Eating Food, Part II: The China Study
March 19th, 2012 | health care reform | 1 Comment »
Eat Food, Not too much, Mostly plants—Michael Pollen
The China Study includes a section on China, but is really about Americans and what we eat. Colin Campbell (the senior author of The China Study) contends that “what we eat” is making us sick and killing us prematurely.
In this well documented, chart filled, and very readable (to me) book, Campbell offers an evidence-rich defense of his proposition that if Americans switched to eating “mostly plants” in their original (whole food) form, they would reduce their risk of getting what Campbell calls “diseases of affluence”: heart disease, diabetes, obesity, a broad range of common cancers (most prominently breast, prostate and colon), several auto-immune diseases (e.g., multiple sclerosis), and others.
Campbell, a nutritional biochemist who rose to the top of his field and has served on a number of national nutrition advisory panels, began his career on a very different track, studying ways to make farm animals put on weight more quickly, with the goal of increasing protein consumption in the third world. His focus changed away from protein when he actually went to the third world (first, the Philippines and then China) and was jolted by some of his research findings.
In the Philippines, for example, children were coming down with liver cancer, an unusual situation given that liver cancer is normally only found in older adults. With some good detective work, Campbell and his colleagues discovered that the liver cancer was due to aflatoxin (a fungus-produced toxin) found in peanut butter made from moldy peanuts. But, the children who developed liver cancer were middle and upper class children. Poor children eating the moldy peanut butter were spared. Campbell and his colleagues finally determined (through further investigations including surveys about eating habits) that it was the high protein (animal-based) diet that was creating the vulnerability.
The China Study and “diseases of affluence”
During the 1970s, Premier Chou EnLai, who was suffering from cancer, commissioned a study to find out the causes of cancer in China. In the 1980s, the study was expanded, and Campbell was brought in due to his professional relationship with a senior Chinese nutrition researcher who had studied in the U.S. The research they designed looked at geographic variation across rural Chinese counties (there are 2400 counties in China all together) and explored the associations between a variety of lifestyle and environmental patterns and death rates from a long list of conditions.
Here is a simplified summary of Campbell’s findings.
- People in rural China who ate a largely plant-based diet had extremely low age-adjusted death rates from heart disease, cancer and the other chronic conditions that Campbell labeled “diseases of affluence.”
- In contrast, those rural areas of China with higher rates of consumption of animal products had higher age-adjusted death rates of the same “diseases of affluence.”
- Eating animal products was strongly associated with “diseases of affluence.”
Furthermore, age-adjusted rates of “diseases of affluence” throughout rural China were far below rates in the United States at the time, even where animal protein consumption was somewhat elevated (though far below the consumption found in the typical American diet). For example, the male, age-adjusted death rate from coronary heart disease in the U.S. was 17 times higher than in rural China at the time. The age-adjusted female death rate for breast cancer was five times higher for U.S. women than for rural Chinese women.
Can Americans (not just Chinese) benefit by avoiding animal products?
In addition to presenting his own scientific work, Campbell reviews numerous clinical and epidemiological studies conducted by others. Here are a few examples from the book.
- Type II diabetics who move to a low fat, plant-based diet can often achieve control without their medicines ( Source: a study by Dr. James Anderson in which 25 type II diabetics were put on a high-fiber, low-fat (limited animal products) diet, and within weeks 24 of the 25 patients were able to discontinue their diabetes medication and maintain control.)
- Heart disease can often be reversed with a low fat, largely plant based diet. (Source: a study by Dr. Caldwell Esselstyn of 18 heart patients followed for 11 years reported only one coronary event during that extended time (the one patient went off-diet for two years), compared to 49 such events by the same patients during the eight years prior to the study. Average total blood cholesterol was lowered (without drugs) from 246 mg/dL to 132 mg/dL during the course of the study.)
- Prostate cancer risk has been linked to dairy consumption (Source: a 2001 research review by Harvard researchers found “12 of…14 case-control studies and 7 of…9 cohort studies observed a positive associate between dairy consumption and prostate cancer.”)
- Breast cancer risk is associated with high levels of female hormones in the blood and with high blood cholesterol, both of which are also associated with a diet rich in animal products. (Source: The China Study found that lifetime exposure to female hormones was 2.5-3.0 times higher in American women than rural Chinese women, who ate a largely plant based diet, and age-adjusted breast cancer death rates in America (in the mid 1980s) were five times the rural Chinese rate.)
Despite the evidence (and the above is just a tiny fraction of his extensive review), Campbell’s challenge is a big one. There are few vegetarians in America (3-4 percent of the adult population by one count) and hardly any vegans (0.5% of adult Americans). The “meat eating” culture and its industrial sponsors are a pervasive and a powerful deterrent to change.
As might be expected, Campbell is controversial. (So too are the USDA guidelines for the school lunch program which take into account the needs of agribusiness as much as the nutrition needs of children.) Like climate science, food science touches on a number of well-established industries and institutions that don’t want their business model (or food preferences) upended. Campbell’s approach to his many scientific adversaries is reasoned and evidence-based. However, he takes a harsher line with those he thinks are charlatans. This about Robert Atkins and his “low carb” diet:
“Perhaps it is a testament to the power of modern marketing savvy that an obese man with heart disease and high blood pressure became one of the richest snake oil salesmen ever to live, selling a diet that promises to help you lose weight, to keep your heart healthy, and to normalize your blood pressure.”
Campbell reviews some of the “clinical studies” promoted as evidence by Adkins, and suggests that the main effect of the Adkins Diet on weight is the low calorie impact. During the initial phase of the diet, adherents are consuming only about 1450 calories a day, well below the US average of around 2250 calories. The Atkins’ diet’s impact on other aspects of health, however, Campbell views as uniformly harmful.
Vegetarian sympathizer’s assessment
My take from The China Study, the analyses by Campbell of numerous other clinical and cohort studies, and my friend’s own personal results (reported in my previous column) is:
- The evidence Campbell brings to the table about the harmful effects of eating animal products is solid and convincing, but not fully conclusive (the science is not “settled”);
- The strength of his arguments and the evidence he brings to the argument varies across diseases, with evidence supporting his claims appearing weak in some cases;
- Campbell is an advocate of a plant-based diet, and his advocacy may sometimes color his assessment of the science;
- Eating vegan apparently does no harm. Almost none of the clinical, cross-national, and cohort studies designed to study the effect of the food we eat on health have found an adverse impact from eating a plant-based diet (any disease or mortality correlations have almost all gone in the opposite direction).
As a result, a shift to a vegan(ish) diet is a step I think is prudent, pending further research, and the benefits appear to accrue on a continuum (you don’t need perfect adherence to the vegan diet to obtain the claimed benefits).
“The China Study: Startling Implications for Diet, Weight Loss and Long-term Health” by Colin Campbell, Ph.D., and Thomas Campbell, M.D., Benbella Books, Dallas, TX , 2006.




















