The China Study
|Author||T. Colin Campbell, Ph.D. and Thomas M. Campbell II, M.D.|
|Pages||417 (first edition)|
The China study : The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health is a book by T. Colin Campbell and his son, Thomas M. Campbell II. It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition.
The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease, diabetes, breast cancer, prostate cancer, and bowel cancer. The authors conclude that people who eat a predominantly whole-food, vegan diet—avoiding animal products as a main source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates—will escape, reduce, or reverse the development of numerous diseases. They write that "eating foods that contain any cholesterol above 0 mg is unhealthy."
The book recommends sunshine exposure or dietary supplements to maintain adequate levels of vitamin D, and supplements of vitamin B12 in case of complete avoidance of animal products. It criticizes low-carb diets, such as the Atkins diet, which include restrictions on the percentage of calories derived from carbohydrates The authors are critical of reductionist approaches to the study of nutrition, whereby certain nutrients are blamed for disease, as opposed to studying patterns of nutrition and the interactions between nutrients.
The book is "loosely based" on the China–Cornell–Oxford Project, a 20-year study—described by The New York Times as "the Grand Prix of epidemiology"—conducted by the Chinese Academy of Preventive Medicine, Cornell University, and the University of Oxford. T. Colin Campbell was one of the study's directors. It looked at mortality rates from cancer and other chronic diseases from 1973–75 in 65 counties in China; the data was correlated with 1983–84 dietary surveys and blood work from 100 people in each county. The research was conducted in those counties because they had genetically similar populations that tended, over generations, to live and eat in the same way in the same place. The study concluded that counties with a high consumption of animal-based foods in 1983–84 were more likely to have had higher death rates from "Western" diseases as of 1973–75, while the opposite was true for counties that ate more plant-based foods.
The China Study is divided into four parts. In the first, The China Study, the authors describe some of the health problems faced by Americans, early lab work by T. Colin Campbell, and the epidemiological study known as the China Study. In Part II, Diseases of Affluence, the authors discuss each of the diseases separately along with scientific studies of their links to diet. In Part III, The Good Nutrition Guide, they give their recommendations for a healthy diet. Finally, in Why Haven't You Heard This Before?, they argue that there are there are systemic problems in science, academia and government that tend to suppress information on the role of diet in preventing disease.
Part I: The China Study
In Chapter 1, Problems We Face, Solutions We Need, the authors describe worsening epidemics of cancer, obesity and diabetes in the United States. They note that the medical system is the third highest cause of death. It is also the most expensive in the world and rapidly becoming more expensive. While good nutrition can solve many of these problems, the American public is getting a lot of contradictory advice on nutrition and is harmed by a series of diet fads. The authors introduce their recommendation, which is to avoid animal-based foods and eat whole, plant-based foods.:Chapter 1
Chapter 2, A House of Proteins, examines the history of protein research and the emphasis on protein in dietary recommendations. In particular, animal protein is described as "high quality" because it comes close to matching the balance of amino acids in human protein, while vegetarians believe that they must carefully match ingredients to get all the amino acids they need. However, the authors state that the human body can synthesize all the amino acids it needs from a varied plant diet. Colin Campbell describes how he began with a traditional view of the importance of protein, but some research changed his mind. A study of nutrition in the Phillipines found that fungus in peanuts and corn was producing aflatoxin, a potent carcinogen; and the highest rates of liver cancer were in affluent families where the children had abundant protein. He also found a research paper from India that showed a strong association between protein consumption and liver cancer in rats. The rest of the chapter describes topics in research methodology, including the difference between correlation and causation, statistical significance, mechanisms of action and meta-analysis.:Chapter 2
Chapter 3, Turning off cancer, begins with a description of the deep public interest in carcinogens. An example is nitrites, chemicals found in foods such as hot dogs, bacon and canned meat. In the rats, these were "anticipated to be human carcinogens" based on laboratory studies with rats. The authors emphasize that these studies exposed the rats to enormous quantities of nitrites, and the effect on cancer rates was modest (in one study, rising from 5% to 10%). Colin Campbell then describes coming across an Indian research paper in which lowering the intake of protein reduced cancer from 100% to 0%.:Chapter 3
The rest of the chapter discusses research that Campbell and colleagues did on the relationship between diet and cancer. He describes three stages of cancer. In the initiation phase, a carcinogen enters a cell and is metabolized by an enzyme called mixed-function oxidase (MFO). Although the products of this metabolism are mostly safe, there are some toxic byproducts that can damage DNA. In the promotion phase, tumors grow from tiny clusters of cells called foci. This phase is reversible, depending on the balance between promoters that feed growth and anti-promoters that inhibit it. Finally, progression is the spreading of the cancer from its source to neighboring parts of the body, at which point it is considered malignant.:Chapter 3
Rats were fed aflatoxin and varying amounts of protein (between 5% and 20% of their diet). A low-protein diet greatly reduced tumor initiation by several mechanisms; for example, enzyme activity dropped and fewer toxins binded to DNA.:44–45 In the promotion phase, the development of foci was "almost entirely dependent on how much protein was consumed, regardless of how much aflatoxin was consumed.":46 They developed if the protein content exceeded the amount (12%) that their bodies required to grow, and focal growth could be switched on or off by varying the protein.:48 Finally, a population of several hundred rats were studied over 100 weeks, close to the normal lifetime of a rat. At the end of this period, all rats on the 5% diet were "alive and active, with sleek hair coats":52 while all those on the 20% diet were dead.:52 Much the same results were obtained in studies of liver cancer and diet in mice.:54
In the above experiments, the rats were fed casein, the dominant protein in cow's milk. However, plant proteins such as gluten (from wheat) and soy protein did not promote the growth of tumors, even at the higher levels.:51 The conclusion is that animal-based foods increase tumor development while plant-based foods decrease it. However, the chapter ends by noting that experiments involving rats do not provide quantitative information on the effect of diet on humans. This serves as an introduction to the next chapter.:Chapter 3
Chapter 4, Lessons From China, discusses the China–Cornell–Oxford Project, a massive epidemiological study conducted in the 1980's, also referred to as the China Study. The book takes its title from this study. It built on a national survey in the 1970s that collected data on mortality for 96% of Chinese citizens and produced an atlas of rates for each kind of disease (of which there were more than four dozen):65 cancer by region. Rates for some cancers varied by a factor of over 100, a far greater variation than in the United States.:60–61
With colleagues Junshi Chen and Junyao Li from China and Richard Peto of Oxford University, Colin Campbell led a study that encompassed 65 counties in China with 100 adults per county. This involved questionnaires, blood tests, urine samples and food samples from local marketplaces.:62 They found that diseases tended to be in one of two groups: diseases of affluence (cancer, diabetes, and heart disease) and diseases of poverty (such as pneumonia, peptic ulcer, and pulmonary tuberculosis).:65–66
One of the strongest predictors of the diseases of affluence (also referred to as Western diseases) was blood cholesterol. The average level in China was 127 mg/dL (far less than the American average of 215 mg/dL) and the county averages were as low as 94 mg/dL. The death rate from heart disease was 17 times lower than in America, yet still was strongly dependent on cholesterol level. The blood cholesterol was in turn strongly correlated with animal protein intake, even though Chinese consumed about ten time less on average than Americans.:67–68 In particular, liver cancer was strongly associated with cholesterol level, as well as chronic infection with the hepatitis B virus ("the virus provides the gun, and bad nutrition pulls the trigger.") The association with cholesterol was consistent with the lab studies described in the previous chapter.:93–94
The chapter examines the role of various components of animal and plant food. Previous international studies had shown a correlation between dietary fat and breast cancer, although only with fat from animals. The China Study found a consistent web of correlations between consumption of animal-based foods and breast cancer as well as a host of risk factors for breast cancer, including age of menarche, estrogen levels and cholesterol.:71–78 Dietary fiber, which is found only in plants, has benefits including an ability to gather up harmful chemicals from the intestines, but there were claims that it inhibited the uptake of iron. The China Study provided evidence for an increase in iron absorption with an increase in fiber because high-fiber foods are also high in iron. Where iron levels were low, in some rural areas, the problem was associated with parasitic diseases.:78–80
Another class of chemicals found almost exclusively in plants is the antioxidants such as carotenoids, ascorbic acid (vitamin C) and vitamin E. These provide much of the color in plant food and are designed to combat free radicals, a harmful byproduct of photosynthesis but also present in the human body for a variety of reasons. In the China Study, strong links were seen between increased levels of vitamin C in the blood (mainly due to fruit consumption) and lower risk of several kinds of cancer (by factors of up to 8). Blood levels of other kinds of antioxidant were more difficult to measure, so few correlations were seen.:81–83
Many fad diets are low-carbohydrate diets that restrict the consumption of carbohydrates. This includes the refined carbohydrates in products like sugar and white flour, but also the complex carbohydrates in fruits, vegetables and whole grains. In their place are increased fat and protein. The authors argue that people who follow these diets lose weight because their calorie intake is restricted. They add that this is unsustainable and cite research that shows adverse health effects.:83–87 They also argue that one of the main justifications for increasing dietary fat is false: a claim that Americans have had a mania for reducing fat, yet they are fatter than ever. However, Americans have actually increased their consumption of fats, and even more rapidly increased their consumption of refined carbohydrates in junk food.:84,88 In the China Study, the least active Chinese consumed 30% more calories than their American counterparts yet their body weight was 20% lower. The excess calories were lost as heat rather than being stored as fat.:88–91
The China Study also found that protein intake is associated with height and body weight, whether the source of protein is animals or plants. They also find strong correlations between low body size and diseases of poverty, which explains why people in developing nations are smaller than people in wealthy nations.:92–93
Part II: Diseases of Affluence
Part II looks at the diseases (like heart disease, cancer, stroke, Alzheimer's, obesity and diabetes) that were classified as diseases of affluence in Chapter 4. Each chapter summarizes research on one or more closely related diseases and the role of diet.:99–100
Chapter 5, Broken Hearts, looks at heart disease and diet. It begins by noting that heart disease is the leading source of mortality in Americans, killing about 40% of them. It is pervasive even in young, active Americans in the form of plaque buildup that partially blocks arteries. If this occurs slowly, the body can compensate by finding new pathways. However, if a plaque deposit ruptures, this can lead to rapid clotting and sometimes full blockage of an artery downstream, and the body does not have time to compensate. The result is a heart attack.:102–103
Starting in 1948, the Framingham Heart Study followed over 5,000 volunteers and developed the concept of a risk factor. For heart disease, risk factors included cholesterol, blood pressure, physical activity, cigarette smoking and obesity.:104–105 Multiple studies showed that fat and cholesterol are harmful, although they could be "merely indicators of animal food intake".:105–109 Others, dating back as far as the beginning of the 20th century, implicated animal protein, but such claims have been very controversial, with detractors mocking plant eaters as effeminate.:109 The main aim of research has been to develop technology such as coronary bypass surgery, coronary angioplasty, defibrillators, pacemakers and heart transplants. Such methods have lowered the death rate but not the incidence rate of heart disease.:111–113 They save lives when a heart attack is in progress, but are costly and have dangerous side effects such as stroke.:111–113 "When used for stable disease, bypass surgery, angioplasty, and stents do not address the cause of heart disease, prevent heart attacks, or extend the lives of any but the sickest heart disease patients.":114
The remainder of the chapter describes research by two doctors: Caldwell Esselstyn and Dean Ornish. While at the Cleveland Clinic, a center for cardiac care, Esselstyn tested the effect of a WFPB diet on 23 of his patients who had severe heart disease. Over 11 years, one of the 17 who stuck with the diet had any further coronary events and one who strayed from the diet for 2 years had a single event. Several had reduced blockages in their arteries. Meanwhile, five who dropped off the diet had ten new events. In a subsequent study of 198 patients, 177 who adhered to a WFPB diet and stopped taking medicine had a total of only one cardiac event, while 62% of the other 21 patients had events.:115–119
The book was first published in 2005. A revised and expanded edition was published in 2016.  The book has also been published in German, Polish, Slovenian, Italian, Chinese, Japanese, Korean, Romanian, Swedish and Urdu.
- Campbell, Thomas (2015). The Campbell Plan : the simple way to lose weight and reverse illness, using the China Study's whole-food, plant-based diet. Rodale Books. ISBN 9781623364106.
- Campbell, Thomas (2016). The China study solution : the simple way to lose weight and reverse illness, using a whole-food, plant-based diet. Rodale Books. ISBN 9781623367572.
- Campbell, LeAnne; Campbell, T. Colin; Disla, Steven Campbell (2013). The China study cookbook : over 120 whole-food, plant-based recipes. BenBella Books. ISBN 9781937856762.
Sanjay Gupta, CNN's chief medical correspondent, said in his documentary The Last Heart Attack in 2011 that The China Study had changed the way people all over the world eat. Former American President Bill Clinton became a supporter when he adopted a plant-based diet after a heart attack.
Wilfred Niels Arnold, professor of biochemistry at the University of Kansas Medical Center, reviewed the book in Leonardo reviews in 2005: "[T]he authors anticipate resistant and hostile sources, sail on with escalating enthusiasm, and furnish a working hypothesis that is valuable. In fact, the surprising data are difficult to interpret in any other way."
In a written debate with Campbell in 2008, nutritionist Loren Cordain argued that "the fundamental logic underlying Campbell's hypothesis (that low [animal] protein diets improve human health) is untenable and inconsistent with the evolution of our own species." Campbell argued that "diet–disease associations observed in contemporary times are far more meaningful than what might have occurred during evolutionary times—at least since the last 2.5 million years or so."
The book was reviewed by Harriet Hall, a physician and skeptic who writes about alternative medicine, in a blog entry posted on the Science-Based Medicine website in 2009. Hall argued that the book had references which do not support directly the claims made by the authors. She also stated that the book does not explain the exceptions to his data—for example that "stomach cancer rates are higher in China than elsewhere in the world." However, subsequent studies have shown helicobacter pylori, a prominent disease in China, to be the prominent cause of stomach cancer in most individuals.
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- Over the strong objections of the authors, who proposed 200 alternate titles but were overruled by the publisher.
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- Campbell, T. Colin; Campbell II, Thomas M. (2016). The China study : the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss, and long-term health (Revised and expanded ed.). BenBella Books. ISBN 9781942952909.CS1 maint: ref=harv (link)
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