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"Everyone in the field of nutrition science stands on the shoulders
of Dr
...
This is one
of the most important books about nutrition ever written reading it may save your life
...
COLIN CAMPBELL, PHD
AND THOMAS M
...
But it is much more; Dr
...
Every health care
provider and researcher in the world must read it
...
D
...
',

t

"Backed by well-documented, peer-reviewed studies and overwhelming
statistics the case for a vegetarian diet as a foundation for a healthy lifestyle has never been stronger
...
com

"The China Study is the most important book on nutrition and health to
come out in the last seventy-five years
...
The science is conclusive
...
Campbells integrity and commitment to truthful nutrition education
shine through
...
Dr
...
"
-FRANK RHODES, PH
...

President (1978-1995) Emeritus, Cornell University

"Colin Campbell's The China Study is an important book, and a highly
readable one
...
The China Study is a
story that needs to be heard
...
RICHARDSON , PH
...

Nobel Prize Winner, Professor of Physics
and Vice Provost of Research, Cornell University

"The China Study is the account of a ground-breaking research study that
provides the answers long sought by physicians, scientists and healthconscious readers
...
Clearly and beautifully written by one of the world's most
respected nutrition authorities, The China Study represents a major turning point in our understanding of health
...
D
...

Colin Campbell, who is one of the giants in the field
...
"
-DEAN ORNISH, M
...
, Founder &: President
Preventive Medicine Research Institute Clinical Professor of Medicine,
University of California, San Francisco
Author, Dr
...
It is the
book of choice both for economically developed countries and for countries undergOing rapid economical transition and lifestyle change
...
D
...
D
...
Campbell's The China Study
...
Campbell's book The China Study is a moving and insightful history of the struggle-still ongoing-to understand and explain the vital
connection between our health and what we eat
...
Campbell knows
this subject from the inside: he has pioneered the investigation of the

diet-cancer link since the days of the seminal China Study, the NAS
report, Diet, Nutrition and Cancer and AICR's expert panel report, Food,
Nutrition and the Prevention of Cancer: A Global Perspective
...
Today, AICR
advocates a predominantly plant-based diet for lower cancer risk because
of the great work Dr
...
"
-MARILYN GENTRY, President
American Institute for Cancer Research

"The China Study is a well-documented analysis of the fallacies of the
modern diet, lifestyle and medicine and the qUick fix approach that often
fails
...
"
-SUSHMA PALMER, PH
...
, Former Executive Director
Food and Nutrition Board, u
...
National Academy of Sciences

"The China Study is extraordinarily helpful, superbly written and profoundly important
...
Campbell's work is revolutionary in its implications and spectacular in its clarity I learned an immense amount from
this brave and wise book
...
But if
you want to truly take charge of your health, read The China Study and do
it soon! If you heed the counsel of this outstanding gUide, your body will
thank you every day for the rest of your life
...
Finally, a world-renowned nutritional
scholar has explained the truth about diet and health in a way that everyone can easily understand-a startling truth that everyone needs to
know
...
Campbell has distilled, with his son
Tom, for us the wisdom of his brilliant career
...
Don't miss it!"
-DOUGLAS)
...
D
...
C
...
Dr
...
As a distinguished professor at Cornell University,
Dr
...
The China Study is based on
hardcore scientific research, not the rank speculation of a Zone, Atkins,
5ugarBusters or any other current fad
...
Campbell lays out his lifetime
of research in an accessible, entertaining way
...
"
-JEFF NELSON, President
VegSource
...
Finally, scientifically valid guidance on
how much protein we need and where we should get it
...
"
-JOHN ALLEN MOLLENHAUER, Founder
MyTrainer
...
com

The China Study


...
_
...
_
...
_
...
- _
...


...
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__jilll____t__y
u_
_
The Most Comprehensive Study
of Nutrition Ever Conducted
and the Startling Implications
for Diet, Weight Loss
and Long-term Health

T
...
D
...
Campbell II

BENBELLA BOOKS

Dallas, Texas

Nothing written in this book should be viewed as a substitute for competent medical
care
...

Copyright © 2006 by T
...
D
...
Campbell II
First BenBella Books Paperback Edition 2006
All rights reserved
...


Ben Bella Books, Inc
...
Central Expressway
Suite 503
Dallas, TX 75206
Send feedback

to

feedback@benbellabooks
...
Colin, 1934The China study: the most comprehensive study of nutrition ever
conducted and the startling implications for diet, weight loss, and
long-term health / by T
...
Campbell II
...
cm
...
Nutrition
...
Nutritionally induced diseases
...
Diet in disease
...
Campbell, Thomas M
...
Title
...
C2352004
6 13
...

Distributed by Independent Publishers Group
To order call (800) 888-4741
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Foe special sales contact Robyn White at robyn@benbellabooks
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And to Thomas McIlwain Campbell and
Betty DeMott Campbell for their incredible gifts
...
But it was the last three that gave the book form
...
I wanted to do it, but she wanted it even more
...
She cajoled, she pushed and she insisted that we
keep our nose to the grindstone
...

Most importantly, Karen first suggested that I work with Tom, the youngest
of our five children
...
He wrote several chapters in this book himself and rewrote
many more, bringing clarity to my message
...
Their love and support cannot be measured in mere
words
...
Regretfully, I could only cite in this book a
small sample of their findings , but far, far more could have been included
...
Alphabetically, they included Nelson Campbell, Ron Campbell, Kent Carroll, Antonia Demas, Mark Epstein, John and Martha Ferger, Kimberly Kathan,
Doug Lisle, John Robbins, Paul Sontrop and Glenn Yeffeth
...

Of course, I am grateful to all those at BenBella Books, including Glenn Yeffeth, Shanna Caughey, Meghan Kuckelman, Laura Watkins and Leah Wilson
for turning a messy Word document into the book you now have
...

The heart of this book is the China Study itself
...
The
actual study in China could not have happened without the extraordinary leadership and dedicated hard work of Junshi Chen and Li Junyao in Beijing, Sir
Richard Peto and Jillian Boreham at the University of Oxford in England, and
Linda Youngman, Martin Root and Banoo Parpia in my own group at Cornell
...
Chen directed more than 200 professional workers as they carried out the
nationwide study in China
...

Similarly, Drs
...
, and John McDougall (and Ann and
Mary, respectively) generously agreed to participate in this book
...

All of this was possible, of course, because of the exceptional start given to
me by my parents, Tom and Betty Campbell, to whom this book is dedicated
...

I must also credit my colleagues who have worked to discredit my ideas and,
not infrequently, me personally
...
They compel
me to ask why there is so much unnecessary hostility to ideas that should be
part of the scientific debate
...

Lastly, I must thank you, the taxpaying American public
...

- T
...
My involvement in this book was, and still is, a gift from them I shall cherish for the
rest of my life
...

Also, Kimberly Kathan provided support, advice, companionship and passion for this project
...

-Thomas M
...

2
...

4
...

6
...

8
...
Autoimmune Diseases
10
...
Eating Right: Eight Principles of Food and Health
12
...

14
...

16
...

18
...
Q&A: Protein Effect in Experimental Rat Studies
Appendix B
...
The "Vitamin" D Connection
References

351
353
361
369

Preface
T
...


When we spend time together we inevitably share our stories from the
farm
...

But from these backgrounds, both he and I went on to other careers
...

He was involved in the discovery of a chemical later called dioxin, and
he went on to direct one of the most important diet and health studies
ever conducted, the China Study
...
As a scientist, he has played an instrumental role in how our
country views diet and health
...
I have come to respect him for his courage and integrity
...
I know
this well because I have been a co-defendant with Oprah Winfrey when
a group of cattlemen decided to sue her after she stated her intention
not to eat beef
...
C
...
I have taken on some of the most influential, wellfunded groups in the country and I know that it's not easy
...
We
started on the farm , learning independence, honesty and integrity in
small communities, and went on to become established in mainstream
careers
...
Challenging the system that provided us with such rewards has
demanded an iron will and steadfast integrity
...
We would do
well to learn from Colin, who has reached the top of his profession and
then had the courage to reach even higher by demanding change
...

Read it carefully, absorb its information and apply it to your life
...
You are barraged by ads for junk foods
...
It's easier to find a Snickers bar, a Big
Mac or a Coke than it is to find an apple
...

You go to your doctor for health tips
...
Published by the American Academy of Family
Physicians and sent free to the offices of allSO,OOO family doctors in the
United States in 2004, it's full of glossy full-page color ads for McDonald's, Dr Pepper, chocolate pudding and Oreo cookies
...
The pages, however, are
filled with ads for Twinkies, M&Ms, Frosted Flakes, Froot Loops, Hostess Cup Cakes and XtremeJell-O Pudding Sticks
...
It is the environment in which most of us live today
...
They want you to keep
eating the foods they sell, even though doing so makes you fat, depletes
your vitality and shortens and degrades your life
...
They do not want you informed, active and
passionately alive, and they are quite willing to spend billions of dollars
annually to accomplish their goals
...
If you want to live with radiant health, lean and
clear and alive in your body; you'll need an ally in today's environment
...
T
...
D
...
Having had the pleasure and
privilege to be his friend, I can attest to all of that, and I can also add
something else
...

Dr
...

One of the many things I appreciate about this book is that Dr
...
He doesn't preach from on high, telling what you should and shouldn't eat, as if you were a child
...
He empowers you to make
informed choices
...
But he always shows you how he has arrived at his conclusions
...
His only agenda is
to help you live as informed and healthy a life as possible
...
This is a brave and wise book
...
Dr
...

If you want to eat bacon and eggs for breakfast and then take cholesterol-lowering medication, that's your right
...

-John Robbins, author of Diet for a New America, Reclaiming Our
Health and The Food Revolution

Introduction
THE PUBLIC'S H NGER for nutrition information never ceases to amaze me,
U
even after devoting my entire working life to conducting experimental
research into nutrition and health
...

Almost every popular magazine features nutrition advice, newspapers
regularly run articles and TV and radio programs constantly discuss
diet and health
...
If this is the case, then you aren't alone
...

This isn't because the research hasn't been done
...
We know an
enormous amount about the links between nutrition and health
...


2

THE CHINA STUDY

I want to change that
...

I have been "in the system" for almost fifty years, at the very highest
levels, designing and directing large research projects, deciding which
research gets funded and translating massive amounts of scientific research into national expert panel reports
...
As a taxpayer who foots the bill for research and health policy in America, you deserve to know that many of
the common notions you have been told about food, health and disease
are wrong:
• Synthetic chemicals in the environment and in your food, as problematic as they may be, are not the main cause of cancer
...

• The hope that genetic research will eventually lead to drug cures
for diseases ignores more powerful solutions that can be employed
today
...

• Vitamins and nutrient supplements do not give you long-term protection against disease
...

• Your doctor probably does not know what you need to do to be the
healthiest you can be
...
The provocative results of my four decades of biomedical
research, including the findings from a twenty-seven-year laboratory
program (funded by the most reputable funding agencies) prove that
eating right can save your life
...
There are over 750 references in this
book, and the vast majority of them are primary sources of information,
including hundreds of scientific publications from other researchers

INTRODUCTION

3

that point the way to less cancer, less heart disease, fewer strokes, less
obesity, less diabetes, less autoimmune disease, less osteoporosis, less
Alzheimer's, less kidney stones and less blindness
...

• Heart disease can be reversed with diet alone
...

• Consuming dairy foods can increase the risk of prostate cancer
...

• Kidney stones can be prevented by a healthy diet
...

These findings demonstrate that a good diet is the most powerful
weapon we have against disease and sickness
...
We must know why
misinformation dominates our society and why we are grossly mistaken
in how we investigate diet and disease, how we promote health and how
we treat illness
...
We spend far
more, per capita, on health care than any other society in the world, and
yet two thirds of Americans are overweight, and over 15 million Americans have diabetes, a number that has been rising rapidly
...
Half of Americans
have a health problem that requires taking a prescription drug every
week, and over 100 million Americans have high cholesterol
...
One third of the young people in
this country are overweight or at risk of becoming overweight
...

These issues all come down to three things: breakfast, lunch and dinner
...
For years
I never gave much thought to which foods were best to eat
...
We all eat what is tasty or
what is convenient or what our parents taught us to prefer
...

So it was with me
...
We were told in school that cow's milk made
strong, healthy bones and teeth
...
On
our farm, we produced most of our own food in the garden or in the
livestock pastures
...
I studied pre-veterinary
medicine at Penn State and then attended veterinary school at the University of Georgia for a year when Cornell University beckoned with
scholarship money for me to do graduate research in "animal nutrition
...
There I did a master's degree
...
My Ph
...
research at Cornell was devoted to finding better ways to make cows and sheep grow faster
...
"
I was on a trail to promote better health by advocating the consumption of more meat, milk and eggs
...
Through these formative years, I encountered a
recurring theme: we were supposedly eating the right foods, especially
plenty of high-quality animal protein
...
I initially worked
at MIT, where I was assigned a chicken feed puzzle
...
After two and one-half years, I helped discover dioxin,
arguably the most toxic chemical ever found
...


INTRODUCTION

5

After leaving MIT and taking a faculty position at Virginia Tech, I
began coordinating technical assistance for a nationwide project in the
Philippines working with malnourished children
...
It was thought that
high consumption of aflatoxin, a mold toxin found in peanuts and corn,
caused this problem
...

For ten years our primary goal in the Philippines was to improve
childhood malnutrition among the poor, a project funded by the U
...

Agency for International Development
...

The aim of these efforts in the Philippines was simple: make sure that
children were getting as much protein as possible
...
Universities and
governments around the world were working to alleviate a perceived
"protein gap" in the developing world
...
Children who ate
the highest-protein diets were the ones most likely to get liver cancer! They
were the children of the wealthiest families
...
Indian researchers had studied two groups
of rats
...
In the other group, they administered
the same amount of aflatoxin, but then fed a diet that was only composed of 5% protein
...
It was a 100 to 0
score, leaving no doubt that nutrition trumped chemical carcinogens,
even very potent carcinogens, in controlling cancer
...
It was
heretical to say that protein wasn't healthy, let alone say it promoted
cancer
...
Investigating such a
provocative question so early in my career was not a very wise choice
...
"
But I never was much for following directions just for the sake of

6

THE CHINA STUDY

following directions
...
It had
to be
...
It was a great classroom, as any farm boy can tell you
...

So, faced with a difficult decision, I decided to start an in-depth laboratory program that would investigate the role of nutrition, especially protein, in the development of cancer
...
I chose to do this research at a very basic science level, studying the biochemical details of cancer formation
...
It was the best of all worlds
...
Eventually, this
research became handsomely funded for twenty-seven years by the bestreviewed and most competitive funding sources (mostly the National Institutes of Health (NIH), the American Cancer SOciety and the American
Institute for Cancer Research)
...

What we found was shocking
...
After cancer initiation was completed, low-protein diets also dramatically blocked subsequent cancer
growth
...
In
fact, dietary protein proved to be so powerful in its effect that we could tum
on and tum off cancer growth simply by changing the level consumed
...
We didn't use extraordinary levels, as is so
often the case in carcinogen studies
...
We found that not all proteins had this effect
...
What type of protein did not promote cancer, even at high levels of intake? The safe proteins were from plants, including wheat and
soy
...


INTRODUCTION

7

These experimental animal studies didn't end there
...
It was a massive undertaking jointly arranged through Cornell University, Oxford
University and the Chinese Academy of Preventive Medicine
...
" This project
surveyed a vast range of diseases and diet and lifestyle factors in rural
China and, more recently, in Taiwan
...
Even relatively small intakes of animal-based
food were associated with adverse effects
...
These results could not be ignored
...
The health
implications of consuming either animal or plant-based nutrients were
remarkably different
...
I sought out the findings of other researchers and clinicians
...

These findings-the contents of Part II of this book-show that heart
disease, diabetes and obesity can be reversed by a healthy diet
...
Most importantly, the diet that has time and again been shown to reverse and/or
prevent these diseases is the same whole foods, plant-based diet that I
had found to promote optimal health in my laboratory research and in
the China Study
...

Yet, despite the power of this information, despite the hope it generates and despite the urgent need for this understanding of nutrition and
health, people are still confused
...
I've talked with women who are so
terrified of breast cancer that they wish to have their own breasts, even
their daughters' breasts, surgically removed, as if that's the only way to
minimize risk
...

Americans are confused, and I will tell you why The answer, discussed in Part IV, has to do with how health information is generated
and communicated and who controls such activities
...
The distinctions between government, industry, science and medicine have become blurred
...
The
problems with the system do not come in the form of Hollywood-style
corruption
...
The result is massive amounts of miSinformation, for which
average American consumers pay twice
...

This story, starting from my personal background and culminating
in a new understanding of nutrition and health, is the subject of this
book
...
It was the first such course
on an American university campus and has been far more successful
than I could have imagined
...
After spending my time at MIT and Virginia Tech, then
coming back to Cornell thirty years ago, I was charged with the task
of integrating the concepts and principles of chemistry, biochemistry,
physiology and toxicology in an upper-level course in nutrition
...
That's what I intend
to do for you; I hope your life will be changed as well
...

_____ [t_
~a
I__

-

THE CHINA STUDY


...
_
...
_
...
_ _ ___~_ _
...
____ _
...
_
...
__
_
...
_
...
___ _
...
_

...
C
...
There was no growl from cars driving by or airplanes burning
trails overhead
...
There were the songbirds, of course, and the
cows, and the roosters who would chime in once in a while, but these
noises merely filled out the quiet, the peace
...
I had just finished a big country breakfast of eggs, bacon, sausage, fried potatoes and ham with a couple of glasses of whole
milk
...
I had been working up my
appetite since 4:30 A
...
, when I had gotten up to milk the cows with my
father Tom and my brother Jack
...
He opened
a fifty-pound sack of alfalfa seed, dumped all the tiny seeds on the

11

12

THE CHINA STUDY

wooden barn floor in front of us and then opened a box containing fine
black powder
...
They would attach themselves to the seeds and become
part of the roots of the growing plant throughout its life
...
The protein, he explained, was good for the cows that would
eventually eat it
...
Always curious, 1 asked my dad why
it worked and how
...

This was important knowledge for a farm boy
...
He
was sixty-one
...

1 was devastated
...

Now, after decades of doing experimental research on diet and health,
1 know that the very disease that killed my father, heart disease, can be
prevented, even reversed
...
1
have learned that it can be achieved simply by eating the right food
...
1 have spent my
career in research and teaching unraveling the complex mystery of why
health eludes some and embraces others, and 1 now know that food
primarily determines the outcome
...
Our health care system costs too much, it excludes far
too many people and it does not promote health and prevent disease
...


SICKNESS, ANYONE?
If you are male in this country, the American Cancer Society says that
you have a 47% chance of getting cancer
...
1 The rates at which we die from cancer are among the
highest in the world, and it has been getting worse (Chart 1
...
Despite
thirty years of the maSSively funded War on Cancer, we have made little
progress
...
Adopting

13

PROBLEMS WE FACE, SOLUTIONS WE NEED
CHART 1
...
Old age can and should be graceful and peaceful
...
Looking elsewhere, we see that there is an overall pattern of
poor health
...
Overweight Americans now significantly outnumber those
who maintain a healthy weight
...
2, our rates of
obesity have been skyrocketing over the past several decades
...
2: PERCENT OBESE POPULATION2

35
30
25
20
15
10
5
0
1976-1980

1988-1994

1999-2000

14

THE CHINA STUDY

person above and beyond a healthy weight
...
3
CHART 1
...
Diabetes has also increased in unprecedented proportions
...
If we don't heed the importance of diet,
millions of additional Americans will unknowingly develop diabetes
and suffer its consequences, including blindness, limb amputation,
cardiovascular disease, kidney disease and premature death
...
We eat out more than ever 4 and speed
has taken precedence over quality
...

Both diabetes and obesity are merely symptoms of poor health in general
...
Two of the most frightening statistics show that diabetes among
people in their thirties has increased 70% in less than ten years and the
percentage of obese people has nearly doubled in the past thirty years
...
It may become an unbearable burden on a health
system that is already strained in countless ways
...
It is heart disease
...
According to the American Heart Association, over 60
million Americans currently suffer from some form of cardiovascular
disease, including high blood pressure, stroke and heart disease
...

But since my own father died from a heart attack over thirty years ago,
a great amount of knowledge has been uncovered in understanding this
disease
...
9 , 10 People who cannot
perform the most basic physical activity because of severe angina can
find a new life simply by changing their diets, By embracing this revolutionary information, we could collectively defeat the most dangerous
disease in this country
...

Unfortunately, both the newspapers and the courts are filled with stories
and cases that tell us that inadequate care has become the norm
...
, stating that physician error, medication error and adverse events from drugs or surgery
kill 225,400 people per year (Chart 1
...
4)
...
4: LEADING CAUSES OF DEATH12

Diseases

of the Heart

Cancer (Malignant
Medical Corell
Stroke (Cerebrovascular Diseases)
Chronic Lower Respiratory Diseases
Accidents
Diabetes Mellitus
Influenza and Pneumonia
Alzheimer's Disease

710,760
553,091
225,400
167,661
122,009
97,900
69,301
65,313
49,558

CHART 1
...
1 6 Even with the use of
approved medicines and correct medication procedures, over one hundred thousand people die every year from unintended reactions to the
"medicine" that is supposed to be reviving their health
...
"15 These are people who took their medicine as directed
...
Nor does it include
adverse drug events that are labeled "possible" effects, or drugs that do

PROBLEMS WE FACE, SOLUTIONS WE NEED

17

not accomplish their intended goal
...
1
5
If nutrition were better understood, and prevention and natural treatments were more accepted in the medical community, we would not be
pouring so many toxic, potentially lethal drugs into our bodies at the
last stage of disease
...
We would not be spending our
money developing, patenting and commercializing "magic bullet" drugs
that often cause additional health problems
...
It is time to shift our thinking toward a broader
perspective on health, one that includes a proper understanding and
use of good nutrition
...


AN EXPENSIVE GRAVE
We pay more for our health care than any other country in the world
(Chart 1
...

We spent over a trillion dollars on health care in 1997
...
17 Costs have so conSistently outpaced inflation
that we now spend one out of every seven dollars the economy produces on health care (Chart 1
...
We have seen almost a 300% increase
in expenditures, as a percentage of GDp, in less than forty years! What is
all the extra financing buying? Is it creating health? I say no, and many
serious commentators agree
...
S
...
19
Other countries spend, on average, only about one-half of what the U
...

spends per capita on health care
...
s
...
lI In a separate analysis, the World Health Organization ranked
the United States thirty-seventh best in the world according to health
care system performance
...
6: HEALTH CARE EXPENDITURES PER PERSON, 1997 $USI7

3912
4000

r-

3000


...


1760

1000

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7: PERCENT OF U
...
GOP SPENT ON HEALTH CAREI7, 18

14
12
10
8
6
4
2
0
1960

1970

1980

1990

1997

in the world, even though we spend, far and away, the most money on
it
...
The consequences of not having health insurance, I suspect, have never been more terrifying, and
close to 44 million Americans are uninsured
...

From three perspectives-disease prevalence, medical care efficacy
and economics-we have a deeply troubled medical system
...

Many of us have spent awful times in hospitals or in nursing homes
watching a loved one succumb to disease
...
Isn't it paradoxical that the system that is supposed to heal us
too often hurts us?

WORKING TO LESSEN CONFUSION
The American people need to know the truth
...
People need to know why we are
unnecessarily sick, why too many of us die early despite the billions
spent on research
...
The answer to the American health crisis is the food that each of us
chooses to put in our mouths each day
...

Although many of us think we're well informed on nutrition, we're
not
...
We disdain saturated fats, butter or carbohydrates, and then embrace vitamin E, calcium
supplements, aspirin or zinc and focus our energy and effort on extremely specific food components, as if this will unlock the secrets of health
...
Perhaps you remember the protein
diet fad that gripped the country in the late 1970s
...
In a
very short while, almost sixty women died from the diet
...
Atkins' New Diet Revolution, Protein Power and The South Beach
Diet
...
What we don't
know-what we don't understand-about nutrition can hurt us
...
In 1988, I was invited before the U
...
Senate Governmental Affairs
Committee, chaired by Senator John Glenn, to give my views on why the
public is so confused about diet and nutrition
...
For example, we pin our efforts
and our hopes on one isolated nutrient at a time, whether it is vitamin A to
prevent cancer or vitamin E to prevent heart attacks
...
Often, investigating minute biochemical parts of food and trying to reach broad conclusions about diet and
health leads to contradictory results
...

A DIFFERENT KIND OF PRESCRIPTION
Most of the authors of several best-selling "nutrition" books claim to be
researchers, but I am not aware that their "research" involves original,
professionally developed experimentation
...
They have few or no publications in peer-reviewed scientific journals; they have virtually no formal training in nutritional science; they
belong to no professional research societies; they have not participated
as peer reviewers
...

If you are familiar with the "health" books at your nearby bookstore,
you have likely heard of Dr
...
These books
have made health information more confusing, more difficult to grasp
and ultimately more elusive
...
What's
the real problem, anyway? Is it fat? Is it carbohydrates? What's the ratio
of nutrients that provides greatest weight loss? Are cruciferous vegetables good for my blood type? Am I taking the right supplements? How
much vitamin C do I need every day? Am I in ketosis? How many grams
of protein do I need?
You get the picture
...
These are fad diets that embody the worst of medicine, science and the popular media
...
I am appealing to your intelligence, not to
your ability to follow a recipe or menu plan
...
I have a prescription for maximum health that is simple, easy to follow and offers more
benefits than any drug or surgery, without any of the side effects
...
Most importantly, the supporting evidence is overwhelming
...

So, what is my prescription for good health? In short, it is about
the multiple health benefits of consuming plant-based foods, and the
largely unappreciated health dangers of consuming animal-based foods,
including all types of meat, dairy and eggs
...
I started at the opposite end of the spectrum: as
a meat-loving dairy farmer in my personal life and an "establishment"
scientist in my professional life
...

My only interest now is to explain the scientific basis for my views
in the clearest way possible
...
People decide what to eat for a number of reasons, health
considerations being only one
...
The rest is up to you
...
It is not illusory, hypothetical
or anecdotal; it is from legitimate research findings
...
To know is science
...
" I plan to show you what I have come to know
...
These studies were
diverse both in design and in purpose
...
29; and a nationwide, comprehensive study of dietary
and lifestyle factors associated with disease mortality in 170 villages in
mainland China and Taiwan (widely known as the China 5tudy)
...

The China Study, of which I was director, began in 1983 and is still
ongoing
...
Begun in
the late 1960s, this National Institutes of Health (NIH)-funded research
investigated the link between diet and cancer in considerable depth
...

When all was said and done, my colleagues and I were honored to
have received a total of seventy-four grant-years of funding
...
From this research I have
authored or co-authored over 350 scientific articles
...
They included, among others, the
1998 American Institute for Cancer Research award "in recognition
of a lifetime of significant accomplishments in scientific research
...
Moreover, invitations
to lecture at research and medical institutions in more than forty states
and several foreign countries attested to the interest in these findings
from the professional communities
...
Interviews on the McNeil-Lehrer News
Hour program, at least twenty-five other TV programs, lead stories in
USA Today, the New York Times, and the Saturday Evening Post and
widely publicized TV documentaries on our work have also been a part
of our public activities
...
Heart diseases, cancers, diabetes,
stroke and hypertension, arthritis, cataracts, Alzheimer's disease, impo-

PROBLEMS WE FACE, SOLUTIONS WE NEED

23

tence and all sorts of other chronic diseases can be largely prevented
...

Additionally; impressive evidence now exists to show that advanced
heart disease, relatively advanced cancers of certain types, diabetes and
a few other degenerative diseases can be reversed by diet
...
But
the evidence can no longer be ignored
...

One of the more exciting benefits of good nutrition is the prevention
of diseases that are thought to be due to genetic predisposition
...

But funding of genetic research continues to spiral upwards in the belief
that specific genes account for the occurrence of specific diseases, in
the hope that we somehow will be able to "turn off' these nasty genes
...
Using this card, we will be expected to go to our doctor, who
will prescribe a single pill to suppress our bad genes
...
These futuristic pipe dreams obscure the
affordable, efficacious health solutions that currently exist: solutions
based in nutrition
...
We have studied these effects in great detail and
have published our findings in the very best scientific journals
...

Eating the right way not only prevents disease but also generates
health and a sense of well-being, both physically and mentally
...
In the
laboratory, we fed experimental rats a diet similar to the usual American
fare-rich in animal-based protein-and compared them with other
rats fed a diet low in animal-based protein
...
This
was the same effect observed by these world-class athletes
...
A century ago,
Professor Russell Chittenden, a famous, well established nutrition researcher at Yale University Medical School, investigated whether eating
a plant-based diet affected students' physical capacities
...
He got the same results as our rats
almost a century later-and they were equally spectacular
...
In its simplest form, eating the right way
would largely obviate the enormous costs of using drugs, as well as their
side effects
...
Health care
costs would drop and medical mistakes would wane as premature death
plummeted
...


SIMPLE BEGINNINGS
As I look back, I often think about life on the farm and how it shaped
my thinking in so many ways
...
In the summer, from sunrise to sunset, we were outdoors planting and harvesting the crops and taking care of the animals
...

I've had an amazing journey, to be sure
...
I wish that my family and others
around us had had the same information back in the mid-1900s that
we now have about food and health
...
He could have met my youngest son, his namesake, who is collaborating with me on this book
...


PROBLEMS WE FACE, SOLUTIONS WE NEED

25

My journey in science over the past forty-five years has convinced me
that it is now more urgent than ever to show how people can avoid these
tragedies
...
We cannot
let the status quo go unchallenged and watch our loved ones suffer unnecessarily
...



...
_
...
2
...
_
...
_
...

AHouse of Proteins
My ENTIRE PROFESSIONAL CAREER in biomedical research has centered on
protein
...
Protein,
often regarded with unsurpassed awe, is the common thread tying together past and present knowledge about nutrition
...
I am reminded of the words of Goethe, first brought to my
attention by my friend Howard Lyman, a prominent lecturer, author
and former cattle rancher: "We are best at hiding those things which
are in plain sight
...
The dogma surrounding protein censures, reproaches and
guides, directly or indirectly, almost every thought we have in biomedical research
...
The word protein comes from the Greek word
proteios, which means "of prime importance
...
Many
people today still equate protein with animal-based food
...
If you did, you aren't alone
...
This belief comes
from the fact that the "soul" of animal-based foods is protein
...
We do this all the
time, with lean cuts of meat and skim milk
...
A non-protein steak, for example, would be a puddle of water,
fat and a small amount of vitamins and minerals
...
Protein is the core element of animal-based foods
...
Voit found that "man"
needed only 48
...

Protein equaled meat, and everyone aspired to have meat on his or her
table, just as we aspire to have bigger houses and faster cars
...

Voit went on to mentor several well-known nutrition researchers of
the early 1900s, including Max Rubner (1854-1932) and WOo Atwater
(1844-1907)
...

Rubner stated that protein intake, meaning meat, was a symbol of civilization itself: "a large protein allowance is the right of civilized man
...
As director of the USDA, he

A HOUSE OF PROTEINS

29

recommended 125 grams per day (only about fifty-five grams per day is
now recommended)
...

A cultural bias had become firmly entrenched
...
If you were rich, you ate meat, and if you were
poor, you ate staple plant foods, like potatoes and bread
...
Elitism and arrogance dominated much
of the burgeoning field of nutrition in the nineteenth century
...

Major McCay, a prominent English physician in the early twentieth
century, provided one of the more entertaining, but most unfortunate,
moments in this history
...
Among other things, he said that people who consumed less
protein were of a "poor physique, and a cringing effeminate disposition
is all that can be expected
...
Fat, carbohydrate and protein, as macronutrients,
make up almost all the weight of food, aside from water, with the remaining small amount being the vitamin and mineral micronutrients
...

Protein, the most sacred of all nutrients, is a vital component of our
bodies and there are hundreds of thousands of different kinds
...
Proteins are constructed as long
chains of hundreds or thousands of amino acids, of which there are
fifteen to twenty different kinds, depending on how they are counted
...
This is accomplished by consuming foods that contain protein
...

Various food proteins are said to be of different quality, depending on
how well they provide the needed amino acids used to replace our body
proteins
...
However, the colored beads on
the string given to us are not in the same order as the string we lost
...
Then, we reconstruct our new
string so that the colored beads are in the same order as our lost string
...
This
is the same concept as in making new tissue proteins to match our old
worn out proteins
...
They are
called "essential" because our bodies cannot make them
...
This is where the idea of protein quality comes into play
...

This is what that word "quality" really means: it is the ability of food
proteins to provide the right kinds and amounts of amino acids to make
our new proteins
...
Its protein has just the right amount of the needed amino acids
...
The proteins of other
animals are very similar to our proteins because they mostly have the
right amounts of each of the needed amino acids
...
" Among animal foods, the proteins of milk and eggs represent the best amino acid
matches for our proteins, and thus are considered the highest quality
...

The concept of quality really means the efficiency with which food
proteins are used to promote growth
...
In fact, to give you
a taste of what's to come, there is a mountain of compelling research

A HOUSE OF PROTEINS

31

showing that "low-quality" plant protein, which allows for slow but
steady synthesis of new proteins, is the healthiest type of protein
...
The quality of protein found in a specific food
is determined by seeing how fast animals would grow while consuming
it
...
1
This focus on efficiency of body growth, as if it were good health, encourages the consumption of protein with the highest "quality
...
For well over 100 years, we have
been captive to this misleading language and have oftentimes made the
unfortunate leap to thinking that more quality equals more health
...

People, for example, who choose to consume a plant-based diet will
often ask, even today, "Where do I get my protein? " as if plants don't
have protein
...
However, this is overstating the
case
...
It doesn't
require eating higher quantities of plant protein or meticulously planning every meal
...


THE PROTEIN GAP
The most important issue in nutrition and agriculture during my early
career was figuring out ways to increase the consumption of protein,
making sure it was of the highest possible quality: My colleagues and I
all believed in this common goal
...
As a
youngster, I remember that the most expensive part of farm animal feed
was the protein supplements that we fed to our cows and pigs
...
D
...
2
...
My graduate research, although cited a few times
over the next decade or so, was only a small part of much larger efforts
by other research groups to address a protein situation worldwide
...
4
The protein gap stipulated that world hunger and malnutrition
among children in the third world was a result of not having enough
protein to consume, especially high-quality (i
...
animal) protein
...
Projects were
springing up all over the place to address this "protein gap" problem
...
desirably [supplemented]
by modest amounts of milk, eggs, meat or fish, the predominantly
cereal diets [of poor nations] are
...
" To address this dire problem:
• MIT was developing a protein-rich food supplement called INCAPARINA
...

• The u
...
government was subSidizing the production of dried milk
powder to provide high-quality protein for the world's poor
...

• Auburn University and MIT were grinding up fish to produce "fish
protein concentrate" to feed the world's poor
...
S
...
I knew most of the projects firsthand, as well as the individuals who organized and directed them
...
Two of its staffers6 declared in 1970

A HOUSE OF PROTEINS

33

that "
...

The great mass of the population of these countries subsists mainly on
foods derived from plants frequently deficient in protein, which results
in poor health and low productivity per man
...
Autret, a very influential man from the FAO, added that "owing to the low-animal protein
content of the diet and lack of diversity of supplies [in developing
countries]' protein quality is unsatisfactory
...
Autret strongly advocated increasing the production and
consumption of animal protein in order to meet the growing "protein
gap" in the world
...
"4
Bruce Stillings at the University of Maryland and the U
...
Department of Commerce, another proponent of consuming animal-based diets, admitted in 1973 that "although there is no requirement for animal
protein in the diet per se, the quantity of dietary protein from animal
sources is usually accepted as being indicative of the overall protein
quality of the diet
...
supply of adequate
quantities of animal products is generally recognized as being an ideal
way to improve world protein nutrition
...
But
it's not the only way, and, as we shall see, it isn't necessarily the way
most consistent with long-term health
...
I left MIT to take a faculty position at Virginia Tech in 1965
...
He was interested in implementing a "mothercraft" self-help
project in the Philippines
...
The idea was
that if mothers were taught that the right kinds of locally grown foods can

34

THE CHINA STUDY

make their children well, they would not have to rely on scarce medicines
and the mostly nonexistent doctors
...

Consistent with the emphasis on protein as a means of solving malnutrition, we had to make this nutrient the centerpiece of our educational "mothercraft" centers and thereby help to increase protein consumption
...
Our own preference was to develop peanuts as a source of protein
because this was a crop that could be grown most anywhere
...
Like
these other nitrogen "fixers," peanuts are rich in protein
...

Considerable evidence had been emerging, first from England7- 9 and
later from MIT (the same lab that I had worked in) 10, 11 to show that peanuts often were contaminated with a fungus-produced toxin called aflatoxin (AF)
...
It was said to be the most potent chemical
carcinogen ever discovered
...

Prior to going to the Philippines, I had traveled to Haiti in order to
observe a few experimental mothercraft centers organized by my colleagues at Virginia Tech, Professors Ken King and Ryland Webb
...
Papa Doc Duvalier, president of Haiti, extracted what little resources the country had for his own rich lifestyle
...

I subsequently went to the Philippines and encountered more of the
same
...
We focused our
efforts on the villages in most need
...
Third degree malnutrition,
the worst kind, represented children under the 65 th percentile
...
s
...


A HOUSE OF PROTEINS

35

In the urban areas of some of the big cities, as many as 15-20% of
the children aged three to six years were judged to be third degree
...

A mother, hardly more than a wisp herself, holding her three-year-old
twins with bulging eyes, one at eleven pounds, the other at fourteen
pounds, trying to get them to open their mouths to eat some porridge
...
Children without legs or arms hoping to get a morsel of food
...
As I mentioned before, we first had to resolve the
problem of AF contamination in peanuts, our preferred protein food
...

Who in the Philippines was consuming AF, and who was subject to liver
cancer? To answer these questions, I applied for and received a National
Institutes of Health (NIH) research grant
...
I succeeded in getting a second NIH grant for this in-depth biochemical research
...
I found studying questions both from the basic and applied
perspectives rewarding because it tells us not only the impact of a food
or chemical on health, but also why it has that impact
...

We began with a stepwise series of surveys
...
We learned that peanuts and corn
were the foods most contaminated
...
s
...
Whole peanuts were much less contaminated;
none exceeded the AF amounts allowed in U
...
commodities
...
The best peanuts, which filled "cocktail" jars, were hand
selected from a moving conveyor belt, leaving the worst, moldiest nuts
to be delivered to the end of the belt to make peanut butter
...
We learned that it was
children
...

We estimated AF consumption by analyzing the excretion of AF metabolic products in the urine of children living in homes with a partially
consumed peanut butter jar
...
Peanut butter was almost
exclusively consumed in the Manila area while corn was consumed in
Cebu, the second most populated city in the Philippines
...
It emerged from my
making the acquaintance of a prominent doctor, Dr
...
He told me that the liver cancer
problem in the Philippines was quite serious
...
Whereas in the West, this disease mostly strikes people only after
forty years of age, Caedo told me that he had personally operated on
children younger than four years of age for liver cancer!
That alone was incredible, but what he then told me was even more
striking
...
The families with the most money ate what we thought were
the healthiest diets, the diets most like our own meaty American diets
...
It was therefore widely
believed that this cancer was the result of a deficiency in protein
...
But now Dr
...
This seemed strange to me, at first, but over time my
own information increasingly confirmed their observations
...
13 It was an experiment involving liver cancer and protein
consumption in two groups of laboratory rats
...
The second group was given
the same level of AF and then fed diets containing only 5% protein
...
It was not a trivial difference; it was 100% versus 0%
...
Those who were most vulnerable to liver cancer were those
who consumed diets higher in protein
...
On a flight from Detroit after returning from a presentation at a conference, I traveled with
a former but much senior colleague of mine from MIT, Professor Paul
Newberne
...
I told him about my impressions in the Philippines and the paper
from India
...
In no way could
a high-protein diet increase the development of cancer
...
Should I take seriously the
observation that protein increased cancer development and run the risk
of being thought a fool? Or should I turn my back on this story?
In some ways it seemed that this moment in my career had been foreshadowed by events in my personal life
...
On several occasions
my uncle took my brother Jack and me to see his wife in the hospital
...
I would
think, "When I get big, I want to find a cure for cancer
...
At that time, I
was becoming aware of a possible diet-cancer connection in our early
research
...
My wife Karen was her only daughter and they had a very
close relationship
...

Looking back on it, this was the beginning of my career focus on diet
and cancer
...
If I wanted to stay with this story, there was only

38

THE CHINA STUDY

one solution: start doing fundamental laboratory research to see not only
if, but also how, consuming more protein leads to more cancer
...
It took me farther than I had ever imagined
...
But even more than that,
the findings led to broader questions, questions that would eventually
lead to cracks in the very foundations of nutrition and health
...
Even more than in the "core" sciences of biology, chemistry and physics, establishing absolute proof in medicine and
health is nearly impossible
...
This is because research
into health is inherently statistical
...
That's physics
...
We know that your
odds of getting lung cancer are much higher than if you didn't smoke, and
we can tell you what those odds (statistics) are, but we can't know with
certainty whether you as an individual will get lung cancer
...
Humans live all sorts of different ways,
have different genetic backgrounds and eat all sorts of different foods
...
Perhaps most importantly,
food, lifestyle and health interact through such complex, multifaceted
systems that establishing proof for anyone factor and anyone disease is
nearly impossible, even if you had the perfect set of subjects, unlimited
time and unlimited financial resources
...
In some cases, we assess whether a hypothetical cause produces a hypothetical effect by observing and measuring the differences
that already exist between different groups of people
...

We might observe and compare the dietary characteristics of people who
already have the disease with a comparable group of people who don't
have the disease
...

In addition to observing what already exists, we might do an experiment and intentionally intervene with a hypothetical treatment to see
what happens
...
One group of people is given the drug and a second group a placebo (an inactive look-alike substance to please the
patient)
...

As we do observational and interventional research, we begin to amass
the findings and weigh the evidence for or against a certain hypothesis
...
It is in
this way that I am advancing an argument for a whole foods, plant-based
diet
...
However, I am confident that those seeking the truth regarding diet
and health by surveying the weight of the evidence from the variety of
available studies will be amazed and enlightened
...

CORRELATION VERSUS CAUSATION
In many studies, you will find that the words correlation and association
are used to describe a relationship between two factors, perhaps even indicating a cause-and-effect relationship
...

If protein consumption, for example, is higher among populations that
have a high incidence of liver cancer, we can say that protein is positively
correlated or associated with liver cancer incidence; as one goes up, the
other goes up
...
In other words, the two factors go in the
opposite direction; as one goes up, the other goes down
...
A classic illustration of this difficulty is that countries with more
telephone poles often have a higher incidence of heart disease, and
many other diseases
...
But this does not prove that telephone poles cause
heart disease
...

This does not mean that correlations are useless
...
The China Study, for example, has
over 8,000 statistically significant correlations, and this is of immense
value
...
These patterns, in turn, are representative of how diet and
health processes, which are unusually complex, truly operate
...


STATISTICAL SIGNIFICANCE
You might think that deciding whether or not two factors are correlated
is obvious-either they are or they aren't
...
When
you are looking at a large quantity of data, you have to undertake a statistical analysis to determine if two factors are correlated
...
It's a probability, which we call statistical significance
...

If you flip a coin three times and it lands on heads each time, it's probably chance
...
That's the
concept behind statistical Significance-it's the odds that the correlation
(or other finding) is real, that it isn't just random chance
...
This means, for example, that
there is a 95% chance that we will get the same result if the study is
repeated
...
Another arbitrary cutoff point is 99%
...
In the
discussions of diet and disease research in this book, statistical significance pops up from time to time, and it can be used to help judge the
reliability, or "weight," of the evidence
...
For example,
telephone poles and heart disease are positively correlated, but there is
no research that shows how telephone poles are biologically related to
heart disease
...
Knowing the process by
which something works in the body means knowing its "mechanism
of action
...
Another way of saying this is that the two correlated factors are
related in a "biologically plausible" way
...


METANALYSIS
Finally, we should understand the concept of a metanalysis
...
By accumulating and analyzing a large body
of combined data, the result can have considerably more weight
...

After obtaining the results from a variety of studies, we can then begin to use these tools and concepts to assess the weight of the evidence
...
Alternative hypotheses no longer seem plausible, and we can be very confident in the result
...
But common sense proof (99% certainty) is attainable and critical
...
Smoking has never been "100%"
proven to cause lung cancer, but the odds that smoking is unrelated to
lung cancer are so astronomically low that the matter has long been
considered settled
...
_
...


...
Slowly and painfully being consumed by cancer for months, even years, before passing
away is a terrifying prospect
...

So when the media reports a newly found chemical carcinogen, the
public takes notice and reacts qUickly
...
Such was the case a few years ago with Alar, a chemical that was
routinely sprayed on apples as a growth regulator
...
In February 1989 a representative
of NRDC said on CBS's 60 Minutes that the apple industry chemical was
"the most potent carcinogen in the food supply
...
One woman called state police to
chase down a school bus to confiscate her child's apple
...
According to
John Rice, former chairman of the U
...
Apple Association, the apple industry took an economic walloping, lOSing over $250 million
...
3
The Alar story is not uncommon
...
You may have heard of some:
43

44

THE CHINA STUDY

• Aminotriazole (herbicide used on cranberry crops, causing the
"cranberry scare'" of 1959)
• DDT (widely known after Rachel Carson's book, Silent Spring)
• Nitrites (a meat preservative and color and flavor enhancer used in
hot dogs and bacon)
• Red Dye Number 2
• Artificial sweeteners (including cyclamates and saccharin)
• Dioxin (a contaminant of industrial processes and of Agent Orange, a defoliant used during the Vietnam War)
• Aflatoxin (a fungal toxin found on moldy peanuts and corn)
I know these unsavory chemicals quite well
...
I was one of the first
scientists to isolate dioxin; I have firsthand knowledge of the MIT lab
that did the key work on nitrites, and I spent many years researching
and publishing on aflatoxin, one of the most carcinogenic chemicals
ever discovered-at least for rats
...
In each and every case, research has demonstrated that these chemicals may increase
cancer rates in experimental animals
...


THE HOT DOG MISSILE
If you hazard to call yourself "middle-aged" or older, when I say, "Nitrites, hot dogs and cancer," you might rock back in your chair, nod
your head, and say, "Oh yeah, I remember something about that
...

The time: the early 1970s
...


Sodium Nitrite: A meat preservative used since the 1920s
...


TURNING OFF CANCER

45

In 1970, the journal Nature reported that the nitrite we consume may
be reacting in our bodies to form nitrosamines
...
No fewer than seventeen nitro sa mines are "reasonably anticipated to be human carcinogens" by the U
...
National Toxicology Program
...
Why are these scary nitrosamines "anticipated to
be human carcinogens"? The short answer: animal experiments have
shown that as chemical exposure increases, incidence of cancer also
increases
...
We need a more complete answer
...
In one
study, twenty rats were divided into two groups, each exposed to a different level of NSAR
...
Of rats given the lower level of NSAR, just
over 35% of them died from throat cancer
...
9- 11
How much NSAR did the rats get? Both groups of rats were given
an incredible amount
...
Let's say you go over to your friend's house to eat every
meal
...
So he gives you the equivalent of the "low"
level given to the rats
...

He offers you another, and another, and another
...
9 , 12 You
better like bologna, because your friend is going to have to feed you this
way every day for over thirty years! If he does this, you will have had
about as much exposure to NSAR (per body weight) as the rats in the
"low" -dose group
...
Although no human studies were used to
make this evaluation, it is likely that a chemical such as this, which
consistently causes cancer in both mice and rats, can cause cancer in
humans at some level
...
Nonetheless, animal experiments alone are considered
enough to conclude that NSAR is "reasonably anticipated" to be a human carcinogen
...
Here was
the official line: "Reduction of human exposure to nitrites and certain
secondary amines, particular1y in foods, may result in a decrease in
the incidence of human cancer
...
Because we humans get exposed to nitrites through consumption of processed meat such as hot dogs and bacon, some products
came under fire
...
Besides containing additives like nitrites, hot dogs can be made out of ground-up lips, snouts,
spleens, tongues, throats and other "variety meats
...
Ralph
Nader had called hot dogs "among America's deadliest missiles
...
3
The issue jolted forward again in 1978, when a study at the Massachusetts Institute of Technology (MIT) found that nitrite increased lymphatic cancer in rats
...
2% of
the time, while animals not fed nitrite got cancer only 5
...

This finding was enough to create a public uproar
...
When the dust
settled, expert panels made recommendations, industry cut back on nitrite usage and the issue fell out of the spotlight
...
A rise
in cancer incidence from 5% to 10% in rats fed large quantities of nitrite
caused an explosive controversy
...

And NSAR, a nitrosamine possibly formed from nitrite, was "reasonably
anticipated to be a human carcinogen" after several animal experiments
where exceptionally high levels of chemical were fed to animals for almost half their lifespan
...
It is the mere possibility, however unlikely it may be, that it could cause cancer that alarms the public
...
The implications for human health would be enormous
...

This is exactly what I saw in the Indian research paper16 when I was
in the Philippines
...
Protein! These results
were more than startling
...

Scientists, myself included, tend to be a skeptical bunch, especially
when confronted with eye-popping results
...
We
might suspect that this finding was unique to rats exposed to aflatoxin
and for no other species, including humans
...
Maybe my friend, the
distinguished MIT professor, was right; maybe the animal identities in
the Indian study got mixed up
...
To further study this question,
I sought and received the two National Institutes of Health (NIH)
research grants that I mentioned earlier
...
I did not "cry wolf' in
either application by suggesting that protein might promote cancer
...

Besides, I wasn't convinced that protein actually might be harmful
...
" The human study,
mostly focused on aflatoxin's effects on liver cancer in the Philippines,
was briefly reviewed in the last chapter and was concluded after three
years
...

A study of this protein effect on tumor development had to be done extremely well
...
The NIH funding for this study continued for the next nineteen years and led to additional funding from
other research agencies (American Cancer Society, the American Institute
for Cancer Research and the Cancer Research Foundation of America)
...

ANIMAL RIGHTS

The rest of this chapter concerns experimental animal research, all
of which included rodents (rats and mice)
...
I respect this
concern
...
The findings and the
principles derived from these animal studies greatly contributed
to my interpretations of my later work, including the China Study,
as you will come to see
...
To date, I have found none, even after
seeking advice from my "animal rights" colleagues
...
These
principles now have enormous potential to benefit all of our fellow creatures, our environment and ourselves
...
To use a rough analogy, the cancer process is similar to planting a
lawn
...

So what is the process that successfully "implants" the grass seed in
the soil in the first place, i
...
, initiates cancer-prone cells? Chemicals
that do this are called carcinogens
...
1: TUMOR INITIATION BY AFLATOXIN INSIDE A LIVER CELL

(2) AF is metabolized
by an enzyme
...

~---v
'(4) It attacks the
cell's DNA
...


Cancer Initiation

Cancerous

OJ"''
(6) A cell multiplies
before the damaged
DNA is repaired and
permanently damaged,
cancerous celis arise

After entering our cells (Step 1), most carcinogens do not, themselves, initiate the cancer
process
...
These carcinogen products then bind tightly to
the cell's DNA to form carcinogen-DNA complexes, or adducts (Step 4)
...
But nature is smart
...
However, if they remain in place
while cells are dividing to form new "daughter" cells, genetic damage occurs and this new
genetic defect (or mutation) is passed on to all new cells formed thereafter (Step 6)
...
These carcinogens
genetically transform, or mutate, normal cells into cancer-prone cells
...

The entire initiation stage (Chart 3
...
It is the time required for the chemical
carcinogen to be consumed, absorbed into the blood, transported into
cells, changed into its active product, bonded to DNA and passed on to
the daughter cells
...
These daughter cells and all their progeny will forever be
genetically damaged, giving rise to the potential for cancer
...


50

THE CHINA STUDY

At this point in our lawn analogy, the grass seeds have been put in
the soil and are ready to germinate
...
The second
growth stage is called promotion
...
This stage occurs over a far longer period of time than initiation,
often many years for humans
...

But just like seeds in the soil, the initial cancer cells will not grow and
multiply unless the right conditions are met
...
If any of these factors are denied or are
missing, the seeds will not grow
...
This is one of the most profound
features of promotion
...
This is
where certain dietary factors become so important
...
Other dietary factors, called
anti-promoters, slow cancer growth
...
It is a push-pull process
...

The third phase, progression, begins when a bunch of advanced cancer
cells progress in their growth until they have done their final damage
...
Similarly, a developing cancer tumor may wander
away from its initial site in the body and invade neighboring or distant
tissues
...
When it actually breaks away from its initial home and wanders, it is metastasizing
...

At the start of our research, the stages of cancer formation were
known only in vague outline
...
We had
no shortage of questions
...


PROTEIN AND INITIATION
How does protein intake affect cancer initiation? Our first test was to
see whether protein intake affected the enzyme principally responsible
for aflatoxin metabolism, the mixed function oxidase (MFa)
...
Paradoxically, this enzyme
both detoxifies and activates aflatoxin
...


THE ENZYME uFACTORY"

(1) Aflatoxin (AF)
enters the cell
...


In a simplistic way, the MFO enzyme system can be thought of as a factory
within the industrious workings of the cell
...

The raw materials may be disassembled or assembled
...
But there also may be byproducts
of these complex processes that are exceptionally dangerous
...
If someone told you to stick your face down
a smokestack and breathe deeply for a couple hours, you'd refuse
...


52

THE CHINA STUDY

At the time we started our research, we hypothesized that the protein
we consume alters tumor growth by changing how aflatoxin is detoxified by the enzymes present in the liver
...
After a series of experiments (Chart
3
...
Enzyme activity could be easily modified
simply by changing the level of protein intake
...
22 What does this mean? Decreasing enzyme activity via
low-protein diets implied that less aflatoxin was being transformed into
the dangerous aflatoxin metabolite that had the potential to bind and to
mutate the DNA
...
3) and showed that the lower the protein intake,
the lower the amount of aflatoxin-DNA adducts
...
These were very impressive findings, to be sure
...
But we wanted to know more and be doubly assured
of this effect, so we continued to look for other explanations
...
Almost evCHART 3
...
;;;

'';:::;

76% decrease
in enzyme
activity with
low-protein
diets

200

«
a;

u

150

E
>,

100

N
C

UJ

50
0

20% Protein

5% Protein

53

TURNING OFF CANCER
CHART 3
...

From our extensive research, one idea seemed to be clear: lower protein intake dramatically decreased tumor initiation, This finding, even
though well substantiated, would be enormously provocative for many
people
...
We found, conclusively, through a number of experiments, that a low-protein diet could decrease, at the time of planting,
the number of seeds in our "cancerous" lawn
...
We wondered: what happens during
the promotion stage of cancer, the all-important reversible stage? Would
the benefits of low protein intake achieved during initiation continue
through promotion?
Practically speaking, it was difficult to study this stage of cancer because of time and money
...
Each such experiment would take more
than two years (the normal lifetime of rats) and would have cost well
over $lOO,OOO (even more money today)
...
These little microscopic cell
clusters were called foci
...
Although
most foci do not become full-blown tumor cells, they are predictive of
tumor development
...
By studying the effects of protein
on the promotion of foci instead of tumors we could avoid spending a
lifetime and a few million dollars working in the lab
...
Foci development was almost
entirely dependent on how much protein was consumed, regardless of how
much aflatOXin was consumed!
This was documented in many interesting ways, first done by my
graduate students Scott Appleton33 and George Dunaip4 (a typical comparison is shown in Chart 3
...
After initiation with aflatoxin, foci grew
(were promoted) far more with the 20% protein diet than with the 5%
protein diet
...
But what if the initial aflatoxin exposure is varied? Would protein

55

TURNING OFF CANCER
CHART 3
...
5
3
...
5
OJ

c

2
...

VI
OJ
0:::

1
...
0

l
...
5
0
20%

5%
Dietary Protein Level

CHART 3
...
/

90
80
OJ

70

VI

c
0

0
...
L

60
50
40
30
20
10
0 1
...
/

1


...


~

High AF

LowAF

Low Protein

High Protein

56

THE (HINA STUDY

still have an effect? We investigated this question by giving two groups
of rats either a high-aflatoxin dose or a low-aflatoxin dose, along with a
standard baseline diet
...
"
Then, during the promotion phase, we fed a low-protein diet to the highaflatoxin dose groups and a high-protein diet to the low-aflatoxin dose
group
...

Again, the results were remarkable (Chart 3
...
Animals starting with
the most cancer initiation (high-aflatoxin dose) developed substantially
less foci when fed the 5% protein diet
...

A principle was being established
...
Protein during promotion trumps the carcinogen, regardless of initial exposure
...
Here is a step-by-step sequence of experiments,
carried out by my graduate student Linda Youngman
...

We divided this twelve-week promotion stage into four periods of three
weeks each
...

When animals were fed the 20% protein diet during periods 1 and 2
(20-20), foci continued to enlarge, as expected
...
And, when animals
were subsequently switched back to the 20% protein diet during period
4 (20-20-5-20), foci development was turned on once again
...
But when these animals were returned to 20% dietary protein during period 3 (20-5-20), we again saw
the dramatic power of dietary protein to promote foci development
...
Foci
growth could be reversed, up and down, by switching the amount of
protein being consumed, and at all stages of foci development
...
That is, exposure to aflatoxin left a
genetic "imprint" that remained dormant with 5% dietary protein until
nine weeks later when this imprint reawakened to form foci with 20%
dietary protein
...
It suggests
that if we are exposed in the past to a carcinogen that initiates a bit of
cancer that remains dormant, this cancer can still be "reawakened" by
bad nutrition some time later
...
But how much protein is too
much or too little? Using rats, we investigated a range of 4-24% dietary
protein (Chart 3
...
Foci did not develop with up to about 10% dietary
protein
...
The results were later repeated a second time in
my laboratory by a visiting professor from Japan, Fumiyiki Horio
...
6: FOCI PROMOTION BY DIETARY PROTEIN

90
80

70
+-'

60

Adequate Protein

C

ClJ

E
0
...
39 That is, when
the animals met and surpassed their requirement for protein, disease
onset began
...
I say this because the protein required
for growth in young rats and humans as well as the protein required to
maintain health for adult rats and humans is remarkably similar
...
This is considerably more than the actual amount required
...
What do most of us routinely consume? Remarkably, it is
considerably more than the recommended 10%, The average American
consumes 15-16% protein
...

Ten percent dietary protein is equivalent to eating about 50-60 grams
of protein per day; depending on body weight and total calorie intake
...
There are about thirteen grams of protein in
100 calories of porterhouse steak Gust over one and a half ounces)
...

A chemical is usually not considered a carcinogen unless higher doses
yield higher incidences of cancer
...
If an increasing response is not observed for a suspect chemical
carcinogen, serious doubt arises whether it really is carcinogenic
...
7 34 )
...
The dose-response

59

TURNING OFF CANCER
CHART 3
...


_

o
u
...
However, in the animals fed 5% protein,
the dose-response curve completely disappeared
...
This
was yet another result demonstrating that a low-protein diet could override the cancer-causing effect of a very powerful carcinogen, aflatoxin
...
Controlling cancer through nutrition was, and still
is, a radical idea
...
So
the next logical question was whether plant protein, tested in the same
way, has the same effect on cancer promotion as casein
...
" In these experiments, plant protein did not promote
cancer growth, even at the higher levels of intake
...
842 )
...


60

THE CHINA STUDY
CHART 3
...
20% Casein

Vl

C

o

0
...
20% Gluten

50

05% Casein

'0

o

L
...
Rats fed 20% soy protein diets did not form
...
Suddenly protein, milk protein in this
case, wasn't looking so good
...
As if
that weren't enough, we were finding that high protein intake, in excess
of the amount needed for growth, promotes cancer after initiation
...
But the cancer-promoting factor in this case was cow's milk
protein
...

THE GRAND FINALE
Thus far we had relied on experiments where we measured only the early indicators of tumor development, the early cancer-like foci
...
We organized a very large study of several hundred
rats and examined tumor formation over their lifetimes using several
different approaches
...
Rats generally live for about two years, thus the
study was 100 weeks in length
...
36
...
This was a virtual 100 to
o score, something almost never seen in research and almost identical
6
to the original research in India
...
Animals switched from a high-protein to a low-protein diet had
significantly less tumor growth (35°tb-40% less!) than animals fed a highprotein diet
...
9A: TUMOR DEVELOPMENT AT 100 WEEKS
QJ

3330

VI

c

o

0
...
98: EARLY FOCI, "LlFETIME"

40

6

QJ
VI

C

0

0
...
20

'u
0

LL

0
% Dietary Casein

14

o

VI
QJ

22

62

THE CHINA STUDY

diet halfway through their lifetime started growing tumors again
...

Namely, nutritional manipulation can turn cancer "on" and "off
...
The
correspondence between foci growth and tumor growth could not have
been greater (Chart 3
...
36,43
How much more did we need to find out? I would never have dreamed
that our results up to this point would be so incredibly consistent, biologically plausible and statistically significant
...

Let there be no doubt: cow's milk protein is an exceptionally potent
cancer promoter in rats dosed with aflatoxin
...

OTHER CANCERS, OTHER CARCINOGENS
Okay, so here's the central question: how does this research apply to human health and human liver cancer in particular? One way to investigate
this question is to research other species, other carcinogens and other
organs
...
So our research became broader in scope, to see whether our discoveries would hold up
...
It was thought that people who
remained chronically infected with HBV had twenty to forty times the
risk of getting liver cancer
...
46 In effect, a piece of the virus gene inserts
itself into the genetic material of the mouse liver where it initiates liver
cancer
...

Virtually all of the research done in other laboratories on HBV transgenic mice-and there was a lot of it-was done primarily to understand
the molecular mechanism by which HBV worked
...
I watched with
some amusement for several years how one community of researchers
argued for aflatoxin as the key cause of human liver cancer and another

TURNING OFF CANCER

63

community argued for HBV No one in either community dared to suggest that nutrition had anything to do with this disease
...
This was a big step
...
A brilliant young graduate student from China in
my group, Jifan Hu, initiated studies to answer this question and was later
joined by Dr
...
We needed a colony of these transgenic
mice
...
Each strain had a different piece of
HBV gene stuck in the genes of their livers, and each was therefore highly
prone to liver cancer
...
Both research
groups asked what we wanted to do and both were inclined to think that
studying the protein effect was foolish
...
The reviewers did nol take kindly
to the idea of a nutritional effect on a virus-induced cancer, especially of
a dietary protein effect
...

We eventually obtained funding, did the study on both strains of
mice and got essentially the same result as we did with the rats
...
The adjoining picture (Chart 3
...

The dark-colored material is indicative of cancer development (ignore
the "hole"; that's only a cross-section of a vein)
...

The adjoining graph (Chart 3
...
Both the
picture and the graph show the same thing: the 22% casein diet turned
on expression of the viral gene to cause cancer, whereas the 6% casein
diet showed almost no such activity
...
10: DIETARY PROTEIN EFFECT ON GENETICALLY-BASED
(HBV) LIVER CANCER (MICE)

Non-transgenic Mice
(Control) with 22%
Casein Diet

Transgenic Mice with
6% Casein Diet

Transgenic Mice with
14% Casein Diet

CHART 3
...


8

><

•

~ 6

022

c

(l)

l:J

4
2

o

14

-Je=---

HBV Gene A

HBV Gene B

TURNING OFF CANCER

65

Not only are these effects substantial, but we also discovered a network of complementary ways by which they worked
...
49- 51 This research showed that increasing intakes of casein promoted the development of mammary (breast) cancer
...
For two
different organs, four different carcinogens and two different species,
casein promotes cancer growth while using a highly integrated system
of mechanisms
...
For
example, casein affects the way cells interact with carcinogens, the way
DNA reacts with carcinogens and the way cancerous cells grow
...
First, rats and humans have an
almost identical need for protein
...
Third, the level of protein intake
causing tumor growth is the same level that humans consume
...
This is because we are very
likely "dosed" with a certain amount of carcinogens in our everyday
lives, but whether they lead to full tumors depends on their promotion,
or lack thereof
...
This was an
exceptionally provocative finding that drew fierce skepticism
...
I wanted to broaden
my evidence still more
...

We initiated more studies using several different nutrients, including
fish protein, dietary fats and the antioxidants known as carotenoids
...
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
...
The Journal of
the National Cancer Institute, which is the official publication of the U
...

National Cancer Institute, took note of these studies and featured some
of our findings on its cover
...
In our large lifetime study of
rats with aflatoxin-induced tumors, the pattern was consistent
...
In studies done by another research group, with breast cancer and different carcinogens, the pattern was consistent
...
52 ,53 In studies on carotenoid
antioxidants and cancer initiation, the pattern was consistent
...
From one mechanism to another, the
pattern was consistent
...
Although there are strong arguments that these provocative findings are qualitatively relevant to human
health, we cannot know the quantitative relevance, In other words, are
these principles regarding animal protein and cancer critically important
for all humans in all situations, or are they merely marginally important
for a minority of people in fairly unique situations? Are these prin-

TURNING OFF CANCER

67

ciples involved in one thousand human cancers every year, one million
human cancers every year, or more? We need direct evidence from human research
...

Having the opportunity to do such a study is rare, at best, but by
incredibly good luck we were given exactly the opportunity we needed
...
Junshi
Chen
...
We were given the chance to do a human study that would
take all of these principles we had begun to uncover in the lab to the
next level
...
We were on to the China Study
...
4
...

For some people, those moments center on family, close friends or related activities; for others those moments may center on nature, spirituality or religion
...

They become the personal moments, both happy and sad, which define
our memories
...
" They are the snapshots of time that define much of our life
experience
...
We
construct experiments, hoping to preserve and analyze the specific details of a certain moment for years to come
...
Junshi Chen, came to Cornell to work in
my lab
...
S
...

THE CANCER ATLAS
In the early 1970s, the premier of China, Chou EnLai, was dying of
cancer
...
It was to be a monumental survey of death rates for
twelve different kinds of cancer for more than 2,400 Chinese counties
and 880 million (96%) of their citizens
...
It involved 650,000 workers, the most ambitious biomedical research project ever undertaken
...
1
CHART 4
...
----_
...
::--

I

This atlas made it clear that in China cancer was geographically localized
...
Earlier studies had set the stage for this idea, showing that
cancer incidence also varies widely between different countries
...
2)
...


71

LESSONS FROM CHINA

CHART 4
...
RANGE OF CANCER RATES IN CHINESE COUNTIES
Cancer Site

Males

Females

All Cancers

35-721
0-75
1-435
6-386
7-248
2-67
3-59

35-491
0-26
0-286
2-141
3-67
2-61
0-26
0-20

Nasopharynx
Esophagus
Stomach
liver
Colorectal
Lung
Breast

-

*Age-adjusted death rates, representing # cases/l 00,000 people/year

Why was there such a massive variation in cancer rates among different counties when genetic backgrounds were similar from place to
place? Might it be possible that cancer is largely due to environmentalJ
lifestyle factors, and not genetics? A few prominent scientists had already reached that conclusion
...
s
...
4
The data behind the China cancer atlas were profound
...
These
are truly remarkable figures
...
S
...

In fact, very small and relatively unimportant differences in cancer
rates make big news, big money and big politics
...
Large amounts of money (about $30 million5) and years and years of work have been spent examining the issue
...
This difference was enough to make front-page news, scare people
and move politicians to action
...


72

THE CHINA STUDY

Because China is relatively homogenous genetically, it was clear that
these differences had to be explained by environmental causes
...
5
...
Chen and I talked, the more we wished that we had
a snapshot in time of the dietary and environmental conditions in rural China
...
If only we could construct a picture of their experience with
unprecedented clarity and detail so that we could study it for years to
come
...

Occasionally science, politics and financing come together in a way
that allows a truly extraordinary study to take place
...

We were able to create the most comprehensive snapshot of diet, lifestyle and disease ever taken
...
There was Dr
...
We enlisted Dr
...
The third
member was Richard Peto of Oxford University
...
I rounded out the team
as the Project Director
...
It was to be the first major research
project between China and the United States
...
We were on our way
...
From
the Cancer Atlas, we had access to disease mortality rates on more than

LESSONS FROM CHINA

73

four dozen different kinds of disease, including individual cancers,
heart diseases and infectious diseases
...
We
went into sixty-five counties across China and administered questionnaires and blood tests on 6,500 adults
...

The sixty-five counties selected for the study were located in rural
to semi-rural parts of China
...
This was a successful strategy, as we were to learn
than an average of 90-94% of the adult subjects in each county still
lived in the same county where they were born
...
We had a
study that was unmatched in terms of comprehensiveness, quality and
uniqueness
...
" In short, we had created that revealing snapshot of time
that we had Originally envisioned
...
Were the findings in the lab going
to be consistent with the human experience in the real world? Were our
discoveries on aflatoxin-induced liver cancer in rats going to apply to
other types of cancer and other types of diseases in humans?

FOR MORE INFORMATION
We take great pride in the comprehensiveness and quality of the
China Study
...
You'll find
a more complete discussion of the basic design and characteristics
of the study
...
It was a rare opportunity to study health-related effects of a mostly plant-based diet
...
But in

74

THE CHINA STUDY

rural China only 9-10% of total calories comes from protein and only
10% of the protein comes from animal-based foods
...
3
...
3
...
5
33
64
0
...
3 are standardized for a body weight
of Sixty-five kilograms (143 pounds)
...
(For an American adult male of seventyseven kilograms, calorie intake will be about 2,400 calories per day
...
)
In every category seen above, there are massive dietary differences
between the Chinese and American experiences: much higher overall
calorie intake, less fat, less protein, much less animal foods , more fiber
and much more iron are consumed in China
...

While the eating pattern in China is far different from that of the
United States, there is still a lot of variation within China
...
e
...
Fortunately, in the China Study considerable
variation existed for most of the measured factors
...
2) and more than adequate variation for clinical measurements and food intakes
...
This was

LESSONS FROM CHINA

75

crucial, as we primarily were concerned with comparing each county in
China with every other county
...
In effect, we are
comparing, within the Chinese range, diets rich in plant-based foods
to diets very rich in plant-based foods
...
The difference
between rural Chinese diets and Western diets, and the ensuing disease patterns, is enormous
...

The media called the China Study a "landmark study
...
"8 Some in the medical establishment
said another study like this could never be done
...

Now, I want to show you what we learned from this study and how
twenty more years of research, thought and experience have changed
not only the way I think about the connection between nutrition and
health, but the way my family and I eat as well
...
There's only
one thing that we have to do in life, and that is to die
...
But I take a different view
...
Good health is about being able to fully enjoy the
time we do have
...
There are many better ways to die, and to live
...
We wondered: do certain diseases tend
to group together in certain areas of the country? For example, did
colon cancer occur in the same regions as diabetes? If this proved to
be the case, we could assume that diabetes and colon cancer (or other
diseases that grouped together) shared common causes
...
However, because all diseases are
biological processes (gone awry), we can assume that whatever "causes"
are observed, they will eventually operate through biological events
...
4)
...
4
...
4 shows that each disease, in either list, tends to associate
with diseases in its own list but not in the opposite list
...
The disease that kills most Westerners, coronary heart disease,
is more common in areas where breast cancer also is more common
...
This is not because people die at a
younger age, thus avoiding these Western diseases
...

Disease associations of this kind have been known for quite some time
...
As expected, certain diseases do cluster together in the
same geographic areas, implying that they have shared causes
...
As a developing population accumulates wealth, people change their eating habits, lifestyles and sanitation
systems
...
Because these diseases of affluence are so tightly linked to eating habits, diseases of affluence might be better named "diseases of nutritional extravagance
...
For this reason, these diseases are often
referred to as "Western" diseases
...
The
core question of the China Study was this: is it because of differences in
dietary habits?

STATISTICAL SIG NIFICANCE
As I go through this chapter, I will indicate the statistical significance of various observations
...
9+% certainty
...
ll
These probabilities also can be described as the probability that an
observation is real
...
9% certainty means a
999 in 1,000 probability that the observation is real
...
lII
IN YOUR FOOD-IN YOUR BLOOD
There are two main categories of cholesterol
...
It is a component of food, much like sugar,
fat , protein, vitamins and minerals
...
How much
dietary cholesterol you consume is not something your doctor can
know when he or she checks your cholesterol levels
...
Instead, the
doctor measures the amount of cholesterol present in your blood
...

Blood cholesterol and dietary cholesterol, although chemically identical, do not represent the same thing
...
Dietary fat is the stuff you eat: the grease on your French fries, for
example
...
Dietary fats and cholesterol don't necessarily turn into body fat and blood cholesterol
...

Because of this complexity, the health effects of eating dietary fat and
dietary cholesterol may be very different from the health effects of
having high blood cholesterol (what your doctor measures) or having
too much body fat
...
What made this so
surprising was that Chinese levels were far lower than we had expected
...
For two groups of about
twenty-five women in the inner part of China, average blood cholesterol
was at the amazingly low level of 80 mg/dL
...
In the U
...
, our range is around 170-290 mg/dL
...
Indeed, in the
U
...
, there was a myth that there might be health problems if cholesterol
levels were below 150 mg/dL
...
But the truth is
quite different
...

At the outset of the China Study, no one could or would have predicted that there would be a relationship between cholesterol and
any of the disease rates
...
As you can see , this is a sizable list
...

There are several types of blood cholesterol, including LDL and HDL
cholesterol
...
In the
China Study higher levels of the bad LDL cholesterol also were associated with Western diseases
...
Our findings made a convincing case that many
Chinese had an advantage at the lower cholesterol levels, even below
170 mgldL
...
You might expect
that these relatively rare diseases, such as heart disease and some cancers, would be prevelant, perhaps even the leading killers!
Of course, this is exactly the case in the West
...
13 The American death rate from breast cancer was five times
higher than the rural Chinese rate
...
During a three-year observation period (1973-1975),
there was not one single person who died of CHD before the age of sixty-four, among 246,000 men in a Guizhou county and 181 ,000 women
in a Sichuan county! 14
After these low cholesterol data were made public, I learned from
three very prominent heart disease researchers and physicians, Drs
...
, that in their long
careers they had never seen a heart disease fatality among their patients
who had blood cholesterol levels below 150 mgldL
...
Castelli was the
long-time director of the famous Framingham Heart Study of NIH; Dr
...
Roberts has
long been editor of the prestigious medical journal Cardiology
...
The
big question is: how will food affect blood cholesterol? In brief, animalbased foods were correlated with increasing blood cholesterol (Chart
4
...
With almost no exceptions, nutrients from plant-based foods were
associated with decreasing levels of blood cholesterol
...
1s- 18 Saturated fat and dietary cholesterol also raise blood
cholesterol, although these nutrients are not as effective at doing this as
is animal protein
...
All of this was consistent with the findings from the
China Study
...
5
...


Blood Cholesterol goes up
...


Blood Cholesterol goes down
...
In rural China, animal protein
intake (for the same individual) averages only 7
...
To put this into perspective, seven
grams of animal protein is found in about three chicken nuggets from
McDonald's
...
But we were
wrong
...

We studied dietary effects on the different types of blood cholesterol
...
Animal protein consumption by

LESSONS FROM CHINA

81

men was associated with increasing levels of "bad" blood cholesterolIIl
whereas plant protein consumption was associated with decreasing levels of this same cholesterol
...
In more recent decades, some might also
mention the cholesterol-lowering effect of soy or high-fiber bran products, but few will say that animal protein has anything to do with blood
cholesterol levels
...
While on sabbatical at the University
of Oxford, I attended lectures given to medical students on the dietary
causes of heart disease by one of their prominent professors of medicine
...
He was unwilling to concede that
animal protein consumption had anything to do with blood cholesterol
levels, even though the evidence at that time made it abundantly clear
that animal protein was more strongly correlated with blood cholesterol
levels than saturated fat and dietary cholesterol
...

As these findings poured in, 1 was beginning to discover that being
open-minded was not a luxury, but a necessity
...
So many people, from
researchers to educators, from government policy makers to industry
representatives, have investigated or made pronouncements on fat for
so long
...

As this strange parade got started on Main Street, USA, the attention
of everyone sitting on the sidewalks would ineVitably be drawn to the
fat float
...
Others would climb on the
unsaturated half of the float and say that these fats are healthy and only
saturated fats are bad
...

Meanwhile, some self-proclaimed diet gurus, like the late Dr
...
At the

82

THE CHINA STUDY

end of the day the average person who gorged on the float would be left
scratching his head and feeling queasy, wondering what he should have
done and why
...
The
unanswered questions on fat remain unanswered, as they have for the
past forty years
...
The details that underlie these questions, when considered in isolation, are very misleading
...

In some ways, however, it is this foolish mania regarding isolated aspects of fat consumption that teaches us the best lessons
...
It illustrates why the public is so confused both about
fat and about diet in general
...
19 We have
been consuming high-fat diets like this since the late nineteenth century,
at the onset of our industrial revolution
...

We were demonstrating our affluence by consuming such foods
...
National
and international dietary recommendations 2°-B emerged to suggest that
we should decrease our fat intake below 30% of calories
...
Some authors of popular books even advocate increased fat intake!
Some experienced researchers have suggested that it is not necessary to
go below 30% fat, as long as we consume the right kind of fat
...
Let's get some perspective on this figure by considering the fat contents of a few foods, as
seen in Chart 4
...


LESSONS FROM CHINA

83

CHART 4
...
5%
1%

With a few exceptions, animal-based foods contain considerably
more fat than plant-based foods
...
The correlation
between fat intake and animal protein intake is more than 90%
...
In
other words, dietary fat is an indicator of how much animal-based food
is in the diet
...


FAT AND A FOCUS ON CANCER
The 1982 National Academy of Sciences (NAS) report on Diet, Nutrition and Cancer, of which I was a co-author, was the first expert panel
report that deliberated on the association of dietary fat with cancer
...
Previously, the U
...
Senate Select
Committee on Nutrition chaired by Senator George McGovern 26 held
widely publicized hearings on diet and heart disease and recommended
a maximum intake of 30% dietary fat
...
Its focus on cancer, as opposed to heart disease, increased public interest and concern
...

0
Many of the reports at the time 2 , 27, 28 were centered on the question of
how much dietary fat was appropriate for good health
...
These were the
diseases that kill the majority of people in Western countries before their
time
...
The China Study was begun in the midst of this environment
...
His findings
showed a very impressive relationship between dietary fat and breast
cancer (Chart 4
...

This finding, which corresponded to the earlier reports of others,3,3O
became especially intriguing when compared with migrant studies
...
This strongly
CHART 4
...
NETHERLANDS

...

• NEW ZEALAND

...
US
BELGIUM
AUSTRALIA •• SWEDEN

25
FEMALE

ci
...

o 20

o
o
d
o

AUSTRIA
...
FRANCE

...
s
~

HONG KONG • POLAND
CHilE
•
•
• BULGARIA

...
PUERTO RICO
•
•
• MEXICO
JAPAN
...
El SALVADOR

5

cV

C\


o
o

20

40

60

80

100

120

Total Dietary Fat Intake (g/day)

140

160

180

85

LESSONS FROM CHINA

implied that diet and lifestyle were the principle causes of these diseases
...

As noted earlier, a very prominent report by Sir Richard Doll and Sir
Richard Peto of the University of Oxford (U
...
) submitted to the u
...

Congress summarized many of these studies and concluded that only
2-3% of all cancers could be attributed to genes
...
Concerning the evidence in Chart 4
...

Most scientists made this conclusion and some surmised that dietary
fat caused breast cancer
...
Other
charts prepared by Professor Carroll were largely, almost totally, ignored
(Charts 4
...
9)
...

In rural China, dietary fat intake (at the time of the survey in 1983)
was very different from the United States in two ways
...
5% of calorie intake in China, compared with about 36% in the U
...

Second, the amount of fat in the diets of rural China depended almost
entirely on the amount of animal-based food in the diet, just like the
CHART 4
...
,SWEDEN 'AUSTRALIA
'ITALY

'PORTUGAL
HONG KONG
BULGARIA C~ILE
VENEZUELA\"'ROMANIA

,
'
,NORWAY
AUSTRIA 'FRANCE
, CZECH
,FINLAND
HUNGARY

,

' POLAND

PANAM!GREECE~p!NYUGOSLAVIA
PHILIPPINES
...
9: PLANT FAT INTAKE AND BREAST CANCER
FEMALE
e NETHERLANDS

25

UKe
e
e e DENMARK
NEW ZEALAND
CANADA
e IRELAND
BELGIUM e

0
...


2

ro

e

eSWITZERLAND
USA

eSWEDEN
AUSTRIA e e GERMANY
e FRANCE elTALY
e CZECHOSLOVAKIA

NORWAye

15

cr:

FINLANDe eHUNGARY


...


e PORTUGAL

+-'

ro

(l)

o

""0

~
:J

10

POLAND e
HONG KONGeeBULGARIA
CHILE e
e
ROMANIAe VENEZUELA
e
epANAMA
e PUERTO RICO
YUGOSLAVIA
PHILIPPINEse eCOLOMBIA
e MEXICO
TAIWANe e JAPAN
eCEYLON
e EL SALVADOR
THAILAND e

~
(l)

::t

5

o
o

10

20

30

40

eSPAIN
eGREECE

50

60

70

Vegetable Fat Intake (g/day)

findings in Chart 4
...
The correlation between dietary fat and animal
protein in rural China was very high, at 70-84%,33 similar to the 93%
seen when comparing different countries
...

Thus, the association between fat and breast cancer might really be telling us that as consumption of animal-based foods goes up, so does breast
cancer
...
s
...
We get as much or more fat from
plant-based food (potato chips, French fries) as we get from processed
animal-based foods (skim milk, lean cuts of meat)
...

At this very low range of dietary fat in China, from 6%-24%, I initially thought that dietary fat would not be linked with diseases like
heart disease or the various cancers, as it is in the West
...
S
...
Therefore, a low-fat diet containing only

LESSONS FROM CHINA

87

25-30% fat was thought to be low enough to obtain the maximum
amount of health benefits
...
Surprise!
Findings from rural China showed that reducing dietary fat from
24% to 6% was associated with lower breast cancer risk
...

This connection of breast cancer with dietary fat, thus with animalbased foods, brought into consideration other factors that also place a
woman at risk for breast cancer:

•
•
•
•

Early age of menarche (age of first menstruation)
High blood cholesterol
Late menopause
High exposure to female hormones

What does the China Study show regarding these risk factors? Higher
dietary fat is associated with higher blood cholesteroF and both of these
factors, along with higher female hormone levels, are associated, in
turn, with more breast cancer! and earlier age of menarche
...
Twenty-five women in each of the l30 villages in the survey were asked when
they had their first menstrual period
...
The U
...

average is roughly eleven years!
Many studies have shown that earlier menarche leads to higher risk for
breast cancer
...
It also is well established
that rapid growth of young girls often leads to greater adult body height
and more body weight and body fatness, each of which is associated with
higher breast cancer risk
...
These hormone levels remain high throughout the reproductive
years if consumption of a diet rich in animal-based food is maintained
...
Other studies have shown that an increase in years of reproductive life is associated with increased breast cancer risk
...
Higher

88

THE CHINA STUDY

fat consumption is associated with higher blood levels of estrogen during the critical years of thirty-five to forty-four years Ill and higher blood
levels of the female hormone prolactin during the later years of fifty-five
to sixty-four years
...
3?
Nonetheless, when hormone levels among Chinese women were compared with those of British women,38 Chinese estrogen levels were only
about one-half those of the British women, who have an eqUivalent hormone profile to that of American women
...
This corresponds to Chinese
breast cancer rates that are only one-fifth of those of Western women
...
It makes clear that
we should not have our children consume diets high in animal-based
foods
...
magazine founder Gloria Steinem, is
that eating the right foods could reduce teenage pregnancy by delaying
the age of menarche
...
Animal protein intake was convincingly associated
in the China Study with the prevalence of cancer in families
...

Diet and disease factors such as animal protein consumption or
breast cancer incidence lead to changes in the concentrations of certain chemicals in our blood
...

As an example, blood cholesterol is a biomarker for heart disease
...
39 Do they confirm the finding that animal protein intake is asso-

LESSONS FROM CHINA

89

cia ted with cancer in families? Absolutely
...
lI-m
In this case, multiple observations, tightly networked into a web,
show that animal-based foods are strongly linked to breast cancer
...

First, the individual parts of this web were consistently correlated and,
in most cases, were statistically significant
...

Our investigation of breast cancer (detailed further in chapter seven)
is a perfect example of what makes the China Study so convincing
...
We were able to examine in multiple ways
the role of diet and cholesterol, age of menarche and female hormone
levels, all of which are known risk factors for breast cancer
...


THE IMPORTANCE OF FIBER
The late Professor Denis Burkitt, of Trinity College, Dublin, was unusually articulate
...
The subject of his work was dietary fiber
...

He asserted that even though fiber was not digested, it was vital for
good health
...
These undigested fibers, like stick-urn paper, also gather up nasty chemicals that find their way into our intestines
and that might be carcinogenic
...
According to Burkitt, these include large bowel cancer, diverticulosis, hemorrhoids and varicose veins
...
Burkitt was awarded the prestigious Bower Award, the
richest award in the world next to the Nobel Prize
...
He offered his opinion
that our China Study was the most significant work on diet and health
in the world at that time
...
This material, which gives rigidity to the cell walls of plants, comes in thousands
of different chemical variations
...
We digest very little or no fiber
...
In doing so, it satisfies our hunger and minimizes
the overconsumption of calories
...
lO) is about three times higher in China
than in the U
...
40 These differences are exceptional, especially considering the fact that many county averages were even much higher
...
s
...
They contend that if fiber intake is too high our bodies
are not able to absorb as much iron and related minerals, which are
essential for health
...
They say
that the maximum level of fiber intake should be around thirty to thirtyfive grams per day, which is only about the average intake of the rural
Chinese
...
As
it turns out, fiber is not the enemy of iron absorption as so many experts
claim it to be
...
Iron was measured in six different ways (four blood biomarkers and two estimates of iron intake) and
CHART 4
...
In fact, we found the opposite effect
...
I As it turns out, high-fiber foods, like wheat
and corn (but not the polished rice consumed in China) also happen to
be high in iron, meaning that the higher the consumption of fiber, the
higher the consumption of ironYI Iron intake in rural China (34 mg/
day) was surprisingly high when compared to the average American intake (18 mg/day) and it was far more associated with plant-based foods
than with animal-based foodsY
The China findings on dietary fiber and iron, like so many other observations in this study, did not support the common view of Western
scientists
...
Unfortunately, a bit of confusion has arisen over the fact that some people in rural China, including
women and children, have low iron levels
...
In areas of rural China
where parasitic diseases were more common, iron status was lower
...

Much of the initial interest in dietary fiber arose with Burkitt's travels
in Africa and his claim that large bowel cancer is lower among populations who consume high-fiber diets
...
In England during the late eighteenth century and early nineteenth century, it was claimed by some of
the leading phYSicians that constipation, which was associated with less
bulky diets (i
...
, low-fiber diets), was associated with a higher risk of
cancer (usually breast and "intestinal" cancers)
...
exerts a
protective effect against colorectal cancer in humans
...
if there is such an effect, specific components of
fiber, rather than total dietary fiber, are more likely to be responsible
...
The question,

92

THE CHINA STUDY

the review of the research literature and the interpretation of the evidence were too focused on looking for a specific fiber as the responsible
cause
...

It was a mistake
...
The results showed that high-fiber intake
was consistently associated with lower rates of cancers of the rectum
and colon
...
l •1I Of course, high-fiber consumption reflected high
plant-based food consumption; foods such as beans, leafy vegetables
and whole grains are all high in fiber
...
If you admire how food is presented, it's hard to beat
a plate of fruits and vegetables
...
This link between
nicely colored vegetables and their exceptional health benefits has often
been noted
...

The colors of fruits and vegetables are derived from a variety of chemicals called antioxidants
...
They are only present in animal-based foods to the extent that
animals eat them and store a small amount in their own tissues
...
They take the energy of the sun and transform it into life through
the process of photosynthesis
...

This complex process amounts to some pretty high-powered activity
within the plant, all of which is driven by the exchange of electrons between molecules
...
The site
at which photosynthesis takes place is a bit like a nuclear reactor
...
If they stray from
their rightful places in the process, they may create free radicals, which
can wreak havoc in the plant
...

So how does the plant manage these complex reactions and protect

LESSONS FROM (HINA

93

against errant electrons and free radicals? It puts up a shield around
potentially dangerous reactions that sponges up these highly reactive
substances
...

Antioxidants are usually colored because the same chemical property
that sponges up excess electrons also creates visible colors
...

They vary in color from the yellow color of beta-carotene (squash), to
the red color of lycopene (tomatoes), to the orange color of the oddsounding crytoxanthins (oranges)
...

What makes this remarkable process relevant for us animals, however, is that we produce low levels of free radicals throughout our lifetime
...
Free radicals are nasty
...
It is a bit like
old age, when our bodies become creaky and stiff
...
This uncontrolled free radical damage also is part of the
processes that give rise to cataracts, to hardening of the arteries, to cancer, to emphysema, to arthritis and many other ailments that become
more common with age
...
As we are not plants, we do not carry
out photosynthesis and therefore do not produce any of our own antioxidants
...
It is a wonderful harmony
...
Then we animals,
in turn, are attracted to the plants and eat them and borrow their antioxidant shields for our own health
...

In the China Study, we assessed antioxidant status by recording the
intakes of vitamin C and beta-carotene and measuring the blood levels
of vitamin C, vitamin E and carotenoids
...


94

THE CHINA STUDY

The most significant vitamin C association with cancer was its relationship with the number of cancer-prone families in each areaY
When levels of vitamin C in the blood were low, these families were
more likely to have a high incidence of cancer
...
It was esophageal cancer that first attracted
NOVA television program producers to report on cancer mortality in
China
...
Vitamin C primarily comes from
fruit, and eating fruit was also inversely associated with esophageal
cancer
...
The same vitamin C effect existing for these
cancers also existed for coronary heart disease, hypertensive heart disease and strokeY Vitamin C intake from fruits clearly showed a powerful protective effect against a variety of diseases
...
These antioxidants are transported in the blood by lipoprotein, which is the carrier of
"bad" cholesterol
...
This was an experimental compromise that diminished our ability to detect the beneficial
effects of the carotenoids and the tocopherols, even when these benefits
are known to exist
...
45
Can we say that vitamin C, beta-carotene and dietary fiber are solely
responsible for preventing these cancers? In other words, can a pill containing vitamin C and beta-carotene or a fiber supplement create these
health effects? No
...
In a bowl of spinach salad, for example, we have fiber, antioxidants and countless other nutrients that are orchestrating a wondrous
symphony of health as they work in concert within our bodies
...

I have been making this point about the health value of whole plantbased foods ever since vitamin supplements were introduced on a large

LESSONS FROM CHINA

95

scale in the marketplace
...
As
we shall see in the later chapters, the promised health benefits of taking Single-nutrient supplements are proving to be highly questionable
...

THE ATKINS CRISIS

In case you haven't noticed, there is an elephant in the room
...
Almost all
diet books on store shelves are variations of this one theme: eat as much
protein, meat and fat as you want, but stay away from those "fatty"
carbs
...
So what is the story,
anyway?
One of the fundamental arguments at the beginning of most lowcarbohydrate, high-protein diet books is that America has been wallowing in low-fat mania at the advice of experts for the past twenty years,
yet people are fatter than ever
...
6 to 65
...
" It is
true that we have had a trend to consuming fewer of our total calories
as fat, when considered as a percentage, but that's only because we have
outpaced our gorging on fat by gorging on sugary junk food
...

In fact, the claim that the low-fat "brainwashing" experiment has
been tried and failed is often the first of many statements of fact in
current diet books that can be described either as severe ignorance or
opportunistic deceit
...
And
yet these books are immensely popular
...


96

THE CHINA STUDY

In one published study47 funded by the Atkins Center for Complementary Medicine, researchers put fifty-one obese people on the Atkins
diet
...
In addition, average
blood cholesterol levels decreased slightly,47 which was perhaps even
more important
...
Unfortunately, the media didn't go much deeper than that
...
The average
American consumes about 2,250 calories per day
...
That's 35% fewer calories! I don't care if you eat worms
and cardboard; if you eat 35% fewer calories, you will lose weight and
your cholesterol levels will improve50 in the short run, but that is not to
say that worms and cardboard form a healthy diet
...
People are notoriously unsuccessful at significantly restricting their energy intake over any long period of
time, and that is why there has yet to be a long-term study that shows
success with the "low-carb" diets
...

In this same study, funded by the Atkins group, researchers report,
"At some point during the twenty-four weeks, twenty-eight subjects
(68%) reported constipation, twenty-six (63%) reported bad breath,
twenty-one (51%) reported headache, four (10%) noted hair loss, and
one woman (1%) reported increased menstrual bleeding
...
vomiting,
amenorrhea [when a girl misses her period], hypercholesterolemia
[high cholesterol] and
...
cited)
...
The weight loss, some of which is simply
initial fluid 10SS,51 may come with a very high price
...
"51 One teenage girl recently died suddenly after
being on a high-protein diet
...
I have heard one doctor call high-protein, high-fat, low-carbohydrate diets "make-yourself-sick" diets, and I think that's an appropriate moniker
...

One final thought: the diet is not all that Atkins recommends
...

In the case of the Atkins diet, Dr
...
"54 In one passage, after making unsubstantiated
claims about the efficacy of antioxidant supplements that contradict
recent studies,55 he writes, "Add to the [antioxidants] the vita-nutrients known to be useful for each of the myriad medical problems my
patients face , and you'll see why many of them take over thirty vitamin
pills a day
...

Perhaps it is a testament to the power of modern marketing savvy that
an obese man with heart disease and high blood pressure 57 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
...
As you will see in this book, there is a mountain of scientific
evidence to show that the healthiest diet you can possibly consume is
a high-carbohydrate diet
...
But it's not
quite as simple as that
...
When these foods are consumed in the
unprocessed, unrefined and natural state, a large proportion of the carbohydrates are in the so-called "complex" form
...

This category of carbohydrates includes the many forms of dietary fiber,
almost all of which remain undigested-but still provide substantial
health benefits
...
Fruits, vegetables and whole grains are the healthiest
foods you can consume, and they are primarily made of carbohydrates
...
Typical simple carbohydrates are found in foods like white
bread, processed snack items including crackers and chips made with
white flour, sweets including pastries and candy bars and sugar-laden soft
drinks
...
They are readily broken down
during digestion to the simplest form of the carbohydrates, which are
absorbed into the body to give blood sugar, or glucose
...
For example, in 1996, 42% of Americans ate cakes, cookies,
pastries or pies on any given day, while only 10% ate any dark green
vegetables
...
Add to that
the fact that the average American consumed thirty-two teaspoons of
added sugars per day in 1996,46 and it's clear that Americans are gorging
almost excluSively on refined, simple carbohydrates, at the exclusion of
healthful complex carbohydrates
...
On this

LESSONS FROM CHINA

99

point, the popular diet authors and I agree
...
Eating this way is a bad idea
...
In
experimental research, the health benefits of a high-carbohydrate diet
come from eating the complex carbohydrates found in whole grains,
fruits and vegetables
...


THE CHINA STUDY WEIGHS IN
With regard to weight loss, there are some surprising findings from the
China Study that shed light on the weight loss debate
...
S
...
Very simply, there were not enough calories
to go around
...

We wanted to compare the calorie consumption in China and
America, but there was a catch
...
To
compare an extremely active laborer with an average American would
be misleading
...
The vast difference in calorie intake sure
to exist between these individuals would tell us nothing of value and
only confirm that the manual laborer is more active
...
After figuring out the calorie intakes of the least active Chinese, the equivalent of office workers,
we then compared their calorie intake with the average American
...

Average calorie intake, per kilogram of body weight, was 30% higher
among the least active Chinese than among average Americans
...
11)
...
11: CALORIE CONSUMPTION (KCAL/KG)
AND BODY WEIGHT

Average Body Mass Index

Calorie Intake (kcal/kg)

30

25
20
15
10~~--~~~---L~

China

u
...


China

u
...


There are two possible explanations for this apparent paradox
...

age Americans
...
Thus, they consume more calories
...

We do know, however, that some people use the calories they consume differently from other people
...
" You know these
people
...
Then there are most of us, who need to watch our calorie
intake-or so we think
...

I have a more comprehensive interpretation that is based on our own
considerable research and on the studies of others
...

Provided that we aren't restricting our calorie intake, those of us who
consume a high-fat, high-protein diet simply retain more calories than
we need
...

Here's the clincher: only a small amount of calories needs to be retained by our body to cause significant change in body weight
...
You may not think that this is a lot, but over
a period of five years, that's an extra fifty pounds
...
This, theoretically, could make a difference, but it

LESSONS FROM CHINA

101

is entirely impractical
...
Think about eating a meal at a restaurant
...

The truth is this: despite any short-term caloric restriction regimes
we may follow, our body, through many mechanisms, will ultimately
choose how many calories to take in and what to do with them
...

The body employs a delicate balancing act and some very intricate
mechanisms in deciding how to use the calories being consumed
...
The body is using multiple intricate mechanisms to decide how
calories get used, stored or "burned off
...
In contrast,
diets low in protein and fat cause calories to be "lost" as body heat
...
I bet that you would rather be a little more
inefficient and convert it into body heat rather than body fat, right?
Well, simply consuming a diet lower in fat and protein can do this
...
Chinese consume more
calories both because they are more physically active and because their
consumption of low-fat, low-protein diets shifts conversion of these
calories away from body fat to body heat
...
Remember, it takes very little, only fifty calories a day, to change our storage of body fat and thus change our body
weight
...
They routinely consumed slightly more calories,
gained less weight, disposed of the extra calories as body heat59 and voluntarily exercised more,60 while still having far less cancer than animals
on standard diets
...
59

102

THE CHINA STUDY

Understanding that diet can cause small shifts in calorie metabolism that lead to big shifts in body weight is an important and useful
concept
...
It also accounts for the frequent observations (discussed in chapter six) that people who consume low-protein,
low-fat diets composed of whole plant foods have far less difficulty with
weight problems, even if they consume the same, or even slightly more,
total calories
...
But
what if you want to become bigger? A desire to be as big as possible
is pervasive in most cultures
...

Body size seems to be a mark of prowess, manliness and dominance
...
This belief stems from the idea that consuming
protein (a
...
a
...
This has been a common notion the world over for a long time
...
Animal-based foods have
more protein, and this protein is considered to be of "higher quality
...

There is, however, a problem with the idea that consuming animalbased foods is a good way of becoming bigger
...
In
the China Study; for example, animal protein consumption was associated
with taller and heavier! people, but was also associated with higher levels
of total and bad cholesterolY Furthermore, body weight, associated with
animal protein intake,! was associated with more cancerII -III and more coronary heart diseaseY It seems that being bigger, and presumably better,
comes with very high costs
...
This information proved surprising
...
6l However, this effect was primarily attributed
to plant protein, because it makes up 90% of the total Chinese protein
intake
...
1! But the good news is this: Greater plant protein intake was
closely linked to greater heightIl and body weightY Body growth is linked
to protein in general and both animal and plant proteins are effective!
This means that individuals can achieve their genetic potential for
growth and body size by consuming a plant-based diet
...
Under
these conditions, growth is stunted and people do not reach their genetic potential for adult body size
...
III
These findings support the idea that body stature can be achieved
by consuming a low-fat, plant-based diet, provided that public health
conditions effectively control the diseases of poverty
...
)
can be simultaneously minimized
...
It better regulates blood cholesterol and reduces
heart disease and a variety of cancers
...
Such consistency of evidence across a broad range
of associations is rare in scientific research
...
It defies the status quo, promises new health benefits
and demands our attention
...
Chapter three delineates the decades-long laboratory work we did with experimental animals, work that passed the
requirements to be called "good science
...
Adjusting the amount of dietary casein has
the power to turn on and turn off cancer growth, and to override the
cancer-producing effects of aflatoxin, a very potent Class IA carcinogen,
but even though these findings were substantially confirmed, they still
applied to experimental animals
...
62
Liver cancer rates are very high in rural China, exceptionally high in
some areas
...
On average, about 12-13% of our
study subjects were chronically infected with the virus
...
2-0
...

But there's more
...
How do we know? The
blood cholesterol levels provided the main clue
...

So, where does HBV fit in? The experimental mice studies gave a
good signal
...
In addition, blood
cholesterol also increased
...
Individuals who are chronically infected with HBV and
who consume animal-based foods have high blood cholesterol and a
high rate of liver cancer
...

A very exciting story was taking shape, at least to my way of thinking
...
It also was a
story that had not been told to the public, and yet it was capable of saving lives
...


LESSONS FROM CHINA

105

So there we had it
...
But now we could see that
these processes were relevant for humans as well
...

But our findings suggested those who were infected with the virus and
who were simultaneously eating more animal-based foods had higher
cholesterol levels and more liver cancer than those infected with the
virus and not consuming animal-based foods
...

PULLING IT TOGETHER

Almost all of us in the United States will die of diseases of affluence
...
Plant-based foods are linked to lower blood cholesterol; animal-based foods are linked to higher blood cholesterol
...
Fiber and antioxidants from plants are linked to a
lower risk of cancers of the digestive tract
...
Our study was comprehensive in design and comprehensive in
its findings
...

When we first started this project we encountered significant resistance from some people
...
I had put forth the idea of investigating how lots of
dietary factors, some known but many unknown, work together to cause
disease
...
If that was what we intended to
do, he said he wanted nothing to do with such a "shotgun" approach
...
He and like-minded
colleagues think that science is best done when investigating singlemostly known-factors in isolation
...
It's okay to measure the specific
effect of, say, selenium on breast cancer, but it's not okay to measure

106

THE CHINA STUDY

multiple nutritional conditions in the same study, in the hope of identifying important dietary patterns
...
I wanted to investigate how
dietary patterns related to disease, now the most important point of this
book
...
The
more we think that a single chemical characterizes a whole food, the
more we stray into idiocy
...

So I say we need more, not less, of the "shotgun approach
...
Does this
mean that I think the shotgun approach is the only way to do research?
Of course not
...
Does it provide enough information
to inform some practical decision-making? Absolutely
...
But does every potential strand (or association) in this
mammoth study fit perfectly into this web of information? No
...
Most, but not all, have since been explained
...

I've had to use care in separating unusual findings that could be due
to chance and experimental insufficiency from those that truly offered
new insights into our old ways of thinking
...
At the
time when the China Study was begun, a blood cholesterol range of
200-300 milligrams per deciliter (mgldL) was considered normal, and
lower levels were suspect
...
In fact, my own cholesterol was 260 mgldL in the late 1970s,
not unlike other members of my immediate family
...
"
But when we measured the blood cholesterol levels in China, we
were shocked
...
It so
happens, for example, that our "normal" cholesterol levels present a

LESSONS FROM CHINA

107

significant risk for heart disease
...
Over the years, standards have been established that
are consistent with what we see in the West
...
s
...

At the end of the day, the strength and consistency of the majority
of the evidence is enough to draw valid conclusions
...
Few
other dietary choices, if any, can offer the incredible benefits of looking
good, growing tall and avoiding the vast majority or premature diseases
in our culture
...
Standing
alone, it does not prove that diet causes disease
...
Instead, a theory is proposed and debated until the
weight of the evidence is so overwhelming that everyone commonly accepts that the theory is most likely true
...
Its experimental features
(multiple diet, disease and lifestyle characteristics, and unusual range of
dietary experience, a good means of measuring data quality) provided an
unparalleled opportunity to expand our thinking about diet and disease
in ways that previously were not available
...

The results of this study, in addition to a mountain of supporting
research, some of it my own and some of it from other scientists, convinced me to turn my dietary lifestyle around
...
My cholesterol has dropped, even as I've aged; I am more
physically fit now than when I was twenty-five; and I am forty-five
pounds lighter now than I was when I was thirty years old
...
My family has also adopted this way of
eating, thanks in large part to my wife Karen, who has managed to create
an entire new dietary lifestyle that is attractive, tasty and healthy
...
From a boyhood of drinking at least two quarts
of milk a day to an early professional career of scoffing at vegetarians, I
have taken an unusual turn in my life
...
Over the years, I have gone well beyond our own research find-

108

THE CHINA STUDY

ings to see what other researchers have found regarding diet and health
...
We now can look at the work of other
scientists to put my findings into a larger context
...


DISEASES OF AFFLUENCE
HERE IN AMERICA, we are affluent, and we die certain deaths because of it
...
You probably know people who suffer from heart disease, cancer,
stroke, Alzheimer's, obesity or diabetes
...
As we have seen, these diseases are relatively unknown in traditional cultures that subsist mostly on whole plant foods,
as in rural China
...

In public lectures, I start my presentation by telling the audience
my personal story, just as I have done in this book
...
Chances are that you
yourself also have a question about a specific disease
...

You might be surprised to know that the disease that interests you
has much in common with other diseases of affluence, especially when
it comes to nutrition
...
The evidence now
amassed from researchers around the world shows that the same diet
that is good for the prevention of cancer is also good for the prevention
109

I
110

THE CHINA STUDY

of heart disease, as well as obesity, diabetes, cataracts, macular degeneration, Alzheimer's, cognitive dysfunction, multiple sclerosis, osteoporosis and other diseases
...

All of these diseases, and others, spring forth from the same influence: an unhealthy, largely toxic diet and lifestyle that has an excess of
sickness-promoting factors and a deficiency of health-promoting factors
...
Conversely, there is one diet to
counteract all of these diseases: a whole foods, plant-based diet
...

Each chapter contains evidence showing how food relates to each disease
...
For me, the consistency of evidence regarding such a
disparate group of diseases has been the most convincing aspect of this
argument
...

America and most other Western nations have gotten it wrong when
it comes to diet and health, and we have paid a grave price
...
As I have moved on from the laboratory studies and the China Study and encountered the information discussed in
Part II, I have become overwhelmed
...
Most unfortunately, the unsuspecting public has paid
the ultimate price
...
As you will come to see in the following chapters, from heart
disease to cancer, and from obesity to blindness, there is a better path
to optimal health
...
5
...
Now put your
hand where you can feel your pulse
...
Your heart, creating that pulse, is working for you every minute
of the day, every day of the year, and every year of your entire life
...
l
Now take a moment to realize that during the time it took you to
read the above paragraph an artery in the heart of roughly one American
clogged up, cut off blood flow and started a rapid process of tissue and
cell death
...
By
the time you finish reading this page, four Americans will have had a
heart attack, and another four will have fallen prey to stroke or heart
failure
...

The heart is the centerpiece of life and, more often than not in America, it is the centerpiece of death
...
Heart disease has been our
number one cause of death for almost one hundred years
...
If you
were to ask most women what disease poses the greatest risk to them,
heart disease or breast cancer, many women would undoubtedly say
breast cancer
...
Women's death rate from heart
disease is eight times higher than their death rate from breast cancer
...
If there is an "American" disease, it is heart disease
...
The
American administration was taken aback but responded quickly
...
Three years later, inJuly
of 1953, a formal cease-fire agreement had been signed and the Korean
War was over
...

At the end of the war, a landmark scientific study was reported in the
Journal of the American Medical Association
...
The soldiers, at an average age of twenty-two years, had never been
diagnosed with heart problems
...

Fully 77
...
? (In this instance, "gross" means large
...
3%, is startling
...
Furthermore,
almost everyone was susceptible! These soldiers were not couch-potato
slouches; they were in top condition in the prime of their physical lives
...
s
THE HEART ATTACK
But what is heart disease? One of the key components is plaque
...
I have heard one surgeon say that if you wipe
your finger on a plaque-covered artery; it has the same feel as wiping
your finger across a warm cheesecake
...
Of
the autopsied soldiers in Korea, one out of twenty diseased men had so
much plaque that 90% of an artery was blocked
...
How could that be enough? It turns out
that if the plaque on the inner wall of the artery accumulates slowly,
over several years, blood flow has time to adjust
...
If you put a few stones on the sides
of a river every day over a period of years, like plaque accumulating on
the walls of the artery, the water will find another way to get to where it
wants to be
...
Perhaps the river will go under the stones forming tiny tunnels,
or maybe the water will flow through small side streams, taking a new
route altogether
...
" The same thing happens in the heart
...

However, too much plaque buildup can cause severe blood restriction,
and debilitating chest pain, or angina, can result
...
9 , 10
So what leads to heart attacks? It turns out that it's the less severe accumulations of plaque, blocking under 50% of the artery, that often cause
heart attacks
...
In
the dangerous plaques, the cap is weak and thin
...
When the cap ruptures,
the core contents of the plaque mix with the blood
...
The clot grows and can qUickly block
off the entire artery
...

When this happens, blood flow downstream of the rupture is severely
reduced and the heart muscles don't get the oxygen they require
...
In short, the victim
starts to die
...
1 million heart attacks that occur in America every year
...
9 , 10
We now know that the small to medium accumulation of plaque, the
plaque that blocks less than 50% of the artery, is the most deadly
...
We can't know which plaque will rupture, when, or how severe it might be
...
What once was a mysterious
death, which claimed people in their most productive years, has been
"demystified" by science
...


FRAMINGHAM
After World War II, the National Heart Institute l3 was created with a
modest budget4 and a difficult mission
...
In the search for answers, the National Heart Institute decided
to follow a population over several years, to keep detailed medical records of everybody in the population and to see who got heart disease
and who didn't
...

Located just outside of Boston, Framingham is steeped in American
history
...
Over the years the town has had supporting roles in the Revolutionary War, the Salem Witch Trials and the abolition movement
...
Over
5,000 residents of Framingham, both male and female, agreed to be
poked and prodded by scientists over the years so that we might learn
something about heart disease
...
By watching who got heart disease
and who didn't, and comparing their medical records, the Framingham
Heart Study developed the concept of risk factors such as cholesterol,
blood pressure, phYSical activity, cigarette smoking and obesity
...
Doctors have for years
used a Framingham prediction model to tell who is at high risk for heart
disease and who is not
...

The shining jewel of the Framingham Study is its findings on blood
cholesterol
...
Researchers noted that

BROKEN HEARTS

115

men with cholesterol levels "over 244 mgldL (milligrams per deciliter)
have more than three times the incidence of CHD (coronary heart disease) as do those with cholesterol levels less than 210 mgldL
...
Cholesterol levels do make a difference
...

The importance given to risk factors signaled a conceptual revolution
...
Our hearts were like car engines; as we got older, the parts
didn't work as well and sometimes gave out
...
Researchers wrote, "
...
"15 Simply lower
the risk factors, such as blood cholesterol and blood pressure, and you
lower the risk of heart disease
...
We spend over 30 billion dollars a year on drugs to control
these risk factors and other aspects of cardiovascular disease
...
This awareness is
only about fifty years old and due in large measure to the scientists and
subjects of the Framingham Heart Study
...
Early research led to the alarming
conclusion that we have some of the highest rates of heart disease in
the world
...
1)
...
If we look at
more traditional societies, we tend to see even more striking disparities
in the incidence of heart disease
...
American men died from heart disease at a rate
almost seventeen times higher than their Chinese counterparts
...
1: HEART DISEASE DEATH RATES FOR MEN AGED 55 TO 59
ACROSS 20 COUNTRIES, CIRCA 1955 16

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Why were we succumbing to heart disease in the sixties and seventies, when much of the world was relatively unaffected?
Quite simply, it was a case of death by food
...
In other words, they subsist
mostly on plant foods while we subsist mostly on animal foods
...
For example, Japanese men
who live in Hawaii or California have a much higher blood cholesterol
level and incidence of coronary heart disease than Japanese men living
in Japan
...
Smoking habits are not the cause because men

BROKEN HEARTS

117

in Japan, who were more likely to smoke, still had less coronary heart
disease than the Japanese Americans
...
" On the flip side, blood
cholesterol "was negatively associated with complex carbohydrate intake
...

This research clearly implicated diet as one possible cause of heart
disease
...

And as other cultures have come to eat more like us, they also have
seen their rates of heart disease skyrocket
...


RESEARCH AHEAD OF ITS TIME
So now we know what heart disease is and what factors determine our
risk for it, but what do we do once the disease is upon us? When the
Framingham Heart Study was just beginning, there were already doctors who were trying to figure out how to treat heart disease, rather
than just prevent it
...

These doctors noticed the ongoing research at the time and made
some common-sense connections
...

One of the most progressive doctors was Dr
...
He started a study in 1946 (two years before the Framingham
Study) to "determine the relationship of dietary fat intake to the incidence of atherosclerosis
...

In the experimental diet group he reduced the consumption of fat and
cholesterol
...
22 Even if you loved cold roast lamb with mint
jelly, you weren't allowed to eat much of it
...
22
Did this progressive diet accomplish anything? After eight years,
only twelve of fifty people eating their normal American diet were alive
(24%)
...
After twelve years, every single patient in the control group was
dead
...
22 While it was unfortunate that so many people in
the dietary group still died, it was clear that they were staving off their
disease by eating moderately less animal foods and moderately more
plant foods (see Chart 5
...

CHART 5
...
MORRISON'S PATIENTS

50
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...
~

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Vl


...
~

a
...
0

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Time (years)

12

BROKEN HEARTS

119

In 1946, when this study began, most scientists believed that heart
disease was an inevitable part of aging, and nothing much could be done
about it
...

Another research group proved much the same thing at about that
time
...
These doctors found that the patients who ate the lowfat, low-cholesterol diet died at a rate four times lower than patients who
didn't follow the diet
...
Heart disease wasn't the inevitable result of old age, and even when a person had advanced disease, a
low-fat, low-cholesterol diet could significantly prolong his or her life
...
Furthermore, this new understanding made diet and
other environmental factors the centerpieces of heart disease
...

These two isolated food components became the bad guys
...
The possibility that no one wanted to consider was that fat and
cholesterol were merely indicators of animal food intake
...
3
...
In addition, dozens of experimental studies
show that feeding rats, rabbits and pigs animal protein (e
...
, casein)
dramatically raises cholesterol levels, whereas plant protein (e
...
, soy
protein) dramatically lowers cholesterol levels
...
25
While some of these studies implicating animal protein were conducted in the past thirty years, others were published well over fifty
years ago when the health world was first beginning to discuss diet and
heart disease
...

These three nutrients (fat, animal protein and cholesterol) characterize

120

2
o
o

THE CHINA STUDY

CHART 5
...
64

•

400
200

3

4

5

6

7

8

9

Percent of total calories coming from animal protein

animal-based food in general
...

It would have led immediately to professional isolation and ridicule
(for reasons discussed in Part IV)
...
A conceptual revolution was taking place, and
a lot of people didn't like it
...
Preventing heart disease by diet was a threatening idea
because it implied that something about the good old meaty American
diet was so bad for us that it was destroying our hearts
...

One status quo scientist had a good time making fun of people who
appeared to have a low risk of heart disease
...
A man with poor appetite, subsisting on fruit and vegetables laced with corn and whale oils, detesting tobacco, spurning

BROKEN HEARTS

121

ownership of radio, TV or motor car, with full head of hair and
scrawny and un-athletic in appearance, yet constantly straining
his puny muscles by exercise; low in income, B
...

The author of this passage might just as well have said, "Only REAL
men have heart disease
...
The
unfortunate association of meat with physical ability, general manliness,
sexual identity and economic wealth all cloud how the status quo scientists viewed food, regardless of the health evidence
...

Perhaps this author should have met a friend of mine, Chris Campbell (no relation)
...
s
...
At the age of thirty-seven
he became the oldest American ever to win an OlympiC medal in wrestling, weighing in at 198 pounds
...
As a
man not likely to have heart disease, I think he might disagree with the
characterization above
...
I remember attending a lecture at Cornell University during the late 1950s when a famous researcher, Ancel Keys, came to talk
about preventing heart disease by diet
...
In those first decades of heart disease research, a heated, personal battle flared , and open-mindedness was the first casualty
...
But there have been significant changes
in the landscape of heart disease
...
Despite the potential of diet and disease prevention, most of the
attention given to heart disease has been on mechanical and chemical
intervention for those people who have advanced disease
...
Surgery, drugs, electronic devices and new diagnostic
tools have stolen the spotlight
...
The ultimate surgery, of course, is the heart transplant, which even utilizes an artificial heart on occasion
...
We have defibrillators to revive
hearts, pacemakers and precise imaging techniques so that we can observe individual arteries without having to expose the heart
...
In summarizing the
initial widespread research on heart disease, one doctor recently highlighted the mechanical:
It was hoped that the strength of science and engineering devel-

oped after World War II could be applied to this battle [against
heart disease]
...
4
Some great advances have been made, to be sure, which may account
for the fact that our death rate from heart disease is a full 58% lower
than what it was in 1950
...
One of the greatest strides
has come from better emergency room treatment of heart attack victims
...
Today, if you make it to the hospital alive, you only
have a 15% chance of dying
...
2
In addition, the number of people smoking has steadily been decreasing,27,28 which in turn lowers our death rate from heart disease
...
We've made progress, so it seems
...
Every
twenty-four hours, almost 2,000 Americans will die from this disease
...

In fact, the incidence rate (not death rate) for heart disease 29 is about
the same as it was in the early 1970s
...
In
seems that we simply have gotten slightly better at postponing death
from heart disease, but we have done nothing to stop the rate at which our
hearts become diseased
...
Bypass surgery has become particularly popular
...
During the operation, the patient's chest is split open,
blood flow is rerouted by a series of clamps, pumps and machines, and
a leg vein or chest artery is cut out and sewn over a diseased part of the
heart, thereby allowing blood to bypass the most clogged arteries
...
More than one of every fifty elective patients
will die because of complications31 during the $46,000 procedure
...
When the
vessels around the heart are clamped shut during the operation, plaque
breaks off of the inner walls
...
Researchers have compared
the intellectual capabilities of patients before and after the operation,
and found that a stunning 79% of patients "showed impairment in some
aspect of cognitive function" seven days after the operation
...
About 70-80% of
patients who undergo bypass surgery remain free of this crippling chest
pain for one year
...
Within three years of the
operation, up to one-third of patients will suffer from chest pain again
...
36 Long-term studies indicate that
only certain subsets of heart disease patients live longer because of their
bypass operationY Furthermore, these studies demonstrate that those

124

THE CHINA STUDY

patients who undergo bypass operation do not have fewer heart attacks than
those who do not have surgery
...
The bypass operation, however, is targeted to the largest, most visible plaques,
which may be responsible for chest pain, but not for heart attacks
...
The procedure is expensive and carries
significant risks
...
It pushes the plaque back
against the vessel, thereby allowing more blood to flow
...
3 ? Assuming that doesn't happen, there is still a good
chance that the procedure will fail
...
38 Nonetheless, barring these unfavorable outcomes, angioplasty does a good job of providing temporary
relief of chest pain
...

So, upon closer examination, our seemingly beneficent mechanical
advances in the field of heart disease are severely disappointing
...

What's going on here? Despite the positive public relations surrounding the past fifty years of heart disease research, we must ask ourselves:
are we winning this war? Maybe we should ask ourselves what we might
do differently
...
Lester Morrison, as discussed earlier?
Those discoveries largely faded away
...
I am bewildered because
the profeSSionals I heard during my graduate student days in the late
1950s and early 1960s vigorously denied that any such work was being done or even being contemplated
...
According to the u
...
Department of Agriculture, we consume Significantly more meat and added
fat than we did thirty years ago
...


BROKEN HEARTS

125

As this information has resurfaced in the past two decades, the fight
against the status quo has been heating up again
...
They are demonstrating revolutionary success, using the most simple of all treatments:
food
...
CALDWELL B
...

If you were to guess the location of the best cardiac care center in the
country, maybe the world, what city would you name? New York? Los
Angeles? Chicago? A city in Florida, perhaps, near elderly people? As
it turns out, the best medical center for cardiac care is located in Cleveland, Ohio, according to US News and World Report
...

One of the doctors at the Clinic, Dr
...
Esselstyn, Jr
...
As a student at Yale University, Dr
...
After being trained at the
Cleveland Clinic, he went on to earn the Bronze Star as an army surgeon
in the Vietnam War
...
Having published over 100 scientific papers,
Dr
...
40 From knowing this man personally, I get the feeling that he has
excelled at virtually everything he has done in his life
...

The quality I find most appealing about Dr
...
Dr
...
For the Second
National Conference on Lipids in the Elimination and Prevention of
Coronary Artery Disease (which he organized and in which he kindly
asked me to participate) Dr
...
S
...
Little had changed in 100 years in the management of
cancer, and in neither heart disease nor cancer was there a serious

126

THE CHINA STUDY

effort at prevention
...
Esselstyn started to reexamine the standard medical practice
...
Esselstyn
decided to test the effects of a whole foods, plant-based diet on people
with established coronary disease
...
42, 43
In 1985, Dr
...
He asked
each patient to record everything he or she ate in a food diary
...
Esselstyn met with his patients
to discuss the process, administer blood tests and record blood pressure and weight
...
In addition, all of his patients met together
a few times a year to talk about the program, socialize and exchange
helpful information
...
Esselstyn was diligent, involved, supportive and compassionately stern on a personal level with
his patients
...
Esselstyn and his wife Ann, followed was
free of all added fat and almost all animal products
...
Esselstyn and
his colleagues report, "[Participants 1were to avoid oils, meat, fish, fowl
and dairy products, except for skim milk and nonfat yogurt
...
Esselstyn recommended to his patients
that they stop consuming any skim milk and yogurt, as well
...
These eighteen patients originally had come
to Dr
...
Within the eight years leading up to
the study, these eighteen people had suffered through forty-nine coronary
events, including angina, bypass surgery, heart attacks, strokes and angioplasty
...
One might imagine that they
were motivated to join the study by the panic created when premature
death is near
...
At the start of
the study, the patients' average cholesterol level was 246 mgldL
...
42 In the end, though, the most impressive result
was not the blood cholesterol levels, but how many coronary events occurred since the start of the study
...
That one event was
from a patient who strayed from the diet for two years
...
The patient eliminated his angina, and has not experienced any further eventsY
Not only has the disease in these patients been stopped, it has even
been reversed
...
43 Eleven of his patients had agreed to angiography, a
procedure in which specific arteries in the heart can be "x-rayed
...
This may sound like a
small change but it should be noted that the volume of blood delivered
is at least 30% greater when the diameter is increased by 7%
...
Authors of
the five-year report note, "This is the longest study of minimal fat nutrition used in combination with cholesterol-lowering drugs conducted to
date, and our finding of a mean decrease of arterial stenosis [blockage)
of 7
...
"42
One physician took special note of Dr
...
He was only
forty-four years of age and seemingly healthy when he found himself
with a heart problem, culminating in a heart attack
...
He visited Dr
...
What follows is the dramatic image of this
patient's diseased artery before and after Dr
...
4)
...
The picture on the left (A) has a section marked by a parenthesis
where severe coronary disease reduced the amount of blood flow
...
4: CORONARY ARTERY BEFORE AND AFTER
CONSUMING PLANT-BASED DIET

adopting a whole foods, plant-based diet, that same artery opened up,
reversing the ravages of heart disease and allowing a much more normal
blood flow, as shown in the picture on the right (B)
...
Esselstyn just got a lucky group of patients? The
answer is no
...
Another way to check the likelihood of this degree of
success is to look at the five patients that dropped out of the dietary program and resumed their standard care
...
45

BROKEN HEARTS

129

Can any sane person dispute these findings? It seems impossible
...
Dr
...


DR
...
Dean Omish, has
been instrumental in bringing diet to the forefront of medical thought
...
If you have heard of the dietlheart disease connection,
chances are that it may well be because of Dr
...

His best-known research is the Lifestyle Heart Trial, in which he
treated twenty-eight heart disease patients with lifestyle changes
alone
...
He followed
both groups carefully and measured several health indicators, including
artery blockages, cholesterol levels and weight
...
Omish's treatment plan was very different from the standards of
high-tech modern medicine
...
He asked them to eat a low-fat, plant-based diet
for at least a year
...
They could eat as much food as they wanted, as long as it was on
the acceptable food list, which included fruits, vegetables and grains
...
"46 In addition to diet, the
group was to practice various forms of stress management, including
meditation, breathing exercises and relaxation exercises for at least one
hour per day
...
To help the patients make these lifestyle changes, the group met twice a week for four
hours at a time for mutual support
...
Omish and his research group
did not use any drugs, surgery or technology to treat these patients
...
On average, their total cholesterol dropped from 227 mgldL
to 172 mgldL, and their "bad" LDL cholesterol dropped from 152 mgl
dL to 95 mgldL
...
Further, it was clear that the closer
the patients adhered to the lifestyle recommendations, the more their
hearts healed
...
Four
percent may seem like a small number, but remember that heart disease
builds up over a lifetime, so a 4% change in only a year is a fantastic
result
...

The control group did not fare so well, despite the fact that they received the usual care
...
For example, although the experimental group
experienced a 91% reduction in the frequency of chest pain, the control
group experienced a 165% rise in the frequency of chest pain
...
The patients
in the group who were the least attentive to diet and lifestyle changes had
blockages that increased in size by 8% over the course of the year
...
amish, Dr
...

Morrison, I believe that we have found the strategic link in our heart
disease battle plan
...
There are no surgical or chemical
heart disease treatments, at the Cleveland Clinic or anywhere else, that
can compare to these impressive results
...
We now know enough to nearly eliminate
heart disease
...
We do not need to crack open our breast plates to
reroute our arteries, and we do not need a lifetime of powerful drugs in
our blood
...

The next step is to implement this dietary approach on a large scale,
which is exactly what Dr
...
His
research group has begun the Multicenter Lifestyle Demonstration
Project, which represents the future of heart disease health care
...
Omish's lifestyle intervention program
...
Instead of surgery, they may
enroll in a one-year lifestyle program
...
32
As of 1998, almost 200 people had taken part in the Lifestyle Project,
and the results are phenomenal
...
The effect was long lasting, as
well
...
32
The health benefits are equaled by the economic benefits
...
32 In 2002,
physician services and hospital care for heart disease patients cost $78
...
2 The angioplasty procedure alone costs $31 ,000, and bypass surgery costs $46,000
...
By comparing the patients who
underwent the lifestyle program with those patients who underwent
the traditional route of surgery, Dr
...
32
Much work remains to be done
...
Diet still
takes the back seat to drugs and surgery
...
One doctor charges that Dr
...
"47 This
criticism is not only wrong and insulting to patients; it is also self-fulfilling
...
There is no greater disrespect a doctor can show patients than that
of withholding potentially lifesaving information based on the assumption that patients do not want to change their lifestyle
...
The American Heart Association recommends a diet for heart
disease that favors moderation, rather than scientific truth
...
These organizations

132

THE CHINA STUDY

pitch moderate diets with trivial changes as being healthy lifestyle "goals
...
48,49 According to them, we should also keep our total
blood cholesterol level under the "desirable" level of 200 mg/dL,49
These venerable organizations are not giving the American public the
most up-to-date scientific information
...
We
also know that the most aggressive reversal of heart disease ever demonstrated occurred when fat was about lO% of total calorie intake
...
51 The innocent victims are health-conscious Americans who
follow these recommendations, keeping their total cholesterol around
180 or 190 mg/dL, only to be rewarded with a heart attack leading to a
premature death
...
Even so, to achieve maximal
benefit, many persons will require LDL [cholesteroll-Iowering drugs
...
The dietary recommendations
for the most diseased hearts among us, given by supposedly reputable
institutions, are severely watered down and followed by the caveat that
we'll probably need a lifetime of drugs anyway
...
But the establishment-recommended diets are not nearly as healthy as the diets espoused by Drs
...
The fact is that a blood cholesterol level of 200
mg/dL is not safe, a 30% fat diet is not "low-fat," and eating foods containing any cholesterol above 0 mg is unhealthy
...
"
Whether scientists, doctors and policy makers think the public will
change or not, the layperson must be aware that a whole foods, plantbased diet is far and away the healthiest diet
...
Omish and

BROKEN HEARTS

133

his scientific colleagues, write, "The point of our study was to determine
what is true, not what is practicable [myemphasisl
...

Dr
...

Dr
...

Dr
...

Now is a time of great hope and challenge, a time when people can
control their health
...
Now is the time
for us to have the courage for legendary work
...
Caldwell B
...
8


...
_ _
...
__
...
6__
...
__
...
_
...

__
...
_
...


Perhaps you've caught a glimpse of the staggering statistics on obesity among Americans
...

Perhaps you've been in classrooms, on playgrounds or at day care
centers and noticed how many kids are already Crippled with a weight
problem and can't run twenty feet without getting winded
...
Open a newspaper or a magazine, or turn on the radio or TV-you know that America
has a weight problem
...
Not only
are these numbers high, but the rate at which they have been rising is
ominous (Chart l
...
1
But what do the terms "overweight" and "obese" mean? The standard
expression of body size is the body mass index (BMI)
...
By most official standards, being overweight is having a BMI above
twenty-five, and being obese is having a BMI over thirty
...
You can determine your own BMI
using Chart 6
...

135

THE (HINA STUDY

136

CHART 6
...
)

(in
...
About 15% of America's
youth Cages six to nineteen) are overweight
...
2
Overweight children face a wide range of psychological and social
challenges
...
Overweight
children find it more difficult to make friends and are often thought of
as lazy and sloppy
...
3
Young people who are overweight also are highly likely to face a host
of medical problems
...
They are more
likely to have problems with glucose intolerance, and, consequently,
diabetes
...
(See chapters seven and nine for a more thorough
discussion of childhood diabetes
...
Sleep apnea, which can cause
neuro-cognitive problems, is found in one in ten obese children
...
Most importantly, an obese young person is much more likely to be an obese adult,3
greatly increasing the likelihood of lifelong health problems
...
You may find that you cannot play vigorously
with your grandchildren (or your children), walk long distances, participate in sports, find a comfortable seat in a movie theatre or airplane
or have an active sex life
...
For many, standing is
hard on the knees
...
So you see, this isn't about death; it really is about missing many of
the more enjoyable things in life
...
So why is it that two out of
three adult Americans are overweight? Why is one-third of the population obese?
The problem is not a lack of money
...
5 In 2002, a mere
three years later, the American Obesity Association listed these costs at
$100 billion
...
Add another $30-40 billion out-of-pocket
money that we spend trying to keep off the weight in the first place
...


138

THE CHINA STUDY

This is an economic black hole that sucks our money away without
offering anything in return
...
I bet you
wouldn't ask that guy to fix your sink again! So then why do we endlessly try those weight-loss plans, books, drinks, energy bars and assorted gimmicks when they don't deliver as promised?
I applaud people for trying to achieve a healthy weight
...
My criticism is of a societal system that allows
and even encourages this problem
...
What we really need, then, is
a new solution comprised of good information for individual people to
use at a price that they can afford
...
It is a long-term lifestyle
change, rather than a quick-fix fad, and it can provide sustained Weight
loss while minimizing risk of chronic disease
...
Now think of traditional
cultures around the world
...
It's hard to imagine these
people-at least until recently-as anything other than slender
...
The people in these images look different, don't they?
Unfortunately, the guy munching his hot dogs and sipping his beer is rapidly becoming the "all-American" image
...

Solving this problem does not require magic tricks or complex
equations involving blood types or carbohydrate counting or soul

OBESITY

139

searching
...
Or trust the findings of some impressive research studies, large and small, showing time and time again
that vegetarians and vegans are slimmer than their meat-eating
counterparts
...
7 J3
In a separate intervention study, overweight subjects were told to
eat as much as they wanted of foods that were mostly low-fat, wholefood and plant-based
...
14 At the Pritikin Center, 4,500 patients who had
gone through their three-week program got similar results
...
5% of their body weight over three weeks
...
18
Sixteen pounds lost over twelve weeks l9
Twenty-four pounds lost after one year 20

All of these results show that consuming a whole foods, plant-based
diet will help you to lose weight and, furthermore, it can happen quickly
...
In most of these
studies, the people who shed the most pounds were those who started
with the most excess weight
...
Most importantly, losing weight this way is consistent with long-term health
...
There are a few very good reasons for this
...
Sweets, pastries and
pastas won't do it
...
As
mentioned in chapter four, these highly processed, unnatural foods are
not part of a plant-based diet that works to reduce body weight and promote health
...

Notice that a strict vegetarian diet is not necessarily the same thing

140

THE (HINA STUDY

as a whole foods , plant-based diet
...
I refer to
these people as "junk-food vegetarians" because they are not consuming a nutritious diet
...
A reasonable amount of physical activity,
sustained on a regular basis, can pay important dividends
...
If you are one of
these people, I can only say that you probably need to be especially rigorous in your diet and exercise
...
Now, as the dietary and lifestyle
practices of people in China are becoming more like ours, so too have
their bodies become more like ours
...

Keeping body weight off is a long-term lifestyle choice
...
Short-term gains should not come along with long-term pain,
like kidney problems, heart disease, cancer, bone and joint ailments
and other problems that may be brought on with popular diet fads
...
One very large study of 21,105 vegetarians and vegans 13 found that body mass index was"
...


WHY THIS WILL WORK FOR YOU
SO there is a solution to the weight-gain problem
...
Generally speaking, you can eat as much as you want and still lose weight-as long you
eat the right type of food
...
) Secondly, stop
expecting sacrifice, deprivation or blandness; there's no need
...
Moreover,
there are mechanisms in our bodies that naturally allow the right kind
of plant-based foods to nourish us, without our having to think about
every morsel of food we put in our mouths
...

Give your body the right food and it will do the right thing
...
It's not because they're starving themselves
...
22 That's because fruits, vegetables and grains-as whole foods-are much less energy-dense than
animal foods and added fats
...
Remember that fat has nine calories per gram
while carbohydrates and protein have only four calories per gram
...
So by eating a healthy meal, you may reduce the calories that you
consume, digest and absorb, even if you eat Significantly more food,
This idea on its own, however, is not yet a sufficient explanation
for the benefits of a whole foods, plant-based diet
...
Over
the long term, these subjects will find it very difficult to continue consuming an abnormally low level of calories; weight loss due to calorie
restriction rarely leads to long-term weight loss
...

These studies document the fact that vegetarians consume the same
amount or even Significantly more calories than their meat-eating counterparts, and yet are still slimmer
...
But here's
the kicker: the rural Chinese are still slimmer while consuming a greater
volume offood and more calories
...
but this comparison is between average

142

TH E CH I NA STU DY

Americans and the least active Chinese, those who do office work
...

What's the secret? One factor that I've mentioned previously is the
process of thermogenesis, which refers to our production of body heat
during metabolism
...
27 A relatively small increase in metabolic rate translates to a
large number of calories burned over the course of twenty-four hours
...


EXERCISE
The slimming effect of physical activity is obvious
...
A recent review of all the credible studies compared the relationship between body Weight and exercise 28 and showed that people
who were more physically active had less body weight
...
No surprise here,
either
...
It
is better to build it into your lifestyle so that you will become and continue to be more fit over all, not just burn off calories
...
Interestingly, we should not forget our "spontaneous" physical activity, the kind that is associated with chores of daily life
...
Recall that our experimental animals were fed
diets containing either the traditional 20% casein (cow's milk protein)
or the much lower 5% casein
...
They also consumed slightly more calories but burned them off
as body heat
...
To test this idea, we housed rats fed either 5% or 20% casein diets
in cages equipped with exercise wheels outfitted with meters to record
the number of turns of the wheel
...
31 Exercise remained conSiderably higher for the
5% casein animals throughout the two weeks of the study
...
A plant-based diet operates on calorie balance to keep body
weight under control in two ways
...
Second, a plantbased diet encourages more physical activity
...
Diet and exercise work
together to decrease body weight and improve overall health
...
Tens of millions of people will fall prey to disability,
putting our health care systems under greater strain than has previously
been seen
...
First,
there are the many quick-fix promises and gimmicks
...
The diet that helps to
reduce Weight in the short run needs to be the same diet that creates and
maintains health in the long run
...
33 is misplaced
...
That is, we sacrifice context
...
A few years ago,34-36 there was great

144

THE (HINA STUDY

publicity given to the discovery of "the obesity gene
...
The purpose behind the obesity gene search is
to allow researchers to develop a drug capable of knocking out or inactivating the underlying cause of obesity
...
Believing that specific identifiable genes are the
basis of obesity (i
...
, it's all in the family) also allows us to fatalistically
blame a cause that we cannot control
...
It is right at the end of our fork
...
1
Diabetes
TYPE 2 DIABETES, the most common form, often accompanies obesity
...
In the eight years from 1990 to 1998, the incidence of diabetes increased 33%
...
That translates to 16 million
Americans
...
2
You know the situation is serious when our children, at the age of
puberty, start falling prey to the form of diabetes usually reserved for
adults over forty
...
3
What is diabetes, why should we care about it and how do we stop it
from happening to us?

TWO FACES OF THE SAME DEVIL
Almost all cases of diabetes are either Type 1 or Type 2
...
This form accounts for 5% to 10% of all diabetes
cases
...
2 But because up to 45% of new diabetes cases in children are
Type 2 diabetes,4 the age-specific names are being dropped, and the two
forms of diabetes are simply referred to as Type 1 and Type 2
...
Normal metabolism goes like this:
• We eat food
...

• Glucose (blood sugar) enters the blood, and insulin is produced by
the pancreas to manage its transport and distribution around the
body
...
Some of the glucose is converted to
short-term energy for immediate cell use, and some is stored as
long-term energy (fat) for later use
...
Type
1 diabetics cannot produce adequate insulin because the insulin-producing cells of their pancreas have been destroyed
...
(Type 1 diabetes and other autoimmune diseases are discussed
in chapter nine
...
This is called insulin resistance, which means that
once the insulin starts "giving orders" to dispatch the blood sugar, the
body doesn't pay attention
...

Imagine your body as an airport, complete with vast parking areas
...
After you eat,
your blood sugar rises
...
The people would drive in, park
in a lot and walk to the stop where the shuttle bus is supposed to pick
them up
...
The shuttle buses, of course, represent insulin
...
In the Type 1 diabetic airport, the shuttle buses simply don't exist
...
In the Type 2 diabetic airport, there are some
shuttle buses, but they don't work very well
...
The
airport system breaks down, and chaos ensues
...
In fact, diabetes

DlAB ETES

147

is diagnosed by the observation of elevated blood sugar levels, or its
"spillage" into urine
...

Stroke

• 2-4 times the risk of stroke
...

Blindness

• Diabetes is the leading cause of blindness in adults
...

• Over 100,000 diabetics underwent dialysis or kidney transplantation in 1999
...

Amputation
• Over 60% of all lower limb amputations occur with diabet-

ics
...

Pregnancy Complications
Increased Susceptibility to Other Illnesses
Death

148

THE CHINA STUDY

Modern drugs and surgery offer no cure for diabetics
...
As a consequence,
diabetics face a lifetime of drugs and medications, making diabetes an
enormously costly disease
...
s
...
2
But there is hope
...
The food
we eat has enormous influence over this disease
...
What, then, is the "right" diet? You
can probably guess what I'm going to say, but let the research speak for
itself
...
This has been known for a hundred years
...
But is that just a coincidence, or is there something else at
work?
CHART 7
...

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What he found was that some cultures were consuming high-fat diets,
while others had diets high in carbohydrates
...
carbohydrate
consumption patterns were the result of animal vs
...
Chart 7
...
5
As carbohydrate intake goes up and fat intake goes down, the number of deaths from diabetes plummets from 20
...
9 per 100,000
people
...

Thirty years later, the question was reexamined
...

Researchers noted that the country with the highest rate of diabetes,
Uruguay, had a diet that was "typically 'Western' in character, being
high in calories, animal protein, [total) fat and animal fat
...
A high proportion
of calories is derived from carbohydrates, particularly from rice
...
The strongest association they found with diabetes was excess weight
...
? Is this
starting to sound familiar?

WITHIN ONE POPULATION
These old, cross-cultural studies can be crude, resulting in conclusions
that are not entirely reliable
...
Perhaps other
unmeasured cultural factors, like phYSical activity, were more relevant
...

The Seventh-day Adventists population is a good example
...
As a result, half of them are vegetarian
...
It

150

THE CHINA STUDY

should also be noted that the meat-eating Adventists are not the meatiest of eaters
...
8 I know plenty of people
who consume this amount of meat (including fish and poultry) every
two days
...
This is not a big difference
...
8 Those Adventists that "deprived" themselves of meat
also "deprived" themselves of the ravages of diabetes
...
8,9 They also
had almost half the rate of obesity
...
1O These men were
the sons ofjapanese immigrants to the u
...
Remarkably, they had more
than four times the prevalence of diabetes than the average rate found in
similar-aged men who stayed in japan
...
1O Total fat intake also was
higher among the diabetics
...
These second-generation japanese Americans
ate a meatier diet with less plant-based food than men born in japan
...
" The consequence: four times as much incidence of
diabetes, 10
Some other studies:
• Researchers found that increased fat intake was associated with an
increased rate of Type 2 diabetes among 1,300 people in the San
Luis valley in Colorado, They said, "The findings support the hypothesis that high-fat, low-carbohydrate diets are associated with
the onset of non-insulin-dependent [Type 2] diabetes mellitus in
humans
...
Researchers say that this dietary

DIABETES

151

shift, along with low exercise levels, might be to blame for this
explosion of diabetes
...
During the war and its aftermath,
fiber and grain intake went up and fat intake went down
...
Around
1950, though, people gave up the grain-based diets and returned
to eating more fat , more sugar and less fiber
...
13
• Researchers studied 36,000 women in Iowa for six years
...
The women who were least
likely to get diabetes were those that ate the most whole grains and
fiber14-those whose diets contained the most carbohydrates (the
complex kind found in whole foods)
...


CURING THE INCURABLE
All of the research cited above was observational and an observed association, even if frequently seen, may only be an incidental association
that masks the real cause-effect relationship of environment (including
diet) and disease
...
This involves changing the diets of people who
already have either full-blown Type 1 or Type 2 diabetes or mild diabetic
symptoms (impaired glucose tolerance)
...
D
...
One of his studies examined the effects of a high-fiber,
high-carbohydrate, low-fat diet on twenty-five Type 1 diabetics and
twenty-five Type 2 diabetics in a hospital settingY None of his fifty
patients were overweight and all of them were taking insulin shots to
control their blood sugar levels
...
He put his patients on
the conservative, American-style diet recommended by the American

152

THE CHINA STUDY

Diabetes Association for one week and then switched them over to the
experimental "veggie" diet for three weeks
...

The results were impressive
...
It is difficult to imagine
any dietary change that might aid their predicament
...
Just as importantly, their cholesterol levels dropped by 30%PS
Remember, one of the dangers of being diabetic is the secondary outcomes, heart disease and stroke
...

Type 2 diabetics, unlike Type 1, are more "treatable" because they
haven't incurred such extensive damage to their pancreas
...
Of the twenty-five Type 2 patients, twenty-four
were able to discontinue their insulin medication! Let me say that again
...
After three weeks of intensive dietary
treatment, his insulin dosage dropped to eight units a day
...
15 Chart 7
...
This is a huge effect
...
16 Some of the results are shown in Chart 7
...

These benefits, representing a decrease in blood cholesterol from 206
mgldL to 141 mgldL, are astounding-especially considering the speed
with which they appear
...
Anderson also found no evidence that this
cholesterol decrease was temporary as long as people continued on the
diet; it remained low for four years Y
Another group of scientists at the Pritikin Center achieved equally
spectacular results by prescribing a low-fat, plant-based diet and exercise to a group of diabetic patients
...
IS This research group also demonstrated that

DIABETES

153

CHART 7
...


20

II'

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10
Type 2 Patients

~

IN=8
0

-6

0

6

12

18

1-------

42

DAYS

the benefits of a plant-based diet will last for years if the same diet is
continued
...

One scientific paper reviewed nine publications citing the use of highcarbohydrate, high-fiber diets and two more standard-carbohydrate,
high-fiber diets to treat diabetic patients
...
(Dietary fiber supplements, by the way, although beneficial, did not have same consistent
effects as a change to a plant-based, whole foods dietY l

THE PERSISTENCE OF HABIT
As you can see by these findings, we can beat diabetes
...
After almost three years, the lifestyle group had

154

TH E CH I NA STU DY
CHART 7
...

o

60~------~------~------~------~----12
18
-6
a
6
Days

58% fewer cases of diabetes than the control group
...
Compared to the control, both
treatments worked, but clearly a lifestyle change is much more powerful and safer than simply taking a drug
...

The second study also found that the rate of diabetes could be reduced by 58% just by modest lifestyle changes, including exercise,
weight loss and a moderately low-fat diet
...
I strongly suspect that virtually all Type 2 diabetes cases
could be prevented
...
Our habit of eating hot dogs, hamburgers and
French fries is killing us
...
James Anderson, who achieved profound results with many patients by prescribing a near-vegetarian diet,
is not immune to habitual health advice
...
However, these
diets allow only one to two ounces of meat daily and are impractical for
home use for many individuals
...
It may seem impractical to give up meat and high-fat foods, but I wonder how practical
it is to be 350 pounds and have Type 2 diabetes at the age of fifteen, like
the girl mentioned at the start of this chapter
...

Radically changing our diets may be "impractical," but it might also
be worth it
...
My
laboratory work was focused on several cancers, including those of the
liver, breast and pancreas, and some of the most impressive data from
China were related to cancer
...

An exceptional number of books have summarized the evidence on
the effects of nutrition on a variety of cancers, each with their own
particularities
...
Using this principle, I can limit my
discussion to three cancers, which will allow me space in the rest of the
book to address diseases other than cancer, demonstrating the breadth
of evidence linking food to many health concerns
...


BREAST CANCER
It was spring almost ten years ago
...

"I have a strong history of breast cancer in my family," the woman,
Betty, said
...
Given
this family problem, I can't help but be afraid for my nine-year-old
daughter
...
" Her fear was evident in her voice
...
One of
the options I've been thinking about is a mastectomy for my daughter,
to remove both breasts
...
Does she let
her daughter grow up into a deathtrap, or grow up without breasts? Although extreme, this question represents a variety of similar questions
faced every day by thousands of women around the world
...
Headline articles in the
New York Times and other newspapers and magazines trumpeted this
discovery as an enormous advance
...
This caused great fear among people
with a family history of breast cancer
...
The possibility was
high that new technologies would be able to assess overall breast cancer
risk in women by doing genetic testing; they hoped they might be able
to manipulate this new gene in a way that would prevent or treat breast
cancer
...

No doubt this contributed to the concern of mothers like Betty
...
"I can't
help you with diagnosis or treatment advice
...
I can speak about the current research in a more general way,
however, if that is of any help to you
...
"
I told her a little bit about the China Study and about the important
role of nutrition
...

I was surprised at how little she knew about nutrition
...
She didn't realize that
food was an important factor in breast cancer as well
...
By the end of the conversation I had the feeling that she was
not satisfied with what I told her
...
Maybe,
I thought, she had already made up her mind to do the procedure
...
I remember
thinking about how often I receive questions from people about specific
health situations, and that this was one of the most unusual
...
One other woman also talked to me regarding
the possibility of her young daughter undergoing surgery to remove both
breasts
...

It's clear that breast cancer is an important concern in our society
...
Breast
cancer grassroots organizations are widespread, strong, relatively well
funded and exceptionally active compared to other health activist organizations
...

When I think back to that conversation I had with Betty, I now feel
that I could have made a stronger statement about the role nutrition
plays in breast cancer
...
So what would I tell her now?

RISK FACTORS
There are at least four important breast cancer risk factors that are affected by nutrition, as shown in Chart 8
...
Many of these relationships
were confirmed in the China Study after being well established in other
research
...
1: BREAST CANCER RISK FACTORS
AND NUTRITIONAL INFLUENCE

Risk of breast cancer increases
when a woman has •••

A diet high in animal foods
and refined carbohydrates •••

·
...
lowers the age of menarche

·
...
raises the age of menopause

·
...
increases female hormone levels


...
increases blood cholesterol levels

With the exception of blood cholesterol, these risk factors are
variations on the same theme: exposure to excess amounts of female
hormones, including estrogen and progesterone, leads to an increased
risk of breast cancer
...
They also have higher levels of female hormones throughout their
lifespan, as shown in Chart 8
...

According to our China Study data, lifetime exposure to estrogen l is
at least 2
...
0 times higher among Western women when compared
CHART 8
...
---------------------------~

~

50

:::J
Vl

o

~ 40

LU
(J)

C

o 30
E

...
This is a huge difference for such a critically important hormone
...
"4, 5
Estrogen directly participates in the cancer process
...
6 , 7 Increased levels of estrogen and related hormones
are a result of the consumption of typical Western diets, high in fat and
animal protein and low in dietary fiber
...
This suggests that the risk of breast cancer is preventable if we eat
foods that will keep estrogen levels under control
...
If this information
were properly reported by responsible and credible public health agencies, I suspect that many more young women might be taking very real,
very effective steps to avoid this awful disease
...
23 ,2 However, one research group
4
found that less than 3% of all breast cancer cases can be attributed to
family history
...
But
genetic fatalism continues to define the nation's mindset
...
26-29 These genes, when mutated, confer a higher risk both for
breast and ovarian cancers
...

In the excitement over these discoveries, however, other information
has been ignored
...
25 Because of
the rarity of these genetic aberrations, only a few percent of the breast
cancer cases in the general population can be attributed to mutated
BRCA-l or BRCA-2 genes
...
Third, the mere presence ofBRCA-l, BRCA-2
or any other breast cancer gene does not guarantee disease occurrence,
Environmental and dietary factors play a central role in determining
whether these genes are expressed
...
Overall, disease risk was 65% for breast
cancer and 39% for ovarian cancer by age seventy for BRCA-l women,
and 45% and 11%, respectively, for BRCA-2 women, Women with these
genes certainly face high risks for breast cancer
...
About half of the women
who cany these rare, potent genes do not get breast cancer
...

I do not mean to diminish the importance of knowing all there is to
know about these genes for the small minority of women who carry
them
...
We've already seen in chapter three how a diet
high in animal-based protein has the potential to control genetic expression
...

Screening is a reasonable step, especially for women who may have
tested positive for the BRCA genes
...

Screening is merely an observation to see whether the disease has
progressed to an observable state
...
This implies that our cancer treatments are more
likely to be successful if the cancer is found at an earlier stage
...

One of the statistics used to support early detection and the ensuing
treatments is that once diagnosed with breast cancer, the likelihood of
surviving for at least five years is higher than ever before
...
When disease is discovered at an earlier stage it is less likely to
lead to death within five years, regardless of treatment
...
38
Beyond the current screening methods, there are other non-nutritional options for prevention that have been promoted
...
These options
include taking a drug such as tamoxifen and/or mastectomy
...
One
major U
...
study showed that tamoxifen administered over a period of
four years to women at increased risk of breast cancer reduced the number of cases by an impressive 49%
...
It was this result that led
the U
...
Food and Drug Administration to approve use of tamoxifen by
women who met certain criteria
...
Two less substantial European trials 43
...
Moreover, there
is the additional concern that tamoxifen raises the risks for stroke, uterine cancer, cataracts, deep vein thrombosis and pulmonary embolism,
although the overall benefits of breast cancer prevention are still believed
to outweigh the risks
...
45
...
In effect, they work by reducing the activity of estrogen,
which is known to be associated with elevated breast cancer risk
...
5 My
question is quite simple: why don't we ask why estrogen is so high in
the first place, and once we recognize its nutritional origin, why don't
we then correct that cause? We now have enough information to show
that a diet low in animal-based protein, low in fat and high in whole
plant foods will reduce estrogen levels
...

The ability of dietary factors to control female hormone levels has
long been known in the research community, but a recent study was
particularly impressive
...

These girls consumed a diet of no more than 28% fat and less than 150
mg cholesterol/day: a moderate plant-based diet
...

Women at high risk for breast cancer are given three options: watch
and wait, take tamoxifen medication for the remainder of their lives or
undergo mastectomy
...
I stand by the usefulness

( 0 MM0 N ( AN( ERS: BREA ST, PRO STATE, l ARGE BOW El

165

of this fourth option even for women who have already had a first mastectomy
...

Environmental Chemicals

There is another breast cancer conversation that has been taking place
for some years now
...
These widely
distributed chemicals have been shown to disrupt hormones, although
it is not clear which hormones in humans are being disrupted
...

There are many different types of offending chemicals, most of which
are commonly associated with industrial pollution
...
Thus they are not excreted from the body
...
Some of these chemicals are
known to promote the growth of cancer cells, although humans may
not be at significant risk unless one consumes excessive quantities of
meat, milk and fish
...

There is a second group of these environmental chemicals that are also
commonly perceived to be significant causes of breast5 2 and other cancers
...

Unlike the PCBs and dioxins, when we consume PAHs (in food and water), we can metabolize and excrete them
...
This is the first step in causing cancer
...
53
In chapter three, I described studies in my laboratory showing that
when a very potent carcinogen is put into the body, the rate at which

166

THE CHINA STUDY

it causes problems is mostly controlled by nutrition
...
Very simply, consuming a Westerntype diet will increase the rate at which chemical carcinogens like PAHs
bind to DNA to form products that cause cancer
...
It is entirely possible that the quantity of PAHs being consumed had nothing to do with
increasing breast cancer risk
...
54
How is this possible? Perhaps all of the women in this Long Island study
consumed a relatively uniform, low level of PAHs, and the only ones
who subsequently got breast cancer were the ones who ate a diet high
in fat and animal protein, thus causing more of the ingested PAHs to
bind to their DNA
...
55 As
a result of the Long Island study, the hype associating environmental
chemicals with breast cancer has been somewhat muted
...


Hormone Replacement Therapy

I must briefly mention one final breast cancer issue: whether to use hormone replacement therapy (HRT), which increases breast cancer risk
...
56
However, it is now becoming widely acknowledged that HRT is not as
beneficial as once thought, and it may have certain severe side effects
...
5 Of special interest are two large randomized intervention trials:
6
the Women's Health Initiative (WHI)57 and the Heart and Estrogen!
Progestin Replacement Study (HERS)
...
2 years the WHI trial is shOwing a 26% increase in breast cancer

( 0 MM0 N (AN ( ERS: BREAST, PRO STATE, LA RGE BOW EL

167

cases while the HERS study is seeing an even greater 30% increase
...
It appears that increased exposure to female hormones, via HRT, does indeed lead to more breast cancer
...
56 However, this is not necessarily true
...
HRT may increase cardiovascular disease risk
after all
...
Among every lO,OOO women, there
were six fewer colorectal cancers and five fewer bone fractures
...
We can tell each individual woman to
make her own decision depending on which disease and which unpleasantry she fears the most, as many physicians are likely to do
...
These women must choose between living unaided
through the emotional and physical symptoms of menopause in order
to preserve a low risk of breast cancer, or taking HRT to manage their
menopause discomforts while increasing their risk of breast cancer and,
possibly, cardiovascular disease
...
We have spent well over a billion dollars
on the research and development of these HRT medical preparations,
and all we get is some apparent pluses and probably even more minuses
...

Instead of relying on HRT, I suggest that there is a better way, using
food
...

• When women reach the end of their reproductive years, it is entirely natural for reproductive hormones of all women to drop to a
low "base" level
...
Using hypothetical numbers to illustrate the concept, the

168

THE CHINA STUDY

levels of plant eaters may crash from forty to fifteen, rather than
sixty to fifteen for animal eaters
...

• Therefore, a plant-based diet leads to less severe hormone crash
and a gentler menopause
...
But even if future studies fail to
confirm these details, a plant-based diet still offers the lowest risk for
both breast cancer and heart disease for other reasons
...

In each of the various issues involving breast cancer risk (tamoxifen
use, HRT use, environmental chemical exposure, preventive mastectomy), I am convinced that these practices are distractions that prevent
us from considering a safer and far more useful nutritional strategy
...


LARGE BOWEL CANCER
(INCLUDING COLON AND RECTUM)
At the end of June 2002, George W Bush handed the presidency over to
Dick Cheney for a period of roughly two hours while he underwent a
colonoscopy
...
Across the country,
whether the comedians were making jokes or the news anchors were
describing the drama, everybody was suddenly, briefly, talking about
this thing called a colon os copy and what it was for
...

Because colon and rectal cancers are both cancers of the large bowel,
and because of their other similarities, they often are grouped together
under the term colorectal cancer
...
60 It is the second most common in the United States, with 6% of Americans getting the
cancer during their lifetime
...
6l

( 0 MM0 N (A N( ERS: BREA ST,P R0 STATE l ARGE BOW E l l 69
I

GEOGRAPHIC DISPARITY
North America, Europe, Australia and wealthier Asian countries Qapan, Singapore) have very high rates of colorectal cancer, while Africa,
Asia and most of Central and South America have very low rates of this
cancer
...
19 per
100,000 males, while Bangladesh has a death rate of 0
...
3 shows a comparison of average death rates between
more developed countries and less developed countries; all these rates
are age-adjusted
...
The question has always been why
...
Migrant studies have shown that
as people move from a low-cancer risk area to a high-cancer risk area,
they assume an increased risk within two generations
...
Other studies have also found that rates of colorectal cancer change rapidly as a
population's diet or lifestyle changes
...
In the context of human society, it takes thousands of
CHART 8
...
Male

10

[J

8
6
4
2
0

More
Developed
Countries

Less
Developed
Countries

Female

THE CHINA STUDY

170

years to get widespread, permanent changes in the inherited genes that
are passed from one generation to the next
...

In a landmark paper published almost thirty years ago, researchers
compared environmental factors and cancer rates in thirty-two countries around the world
...
Chart
8
...

In this report, countries where more meat, more animal protein, more
sugar and fewer cereal grains were consumed had far higher rates of
colon cancer
...
He compared stool samples and fiber intakes
in Africa and Europe and proposed that colorectal cancers were largely
the result of low fiber intake
...
It is the part of the plant that our body cannot digest
...
67 There
are ten grams of fiber in one cup of red raspberries, one Asian pear or
CHART 8
...


o
o

o

g

...
S
...

• CANADA

-- 30
GJ
v

I:

DENMARK

GJ

-c
'u

...

~

I:

III

U
I:

10

o

"0
u

o

•

...
ISRAEL
• • ICELAND
JAMAICA
•
•
FINLAND PUERTO RICO GERMANY
YUGOSLAVIA
...

CHILE •
ROMANIA
...
NIGERIA
• COLOMBIA

o

40

80

120

160

200

240

Per Capita Daily Meat Consumption (grams)

280

320

COMMON CANCERS: BREAST, PROSTATE, LARGE BOWEl

171

one cup of peas
...

From all this research, it seems clear that something can be said for
the importance of diet in colorectal cancer
...
The debate has raged, and solid answers are seldom agreed
upon
...
Because of Burkitt's prominence, many people have believed that fiber is
the source of colorectal health
...
At least you probably have
heard that fiber "keeps things running well
...
There are important technical reasons
why a definitive conclusion regarding fiber is difficult to make
...
Fiber represents hundreds of substances, and "its" benefits
operate through an exceptionally complex series of biochemical and
physiological events
...
It is nearly impossible
to establish a standard procedure because it is virtually impossible to
know what each fiber sub-fraction does in the body
...
As summarized in chapter four, as consumption of almost all of these fiber
types went up, colon and rectal cancer rates went down
...

Despite the uncertainties, I continue to believe that Burkitt's66 initial hypothesis that fiber-containing diets prevent colorectal cancers is
correct and that some of this effect is due to the aggregate effect of all
the fiber types
...
In 1990, a group of
researchers reviewed sixty different studies that had been done on fiber
and colon cancer
...
They noted that the combined results showed that the people who consumed the most fiber had
a 43% lower risk of colon cancer than the people who consumed the
least fiber
...
71 But even in this
large review of the evidence, researchers noted, "the data do not permit
discrimination between effects due to fiber and non-fiber effects due to
vegetables
...

Two years later, in 1992, a different group of researchers reviewed
thirteen studies that had compared people with and without colorectal
cancer (case-control design)
...
72 In fact, they found that if Americans
ate an additional thirteen grams of fiber a day from food sources (not as
supplements), about a third of all colorectal cancer cases in the u
...

could be avoided
...

More recently, a mammoth study called the EPIC study collected
data on fiber intake and colorectal cancer in 519,000 people across
3
Europe
...
73 It's important to note once again
that, as with all of these studies, dietary fiber was obtained in food, not
as supplements
...
We still can't say anything
definitive about isolated fiber itself
...
But consuming plant
foods naturally high in fiber is clearly beneficial
...

In reality, we can't even be sure how much of the prevention of
colorectal cancer is due to fiber-containing foods , because as people
eat more of these foods they usually consume less animal-based foods
...
White South Africans have seventeen times
more large bowel cancer than black South Africans, and this was first
thought to be due to the much higher consumption of dietary fiber
among black South Africans provided by unrefined maize
...
They
now eat even less fiber than the white South Africans
...

A more recent study76 showed that the higher colon cancer rates among
white South Africans could well be due to their elevated consumption
of animal protein (77 vs
...
71 g/day) and
cholesterol (408 vs
...
5
...
5: INTAKE OF ANIMAL PROTEIN, TOTAL FAT AND
CHOLESTEROL AMONG BLACK AND WHITE SOUTH AFRICANS
450
400
350
300
Daily Intake 250
(milligra ms) 200
150
100
50

• Black SA

o White SA

Cholesterol
120
100

80
Daily Intake
(Grams)

60
40
20

o
Animal Protein

Total Fat

174

THE CHINA STUDY

Africans may be more related to the quantity of animal protein and fat in
their diets than their lacking the protective factor of dietary fiber
...
Even in the absence of more
specific details, we can still make important public health recommendations
...
We don't need to know which fiber
is responsible, what mechanism is involved or even how much of the effect
is independently due to fiber
...
77- 79 From there, scientists have hypothesized that insulin resistance may be responsible for colon cancer
...
And what's good for
keeping insulin resistance under control is also good for colon cancer: a
diet of whole, plant-based foods
...
Because carbohydrateconfusion persists, let me remind you that there are two different types
of carbohydrates: refined carbohydrates and complex carbohydrates
...
This "food" (regular
sugar, white flour, etc
...
Foods such as
pastas made from refined flour, sugary cereals, white bread, candies and
sugar-laden soft drinks should be avoided as much as possible
...
These unprocessed carbohydrates, especially from fruits
and vegetables, are exceptionally health-promoting
...
This, of course, gets extended to the argument that cow's milk
fights colon cancer
...
s4 and second, it binds up intestinal bile acids
...
By binding
these bile acids, calcium is said to prevent colon cancer
...
Furthermore, it is not clear whether these presumably
favorable biochemical effects really lead to less cancer growth
...
86 But-and this is the really
odd part-when a combination high-calcium and high-wheat diet was
consumed, the binding effect on bile acids was weaker than for each
individual supplement taken alone
...

I doubt that a high-calcium diet, obtained through calcium supplements or through calcium-rich cow's milk, has a beneficial effect on
colon cancer
...
S
...

Another lifestyle choice that is clearly important for this disease is
exercise
...
In one summary from the World Cancer Research Fund and
the American Institute for Cancer Research, seventeen out of twenty
studies found that exercise protected against colon cancer
...


SCREENING FOR TROUBLE
The benefits of exercise bring me back to President George W Bush
...
But what is a colonoscopy anyway,
and is it really worth the effort to get checked? When people go to the
doctor to get a colonoscopy, the doctor inspects the large bowel using a
rectal probe and looks for abnormal tissue growth
...
Although it is not yet clear exactly how tu-

176

THE CHINA STUDY

mors are related to polyps, most scientists would agree88,89 that they share
similar dietary associations and genetic characteristics
...

So getting screened for polyps or other problems is a reasonable
way to establish risk for large bowel cancer in the future
...
89 , 91 It is commonly recommended that people get a
colonoscopy once every ten years starting at the age of fifty
...

How do you know if you are at a higher risk for colorectal cancer? We
can very roughly assess our personal genetic risk in several ways, We
can consider the probability of our getting colon cancer based on the
number of immediate family members who already have the disease, we
can screen for the presence of polyps, and we now can clinically test for
the presence of suspect genes
...
However, in the enthusiasm for
studying the genetic basis for this cancer, two things often get overlooked
...
89 Another 10-30%89 tend to occur in some
families more than others (called familial clustering), an effect possibly
reflective of a significant genetic contribution
...
"
Except for the very few people whose colon cancer risk is largely
determined by known inherited genes (1-3%), most of the family-connected colon cancer cases (i
...
After all, place of residence and diet are often shared experiences within families
...
Because a high-fiber diet can only prevent colon
cancer-extra fiber won't ever promote colon cancer-dietary recommendations should be the same regardless of one's genetic risk
...
The prostate is a male
reproductive organ about the size of a walnut, located between the bladder and the colon
...

For such a little thing, it sure can cause a lot of problems
...
As one recent report pointed out, "Prostate cancer is
one of the most commonly diagnosed cancers among men in the United
States, representing about 25% of all tumors
...
Prostate cancer is not
only extremely prevalent, but also slow-growing
...
95 This makes it difficult to
know how and if the cancer should be treated
...
Men are diagnosed as having prostate problems when their
PSA levels are above four
...
The ambiguity
of this test leads to some very difficult deciSion-making
...
Should they have a little surgery or a lot?
Is a PSA value of 6
...

Although there is debate regarding the specifics of diet and this cancer, let's start with some very safe assumptions that have long been accepted in the research community:
• Prostate cancer rates vary widely between different countries, even
more than breast cancer
...


178

THE CHINA STUDY

• In developing countries, men who adopt Western eating practices
or move to Western countries suffer more prostate cancer
...
Mostly this tells us that although prostate cancer certainly has a
genetic component, environmental factors play the dominant role
...

A 2001 Harvard review of the research could hardly be more convincing96 :

...
fourteen case-control studies and seven of
...
In these studies, men with the highest
dairy intakes had approximately double the risk of total prostate
cancer, and up to a fourfold increase in risk of metastatic or fatal
prostate cancer relative to low consumers
...

Another review of published literature done in 1998 reached a similar conclusion:
In ecologic data, correlations exist between per capita meat and
dairy consumption and prostate cancer mortality rate [one study
cited]
...

[twenty-three studies cited]
...
The consistent associations
with dairy products could result from, at least in part, their calcium and phosphorous content
...
In the case of dairy, the
high intake of calcium and phosphorus also could be partly responsible
for this effect
...


THE MECHANISMS
As we have seen with other forms of cancer, large-scale observational
studies show a link between prostate cancer and an animal-based diet,
particularly one based heavily on dairy
...

The first mechanism concerns a hormone that increases cancer
cell growth, a hormone that our bodies make, as needed
...

Under normal conditions, this hormone efficiently manages the rates at
which cells "grow"-that is, how they reproduce themselves and how
they discard old cells, all in the name of good health
...
So what does this have to do with the
food we eat? It turns out that consuming animal-based foods increases
-101
the blood levels ofthis growth hormone, IGF_P9
With regard to prostate cancer, people with higher than normal blood
levels of IGF-I have been shown to have 5
...
98 There's more: when men also have low blood
levels of a protein that binds and inactivates IGF_I,lo2 they will have 9
...
They are big and impressive-and fundamental to this
finding is the fact that we make more IGF-I when we consume animalbased foods like meat and dairy
...
This "vitamin" is not a nutrient that we need to consume
...
In addition to the production of vitamin D being

180

THE CHINA STUDY

affected by sunlight, it is also affected by the food that we eat
...
This process is a great example
of our bodies' natural balancing act, affecting not only prostate cancer,
but breast cancer, colon cancer, osteoporosis and autoimmune diseases
like Type 1 diabetes
...
This web of reactions illustrates many similar and
highly integrated reaction networks showing how food controls health
...
This active or "supercharged" D produces many benefits throughout the body, including the prevention of cancer, autoimmune diseases
and diseases like osteoporosis
...
A drug composed of
isolated supercharged D would be far too powerful and far too dangerous for medical use
...

As it turns out, our diet can determine how much of this supercharged D is produced and how it works once it is produced
...
If these low levels persist, prostate cancer can result
...

So what food substance has both animal protein and large amounts
of calcium? Milk and other dairy foods
...
This information provides what we call biological plausibility and shows how the
observational data fit together
...

• Animal protein suppresses the production of "supercharged" D
...


COMMON CANCERS: BREAST, PROSTATE, LARGE BOWEL

181

• "Supercharged" D is responsible for creating a wide variety of
health benefits in the body
...

The important story here is how the effects of food-both good and
bad-operate through a symphony of coordinated reactions to prevent
diseases like prostate cancer
...
We tend to think of these reactions within the network as independent
...
What impresses
me is the multitude of reactions working together in so many ways to
produce the same effect: in this case, to prevent disease
...
Indeed, it would be foolish to even think along
these lines
...


BRINGING IT TOGETHER
Roughly half a million Americans this year will go to the doctor's office
and be told that they have cancer of the breast, prostate or large bowel
...
These three cancers devastate the lives of not only the victims
themselves, but also their family and friends
...

It wasn't that we didn't care about the health of our loved ones-of
course we did
...
Yet, over thirty years
later, not much has changed
...
Probably they,
too, don't have the information
...
Even cancer
organizations, at both the national and local level, are reluctant to discuss
or even believe this evidence
...
The widespread communities of nutrition professionals, researchers and doctors are, as a whole, either unaware
of this evidence or reluctant to share it
...

There is enough evidence now that doctors should be discussing
the option of pursuing dietary change as a potential path to cancer
prevention and treatment
...
S
...
There is enough evidence now
that local breast cancer alliances, and prostate and colon cancer institutions, should be discussing the possibility of providing information to
Americans everywhere on how a whole foods, plant-based diet may be
an incredibly effective anti-cancer medicine
...
The year after
that, even fewer friends, coworkers and family members would be given
the most dreaded of all diagnoses
...

The possibility that this future could be our reality is real, and as long
as this future holds such promise for the health of people everywhere, it
is a future worth working for
...
_
...
_
...
_
...
_
...

Autoimmune Diseases
No GROUP OF DISEASES is more insidious than autoimmune diseases
...
Unlike heart disease, cancer, obesity and
Type 2 diabetes, with autoimmune diseases the body systematically at·
tacks itself
...

A quarter million people in the u
...
are diagnosed with one of the
forty separate autoimmune diseases each year
...
2 Women are 2
...
About 3% of Americans (one in
every thirty-one people) have an autoimmune disease, a staggering total
of 8
...
3
The more common of these diseases are listed in Chart 9
...
2 The first
nine comprise 97% of all autoimmune disease cases
...
2 These are also the primary autoimmune
diseases that have been studied in reference to diet
...
1 include inflammatory bowel disease,4
Crohn's disease,4 rheumatic heart disease3 and (possibly) Parkinson's
disease
...
it is important to consider
...
" They show similar clinical backgrounds,3
...
7 they sometimes
occur in the same person and they are often found in the same populations
...
1: COMMON AUTOIMMUNE DISEASES
(FROM 'MOST COMMON TO LEAST COMMON)
l
...

3
...

5
...

7
...
Type 1 diabetes
9
...

1l
...

13
...

15
...

17
...
"8 Autoimmune diseases in general
become more common the greater the distance from the equator
...
9 MS, for example, is over a
hundred times more prevalent in the far north than at the equator
...
We refer in this
way to cancer, which is specifically named depending on what part of
the body it resides in
...
In this case, the mechanism is the immune
system mistakenly attacking cells in its own body
...
It is an internal mutiny of the worst kind, one in which our
body becomes its own worst enemy
...
I often hear people
speaking about this system as if it were an identifiable organ like a lung
...
It is a system, not an organ
...
The "soldiers" of this network are the white
blood cells, which are comprised of many different sub-groups, each having
its own mission
...


AUTOIMMUNE DISEASES

185

The "recruitment center" for the system is in the marrow of our
bones
...
Some of these cells are released into circulation for
use elsewhere in the body; these are called B-cells (for bone)
...
These "soldier" cells, along with other specialized cells, team
up to create intricate defense plans
...
These meeting points are like command
and control centers, where the "soldier cells" rearrange themselves into
teams to attack foreign invaders
...

They are able to respond to different circumstances and different foreign substances, even those they have never before seen
...
It is one of
the true wonders of nature
...
These
foreign cells can be a bacterium or a virus looking to corrupt the body's
integrity So when our immune system notices these foreign cells, or
antigens, it destroys them
...
It is analogous to each and every person having
a different face
...
"
To counter these antigens, our immune system must customize its
defense to each attack
...
The mirror image is able to fit perfectly onto the
antigen and destroy it
...
Every time it sees that face after the initial
encounter, it uses the custom-made mold to "capture" the invader and
destroy it
...

Remembering each defense against each invader is what immunization is all about
...
You may not even get sick
...
This self-destructive process is
common to all autoimmune diseases
...

One of the fundamental mechanisms for this self-destructive behavior is called molecular mimicry
...
The immune system "molds" that fit these invaders also fit
our own cells
...
This is
an extremely complex self-destructive process involving many different
strategies on the part of the immune system, all of which share the same
fatal flaw of not being able to distinguish "foreign" invader proteins
from the proteins of our own body
...
During the process of digestion, for example, some proteins
slip into our bloodstream from the intestine without being fully broken
down into their amino acid parts
...

One of the foods that supply many of the foreign proteins that mimic
our own body proteins is cow's milk
...
Just like an army arranges for safeguards against
friendly fire, the immune system has safeguards to stop itself from attacking the body it's supposed to protect
...
In fact, the immune system may use our own cells to practice making molds against
the invader antigen without actually destroying the friendly cell
...
When our
immune system is working properly, we can use the cells in our body that
look like the antigens as a training exercise, without destroying them, to
prepare our soldier cells to repulse the invading antigens
...


AUTOIMMUNE DISEASES

187

The immune system uses a very delicate process to decide which proteins should be attacked and which should be left alone
...
We just know that the immune system
loses its ability to differentiate between the body's cells and the invading
antigen, and instead of using the body's cells for "training," it destroys
them along with the invaders
...
This devastating, incurable
disease strikes children, creating a painful and difficult experience for
young families
...
The ability of cow's milk protein to initiate Type 1
diabetes 12- 14 is well documented
...

• The milk reaches the small intestine, where it is digested down to
its amino acid parts
...

• These incompletely digested protein fragments may be absorbed
into the blood
...

• Unfortunately, some of the fragments look exactly the same as the
cells of the pancreas that are responsible for making insulin
...

• The infant becomes a Type 1 diabetic, and remains so for the rest
of his or her life
...
For

188

THE CHINA STUDY

obvious reasons, this is one of the most contentious issues in nutrition
today
...
12 The researchers, from Finland, obtained blood from Type
1 diabetic children, aged four to twelve years
...

They did the same process with non-diabetic children and compared
the two groups (remember, an antibody is the mirror image, or "mold,"
of a foreign antigen)
...
It also means that undigested protein fragments of the cow's milk proteins had to have entered
the infant's circulation in order to cause the formation of antibodies in
the first place
...
Of the 142
diabetic children measured, every Single one had antibody levels higher
than 3
...
Of the seventy-nine normal children measured, every single
one had antibody levels less than 3
...

There is absolutely no overlap between antibodies of healthy and
diabetic children
...
This implies two things: children with more antibodies consumed
more cow's milk, and second, increased antibodies may cause Type 1
diabetes
...
It
was the complete separation of antibody responses that made this study
5
so remarkable
...
13
...
19
Several studies have since investigated this effect of cow's milk on
BSA antibody levels
...

Over the past decade, scientists have investigated far more than
just the BSA antibodies, and a more complete picture is coming into
view
...
A study in Chile23 considered the
first two factors, cow's milk and genes
...
1 times greater than children who did not have these
genes and who were breast-fed for at least three months (thus minimizing their exposure to cow's milk)
...
S
...
3 times greater than children who did not have these
genes and who were breast-fed for at least three months
...
To
put this in perspective, smokers have approximately ten times greater
risk of getting lung cancer (still less than the eleven to thirteen times
risk here) and people with high blood pressure and cholesterol have a
2
...
0 times greater risk of heart disease (Chart 9
...
18
So how much of the eleven to thirteen times increased risk of Type
1 diabetes is due to early exposure to cow's milk, and how much is due
CHART 9
...
LJ

600%

Heart
Disease

Type 1
Diabetes

-'t::

Vl

a:

400%
200%

High Blood Pressure
and Cholesterol

Smoking

Risk Factors

Cow's Milk
+ High-Risk Genes

THE CHINA STUDY

190

to genes? These days, there is a popular opinion that Type 1 diabetes is
due to genetics, an opinion often shared by doctors as well
...
Genes do not act in isolation; they need a trigger for their effects to be produced
...
l3 , 20, 21, 25
...
In addition, it is possible that
the 13-33% risk for the second twin is due to the sharing of a common
environment and diet, factors affecting both twins
...
3, which
highlights the link between one aspect of environment, cow's milk consumption, and this disease
...
28 The greater the consumption of
cow's milk, the greater the prevalence of Type 1 diabetes
...
29 Large
amounts of cow's milk products are consumed in Finland but very little
is consumed in JapanY
CHART 9
...
s
(J)

u

c

~

'u
c

10

JAPAN

DENMARK
: NEW ZEALAND
• NETHERLANDS
CANADA
• • ISRAEL

o~
...
-~~~~r-~
...
3O-32This shows that even
though individuals may have the necessary gene(s) , the disease will occur
only in response to certain dietary and/or environmental circumstances
...
The worldwide prevalence of Type 1 diabetes is increasing at an alarming rate of 3% per year
...
This relatively rapid increase cannot be due to genetic susceptibility
...
For example, if all families with
Type 1 diabetic relatives had a dozen babies and all the families without
Type 1 diabetic relatives died off, then the gene or genes that may be
responsible for Type 1 diabetes would become much more common in
the population
...

It seems to me that we now have impressive evidence shOWing that
cow's milk is likely to be an important cause of Type 1 diabetes
...
5-1
...
34
The earlier information on diet and Type 1 diabetes was impressive
enough to cause two Significant developments
...
Second, many researchers 19 have developed
prospective studies-the kind that follow individuals into the futureto see if a careful monitoring of diet and lifestyle could explain the onset
of Type 1 diabetes
...
35
One has shown that cow's milk consumption increases the risk of Type
1 diabetes five- to sixfold,36 while the second35 tells us that cow's milk
increases the development of at least another three to four antibodies

192

THE CHINA STUDY

in addition to those presented previously (p
...
In a separate study,
antibodies to beta-casein, another cow's milk protein, were significantly
elevated in bottle-fed infants compared to breast-fed infants; children
with Type 1 diabetes also had higher levels of these antibodies
...


THE CONTROVERSY OF CONTROVERSY
Imagine looking at the front page of the newspaper and finding the
following headline: "Cow's Milk the Likely Cause of Lethal Type 1
Diabetes
...
Stifling this headline is accomplished under the powerful label of "controversy
...
Controversies are a natural part
of science
...
For example, if I say cigarettes are bad for
you and provide a mountain of evidence to support my contention,
the tobacco companies might come along and pick out one unsolved
detail and then claim that the whole idea of cigarettes being unhealthy
is mired in controversy, thereby nullifying all my conclusions
...
Some groups use controversy to stifle certain ideas,
impede constructive research, confuse the public and turn public
policy into babble rather than substance
...

It can be difficult for the layperson to assess the legitimacy of a highly
technical controversy such as that regarding cow's milk and Type 1 diabetes
...

Take a recent scientific review38 of the cow's milk-Type 1 diabetes
association
...
Obviously, this at first seems to demonstrate considerable uncertainty, going a long way to discredit the hypothesis
...
These five studies
showed no statistically significant effect either way
...
There is only one chance in sixty-four that this
was a random or chance result
...
Perhaps the study
didn't include enough people, and statistical certainty was unattainable
...
Maybe trying to
measure infant feeding practices from years ago was inaccurate enough
that it obscured the relationship that does exist
...

The point is, if five of the ten studies did find a statistically significant
relationship, and all five showed that cow's milk consumption is linked
to increasing Type 1 diabetes, and none show that cow's milk consumption is linked to decreasing Type 1 diabetes, I could hardly justify saying, as the authors of this review did, that the hypothesis "has become
quite murky with inconsistencies in the literature
...
This compilation involved fifty-two
possible comparisons, twenty of which were statistically significant
...
Again the odds heavily favored the
hypotheSized association, something that the authors failed to note
...
This practice
is more common than it should be and is a source of unnecessary confusion
...
Indeed, shortly after I wrote this, I heard a brief National Public
Radio interview on the Type 1 diabetes problem with the senior author

194

THE CHINA STUDY

of this review paper
...

Because this issue has mammoth financial implications for American
agriculture, and because so many people have such intense personal
biases against it, it is unlikely that this diabetes research will reach the
American media anytime soon
...
We not only have evidence of the danger of cow's
milk, we also have considerable evidence showing that the association
between diabetes and cow's milk is biologically plausible
...

MULTIPLE SCLEROSIS
AND OTHER AUTOIMMUNE DISEASES
Multiple sclerosis (MS) is a particularly difficult autoimmune disease,
both for those who have it and for those who care for its victims
...

MS patients often pass through episodes of acute attacks while gradually
losing their ability to walk or to see
...

About 400,000 people in the u
...
alone have the disease, according
to the National Multiple Sclerosis Society
...

Even though there is widespread medical and scientific interest in
this disease, most authorities claim to know very little about causes
or cures
...
They generally list genetics, viruses and environmental factors as possibly playing roles in the development of this disease but pay almost no heed to a possible role for diet
...
40--42 Once again cow's
milk appears to play an important role
...
The electrical signals carrying messages to and from the
central nervous system (brain and spinal cord) and out through the peripheral nervous system to the rest of the body are not well coordinated

l

AUTOIMMUNE DISEASES

195

and controlled
...

Think of what would happen to your household wiring if the electrical
insulation became thin or was stripped away, leaving bare wires
...
That is what happens with
MS; the wayward electrical signals may destroy cells and "burn" patches
of neighboring tissue, leaVing little scars or bits of sclerotic tissue
...

The initial research showing an effect of diet on MS goes back more
than half a century to the research of Dr
...
Later, Dr
...
43
Dr
...
44 This distribution is
very similar to the distribution of other autoimmune diseases, including
Type 1 diabetes and rheumatoid arthritis
...
Swank thought it was diet, especially
animal-based foods high in saturated fats
...

Dr
...
He kept records on
these patients for the next thirty-four yearsY He advised his patients
to consume a diet low in saturated fat, most of whom did, but many
of whom did not
...
(For comparison, a bacon cheeseburger with
condiments has about sixteen grams of saturated fat
...
)
As the study continued, Dr
...
He summarized his work
in 1990,47 concluding that for the sub-group of patients who began the

THE CHINA STUDY

196

CHART 9
...
, - - Poor Dieters
Good Dieters

low-saturated fat diet during the earlier stages of their disease, "about
95%
...
"
Only 5% of these patients died
...

The results from all 144 patients, including those who started the diet
at a later stage of disease, are shown in Chart 9
...

This work is remarkable
...
Moreover,
if this were a study testing a potential drug, these findings would make
any pharmaceutical manufacturer jingle the coins in his or her pocket
...

More recently, additional studies 42 , 51, 52 have confirmed and extended
Swank's observations and gradually have begun to place more emphasis on cow's milk
...
S
...
5, published by
French researchers, compares the consumption of cow's milk with MS
for twenty-six populations in twenty-four countries
...
51 In some studies 52 , 53
researchers suggest this strong correlation with fresh cow's milk might

AUTOIMMUNE DISEASES

197

CHART 9
...


•

0

C-

o
0
0

6
0


...
t
Vl

::2:

•
•

•••

•
• •

0
0

100

200

Milk Consumption (kg/inhabitants/year)

be due to the presence of a virus in the milk
...
The consumption of meat high in saturated fat, like
milk, was also associated with MS in these multi-country studies,54
while the consumption of fish, containing more omega-3 fat, was associated with low rates of disease
...
5, may be
impressive, but it does not constitute proof
...

In the case of viruses, no definite conclusions are yet possible
...
However, nothing very
convincing has been proven
...
13 , 19
...
People acquire
the risk of the population to which they move, especially if they move
before their adolescent years
...
58 This tells us that this disease is more
strongly related to environmental factors than it is to genes
...
Therefore, it will undoubtedly be a long
time before we determine with any precision which genes or combinations of genes predispose someone to MS
...
60
Although MS and Type 1 diabetes share some of the same unanswered
questions on the exact roles of viruses and genes and the immune system, they also share the same alarming evidence regarding diet
...
Despite the efforts of those who would rather dismiss or mire
these observational studies in controversy, they paint a consistent picture
...

Dr
...
James Anderson successfully reduced the medication requirements for Type 1 diabetics using diet alone
...
I wonder what would
happen to these autoimmune patients if the ideal diet were followed
...


THE COMMONALITY OF AUTOIMMUNE DISEASES
What about other autoimmune diseases? There are dozens of autoimmune diseases and I have mentioned only two of the more prominent
ones
...
The more they have in common, the greater the
probability that they also will share a common cause (or causes)
...

Just as we hypothesized that diseases of affluence such as cancer and

AUTOIMMUNE DISEASES

199

heart disease have common causes because they share similar geography and similar biochemical biomarkers (chapter four), we can also
hypothesize that MS, Type 1 diabetes, rheumatoid arthritis, lupus and
other autoimmune diseases may share a similar cause if they exhibit
similar characteristics
...

Second, all the autoimmune diseases that have been studied have
been found to be more common at the higher geographic latitudes
where there is less constant sunshine
...
MS and Type 1 diabetes, for example, have been shown to coexist in the same individuals
...
5
MS also has been associated-either geographically or within the same
individuals-with other autoimmune diseases like lupus, myasthenia
gravis, Graves' disease and eosinophilic vasculitis
...
67
Fourth, of those diseases studied in relation to nutrition, the consumption of animal-based foods-especially cow's milk-is associated
with greater disease risk
...

A sixth and most important characteristic binding together these
diseases is the evidence that their "mechanisms of action" have much
in common-jargon used to describe the "how to" of disease formation
...
Sunlight exposure, which decreases with increasing latitude, could be important-but clearly there are other factors
...
In fact, in one of the more extensive studies, cow's milk was found to be as good of a predictor of MS
as latitude (Le
...
Swank's studies in Norway, MS was
less common near the coastal areas of the country where fish intake was
more common
...
What is almost never mentioned,
however, is that dairy consumption (and saturated fat) was much lower
in the fish-eating areas
...

As it turns out, the idea is not so crazy
...
There are experimental animal models of lupus,
MS, rheumatoid arthritis and inflammatory bowel disease (e
...
, Crohn's
disease, ulcerative colitis), each of which is an autoimmune disease
...
68
Vitamin D, operating through a similar mechanism in each case, prevents
the experimental development of each of these diseases
...

The first step in the vitamin D process occurs when you go outside
on a sunny day
...
The vitamin D then must be activated in the kidney in order to produce a form that helps repress the development of
autoimmune diseases
...
Under experimental conditions, the activated
vitamin D operates in two ways: it inhibits the development of certain
T-cells and their production of active agents (called cytokines) that
initiate the autoimmune response, and/or it encourages the production
of other T-cells that oppose this effect
...
70 (An abbreviated schematic
of this vitamin D network is shown in Appendix C
...

Knowing the strength of the evidence against animal foods, cow's milk
in particular, for both MS and Type 1 diabetes, and knowing how much
in common all of the autoimmune diseases have, it is reasonable to begin thinking about food and its relationship to a much broader group of
autoimmune diseases
...
But the evidence we have now is already striking
...
The Web site of the Multiple Sclerosis International Federation, for example, reads, "There is no credible

AUTOIMMUNE DISEASES

201

evidence that MS is due to poor diet or dietary deficiencies
...
"7l If changing your diet is expensive, I don't know
what they would say about being bedridden and incapacitated
...

There are 400,000 Americans who are victims of multiple sclerosis,
and millions more with other autoimmune diseases
...
Anyone of these
serious diseases I've talked about in this chapter can forever alter the
life of any person-a family member, a friend, a neighbor, a coworker
or you yourself
...
Reason must prevail
...


t

__
...
_
...
_
...
_
...
_
...
_
...
_
...


...
_
...
_ 0
...
__
...


...
If I have a conversation with
someone about a single study showing the protective effect of fruits
and vegetables on heart disease, they may agree that it's all very nice for
fruits and vegetables, but they will probably still go home to meatloaf
and gravy
...

The fact is that most people have a healthy skepticism about one study
standing alone-as well they should
...

If I keep talking and go through this process not only for heart disease, but obesity, Type 2 diabetes, breast cancer, colon cancer, prostate

ONE

203

204

THE CHINA STUDY

cancer, multiple sclerosis and other autoimmune diseases, it's quite possible that people may never eat meatloaf and gravy again
...
While a single study might be found to support almost any idea under the sun, what are the chances that hundreds,
even thousands, of different studies show a protective benefit of plantbased foods and/or harmful effects of animal-based foods for so many
different diseases? We can't say it's due to coincidence, bad data, biased
research, misinterpreted statistics or "playing with numbers
...

I have so far presented only a small sample of the breadth of evidence
that supports plant-based diets
...
These disorders are not often fatal and are
often regarded as the inevitable consequences of aging
...
But, as we shall see, even these diseases have a dietary link
...
the ankle bone is connected to the shin bone, the shin bone is connected to the knee bone," etc
...
Because
none of us want to be shapeless blobs, and because our celebrities have
been paid to advertise milk's presumed benefits, we drank it
...

Americans consume more cow's milk and its products per person
than most populations in the world
...
A recent study showed that
American women aged fifty and older have one of the highest rates of hip
fractures in the world
...
What's going on?
An excess rate of hip fractures is often used as a reliable indicator of
osteoporosis, a bone disease that especially affects women after meno-

WIDE-RANGING EFFECTS: BONE, KIDNEY, EYE, BRAIN DISEASES

205

pause
...

Therefore, health policy people often recommend higher calcium consumption
...
These
efforts have something to do with why you were told to drink your milk
for strong bones-the politics of which are discussed in Part IV
...
One possible explanation is found in a report
showing an impressively strong association between animal protein
intake and bone fracture rate for women in different countries
...
All the subjects in
these surveys were women fifty years and older
...

These researchers explained that animal protein, unlike plant protein, increases the acid load in the body
...
The body does not like
this acidic environment and begins to fight it
...
This
calcium, however, must come from somewhere
...

We have had evidence for well over a hundred years that animal protein decreases bone health
...
5 We also have known that
animal protein is more effective than plant protein at increasing the
metabolic acid load in the body
...
7,8
When animal protein increases metabolic acid and draws calcium
from the bones, the amount of calcium in the urine is increased
...
Summaries of these studies were published in 1974,9 198po and 1990Y Each of these summaries clearly
shows that the amount of animal protein consumed by many of us on
a daily basis is capable of causing substantial increases in urinary cal~
I
I

f

I

L

206

THE CHINA STUDY

CHART 10
...


100


...
(5)

~


...
~

50

OJ
Vl

Y=0
...
85

rc

~

u


...

0

0
100

200

% Increase in Protein Intake

cium
...
1 is taken from the 1981 publication
...
This effect occurs well within the range
of protein intake that most of us consume; average American intake is
around 70-100 glday
...
12
The initial observations on the association between animal protein
consumption and bone fracture rates are very impressive, and now we
have a plausible explanation as to how the association might work, a
mechanism of action
...
A more
recent study, published in 2000, comes from the Department of Medicine at the University of California at San Francisco
...
2)
...

These studies are compelling for several reasons
...
2: ASSOCIATION OF ANIMAL VERSUS PLANT PROTEIN
INTAKE AND BONE FRACTURE RATES FOR DIFFERENT COUNTRIES
200
175
150
~

Qlet>
vQl

c>QI

I

"C
-- 0

125

v",

c
...


...
0 '-'-0

100
75

Cl
...
s-

50
25
0
0_
0

1_
0

2
...
0

4
...
0

6
...
They cannot be dismissed as
just another couple of studies; the most recent study represents a summary of eighty-seven separate surveys!
The Study of Osteoporotic Fractures Research Group at the University of California at San Francisco published yet another study 13 of over
1,000 women aged Sixty-five and up
...
After seven years of observations, the women with the
highest ratio of animal protein to plant protein had 3
...
Also during this time
the women with the high ratio lost bone almost four times as fast as the
women with the lowest ratio
...

This 3
...
I can't help but
wonder how much greater the difference might have been had they consumed not 50% but 0-10% of their total protein from animal sources
...
S
...
1
These observations raise a serious question about the widely advertised claim that protein-rich dairy foods protect our bones
...
An avalanche of commentary warns that most
of us are not meeting our calcium requirements, especially pregnant and
lactating women
...
In
one study of ten countries,14 a higher consumption of calcium was associated with a higher-not lower-risk of bone fracture (Chart 10
...

Much of the calcium intake shown in this chart, especially in high consumption countries, is due to dairy foods, rather than calcium supplements or non-dairy food sources of calcium
...
3, was a longtime Harvard professor
...
Professor Hegsted believes that excessively high intakes of calcium consumed over a long time
impair the body's ability to control how much calcium it uses and when
...
Calcitriol is considered a
hormone; when more calcium is needed, it enhances calcium absorption
and restricts calcium excretion
...
Ruining the regulatory mechanism in this way is a recipe
for osteoporosis in menopausal and post-menopausal women
...
The fact that the body loses its ability to control finely tuned
mechanisms when they are subjected to continuous abuse is a well-established phenomenon in biology
...
3: ASSOCIATION OF RATES OF HIP FRACTURES
WITH CALCIUM INTAKE FOR DIFFERENT COUNTRIES
120

• UNITED STATES
• NEW ZEALAND

100
0
0
0

• SWEDEN

0"
0

(jj
"-

80
• JERUSALEM

Vl

~
~

t

~

L
...


• UNITED KINGDOM

60

0-

£

• HOLLAND

'0
OJ

u

c

40

• FINLAND

• YUGOSLAVIA

OJ

-c
·0

...
Dairy, unfortunately, is the only food
that is rich in both of these nutrients
...
hip
fractures are more frequent in populations where dairy products are
commonly consumed and calcium intakes are relatively high
...
The confusion,
conflict and controversy rampant in this area of research allow anybody
to say just about anything
...
One of the most cited osteoporosis experts-one funded
by the dairy industry-angrily wrote in a prominent editoriaP5 that the
findings favoring a diet with a higher ratio of plant-to-animal protein
cited above could have been "influenced to some extent by currents in

210

THE CHINA STUDY

the larger society
...

Much of the debate regarding osteoporosis, whether it is conducted
with integrity or otherwise, resides in the research concerning the details
...

Many scientists have investigated how various diet and lifestyle factors affect BMD
...
If your bone density falls below a certain level,
you may be at risk for osteoporosis
...
I 6-18 But
there are some devilishly contradictory and confUSing details in this
great circus of osteoporosis research
...
19
• A high BMD has been linked to a higher risk of breast cancer
...
22
• Rate of bone loss matters just as much as overall BMD
...
"24--26
• Being fat is linked to greater BMD,H, 27 even though areas of the
world that have higher rates of obesity also have higher rates of
osteoporosis
...
In contrast, an alternative, but much better, predictor
of osteoporosis is the dietary ratio of animal-to-plant protein
...
And guess what? BMD is
not significantly associated with this ratio
...
Here
is what I would recommend you do, based on the research, to minimize
your risk of osteoporosis:

WIDE-RANGING EFFECTS: BONE, KIDNEY, EYE, BRAIN DISEASES

211

• Stay physically active
...
Swim, do yoga or aerobics every couple
of days and don't be afraid to buy barbells to use once in a while
...
The
possibilities are endless, and they can be fun
...

• Eat a variety of whole plant foods, and avoid animal foods, including dairy
...
As long as you stay
away from refined carbohydrates, like sugary cereals, candies,
plain pastas and white breads, you should have no problem with
calcium deficiency
...
Avoid highly processed and
packaged foods, which contain excess salt
...


KIDNEYS
At the Web site for the UCLA Kidney Stone Treatment Center,28 you will
discover that kidney stones may cause the following symptoms:
•
•
•
•
•
•
•
•

Nausea, vomiting
Restlessness (trying to find comfortable position to ease the pain)
Dull pain (ill-defined, lumbar, abdominal, intermittent pain)
Urgency (urge to empty the bladder)
Frequency (frequent urination)
Bloody urine with pain (gross hematuria)
Fever (when complicated by infection)
Acute renal colic (severe colicky flank pain radiating to groin, scrotum, labia)

Acute renal colic deserves some explanation
...
In describing the pain involved, the Web site states, "This is
probably one of the worst pains humans experience
...
The severe pain of renal colic needs to be
controlled by potent pain killers
...

Get yourself to a doctor or an emergency room
...
Unfortunately, up to 15% of Americans, more men than women, will be diagnosed with having a kidney stone in their lifetime
...
Although one is a genetically rare type 30 and another is related to urinary infection, the majority involve stones made of calcium and oxalate
...
3l Again, this illness falls into the same global
patterns as all the other Western diseases
...
I was invited to
give a seminar on our China Study findings and while there I met Professor W G
...
This chance encounter was extremely rewarding
...
Robertson, as I have come to learn, is one of the world's foremost experts on
diet and kidney stones
...
Robertson's research group has investigated
the relationship between food and kidney stones with great depth and
breadth, both in theory and in practice
...
A search of the scientific publications authored or co-authored by Robertson shows at least
100 papers published since the mid-1960s
...
4)
...

This is an impressive relationship
...
They have
developed a model for estimating the risk of stone formation with remarkable accuracy
...

Consumption of animal protein at levels commonly seen in affluent
countries leads to the development of four of the six risk factors ,34, 35
Not only is animal protein linked to risk factors for future formation
of stones, but it affects recurring stones as well
...
4: ASSOCIATION BETWEEN ANIMAL PROTEIN INTAKE
AND FORMATION OF URINARY CALCULI
ci
...
r:
u

Vl

20

0

m
::::l
c
c

«

18
20

21

22

23

24

25

Meat, Fish and Poultry Protein Intake (g/head/day)

How does this work? When enough animal protein-containing foods
are consumed, the concentrations of calcium and oxalate in the urine
increase sharply, usually within hours
...
5 shows these impressive changes, published by Robertson's group
...
This amount of animal
protein consumption is well within the levels most Americans regularly
eat
...

When the kidney is under a persistent, long-term assault from increased calcium and oxalate, kidney stones may result
...
Evidence points, in particular, to a high-meat protein
intake as being the dominant factor
...


214

THE CHINA STUDY
CHART 10
...


,

2

:4

6

Basal:

,

:

8

,

i

,

10

12

+ Animal Protein

A substantial and convincing effect on stone formation has been demonstrated for animal-based foods
...
For yet another organ and another disease, we
see opposing effects (in this case on stone formation) by animal- and
plant-based foods
...
We treat our
eyes more as little bits of technology than as living parts of the body;
and are all too willing to believe that lasers are the best course of action
for maintaining healthy eyes
...
Our breakfasts, lunches and dinners have
a particular effect on two common eye diseases, cataracts and macular
degeneration-diseases which afflict millions of older Americans
...
I'm about to tell you that if you eat animal foods instead of plant foods, you just might go blind
...
Over l
...
39 As the name implies,
this condition involves destruction of the macula, which is the biochemical intersection in the eye-where the energy of the light coming
in is transformed into a nerve signal
...

Around the macula there are fatty acids that can react with incoming
light to produce a low level of highly reactive free radicals
...
But fortunately for us, free radical damage
can be repressed thanks to the antioxidants in vegetables and fruits
...
Both studies were published a decade
ago
...

The study on dietary intakes4! compared 356 individuals fifty-five to
eighty years of age who were diagnosed with advanced macular degeneration (cases) with 520 individuals with other eye diseases (controls)
...

Researchers found that a higher intake of total carotenoids was associated with a lower frequency of macular degeneration
...
When carotenoid intakes were ranked, those individuals who
consumed the most had 43% less disease than those who consumed the
least
...
Spinach or collard greens conferred the most protection
...
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
...
All but one of these five showed a highly

216

THE CHINA STUDY

significant protective effect, especially the carotenoids found in the
dark green leafy vegetables
...
Yet again, we see that while supplements may give great wealth to supplement manufacturers, they will
not give great health to you and me
...
Herein lies a problem, however
...
The
abilities of these chemicals to scavenge and reduce free radical damage
are well established, but the activities of the individual carotenoids vary
enormously depending on dietary and lifestyle conditions
...
The logic of using them as supplements is much too
particular and superficial
...
It's much
safer to consume these carotenoids in their natural context, in highly
colored fruits and vegetables
...
Five of the leading clinical centers
specializing in eye diseases and their researchers participated in this
study
...
Four kinds of antioxidants were
measured: carotenoids, vitamin C, selenium and vitamin E
...
Risk of macular degeneration was reduced by
two-thirds for those people with the highest levels of carotenoids in
their blood, when compared with the low-carotenoid group
...
These two studies conSistently
demonstrated the benefits of antioxidant carotenoids consumed as
food
...
What we can say, howev-

L

WIDE-RANGING EFFECTS: BONE, KIDNEY, EVE, BRAIN DISEASES

217

er, is that eating antioxidant-containing foods, especially those containing the carotenoids, will prevent most blindness cases resulting from
macular degeneration
...

Cataracts are slightly less serious than macular degeneration because
there are effective surgical options available to restore vision loss caused
by this disease
...
By the age of eighty, half of all Americans
will have cataracts
...

Cataract formation involves the clouding of the eye lens
...
The development of the opaque condition, like the degeneration of the macula and so many other disease conditions in our body, is
closely associated with the damage created by an excess of reactive free
radicals
...

Starting in 1988, researchers in Wisconsin began to study eye health
and dietary intakes in over 1,300 people
...
The people who consumed the most lutein,
a specific type of antioxidant, had one-half the rate of cataracts as the
people who consumed the least lutein
...
46 , 47 Similarly, those who consumed the most spinach had
40% less cataracts,
These two eye conditions, macular degeneration and cataracts, both
occur when we fail to consume enough of the highly colored green and
leafy vegetables, In both cases, excess free radicals, increased by animalbased foods and decreased by plant-based foods, are likely to be responsible for these conditions,

MIND-ALTERING DIETS
By the time this book hits the shelves, I will be seventy years old, I
recently went to my high school's fiftieth reunion, where I learned that
many of my classmates had died, I receive the AARP magazine, get
discounts on various products for being advanced in age and receive
social security checks every month
...
I still have an active

218

THE (HINA STUDY

work life, perhaps more active than ever
...

Some things have changed, though
...
I am slower, not aS
strong, work fewer hours every day and am prone to taking naps more
frequently than I used to
...
But there is good science to show that
thinking clearly well into our later years is not something we need to
give up
...

There is now good dietary information for the two chief conditions
referring to mental decline
...
" This condition describes the declining ability to remember and think as well as one
once did
...

Then there are mental dysfunctions that become serious, even life
threatening
...
Vascular dementia is
primarily caused by multiple little strokes resulting from broken blood
vessels in the brain
...
A stroke is considered silent if it goes undetected and undiagnosed
...
The other type of dementia, Alzheimer's, occurs when a protein
substance called beta-amyloid accumulates in critical areas of the brain
as a plaque, rather like the cholesterol-laden plaque that builds up in
cardiovascular diseases
...
It is said that 1% of people at
age sixty-five have evidence of Alzheimer's, a figure that doubles every
five years thereafter
...

It has been estimated that 10-12% of individuals with mild cognitive
impairment progress to the more serious types of dementia, whereas
only 1-2% of individuals without cognitive impairment acquire these

I

!

l

,

l

WIDE-RANGING EFFECTS: BONE, KIDNEY, EYE, BRAIN DISEASES

219

diseases _9, 50 This means that people with cognitive impairment have
"
about a tenfold risk of Alzheimer's
...
55, 56 All of these diseases cluster in the same
populations, oftentimes in the same people
...
Hypertension (high blood
pressure) is one factoyS1, 57, 58; another is high blood cholesterol
...

A third risk factor is the amount of those nasty free radicals, which
wreak havoc on brain function in our later years
...
Animal-based
foods lack antioxidant shields and tend to activate free radical production and cell damage, while plant-based foods , with their abundant antioxidants, tend to prevent such damage
...

Of course, genetics plays a role, and specific genes have been identified that may increase the risk of cognitive decline
...

In a recent study, it was found that Japanese American men living
in Hawaii had a higher rate of Alzheimer's disease than Japanese living
in Japan
...
60 Both of these findings clearly support the idea that environment
plays an important role in cognitive disorders
...
Rates of Alzheimer's are low in less
developed areas
...
62, 63
We seem to be on to something
...
But what exactly
is good for us?
With regard to the more mild cognitive impairment condition, recent
research has shown that high vitamin E levels in the blood are related
to less memory 10ss
...
65 Vitamins E and C are antioxidants found almost exclusively in
plant foods, while selenium is found in both animal- and plant-based
foods
...
"66 This conclusion advocates plant-based foods and
condemns animal-based foods for optimal brain function
...
67 Other studies have also found that a low level of
vitamin C in the blood is linked to poorer cognitive performance in old
age,68,69 and some have found that B vitamins,69 including beta-carotene,1° are linked to better cognitive function
...
Experimental animal studies have not
only confirmed that plant foods are good for the brain, but they show
the mechanisms by which these foods work
...
No study has ever found that
consuming more dietary antioxidants increases memory loss
...
Furthermore,
the association appears to be Significant, although more substantial research must be done before we can know exactly how much cognitive
impairment is due to diet
...
In a publication from the famous Framingham
Study, researchers conclude that for every three additional servings of
fruits and vegetables a day, the risk of stroke will be reduced by 22%
...
The
following examples count as one serving in this study: 112 cup peaches,

WID E- RAN GIN G EFFECT S: BON E,K I DNEY EYE
I

I

BRA IN DIS EASES 221

1/4 cup tomato sauce, 112 cup broccoli or one potato
...
In fact, the men in this study who consumed the most fruits
and vegetables consumed as many as nineteen servings a day
...

This study provides evidence that the health of the arteries and vessels that transport blood to and from your brain is dependent on how
well you eat
...

Research again seems to prove the point
...
They found that the people
who consumed the most total fat and saturated fat had the highest risk
of dementia due to vascular problems
...
We know what causes heart disease, and we know what offers
the best hope of reversing heart disease: diet
...
53 In confirming these experimental animal results, a study of more than 5,000
people found that greater dietary fat and cholesterol intake tended to
increase the risk of Alzheimer's disease specifically,15 and all dementia
in general
...
3 times greater among people whose blood folic acid levels were in
the lowest one-third range and 4
...
What are folic acid and
homocysteine? Folic acid is a compound derived exclusively from
plant-based foods such as green and leafy vegetables
...
77 This
study found that it was desirable to maintain low blood homocysteine
and high blood folic acid
...
7
Mild cognitive impairment, the stuff jokes are made of, still permits
the afflicted person to maintain an independent, functional life, but
dementia and Alzheimer's are tragic, imposing almost impossibly heavy
burdens on victims and their loved ones
...

The diseases I've covered in this chapter take a heavy toll on most of
us in our later years, even though they may not be fatal
...
Their quality of life, however, deteriorates steadily, until the
illness renders them largely dependent on others and unable to function
in most capacities
...
" I grew up with these people, went to school with these
people and made great friends with these people
...
During the many visits I made to the
nursing home, I never failed to come away with a deep appreciation for
the health I still possess in myoId age
...
Too often, they had Alzheimer's and were housed in a
special section of the facility
...
I, for one, hope that I am able to
fully enjoy not only the time in the present, but also the time in the future, with good health and independence
...
_____
...
The vast majority of calories
in the meal clearly came from carbohydrates
...
At various other times I've noted
that salads, breads and even cinnamon buns are labeled "low-carb," even
though their ingredient lists demonstrate that, in fact, the bulk of calories
are prOvided by carbohydrates
...
Atkins and his
dietary message
...
Atkins' New Diet Revolution has been
toppled and replaced by The South Beach Diet as the king of the diet
books
...
Both of the diets are divided into three stages, both diets severely limit carbohydrate
intake during the first phase, and both diets are heavily based on meat,
dairy and eggs
...
After that, you can be weaned back onto carbohydrates until
you are eating what appears to me to be a fairly typical American diet
...
According
to The South Beach Diet Web site, Newsweek wrote, "the real value of
the book is its sound nutritional advice
...
"l

223

224

THE CHINA STUDY

Who at Newsweek reviewed the literature to know whether this is
sound nutritional advice or not? And if you have the Atkins Diet plus
some "carbs," how different is this diet from the standard American
diet, the toxic diet that has been shown to make us fat, give us heart
disease, destroy our kidneys, make us blind and lead us to Alzheimer's,
cancer and a host of other medical problems?
These are merely examples of the current state of nutrition awareness in the United States
...
I remember the
adage told several decades ago: Americans love hogwash
...
It would appear from a quick glance that these two sayings are true
...
It's not true that Americans love hogwash-it's that hogwash inundates Americans, whether
they want it or not! I know that some Americans want the truth, and
just haven't been able to find it because it is drowned out by the hogwash
...

One day olive oil is terrible, the next it is heart healthy
...
One
day potatoes and rice are great, the next they are the gravest threats to
your weight you will ever face
...

So far, you have seen a broad sample-and it's only a sample-of that
evidence
...

I want to condense the nutritional lessons learned from this broad
range of evidence and from my experiences over the past forty-plus
years into a simple guide to good nutrition
...
Furthermore, I have translated the
science into dietary recommendations that you can begin to incorporate
into your own life
...
What you decide to do with this
information is up to you, but you can at least know that you, as a reader
and a person, have finally been told something other than hogwash
...
_
...
_
...
_
...
1
__
...
1
Eating Right: Eight Principles
of Food and Health
--- -
...
I want you to know
that you can:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

live longer
look and feel younger
have more energy
lose weight
lower your blood cholesterol
prevent and even reverse heart disease
lower your risk of prostate, breast and other cancers
preserve your eyesight in your later years
prevent and treat diabetes
avoid surgery in many instances
vastly decrease the need for pharmaceutical drugs
keep your bones strong
avoid impotence
avoid stroke
prevent kidney stones
keep your baby from getting Type 1 diabetes
alleviate constipation
lower your blood pressure
avoid Alzheimer's

225

THE (HINA STUDY

226

• beat arthritis
• and more
...
The
price? Simply changing your diet
...

I have given you a sampling of the evidence and told you the journey
that I have taken to come to my conclusions
...
These principles should inform the
way we do science, the way we treat the sick, the way we feed ourselves,
the way we think about health and the way we perceive the world
...
The whole is
greater than the sum of its parts
...
Let's say you prepare sauteed spinach with
ginger and whole grain ravioli shells stuffed with butternut squash and
spices, topped with a walnut tomato sauce
...

Chart Il
...

As you can see, you've just introduced a bundle of nutrients into your
body
...

As soon as this food hits your saliva, your body begins working its
magic, and the process of digestion starts
...
It is an infinitely complex process, and it is literally
impossible to understand precisely how each chemical interacts with
every other chemical
...


EATING RIGHT: EIGHT PRINCIPLES OF FOOD AND HEAlTH

CHART 11
...
These chemicals are carefully
orchestrated by intricate controls within our cells and all through our
bodies, and these controls decide what nutrient goes where, how much
of each nutrient is needed and when each reaction takes place
...
The misguided may trumpet the virtues of one specific
nutrient or chemical, but this thinking is too simplistic
...
I cannot
stress this enough, as it is the foundation of understanding what good
nutrition means
...


Because nutrition operates as an infinitely complex biochemical system
involving thousands of chemicals and thousands of effects on your
health, it makes little or no sense that isolated nutrients taken as supplements can substitute for whole foods
...
Furthermore,
for those relying on supplements, beneficial and sustained diet change
is postponed
...

As I have watched the interest in nutrient supplements explode over
the past twenty to thirty years, it has become abundantly clear why
such a huge nutrient supplement industry has emerged
...
Furthermore, consumers want to
continue eating their customary foods , and popping a few supplements
makes people feel better about the potentially adverse health effects
caused by their diet
...
As a result, a multibillion-dollar supplement industry is now

EATING RIGHT: EIGHT PRINCIPLES OF FOOD AND HEALTH

229

part of our nutritional landscape, and the majority of consumers have
been duped into believing that they are buying health
...
Atkins's formula
...
l
This strategy of gaining and maintaining health with nutrient supplements, however, started to unravel in 1994-1996 with the large-scale
investigation of the effects of beta-carotene (a precursor to vitamin A)
supplements on lung cancer and other diseases
...

Since then, a large number of additional trials costing hundreds of
millions of dollars have been conducted to determine if vitamins A, C
and E prevent heart disease and cancer
...
4 , 5 The researchers, in their words, "could
not determine the balance of benefits and harms of routine use of
supplements of vitamins A, C or E; multivitamins with folic acid; or
antioxidant combinations for the prevention of cancer or cardiovascular
disease
...

It is not that these nutrients aren't important
...
Isolating nutrients and
trying to get benefits equal to those of whole foods reveals an ignorance
of how nutrition operates in the body
...
As time passes, I am confident that we will
continue to "discover" that relying on the use of isolated nutrient supplements to maintain health, while consuming the usual Western diet,
is not only a waste of money but is also potentially dangerous
...


Overall, it is fair to say that any plant-based food has many more similarities in terms of nutrient compositions to other plant-based foods
than it does to animal-based foods
...
For example, even though fish is
significantly different from beef, fish has many more similarities to beef
than it has to rice
...

Eating animals is a markedly different nutritional experience from
eating plants
...
2/ , 8, 9 illustrate these striking nutritional
differences
...
2: NUTRIENT COMPOSITION OF PLANT AND
ANIMAL-BASED FOODS (PER 500 CALORIES OF ENERGY)

Nutrient
Cholesterol (mg)
Fat (g)
Protein (g)
Beta-<:arotene (meg)
Dietary Fiber (g)
Vitamin C (mg)
Folate (meg)
Vitamin E (mg_ATE)
Iron (mg)
Magnesium (mg)
Calcium (mg)

Plant-Based Foods·

4
33
29,919
31
293
1168
11
20
548
545

* Equal parts of tomatoes, spinach, lima beans, peas, potatoes

** Equal parts of beef, pork, chicken, whole milk

Animal-Based
Foods"

137
36
34
17

4
19
0
...
In fact, animal foods are almost
completely devoid of several of these nutrients
...
They also have slightly
more protein than plant foods, along with more B]2 and vitamin D, although the vitamin D is largely due to artificial fortification in milk
...
g
...
g
...
But if one looks a little more closely,
the fat and the protein of nuts and seeds are different: they are more
healthful than the fat and protein of animal foods
...
On the other hand,
processed, low-fat, animal-based foods still have some cholesterol, lots
of protein and very little or no antioxidants and dietary fiber, just like
other animal-based foods
...

While cholesterol is essential for health, our bodies can make all that
we require; so we do not need to consume any in food
...

There are four nutrients which animal-based foods have that plantbased foods, for the most part, do not: cholesterol and vitamins A, D
and B12 • Three of these are nonessential nutrients
...
Vitamin A can be readily
made by our bodies from beta-carotene, and vitamin D can be readily
made by our bodies simply by exposing our skin to about fifteen minutes of sunshine every couple days
...
This is one more indication that it
is better to rely on the vitamin precursors, beta-carotene and sunshine,
so that our bodies can readily control the timing and quantities of vitamins A and D that are needed
...
Vitamin B12 is made by microorganisms found in the soil and by microorganisms in the intestines of
animals, including our own
...

Research has convincingly shown that plants grown in healthy soil that
has a good concentration of vitamin B12 will readily absorb this nutrient
...
In the United States, most of our agriculture
takes place on relatively lifeless soil, decimated from years of unnatural
pesticide, herbicide and fertilizer use
...
In addition, we live in such a
sanitized world that we rarely come into direct contact with the soilborne microorganisms that produce B12
...
Therefore, it
is not unreasonable to assume that modern Americans who eat highly
cleansed plant products and no animal products are unlikely to get
enough vitamin B12
...
It is estimated
that we hold a three-year store of vitamin B12 in our bodies
...
Likewise, if you never get sunshine
exposure, especially during the winter months, you might want to take
a vitamin D supplement
...

I call these supplements "separation from nature pills," because a
healthy diet of fresh, organic plant-based foods grown in rich soil and
a lifestyle that regularly takes you outdoors is the best answer to these
issues
...


EATING RIGHT: EIGHT PRINCIPLES OF FOOD AND HEAlTH

233

PRINCIPLE #4
Genes do not determine disease on their own
...


I can safely say that the origin of every single disease is genetic
...
Without genes,
there would be no cancer
...
And without genes, there would be no life
...
This also explains why some perfectly
healthy young women have had their breasts removed simply because
they were found to carry genes that are linked to breast cancer
...
At Cornell University alone $500
million is being raised to create a "Life Sciences Initiative
...
" What is one of the main thrusts of
the program? Integrating each scientific discipline into the all-encompassing umbrella of genetic research
...
11
Much of this focus on genes, however, misses a simple but crucial
point: not all genes are fully expressed all the time
...
Dormant genes
do not have any effect on our health
...
What happens to cause some genes to remain dormant, and others to express themselves? The answer: environment, especially diet
...
As
any good gardener knows, seeds will not grow into plants unless they
have nutrient-rich soil, water and sunshine
...
In our body, nutrition
is the environmental factor that determines the activity of genes
...
In my research group, we learned

1
l

234

THE CHINA STUDY

that we could turn the bad genes on and off simply by adjusting animal
protein intake
...

These are people said to have similar genes, and yet they get different diseases depending on their environment
...
They do not change their genes, and
yet they fall prey to diseases and illnesses at rates that are rare in their
homeland population
...
In
twenty-five years, the percentage of our population that is obese has
doubled, from 15% to 30%
...

So while we can say that genes are crucial to every biological process,
we have some very convincing evidence that gene expression is far more
important, and gene expression is controlled by environment, especially
nutrition
...
It is not
...
12 The scientists
went through 16,757 genes, turning each one off, and observed the effect on weight
...
How these
hundreds of genes interact over the long term with each other and their
ever-changing environment to alter weight gain or loss is an incredibly
complex mystery
...
" 13
Expression of our genetic code represents a universe of biochemical
interactions of almost infinite complexity
...
With genetic
research, I suspect we are embarking on a massive quest to shortcut
nature only to end up worse off than when we started
...
If
you take two Americans living in the same environment and feed them
exactly the same meaty food every day for their entire lives, I would not

i

EATING RIGHT: EIGHT PRINCIPLES OF FOOD AND HEALTH

235

be surprised if one died of a heart attack at age fifty-four, and the other
died of cancer at the age of eighty
...

Genes give us our predispositions
...
But while we will never know exactly which risks
we are predisposed to, we do know how to control those risks
...
Even though the two Americans in the
example above succumbed to different diseases at different ages, it is entirely possible that both could have lived many more years with a higher
quality of life if they would have practiced optimal nutrition
...


Stories of cancer-causing chemicals regularly appear in the press
...

There is a widely held perception that cancer is caused by toxic
chemicals that make their way into our bodies in a sinister way
...
The assumption
is that the meat would be safe to eat if it didn't have those unnatural
chemicals in it
...

Long before modern chemicals were introduced into our food, people
still began to experience more cancer and more heart disease when they
started to eat more animal-based foods
...
Here, it seemed that chemical contaminants from certain
industrial sites were creating breast cancer for women who lived nearby
...

Another chemical carcinogen concern surrounds acrylamide, which
is primarily found in processed or fried foods like potato chips
...

50 many of us seem to want a scapegoat
...

In chapter three, we saw that the potential effects of aflatoxin, a
chemical touted as being highly carcinogenic, could be entirely controlled by nutrition
...
We
also saw how small findings can make big news every time cancer is
mentioned
...
However, like genes, the activities of these chemical
carcinogens are primarily controlled by the nutrients that we eat
...
The organic beef might be
marginally healthier, but I would never say that it was a safe choice
...

It is useful to think of this principle in another way: a chronic disease
like cancer takes years to develop
...
What does not make headlines,
however, is the fact that the disease process continues long after initiation, and can be accelerated or repressed during its promotion stage by
nutrition
...


PRINCIPLE #6
The same nutrition that prevents disease in its early stages
(before diagnosis) can also halt or reverse disease
in its later stages (after diagnosis)
...


For example, there is a general thought that breast cancer can be initi-

EATING RIGHT: EIGHT PRINCIPLES OF FOOD AND HEALTH

l

237

ated in adolescence and not become detectable until after menopause!
So we very well may have lots of middle-aged women walking around with
breast cancer initiated during their teens that will not be detectable until
after menopause
...
Does this mean that these women should start smoking and eating more chicken-fried steak because
they're doomed anyway? What do we do, given that many of us may
already have an initiated chronic disease lurking in our bodies, waiting
to explode decades from now?
As we saw in chapter three, cancer that is already initiated and growing in experimental animals can be slowed, halted or even reversed by
good nutrition
...
In humans, we have seen research findings
showing that a whole foods, plant-based diet reverses advanced heart
disease, helps obese people lose weight and helps diabetics get off their
medication and return to a more normal, pre-diabetes life
...
1
5
Some diseases, of course, appear to be irreversible
...
And yet, amazingly, even
some of these diseases may be slowed or attenuated by diet
...
Evidence also shows that rheumatoid arthritis can be slowed by diet,16 as can multiple sclerosisY' 18
I believe that an ounce of prevention does equal a pound of cure, and
the earlier in life good foods are eaten, the better one's health will be
...


PRINCIPLE #7
Nutrition that is truly beneficial for one chronic disease
will support health across the board
...
The editor asked, in effect, "Can you make specific
diet plans for each disease, so that every chapter doesn't have the same
recommendations?" In other words, could I tell people to eat a specific
way for heart disease and a different way for diabetes? The implication,
of course, was that the same eating plan for multiple diseases simply
wasn't catchy enough, wasn't sufficiently "marketable
...
As
I have come to understand more about the biochemical processes of
various diseases, I have also come to see how these diseases have much
in common
...
Even if a whole foods, plant-based diet is more
effective at treating heart disease than brain cancer, you can be sure that
this diet will not promote one disease while it stops another
...
This one good diet can only help across the board
...

I only have one dietary prescription
...
It is a chance to clear away much
of the incredible public confusion
...


PRINCIPLE #8
Good nutrition creates health in all areas of our existence
...


Much has been made of "holistic" health in recent times
...
Many people lump all
of the "alternative" medicines and activities into this concept, so holistic health comes to mean acupressure, acupuncture, herbal medicines,
meditation, vitamin supplements, chiropractic care, yoga, aroma therapy, Feng 5hui, massage and even sound therapy
...
Food
and nutrition, for example, are of primary importance to our health
...
But other experiences also are important, such as physical
activity, emotional and mental health and the well-being of our environment
...
Indeed, this is a holistic
concept
...
The rats fed the low-protein diets were
not only spared liver cancer, but they also had lower blood cholesterol,
noticeably more energy and voluntarily exercised twice as much as the
high-protein rats
...

This synergy between nutrition and physical activity is extremely important, and is evidence that these two parts of life are not isolated from
each other
...

We also know that physical activity has an effect on emotional and
mental well-being
...
And experiencing the rewards of feeling better
emotionally and being more mentally alert provides the confidence and
motivation to treat ourselves to optimal nutrition, which reinforces the
entire cycle
...

Sometimes people try to play these different parts of their lives
against each other
...
The answer to this is no
...
Besides, why would anyone want to try and balance benefits and risks when they could have all the benefits, working
together? People also wonder whether a perceived health benefit is because of the exercise or because of a good diet
...
The fact is that these two spheres of our lives
are intimately interconnected, and what's important is that it all works
together to promote or derail health
...

By eating a whole foods, plant-based diet, we use less water, less land,
fewer resources and produce less pollution and less suffering for our

240

THE CHINA STUDY

farm animals
...

Our food choices have an incredible impact not only on our metabolism, but also on the initiation, promotion and even reversal of disease,
on our energy; on our physical activity, on our emotional and mental
well-being and on our world environment
...

I have mentioned the wisdom of nature at various points in this
book, and I have come to see the power of the workings of the natural
world
...
This is nature
at work, from the microscopic to the macroscopic
...
In large measure, the principles in this chapter are the answers to the far-reaching questions that I could not help but ask during
my career
...

Most importantly, they can help to reduce public confusion regarding
food and health
...
We need not leap from
our seats every time a chemical is called a carcinogen, every time a new
diet book hits the shelf or every time a headline screams about solving
disease through genetic research
...
We can take a much-needed deep breath
and sit back
...
In effect, we can interpret new findings with a broader context
in mind
...
The benefits of understanding
these principles are wide-ranging and profound for individuals, societies, our fellow animals and our planet
...
_
...
_
...
__
...
_
...
__1
...
_
...
_
...
_ _
...
_
...
_ _
...

_
...
One Sunday morning, Tom came home from a sleepover at a
close friend's house and told us a story I still remember
...
The sister of Tom's friend had asked him, rather incredulously, "You don't eat meat?" My son had never justified his eating habits; he had just gotten used to eating what was on the dinner table
...
So
he simply answered, "No, I don't," without offering any explanations
...
plants
...

The reason I enjoy this story is because my son's response, "plants,"
was so simple
...
When someone asks for the glazed ham across the
table, she doesn't say, "Pass the flesh of the pig's butt, please," and when
someone tells his children to finish their peas and carrots, he doesn't
say, "Finish your plants
...

It fits well into my philosophy of keeping the information on food and
health as simple as possible
...
I often marvel at the complexity of various weight-loss plans
...
Followers of these diets have to count calories, points, servings or nutrients or
eat specific amounts of certain foods based on specific, mathematical
ratios
...
It is no wonder that dieting seldom succeeds
...
Keeping it simple is essential if we are to
enjoy our food
...
The
biology of the relationship of food and health is exceptionally complex,
but the message is still Simple
...
(See table on page 243
...
For vitamin D, you shouldn't exceed RDA recommendations
...
That's the diet science has found to be consistent with the
greatest health and the lowest incidence of heart disease, cancer, obesity
and many other Western diseases
...
So it's not unreasonable to assume that the optimum percentage of
animal-based products is zero, at least for anyone with a predisposition
for a degenerative disease
...
Certainly it is true that most
of the health benefits are realized at very low but non-zero levels of
animal-based foods
...
If a tasty vegetable soup has a chicken stock
base, or if a hearty loaf of whole wheat bread includes a tiny amount of

HOW TO EAT

243

EAT ALL YOU WANT (WHILE GEnlNG LOTS OF VARIETY)
OF ANY WHOLE, UNREFINED PLANT-BASED FOOD
Fruits

orange, okra, kiwi, red pepper, apple, cucumber, tomato,
avocado, zucchini, blueberries, strawberries, green pepper, raspberries, butternut squash, pumpkin, blackberries,
mangoes, eggplant, pear, watermelon, cranberries, acorn
squash,
grapefruit,

Flowers

broccoli, ca
flowers are

Stems and leaves

spinach, artichokes, kale, lettuce (all varieties), cabbage,
Swiss chard, collard greens, celery, asparagus, mustard
greens, brussels sprouts, turnip greens, beet greens, bok
choi, arugula, Belgian endive, basil, cilantro, parsley, rhubarb, seaweed

Roots

potatoes (all varieties),
leeks, radish,

carrots, turnips, onions, garlic,

green beans, soybeans, peas, peanuts, adzuki beans, black
beans, black-eye peas, cannellini beans, garbanzo beans,
beans, lentils, nto beans, white beans
Mushrooms

white button, baby bella, cremini, Portobello, shiitake, oyster

Nuts

walnuts, almonds, macadamia, pecans, cashew, hazelnut,
pistachio
wheat, rice, corn, millet, sorghum, rye,
buckwheat, amaranth,
kamut,

~~

244

THE (HINA STUDY

egg, don't worry about it
...
Even more importantly, the ability to relax about very
minor quantities of animal-based foods makes applying this diet much
easier-especially when eating out or buying already-prepared foods
...
My recommendation is that you try to avoid all animal-based products
...
First, following
this diet requires a radical shift in your thinking about food
...
If you plan for animal-based products, you'll
eat them-and you'll almost certainly eat more than you should
...
Instead of viewing your new food habit as being able
to eat all the plant-based food you want, you'll be seeing it in terms of
having to limit yourself, which is not conducive to staying on the diet
long-term
...


CAN YOU DO THIS?
For most Americans, the idea of giving up virtually all meat productsincluding beef, chicken, fish, cheese, milk and eggs-seems impossible
...
The whole idea
seems strange, fanatical or fantastic
...

If you are one of these people-if you are curious about these findings but know in your heart that you will never be able to give up
meat-then I know that no amount of talk will ever convince you to
change your mind
...

Give it one month
...

A month isn't enough time to give you any long-term benefits, but it
is long enough for you to discover four things:

HOW TO EAT

245

1
...
You may not be eating everything you want (desire for meat may last longer than a
month), but you will be eating lots of great, delicious foods
...
It's not all that bad
...
Many take months to fully adjust to it
...

3
...
Even after only a month, most people will feel
better and likely lose some weight, too
...
Odds are, you'll see significant
improvement in even that period of time
...
Most importantly, you'll discover that it's pOSSible
...
You can do
it, if you choose to
...
You can
have them too
...

The first month can be challenging (more on this shortly), but it gets
much easier after that
...

I know this is hard to believe until you experience it for yourself, but
your tastes change when you are on a plant-based diet
...
A friend of mine once described it as like being dragged to an
independent film when you wanted to go to the latest Hollywood action
flick
...


THE TRANSITION
If you take me up on my suggestion of trying a plant-based diet for one
month, there are five main challenges you'll likely face:
• In the first week, you may have some stomach upset as your digestive system adjusts
...

• You'll need to put some time into this
...
Specifically, you'll need to
learn some new recipes, be willing to try new dishes, discover new

246

THE CHINA STUDY

restaurants
...
This is key
...
No matter how full the plate
is, many of us were trained to think that without meat, it's not a
real meal-especially at dinner
...

• You may not be able to go to the same restaurants you used to go
to, and if you can, you certainly won't be able to order the same
things
...

• Your friends, family and colleagues may not be supportive
...
Perhaps it's because, deep down,
they know their diet isn't very healthy and find it threatening that
someone else is able to give up unhealthy eating habits when they
cannot
...
Do it
...

• Eat well
...
Often, ethnic restaurants not only offer the most options for plant-based meals, but the unique tastes are exquisite
...

• Eat enough
...
That's
fine, and on a plant-based diet you almost certainly will
...

• Eat a variety
...

The bottom line is that you can eat a plant-based diet with great pleasure and satisfaction
...
There
are psychological barriers and practical ones
...

You may not get support from your friends and family
...
And you'll be amazed at how easy it
becomes once you form new habits
...
You'll not only do great things for
yourself, you'll be part of the vanguard working toward moving America into a healthier, leaner future
...
In fact, he was recently on the Atkins diet, lost some
weight, but dropped off it when his cholesterol went through the
roof
...
I gave him a draft of the manuscript for the China Study and he agreed to take the one-month
challenge
...
It's hard to figure out what to eat
...
As someone who would swing through McDonald's
or heat up a frozen dinner, I found it annoying to have to cook meals
each evening
...
But over time I found a few that were fantastic
...
My mom gave me a vegetarian chili recipe that was
great
...

I challenge anyone to know that this was a vegan dish
...

I'm rediscovering fruit
...
Maybe it's not eating meat, but I'm finding
that I'm enjoying fruit more than ever
...
I really like it! I would have never done that before; I actually think my tastes are getting more sensitive
...
But I'm getting more adventurous
now
...
The other day I got
dragged into a pizza place with a large group; there was nothing I could
do, and I was starved
...
They even made it with a whole wheat crust
...
I've brought that
home a few times since
...
And, honestly, I'm eating

248

THE (HINA STUDY

like a pig
...
Now I eat like a madman, and feel virtuous to boot
...
I only eat foods I really like
...
I've lost
eight pounds and my cholesterol has dropped dramatically
...

My freezer is stocked with vegan goodies
...
I can't imagine why I would go back to myoid eating patterns
...
"If all that you
say is true," they wonder, "why haven't I heard it before? In fact, why
do I usually hear the opposite of what you say: that milk is good for us,
that we need meat to get protein and that cancer and heart disease are
all in the genes?" These are legitimate questions, and the answers are
a crucial part of this story
...

As you will come to see, much is governed by the Golden Rule: he
who has the gold makes the rules
...
Their financial
health depends on controlling what the public knows about nutrition
and health
...

You might be inclined to think that industry pays scientists under
the table to "cook the data," bribes government officials or conducts
illegal activities
...
But the powerful interests that maintain the status quo do not usually conduct illegal

249

250

TH E CH I NA STU DY

business
...
"
They do not bribe elected officials or make sordid underhanded deals
...

The entire system-government, science, medicine, industry and
media-promotes profits over health, technology over food and confusion over clarity
...
The most damaging aspect of the system is not sensational, nor is it likely to create much of a stir upon its discovery
...

My experiences within the scientific community illustrate how the
entire system generates confusing information and why you haven't
heard the message of this book before
...



...


...
Kinsey,
who always had a funny story to tell
...
One of my favorites was
the great potato bug scam
...
One day, Mr
...
Although five dollars was no small sum
of money in those days, Mr
...
A short while later, when he received
the great potato bug killer, he opened the package and found two blocks
of wood and a short list of three instructions:
• Pick up one block of wood
...

• Pick up the second block of wood and press firmly onto the potato bug
...
Very few experiences
are as personal and as powerful as those of people who have lost their
health prematurely
...
They are a highly vulnerable group
of consumers
...
It concerned an alternative
cancer treatment called Laetrile, a natural compound made largely from
apricot pits
...
Washington Post Magazine documented the
story of Sylvia Dutton, a fifty-three-year-old woman from Florida, who
had done just that as a last attempt to thwart a cancer that had already
spread from her ovaries to her lymph system
...
In the magazine article, 1 Sylvia's
husband said, "There are at least a dozen people in this area who were
told they were going to be dead from cancer who used Laetrile and now
they're out playing tennis
...
Some people in the medical establishment argued that animal
studies had repeatedly shown Laetrile to have no effect on tumors
...
S
...
One famous hospital in Tijuana treated "as many
as 20,000 American patients a year
...

But Laetrile was only one of many alternative health products
...
2 These
included pangamic acid, which was touted as a previously undiscovered
vitamin with virtually unlimited powers, various bee concoctions and
other supplement products including garlic and zinc
...
In 1976, Senator George McGovern had convened
a committee that drafted dietary goals recommending decreased consumption of fatty animal foods and increased consumption of fruits and
vegetables because of their effects on heart disease
...
In a personal conversation McGovern told me that he and five other powerful
senators from agricultural states lost their respective elections in 1980
in part because they had dared to take on the animal foods industry
...
At about the same time, there were widely publicized government
debates about whether food additives were safe, and whether saccharin
caused cancer
...
By 1975 my program in the Philippines had ended, and
I was well into my experimental laboratory work here in the United
States, after having accepted a full professorship with tenure at Cornell
University
...
At
that time, I had one of only two or three laboratories in the country doing basic research on nutrition and cancer
...

From 1978 to 19791 took a year-long sabbatical leave from Cornell to
go to the epicenter of national nutritional activity, Bethesda, Maryland
...
Six individual research societies made up the federation, representing pathology, biochemistry, pharmacology, nutrition, immunology and physiology
...
I was a member of two
of these societies, nutrition and pharmacology, and was particularly active in the American Institution of Nutrition (now named the American
Society for Nutritional Sciences)
...

While there, I also was invited to be on a public affairs committee
that served as liaison between the FASEB and Congress
...
We reviewed policies, budgets and position statements, met with congressional staffs,
and held meetings around big, impressive "boardroom" tables in distinguished, august meeting rooms
...


254

TH E CH I NA STU DY

As a prerequisite to representing my nutrition society on this public affairs committee, I first had to decide, for myself, how nutrition is
best defined
...
We
had scientists who were interested in applied nutrition, which involves
people and communities
...
We even had people who thought nutrition studies should
focus on livestock as well as people
...
The average American's view of nutrition was even more varied and confused
...

One day in late spring of 1979, while doing my more routine work, I
got a call from the director of the public affairs office at the FASEB who
coordinated the work of our congressional "liaison" committee
...

"It's being called the Public Nutrition Information Committee," he
told me, "and one of its responsibilities will be to decide what is sound
nutritional advice to give to the public
...
"
I agreed
...

The proposal sounded good to me because it was early in my career
and it meant getting a chance to hear the scholarly views of some of
the "big name" nutrition researchers
...
It might serve, for example, to identify nutrition
quackery
...
A public dispute was taking
place between the NAS president, Phil Handler, and the internal NAS
Food and Nutrition Board
...
This did
not please his internal Food and Nutrition Board, which wanted control over this project
...

Within the scientific community it was widely known that the NAS
Food and Nutrition Board was strongly influenced by the meat, dairy
and egg industries
...
Olson was a well-paid consultant to the egg industry, and Harper acknowledged that lO% of his
income came from offering his services to food companies, including
large dairy corporations
...
4 As it turned out, I was one of thirteen scientists chosen to be on
the panel to write the report
...
They knew that the report could greatly influence national opinion about diet and disease
...

James S
...
"3
After being denied control of this promising new report on diet,
nutrition and cancer, the pro-industry Board needed to do some damage control
...
Who were the leaders of
the new Public Nutrition Information Committee? Bob Olson, Alfred
Harper and Tom Jukes, a long-time industry scientist, each of whom
held a university faculty position
...

This committee was a stacked deck; its members were entrenched in
the status quo
...
They enjoyed the meaty
American diet themselves and were unwilling to consider the possibility
that their views were wrong
...
Although there was nothing illegal about any of these activities, it certainly laid bare a serious conflict
of interest that put most of the committee members at odds with the
public interest
...
When scientific evidence first emerged to show that
cigarettes were dangerous, there were hordes of health professionals
who vigorously defended smoking
...
In
many cases, these scientists were motivated by understandable caution
...

So there I was, on a committee that was to judge the merit of nutrition information, a committee that was comprised of some of the most
powerful pro-industry scientists
...
At that point in my career, I had not formed
any particularly strong views for or against the standard American diet
...


SCIENCE-THE DARK SIDE

257

THE FIRST MEETING
From the first moment of the first meeting in April 1980, I knew I was
the chicken who had wandered into a fox's den, although I went in with
high hopes and an open, though naive, mind
...

In the second session of our first committee meeting the chairman,
Tom Jukes, passed around a proposed news release, handwritten by
himself, regarding the mission of the committee
...

As I scanned the list of so-called frauds, I was stunned to see the
1977 McGovern dietary goals5 on the list
...

In this proposed news release, they were described as nothing more
than simple quackery, just like the widely condemned Laetrile and
pangamic acid preparations
...
This was the committee's attempt to demonstrate their ability to
be the supreme arbiter ofreliable scientific information!
Having looked forward to my membership on this new committee,
I was shocked to see what was emerging
...
The scientific results with which I was familiar very clearly
seemed to justify the moderate recommendations made by McGovern's
dietary goals committee
...
Early in the meeting, when
this handwritten proposed news release was passed out to the committee members, I leaned over to Harper and pointed to the place where
it listed McGovern's dietary goals amongst other common scams and
whispered incredulously, "Do you see this? "
Harper could sense my unease, even disbelief, and so quickly spoke

258

THE CHINA STUDY

up
...
Perhaps we should put it on hold
...

With the conclusion of the news release issue, the meeting came to
an end
...

A couple of weeks later, back in upstate New York, I turned on a
morning TV news show and Tom Brokaw appeared on the screen and
started talking about nutrition with Bob Olson, of all people
...
" This
report, which was one of the briefest, most superficial reports on health
ever produced by the NAS, extolled the virtues of the high-fat, highmeat American diet and basically confirmed that all was well with how
America was eating
...
I remember one exchange where Tom Brokaw asked about fast food, and Olson
confidently stated that McDonald's hamburgers were fine
...
Only a handful of insiders could possibly know that his views
did not even come close to reflecting the best understanding of the science at the time
...
From our correspondence over the past year, the
committee already had an informal agenda in place
...
Second, we needed to publicize the idea that advocating more vegetable and fruit consumption
and less meat and high-fat foods was, itself, a scam
...
Up
to this point, our group had only served in a temporary capacity, as
an exploratory committee
...
S
...
"Did you hear?" he whispered
...
" At
that time, Olson was still serving his one-year term as president of the
parent society, the American Institute of Nutrition, and had the power
to do such things
...
I knew I was the black sheep of the committee and had already stepped out of line at our inaugural meeting the previous year
...
The only reason I
was involved in the first place was because the director of the public affairs office at the FASEB had secured me the spot
...
When the proposal
to become a permanent organization within our society was put forth,
I was the only one to challenge the idea
...
What I was saying made the chair of the
committee intensely angry and physically hostile, and I decided it was
best to just leave the room
...

After relating the whole ordeal to the newly-elected incoming president of the society, Professor Doris Calloway of UC Berkeley, the committee was abolished and reformed, with me as the chair
...

To stay and "fight the good fight," so to speak, was not an option
...
For many of these characters, searching for a truth that promoted public health over the status
quo was not an option
...
Research funding and publications would have been
difficult if not impossible to obtain
...

Headquartered in New York City, the ACSH bills itself, still today, as a

260

THE (HINA STUDY

"consumer education consortium concerned with issues related to food,
nutrition, chemicals, pharmaceuticals, lifestyle, the environment and
health
...
7
According to the National Environmental Trust,? the ACSH has
claimed, in their reports, that cholesterol is not related to coronary
heart disease, "the unpopularity of food irradiation
...
g
...
) are not a
human health problem, saccharin is not carcinogenic and implementation of fossil-fuel restrictions to control global warming should not be
implemented
...
Although I believe
that some of their arguments may have merit, I seriously question their
claim to be an objective broker of "consumer education
...
4 As might
have been expected, when this report was published all hell broke loose
...
It was establishing high-profile goals for the dietary prevention of cancer which were
very similar to those of the 1976 McGovern Committee report on diet and
heart disease
...
The fact that this report was concerned with cancer instead of heart
disease, however, elevated emotions
...

Given the stakes, some powerful enemies came out of the woodwork
...
Olson, Jukes, Harper and their like-minded
colleagues on the now defunct Public Nutrition Information Committee weighed in as experts
...
s
...
It was clear
that the CAST was deeply concerned about the possible impact that our
report might have on the public
...
In addition, there were the American Meat Institute, National
Broiler Council, National Cattlemen's Association, National Livestock
and Meat Board, National Meat Association, National Milk Producers
Federation, National Pork Producers Council, National Turkey Federation and United Egg Producers
...

It was ironic that I had learned some of my most valuable lessons
growing up on a dairy farm, and yet the work I was doing was portrayed
as being at odds with agricultural interests
...
I often have wondered whether these
Washington agricultural interests truly represent America's great farming tradition, or whether they only represent agricultural conglomerates
with operations worth tens of millions of dollars
...
" A petard is a
type of bomb or firecracker
...

Times were hot, to be sure
...


AMERICAN INSTITUTE FOR CANCER RESEARCH
It seemed that for the first time in our history, the government was seriously thinking about what we eat as a means of controlling cancer
...
I was invited to assist a new organization called
the American Institute for Cancer Research (AICR) in Falls Church,
Virginia
...
It seemed that many people were
interested in learning something new about cancer beyond the usual
model of surgery, radiation and cytotoxic drugs
...
I encouraged them to focus on diet because the
nutrition connection with cancer was becoming an important area of
research, yet was receiving very little, if any, support from the major
funding agencies
...

As I began to work with the AICR, two challenges Simultaneously
arose
...
Second, the NAS recommendations needed to be publiCized
...
Dr
...
Simultaneously, the
AICR preSident, Marilyn Gentry, suggested that the AICR could publish
the NAS report and send free copies to 50,000 physicians in the u
...

These projects, which seemed to me to be logical, useful and socially
responsible, were also highly successful
...
As I was qUick to find out, however, creating an organization focused on diet as a central link in cancer causation was seen as a
threat to a great many people
...
It seemed that every effort was being made to discredit them
...

National and state attorney general offices questioned the AICR's status
and its fund-raising procedures
...
s
...
We all had our suspicions as to who were encouraging these
government offices to quash the dissemination of this diet and cancer
information
...
Why were they attacking a nonprofit organization promoting

f

SCIENCE-THE DARK SIDE

263

cancer research? It all came down to the fact that the AICR, like the
NAS, was pushing an agenda that connected diet and cancer
...
In its eyes, the AICR had two strikes against it: it might compete for
the same funding donors, and it was trying to shift the cancer discussion toward diet
...
(It wasn't until
many years later in the early 1990s that it developed dietary recommendations to control cancer when the idea was receiving considerable
currency with the public
...

A short while before, the American Cancer Society had contacted our
NAS committee about the possibility of our joining them to produce
dietary recommendations to prevent cancer
...
The American Cancer Society seemed to sense a big
story on the horizon and didn't like the idea that another organization,
the AICR, might get the credit
...

On one occasion, I traveled to an upstate New York town where I
had been invited to give a lecture to the local chapter of the American
Cancer Society, as I had done elsewhere
...
I did not mention my personal association, so the audience was not aware that I was
their senior science advisor
...
" I'm afraid 1 didn't do such a good job of hiding my skepticism of her comment, because she felt obliged to explain,
"That organization is being run by a group of quacks and discredited
doctors
...
"
Prison time? This was news to me!
Again, without revealing my association with the AICR, 1 asked,
"How do you know that?" She said she saw a memo that had been circulated to local American Cancer SOciety offices around the country
...

The memo had been sent from the office of the national president of
the American Cancer Society, who also was a senior executive of the prestigious Roswell Park Memorial Institute for Cancer Research in Buffalo
...
It was total fabrication
...

After snooping around a little more, I discovered the person in the
American Cancer Society office in Buffalo who was responsible for the
memo
...
Not surprisingly, he was evasive and only said
that he had gotten this information from an unnamed reporter
...
The one thing I do know for
sure was that this memo was distributed by the office of the American
Cancer Society's president
...

The smear campaign against the AICR was widespread
...
Prevention of cancer with low-cost, low-profit plant foods
was not welcomed by the food and pharmaco-medical industries
...


PERSONAL CONSEQUENCES
The ending of this story, however, is a happy one
...
No longer considered "on the fringe," the AICR has now expanded to England
(the World Cancer Research Fund, WCRF, in London) and elsewhere
...
I
initially organized and chaired that grant program, and then continued
as the AICR's senior science advisor for several years, in a few different
stints, after its initial founding
...
I was informed
by my nutrition society's Board of Directors that two society members
(Bob Olson and Alf Harper) had proposed to have me expelled from the
society, supposedly because of my association with the AI CR
...
I had to go to
Washington to be "interviewed" by the president of the society and the
director of nutrition at the FDA
...

The whole ordeal proved stranger than fiction
...
He, of course, knew all about the investigation, as well as other shenanigans
...
His response
has resonated with me ever since
...
"It's
about what you did on the National Academy of Sciences report on diet,
nutrition and cancer
...
Supposedly, as one of the two diet and
cancer experimental researchers on the panel, it was my job to protect
the reputation of the American diet as it was
...

Luckily, reason prevailed in this whole farcical encounter
...

It was hard not to take all of this personally, but there's a larger point
here, and it's not personal
...
Coming to
the "wrong" conclusions, even through first-rate science, can damage
your career
...
Mine was
not destroyed-I was lucky, and some good people stood up for me
...

After all of these numerous ordeals, I have a better understanding of

266

THE CHINA STUDY

why my society did the things it did
...
8 Do you believe that these "friends" of the society are interested
in pursuing scientific investigation, no matter what the conclusions
maybe?

CONSEQUENCES FOR THE PUBLIC
Ultimately, the lessons I learned in my career had little to do with
specific names or specific institutions
...
What
happens behind the scenes during national policy discussions, whether it happens in scientific societies, the government or in industry
boardrooms, is supremely important for our health as a nation
...
These experiences illustrate the
dark side of science, the side that harms not just individual researchers who get in the way, but all of society
...

There are some people in very influential government and university
positions who operate under the guise of being scientific "experts,"
whose real jobs are to stifle open and honest scientific debate
...

Personal bias is stronger than you may think
...
Likewise, there are scientists for whom
the high-fat, high animal-based food diet they eat every day is simply
what they learned was healthy at a young age; they love the habit, and
they don't want to change
...
However,
there are a few scientists who are willing to sell their souls to the highest bidder
...

I

t

267

vast
...
You might turn on the
TV one day to see an expert praising McDonald's hamburgers, and then
read a magazine the same day that you should eat less high-fat red meat
to protect yourself against cancer
...
Committees like
the Public Nutrition Information Committee and the American Council
on Science and Health generate lopsided panels and committees and
institutions that are far more interested in promoting their point of
view than debating scientific research with an open mind
...
The American Cancer SOCiety was not the only health institution that worked to make life difficult for the AICR
...
The hostility of
medical schools first surprised me, but when the American Cancer
Society, a very traditional medical institution, also joined the fray,
it became obvious that there really was a "Medical Establishment
...
Big Medicine in America is in the business of treating disease
with drugs and surgery after symptoms appear
...
Who
do you trust?
Only someone familiar with the inside of the system can distinguish
between sincere positions based in science and insincere, self-serving
positions
...

It far too often involves money, power, ego and protection of personal
interests above the common good
...
It doesn't involve large payoffs being delivered to secret bank
accounts or to private investigators in smoky hotel lobbies
...


_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ____1_ _ _ _ _ _ _ _ _ _ ______ _ _ _ _ _ _ _ _ _
_ 4
Scientific Reductionism
WHEN OUR NATIONAL ACADEMY OF SCIENCES (NAS) Diet, Nutrition and
Cancer Committee was deciding how to summarize the research on diet
and cancer, we included chapters on individual nutrients and nutrient
groups
...
For example, the chapter on vitamins included information on
the relationships between cancer and vitamins A, C, E and some B vitamins
...
We explicitly stated that
"These recommendations apply only to foods as sources of nutrientsnot to dietary supplements of individual nutrients
...
They ignored our cautionary message distinguishing foods from pills and began advertising vitamin pills
as products that could prevent cancer, arrogantly citing our report as
justification
...

General Nutrition, Inc
...
Then they
advertised their product by making the following claims2 :
[The Diet, Nutrition and Cancer reportl recommended we increase
among other things our amounts of specific vegetables to help
safeguard our bodies against the risk of certain forms of cancer
...
are the ones we should increase[:l cabbages, Brussels sprouts, cauliflower, broccoli, carrots and spinach
...

[Tlhe result is Health Greens [sic], a new potent breakthrough
in nutrition that millions of people can now help safeguard their
well-being with
...
So the Federal
Trade Commission went to court to bar the company from making these
claims
...
about $7 million
...

A research associate in my group, Dr
...
In 1988, General Nutrition,
Inc
...
3 This was a small price for the
company to pay, considering the ultimate revenues that were generated
by the exploding nutrient supplement market
...
As mentioned before, our committee organized the
scientific information on diet and cancer by nutrients, with a separate
chapter for each nutrient or class of nutrients
...
I am
convinced it was a great mistake on our part
...

The nutrient that our committee focused on the most was fat
...
The accompanying text said, "[Tlhe data could be used to justify
an even greater reduction
...
" One of the committee members, the director of the
United States Department of Agriculture (USDA) Nutrition Laboratory;
told us that if we went below 30%, consumers would be required to reduce animal food intake and that would be the death of the report
...
This meant that these cancers could just as
easily be caused by animal protein, dietary cholesterol, something else
exclUSively found in animal-based foods, or a lack of plant-based foods
(discussed in chapters four and eight)
...
I argued against putting the emphaSiS on specific nutrients
in the committee meetings, but only with modest success
...
)
This mistake of characterizing whole foods by the health effects of specific nutrients is what I call reductionism
...
Saturated fat is merely one ingredient
...
Even if you change the
level of saturated fat in the meat, all of the other nutrients are still present
and may still have harmful effects on health
...

One scientist especially took note 4 of our focused critique of dietary
fat, and decided to test the hypothesis that fat causes breast cancer in
a large group of American women
...
Walter Willett of the

272

THE CHINA STUDY

Harvard School of Public Health, and the study he used is the famous
Nurses' Health Study
...
5 Beginning in 1980, Professor Willett added a dietary questionnaire to the study and four years later, in
1984, expanded the dietary questionnaire to include more food items
...

Data now have been collected for over two decades
...
6 It has spawned three satellite studies, all together
costing $4-5 million per year
...

The scientific community has followed this study closely
...
The design of the study
makes it a prospective cohort study, which means it follows a group of
people, a cohort, and records information on diets before disease events
are diagnosed, making the study "prospective
...

The question of whether diets high in fat are linked to breast cancer
was a natural outgrowth of the fierce discussion going on in the mid1970s and the early 1980s
...
What better study to answer this
question than the Nurses' Health Study? It has a good deSign, massive
numbers of women, top-flight researchers and a long follow-up period
...

The Nurses' Health Study suffers from flaws that seriously doom its
results
...
Hardly any study has done more damage to the nutritional landscape than the Nurses' Health Study, and it
should serve as a warning for the rest of science for what not to do
...
7 Americans eat a lot of meat and fat compared to developing
countries
...
The fact that 70% of our total
protein comes from animal sources means only one thing: we are consuming very few fruits and vegetables
...
For example,
the United States Department of Agriculture (USDA) national school
lunch program counts French fried potatoes as a vegetable!
In contrast, people in rural China eat very little animal foods; they
provide only about 10% of their total protein intake
...
1
...
In general, people in Western
countries are mostly meat eaters, and people in traditional countries are
mostly plant eaters
...
Their average
protein intake (as % of calories) is around 19%, compared with a U
...

CHART 14
...
S
...
f:

c

·w

...



...
'-

c
·w 100

...


63

60
40
20
0

'+-

a


Ol

ro

...


1

80
60
40
20
0

US

China

I_ Animal Prote in 0 Plant Protein I

274

THE CHINA STUDY
CHART 14
...
,

~

'0
OJ

01

II)

C
OJ

u

Qj
a
...
Animal Protein

Nurses

US

China

average of about 15-16%
...

But even more importantly, of the protein consumed by the nurses in this
study, between 78% and 86% comes from animal-based foods ,9 as shown in
Chart 14
...
8, 9 Even in the group of nurses that eat the lowest amount of
total protein, 79% of it comes from animal-based foods
...
They consume very few whole, plant-based foods
...
To get further perspective, I must
return to the 1975 international comparison by Ken Carroll shown earlier in Charts 4
...
9
...
7 is reproduced here in Chart 14
...

This chart became one of the most influential observations on diet
and chronic disease of the last fifty years
...
This report and other consensus reports that followed thereafter eventually set the stage for an explosion of low-fat products in the marketplace ("low-fat" dairy products,
lean cuts of meat, "low-fat" sweets and snack foods)
...
Carroll's
study, like all the other international comparisons, was comparing
populations that mostly ate meat and dairy to populations that mostly
ate plants
...
3: FAT INTAKE AND BREAST CANCER MORTALITY
25

• NETHERLANDS

...

• NEW ZEALAND

...
US
BELGIUM
AUSTRALIA •• SWEDEN

FEMALE

IN
...


g 20
0

o·

AUSTRIA
...
FRANCE
• ITALY

...


...
s

HONG KONG • POLAND
CHILE
•
•
•

...

PANAMA
• YUGOSLAVIA GREECE
PHILIPPINES
COLOMBIA
...
TAIWAN
• CEYLON
THAILA~

...

But because the women in the Nurses' Health Study are so far from a
plant-based diet, there is no way to study the diet and breast cancer relationship originally suggested by the international studies
...
Make no mistake about it: virtually this entire cohort of nurses
is consuming a high-risk diet
...

The group of nurses who consume the least fat eat 20-25% of their
calories as fat, and the group of nurses who consume the most fat eat
50-55% of their calories as fat
...

That begs the question, how can their fat intake vary dramatically while
they all uniformly consume large amounts of animal-based foods?
Ever since "low-fat" became synonymous with "healthy," technology
has created many of the same foods that you know and love, without
the fat
...
In other

276

THE CHINA STUDY

words, you can eat mostly the same foods as you did twenty-five years
ago , while substantially reducing your fat intake
...

In practical terms this means that beef, pork, lamb and veal consumption is decreasing while lower-fat chicken, turkey and fish consumption
is increasing
...
In addition,
whole milk is being consumed less, but low-fat and skim milk are being consumed more
...
13
Overall, we are as carnivorous now as we were thirty years ago, but
we are able to selectively lower our fat intake if we so desire, due to the
wonders of food technology
...
14, 15
Meal #1 is served in a health-conscious horne, where the main grocery
shopper in the family reads the nutrition labels on every food item he or
she buys
...

Meal #2 is served in a home where the standard American fare is everyone's favorite
...
"
The result: a high-fat dining experience
...
4: LOW-FAT AND HIGH-FAT AMERICAN DINNERS
(ONE PERSON'S DINNER)

Low-Fat Meal # 1
Dinner

High-Fat Meal #2

8 oz
...
5 oz
...
The low-fat meal (#1) contains about twenty-five
grams of fat, and the high-fat meal (#2) contains just over sixty grams
of fat
...


l

SCIENTIFIC REDUCTIONISM

277

The health-conscious home has managed to create a meal that is
much lower in fat than the average American dinner, but they've done
it without adjusting their proportionate intakes of animal- and plantbased foods
...
In fact,
the low-fat meal actually has more animal-based foods than the highfat meal
...
Some nurses simply are
more diligent about choosing low-fat animal products
...
In addition, the low-fat meal contains almost twice as much cholesterol (Chart 14
...
14,15
CHART 14
...
In the low-fat meal, the
amount of both of these unhealthy nutrients is significantly higher
...

Instead, they use low-fat and nonfat animal products, along with less fat
during cooking and at the table
...


278

THE CHINA STUDY

This is a very important discrepancy, and is illustrated by the correlation between the consumption of dietary animal protein and dietary fat
for a group of countries (Chart 14
...
8,9, 18,20-22 The most reliable comparison was published in 1975 2°; it showed a highly convincing correlation of more than 90%
...
Likewise, in the China Study, the intakes of fat and animal protein also show a similar correlation of 84%
...
The correlation
between animal protein and total fat intakes is only about 16%
...
This
practice is typical of American women who have been led to believe
that, by decreasing their fat intake, they are changing to a healthier diet
...
4)
...
Because of this, the
Nurses' Health Study and virtually every other human epidemiological
study published to date have been seriously shortchanged in their inCHART 14
...
Virtually all the subjects
under study consume the very diet that causes diseases of affluence
...
To make matters worse, these studies often focus on
the consumption of just one nutrient, such as fat
...


THE $1 OO( +) MILLION RESULTS
SO now that you know how I interpret the Nurses' Health Study and its
flaws, we should take a look at its conclusions
...
So what are
they? The logical place to start is, of course, the question of whether fat
intake really is linked to breast cancer
...

• "we found no evidence that lower intake of total fat or specific major
types of fat was associated with decreased risk of breast cancer"l0

Translation: The Nurses' Health Study did not detect a relationship
between reducingfat, whether it be total fat or certain kinds offat, and
breast cancer risk
...


r

l

280

THE CHINA STUDY

• "relative risks for
...

were close to unity"25

Translation: The Nurses' Health Study did not detect a relationship
between these "good" fats and breast cancer risk
...

• "our findings do not support a link between physical activity, in
late adolescence or in the recent past, and breast cancer risk among
young adult women"27

Translation: The Nurses' Health Study did not detect a relationship
between exercise and breast cancer risk
...

• "selenium intake later in life is not likely to be an important factor
in the etiology of breast cancer"29

Translation: The Nurses' Health Study did not detect a protective effect
of selenium on breast cancer risk
...

So there it is, readers
...
Breast cancer is not prevented

SCIENTIFIC REDUCTIONISM

281

by increased intakes of fruits and vegetables, or reduced by exercise
(either during the teenage years or during adulthood), dietary fiber,
monounsaturated fats or polyunsaturated fats
...
In other words, we might as well conclude that diet is
completely unrelated to breast cancer
...
"6 He
was making his comment in response to an opinion that "the Single biggest challenge for the future [is] sorting out the mess of contradictory
findings and lack of information on breast cancer
...
Perhaps the most rewarding finding, ironically, was the demonstration that tinkering with one nutrient at a time,
while maintaining the same overall dietary patterns, does not lead to
better health or to better health information
...
From their slew of studies, here are some
findings that I would consider as very troubling contradictions when
comparing disease risks for men versus women:
• Men who consume alcohol three or four times a week have a lower
heart attack risk
...
32
And yet
...
33
Apparently alcohol is good for heart disease and bad for breast cancer
...
Is this a difference between men and women, or is this
a difference in response between heart disease and cancer? Do you feel
more informed or more confused?
Then there are those wonderful omega-3 fatty acids
...
If you've heard anything about
omega-3 fatty acids, it's that you need more of them to be healthy
...
contrary to the predominant hypothesis, we found an increased risk of breast cancer associated with omega-3 fat from fish"
(This increased risk was statistically significant and was associated
with an increase of only 0
...
)l0
• "our findings suggest that eating fish once per month or more can
reduce the risk of ischemic stroke in men"34
• "data suggest that consumption of fish at least once per week may
reduce the risk of sudden cardiac death in men [but not reduce
the] risk of total myocardial infarction, non-sudden cardiac death
or total cardiovascular mortality"35 (In other words, fish may prevent some aspects of heart disease but ultimately has no effect on
mortality from heart disease, or even heart attack risk
...
One egg has a
whopping 200 mg or more of cholesterol,36 which takes up a large proportion of our 300 mg recommended daily limit
...
consumption of up to one egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy
men and women3?
But, for breast cancer,
Our findings [representing eight prospective studies] suggest a possible modest increase in [breast cancer] risk with egg consumption
...
J26
But earlier, the Harvard researchers took a slightly different position:

...
A recent news item
stated:
Eating eggs during adolescence could protect women against
breast cancer
...
had a lower risk of breast cancer
...
Eggs will
only seem to be more healthful when the henhouse industry adds their
words of wisdom
...
By the way, here's
something else to think about
...
w
What are we to believe? One minute alcohol intake can reduce our
disease risks, the next minute it can increase them
...
One minute eggs are bad, the next minute they can be healthy
...
What you
have without that context is just a lot of confusion
...


r

UNRAVELING DIET AND CANCER
In addition to stating that diet and exercise are unrelated to breast cancer, the Harvard researchers have been chipping away at other popular
notions regarding diet and cancer
...
4 • 4 1, 42
Dietary fiber, of course, only comes from plant-based foods, thus
these findings put a dent in the idea that fiber or fruits , vegetables and
cereals prevent large bowel cancer
...
It is likely that the potential protective effect of

284

THE CHINA STUDY

fiber or fruits and vegetables does not kick in against colorectal cancer
until there is a complete dietary shift away from an animal-based diet
...
After these decades of work, Professor Walt
Willett says:

...
the benefits
[of these foods] appear greater for cardiovascular disease than for
cancer4
This statement sounds a bit ominous
...
In fact, I
have already heard people within the scientific community beginning to
say that diet may have no effect on cancer
...
It has virtually
nullified many of the advances that have been made over the past fifty
years without actually posing a scientifically reliable challenge to earlier
findings regarding diet and cancer
...
It is common
to virtually all studies using Western subjects
...

A pooling strategy is often used for identifying cause-and-effect associations that are more subtle and uncertain within single studies
...
The combined results
only give a more reliable picture of the flaw
...
One such pooled analysis concerned the question of
whether meat and dairy foods had any effect on breast cancer
...
46 The Harvard researchers
therefore summarized in 2002 a more recent group of studies, this time
including eight large prospective studies where dietary information was
thought to be more reliable and where a much larger group of women
was included
...
26
Most people would say, "Well, that's it
...
"
But let's take another look at this supposedly more sophisticated analysis
...
In effect, each study in this pool was subject to
the same flaw from which the Nurses' Health Study suffered
...
In spite of there being
351,041 women and 7,379 breast cancer cases in this mega-database,
these results cannot detect the true effect of diets rich in meat and dairy
on breast cancer risk
...
Like the Nurses' Health Study, these studies
all involved typical Western diets highly skewed toward the consumption of animal-based foods, where people are tinkering with the intake
of only one nutrient or one food at a time
...


IGNORING MY CRITIQUE
Once, after reading a publication on animal protein and heart disease
in the Nurses' Health Study,9 I published a critique47 summarizing some
of the same points that I am making in this chapter, including the inability of the Nurses' Health Study to advance our understanding of
the original international correlation studies
...

First, my comment:
Within a dietary range [so rich in animal-based foods 1, it makes no
sense to me that it is possible to reliably detect the so-called independent associations of the individual constituents of this group
when it can be expected that they share the same disease outcomes

286

THE CHINA STUDY

and when there are so many difficult-to-measure and interacting
risk factor exposures
...
Hu and Professor Willett:
Although we agree that overall dietary patterns are also important
in determining disease risk (ref
...
Specific
components of diet can be modified, and individuals and the food
industry are actively doing so
...
48
I agree that studying the independent effects of individual food
substances (their identities, functions, mechanisms) is worthwhile,
but Willett and I sharply disagree with how to interpret and use these
findings
...

This is precisely what is wrong with this area of research
...
Women who
tinker with fat, while maintaining a near-carnivorous diet, do not have
a lower breast cancer risk
...
As long as scientists
study highly isolated chemicals and food components, and take the information out of context to make sweeping assumptions about complex diet
and disease relationships, confusion will result
...
The more impressive message about the benefits of broad dietary
change will be muted as long as we focus on relatively trivial details
...
I have always made the same
point: whole foods , plant-based diets, naturally low in fat, are not included in the Nurses' Health Study cohort, and that it is these types of
diets that are the most beneficial for our health
...
" This comment has disturbing
implica tions
...
Too often during my career, I
have heard comments that seem to be more of an attempt to please the
public than to engage in an open, honest debate, wherever it may take
us
...
The role of science in a society is to observe, to ask
questions, to form and test hypotheses and to interpret the findings
without bias-not to kowtow to people's perceived desires
...
It is
they who paid for this research and it is only they who have the right to
decide what to do with it
...
I have
learned in my public lectures that there is more interest in dietllifestyle
change than the academic community is willing to admit
...

It is even more damaging than the misbehavior of the small minority
of scientists I discussed in chapter thirteen
...
As a consequence,
honest, hardworking, well-intentioned scientists around the world are
forced to make judgments about whole dietary effects on the basis of
narrowly focused studies on individual nutrients
...
Indeed, I know many researchers who
would even say that this is what defines "good" science
...
As I noted at the beginning of the chapter, I spent
over three years during the early history of the nutrient supplement

288

THE (HINA STUDY

business developing testimony for the Federal Trade Commission and
the National Academy of Sciences in their court case against General
Nutrition, Inc
...
For this, I took a lot of heat from my colleagues who believed
otherwise
...
s
...
49 • 5o
How many more billions of dollars must be spent before we understand the limitations of reductionist research? Scientific investigations
of the effects of single nutrients on complex diseases have little or no
meaning when the main dietary effect is due to the consumption of
an extraordinary collection of nutrients and other substances found in
whole foods
...
I categorically reject the idea
of doing reductionism research in this field without seeking or understanding the larger context
...


____ _____ ____1_ _____ __ _ _
...
_
...

After a lifetime of eating, what do we all do? Die-a process that usually involves large costs as we try to postpone it for as long as possible
...

Because of this, the food and health industries in America are among
the most influential organizations in the world
...
Many individual food companies have over $10 billion in annual
revenues
...
The Danone
Group, an international dairy company based in France, operates the
Dannon brand and has revenues of $15 billion a year
...
McDonald's has revenues in excess of $15 billion a year, and Wendy's International generates almost $3
billion a year
...
l
The massive drug company Pfizer had $32 billion in revenue in 2002,
while Eli Lilly &:
...
chalked up over $11 billion
...
It's not an overstatement to say over a trillion dollars every year is riding on what we
choose to eat and how we choose to treat sickness and promote health
...

There are powerful players that compete for your food and health
289

290

THE CHINA STUDY

dollars
...
The National Dairy Council,
National Dairy Promotion and Research Board, National Fluid Milk
Processor Promotion Board, International Sprout Growers Association, American Meat Institute, Florida Citrus Processors Association,
and United Egg Producers are examples of such industry groups
...

These food companies and associations use whatever methods they
can to enhance their products' appeal and grow their market
...
At the same time, these companies and associations must
protect their products from being considered unhealthy
...
So food business interests need to claim that their product is good
for you, or, at least, that it's not bad for you
...


THE AIRPORT CLUB
While I was getting the China Study off the ground, I learned of a committee of seven prominent research scientists who had been retained
by the animal-based foods industry (the National Dairy Council and
the American Meat Institute) to keep tabs on any research projects in
the u
...
likely to cause harm to their industry
...
A graduate student of mine was visiting with one of these scientists and was given a file on the committee
activity
...
Perhaps
the scientist's conscience was getting the better of him
...

The file contained minutes of committee meetings, the latest being
held at Chicago's O'Hare Airport
...
" It was run by Professors E
...
Foster
and Michael Pariza, faculty members of the University of Wisconsin
(where AU Harper was located), and was funded by the meat and dairy
industry
...
With such surveillance,
the industry could more effectively respond to unexpected discoveries

L

THE ·SCIENCE" OF INDUSTRY

291

from researchers that might make otherwise unanticipated news
...

They listed about nine potentially damaging projects, and I had the
dubious distinction of being the only researcher responsible for two
of the projects
...
Another panel member had the task of
keeping an eye on the AICR activity
...
I went into the first AICR review
panel meeting after learning of the Club with an eye on the spy who was
keeping an eye on me!
One might argue that this industry-funded "spying" was not illegal,
and that it is prudent for a business to keep tabs on potentially damaging information that might affect its future
...

But industry does more than just keep tabs on "dangerous" research
...
This is especially troubling when academic scientists do the spying and hide their
intentions
...
Founded in 1915, the well-organized,
well-funded National Dairy Council has been promoting milk for almost a hundred years
...
The purpose of this new group was "to do one thing: increase demand for U
...
-produced dairy products," to cite their Web site
...
4 In
comparison, the National Watermelon Promotion Board has a budget
of $1
...
5 A Dairy Management, Inc
...
7 million for a 2003
Unified Marketing Plan (UMP) designed to help increase dairy
demand
...
Major program areas include:
Fluid Milk: In addition to key ongoing activities in advertising,
promotion and public relations efforts targeted to children ages six
to twelve and their mothers, 2003 dairy checkoff efforts will focus
on developing and extending partnerships with major food marketers, including Kellogg's®, Kraft foods® and McDonald's®
...
School Marketing: As part of an effort to gUide school-age
children to become life-long consumers of dairy products, 2003
activities will target students, parents, educators and school foodservice profeSSionals
...

·
...
A major component involves conducting
and communicating the results of dairy nutrition research showing the healthfulness of dairy products, as well as issues and crisis
management
...

Many people are not aware of the dairy industry'S presence in our
schools
...

The dairy industry has enlisted the public education system as the
primary vehicle for increasing demand for its products
...
, annual report stated6 :
As the best avenue to increase fluid milk consumption long-term,
children are without a doubt the future of dairy consumption
...


THE "SCIENCE" OF INDUSTRY

293

Dairy producers
...
A yearlong school milk research program that began in the
fall of 2001 examines how improved packaging, additional flavors,
coolers with merchandising and better temperature regulation can
affect fluid milk consumption and kids' attitudes toward milk both
in and out of school
...
Also, dairy producers and processors worked together to conduct a five-month vending study in middle and high
schools in five major U
...
markets
...

Many other successful school programs continue to encourage children to drink milk
...
In addition, the popular "got milk" campaign continues to
reach children at school and through such kid-focused media outlets as
Nickelodeon and the Cartoon Network
...
"7 According to a dairy industry report to
Congress,8 the dairy industry's "nutrition education" programs are doing quite well:
"Pyramid Cafe®" and "Pyramid Explorations™,'' targeted to second and fourth grades, reach over 12 million students with messages that milk and dairy products are a key part of a healthy diet
...


,
...
In addition to ubiquitous
nutrition lesson plans and "educational" kits, the industry supplies high
schools with videos, posters and teaching gUides regarding nutrition; it
runs special promotions in cafeterias to increase milk consumption in

294

THE CHINA STUDY

thousands of schools; it distributes information to principals at national
conferences; it runs back-to-school promotions with over 20,000 schools;
and it runs sports promotions targeted toward youth
...
If you are curious as to what
kind of "education" is being taught by the dairy industry, take a look at
their Web site
...
"
Upon clicking for more information on National Ice Cream Month, I
read, "If you're wondering if you can have your ice cream and good
nutrition too, the answer is 'yes'!"9 Great
...
When I looked at the
Web site in July 2003 (the Web site regularly changes its content), in
the educator portion of the site, teachers could download lesson plans
to teach nutrition to their classrooms
...
Once
the puppets are made, the teacher should "[ tl ell the students they're
going to meet five special friends, and these friends want boys and girls
to grow up to be strong and healthy
...
9 Or teachers could lead their classes in making
"Moo Masks
...
)
Meat Group (Build strong muscles
...
)
Fruit Group (Help heal cuts and bruises
...
)
Based on the evidence presented in the previous chapters, you know
that if this is what our children are learning about nutrition and health
then we are in for a painful journey, courtesy of Dairy Management,
Inc
...


THE ·SCIENCE" OF INDUSTRY

295

In 2002, this marketing Web site delivered over 70,000 lesson plans to
educators
...

The industry has been doing this for decades, and it has been successful
...
" Usually these people don't have any evidence to support their position; they just have a feeling that milk is good
...
You can trace some of their
opinions back to their school days, when they learned that there are
seven continents, two plus two equals four, and milk is healthy
...

If this marketing program weren't such a widespread threat to our
children's health, it would be downright laughable that an industry
group would try to peddle its food product under such a thinly-veiled
"education" plan
...


~
I

r

t

CONJUGATED LINOLEIC ACID
The dairy industry doesn't stop with kids
...
The dairy industry spends $4 to $5 million a year to fund
research towards the goal of finding something healthy to talk about
...

These scientists are the ones who appear as medical professionals in
the media, proViding science-based statements supporting the health
benefits of milk
...
" In addition to keeping an
eye on potentially damaging projects, the Club was trying to generate
research that might show that cancer could be prevented by drinking
cow's milk
...

Their hook for this research was an unusual group of fatty acids
produced by bacteria in the cow's rumen (the biggest of the four stomachs)
...
From the cow's rumen, CLA is then absorbed
and gets stored in the meat and milk of the animal, eventually to be
consumed by humans
...
ll , 12 But there was a catch in this research
...
The ordering of these chemical feedings was
backwards
...
When a chemical such as
CLA is initially consumed, it "excites" that enzyme system so that it has
increased activity
...
In this order, the enzyme system excited by CLA would be more effective at getting rid of the
carcinogen
...

Let me give you an analogous situation
...
The pesticide bag says, "Do not swallow! In case of ingestion, contact your local poison control health authorities," or some such warning
...
That pesticide in your body will "rev up"
the enzyme systems in all of your cells that are responsible for eliminating nasty things
...
So, the pesticide, which will ultimately do all sorts of nasty
things in your body, is an anticarcinogen! This scenario is obviously
absurd, and the research on mice that initially showed CLA to be an

THE "SCIENCE" OF INDUSTRY


...
However, the end results of the
mice research sounded pretty good to people who don't know this
methodology (including most scientists)
...
13- 1S Later, at Roswell Park Memorial Institute
for Cancer Research in Buffalo, a very good researcher and his group
extended the research still further and demonstrated that it did more
than merely block the first step in the formation of tumors
...

Regardless of how promising these mouse and cow studies were becoming, this research remained two major steps removed from human
cancer, First, it had not been shown that cow's milk containing CLA,
as a whole food (as opposed to the isolated chemical CLA), prevents
cancer in mice
...
In fact, as has been discussed earlier
in this book, if cow's milk has any effect at all, it has been shown to increase, not decrease, cancer
...
e
...
Lo and
behold, a recent front-page headline in our local newspaper, the Ithaca
Journal, stated "Changing Cows' Diets Elevates Milk's Cancer-Fighting
...
He showed that he could increase CLA in cow's milk by feeding
the animals more corn oil
...
The headline delivers a powerful but very simple message to the
public: drinking milk reduces cancer risk I know that media people
like punchy statements so, initially, I suspected that the reporter had
made claims beyond what the researchers had said
...
The study cited in this article only
showed that CLA is higher in the milk of cows fed corn oil
...
No studies had yet
shown that humans or even mice drinking cow's milk had a lower risk
of cancer-of any kind
...
" The
journalist went on to say "CLA has been shown to suppress carcinogens
and inhibit the spread of colon, prostate, ovarian and breast cancers and
leukemia," and concluded that "all indications are that CLA is effective in humans even in low concentrations
...
" These claims
could not be more dramatic, conSidering the absence of the necessary
human research
...
Although additional beneficial effects of
CLA are said to exist, the key research still has not been done, namely,
testing whether the consumption of milk from cows fed high-corn oil
diets really will reduce human cancer risk
...
They have shown that
the milk fat of cows fed high amounts of corn oil (i
...
, linoleic acid, the
parent of CLA), like synthetic CLA, was able to decrease tumors in rats
treated with a carcinogen
...
They administered the milk fat before, not after the carcinogen
...
e
...
Translated: eat butter from cows fed corn
oil-it prevents cancer!

THE SCIENCE OF INDUSTRY
The CLA story is a good example of how industry uses science to increase demand for its product in order to make more money
...


THE "SCIENCE" OF INDUSTRY

299

Conflicts of interest abound in this science of industry
...
The National Dairy Council,20--22
Kraft Foods, Inc
...
21
0
the Cattlemen's Beef Board23 and the Cattlemen's Beef Association 23 are
groups that have frequently funded these studies
...
This influence does not need to be
a crass payoff to researchers to fabricate data
...
The more Significant way for corporate interests to influence academic research is much more sophisticated and effective
...
Almost no one knows where the CLA hypothesis started and
who originally funded it
...
Very few people, especially among the public, know which
studies are "benefiting" from direct corporate funding
...
Almost everyone,
however, understands that headline in my local newspaper
...
If I wanted to hurt the dairy industry and
be a little wild in my interpretation of study results, I could produce another headline to say, "New birth control chemical discovered in cow's
milk
...
13 Also, CLA increases the tissue level of saturated fats
that could (using our dramatic method of interpretation) exacerbate
heart disease risk
...
I don't really know whether these
CLA effects actually translate into less fertility and more heart disease
for humans, but if I were playing the game the way industry enthusiasts
do, I wouldn't mind
...

I recently met with one of the members of The Airport Club, a scientist who has been involved in the CLA effort, and he confessed that the
CLA effect will never be anything more than a drug effect
...

I

•

r
!

300

THE CHINA STUDY

INDUSTRY'S LOVE OF TINKERING
Much of The Airport Club and the CLA story is a story about the "dark
side" of science, which I detailed in chapter thirteen
...
Like academia, industry is also an essential player in
the system of scientific reductionism that undermines the knowledge
we have about dietary patterns and disease
...
Securing patents based on details leads to marketing claims and,
ultimately, to greater revenues
...
20
I know that, for Bauman and others, "making radical changes
in
...

Rather than avoiding bad foods altogether, these researchers are suggesting that we tinker with the existing, but problematic, foods to correct the problem
...

This faith in technological tinkering, in man over nature, is everpresent
...
It has become part of every single food
and health industry in the country; from oranges to tomatoes, from cereals to vitamin supplements
...
" You've probably heard ofit
...
In 1995, it was reported
that people who ate more tomatoes, including whole tomatoes and
tomato-containing foods like pasta sauces, had a lower risk for prostate
cancer,24 supporting an earlier report
...
Marketing people in the corporate world quickly got
the message
...


l

THE "SCIENCE" OF INDUSTRY

301

The media, willing to oblige, rose to the occasion
...
The scientific world, investigating
details, escalated its efforts to decipher the "lycopene magic
...
26 A major market is developing,
with trade names like Lycopene lO Cold Water Dispersion and LycoVit
lO% to be used as food supplementsY Judging by the health claims,
we might be on the way to bringing prostate cancer, a leading cancer
among men, under control
...
First, after
spending millions of research and development dollars, there is some
doubt whether lycopene, as an isolated chemical, can prevent prostate
cancer
...
2 But these studies measured lycopene intake from whole foods, namely tomatoes
...
Do we have evidence that isolated lycopene will do what
tomatoes do, especially for those who don't like tomatoes? The answer
is no
...

Nonetheless the lycopene business is up and running
...
27 Also, consideration is being
given to the possibility of genetically modifying plants for higher levels
of lycopene and other carotenoids
...
In my book, this is what I call
technological tinkering and marketing, not science
...
31,32 Depending on what we were testing and how

302

THE CHINA STUDY

we did the test, single carotenoids could have widely ranging potencies
...
This variation manifests itself in
countless ways involving hundreds of antioxidants and thousands of
different reactions, forming a nearly indecipherable network
...

Five years after our rather obscure work on these antioxidants,32 a
Harvard study33 effectively kicked off the lycopene campaign
...


FRUIT CLAIMS
The fruit industry plays this game just like everyone else
...
Most of us
have heard ad nauseum that oranges are a good source of vitamin C
...
How
much do you know, for example, about vitamin C's relationship to diet
and disease? Let's start with the basics
...
One cup of
peppers, strawberries, broccoli or peas all have more
...
34
Beyond the fact that many other foods are better sources of vitamin
C, what can we say about the vitamin C that is in oranges? This concerns the ability of the vitamin to act as an antioxidant
...
35 Furthermore, measuring
antioxidant activity by using "test tube" studies does not represent the
same vitamin C activity that takes place in our bodies
...
Who
first established these assumptions? Orange merchants
...

Did these assumptions (presented as fact) sound good to the marketing
people? Of course they did
...
Would I eat an orange because it is a healthy plant food with a
complex network of chemicals that almost certainly offer health benefits? Absolutely
...
In the
1970s and 1980s, I appeared in a television ad for citrus fruits
...
This interview,
unknown to me at the time, was the source of my presence on the ad
...
Why did I do the interview? At that point in my career, I probably thought that the vitamin
C in oranges was important, and, regardless of vitamin C, oranges were
very healthy foods to eat
...
It has not been until recently, after a lifetime of research, that I have come to realize how damaging
it is to take details out of context and to make subsequent claims about
diet and health
...
Every year, it seems, some new product is being
touted as the key to good health
...
Don't be tricked: the healthiest section of any store is the place
where they sell whole fruits and vegetables-the produce section
...
Our kids are often the most coveted targets of their marketing
...
Why have we ignored food?
Even though it is accepted that food plays a major role in many chronic
diseases, we allow food industries not only to market directly to children, but also to use our publicly-funded school systems to do it
...



...
_
...
_
...
__ _
...
_
...
_
...
_
...
_
...
_
...
Expert government panels have said it, the surgeon
general has said it and academic scientists have said it
...
We know that the incidence of obesity and diabetes is skyrocketing and that Americans' health is slipping
away, and we know what to blame: diet
...
It is a
message soundly based on the breadth and depth of scientific evidence,
and the government could make this clear, as it did with cigarettes
...
But instead of doing this, the
government is saying that animal products, dairy and meat, refined sugar
and fat in your diet are good for you! The government is turning a blind
eye to the evidence as well as to the millions of Americans who suffer
from nutrition-related illnesses
...
s
...
The United
DURING THE PAST TWO TO THREE DECADES,

305

306

TH E CH I NA STU DY

States government is not only failing to put out our fires, it is actively
fanning the flames
...
The FNB has been making nutrient recommendations since 1943 when it established a plan for the u
...
Armed
Forces wherein it recommended daily allowances (RDAs) for each individual nutrient
...
For good health, we are now advised to
consume from 45% to 65% of our calories as carbohydrates
...

A few quotes from the news release announcing this massive 900+
page report say it all
...

Further, we find:

...
added sugars are those incorporated into foods
and beverages during production [and] major sources include
candy, soft drinks, fruit drinks, pastries and other sweets
...
What are these recommendations really saying? Remember, the news release starts off by stating the report's objective of "minimizing risk for chronic disease
...
It also recommends that we can
consume up to 35% of calories as protein; this number is far higher than
the suggestion of any other responsible authority
...

We can consume up to 25% of calories as added sugars
...
In effect, although

GOVERNMENT: IS IT FOR THE PEOPLE?

307

the report advises that we need a minimum of 45% of calories as carbohydrates, more than half of this amount (i
...
, 25%) can be the sugars
present in candies, soft drinks and pastries
...
" Forget any words of
caution you may find in this report-with such a range of possibilities,
virtually any diet can be advocated as minimizing disease risk
...
l)yl
CHART 16
...
soda,
1 serving Archway sugar cookies

CHART 16
...
This disastrous menu plan fits the recommendations of the report and is supposedly consistent with "minimizing
chronic disease
...
At this point in the book, I don't need to
tell you that when we eat a diet like this day in and day out, we will be
not just marching, but sprinting into the arms of chronic disease
...


PROTEIN
Perhaps the most shocking figure is the upper limit on protein intake
...

About 9-10% protein, however, is the amount that has been recommended for the past fifty years to be assured that most people at least get
their 5-6% "requirement
...
5
Almost all Americans exceed this 9-10% recommendation; we consume protein within the range of about 11-21 %, with an average of about
15-16%
...

It is extremely puzzling that these new government-sponsored 2002
FNB recommendations now say that we should be able to consume
protein up to the extraordinary level of 35% as a means of minimizing
chronic diseases like cancer and heart disease
...
The evidence presented
in this book shows that increasing dietary protein within the range of
about 10-20% is associated with a broad array of health problems, especially when most of the protein is from animal sources
...

Furthermore, the FNB panel had the audacity to say that this 10-35%
recommendation range is the same as previous reports
...
" I know of no report that has even remotely suggested a
level as high as this
...
But, no, it was correct
...
The first panel member, a long-time acquaintance, said this was
the first time he had even heard about the 35% protein limit! He suggested that this protein recommendation might have been drafted in the
last days of preparing the report
...
He had not worked in the protein area, so he did
not know the literature
...
He is
not a nutritional scientist and also was surprised to hear my concerns
about the upper limit for protein
...
When I reminded him of some of the evidence
linking high-animal protein diets to chronic disease, he initially was
a little defensive
...
" How, then, was he a member-let alone the
chair-of this important subcommittee? And it gets worse
...


A SUGARCOATED REPORT
The recommendation on added sugar is as outrageous as the one for
protein
...
Professor
Phillip James, another friend of mine, was a member of this panel and a
panel spokesperson on the added sugar recommendation
...

Politics, however, had early entered the discussion, as it had done in

4

310

THE CHINA STUDY

earlier reports on added sugars
...
S
...
" They did not like setting the upper safe limit so low According to the Guardian newspaper of London,? the U
...
sugar industry was
threatening "to bring the World Health Organization to its knees" unless it abandoned these gUidelines on added sugar
...
"7 The U
...
-based group even
publicly threatened to lobby the U
...
Congress to reduce the $406 million u
...
funding of the WHO if it persisted in keeping the upper limit
so low at 100
...
I, and
many other scientists, were being encouraged at that time to contact
our congressional representatives to stop this outrageous strong-armed
tactic by the U
...
sugar companies
...
S
...
S
...
This is nothing more than naked political muscle
...
The
U
...
panel received funding from the M&:M Mars candy company and
a consortium of soft drink companies
...
s
...
In other words, the FNB committee
produces a friendly recommendation for the sugar industry which then
turns around and uses this finding to support its claim against the WHO
report
...
Mostly, industry develops consultancies with a few publicly visible figures in academia, who then take
leadership in policy positions outside of academia
...
They organize
symposia and workshops, write commissioned reviews, chair expert
policy groups and/or become officers of key professional societies
...

Once in these positions, these people then have the opportunity
to assemble teams to their liking, by choosing committee members,
symposia speakers, management staff, etc
...
" It's called
"stacking the deck," and it really works
...
He helped in selecting the "right" people and helped in setting
the agenda for the report, the most Significant roles that anyone could
have played
...

Ironically, they can even help set the agenda for the same government
authorities who have long been restricted from such corporate associations
...
In effect, the
entire system is essentially under the control of industry
...

In addition to M&M Mars company, the corporate sponsors of the
FNB report also included major food and drug companies that would
benefit from higher protein and sugar allowances
...
Corporate members
include Coca-Cola, Taco Bell, Burger King, Nestle, Pfizer and Roche
Vitamins
...
I
don't recall private corporations providing financial support for the NAS
expert panels that I served on
...
The chair of the FNB has
been an important consultant to several major dairy-related companies
(e
...
, National Dairy Council, Mead Johnson Nutritionals, which is
a major seller of dairy-based products, Nestle Company and a Dannon yogurt affiliate)
...
I, 10 As chair of this
latter committee, his personal financial associations with the food industry were not publicly revealed as required by federallaw
...
Although the chair's industry
associations were more substantial, six of the eleven committee members
also were shown to have ties to the dairy industry
...
They run
the show
...

It seems curious that while government scientists are not allowed
to receive personal compensation from the private sector, their colleagues in academia can receive all that they can get
...
However, restricting academics from receiving corporate consultancies is not the answer
...
Rather, the situation would be best handled by making one's industry connections a matter of public disclosure
...
Disclosure and full transparency is in everyone's

GOVERNMENT: IS IT FOR THE PEOPLE?

313

interest
...


SEnlNG US BACK FOR YEARS
Lest you think that this Food and Nutrition Board report is merely a
five-second news bite that then gets filed into a dusty old cabinet somewhere in Washington, let me assure you that tens of millions of people
are directly affected by this panel's findings
...
[They are]
used to determine the types and amounts of food:
• provided in the WIC (Women, Infants and Children) Supplemental Feeding Program and the Child Nutrition Programs
such as School Lunch,
• served in hospitals and nursing homes for Medicare reimbursement,
• found in the food supply that should be fortified with specific
nutrients,
• used in a host of other important federal and state programs
and activities [such as establishing reference values used in
food labeling] 13
The School Lunch Program feeds 28 million children every day
...
By the way, the 2002 FNB report does make one special exception
for children: it says that they can consume up to 40% of calories as fat, up
from 35% for the rest of us, while minimizing the risk of chronic disease
...
It is safe to say that the food provided by these government programs directly feeds at least 35 million Americans a month
...
From September
2002 onwards, nutrition education programs around the country

314

THE CHINA STUDY

have incorporated these new gUidelines
...
Food labels also will be affected by these
changes, as will the nutrition information that seeps into our lives via
advertising
...
In school, our children can be fed more fat, more
meat, more milk, more animal protein and more sugar
...
The ramifications
of this are serious, as a whole generation will walk the path of obesity,
diabetes and other chronic illnesses, all the while believing that they
are doing the right thing
...
g
...
I consider this to be an irresponsible
and callous disregard for American citizens
...
Posters
that deck the bulletin boards of public institutions will now feature
these new government guidelines as well
...
Having been a member of several diet and health policy-making
expert panels over a twenty-year period I harbored the view that these
panels were dedicated to the promotion of consumer health
...


UNFUNDED NUTRITION
Not only is the government failing to promote health through its recommendations and reports, it is squandering an opportunity to promote
public health through scientific research
...
s
...
To address various health topics, the NIH is comprised of
twenty-seven separate institutes and centers, including its two largest,
the National Cancer Institute (NCO and the National Heart, Lung and
Blood Institute
...

In terms of nutrition research, however, something is amiss
...
One of the arguments against having a
separate institute for nutrition is that the existing institutes already concern themselves with nutrition
...
Chart 16
...
l6
Of the $28 billion NIH budget proposed for 2004, only about 3
...
That may not sound too
bad
...

Most of the prevention and nutrition budgets have absolutely nothing to do with prevention and nutrition, as I have written in this book
...
3: NIH 2004 ESTIMATED FUNDING
FOR DIFFERENT HEALTH TOPICS17
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...

Instead, the prevention and nutrition budgets will be designated for
developing drugs and nutrient supplements
...
"1 This so-called prevention is all about manipulation ofisolated
8
chemicals
...

Considered from another perspective, the NCI (of the NIH), in 1999,
had a budget of $2
...
1 In a "major" 5-A-Day dietary program, it
9
was spending $500,000 to $1 million to educate the public to consume
five or more servings of fruits and vegetables per day
...
0256%) of its budget
...
56 for every
$1O,000! If it calls this a major campaign, I pity its minor campaigns
...
These rare nutrition-related studies unfortunately
suffer from the same experimental flaws described in chapter fourteen
...
These studies have a very high probability
of creating some very expensive confusion that we hardly need
...
In essence, the vast bulk of biomedical
research funded by you and me is basic research to discover products
that the pharmaceutical industry can develop and market
...

Marcia Angell, a former editor of the New England Journal of Medicine,
summarized it well when she wrote2°:

...
Much of the early basic research that

GOVERNMENT: IS IT FOR THE PEOPLE?

317

may lead to drug development is funded by the National Institutes
of Health (ref
...
It is usually only later, when the research
shows practical promise, that the drug companies become involved
...
Not only are
its research and development costs deductible, but so are its massive marketing expenses
...
s
...
3% of revenues
...
2% (ref
...
Most important, the drug companies enjoy seventeen-year government-granted monopolies on their new
drugs-that is, patent protection
...
20
Our tax dollars are used to make the pharmaceutical industry more
profitable
...
Our chronic diseases are largely the result of infinitely complex
assaults on our bodies resulting from eating bad food
...
In addition, isolated chemicals in drug form can be very dangerous
...
"21 There is no danger to eating a healthy diet, and there are far
more benefits, including massive cost savings both on the front end of
preventing disease and on the back end of treating disease
...
One of my former
graduate students at Cornell, Antonia Demas (now Dr
...
She had been doing
this work as a volunteer mother in her children's schools for seventeen

318

THE CHINA STUDY

years prior to her graduate studies
...

The U
...
Department of Agriculture administers the school lunch
program to 28 million children, largely relying on an inventory of government-subsidized foods
...
At the local level, this usually means
that consumption of milk is mandatory
...
Demas's innovative research on the school lunch program was a
great success; children loved the learning style and were excited to eat
the healthy foods when they went through the lunch line
...
Dr
...
" The
program has proven to be of interest to more than 300 school lunch and
behavioral rehabilitation programs around the U
...
, including schools
in areas as widely dispersed as Hawaii, Florida, Indiana, New England,
California and New Mexico
...
Demas has organized a
nonprofit foundation (Food Studies Institute, Trumansburg, New York)
and written a curriculum ("Food is Elementary")
...
Demas's program is entirely plant-based
...
Eileen
Kennedy, who, at the time, was the director of the Center for Nutrition
Policy and Promotion at the USDA
...
Kennedy was deeply involved
both in the school lunch program and the dietary guidelines committee, on which it was revealed that she had ties to the dairy industry
...
The topic of our discussion was Dr
...
At the end of this discussion, I said to her, "You know, that
program is entirely plant-based
...
"
I have come to the conclusion that when it comes to health, government is not for the people; it IS for the food industry and the pharmaceutical industry at the expense of the people
...
Industry provides funding for public health reports,
and academic leaders with industry ties play key roles in developing
them
...
It is a system built by
people who play their isolated parts, oftentimes unaware of the top decision makers and their ulterior motivations
...



...


...
But the vast majority of Americans will fall prey to one of the
chronic diseases of affluence discussed in Part II, and, as you have seen,
there is a wealth of published research that suggests these diseases are a
result of poor nutrition, not poor genes or bad luck
...
While it is unfair to
generalize about individual doctors, it is safe to say that the system they
work in, the system that currently takes responsibility for promoting
the health of Americans, is failing us
...
Two of the most prominent doctors in this minority have
spent many years emphasizing diet and health, both in public within
their profession and in private with their patients
...
These
two doctors are Caldwell B
...
, whose work I discussed in
chapter five, and John McDougall, an internist
...

321

322

THE CHINA STUDY

DR
...
One of these settler families
were the Esselstyns
...
Nine
generations later, that farm still belongs to the Esselstyn family
...
Esselstyn and his wife Ann own the several-hundred-acre Hudson Valley
farm, just over two hours north of New York City
...

Ess and Ann have a modest house: a large, rectangular, converted
storage building
...
Only upon closer inspection does
it become apparent that there is something unusual about this place
...
Nearby an oar hangs on the
wall
...
Ess explains he has three other oars: two from
beating Harvard in other years, and one for winning the gold medal in
the Olympics with the Yale crew in 1956
...
Around the corner there's an impressivelooking museum-style schematic of the Esselstyn family tree, and on
the other end of the hall, there's a large black and white picture of Ess's
father standing in front of a microphone, exchanging comments with
John F
...
Despite its humble
appearance, it is very clear that this is a place with a distinguished history
...
After graduating from Yale, he was trained as a surgeon at the Cleveland Clinic and at St
...

He remembers fondly some of his most influential mentors: Dr
...
, Dr
...
Brook
...
Crile, a giant at the Cleveland Clinic, eventually became Ess's father-in-law upon Ess's marriage
to Ann
...
Crile was a man of exceptional accomplishment, playing
a courageous, leading role in questioning the macabre surgery called
"radical mastectomy
...
Turnbull and Dr
...
In addition, Ess's own father was a distinguished physician
with a national reputation
...
" His own father had a heart attack at age forty-two and Dr
...

These were the men he looked up to, and when it came to cardiovascular disease, all of them were helpless
...
These people, who were giants in the prime of
their years, just withered
...
He was saying, 'We are going to have to show
people how to lead healthier lives
...
He was intensely
interested in preventive medicine, but he didn't have any information
...

Following in these men's footsteps, Ess went on to amass an extraordinarily impressive list of awards and credentials: an Olympic gold
medal in rowing; a Bronze Star for military service in Vietnam; President
of the Staff, member of the Board of Governors, chairman of the Breast
Cancer Task Force, and head of the Section of Thyroid and Parathyroid
Surgery at the Cleveland Clinic, one of the top-ranked medical institutions in the world; president of the American Association of Endocrine
Surgeons; over 100 professional scientific articles; and inclusion on a
list in 1994-95 of the best doctors in America
...
As Dr
...
I didn't get home until late at night, but I had
a position that was secure
...

But despite the accolades, the titles and the awards, something was
not right
...
As Ess described it, he had "this haunting feeling that was
really beginning to bother me
...
" Slightly exasperated, he said, "What is
the survival rate for cancer of the colon? It's not so great!" He recounted
the operation for colon cancer on one of his best friends
...
Ess
lowered his voice ever so slightly in remembering this, saying, "You get
there after the horse has left the barn
...
"
He began to do some soul searching
...
maybe
you've helped a little
...
Esselstyn began studying the literature on the diseases he commonly treated
...
John McDougall, who had just written a best-selling diet and health book called The
McDougall Plan
...
He came to the
realization that the diseases that so often plagued his patients were due
to a diet rich in meat, fat and highly refined foods
...
She said that nobody had ever
shown that heart disease in humans could be reversed by using dietary
treatment
...
The study he published, of eighteen patients with heart disease, demonstrated the most
dramatic reversal of heart disease in the history of medicine, simply by
using a low-fat, plant-based diet and a minimal amount of cholesterolreducing medication
...
But it hasn't been easy
...
Somewhere in this transition from top-ranked,
self-described "macho, hard-ass surgeon" to dietary advocate, he has
become known, behind his back, as Dr
...


A DAUNTING TASK
What's interesting about this story is that a man who had reached the
pinnacle of a highly respected profession dared to try something different, succeeded, and then quickly found himself on the outside of

81G MEDICINE : WHOSE HEALTH ARE THEY PROTECTING?

325

the establishment looking in
...

Some of Ess's colleagues have disparaged his treatment as being too
"extreme
...
Some doctors have said to Ess, "Yeah
okay, but nobody is going to eat like that
...
" Ess's response was, "Well, you really have no training
in this
...
It takes
three hours for me to counsel a patient," not to mention the diligence
required for the constant follow-up and monitoring of the patient's
health
...
The cardiologist responded, "Now you listen to me
...
" You'd think that doctors would be more excited about healing
their patients!
In talking about doctors and their unwillingness to embrace a whole
foods, plant-based diet, Ess says, "You can't get frustrated
...
There are sixty cardiologists [at the Cleveland Clinic] , any
number of whom are closet believers in what I do , but they're a little
afraid because of the power structure
...
Early on, when he was first suggesting dietary treatment of heart
disease, colleagues greeted the idea with caution
...
But later, scientific results of unparalleled success, including
Esselstyn's, were published
...
And there's all
these nurses and there's lights out and there's drama
...
The ego of
these people is enormous
...
" The doctor's response is, "WHAT? I learned all this crap, I'm
making a freakin' fortune, and you want to take it all away?"
Then when that person comes along and actually cures patients with
brussels sprouts and broccoli, as Esselstyn did, and gets better results
than any other pill or procedure known, you've suddenly announced
that something works, hands down, better than what 99% of the profession is doing
...
They can
treat the symptoms, they can take care of arrythmias, they can get
you interventions, but they don't know how to treat the disease,
which is a nutritional treatment
...
These experts, after all,
are built up to be the dispensers of health and healing
...
" With
all of the doctor's gadgets, technologies, training and knowledge, nothing is more effective than gUiding the patient to make the right lifestyle
choices
...
Anywhere you go, 99% of the people are eating
incorrectly
...
"
Another obstacle: lack of nutrition knowledge amongst physicians
...
You wonder, what is the literature that these guys read?"
Physician knowledge often involves only the standard treatments:
pills and procedures
...
Right?" Esselstyn
leans forward and, with a slight grin, as if he's about to tell us the emperor has no clothes, he says, "But who ever says, 'Maybe we ought to stop
disease'?" In Dr
...


LACK OF TRAINING
The medical status quo relies heavily on medication and surgery, at the
exclusion of nutrition and lifestyle
...
In 1985 the United States National
Research Council funded an expert panel report that investigated the
quantity and quality of nutrition education in U
...
medical schools
...
s
...
"4 But this finding was nothing new
...
S
...
'''4
...
Nothing had changed by 1985, and up to the present
time, articles continue to be written documenting the lack of nutrition
training in medical schools
...
Nutrition training of doctors is not merely
inadequate; it is practically nonexistent
...
4 The majority of the schools surveyed
actually taught less than twenty contact hours of nutrition, or one to
two credit hours
...

It gets worse
...
Topics
covered in a basic biochemistry course may include nutrient metabolism and/or biochemical reactions involving certain vitamins or minerals
...
In conjunction with the 1985

328

THE (HINA STUDY

government report, the president of the American Medical Students Association, William Kassler, writes8 :
Most nutrition in the formal curriculum is incorporated into
other courses
...

Too often in such courses, nutrition is touched on briefly, with the
primary emphasis on the major discipline
...
Nutrition taught by those whose interest and expertise
lie elsewhere simply doesn't work
...
9 • 1o Do you think that this all-star team of animal
foods and drug industries representatives is going to objectively judge
and promote optimal nutrition, which science has shown to be a whole
foods, plant-based diet that minimizes the need for drugs? Or might
they try to protect the meat-centered, Western diet where everyone
expects to pop a pill for every sickness? This organization is creating
nutrition curricula, involving CD-ROMS, and giving them away to
medical schools for free
...
ll According to their Web site, "Plans are underway for developing versions for undergraduate nutrition students,
continuing medical education and other health professions audiences
...
med
...
eduinutr/nimlFAQ
...
13 , 14 These efforts show that industry is well prepared to promote
its monetary interests whenever the opportunity presents itself
...
It's a situation in which nutritionally untrained doctors prescribe
milk and sugar-based meal-replacement shakes for overweight diabetics, high-meat, high-fat diets for patients who ask how to lose weight

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?

329

and extra milk for patients who have osteoporosis
...

Apparently, there aren't enough "nutrition-oriented physician role
models" in medical education
...
"12 I suspect that these medical programs
lack nutrition-oriented physicians simply because they do not make it a
priority to hire them
...
John McDougall
...
MCDOUGALL'S CHALLENGE
Dr
...
He has written ten
books, including several that have sold over a half a million copies each
...
We met recently in his Northern California home, and one of the
first things he showed me was his bank of four or five full- size metal file
cabinets lined up along the back of his study
...
It is not unusual for him to spend a
couple of hours a day on the Internet reviewing the latest journal articles
...
John McDougall
...
As he says, he had four
feasts a day: Easter during breakfast, Thanksgiving at lunch, Christmas
at dinner and a birthday party for dessert
...
After recovering with a new appreciation for life, he became a straight A student
as an undergraduate and then completed medical school in Michigan
and an internship in Hawaii
...

It was there that John became an unhappy doctor
...
John would treat them as
he was taught, with the standard sets of pills and procedures, but very

330

THE CHINA STUDY

few of them became healthy
...
He also
started to learn something else from his patients: the first and second
generation Americans from Asia, the ones who ate more traditional,
Asian staple diets of rice and vegetables, were trim, fit and not afflicted
with the chronic diseases that plagued John's other patients
...
It was from these people thatJohn
began to notice how important diet was for health
...
It was there that he began to understand the boundaries that
the medical establishment had set and the way that medical education
molds the way doctors are supposed to think
...
But
after observing experienced doctors treating their patients with pills
and procedures, he realized that these authoritative doctors didn't do
any better than he did
...
John realized something was wrong with the system, not him,
so he began to read the scientific literature
...
Esselstyn, once
he started reading the literature, John became convinced that a whole
foods , plant-based diet had the potential not only to prevent these diseases that were plaguing patients, but also the potential to treat them
...

In this environment, diet was considered quackery
...
John continued to read the scientific research and to talk to his colleagues and only
became even more baffled
...
It was absolutely clear what the literature said
...
I'm confused
...

That's all it is
...
As the attending
resident (not their primary physician), he asked the patient what he
was going to do to prevent a third, fatal heart attack
...
What are you going to
do to keep your wife from being a widow and your kids from becoming fatherless?" The man was despondent, frustrated and said, "There's
nothing 1 can do
...
1 don't smoke
...
There's nothing more 1 can do
...
He suggested that the man might reverse his disease if he ate the right way
...
John talked
with them for quite a long time, left the room and felt great
...

That lasted for about two hours
...
The Chief of Medicine wields absolute authority over the
residents
...
The excited couple had told
their primary physician what they had just learned
...

The Chief of Medicine had a serious conversation with John, who
remembers being told that "I was stepping far beyond my duties as
a resident
...
" The Chief
of Medicine made it clear that on this point, John's job, and his subsequent career, was on the line
...

On the day of John's graduation, he and the Chief of Medicine had a
final talk
...
The Chief of Medicine sat
him down and said, "John, 1 think you're a good doctor
...
I want you to know that I like your family
...
I'm concerned that you're going to starve to death
with all your crazy ideas about food
...
"

332

THE CHINA STUDY

John paused to gather his thoughts, and then said, "That may be the
case
...
I can't put people on drugs or surgeries
that don't work
...
I don't think it will be
bums and hippies
...
They'll ask themselves, 'I'm such a big success, so how come
I'm so fat?''' With that, John looked at the Chief's generous belly, and
continued, "They'll ask, 'If I'm such a big success, why are my health
and my future out of contro!?' They'll look at what I have to say, and
they're going to buy it
...
His experience confirms every study that has found nutrition
training among physicians to be sorely inadequate
...
Medical education
and drug companies are in bed together, and have been for quite some
time
...
He said:
The problem with doctors starts with our education
...

The drug industry has bought the minds of the medical profession
...
All the way through
medical school everything is supported by the drug industry
...
Many prominent scientists have published scathing observations showing how corrupt the
system has become
...
15- 17
• Graduate medical students (physician residents) and other physicians actually change their prescribing habits because of information provided by drug salespeople, 18-20 even though this information

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?

333

is known to be "overly positive and prescribing habits are less appropriate as a result
...
This can happen because: the drug companies, and not researchers, may design the research, which allows
the company to "rig" the study 23, 24; the researchers may have a
direct financial stake in the drug company whose product they are
studying I5 ,25; the drug company may be responsible for collecting
and collating the raw data, and then only selectively allowing researchers to view the data 2), 26; the drug company may retain veto
power over whether the findings are published, and may retain
editorial rights over any scientific publications resulting from the
research 2 25, 27; the drug company may hire a communications firm
),
to write the scientific article, and then find researchers willing to
attach their names as authors of the paper after it has already been
written
...
The leading medical journals
derive their primary income from drug advertising
...
Perhaps more disconcerting, the majority of clinical trial research reported in the journals is
funded by drug company money, and the financial interests of the
researchers involved are not fully acknowledged
...
In one instance ,
a scientist's integrity was maligned in a variety of ways by both a drug
company and her university administration after she found that a drug
under study had strong side effects and it lost its effectiveness
...
26
The examples go on and on
...
Marcia Angell, an ex-editor of the New England Journal oj Medicine,
wrote a scathing editorial called "Is Academic Medicine for Sale?"15:
The ties between clinical researchers and industry include not
only grant support, but also a host of other financial arrangements
...
Many also have equity interest in the companies
...
Angell goes on to say that these financial associations often significantly "bias research, both the kind of work that is done and the way
it is reported
...
Research on the causes of disease and non-drug
interventions simply doesn't occur in medical education settings
...
Dr
...

As the critics of medicine so often charge, young physicians learn
that for every problem, there is a pill [my emphasis] (and a drug
company representative to explain it)
...
The academic medical centers, in allowing themselves to become research
outposts for industry, contribute to the overemphasis on drugs and
devices
...
Not unless your doctor has decided
that standard medical practice as it is taught does not work, and decides
to spend a Significant amount of time educating himself or herself about
good nutrition
...

The situation has gotten so bad that Dr
...
When I read a paper that says I

BIG ME 0 I (I NE: WHO SE HE ALT H ARE THE Y PRO TE CT IN G?

335

should be giving my heart patients beta blockers and ACE inhibitors,
two classes of heart drugs, I don't know whether it's true
...
"
Do you think the following headlines are related?
"Schools report research interest conflicts" (between drug companies
and researchers)28
"Prescription use by children multiplying, study says"29
"Survey: Many guidelines written by doctors with ties to companies"3o
"Correctly Prescribed Drugs Take Heavy Toll; Millions Affected by
Toxic Reactions"3l
We pay a high price for allowing these medical biases
...
32 Twenty percent of all new drugs have serious
unknown side effects, and more than 100,000 Americans die every year
from correctly taking their properly prescribed medication?3 This is one
of the leading causes of death in America!

DR
...
John McDougall finished his formal medical education, he set
up a practice on the Hawaiian island of Oahu
...
In the
mid-1980s John was contacted by St
...
The hospital was a Seventh-day Adventist hospital; if you recall
from chapter seven, the Seventh-day Adventists encourage followers to
eat a vegetarian diet (even though they consume higher-than-average
amounts of dairy products)
...

John had a good home at St
...
He taught
nutrition and used nutrition to treat sick patients, which he did with
fantastic success
...
Perhaps more importantly, John saw these patients get well
...
But as time passed, he realized that things weren't
quite the same as when he first arrived
...


336

THE CHINA STUDY

Of those later years he says, "I just didn't think I was going anyplace
...
Never grew
...
"
He had small clashes with the other doctors at the hospital
...
John told them, ''I'll tell you what, I'll send everyone of my
heart patients to you for a second opinion if you'll send yours to me
...
On another occasion John
had referred a patient to a cardiologist and the cardiologist incorrectly
told the patient that he needed to have bypass surgery
...
Finally,
after the cardiologist recommended surgery for another one of John's
patients, John called him and said, "I want to talk with you and the
patient about this
...
" The cardiologist said that he
wouldn't do that, to which John responded, "Why not? You just recommended that this guy have his heart opened! And you're going to charge
him 50,000 or 100,000 bucks for it
...
That was the last time he recommended
heart surgery for one of John's patients
...
Not once
...

The reason, according to John:
They were worried [about what would happen when] their patients would come to see me, and it happened all the time when
patients would come on their own
...
I'd put them on the diet
and they'd go back off all their pills and soon their numbers would
be normal
...

There were other moments of friction between John and the hospital,
but the last straw involved the Dr
...


BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?

337

John had contacted Dr
...
John had known and respected Dr
...
Helena Hospital, preserving it
in honor of Dr
...
Dr
...

As John said, there were four reasons that this would be a perfect fit for
St
...
After listening, she said that she didn't think the hospital
wanted to do this
...
" John, dumbfounded, asked her,
"Please tell me why
...
"
Her response was a doozy: "Well, you know we are, but you know,
MS patients are not really desirable patients
...
" John could not
believe what he had just heard
...
I'm a doctor
...
As far as 1 know our
job is to relieve the suffering of the sick
...
Just
because other doctors can't help them in their suffering doesn't
mean that we can't
...
I have
an effective treatment for people who need my care and this is a
hospital
...
I want to explain to her
why 1 need this program and why the hospital needs this program
and why the patients need this program
...


338

THE CHINA STUDY

Ultimately, though, the head of the hospital proved to be just as difficult
...
He was supposed to
renew his contract with the hospital in a couple of weeks, and he decided not to do it
...
He just explains it by saying that their directions in
life were different
...
Helena for what it
was: a good home to him for sixteen years, but a place nonetheless that
was "just into that whole drug money thing
...
drmcdougall
...
This is a man with a wealth of knowledge
and qualifications, who could benefit the health of millions of Americans
...
He is reminded of this fact all the time:
Patients will come in with rheumatoid arthritis
...
And I'll
take care of them and three or four weeks later, they'll go back to
see their doctor
...
Doctor will say, "Wonderful
...
I went to
see this Dr
...
" Their doctor simply responds, "Oh my goodness
...
Whatever you're dOing, just keep doing it
...
"
That's always the response
...
" It's, "Whatever you're doing,
that's just great
...
Thanks a lot
...
" Get them out
of the office as qUickly as they can
...
very
threatening
...
Esselstyn retired from active surgery in June of 2000
and assumed the position of preventive cardiology consultant in the department of general surgery at the Cleveland Clinic
...
He holds three-hour counseling sessions in his home with new heart disease patients, gives them research evidence and provides a delicious "heart-safe" meal
...

In March of 2002, Ess and his wife Ann, whose grandfather founded
the Cleveland Clinic, drafted a letter to the head of the cardiology department and the head of the hospital at the Cleveland Clinic
...
Ess formally proposed the idea that he
could help set up an arrest and reversal dietary program in the department of preventive cardiology at the Cleveland Clinic
...
Ideally, a young physician with passion for
the idea would head the program
...

You'd think that if an opportunity arose to profoundly heal sick
people, and one of the most reputable people in the country was going
to help you, a hospital would jump at the opportunity
...
They
didn't call
...
They completely ignored him
...
Finally, after
seven calls, the head of the hospital got on the phone
...
He obviously knew exactly
what Ess was calling about, and told Ess that the head of the cardiology department didn't want to do it
...
If the head of the hospital wanted it to be done, it would be done,
regardless of what the head of cardiology wanted
...
The man was abrasive and rude
...


340

THE CHINA STUDY

Ess hasn't talked to either of these doctors since, but he still has hope
that he can change their minds as more and more research supports
what he has been saying
...
Many of them want to see a wider application
of his program, but the powers that be will not let it happen
...
It's all just so vague
...
This isn't cancer for God's sake!
An interesting situation is now developing: just as with Dr
...
They know it
works, and they seek out the program on their own
...
I have also treated a number
of senior staff trustees
...
"
For the time being, Ess, with his wife's help, will continue to run
counseling sessions out of his own home because the institution to
which he gave the greater part of his life does not want to endorse a
dietary approach that competes with its standard menu of pills and
procedures
...
As much as Ess likes a more
relaxed life, he would also love to continue to help diseased people get
better with the aid of the Cleveland Clinic
...
As far as I am concerned, this is nothing short of criminal
...
For them
to provide care that is knOwingly less than optimal, that doesn't protect
our health, doesn't heal our disease and costs us tens of thousands of
dollars is morally inexcusable
...
Wouldn't it be easier to stop the disease? It's appalling, isn't it? It's just so grippingly unbelievable to think that we're
being led around by people who refuse to believe the obvious!
Both Esselstyn and McDougall have now been denied reentry into
the establishment, after headline-making success at healing people with
a nutritional approach
...
Helena's and 65% of the Cleveland Clinic's respective
incomes were generated by traditional heart disease treatments, surgical interventions-but it's something more than just money
...
Whatever it is, it has become clear that
the medical industry in this country is not protecting our health as it
should
...
"


...
_
...
_
...
_
...
__
...
_
...
_
...
_ _
...
_
_
...
_

...


IN 1985, when I was on sabbatical in Oxford, England, I had the opportunity to study the history of diet and disease at some of the great
medical history libraries in the Western world
...
In the quiet
recesses of these marble-lined sanctuaries, I was thrilled to find authors
who wrote eloquently on the topic of diet and cancer, among other diseases, over 150 years ago
...
Macilwain was born and raised in Northern
Ireland
...
He was to become a member, and later, an honorary fellow, of the Royal College of Surgeons
...
l Macilwain also popularized the theory of the
"constitutional nature of disease," mostly in reference to the origins and
treatment of cancer
...
It is the result of multiple
systems throughout the body breaking down
...
At that time, a fierce
fight was under way between those who believed in diet and those who
343

344

THE CHINA STUDY

supported surgery and the emerging use of drugs
...
In contrast, those who
favored diet and lifestyle believed that disease was a symptom resulting
from the "constitutional" characteristics of the whole body
...
As
I learned more about Macilwain, I came to realize that he was a relative
of mine
...
Furthermore, there were family
stories about a famous Macilwain who had left the family farm in Ireland
to become a very well-known doctor in London in the early 1800s
...

Through further genealogical research, I have come to the near certain
conclusion that George Macilwain was my great-great uncle
...
My wife Karen says, "If there's such a thing as reincarnation
...
He and I
had similar careers; both of us became acutely aware of the importance
of diet in disease, and both of us became vegetarian
...

I discovered more than my family history while reading in these august, history-laden libraries
...
Almost 2,500
years ago, Plato wrote a dialogue between two characters, Socrates and
Glaucon, in which they discuss the future of their cities
...
2 Socrates says,
"And thus, passing their days in tranqUility and sound health, they will,
in all probability, live to an advanced age
...
" He continues, "They ought to recline on couches
...
" In other words, the

REPEATING HISTORIES

345

citizens should have the "luxury" of eating meat
...
We shall also need great quantities of all kinds of cattle for
those who may wish to eat them, shall we not? "
Glaucon says, "Of course we shall
...

"Yes, indeed," he says
...
This shortage will lead the citizens to take land from others, which could precipitate violence and war, thus a need for justice
...
2
Plato, in this passage, made it perfectly clear: we shall eat animals
only at our own peril
...
Hardly anybody knows, for example, that
the father of Western medicine, Hippocrates, advocated diet as the chief
way to prevent and treat disease or that George Macilwain knew that
diet was the way to prevent and treat disease or that the man instrumental in founding the American Cancer Society, Frederick L
...

How did Plato predict the future so accurately? He knew that consuming animal foods would not lead to true health and prosperity
...
This is a pretty good description of some of the challenges
faced by modern America!
How did Seneca, one of the great scholars 2,000 years ago, a tutor
and advisor to Roman Emperor Nero, know with such certainty the
trouble with consuming animals when he wrote 2 :
An Ox is satisfied with the pasture of an acre or two : one wood
suffices for several Elephants
...
What! Has Nature indeed given
us so insatiable a stomach, while she has given us so insignificant
bodies?
...
Nay, not of
them, but rather of the dead
...
"
How did George Macilwain predict the future when he said that the
local theory of disease would not lead to health? Even today, we don't
have any pills or procedures that effectively prevent, eliminate or even
treat the causes of any chronic diseases
...

How did we forget these lessons from the past? How did we go from
knowing that the best athletes in the ancient Greek OlympicS must
consume a plant-based diet to fearing that vegetarians don't get enough
protein? How did we get to a place where the healers of our society, our
doctors, know little, if anything, about nutrition; where our medical
institutions denigrate the subject; where using prescription drugs and
going to hospitals is the third leading cause of death? How did we get
to a place where advocating a plant-based diet can jeopardize a professional career, where scientists spend more time mastering nature than
respecting it? How did we get to a place where the companies that profit
from our sickness are the ones telling us how to be healthy; where the
companies that profit from our food choices are the ones telling us
what to eat; where the public's hard-earned money is being spent by
the government to boost the drug industry'S profits; and where there is
more distrust than trust of our government's policies on foods, drugs
and health? How did we get to a place where Americans are so confused
about what is healthy that they no longer care?
Our country's population, which numbers almost 300 million people,3 is sick
...
" Starvation, poor
sanitation and communicable diseases, symbols of impoverishment,
have been largely minimized in the Western world
...
Never before have such large percentages
of the population died from diseases of "affluence
...
Never before has the financial strain
of health care distressed every sector of our society, from business to
education to government to everyday families with inadequate insurance
...
lO We are changing our climate so rapidly that
many of the world's best-informed scientists fear the future
...
Never before have we introduced, on such a
large scale, genetically altered varieties of plants into the environment
without knowing what the repercussions will be
...
II
As the billions of people in the developing world are accumulating
more wealth and adopting the Western diet and lifestyle, problems created by nutritional excess are becoming exponentially more urgent with
each passing year
...
Hiroshi Nakajima, referred to the future chronic disease burden in developing countries as "a crisis of suffering on a global scale
...
We certainly
won't have another 2,500 years to remember the teachings of Plato,
Pythagoras, Seneca and Macilwain; we won't even have 250 years
...
People are beginning to sense the need for change and are
beginning to question some of the most basic assumptions that we have
about food and health
...

Never before has there been such a mountain of empirical research
supporting a whole foods, plant-based diet
...
Dean Ornish and Caldwell Esselstyn,jr
...
13 We now have the knowledge to understand how this actually works
...

International comparisons between countries show that populations
subsisting on traditional plant-based diets have far less heart disease, and
studies of individuals within single populations show that those who eat
more whole, plant-based foods not only have lower cholesterol levels, but
have less heart disease
...

Never before have we had such a depth of understanding of how diet
affects cancer both on a cellular level as well as a population level
...

Animal protein increases the levels of a hormone, IGF-l, which is a risk
factor for cancer, and high-casein (the main protein of cow's milk) diets
allow more carcinogens into cells, which allow more dangerous carcino-

REPEATING HISTORIES

349

gen products to bind to DNA, which allow more mutagenic reactions
that give rise to cancer cells, which allow more rapid growth of tumors
once they are initially formed
...
We now have a deep
and broad range of evidence showing that a whole foods , plant-based diet is
best for cancer
...
Intervention studies
show that Type 2 diabetics treated with a whole foods, plant-based diet
may reverse their disease and go off their medications
...

We now know how our autoimmune system can attack our own bodies through a process of molecular mimicry induced by animal proteins
that find their way into our bloodstream
...
Dietary intervention studies have shown
that diet can help slow, and perhaps even halt, multiple sclerosis
...

Never before have we had such a broad range of evidence showing that
diets containing excess animal protein can destroy our kidneys
...
We know now that cataracts and agerelated macular degeneration can be prevented by foods containing large
amounts of antioxidants
...
Investigations of human populations
show that our risk of hip fracture and osteoporosis is made worse by diets high in animal-based foods
...
We now have a deep
and broad range of evidence showing that a whole foods, plant-based diet is
best for our kidneys, bones, eyes and brains
...
No longer are there just a few
people making claims about a plant-based diet based on their personal

350

THE CHINA STUDY

experience, philosophy or the occasional supporting scientific study
...

Furthermore, 1 have hope for the future because of our new ability to exchange information across the country and around the world
...
People can
make a whole foods, plant-based diet varied, interesting, tasty and convenient
...

All of these things together create an atmosphere unlike any other,
an atmosphere that demands change
...
1 have also seen the public image of vegetarianism emerge from
being considered a dangerous, passing fad to a healthful, endUring lifestyle choice
...
14 Restaurants around the country now regularly offer
meat-free and dairy-free options
...
16 Now, over 150 years after my great-great uncle George
Macilwain wrote books about diet and disease, 1 am writing a book about
diet and disease with the help of my youngest son Tom
...
History can repeat itself
...
More than that, 1 believe the world is
finally ready to change
...
We, as a society, are on the edge of
a great precipice: we can fall to sickness, poverty and degradation, or we
can embrace health, longevity and bounty
...
How will our grandchildren find themselves in 100 years?
Only time will tell, but I hope that the history we are witnessing and the
future that lies ahead will be to the benefit of us all
...
ENDIX A
__
Q&A: Protein Effect in
Experimental Rat Studies
COULD THE DIETARY PROTEIN EFFECT
BE DUE TO OTHER NUTRIENTS IN THE RAT DIET?
Decreasing dietary protein from 20% to 5% means finding something to
replace the missing 15%
...
As dietary protein decreased,
a 1: 1 mixture of starch and glucose increased by the same amount
...
! If
anything, a little extra carbohydrate in the low-protein diet would only
increase cancer incidence and offset the low-protein effect
...


MIGHT THE PROTEIN EFFECT BE DUE
TO THE RATS ON A LOW-PROTEIN DIET
EATING LESS FOOD (I
...
, LESS CALORIES)?
Many studies done in the 1930s, 1940s and 1950s2 had shown that
decreasing total food intake, or total calories, decreased tumor development
...
3,4 Again, this only reinforced
the tumor-promoting effect observed for casein
...
However, the low-protein animals were
healthier by every indication
...
Also, animals consuming
less dietary casein not only ate more calories, but they also burned off
more calories
...
This occurs through a process of "thermogenesis,"
i
...
, the expenditure of calories as body heat
...
7- 11 Low-protein diets enhance the burning off of calories, thus leaving less calories for body weight
gain and perhaps also less for tumor growth as well
...
A monitor recorded the number of times the animals turned
the exercise wheel
...
I have heard that a side effect of the protein-drenched
Atkins Diet is fatigue
...
E N DIX _ B_ _ _ _ _

Experimental
Design of the China Study
SIXTY-FIVE COUNTIES in twenty-four different provinces (out of twentyseven) were selected for the survey
...
They also
provided broad geographic coverage and were within four hours' travel
time of a central laboratory
...


Except for suburban areas near Shanghai, most counties were located
in rural China where people lived in the same place their entire lives
and consumed locally produced food
...
3 million people for the county on the outskirts
of Shanghai
...

We determine how these characteristics, as county averages, correlate
353

354

THE CHINA STUDY

or associate with each other
...
We did thousands of
different comparisons of this type
...
Individuals are not
being compared with individuals (in reality, neither does any other epidemiological study design)
...
Most such studies only have ten
to twenty such population units, at most
...

One-half were male and one-half female, all aged thirty-five to sixtyfour years
...

One of the more important questions during the early planning
stages was how to survey for diet and nutrition information
...

Can you remember what foods you ate last week, or even yesterday?
Can you remember how much? Another even more crude method of
estimating food intake is to see how much of each food is sold in the
marketplace
...

Although each of these relatively crude methods can be useful for
certain purposes, they still are subject to considerable technical error
and personal bias
...

We wanted to do better than crudely measure which foods and how

EXPERIMENTAL DESIGN OF THE CHINA STUDY

355

much of these foods were being consumed
...
These analyses would be
far more objective than haVing people recall what they ate
...
The initial problem was getting
enough blood
...
A finger prick seemed to be the only possibility but
this was not good enough
...

Dr
...
He succeeded
...
This strategy gave more
than 1,200-1,300 times more blood when compared with the finger
prick method
...
It allowed analyses
of far more indicators of diet and health
...
For more detail on the theoretical and practical
basis for collecting and analyzing blood in this way the reader is referred
to the original monograph of the study
...
We wanted nothing but the best
...

Chen's Beijing lab, the rest of the analyses, especially the more specialized types, were done in about two dozen laboratories located in six
countries and in four continents
...
The laboratory participants
are listed in the original monograph
...
It was comprehensive; it was
high quality; and its uniqueness allowed new opportunities to investigate diet and disease that were never before possible
...
Indeed, the New York
Times, in a lead story in its Science Section, called the study "The Grand
Prix" of epidemiological studies
...
After all the blood, urine and food samples were collected,
stored and analyzed, and after the final results were tabulated and evaluated for quality (a few suspect results were not included in the final
publication), we were able to study 367 variables
...
l There were:
• disease mortality rates on more than forty-eight different kinds of
disease 2 ;
• 109 nutritional, viral, hormonal and other indicators in blood;
• over twenty-four urinary factors ;
• almost thirty-six food constituents (nutrients, pesticides , heavy
metals) ;
• more than thirty-six specific nutrient and food intakes measured in
the household survey;
• sixty diet and lifestyle factors obtained from questionnaires;
• and seventeen geographic and climatic factors
...
Broad ranges strengthened
our ability to detect important preViously undiscovered associations of
variables
...

• The adults chosen for this survey were limited to those who were
thirty-five to sixty-four years of age
...
Information on
death certificates of people older than sixty-four years was not included in the survey because this information was considered less
reliable
...
Having two villages
in each county rather than one gives a more reliable county average
...
3
• When possible, variables were measured by more than one kind
of method
...
Also , in
many cases, we could assess the quality and reliability of data by
comparing variables known to have plausible biological relationships
...
An average
of 93-94% of the men in the survey were born in the county where
they lived at the time of the survey; for women it was 89%
...
This was ideal because those earlier years represented the
time when the diseases were initially forming
...
Critics of the ecologic study design correctly assume that it is a
weak design for determining cause-and-effect associations when one is
interested in the effects of Single causes acting on Single outcomes
...
Rather, nutrition causes or prevents disease by multiple nutrients and other chemicals acting together,
as in foods
...
It is the comprehenSive effects of nutrients and other factors on disease occurrence
where the most important lessons are to be learned
...

Perhaps the most unique characteristic that set this study apart concerned the nutritional characteristics of the diets consumed in rural
China
...
This is true even when vegetarians are included in the study because 90% of vegetarians still consume rather large amounts of milk,
cheese and eggs, while a significant number still consume some fish
and poultry
...
1),5 there
is only a small difference in the nutritional properties of non-vegetarian
and vegetarian diets as consumed in Western countries
...
l: VEGETARIAN AND NON-VEGETARIAN DIET
COMPARISONS AMONG WESTERNERS

Nutrient
Fat (% of calories)
Cholesterol (g/day)
Carbohydrates (% of calories)
Total protein (% of calories)
Animal protein (% of total protein)

Vegetarian

Non-vegetarian

30-36
150-300
50-55
12-14
40-60

34-38
300-500
<50
14-18
60-70

A strikingly different dietary situation existed in China
...
In other words, we gorge on protein and
we get most of it from meat and dairy products
...
This means that there are many
other major nutritional differences in the Chinese and American diets,
as shown in Chart B
...
l
CHART B
...
/day)
Total fat (% of calories)
Dietary fiber (g/day)
Total protein (g/day)
Animal protein (% of total calories)
Total iron (mg/day)
"Non·fish animal protein

China

United States

40
...
5
33
64
0
...
6
34-38
12
91
10-11
18

EXPERIMENTAL DESIGN OF THE (HINA STUDY

359

This was the first and only large study that investigated this range of
dietary experience and its health consequences
...
In all other studies done on
Western subjects, diets ranged from rich to very rich in animal-based
foods
...


MAKING IT HAPPEN
Organization and conduct of a study of this size, scope and quality was
possible because of the exceptional skills of Dr
...
Survey
sites were scattered across the far reaches of China
...
Travel between these
places was more difficult than in the United States, and supplies and
instructions for the survey had to be in place and standardized for all
collection sites
...

It was important that the twenty-four provincial health teams, each
comprised of twelve to fifteen health workers, be trained to carry out
the blood, food and urine collections and complete the questionnaires
in a systematic and standardized manner
...
Chen divided the country into regions
...
They, in tum, returned to their home provinces to train the provincial health teams
...
s
...
It is my estimate that the Chinese contribution to
the project was approximately $5-6 million
...
s
...
9 million over a ten-year period
...
S
...
S
...


_ A ~ ~
...
Although the biological processes are exceptionally complex, these factors still work together as a beautifully
choreographed, self-correcting network
...

Perhaps a couple of analogies might help to illustrate such a process
...
They
seem to have a collective consciousness that knows where they are going and when they will rest
...

For those unfamiliar with biomedical research laboratories, the walls
of these labs are often covered with large posters showing thousands of
biochemical reactions operating within our bodies
...
The interdependence
of these reactions with each other is especially informative, even awesome in its implications
...
This particular network illustrates a complex interconnection between the inner workings of our cells, the food we
eat and the environment in which we live (Chart Cl)
...
In fact, it
is our ability to make our vitamin D that leads to the idea that it is not a
vitamin; it is a hormone (i
...
, made in one part of our body but functioning in another part)
...
Provided we get adequate sunshine, this is
all the vitamin D we need
...

The vitamin D made in our skin then travels to our liver, where it is
converted by an enzyme to a vitamin D metabolite
...

The next step is the crucial one
...
The rate at which the storage form of vitamin
D is converted to the supercharged 1,25 D is a crucial reaction in this
network
...

This supercharged 1,25 D is about 1,000 times more active than the
storage vitamin D
...
In contrast, our storage vitamin D survives for
twenty days or more
...
Small changes, making a
big difference, can occur quickly
...
It is critical that the
amount and timing of gas (1,25 D) coming to our stove top be carefully

THE ·VITAMIN" 0 CONNECTION

363

CHART C
...
However, it is also useful that we maintain
an adequate supply in our storage tank
...

One of the more important things that vitamin D does, mostly
through its conversion to supercharged 1,25 D, is to control the development of a wide variety of serious diseases
...
4-12
So far, we can see how adequate sunshine exposure, by ensuring
enough storage form of vitamin D, helps to prevent cells from becoming diseased
...
Indeed there is such evidence
...

Researchers have known for eighty years that multiple sclerosis,
for example, is associated with increasing latitude
...
2, there is a huge difference in MS prevalence as one goes away
from the equator, being over 100 times more prevalent in the far north
than at the equator
...
2: WORLDWIDE DISTRIBUTION
OF MS FOR 120 COUNTRIES
180 ,-------------------------------------------~
160
140

ci
...
--~--_r--~
South

80

60

40

20

o

20

Latitude

40

60

80

North
Latitude

Degrees Latitude

more MS as one goes farther south (r=91 %)
...
16
A lack of sunshine, however, is not the only factor related to these
diseases
...
The first thing to note is the control
and coordination of these vitamin D-related reactions
...
In considerable measure, this control is exercised by another complex network of reactions involving a "manager"type hormone produced by the parathyroid gland located in our neck
(Chart C
...

When, for example, we need more 1,25 D, parathyroid hormone induces the kidney enzyme activity to produce more 1,25 D
...
Within seconds, parathyroid hormone manages how much 1,25
D there will be at each time and place
...
By being aware of the role of each player in its "orchestra,"
it coordinates, controls and finely tunes these reactions as a conductor
would a symphony orchestra
...
Even the elderly, who are not able to produce as much vitamin D from sunshine, have nothing to worry about if there is enough
sunshineY How much is "enough"? If you know how much sunshine
causes a slight redness of your skin, then one-fourth of this amount,
provided two to three times per week, is more than adequate to meet
our vitamin D needs and to store some in our liver and body fatY If
your skin becomes slightly red after about thirty minutes in the sun,
then ten minutes, three times per week will be enough exposure to get
plenty of vitamin D
...
Almost all of the vitamin D found in our
diet has been artificially added to foods like milk and breakfast cereals
...
18-21
In this scheme, sunshine and parathyroid hormone work together in
a marvelously coordinated way to keep this system running smoothly,
both in filling our vitamin D tank and in helping to produce from moment to moment the exact amount of 1,25 D that we need
...


THROWING WRENCHES INTO THE SYSTEM
There are several studies now showing that if 1,25 D remains at consistently low levels, the risk of several diseases increases
...
22 These proteins create
an acidic environment in the blood that blocks the kidney enzyme from
producing this very important metabolite
...
Calcium in
our blood is crucial for optimum muscle and nerve functioning, and it

366

TH E (H I NA STU DY
CHART C
...

-

--
...
The 1,25 D keeps the
blood levels of calcium operating within this narrow range by monitoring and regulating how much calcium is absorbed from food being
digested in the intestine, how much calcium is excreted in the urine and
feces and how much is exchanged with the bone, the big supply tank
for the body's calcium
...
It is a very sensitive balancing act in our bodies
...

goes down, 1,25 D goes Up
...
1
...

The blood levels of 1,25 D therefore are depressed both by consuming too much animal protein and too much calcium
...
Cow's milk, however, is high
both in protein and calcium
...
26
For example, the association of MS with latitude and sunshine shown
in Chart C
...
4
...
This is supported by the
observation that northern people living along coastlines (e
...
, Norway

THE ·VITAMIN" 0 CONNECTION

367

and Japan) 26 who consume lots of vitamin D-rich fish have less MS than
people living inland
...
Consuming
cow's milk has been shown to associate with MS26 and Type 1 diabetes 27
independent of fish intake
...
5 In effect, there are many reactions acting in a coordinated and mutually consistent way to cause disease when a diet
high in animal protein is consumed
...
Together, these
factors increase the birth of new cells while simultaneously inhibiting the removal of old cells, both favoring the development of cancer
(seven studies cited biS)
...
1 times the risk of
CHART C
...

...


...
£

•

III

"0


...


12

0
0

Iii
E

«

•

•

•• •

6

•

0
South
Latitude

40

30

20


...


••
...
•

10

0

10

Degrees Latitude

•
20

30

40

North
Latitude

368

TH E CH I NA STU DY

advanced-stage prostate cancer
...
, more IGF-l activity), there is 9
...
2S This level of disease risk
is alarming
...

These are only a few of the factors and events associated with this
vitamin D network
...
In contrast, when the wrong food is consumed, its adverse effects
are mediated by not one, but many, of the reactions within this network
...
And, finally, it often is not one disease but many that are likely to occur
...
When that common result is
more than one disease, it is even more impressive
...
This example begins to explain why dairy foods
would be expected to increase the risk of these diseases
...

Nature would not have been so devious as to refine such a useless internally conflicting maze
...
But of even more importance, they are highly integrated into a far larger dynamic called "life
...
American Cancer Society
...
" Atlanta, GA: American Cancer
Society, 1998
...
Flegal KM, Carroll MD, Ogden CL, et al
...
s
...
"JAMA 288 (2002): 1723-1727
...
National Center for Health Statistics
...
The U
...
Department of Health and Human Services News Release
...
Washington, DC:
2002
...
cdc
...
htm
4
...
"Nutrient Contribution of Food Away from Home
...

Frazao (ed
...
Washington, DC: Economic
Research Service, USDA, 1999
...
138 in: Information Plus
...
Wylie, TX: Information Plus, 1999
...
Mokdad AH, Ford ES, Bowman BA, et al
...
S
...
" Diabetes
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...
Centers for Disease Control and Prevention
...
" Atlanta,
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American Diabetes Association
...
S
...
" Diabetes Care 21 (1998): 296-309
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"Diabetes trends in the U
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8
...
"Heart Disease and Stroke Statistics-2003 Update
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9
...
"Can lifestyle changes reverse coronary heart disease?" Lancet 336 (1990): 129-133
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Esselstyn CB, Ellis SG, Medendorp Sv, et al
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" J
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11
...
"Is U
...
health really the best in the world?" JAMA 284 (2000): 483-485
...
Anderson RN
...
" National Vital Statistics Reports 50(16)
(2002):
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s
...
" Lancet 351 (1998): 643-644
...
U
...
Congressional House Subcommittee Oversight Investigation
...
" Washington, DC: 1976
...
"Unnecessary surgery
...
Rev
...
Health 13 (1992): 363-383
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Lazarou j, Pomeranz B, and Corey PN
...
" ]AMA 279 (1998): 1200-1205
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World Health Organization
...
425
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" Geneva, Switzerland: World Health Organization, 1966
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Health Insurance Association of America
...

Washington, DC, 1999
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National Center for Health Statistics
...
Hyattsville, MD: National Center for Health Statistics, 2000
...
Star field B
...
New York, NY:
Oxford University Press, 1998
...
World Health Organization
...
"World Health Organization assesses the world's health systems
...
Geneva
...
who
...
Coble YD
...
"AMA decries rise in number of uninsured Americans
...
Chicago, IL
...
ama-assn
...
html
22
...
"Present day knowledge on aflatoxin
...

23
...
, Bulatao-jaymej, et al
...
" Nature 227
(1970): 403-404
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This program was conducted in collaboration with the Philippine Department of Health and
was funded by the United States Agency for International Development (USAID)
...
Progress on this contract was prepared as monthly reports to USAID
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...

25
...
"Dietary calcium and bone density among middle-aged and elderly
women in China
...
Clin
...
58 (1993): 219-227
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Huj, Zhao X, Parpia B, et al
...
" Am
...
Nutr
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27
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Clin
...
48 (1994): 442-452
...
Potischman N, McCulloch CE, Byers T, et al
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...
Nutr
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Cancer 15 (1991) : 205-215
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Chenj, Campbell TC, Lij, et al
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...
P
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Totowa, NJ: Humana Press, 1994
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Campbell TC, and Chen J
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" In: N
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Burkitt (eds
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34
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...
Stokes, 1904
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...
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All plus correlations were assembled in one list and all minus correlations were
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Most, but not all,
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People who do not consume animal-based
foods are at risk for having low Bn levels, and thus high homocysteine levels
...


394

THE (HINA STUDY

PART III
1
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Diet, life-style and mortality in China
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Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press;
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Hu FB, Stampfer Mj, MansonjE, et al
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Holmes MD, Hunter Dj, Colditz GA, et al
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U
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Department of Agriculture
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" Washington, DC: U
...
Department
of Agriculture, 1998
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Wylie, TX:
Information Plus, 1999
...
While the average percentage of calories derived from fat has gone down slightly, average
daily fat intake, in grams, has stayed the same or has gone up
...
Information Plus
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Wylie, TX: Information Plus, 1999
...
Wegmans
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Accessed at http://mardiweb,com/lowfat/dessert,ht
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Cancer Ins!
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18, Henderson MM, Kushi LH, Thompson Dj, et al
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Tanasescu M, Hu FB, Willett WC, et al
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Preventive Services Task Force
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Internal Med
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12
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131 (2001): 800-806
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Peters JM, Park Y, Gonzalez FJ, et al
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NtambiJM, Choi Y, Park Y, et al
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" Can
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Physiol
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16
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51 (1991) : 6118-6124
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"
Carcinogens is 18 (1997): 755-759
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Yaukey]
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" IthacaJoumal November 12,
1996: 1
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Belury MA
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20
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129 (1999): 2135-2142
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Griinari JM , Corl BA, Lacy SH, et al
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" ]' Nutr
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22
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conjugated linoleic acid
...
Cancer 39 (2001): 233-238
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Ip C, Dong Y, Ip MM, et al
...
" Nutr
...

24
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"Insulin and colon cancer
...

25
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...

26
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ncbLnlm
...
gov
27
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"Developmental (embryo-fetal toxicity/teratogenecity)
toxicity studies of synthetic crystalline lycopene in rats and rabbits
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prostate cancer risk
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Cancer Inst
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29
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Nat
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95 (2003) : 1563-1565
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Tucker G
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31
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Effects of carotenoids and dietary carotenoid extracts on aflatOxin B,-induced mutagenesis
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32
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...
" Nutr
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33
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"Intake of carotenoids and retinol in relation to
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Cancer Inst
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Eberhardt MY, Lee CY, and Liu RH
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usda
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The RDA has been expressed as a Singular quantity of protein, as O
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Assuming a daily intake of 2,200 calories for a 70 kg person, this
O
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B gmlkg X 4 caVgm X
112200 cal X 100 z 10
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Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids [summary statementl
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14
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February 2004
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nih
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National Institutes of Health
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NIH Disease Funding Table: Special Areas of Interest
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17
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See previous reference
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National Cancer Institute
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cancer
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Food Education in the Elementary Classroom as a Means of Gaining Acceptance of
Diverse Low Fat Foods in the School Lunch Program [PhD Dissertation]
...


Chapter 17
1
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"The 'treatment of choice': breast cancer surgery 1860-1985
...
Soc
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Med
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(London) 37 (1985): 100-107
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Naifeh SW The Best Doctors in America, 1994-1995
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c
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3
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The McDougall Plan
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S
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White PL, Johnson OC, and Kibler MJ
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6
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Clin
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Pearson TA, Stone EJ, Grundy SM, et al
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Nutr
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9
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Coli
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18 (1999): 287
...
Two or three reputable agencies have also sponsored this program, but I suspect that the administrators of these agencies felt it necessary to associate with a project in medical education
for their own purposes, regardless of the dubious list of other organizations
...
http://www
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unc
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htm#anchor 197343
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Clin
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54 (1991): 957-962
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Med
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29
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19, 2002: lA
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32
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33
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patients
...


Chapter 18
1
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The General Nature and Treatment of Tumors
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2
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The Ethics of Diet
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London: F Pitman, 1883
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U
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htm

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THE CHINA STUDY

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Appendix A
1
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Proc
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2
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"Nutrition in relation to cancer
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Cancer Res
...

3
...
The growth and development of aflatoxin Bl-induced preneoplastic lesions, tumors, metastasis, and spontaneous tumors as they are influenced by dietary protein level, type, and
intervention
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D
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4
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"Inhibition of aflatoxin Bl-induced gamma-glutamyl
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5
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Krieger E, Youngman LD, and Campbell TC
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" FASEB]
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Appendix B
1
...
Diet, life-style and mortality in China
...
Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press;
Cornell University Press; People's Medical Publishing House, 1990
...
There were eight-two mortality rates, but about a third of these rates were duplicates of the
same disease for people of different ages
...
This also means that very little or no useful information is obtained by including the values of
all the individuals in the county
...

4
...
Food consumption and nutritional status in the People~ Republic of China
...

5
...
Issues and Applications
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, 1996
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Holick ME In: M
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Shils,J
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Olson, M
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al (eds
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Baltimore, MD: Williams and Wilkins, 1999
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" Osteoporosis Int
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3
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4
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5
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6
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National
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8
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Nat
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"
Neurology 51 (1998): 1161-1165
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" Cancer Res
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11
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Nutr
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12
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417 (2003): 77--80
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Davenport CB
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Arch
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Pschiatry 8 (1922): 51-58
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Holick ME "Vitamin D: a millenium perspective
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Cell
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88 (2003): 296-307
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MacLaughlinJA, Gange W, Taylor D, et al
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National Acad
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THE CHINA STUDY

19
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"Multiple sclerosis: decreased relapse rate through
dietary supplementation with calcium, magnesium and vitamin D
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Hypoth
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20
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effects of high dose la(OH)D) in rheumatoid arthritis patients
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Exp
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"]' elin
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Metab
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23
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"Calcitriol metabolism during chronic metabolic acidosis
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Nephrol
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24
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"Dairy products, calcium, phosphorus,
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25
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"Vitamin D supplementation in the elderly: review
of safety and effectiveness of different regimes
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56 (1995): 518-520
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AgranoffBW, and Goldberg D
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Lancet 2(7888) (November 21974): 1061-1066
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Akerblom HK, Vaarala 0, Hyoty H, et al
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" Am
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Genet
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) 115 (2002): 18-29
...
Chan JM, Stampfer MJ, Ma J, et al
...
" J Nat! Cancer Inst 94 (2002):
1099-1109
...
Cohen P, Peehl DM, and Rosenfeld RG
...
" Horm
...
res
...

30
...
"low-protein diet suppresses serum insulin-like growth factor-I and decelerates the progresseion of growth hormone-induced glomerulosclerosis
...

]
...
21 (2001): 331-339
...
Heaney RP, McCarron DA, Dawson-Hughes B, et al
...
"]' Am
...
Assoc
...

32
...
"Hormones and diet: low insulin-like growth factor-I
but normal bioavailable androgens in vegan men
...
Cancer 83 (2000): 95-97
...
See diseases of
affluence
aflatoxin, 5,236
binding to DNA, 51-53
children, 36
in com, 35-36
foci development, 54,59
liver cancer, 21, 35-36, 49
low-protein diet, 53
in peanuts and peanut butter, 35-36
protein, 51-59
tumor development, 60-61
Agriculture, United States Department
of,28
Alar, 43
alcohol, 281
alternative medicine, 252, 334
Alzheimer's disease, 218-22
See also cognitive impairment
American Cancer Society, 263-64, 267
American Council on Science and Health
(ACSH),259-60
American Diabetes Association, 152

American Heart Association, 131
American Institute for Cancer Research
(AICR), 261-67
American Meat Institute, 290
amino acids, 29-30
aminotriazole, 44
Anderson, james, 151 , 154
Angell, Marcia, 316-17, 333-34
angina, 113
angioplasty, 122, 124
animal-based diet, 21, 28
antioxidants, 92
blood cholesterol, 77-78, 80-81
breast cancer, 85-89, 285
calorie consumption, 367
comparison with plant-based
diet, 358
diabetes, 149-50
dietary fat, 83, 86
government promotion of, 258
heart disease , 11 7-19
historical baSis, 344-45
hormones (reproductive) , 88, 160,
160-61
IGF-l (Insulin-like Growth Factor
1), 179
large bowel cancer, 170, 170-71
nutrition, 230, 230-32
prostate cancer, 178
tumor development, 66-67
in the United States, 274, 276-78

405

406

THE CHINA STUDY

vitamin D, 179-81
See also dairy foods
animal-based protein
biomarkers, 88-89
blood cholesterol, 80, 173
calcium, 205
cancer, 367
in China, 274
dietary fat, 276-78, 278
heart disease, 119 , 120
IGF-l (Insulin-like Growth Factor
1),367
kidney stones, 212-14,213
osteoporosis, 205-8
quality of protein, 30
in the United States, 274
urinary calcium, 206, 214
vitamin D, 200, 365-67, 366
animal experimentation, 45 , 48, 62-64,
67,351-52
animal foods industry, 252, 255-68
See also food industry
antigens, 185-86
antioxidants, 3, 66, 92-93, 214-17,
219-20, 301-2
Applebaum, Howard, 258
apples, 43
Appleton, Scott, 54
arthritis, 199, 210,338
artificial sweeteners, 44
ascorbic acid, 93
atherosclerosis, 117
Atkins Center for Complementary
Medicine, 96-97
Atkins Diet
...
, 28
Auburn University, 32
autoimmune diseases, 183-87, 184, 199201,237,349
See also diabetes; multiple sclerosis
Autret, M
...
See diabetes
BMD (bone mineral density), 210
BMI (body mass index) , 100, 135-36,
136
body fat, 78
body mass index (BMI), 100, 135-46,136
body size, 102-4
bone mineral density (BMD) , 210
bovine serum albumin (BSA), 188
BRCA 1 and 2, 158,162
breast cancer
alcohol, 281
biomarkers, 21
blood cholesterol, 87
bone mineral density, 210
casein, 65
in China, 70
death rates, 275
diet and nutrition, 65, 84-86, 85-89,
271-83 , 285
dietary fat, 83-89, 84-86, 271-75,275
estrogen, 87-88, 160-61, 164
genetic predispOSition to, 158, 161-62
hormone replacement therapy (HRT),
166-67
hormones (reproductive), 3, 87-88,
160, 164, 167-68
menarche, 87
risk factors, 160, 160-61
scientific studies, 21, 167-68, 272-85
survival rates, 163
tamoxifen, 163-64
in the United States, 71 , 79
See also BRCA 1 and 2
Bristol-Myers Squibb Company, 328

IN 0EX
Brokaw, Tom, 258
BSA (bovine serum albumin), 188
Burger King, 312
Burkitt, Denis, 89-91,170-71
Bush, George W, 168, 175-76

C
Caedo, Jose, 36
calcitrol, 208
calcium
animal-based protein, 205
consumption, 209
large bowel cancer, 174-75
osteoporosis, 209
vitamin D, 179-81,365-67,366
Calloway, Doris, 259
calorie consumption, 99-102,100, 141,
367
Campbell, Chris, 23,121
Campbell, T
...
See blood cholesterol; dietary
cholesterol
Chou EnLai, 69
CLA (conjugated linoleic acid), 296-99
Cleveland Clinic, 125, 322-24, 338-41
Coca-Cola, 312
cognitive impairment, 3, 218-22, 349
Cold is Cool, 293
colon cancer
...
See large bowel cancer
Committee on Nutrition, United States
Senate Select, 83
complex carbohydrates, 98
conjugated linoleic acid (CLA), 296-99
constitutional nature of disease,
343-44
corn, 35-36
Cornell University, 32
coronary bypass surgery, 122, 123-24
coronary heart disease
...
, 322
crytoxanthins, 93
cyclamates, 44

D
dairy foods
autoimmune diseases, 199-201
osteoporosis, 204-5, 208-10
prostate cancer, 3, 178
vitamin D, 179-81
See also animal-based diet; casein;
milk
dairy industry, 209-10, 255-68, 290-98,
328
See also food industry
Dairy Management, Inc
...
See nutrition; specific diets
Diet, Nutrition and Cancer (NAS report),
83-84,255,260-61,269

IN 0EX
dietary changes, xvi, 3, 164-65, 181--82,
226,242-48,346
dietary cholesterol, 77-81, 221, 282-83
dietary fat, 66, 78
animal-based diet, 83, 86
animal-based protein, 276-78, 278
breast cancer, 83-89, 84--86, 271-75,
275
cancer, 84, 271
confusion about, 81--82
diabetes, 149-55
in foods, 83
government dietary recommendations,
83-84,306--8
hormones (reproductive), 88
nutrition, 81--82
plant-based diet, 83
dietary fiber
...
See pharmaceutical
industry
drug reactions, adverse, 16, 335
Dunaif, George, 54
Duvalier, Papa Doc, 34

E
ecological study deSign, 353-59
egg industry, 255-68
See also food industry

409

Egg Nutrition Board, 328
eggs, 30, 282--83
Eli Lilly &: Co
...
, Jr
...
See body fat; dietary fat
fatigue, 352
fatty acids, 296
Federal Trade Commission, 270
Federation of American Societies
for Experimental Biology and
Medicine, 253
fibe~89-92,90, 170-74
fiber supplements, 153
Finland, 188, 191
fish, 281-82
fish protein, 32, 66
Florida Citrus Commission, 303
Florida Citrus Processors Association,
290
foci, 54-61,55,57, 62
folic acid, 221
food additives or modification, 253, 300
Food and Agriculture Organization
(FAO), 32-33, 309-10

410

THE (HINA STUDY

Food and Nutrition Board (ofNAS), 255,
306-14
Food Guide Pyramid, 312, 313
food industry
influence of, 289-90, 310-13
marketing, xv, 292-95
misuse of scientific information, 8,
303
nutrition education, 328
food labels, 314
Food Stamp program, 312
Food Studies Institute, 318
Foster, E
...
, 290
Framingham Heart Study, 114-15, 220-21
free radicals, 92, 214-17, 219-20
fruit industry, 302-3
fruits, 92-93, 98

G
garlic, 252
General Nutrition, Inc
...
, 149
Hippocrates, 345
Hoffman, Frederick L
...
B
...
See diabetes
Insulin-like Growth Factor 1 (IGF-l),
179
International Life Sciences Institute, 311
International Sprout Growers
Association, 290
Intolerable Risk: Pesticides in Our
Children's Food (NRDC report), 43
iron, 90-91

J
James, Phillip, 309-10
Japan, 150
Johnson and Johnson, 289
Jukes, Tom, 256-57, 260
juvenile-onset diabetes
...
, 289, 299

L
Laetrile, 252
large bowel cancer, 91-92
calcium, 174-75
death rates, 169,169
diabetes, 174
diet and nutrition, 170, 170-71,
283-84
exercise, 175
fiber, 170-74
genetic predisposition to disease, 176
geographic distribution, 169
scientific studies, 170-74
in South Africa, 172-74, 173
Lewis, Carl, 23
Li,Junyao,72
lifestyle changes, 129-30, 153-55,24248,346

412

THE CHINA STUDY

Lifestyle Heart Trial (Lifestyle Project),
129-30
linoleic acid, 296-99
liver cancer
aflatoxin poisoning, 21, 35-36, 49
blood cholesterol, 104
casein, 63, 63-65, 64
in China, 104
HBV (hepatitis B virus), 62-65, 63,
64, 104
nutrition, 66
protein,S, 36-37, 47
local theory of disease, 343-44
low-carbohydrate diet
...
See breast cancer
mammography, 163
marketing strategies, xv; 292-95
Massachusetts Institute of Technology
(MIT), 32
McCay, Major, 29

McDonald's, 258, 274, 289
McDougall, John, 324, 329-32, 334-38
McDougall Plan, The, 324
McGovern, George, 83, 252-53
Mead Johnson Nutritionals, 312
meat, 28
See also animal-based diet; animalbased protein
meat industry, 255-68, 290-98
See also food industry
mechanisms of action, 41, 199-200
medical care
...
, 310
molds
...
See diseases of poverty
Preston, Rachel, 53
Pritikin Center, 139, 152-53
progesterone, 160
prolactin, 88
prostate cancer, 3, 177-81,300-302,367
prostate specific antigen (PSA), 177
protein
about, 27-28
aflatoxin, 51-59, 54
amino acids, 29-30
blood cholesterol, 80
body size, 102-3
cancer development, 36-37, 51, 65
carcinogens, 47, 53
enzymes, 51-53,51-53
foci development, 54-59,55,57,60
government dietary recommendations,
58,258,306-9
in India, 47
liver cancer,S, 36-37, 47
meat, 28
in the Philippines, 34
quality of, 30-31, 102-4
scientific studies, 351-52
See also animal-based protein; casein;
gluten; high-protein diet; lowprotein diet; plant-based protein;
soy protein
protein gap, 31-33
Protein Power
...
See menarche
Public Nutrition Information Committee,
254-68,256-59
Purdue University, 32
Pyramid Cafe, 293
Pyramid Explorations, 293

R
recommended daily allowance
(RDA)
...
See large bowel
cancer

415

reductionism, 271 , 272, 286-87, 300
research, theory and practice, 38, 193,
284-88,296-98,317,334,353-59
retinol, 216
rheumatoid arthritis, juvenile, 199
rice, 32
Rice, John, 43
risk factors for disease, 114, 160, 160-61,
189
Robbins, John, xv-xvi, 239-40
Roberts, Bill, 79
Robertson, W G
...
See diseases of poverty
School Lunch and Breakfast programs,
312-13,317-18
schools, 292-95, 317-18
Schulsinger, David, 59
scientific community's resistance to
change, 120-21,260,265-66,287
scientific controversy, 192-94, 208-10
scientific or research committees, 253-68
scientific studies
alternative medicine, 334
Alzheimer's disease, 221
animal experimentation, 351-52
breast cancer, 21, 167-68,272-85
cancer, 53-67, 84,181-82,260-61,
351-52
causes of disease, 334
in China, 21-22
CLA,296-98
cognitive impairment, 219-20
diabetes, 149-53, 188-97
diet and nutrition, 53-67, 84,126-30,
181-82,203-4,253-68,260-61
food industry, 296-98, 299
funding, 291,315
heart disease, 112, 114-15, 117-19,324
in India, 47
industry attention, funding or
influence,255-68,291,332-34

416

TH E CH I NA STU DY

kidney stones, 212-14
large bowel cancer, 170-74
lycopene, 300-302
macular degeneration, 215-17
metanalysis, 41
multiple sclerosis, 195
Nurses' Health Study, 272-80
osteoporosis, 205-10
pharmaceutical industry, 332-34
in the Philippines, 21 , 33-35
prostate cancer, 300-302
protein, 351-52
stroke, 220-21
vitamin supplements, 229
women's health, 272-80
See also China Study, The
Scott, Dave, 23
selenium, 280
Seneca, 345-46
Seventh-day Adventists , 149-50, 335
simple carbohydrates, 98-99
60 Minutes (television program), 43
smoking, 122, 256
Socrates, 344-45
sodium nitrite, 44-46
South Africa, 172-74, 173
South Beach Diet
...
,255
Type 1 and 2 diabetes
...
See plantbased diet
Virginia Tech, 33
viruses, 190, 197-99
vitamin supplements, 2, 94-95, 216,
228- 29, 242, 269-70,288
vitamins, 29, 93, 269
vitamin A, 231
vitamin B12 , 232
vitamin C, 93-94, 302-3
vitamin D, 179-81 , 200-201 , 208,
231,361-68,363
Voit, Carl, 28

WIC (Women, Infants and Children
Supplemental Feeding program) ,
312,313
Willett, Walter, 271-75 , 284, 286
Women, Infants and Children
Supplemental Feeding Program
(WIC), 312, 313
Women's Health Initiative (WHI), 166,
316
Women's Health Trial, 277-78
World Health Organization, 309-10
World Sugar Research Organization, 310
Wyeth-Ayerst LaboratOries, 328

W

y

Webb, Ryland, 34
weight (gain or loss) , 102-4, 138-43
Wendy's, 289
Western diseases
...
T
...
His legacy, the China Study, is the
most comprehensive study of health and nutrition ever conducted
...

Campbell is Jacob Gould Schurman Professor Emeritus of Nutritional
Biochemisty at Cornell University
...
The China Study was the culmination of a twentyyear partnership of Cornell University, Oxford University and the Chinese Academy of Preventive Medicine
...
In addition, he is a writer, actor
and three-time marathon runner
...
Mr
...


"Colin Campbell's The China Study is an important book, and a highly readable one
...
Th e China Study is a story that needs to be heard
...
Richardson, PhD, Nobel Prize Winner,
Professor of Physics and Vice Provost of Research, Cornell Uni,rersity

" The China Study gives critical, life-saving nutritional information
...
Campbell's expose of the research and medical establishment makes this book
a fascinating read and one that could change the future for all of us
...
"
- The New York Times
THE SCIENCE IS CLEAR
...
CHANGE
YOUR DIET AND DRAM ,\TIC\LLY REDUCE YOUR RISK (W CANCER,
HEART DISEASE, DIABETES AND OBESITY
...
We spend far more, per capita, on
health care than any other society in the world, and yet two-thirds of Americans
are overweight, and more than 15 million Americans have diabetes
...
The War on Cancer, launched
in the 1970s, has been a miserable failure
...

To make matters worse, we are leading our youth down a path of disease earlier and
earlier in their lives
...

These issues all come down to three things: breakfast, lunch and dinner
...


;-=- r-\~\ Trade Paperback
~~~ $ 16
...
95 CAN

benbellabooks
...
com
Distributed by Independent Publishers Group
Cover design by Melody Cadungog & Laura Watkins

ISBN 978-1-932100-66-2
51695>

I



---

Title: The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health 1st Edition
Description: Even today, as trendy diets and a weight-loss frenzy sweep the nation, two-thirds of adults are still obese and children are being diagnosed with Type 2 diabetes, typically an “adult” disease, at an alarming rate. If we’re obsessed with being thin more so than ever before, why are Americans stricken with heart disease as much as we were 30 years ago? In The China Study, Dr. T. Colin Campbell details the connection between nutrition and heart disease, diabetes, and cancer. The report also examines the source of nutritional confusion produced by powerful lobbies, government entities, and opportunistic scientists. The New York Times has recognized the study as the “Grand Prix of epidemiology” and the “most comprehensive large study ever undertaken of the relationship between diet and the risk of developing disease.” The China Study is not a diet book. Dr. Campbell cuts through the haze of misinformation and delivers an insightful message to anyone living with cancer, diabetes, heart disease, obesity, and those concerned with the effects of aging. [This book is also available in Spanish, El Estudio de China.]

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