Book Review: “The China Study” by T. Colin Campbell

The book begins with a preface and foreword, each written by a different author, and then continues with an introduction written by T. Colin Campbell, in which he describes his history and motivation, and highlights interesting and important facts.

Next, come the four main parts of the book: The China Study, Diseases of Affluence, The Good Nutrition Guide, and Why Haven’t You Heard This Before? Starting on page 351, there are also four appendices titled Q&A: Protein Effect in Experimental Rat Studies, Experimental Design of the China Study, The “Vitamin D” Connection, and References. These are followed (starting on page 405) by an index and additional information about the authors.

The book begins with a preface by Howard Lyman, author of "Mad Cowboy". He respects Colin Campbell because of his courage and integrity and explains how even with solid evidence not much is able to be done against the mainstream.

Lyman served as codefendant for Oprah Winfrey when some cattlemen sued her after she announced her intention not to eat beef any more.

The foreword was written by John Robbins, author of "Diet for a New America, Reclaiming Our Health", and "The Food Revolution". Robbins writes:

It’s easier to find a Snickers bar, a Big Mac or a Coke than it is to find an apple. And your kids eat at a school cafeteria whose idea of a vegetable is the ketchup on the burgers.

Robbins then describes the glossy magazine called "Family Doctor: Your Essential Guide to Health and Well-Being", which all doctors in the US get for free from the American Academy of Family Physicians. It is filled with full-page ads for McDonald’s, Dr. Pepper, and the like and advertising for chocolate pudding and Oreo cookies. It is similar in Europe, but perhaps even more sophisticated. There you will find ads paid for by convenience food manufacturers (PR, public relations) in which so-called dieticians stress the advantages of instant soups and frozen foods. Critical scholars at Yale University call it a toxic food environment.

Robbins describes "The China Study" as a brave and wise book and the author as a man of humility and human depth. Robbins adds, He always shows you how he has arrived at his conclusions. Robbins mentions some of the aspects in the book that he feels to be most important and interesting.

Dr. Gunter R. Neeb, from Idstein, Germany, wrote the preface for the German edition. He is a practitioner of traditional Chinese medicine and has been a visiting professor at numerous universities around the world (Since some of the information in the German edition is of particular interest, I have included it in this book review as well).

Neeb writes that "The China Study", the largest epidemiological study on the human diet ever conducted, would not be easy for people to believe as the subject matter is too different and unfamiliar. He thought that this would be the case even though the evidence cited in the book on hundreds of substudies is very convincing and believable. The conclusions are based on studies that involved more than 10'000 test subjects over a period of more than 20 years.

He continues, It says in the book, for example, that dairy products accelerate tumor cell division, presumably through cell stimulation caused by IGF-1 (somatomedin C). Yet doctors still recommend emaciated oncology patients to increase their protein intake by means of consuming more concentrated dairy products such as cheese and yogurt.

IGF-1 is a kind of "insulinlike" growing factor ("insulinlike" growing factor 1), also called somatomedin C (SM-C).

Wikipedia on the problems with IGF-1:
"It is now widely accepted that signaling through the IGF-1-like receptor pathway is a significant contributor to the biological aging process in many organisms. ... Reduced IGF-1 signaling is also thought to contribute to the ‘anti-aging’ effects of calorie restriction. ... The IGF signaling pathway has a pathogenic role in cancer. Studies have shown that decreased levels of IGF lead to the decreased "growing" of existing cancer cells. People with Laron syndrome have also recently been shown to have a much lower risk of developing cancer."

Neeb criticizes how the German Nutrition Society, whose members include many business organizations, “plays down” these facts. This is particularly frustrating since studies demonstrate that not only the "insulinlike" growing factor IGF-1 of cows (bovine IGF) enters the bloodstream, but also the production of human IGF-1 is increased by the casein found in milk. See also this book review on the dangers of milk.

Neeb further mentions that consumers are not informed about the different effects of externally supplied vitamin D (cholecalciferol and calcium) and its role in the causation of breast cancer and osteoporosis versus active vitamin D obtained through sunlight. He suspects the reason for this is that sunlight is free and doesn’t offer any business opportunities for the industry.

After reading The China Study, Dr. Neeb changed over to a nearly vegan (some fish) diet, and he now swears by this “modern” diet.

© Public Domain, Zeetz Jones, Wikipedia

The liver binds the storage form calcidiol (25(OH)vitamin-D₃) to the vitamin D-binding protein (gc-globulin), which the kidney activates, and it becomes the active compound 1α,25(OH)₂Vitamin D₃. The medium to the longer-term supply of vitamin D is best determined through the level of 25(OH)Vitamin D₃. The bound calcidiol has a biological half-life of about 19 days in the blood. The 25(OH)Vitamin-D₃ level in the blood shows the supply over the last three to four months, while the vitamin D3 level shows only the supply over the last few hours to days.

It is best to get your vitamin D from the sun. However, people in northern countries often get too little sun exposure. In 100 g of food, young salted herring contains 27 µg, salmon 16 µg, veal 3.8 µg, avocado 3.43 µg, and mushrooms 1.9 µg. For vitamin D, 1 IU = 0.025 µg of vitamin D₃ = 65.0 pmol. IU stands for an international unit. The IU is usually a randomly selected, reproducible drug dosage based on its effect rather than its amount. The World Health Organization defines these units.

The images below serve to break up the text and provide space for additional comments. The book itself contains few pictures, but it does have numerous tables. These images are from Wikipedia, taken by me, or have public domain status.

The main author didn’t gain fame because of this book or his work in China. It’s quite the reverse; he received this large and important task because of his reputation, his integrity and his ability. You cannot compare this book with one written by an author who made a name for himself by publishing his own views as this book is written by a person with great professional and personal credibility. It includes 708 references, which are listed out for each chapter at the end of the book.

Since much sound and convincing evidence was required for these conclusions, my book review is much longer than it would usually be. The findings are extensive.

I refer to both authors with the name Campbell, father Dr. T. Colin Campbell (PhD in nutrition, biochemistry, and microbiology) and son, Dr. Thomas M. Campbell II, MD. I normally write using the singular, but in certain places, I do write using the plural and title “Drs.” to make it clear that I am referring to two authors.

Wikipedia has an entry for the China-Cornell-Oxford project.

The book reviews of Salt Sugar Fat by Michael Moss, which deals with the American situation, and Lügen Lobbies Lebensmittel (Lies lobbies food), which looks at the situation in the EU, take up the problem of younger readers who eat a large number of convenience foods and junk food.

Here is a link to a book review of Die Ernährungslüge (The nutrition lie), which deals with the additives in our food.

Based on the experiences my wife and I have had and the experiences of others we know who have also changed their diet, I can confirm that both the first two statements and the fourth statement quoted here are very true. But most doctors would probably still say that it can’t be that easy.

Usually, the reason for such a reaction is ignorance and doesn’t have to do with money at all. Medical school does not include an in-depth study of nutrition. And nutritional guidelines are largely determined by the food industry.

After reading "The China Study" or this text, a responsible doctor would want to inform patients about what actions they should take on their own. This would be an adjuvant to the treatment provided. If the patients aren’t interested, at least the doctor would have done his or her best.

The results of the hundreds of studies summarized in "The China Study" provide evidence that proper nutrition is the most powerful weapon against disease. Campbell also explains why misinformation or even disinformation persists so stubbornly. He believes that half of the American people are suffering from health problems that require them to take prescription drugs regularly. Hundreds of millions of Americans have elevated cholesterol levels.

I think this situation is making its way to Europe as well. Such a book doesn’t usually reach the masses. And neither do the findings. And if this were to happen, the information would normally be dismissed. This information will therefore most likely benefit only a very small part of the population. Above all, the readers themselves must be interested in reading something like this; in other words, it’s the reader's responsibility to inform themselves, not the author's responsibility to make sure they do so. But I am definitely still committed to this cause.

Dr. Campbell writes on page 4: I just ate what everyone else did: what I was told was good food. We all eat what is tasty or what is convenient or what our parents taught us to prefer.

He grew up on a dairy farm, where milk production was the major food and income source. His dissertation at Cornell University was about better methods for the faster "growing" of cows and sheep. He wanted to promote higher consumption of meat, milk, and eggs as he believed this would help to improve people’s overall health.

The author was the last graduate student under the guidance of Professor Clive Maine McCay (1898–1967). Clive McCay was known for conducting experiments with rats in which they were fed much less food than they would normally eat. These rats actually had significantly longer and more active lives than rats that were allowed to eat as much as they pleased. The same thing happened with dogs. McCay died from a serious illness.

At the Massachusetts Institute of Technology (MIT), Campbell then investigated why millions of chicks were dying as a result of an unknown toxic chemical in their food and determined that dioxin was the cause (polychlorinated dibenzodioxins and dibenzofurans), probably the most toxic chemical compound.

I initially worked at MIT, where I was assigned a chicken feed puzzle. Millions of chicks a year were dying from an unknown toxic chemical in their feed, and I had the responsibility of isolating and determining the structure of this chemical. After two and one-half years, I helped discover dioxin ... (p. 4)

See also this devastating story of the Seveso disaster and information about Ukraine and Victor Yushchenko, who ingested the carcinogen TCDD. This is what humanity does to itself.

After that, Campbell examined the unusually high incidence of primary liver cancer in children in the Philippines. For ten years, the main goal of this development aid project was to get children to eat more animal protein. One of the ways they did this was to establish “self-help” education centers. Then he discovered that:

Children who ate the highest-protein diets were the ones most likely to get liver cancer (p. 5).

He next heard about some rat experiments in India. The rats there received carcinogenic aflatoxin. One group was given 20% protein in their diet, the other 5%—both groups received the same amount of aflatoxin. The result was that all of the rats receiving 20% protein developed liver cancer. But with the group receiving only 5%, there were no cases of cancer! It was heretical to claim that a high-protein diet was unhealthy. This was contrary to everything he had learned before. It was a defining moment for Campbell.

Finally, Campbell concludes that the boundaries between politics, government, the food industry, pharmaceutical companies, science, and medicine have blurred over time. At best, they represent a mix between the making of profit and what is best for society.

Justice and health are the losers. The problems are much more subtle than, for example, corruption and therefore are also much more dangerous.

The result is massive amounts of misinformation, for which average American consumers pay twice. They provide the tax money to do the research, and then they provide the money for their health care to treat their largely preventable diseases (p. 8).

Campbell tells briefly about growing up on a farm, the heart attack his father suffered at age 61, and his father’s death at age 70 due to coronary artery occlusion.

Eating his meat-based Atkins diet, Dr. Robert Atkins lived only one year longer than Campbell's father. He died in 2003 at the age of 71 from stroke complications. According to Wikipedia, Atkins had previously suffered from a long history of illness, including myocardial infarction, heart failure, and high blood pressure. His profession: cardiologist!

Campbell highlights studies showing that a healthy diet not only has the ability to prevent coronary artery disease (also coronary heart disease) but can also partially reverse it (p. 3).

Campbell discusses the first wave of promised weight loss in the 1970s, which began with a protein drink. Within a short period of time, almost 60 women died from this diet (life expectancy). Other diets soon appeared on the market and received similar praise, for example, Dr. Atkins diet, Protein Power, and the South Beach Diet. In many cases, these have led to dangerous health problems (p. 19).

The author also states that diets from “health” books such as "Sugar Busters, The Zone", or "Eat Right For Your Type" have made health information even more confusing for consumers who are interested in learning about how to improve their diet.

He regrets that scientists focus on details such as extremely specific food components, rather than taking the broader scope into consideration. The consequences are contradictions (falsificationism), misleading fad diets (food faddism), and consumer uncertainty.

For him, these kinds of fad diets and emphasis on individual dietary components such as vitamin E or calcium supplements embody the worst of medicine, science, and popular media.

A proper diet not only prevents or reduces diseases, it also generates physical and mental well-being. To this effect, Campbell lists some world-class athletes such as: Ironman triathlete Dave Scott, track and field stars Carl Lewis (vegan since 1990) and Edwin Moses, and tennis ace Martina Navratilova. He also mentions the 68-year-old marathoner Ruth Heidrich. Ruth Heidrich is on the list of notable vegans on Wikipedia.

Human studies conducted by Dr. Russell Henry Chittenden (1856–1943) a century ago at Yale University describe superior physical performance in people on a purely vegan diet (only plant-based foods). This was confirmed by rat experiments carried out by the author.

He came to the conclusion that fewer people would have to spend their final years with lengthy and costly battles against chronic diseases in hospitals. His motto:

It is time to stand up, clear the air, and take control of our health (p. 25).

Several students under Voit adopted this concept without critical inspection. W.O. Atwater (1844–1907) even advocated 125 g daily when he was head of the USDA. Today, the recommendation is less than half this. Max Rubner (1854–1932) believed that a large protein allowance is the right of civilized man (p. 29).

Campbell notes that protein is essential to life and after digestion provides essential amino acids, which are used for the development of new cells and other processes. He explains that with the past euphoria about high-quality protein—with a composition as close as possible to human protein—actually, human flesh would be the best. But of course, we don’t act like cannibals, but instead, turn to animals.

For over a hundred years, we have believed that more quality equals more health (p. 31).

We then read about a mountain of compelling research showing that ‘low-quality’ plant protein, which allows for the slow but steady synthesis of new proteins, is the healthiest type of protein.

We now know that through enormously complex metabolic systems, the human body can derive all the essential amino acids from the natural variety of plant proteins that we encounter every day (p. 31).

As a staunch meat-eater, Campbell wanted to teach the mothers of malnourished children about what types of locally grown foods would be best for their children. He did this as part of his job as campus coordinator, with several extended stays on-site.

Peanuts were to be developed as a primary source of protein, but there was a high incidence of liver cancer in the area due to the aflatoxin found in peanut butter. The good peanuts were sold as cocktail nuts, but the moldy ones ended up in factories and were used to make peanut butter.

Peanut butter is similar to the Western diet, and in the Philippines, only wealthy families were able to afford this “more healthy food.” Their children were also the ones to be affected with liver cancer most often, which in the West doesn’t usually occur until about age 40.

At the same time, a study was being conducted in India comparing liver cancer incidence in rats with the amount of protein they consumed. Rats were either given 5 % or 20 % protein, and both groups received the same amount of aflatoxin. All of the rats receiving 20 % protein developed liver cancer or the prior typical cell damage, but not a single rat in the other group showed any detectable signs. No one seemed to accept the report from India (p. 37).

If you ask the question, does a ball fall down when we throw it in the air, we know the answer and it is 100 % correct. But the question if a person smokes four packs of cigarettes a day, will they get lung cancer, can only be answered with a “maybe.” Campbell stresses that statistics only provide percentages but can’t give a reliable prognosis for an individual person.

He then explains the various strategies and possibilities used in investigations. Researchers usually confirm or reject hypotheses by means of comparisons, measurements, and observations. Correlation and causality are used to describe these.

The China Study is based primarily on the cause-and-effect relationship, that is causality from a holistic perspective. We observed whether there were patterns of associations for different dietary, lifestyle and disease characteristics within the survey of 65 counties, 130 villages, and 6'500 adults and their families (p. 39).

Campbell stresses the importance of finding root causes. For example, there is a greater incidence of heart disease in countries that have more telephone masts. So these are positively correlated, but that is not causality because relevance is not a given. Telephone poles don’t cause heart disease.

We rarely know the all-important background information of such studies or meta-studies. And when a strong representation from the industry is behind these, the result is problematic. You can almost count on it—if something hits the tabloids, consumer magazines, and the like, it is most likely supported by financial interest groups and you will only be reading part of the story.

He next explains how such scientific publications come into being.

As an example, he tells about a study using rats that looked at nitrosamine (N-nitrososarcosine). Even the “low-dose” group received extremely high levels of NSAR.

As a comparison, to get the equivalent amount of NSAR, you would have to eat a bologna sandwich with a pound of meat on it every day for thirty years. That would be 270'000 bologna sandwiches!

Nevertheless, this report received so much attention that even the consumer advocate Ralph Nader, stated that hot dogs were among America’s deadliest missiles (p. 46).

Experiments conducted by Dr. Campbell’s undergraduate student, Rachel Preston, showed that when the milk protein (casein) was 5 % of the total food intake, instead of 20 %, the dangerous aflatoxin-DNA adducts decreased dramatically. The results were as follows:

• Less aflatoxin entered the cell.
• Cells multiplied more slowly.
• Multiple changes occurred within the enzyme complex to reduce its activity.
• The quantity of critical components of the relevant enzymes was reduced.
• Less aflatoxin-DNA adducts were formed.

Conclusion:

Lower protein intake dramatically decreased tumor initiation (p. 53).

This was consistent with the earlier studies in India that had been ridiculed.

Another study conducted by Scott Appleton and George Dunaif dealt with the foci, that is microscopic cell clusters that are considered precancerous. They discovered that even if the levels of aflatoxin consumed were much higher, the foci grew a lot less with the 5 % protein diet and the same amount of aflatoxin than with the 20 % protein diet and less aflatoxin.

The studies carried out by Linda Youngman prove that the process can even be controlled at a later stage, just by changing the amount of protein.

The foci then act as a kind of memory. With more than 10 % dietary protein, the foci increase dramatically in response to the increase of protein in the food.

Sometime later, the Japanese visiting professor, Fumiyiki Horio, came to the same conclusions.

The same results were obtained with completely developed liver cancer. Tumor "growing" decreased by 35–40 % when the animals were given lower levels of milk protein. And despite high aflatoxin levels, 100 % of the animals that received only 5 % milk protein lived a long life without cancer, whereas none of the animals that received 20 % milk protein survived. The book describes the study more fully and in much greater depth.

People who are chronically infected with hepatitis B virus (HBV) are 20–40 times more likely to get liver cancer.

To find out how the virus causes liver cancer, researchers bred transgenic mice infected with the virus. Campbell had Jifan Hu, one of his graduate students, and later also Dr. Zhiqiang Cheng studies this form of liver cancer in mice.

They received two different strains of transgenic mice. The casein showed the same effect. The details are on page 63 and followed by a chart with images of the different tissues.

After this, the author gives reasons why these findings suggest that they are also relevant for humans.

Finally Tom O’Connor and Youping He investigated the effects of fish protein, fats, and carotenoids and their relationship to liver cancer and pancreatic cancer. Campbell writes:

The results of these, and many other studies, showed nutrition to be far more important in controlling cancer promotion than the dose of the initiating carcinogen (p. 66).

The big question is whether these experimental studies on animals really apply to all different types of cancer and to people. Evidence from a large human study was needed. Dr. Junshi Chen from China made that possible in 1980. And that is what just a little later became "The China Study".

Campbell lists out the participants of this joint study, the actual "China Study": Dr. Junshi Chen, deputy director of the most important government diet and health research laboratory in China, Junyao Li, one of the authors of the Cancer Atlas Survey, Richard Peto of Oxford University (UK), one of the leading epidemiologists worldwide, and Dr. T. Colin Campbell as the director.

The team looked at the mortality rates of more than four dozen different diseases such as various types of cancer, heart disease, and infectious diseases. They took blood and urine samples from 6,500 adults and recorded all of the foods that these families consumed during a three-day period.

In addition, the team also analyzed food samples from markets across the country. Selecting rural areas where people had lived for generations and had consistent eating habits gave the study great validity with more than 8'000 statistically significant associations between lifestyle, diet, and disease variables (p. 73).

Experimental variation (i.e., a range of values) is essential when we investigate diet and health associations. Fortunately, in the China Study considerable variation existed for most of the measured factors. There was exceptional variation in disease rates (Chart 4.2) and more than adequate variation for clinical measurements and food intakes. For example, blood cholesterol ranged—as county averages—from highest to lowest almost twofold, blood beta-carotene about ninefold, blood lipids about threefold, fat intake about sixfold, and fiber intake about fivefold. This was crucial, as we primarily were concerned with comparing each county in China with every other county (p. 74).

The media called The China Study a 'landmark study. It compared diets that were more or less based on plant-based foods, but all of which were significantly richer in plant-based foods than Western diets. Western studies, in contrast, had so far only compared different types of Western diets, that is diets based more or less on a relatively high proportion of animal protein.

Whereas in the West we primarily see diseases caused by excess, China has a higher incidence of diseases caused by poverty. These are quite different from cancer, diabetes, and coronary heart disease. And if they aren’t corrected, they lower life expectancy below that in the West.

The differences between the eating habits in China and the US are enormous. The Chinese who do more physical work ate 2'641 cal/day (findings are standardized for a bodyweight of 65 kg or 143.3 pounds) compared with 1'989 cal/day in the United States. In the US, people with a bodyweight of 77 kg (or 169.8 pounds) would eat about 2'400 cal/day. In China, it would be 3'000 cal/day for a bodyweight of 77 kg (or 169.8 pounds).

Blood cholesterol comes from two main sources, the body’s own synthesis to covers its needs and animal-based foods. The blood cholesterol level is usually much lower with a diet that doesn’t include any animal-based foods. Cholesterol is also an excellent early indicator of coronary heart disease.

Cholesterol biosynthesis occurs mainly in the liver, but also in the intestines and skin (by eukaryotes) using simple starting materials.

From "Taschenatlas der Ernährung" (Pocket atlas of nutrition) by Biesalski and Grimm: "A low cholesterol intake, which can only be achieved by a strict diet regimen, lowers the dietary cholesterol portion of the overall cholesterol level quite considerably ... and constitutes ... only 10–15% of the daily cholesterol level. The plasma cholesterol levels and LDL receptors (responsible for the cellular uptake) remain in a steady-state (equilibrium)."

"In fact, a smaller part of the population (about 20–25%) reacts to an exogenous cholesterol supply pathologically." The internal process of cholesterol homeostasis can no longer be maintained.

The average blood cholesterol level in China is 127 mg/dL and in the US, it is 215 mg/dL. In China, there are counties with high levels and others with very low levels. One county had an average of 94 mg/dL, and two groups of young women had levels of only 80 mg/dL. The US has been upholding the myth that levels below 150 mg/dL can lead to health problems!

In the counties in China, there was a strong correlation between cholesterol and disease rates: As blood cholesterol levels decreased from 170 mg/dL to 90 mg/dL, cancers of the liver, rectum, colon, male lung, female lung, breast, childhood leukemia, adult leukemia, childhood brain, adult brain, stomach, and esophagus (throat) decreased.

At the time of our study, the death rate from coronary heart disease was seventeen times higher among American men than rural Chinese men” (p. 78–79).

The three most renowned heart researchers and physicians Bill Castelli, Bill Roberts, and Caldwell Esselstyn Jr. confirmed Dr. Colin Campbell's findings by stating that they had never seen a patient die of heart disease who had had blood cholesterol levels below 150 mg/dL.

See also information on Wikipedia about cholesterol.

Dr. Castelli was the long-time director of the famous Framingham Heart Study of NIH; Dr. Esselstyn was a renowned surgeon at the Cleveland Clinic who did a remarkable study [on] reversing heart disease (chapter five); Dr. Roberts has long been editor of the prestigious medical journal Cardiology (p. 79). (NIH stands for National Institutes of Health.) Castelli's study was a cohort study.

Plant-based foods, in contrast, contain no cholesterol and, in various other ways, help to decrease the amount of cholesterol made by the body. ... In rural China, animal protein intake (for the same individual) averages only 7.1 g/day whereas Americans average a whopping 70 g/day (p. 80).

But even in China, where the protein intake is generally quite low, there are the same differences in areas with higher consumption of animal-based products. However, these levels are still far below Western standards.

On the pages that follow, Dr. Campbell explains the effect that fat has on our health. He describes the history of why we consume too much “bad” fat today. His conclusion: The correlation between fat intake and animal protein intake is more than 90 % (p. 83).

Professor Ken Carroll, who taught at the University of Western Ontario in Canada, showed a very impressive relationship between dietary fat and breast cancer.

He is also known for including immigrants in his studies to prove that cancer incidence cannot be explained by heredity. Sir Richard Doll and Sir Richard Peto of the University of Oxford (UK) concluded that only 2–3% of all cancers could be attributed to genes (p. 85).

There is an article on Ken Carroll (1923–1998) in the JN, The Journal of Nutrition. (He also helped to create the ChinesePod: Chinese Learning for Busy People.)

The average amount of fat consumed in China is 14.5% of the caloric intake but does vary depending on the area from between 6–24%, while the average in the US is at 36%. In contrast to the US, the industry in China is not (yet) tinkering with the fat content of food. In China, fat comes primarily from animal products.

Campbell also looks at menarche in young women and finds it to be between 15 and 19 years of age in China, with an average age of 17. The average age in the US is about 11 years!

He lists out the resulting consequences and concludes that children should consume a diet that is low in animal-based foods, that is dairy and meat products. This is because there are great disadvantages to an early onset of menstruation. The author gives several reasons for this.

Denis Parsons Burkitt, a specialist in tropical medicine at Trinity College in Dublin, published work on the benefits of fiber, for which he received the prestigious Bower Award. However, for almost 200 years, we have known that a low-fiber diet is associated with an increased risk of cancer, primarily breast and “intestinal” cancers.

Many experts claim that too much dietary fiber reduces iron absorption. However, the reverse was actually found in The China Study.

Iron consumption in China is surprisingly high with 34 mg of iron per day as common high-fiber foods such as wheat and corn (but not polished rice) are also high in iron. In the United States, it is 18 mg/day.

He mentions, for example, various carotenoids, of which there are hundreds, such as beta-carotene in pumpkins, lycopene in tomatoes, and cryptoxanthin and ascorbic acid (vitamin C) in oranges. In this context, he lists out diseases that occur in areas with increased consumption of animal products: esophageal cancer, leukemia, and cancer of the nasopharynx, chest, stomach, liver, rectum, colon, and lung.

He also states that increased fruit consumption reduces heart disease, hypertensive heart disease, and strokes—thanks to the high amount of natural vitamin C (p. 94).

In the section titled “The Atkins Crisis,” Campbell critically examines the Atkins diet and makes very good arguments against the diet.

He debunks the “low-carb diet” that has become so popular as follows. According to a report that summarized the government food statistics, Americans consumed 13 pounds more fats and oils per person in 1997 than in 1970. In other words, fat consumption increased from 52.6 to 65.5 pounds.

Because of the enormous increase in the total amount of food intake, the proportion in percent did decrease slightly. The reason for this increase in food intake is that Americans now eat more sugary junk food.

He calls statements in popular diet books either severe ignorance or opportunistic deceit (p. 95). These books are popular because people who eat a low-carb diet and a large portion of meat really do lose weight in the short term. This is not surprising as people on this diet reduce their calorie consumption from an average of 2,250 cal/day to only 1,450 cal/day.

However, the subjects on the Atkins diet complained of many side effects including 68 % who complained of constipation, 63 % of halitosis (bad breath), and 51 % of headaches. In addition, the participants excreted 53 % more calcium in their urine, which is a catastrophe for bone health.

The initial high loss of fluid is also very unhealthy. Australian scientists came to the following conclusion: Complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities can all be linked to long-term restriction of carbohydrates in the diet (p. 97).

Atkins wrote in one passage that many of them [the patients] take over thirty vitamin pills a day.

Campbell concludes the section on Dr. Atkins as follows: 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 (p. 97).

Of course, when it comes to carbohydrates, you have to distinguish between natural fruits, vegetables, and whole grains and highly refined simple and therefore harmful carbohydrates. In industrialized countries, people often primarily consume refined carbohydrates—which is the main problem. And then they eat iceberg lettuce, one of the vegetables with the least amount of nutrients.

The author states that our major sins are junk food containing a lot of fructose, pasta made with refined flour, potato chips, soda, sugary cereals, and low-fat candy bars.

He lists out differences between China and the United States such as Average calorie intake, per kilogram of body weight, was 30 % higher among the least active Chinese than among average Americans. Yet, body weight was 20 % lower (p. 99).

He explains why a genetically determined “faster metabolism” is not the cause, but that this difference is the result of the different diets and greater activity in China. He mentions for example, how Chinese people ride their bikes to work. He is critical of the Chinese government for recommending a diet high in animal protein as a way to increase the body size of the Chinese, despite the fact that they have seen the results of The China Study. The country is welcoming the dairy industry and repeating the same mistakes that the West has made (p. 102).

He often fought against the old theory of examining individual substances, such as the effect of selenium on breast cancer. We should approach this issue holistically.

Everything in food works together to create health or disease. The more we think that a single chemical characterizes a whole food, the more we stray into idiocy (p. 106).

Here is another important statement from the author: Sadly, it’s also ‘normal’ to have heart disease in America. Over the years, standards have been established that are consistent with what we see in the West. We too often have come to the view that US values are ‘normal’ because we have a tendency to believe that the Western experience is likely to be right (p. 107).

Campbell reports that he stopped eating meat 15 years ago, and later cut out almost all animal-based foods and that his blood cholesterol levels have improved although he has gotten older. He is physically fitter now than he was at age 25 and weighs 45 pounds less than he did at age 30—and he is now at an ideal weight for his height. As a child, he drank two quarts (almost 2 liters) of milk daily. He admits that he scoffed at vegetarians early on in his professional career.

And on page 123, he says that almost 2'000 Americans die from this disease each day. This information comes from a publication of the National Heart, Lung, and Blood Institute titled "Morbidity and Mortality: 2002 Chart Book on Cardiovascular, Lung, and Blood Diseases".

As early as 1953, at the end of the Korean War, researchers studied 300 hearts of dead soldiers, who were all about 22 years old. They found that 77.3 % of them had clear signs of heart disease. They had never suffered from or been diagnosed with a heart problem.

The author then explains the relationship between plaque (atherosclerosis) and collaterals, which the body forms to be able to somewhat maintain blood flow. About 15 of the young men’s hearts had a plaque that clogged 90 % of an artery. But that isn’t usually the reason for a heart attack.

It turns out that it’s the less severe accumulations of plaque, blocking under 50% of the artery, that often cause heart attacks (p. 113).

We have our lipid levels tested. The results are listed in mmol/L. Cholesterol (T-Cho) should be <5.0, triglycerides (TG) <2.0, and HDL-cholesterol (HDL-c) >1.0. HDL is short for high density lipoprotein.

For total cholesterol, LDL or HDL, 100 mg/dL correspond to 2.6 mmol/L or vice versa 1 mmol/L would be 39 mg/dL. For triglycerides, the conversion is: 100 mg/dL corresponds to 1.1 mmol/L or 1 mmol/L corresponds to 88 mg/dL.

It has long been known that, for example, men of Japanese ancestry who live in Hawaii or California have much higher blood cholesterol levels than those who live in Japan.

In 1946, Dr. Lester Morrison (Los Angeles) did a study of more than 100 people who had survived a heart attack. Half of them continued to eat their normal diet, and the other half reduced the amount of meat they ate significantly. Eight years later, 24% of the people in the first group were alive. But in the second group, 56% were still alive. After 12 years, every single person in the first group had died, but 38% of the second group was still alive.

A group of doctors in Northern California selected a large number of people with advanced heart disease and put them on a low-fat, low-cholesterol diet. They achieved a mortality rate four times lower than patients who did not participate.

This occurred in spite of successful studies conducted by Dr. Caldwell B. Esselstyn Jr. at the treatment center for heart disease in Cleveland.

He began his study in 1985 with 18 patients who combined had suffered 49 coronary events within the last eight years prior to the study.

These included angina pectoris, bypass surgery, heart attacks (myocardial infarction), strokes, and angioplasty.

In the beginning, their average cholesterol level was 246 mg/dL. Esselstyn saw his patients every 14 days, took blood samples, and did other tests, and also discussed the process.

Soon the patients had an average cholesterol value of only 132 mg/dL. The LDL-cholesterol decreased dramatically.

In the following eleven years, there was exactly ONE coronary event among the eighteen patients who followed the diet. That one event was from a patient who strayed from the diet for two years. After straying, the patient consequently experienced clinical chest pain (angina) and then resumed a healthy plant-based diet. The patient eliminated his angina and has not experienced any further event (p. 127).

Seventy percent of Esselstyn’s patients experienced an opening of their previously clogged arteries. Campbell includes images (angiography) of a patient’s coronary artery with arterial stenosis (narrowing) from before and after the diet program. These images show very clear differences (p. 128).

By 2003, all except one of the 18 patients were still alive, and after these 17 years had gone by, they were now all heading into their seventies and eighties.

Dr. Dean Ornish, a graduate of Harvard Medical School, had similar experiences. He treated 28 patients as part of his Lifestyle Heart Study, with solely a change in diet that excluded animal-based products except for one egg white and a cup of low-fat milk or yogurt a day, plus one hour of stress management daily and three hours of physical activity a week.

After one year, this group had a cholesterol level of 172 instead of the initial 227 mg/dL, and the LDL cholesterol level had dropped from 152 to 95 mg/dL.

The frequency, duration, and severity of their chest pain (angina pectoris) had also decreased sharply. Not everyone stuck to the diet program strictly, but the best participants decreased their arterial blockages by more than 4 %, while the group treated with conventional medicine had an increase of 8 % in the blockages in their arteries within the same time period.

As of 1998, almost 200 people had taken part in the Lifestyle Project, and the results are phenomenal. After one year of treatment, 65 % of patients had eliminated their chest pain. The effect was long-lasting, as well. After three years, over 60 % of the patients continued reporting no chest pain (p. 131).

He cites studies showing that vegetarians and vegans weigh on average 5 to 30 pounds (2.3 to 13.6 kg) less.

An independent intervention study encouraged obese participants to eat as much food that was low-fat, whole-food, and plant-based as they liked. These people lost an average of 16 pounds (7.7 kg) within three weeks.

At the Pritikin Center, 4'500 patients achieved similar results. They lost 5.5 % of their body weight (p. 139).

Another long-term study resulted in an average weight loss of 24 pounds (11 kg) after one year. But these reductions will not occur if a large percentage of your diet consists of sweets, pasta, baked goods, and the like.

The author explains differences between type 1 diabetes, when the body no longer produces the proper amount of "I.", and type 2, when there is enough peptide hormone "I" but the cells no longer respond appropriately to it. This is called "insulinresistance". In the US, diabetes costs come to $130 billion a year.

He goes on to describe the complications that arise because of diabetes such as heart disease with two to four times the risk of death, strokes, high blood pressure, blindness, kidney diseases, nervous system disorders, and increased susceptibility to other diseases. Seventy percent of people with diabetes also have high blood pressure.

He next looks at a study conducted by physician Dr. James Anderson. In this study, he used only dietary means to treat 25 type 1 diabetics and 25 type 2 diabetics who had to take "insulinshots". After just three weeks, the Type 1 diabetic patients were able to lower their "insulinmedication" by an average of 40 % (p. 152). And their cholesterol levels also decreased by 30 %.

This included a man who had suffered from this disease for 21 years and previously was taking 35 units of "I." daily. The Pritikin Center achieved similar results: Of forty patients on medication at the start of the program, thirty-four were able to discontinue all medication after only twenty-six days (p. 152).

A later study examined groups with elevated blood sugar levels, which is a precursor to diabetes. One group received a dimethylbiguanid which is a first-line medication plus diet guidelines, and the other group only participated in intensive lifestyle counseling that included an exercise program.

After three years, the group with the drug had 31 % fewer cases of diabetes than the placebo group. Both groups followed the same standard dietary guidelines.

However, the lifestyle group had an astounding 58 % fewer cases of diabetes. In addition, this group also benefited in terms of improving other health problems.

Even just a moderate change in diet brings greater benefits: Using diet as an effective treatment of already-diagnosed disease has been well documented in human studies with advanced heart disease, clinically documented Type 2 diabetes (see chapter seven), advanced melanoma (a deadly skin cancer) and, in experimental animal studies, liver cancer (p. 165).

Our body can transform and excrete environmental toxins such as PAHs (polycyclic aromatic hydrocarbons), but this is very much controlled by what we eat (p. 166). The right kinds of food prevent the PAHs from binding to our DNA and causing damage.

The author describes the various correlations with respect to breast cancer risk and also addresses the subject of hormone replacement therapy (HRT). He believes that it does more damage than good. He explains five reasons for this.

Thirty years ago, a comprehensive study was conducted in 32 countries (Ferlay J, Bray F, Pisani P, et al.) that showed a major link between colon cancer and meat consumption.

Denis Parsons Burkitt also believes that consuming enough dietary fiber is also essential for general digestive health. And fiber is only found in plant-based foods (p. 170)—and much less in processed foods made from plants.

We read about different study results including those of the EPIC study, which is based on data from over 519'000 people from Europe, and a study of white South Africans (European Prospective Investigation into Cancer and Nutrition). The best results are achieved from leafy and fruit-like vegetables, less so from root vegetables. Animal-based foods definitely have the most unfavorable effect.

Amazing for Wikipedia

"Participants with a high BMI died more frequently from cancer or cardiovascular disease than participants with a moderate BMI. Participants with a low BMI, however, died more frequently from diseases of the respiratory system."

"In March 2013, Rohrman et al. published an analysis of the EPIC data (full text) that examined the relationship between the consumption of red meat, processed meat, and poultry and the risk of premature death. The researchers analyzed data from a total of 448'568 men and women who were not suffering from cancer at the beginning of the study and also had not had a stroke or heart attack. Information on each participant was recorded, including how much they ate, how much they exercised, whether they smoked, and what their body mass index was. At the beginning of the study, all participants were between 35 and 69 years old. They came from ten European countries and on average were part of the study for 12.7 years. A total of 26,344 participants died during this period. The analysis showed that the consumption of processed meat (e.g., sausage) had a significant statistical correlation with a higher mortality rate. The participants who consumed more than 160 grams of processed meat daily had a 44 percent higher risk of dying during the study period than those who consumed only about 20 grams per day." (Wikipedia, German version).

"The maxim of ‘fruit and vegetables 5 times a day’ (5 A Day), which was recommended years ago, is based on desirable health policy assumptions, but lacked a scientific basis."

Professor Campbell had a similar suggestion—if meat consumption was at the same time more than 10 % of the protein in one’s diet.

And other factors did enter into the study.

Calcium was demonstrated to inhibit the "growing" of critical cells in the colon and bind intestinal bile acid.

This is a statement that the dairy industry likes to use to justify its claim that it is necessary to drink milk. The truth is: "The parts of the world that consume the most calcium, that is Europe and North America, have the highest rates of colorectal cancer” (p. 175). Physical exercise is also effective in providing protection against colon cancer.

A 2001 Harvard review of the research could hardly be more convincing (p.186).

In these studies, men with the highest consumption of dairy products had up to a fourfold increased risk for metastatic or fatal prostate cancer in comparison to those who had low consumption of dairy products.

Let’s consider that again: dairy intake is ‘one of the most consistent dietary predictors for prostate cancer in the published literature'. (p. 178).

Campbell believes the reason to be mainly the "Insulinlike Growing Factor" 1 (IGF-1). Under unhealthy conditions, it directly increases the division rate and enlargement of new cells. He references seven studies that have demonstrated this.

High IGF-1 levels and low blood levels of a particular protein cause men to have 9.5 times the risk of advanced-stage prostate cancer (p. 179).

According to various studies, the human body produces more IGF-1 when we eat more animal-based foods such as meat and dairy products.

Animal protein and calcium contained in cow’s milk also block the formation of vitamin D in the body.

Concerning type 1 diabetes Campbell writes: What most people don’t know, though, is that there is strong evidence that this disease is linked to diet and, more specifically, to dairy products. The ability of cow’s milk protein to initiate Type 1 diabetes is well documented. Here, he cites three reports (p. 187).

He then explains in eight steps what can happen when a baby isn’t nursed long enough and is instead fed cow’s milk proteins (such as in infant formula) and quotes from one of the reports: cow’s milk may cause one of the most devastating diseases that can befall a child (p. 187).

A 1992 study demonstrated how incompletely digested cow’s milk protein called bovine serum albumin (BSA) can bring the antibody levels above 3.55 if type 1 diabetes is present—all other children had values below that.

Campbell explains why genes don’t work in isolation but instead need a trigger to produce effects. Other researchers came to the same conclusions after observing identical twins.

Cow’s milk consumption by children zero to fourteen years of age in twelve countries shows an almost perfect correlation with Type 1 diabetes. The greater the consumption of cow’s milk, the greater the prevalence of Type 1 diabetes. In Finland, Type 1 diabetes is thirty-six times more common than in Japan (p. 190).

Two well-known studies conducted in Finland that began in the late 1980s and mid-1990s prove this point. One of them even shows that cow’s milk consumption increases the risk of Type 1 diabetes five- to sixfold. The second study shows that milk increases the development of at least three other antibodies in addition to the ones previously discussed in the book.

The author lists numerous proofs and examples that clearly show the significant connection established between the consumption of milk and dairy products and various diseases. But he knows that the industry will make sure that these findings don’t find their way into doctors’ offices. That would put the existence of the industry at risk. The huge budget for PR, marketing, and direct manipulation facilitates the industry’s endeavors.

Meanwhile, the incidence of type 1 diabetes increases by 3 % each year (p. 191).

The very powerful tobacco-industry used controversies for decades to make sure that the harmfulness of cigarettes wasn’t discovered, and today, the dairy industry is doing much the same thing and having just as much success.

It learned from war how to completely obscure a hazard. An umpteen number of studies exist that are designed to obtain different results. And with the media’s marketing power, these results can also be easily spread.

In contrast, reliable scientific studies rarely make their way into politics or to the consumer. How could they?

Next, we read about multiple sclerosis (MS). The author explains the effects of the disease and that MS is 100 times more frequent in the northern climates than at the equator.

Dr. Roy Swank, who conducted research in Norway and then at the Montreal Neurological Institute, was the first well-known researcher to study the effect of diet on the progression of MS.

Dr. Swank conducted a trial on 144 MS patients and kept records on them for the next thirty-four years.

He summarized his work in 1990, concluding that for the sub-group of patients who began the low-saturated fat diet during the earlier stages of their disease, ‘about 95 % ... remained only mildly disabled for approximately thirty years.’ Only 5 % of these patients died. In contrast, 80 % of the patients with early-stage MS who consumed the ‘poor’ diet (higher saturated fat) died of MS (pp. 195 and 196).

Success stories like these about people’s experiences eating a diet with as little animal protein as possible do not usually appear on Wikipedia. The results are probably better than with drugs, but people don’t have to buy any products to get these results and therefore don’t have a lobby.

© Public Domain, Vhancer, Wikipedia

In recent years, numerous studies have confirmed Dr. Swank’s results. If this were a medication, the company producing it would now be making billions in sales, says Campbell. James Anderson, mentioned above, also practiced diet therapy successfully.

Researchers believe there is much less incidence of MS in the far northern coastal areas, where there is a high level of fish consumption, because of the consumption of omega-3 fatty acids. The people in those areas also consume far fewer dairy products, which, however, is not mentioned.

Websites to help people with MS do not address the fact that dairy products are the biggest problem for MS patients. ...

An example of how the dairy industry manipulates the information available is the following entry on the German Wikipedia site from February 2014:

Adequate calcium intake (about 1 g/day) contributes significantly to prevention (basic therapy, DVO—Dachverband Osteologie e.V., [German umbrella organization for osteology]). One gram of calcium is contained in one liter of milk or 100 g of hard cheese. In addition to dairy products (in this case, milk and yogurt in particular), green vegetables such as kale and broccoli are especially good calcium suppliers. People who do not drink milk or eat cheese should take 800 mg of calcium in tablet form daily.

This is typical for German Wikipedia and does not appear in the English version, where they advise against taking tablets.

“As of 2013, there is insufficient evidence to determine if supplementation with calcium and vitamin D results in greater harm or benefit in men and premenopausal women.

Low dose supplementation (less than 1 g of calcium and 400 IU of vitamin D) is not recommended in postmenopausal women as there does not appear to be a difference in fracture risk. It is unknown what effect higher doses have. There however may be some benefit for the frail elderly living in nursing homes.

While vitamin D supplementation alone does not prevent fractures, combined with calcium it might. There is, however, an increased risk of myocardial infarctions and kidney stones. Vitamin K supplementation may reduce the risk of fractures in postmenopausal women; however, there is no evidence for men.”

This can lead to calcium excretion in the urine. The author gives summaries of studies conducted in 1974, 1981, and 1990.

This was shown in a study conducted by the Atkins Center.

On page 207, the author provides an impressive graph that shows the relationship between the intake of animal-based protein versus plant-based protein and hip fractures in different countries. Hip fracture incidence increases from virtually zero to 200 per 100'000 persons a year. See also alkaline diet.

Campbell goes over the work conducted by Harvard professor Mark Hegsted and explains the body’s mechanisms that regulate calcium and "calcitriolum" and how this ability becomes impaired if high levels of calcium are consumed over a long period of time.

This is virtually a guarantee for osteoporosis, and yet doctors still recommend that their patients consume more milk. In addition, milk has a relatively high level of phosphorus, which also negatively affects the body.

The author states that there are some devilishly contradictory and confusing details in this great circus of osteoporosis research, and lists out six facts related to the topic. Ultimately, though, these studies show that a much better, predictor of osteoporosis is the dietary ratio of animal-to-plant protein (p. 210).

Animal-based products are also a burden on the kidneys. Professor W.G. Robertson from the Medical Research Council in Leeds is one of the world’s foremost experts on diet and kidney stones, and a research group of his has investigated the relationship between food and kidney stones more closely.

The most impressive graph from his research can be found on page 213. Two other graphs show the effect animal protein has on calcium and oxalate in the urine.

Note from Wikipedia: “Since oxalic acid and its salts bind with calcium (needed for bone structure) to form insoluble salts, the body can eliminate it only very slowly. We should therefore consume oxalic acid and its salts only in small doses. Oxalic acid is also present in chocolate, nuts, cocoa powder, spinach, and rhubarb.”

Cataract surgery, in particular, is common for people age 70 and up. It’s a fairly simple procedure today, but macular degeneration is incurable and progressively and slowly leads to blindness. It begins with a yellow spot at the site of the retina, where the eye sees best—and continues with a gradual loss of function.

Five eye care centers worked together with 356 people between the ages of 55 and 80 to study advanced macular degeneration. The study showed that:

five out of six plant-based foods measured also were associated with lower rates of macular degeneration (broccoli, carrots, spinach or collard greens, winter squash and sweet potato). Spinach or kale conferred the most protection (p. 215).

Study participants who consumed a lot of carotenoids with these foods had 43 % less disease than the group with a low intake of plant-based foods.

There was 88 % less disease for people who ate these greens five or more times per week when compared with people who consumed these greens less than once per month. The only food group not showing a preventive effect was the cabbage/cauliflower/brussels sprout group, which sports the least color of the six food groups (p. 215).

In a review of the five carotenoids in food, those from dark green leafy vegetables showed the highest protective effects. In contrast, supplements of a few vitamins, including retinol (preformed ‘vitamin’ A), vitamin C, and vitamin E showed little or no beneficial effects (p. 216).

The second study compared 421 patients suffering from macular degeneration with 615 people that did not have the disease. The researchers measured the levels of antioxidants in the blood instead of the levels of antioxidants consumed and came to similar conclusions.

The reduction was about 65–70%. In this case, as well, carotenoids had statistically significant results while selenium and specific vitamins did not.

People who consumed more dark green leafy vegetables also had 40 % fewer cataracts. This is based on a study of 1'300 people conducted from 1988 to 1998. The researchers found that the people who consumed more lutein had a lower rate of cataracts. And this makes sense since lutein is a major component of the lens tissue in the eye. The carotenoid zeaxanthin is also a key factor.

The German Wikipedia entry discusses genetic predisposition but also describes the following: "There are also food-related risk factors such as cholesterol level. When there is a lack of cholesterol, amyloid-beta peptides do not form in vitro. This may have to do with the fact that Aβ (amyloid-beta) production occurs exclusively in lipid rafts of the cell membrane, and that these structures contain high levels of cholesterol."

"However, there also seem to be other risk factors involved. Several drugs (medications) increase Aβ42 production to dangerous levels in vitro and in a mouse model. Specific inhibitors of cyclooxygenase 2 and certain isoprenoids are suspect."

Campbell continues: Alzheimer’s is surprisingly common. It is said that 1% of people at age sixty-five have evidence of Alzheimer’s, a figure that doubles every five years thereafter (p. 218).

People with cognitive impairments have a tenfold risk for Alzheimer’s—but also develop more cardiovascular diseases, strokes, and type 2 diabetes.

Hypertension (high blood pressure) and elevated blood cholesterol levels are considered risk factors. Both are influenced by diet, as is the third factor, free radicals.

The author stresses the negative effects of the low-carb Atkins diet and its successor the South Beach Diet, which was developed by Dr. Arthur Agatston. When Campbell was at a restaurant one day, he saw Pasta Primavera, a huge portion of noodles with vegetables, listed as a “low-carb dish” on the menu. This dish consists almost entirely of carbohydrates “of the bad kind” and just a few of “the good kind” from the vegetables.

The fact that chefs can’t even distinguish between low-carb and high-carb dishes shows just how great the confusion must be.

The South Beach Diet is actually the regular American diet, which is successfully being sold as a healthy option, but which in fact is a toxic diet that has been shown to make us fat, give us heart disease, destroy our kidneys, make us blind and leads us to Alzheimer’s, cancer and a host of other medical problems (p. 224).