The Game Changers Review – Via a Plant Based Sports Dietitian

As a dietitian who promotes a plant-forward eating pattern, I am the first to admit I’m excited about current the plant-based movement for health, performance, and sustainability. However, I also root my practice in science and it’s important that I don’t let nutrition documentaries be a main source of information for anyone looking to improve their eating pattern. So far, I’ve only seen people completely rip the documentary apart or blindly praise it. So, who better than me with both my dietitian and plant-based hats on, to write up The Game Changers review?

I spent (too) many hours on this review and worked to remove my personal bias toward plant-based patterns. It’s important for me to encourage my athletes and audience to eat more plants without pushing my own diet on them. I choose not to eat meat for ethical and environmental reasons and if someone else wants to make the switch for those reasons, too, I’m here to help them do that in a healthful way! But, when it comes to direct health and performance benefits, I’m reviewing based on sound science. Please feel free to leave comments and questions!

The Quick Game Changers Review

First and foremost, I want to acknowledge that often when you’re hearing about benefits of vegan diets, they are being compared to the standard American Diet (SAD). Is an adequate vegan diet more nourishing and better for the environment than SAD? When you remove heavy meat intake and mostly ultra-processed food and add in fruits, vegetables, whole grains, legumes, nuts and seeds, the answer is an easy yes. However, there is plenty of room to be healthy and fuel performance along the spectrum, without bouncing from one end to the other.

In case you aren’t here for all of the in depth details below, I’ve put together my main pros and cons in bullet form.

The All or Nothing Mentality

Unfortunately, that’s what most people walk away from documentaries with. I don’t believe that The Game Changers advocated everyone drop meat from their diet immediately and go vegan overnight, but I can certainly see that being the impression some athletes and health professionals have. I’ve gotten questions from family, friends, athletes and Instagram followers, there’s been some buzz on my list-serves regarding athletes wanting to go vegan out of nowhere after watching this and I received a call from a friend who is a college swim coach about his athletes wanting to do the same.

Before jumping further into my detailed review, I want to share the photo from The Game Changers official website, in an effort to help everyone take a deep breath and approach plant-based in a more balanced and realistic way. Despite what you may have taken from the documentary, and how they presented it, even they don’t want you to do something that isn’t practical! This should have been conveyed better in the film, but I’m sharing in hopes that anyone who IS on a journey to plant-based chills out, does it gradually, and finds a dietitian to help.

What the film failed to do is describe what “plant-based” actually means. It does NOT mean vegan, despite the fact that only vegan athletes and physicians were interviewed. And I do find it odd that only vegans were interviewed when much of their claims were about predominantly plant based eating patterns (which I dive into more below).

Credibility of the Narrator

The documentary is narrated by former UFC champion James Wilks, who currently trains military MMA techniques for self defense. He goes on to explain how an injury kept him from training or teaching for 6 months. In that time he says he spent “over 1,000 hours studying peer-reviewed science on recovery and nutrition” as if this makes him a nutrition expert.

As a registered dietitian, my internship alone included 1200+ supervised practice hours. This was after studying nutrition and exercise science in undergrad and actually matching to an internship program. On top of this was graduate level coursework and research in the same disciplines. 

What’s funny (but not really) is that they didn’t interview a single registered dietitian. There are over 1,000 of us in the US who are board certified in sports dietetics (that’s the CSSD behind my name). This means that on top of the coursework, internship work, passing of the registration exam to become a dietitian, and continuing education to remain a dietitian, we log 2,000 hours of work specifically related to sports and fitness nutrition before taking an even harder board exam. We must take an updated exam every five years to ensure we’re on top of the latest research.

“History Lessons”

Several times in the documentary, Wilks references ancient humans or the perceived roots of some myths. Here’s an overview.

References on Ancient Humans
The documentary goes on to highlight how archaeologists have investigated the remains of Roman gladiators. Their results show a high bone mineral density, indicative of a high training load as well as a “high quality diet”. Referred to as “hordearii”, which translates to “the barley men”, they ate beans and barley as a main source of nutrition, and their diet is thought to have been very low in meats. This is the first of many examples of how it is possible to maintain strength, endurance and muscle mass on a plant-based diet. However, these men were also essentially slaves and fed the least expensive foods available at the time, too.

The Myth That Meat Gives You Energy
First things first, this really isn’t a myth. Meat DOES give you energy as that is what calories are. I’ve already covered the functions of our three energy nutrients, so review that for a better understanding and you’ll see you’re certainly getting energy in the form of fat and protein from meats.

Still, protein is best as a structural and metabolic nutrient, not an energy source. Protein can convert to useable energy if you aren’t eating adequate carbohydrate and fat – it will supply energy systems and can store as fat, too. However, it’s a less efficient energy source and greater intensity and duration are able to be reached when carbohydrate is available as fuel. 

Diet of Ancient Humans
I’m thrilled that they interviewed anthropologists to comment on the fact that what a modern “Paleo” diet is not actually what humans ate in that era. However, they likely didn’t eat just plants either. Plants were reliable and widely available, and a Paleolithic diet was abundant in plants… but not exclusively plants.

The Athletes

UFC and Boxing

Former UFC Champion Conor McGregor’s interviews were highlighted where he bragged about his grass-fed beef diet (eating beef for breakfast, lunch, dinner), and made comments to Nate Diaz in press conferences about how he’d get eaten alive due to being a vegetarian. 

As you may have imagined, this was featured in the film because Diaz, the underdog, defeated McGregor in a huge upset. McGregor was shown saying “it was a battle of energy and he got the better of that… I was eating two steaks a day and it came to bite me in the ass.” This surely shows that a carnivorous diet is not going to give you the endurance you need for exercise, but is an extreme comparison.

Bryant Jennings, a heavyweight boxer featured in the film, was quoted saying “I grew up not even knowing about half of these other vegetables…asparagus to me just came out like 5 years ago!”. This shows how any increase in vegetable and plant food intake will increase the variety of nutrients consumed and offer benefits.

Ultra-Marathoners

It may seem more likely for an endurance athlete to succeed on a vegan diet than athletes in other sports. The documentary features Scott Jurek, a 7 time consecutive winner of the prestigious Western States 100 Miler. He’s also the 24 hour American record holder, and the only American to ever win the 153 mile Greece Spartathlon. The documentary follows him as he breaks the Appalachian Trail speed record (it’s a 2,189 mile feat) despite a quad injury in the first month.

Not followed in the documentary, which was filmed before his feat, was Robbie Balenger. I had the opportunity to hear him speak back in June in New York City at the Plant Based World Conference and Expo. He had just completed a 75 day 3,175 mile trek from LA, all in the name of raising awareness of veganism for environmental benefits. He just wanted to show what is possible on a vegan diet… not to say that his diet is healthier or that you need a vegan diet to be a successful athlete.

Runners tend to have small frames, so I’m sure this doesn’t impress anyone looking to build or maintain muscle mass, but it does show that the highest level of endurance success is possible without animal products. The average endurance athlete requires around 1.7g/kg of protein per day, so in a 46 day (Jurek) or 75 day (Balenger), needs are certainly higher, and clearly able to be met.

Sprinters

Carl Lewis, a 9 time gold medalist who competed in the 100m, 200m and long jump events was featured briefly. He set all of his PRs at 30 years old after adopting a vegan diet. Morgan Mitchell, who used to compete in the 400m and now in the 800m, is a two-time Australian champion and 2016 Olympian (and I’ll get to some of her comments later).

As is the theme of this Game Changers review post, there was likely a large increase in energy and nutrients from a more varied intake of plant foods, which could be achieved on a diet that still includes some animal products.

Cyclist

Dotsie Bausch is an 8 time national champion in indoor track cycling and the oldest person in her sport to go to the Olympics (where her team won gold). In the documentary, she speaks about her impressive training regimen and how at nearly 40, her teammates had a hard time keeping up with her. She spoke to success with endurance as well as strength and power in the weight room. 

She makes a great point that the better and quicker you recover, the more you can train; and diet is a key to fast recovery. Her vegan diet no doubt provides her with compounds that can aid in recovery by reducing inflammation and oxidative stress, while also improving vascular function. I’m sure you’ve heard by now that beets may enhance athletic performance (maybe not for weight lifters to the extreme that Game Changers claims). However, in addition to all of the vitamins, minerals and antioxidants in other produce, you’ll also get higher levels of nitrates, the key to beet’s effects on dilating blood vessels, to enhance oxygen and nutrient delivery during exercise. 

Vegan or not, adding a variety of plant foods to one’s diet will provide those compounds. Inclusion of a variety of plant foods is likely the main reason that vegetarian diets are associated with better long term health outcomes, rather than total elimination of meats.

Strength Athletes

These are the stories prove that plant foods can support not only endurance performance, but also the highest levels of strength and power.

Kendrick Farris had already made two Olympic teams in the past, but after switching to a vegan diet, he qualified for his third Olympic team and broke two American records as the only Olympic lifter for team USA in 2016. Again, we have a case showing that it’s possible to continue success without animal products, but we do know he was also successful before his vegan diet. He does say he wished he went vegan sooner.

Patrik Baboumian holds several world records in power-lifting and set the record for highest amount of weight ever carried while following a vegan diet. He mentions how he got bigger and stronger when he stopped eating meat. If he isn’t proof you can build and maintain muscle on a vegan diet, I don’t know who is. 

I sort of want to just skip Arnold Schwarzenegger, but won’t because he actually offered the advice to start just with meatless Monday, a more balanced approach. However, after eating straight raw eggs, way too much meat and taking steroids for years, I’m sure that he can benefit from all of the extra antioxidants he can get.

NFL

Derrick Morgan describes how when he turned to a plant-based diet after reading about recovery benefits, he felt less sore, tired and swollen. His blood pressure, cholesterol and inflammatory markers were significantly lower after 6 months, which is a common theme seen with these eating patterns. What we don’t know is his eating pattern before, where he may have been eating a meat heavy, low plant diet before making a dramatic switch.

They cover how 14 of the Titans wound up eating plant based in their best season in over a decade. What made this way easier than it would be for any other athletes reading this? Derrick’s wife started cooking delicious plant-based meals for him and the team, so they didn’t even have to think about what to eat!

Physician’s Perspectives

Whether vegan or not, any athlete needs to be educated on what nutrients actually do for the body.

Dr. James Loomis
The team internist for the Rams and Cardinals and director of prevention and wellness at St. Luke’s hospital. Dr. Loomis was interviewed since he had adopted a plant-based diet after a knee injury and surgery. He explained how the teams had outdated ideas about protein sustaining energy for exercise and that he’d see large spread of meat at pregame meals.

Whether vegan or not, any athlete needs to be educated on what nutrients actually do for the body and build an understanding of the role of carbohydrates as an energy source for exercise. I see it often, too, whether it’s with my role in the Philadelphia Phillies organization, grading diet analysis projects for my nursing and exercise science students, or just getting questions from my social media audience.

There are too many misconceptions about carbs, and while a vegan diet easily provides you with more of them, anyone can incorporate more quality carbohydrates. It’s important to eat them throughout the day and especially before exercise to enhance energy levels for athletic performance. So long as adequate energy is still eaten, less meat naturally equals higher quality carb intake, which is why my message is always about adding more plants!

Dr. Robert Vogel
Vogel is the co-chair of the NFL subcommittee on cardiovascular health. A credible source, he unfortunately compared a blood sampling of three NFL athletes after eating burritos with beef or chicken one day to bean burritos the next, rather than discussing published peer reviewed research. Why? Cause it makes for better viewing! He did compare blood samples of the same athletes with the different foods, but this was not a controlled study. They also equate the effects of poultry with beef intake, and do not discuss that both of those burritos also had cheese; the saturated fat from the dairy may have been a factor in differences rather than the chicken.

He does begin by covering how a single meal can impact endothelial function (the endothelium lines the heart and blood vessels). If the endothelium constricts, it limits blood flow and thereby limits oxygen and nutrient delivery to muscle cells to enhance performance. This would have been a great opportunity to dive into the dietary nitrate information I mentioned above, indicating how not only beets, but a variety of vegetables can dilate blood vessels and have a benefit. 

Dr. Dean Ornish and Dr. Caldwell Esselstyn, Jr.
Dr. Ornish is world renowned for his vegan program for reversing heart disease and Esselstyn is the director of heart disease reversal at the Cleveland Clinic. When treating patients post-emergency heart surgery or who have dramatically high blood lipids and serious risk for a heart attack, it may make more sense to follow their evidence based programs for heart disease reversal. A drastic overnight change means a more dramatic increase in antioxidants and fiber with a more dramatic decrease in compounds found in meats. This may be warranted in these dire clinical situations, but to build a nourishing, adequate and sustainable diet for an athlete, a more gradual and practical approach is always my recommendation. I also have a big post on omega-3’s in the works, which may be a concern while switching to a vegan diet without proper education.

They also show results from a one week vegan diet for firefighters. Dramatic improvements in lipid levels were shown, while it often can take months to see results from other interventions. Ornish goes on to showcase how genes can be turned on and off by diet and lifestyle choices – but we do not test patients genes, so it’s hard to say going plant based alone will save their life and no one needs medication.

Dr. Aaron Spitz
They included this urologist to prove the point that you don’t need to eat meat to “be a man”. And to pique viewer interest did a sleep erection study on three NCAA athletes. In short, they had more erections when they ate plant-based burritos before sleep than when they ate meat burritos. I probably just convinced you to watch this documentary based on this ridiculous inclusion alone. Either way, they go on to reference studies showing no difference in testosterone and then thankfully address the fact that soy does NOT increase estrogen in the body and actually has health benefits. I always reference this video by RD Whitney English when I get soy questions.

Dr. David Katz
He was only briefly featured, but is a doctor who I follow and respect. Katz maybe was only featured for a few sentences because his stance wasn’t as polarizing. He reiterated that world wide, no matter if the eating pattern is higher or lower in fat or carbs, an eating pattern that is predominantly plants is best for health. Again, he didn’t say exclusively plants.

The Drawbacks of Meat Intake?

A study showed that a single burger can impair blood flow and increase inflammation. This means you may have a reduction in blood flow impacting heart health, joint health and more. Plant foods do have more antioxidant content than animal foods, but that does not at all mean one burger is going to cause poor performance, heart disease or cancer. I hate to sound like a cliche dietitian, but it’s all about balance and inclusion of the other nutrients, too. What if the burger was eaten on a sprouted whole grain bun with a spinach salad?

There were several compounds that made an appearance on the screen with no explanation as to what they are or why they’re “bad”. One example is heterocyclic amines – they’re those compounds that form when you grill meat (especially overcook it) and have carcinogenic effects. These should not be present when meat is cooked appropriately (not charred and with a marinade). They also quickly compare amines created by normal digestion of animal protein to those that result from charred and cured meat, without providing evidence. While this certainly may be an area we find to be true with more research, for now, we don’t have adequate evidence. 

Heme Iron is the type of iron that comes from animal products (more on this below). The documentary references a meta-analysis that showed participants with higher heme iron intake had a 31% greater chance of developing coronary heart disease. A study also showed heme iron to be associated with colon cancer. This information is worth noting and continuing to pay attention to; but an association is not always indicative of a cause and effect relationship. Further research is warranted before claims can be made.

Studies were mentioned showing higher risks of prostate cancer associated with higher dairy intake and higher rates of colon cancer associated with poultry intake. You can click to view the prostate cancer study, but I was not able to find one on their colon cancer claim.

Finally, they took time to focus on monetary power of the beef, pork and dairy industries to fund studies and pay RDs and doctors to promote these foods. As much as I agree that this can create a conflict, since the plant industry doesn’t have as much money to fund studies, a portion of my own income is from food companies and commodity boards. Brands and commodity boards have sponsored posts on my blog and instagram, as well as TV segments. I do feel I have higher ethical standards than some other people and have turned down a lot of money from companies who don’t align with my values and who I believe stretch the truth with their messaging. It’s important for you as a consumer to determine what your ethical standards are and dive into research and media stories a bit more on your own if you are concerned with these ties. 

Environmental Concerns
I’m glad this wasn’t left out, because it’s the main reason I encourage people to eat less meat and more plants. Beef promoters state how carbon emissions directly from cattle aren’t that high, and that may be true, but the land and water use as well as the deforestation from overproduction of cattle is immense. It largely drove the fires in the Amazon and is something we should all consider as scientists continue on a regular basis to reiterate the climate emergency many people continue to ignore.

Nutrient Concerns

I encourage any significant dietary changes be made in the off-season.

From energy needs to B12, iron, and omega-3, there’s a handful of nutrients you need to pay attention to, and it’ll be hard without some hand holding from a dietitian in the beginning!

Energy
My first concern when someone wants to drop everything and switch to a vegan diet is their energy intake (not their protein). It is clearly possible to eat an adequate vegan diet, but if you watch this documentary and just decide you’re going to cut out animal products, what are you going to eat?! 

As a supporter of plant-based diets, I believe you should transition to them responsibly (if you choose to move in that direction). I will never advocate for large dietary changes during a competitive season for an athlete. Additionally, I encourage significant dietary changes be made in the off-season, unless of course you have access to a dietitian and chef who can work together to make this possible for you. For most athletes that isn’t reality.

Eliminating animal products may sound easy, but you need to have replacements for not only single food sources, but also sources of energy that may have come along with the animal foods. For example, it’s easy to swap dairy milk for soy milk. But, what about the pizza you used to eat on a Friday? Removing the cheese and pepperoni and adding veggies and cashew parm sounds like the healthy choice, but now your total energy and fat intake is a lot lower. One meal may not make a big difference, but when these instances continue to add up, you can wind up in a large energy deficit that impairs performance, immune system function, bone health, and more. You’ll have to be strategic to fit more fat and energy in at that meal or other points throughout the day (hint: find a sports dietitian). 

Protein Quality
They incorrectly state that the source of protein is irrelevant. It’s true that it’s a myth that plants don’t contain all of the essential amino acids. But, as I mentioned in my recent post on plant protein, athletes may need to be more mindful about choosing more digestible plant proteins and pairing plant proteins together to increase their bioavailability. 

Evidence shows that the amino acid leucine is an important trigger for muscle protein synthesis and it is in fact harder to get recommended amounts from single plant sources, other than soy. However, some newer evidence has shown that despite lower leucine levels, pea protein may be equal to whey protein for muscle recovery. We still need more data, but you can read more in this extensive article I wrote for Clif Bar.

B12
While interviewing Morgan Mitchell, she alludes to not having any issues with B12 as is often a fear when going plant-based. Unfortunately, this is a harmful statement that can make athletes who are going plant-based feel as if they don’t need to find alternative sources. In our modern food system, B12 is not present in plant foods. It is a nutrient formed by bacteria, and since we no longer eat foods with dirt residue or drink water directly from rivers, we don’t get B12 from plants. 

B12 is a unique water soluble nutrient – unlike other water soluble vitamins, it is stored in the liver. Once intake ceases, it may take 3-5 years before symptoms of a deficiency show up, which may be why people don’t notice issues right away. Take a reputable B12 supplement (if you’re an athlete, one that is NSF certified for sport or Informed Choice certified). 

Iron
Since heme-iron is absorbed more efficiently than non-heme (plant) iron in omnivores, it is a common concern that vegan diets do not provide adequate iron for athletes. Athletes do have higher iron requirements, so the concern is understandable. However, many plant foods contain high levels of iron and inclusion of vitamin C with plant iron can enhance it’s absorption by 4 times. Adaptation to absorb more iron also occurs when meat is not included in one’s diet. I’ll have a couple of extensive posts on iron for fitness up next week!

The Game Changers Review: Key Takeaways

1. Veganism isn’t a diet, it’s a lifestyle. It’s something you may choose to work towards for animal welfare and/or environmental reasons, and it may also improve your health. But, it isn’t something to achieve overnight and it doesn’t guarantee miraculous performance benefits.
2. Swapping excess animal products in your diet for whole plant foods may produce both short and long term health benefits by increasing intake of carbohydrate, fiber, vitamins, minerals, phytochemicals, and other compounds (like dietary nitrates). It can also reduce saturated fat and cholesterol intakes, which can be beneficial to some people (but the degree to those benefits may be based on genetics and other lifestyle factors).
3. A proper portion of meat is just 3-4 ounces – 3 ounces of lean beef or chicken breast provides 23-25 grams of protein, which is more than enough considering you also get protein from whole grains, vegetables, nuts and seeds that may be at that same meal. Improve your diet by reducing portion sizes to make more room for nutrient rich carbs and healthy fats on your plate. If you reduce meat intake, again, you need to replace those calories somewhere else at meals and snacks throughout the day.
4. If you’re concerned with animal welfare and climate change, you can start by selecting more humanely raised meats and fish that have a more sustainable foot print. Eat Lancet – the dietary recommendations for sustainability – suggest eating no more than about 100 grams of beef (3.5 oz) , 200 grams of poultry (7 oz), and 200 grams of fish (7 oz) per week.
5. If you’re at risk for heart disease, pay attention to what research is released on TMAO and heme-iron in the future (since we don’t have enough now), while putting most of your effort into increasing whole plant food intake.
6. If you’ve considered the drawbacks of this film, but still want to make changes fast, please don’t do it alone… and don’t turn to a random health coach or meal plan. Whether it’s my team or someone I don’t even know, meet with a sports dietitian!