warning the public of the possible negative effects of meat consumption!

Gorillas

Layne just passes right over the discussion of evolutionary biology and comparative anatomy, a fascinating and pertinent part of the movie. The Game Changers had some leading scientists going through how brain development would have to have been dependent on dense carbohydrate sources like bulbs and tubers, and how our anatomy is extremely different to carnivores. We make amylase in our saliva to break down starch. We are hind gut fermenters with our body surface area to intestinal length ratio putting us on level with frugivores. https://www.newscientist.com/article/2115127-ancient-leftovers-show-the-real-paleo-diet-was-a-veggie-feast/, https://blogs.scientificamerican.com/guest-blog/human-ancestors-were-nearly-all-vegetarians/ (read this one if you are interested in the topic).

Instead, Layne wants to focus on the fact that apes eat a lot of protein because people point out that apes are strong and eat mainly plants. What is his point? The whole “apes have muscles and are vegetarian” is somewhat tongue and cheek, but they do eat mainly plants so point is made. This tangent he takes has very little to do with the movie.

Erections

Layne completely glosses over the erection experiment. Amazing. This was a real life display of the effects of the diet on vasculature. The experimental design used in the movie is soon to be part of a randomized control trial. Just wait for those results. We know that fruits and vegetables and lower meat diets prevent erectile dysfunction by mechanisms discussed earlier when it comes to blood flow. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291878/#ref50, https://www.goldjournal.net/article/S0090-4295(13)01129-1/fulltext.

The fact that Layne glosses over this part of the movie shows you how cherry picked his review is. The only thing he focused on is their very quick comment that a vegan diet raises testosterone. They were NOT lying. It does raises testosterone, but as Layne goes at length to point out, also raises a binding protein that essential wipes out the raise in testosterone making free testosterone insignificantly lower. So basically, testosterone in meat eaters and vegans is not different. But point taken. It is misleading to say vegans have higher testosterone levels. Should have just stuck with better boners ; ).

Vegan Bodybuilders

Now Layne criticizes the fact that the movie shows vegan bodybuilders with impressive physiques. He says this is anecdotal. Of course it is!!!! The movie is about vegan athletes: showing that you can be vegan and be a bodybuilder. The purpose was not to compare vegan bodybuilders to meat eating bodybuilders. Remember how earlier Layne wished the movie was about vegan athletes demonstrating they can succeed on a plant based diet? RIDICULOUS.

Carbs Are Better For Building Muscle

Getting old now. He tries to discredit the film again because of a very quick reference that compared keto to normal carb group. He somehow suggests the movie is saying this is a plant based vs low carb group. THAT IS NOT SAID in the movie. The study is correctly labeled and presented. Check it out if you don’t believe me. It is 59:00 into the movie.

Stop Eating Meat To Save The Planet

This section really pissed me off. Talk about cherry picking again. Layne finishes off as miserably as he started, if not worse. The movie goes into the huge effects of an animal based diet on our environment. ¾ of all farmable land in the world is utilized for animal agriculture, and upwards of 70%-80% of the food raised in America goes to farm animals yet they only produce 18% of our calories. We have to provide animals 6x the amount of protein we eventually get for them as food. Animal agriculture is one of the biggest utilizers of water and a large part of the reason 25% of rivers never reach the ocean. There are 7 billion humans but 17-70 billion animals killed every year for food. That is a huge waste. On top of that, we need space for these animals which makes animal agriculture the leading cause of deforestation and species extinction. These animals make huge amounts of waste that poison our lands and our waters. And yes, they burp and fart CO2 and methane. Depending what source you read that can mean anywhere from 10-30% of greenhouse gasses. The movie says 15% which is pretty average. That number depends on many variables. Are you counting transportation of food in the food sector or the transportation sector? Are you balancing the offset of deforestation? Are you counting methane or just CO2. These can all vary the 1 number that Layne focuses on. Absolutely no nuance whatsoever. The whole section on the movie about climate change reduced to an argument of the 15% emissions number mentioned in one brief moment, and backed by considerable data.

The recent Eat Lancet Commission is a collection of experts that have been looking at what diet can best nurture our health and the health of our planet. Not surprisingly, their report details the problems of animal agriculture and suggests a diet higher in fruits and vegetables, and lower in meat, is best for both our health and the health of our environment. https://www.thelancet.com/commissions/EAT. Why would we argue over whether animal agriculture is 10% or 15% of emissions. It represents a choice that has very real consequences for the planet.

Summary

In summary, Layne throws out accusations of cherry picking and bias, and yet exhibits unbelievable bias and cherry picking. His critique of the movie is more a critique of veganism. I really don’t think he watched the whole movie, and I am certain most of the on line critics have not seen a single minute.

The movie was designed to show that you can get enough protein and be successful as a vegan athlete, even at a very high level of competition. In that, it succeeds with many interesting stories. The movie supplies peer reviewed research to provide possible reasons why plant based diet may improve athletic performance. If you would like a good review of that science see this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356661/.

People choose to become vegan for varying reasons. Some do it for health issues. Others do it because they worry about animal agriculture’s contribution to pollution and climate change. Yet, others are vegan for the animals. For me, I am vegan for all of these reasons, and these reasons are compelling enough for me to remain vegan even if it hurt my athletic performance. Thankfully, I have been able to run faster and lift more while being on a vegan diet. I have completed an Ironman, a half Ironman, several marathons, and many other races. At almost 50 I feel young and stronger than I was as a meat eating 35 y/o. Yes, that is anecdotal but there are thousands of people that mirror my results, and more joining this story daily, thanks to The Game Changers.

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