Diet and Book Review: The China Study by T. Colin Campbell

T. Colin Campbell and his book ¨The China Study.¨ Image taken from silvieandmaryl.com

The China Study is an evidence-based nutritionist’s bible.  All hail T. Colin Campbell (and Thomas Campbell, his son and co-author) for the comprehensively cited critical analysis of nutritional literature.  In this book, he meticulously combs through animal and human studies on high protein versus low protein diets, arguing that a plant-based, low protein, whole foods diet offers the most health benefits in general and specifically for certain conditions.  His entire professional career has been devoted to nutritional research both in animals and clinical trials, namely his most comprehensive trial, “The China Study.”  Since the publication of this monumental work, many organizations have risen to the task of spreading his message.  One of these is his own nonprofit organization called the T. Colin Campbell Center for Nutrition Studies, founded in 2007.  Here, practitioners and patients can access useful resources that simplify his message and answer common concerns.

Though my few years of molecular/micro-biology and couple years in nutritional research background could never compare to Dr. Campbell’s, I have to say that I do have some criticisms of his general message.  He certainly got most things right.  He objectively makes a strong argument that diets low in protein (where less than 10% of the diet is protein, especially animal protein) are associated with a lower prevalence of cancer, and that this diet can also prevent and even reverse cardiovascular disease.  That’s HUGE!!  To put some numbers to the differences in American versus Chinese diets, he says, “In America, 15-16% of our total calories comes from protein and upwards of 80% of this amount comes from Animal-based foods.  But in rural China only 9-10% of total calories comes from protein and only 10% of the protein comes from animal-based foods.”(1)  He also debunks and explains the history behind the common misunderstanding that high fat diets cause cancer and disease, when really the research shows that high fat content from animal products cause cancer and disease.  The result of this inaccurate association is industry’s production of a plethora of nonfat and low fat animal products, leading many Americans to ironically and justifiably consume even more animal products.  His book is, thus, a must-read for altering the cuisine landscape of America.  Eating the way he suggests would surely help most Americans who suffer from America’s most prevalent diseases.  In three words:  MORE VEGGIES PERIOD.

T. Colin Campbell goes as far as to say that optimal health can perhaps be achieved with the elimination of all animal products.  This is where I think that an important book like his with such a strong general message should include a clinician’s perspective.  While I think eating this way is healthy if done correctly (i.e., cooking your food, minimal boxed or canned products and fruit juices, more greens than grains), it is difficult to implement without individual modification.

Clinicians who get results are implementing various diets, all plant-based, but not many prohibiting all animal products.  Almost every low protein study in this book showing diets that could lower the risk of cancer, diabetes, and autoimmune disease, actually had some low amount of animal protein.  This includes the China Study, the Women’s Health Study, and the Framingham Study.  One major study this statement excludes is the studies involving Seventh-day Adventists, who either exclusively ate plants or ate a plant-based diet including yogurt and other dairy products.  Dean Ornish, MD, one of few medical doctors who treats chronic disease with nutrition prioritized above drugs is one example of a doctor who is getting results but doesn’t exclusively prescribe a completely vegan diet.  He admits that there is a spectrum of what people need to eat according to their health.  Even the Ornish diet, proven to reverse heart disease (2), includes a little bit of nonfat yogurt.  What’s great about Dr. Ornish is that he has the nutritional training and the clinician’s understanding of a patient’s lifestyle and health obstacles to make appropriate recommendations for an individual.  Two other very successful diets, that have a lot of research behind them are the DASH diet and the Mediterranean diet.  The DASH diet includes fruit, vegetables, whole grains, low fat dairy products, poultry, fish and nuts, and excludes alcohol, refined sugar and added salt.  Both the DASH diet and the Mediterranean diet are healthier diets than the high meat and highly processed diet of typical Americans, and are sometimes easier to implement.

Different people have different needs.  Dr. Campbell cites excellent statistics on the amount of protein a person actually needs.  But as any nutritionist knows, other factors come into play.  We need different amounts of nutrition in different stages of life, and with different levels of activity.  Many of the laboratory studies he cites in The China Study involve zero or slower growth of tumor foci when rats or cell cultures are fed a lower protein regimen.  In the same way that he explains the function of proteins as enzymes and as the machinery that builds substance in animals, he neglects to point out that protein is essentially a rate limiting factor for tumors.  This is similar to limiting protein levels for growing children (3) or athletes who build muscle.  Surely, these demands can be met solely by plant proteins as he exemplifies by the vegan Olympic athletes he cites.  Yet he does not explain the different amounts of protein or calories required for these special groups.  Nor does he make any exceptions or modifications in his recommendations for these groups.

Diet therapy should be modified for each individual.  Principle #7 of Dr. Campbell’s eight principles of food and health is “Nutrition that is truly beneficial for one chronic disease will support health across the board.” (1a.)  I want to add a few words to that statement.  “Nutrition that is truly beneficial for one chronic disease in that individual will support health across the board.”  Some people are prone to anemia, others get gastrointestinal upset, and still others are susceptible to breast cancer, cardiovascular disease, diabetes, and stroke.  The diet Dr. Campbell recommends will absolutely make a huge difference for those suffering from the most prevalent diseases in America today:  obesity, cancer, heart disease and diabetes.  For those who have already had a heart attack and are taking 2 blood pressure medications and a statin, for example, will get the most out of following his recommendations strictly.  But for those with milder functional issues like anemia, gastrointestinal upset, hypothyroidism, or any other health condition that is contingent upon their ability to absorb nutrients, a little more meat and less of certain food sensitivity triggers can go a long way. (4)

Animal products in America have more harmful constituents than just protein.  This topic really deserves its own book.  America’s beef, poultry, and dairy products are inundated with antibiotics and anabolic steroids. (5)  Many of these animal products exhibit unnaturally low levels of omega-3 fats when compared to their non-industrially-farmed counterparts.  (6)  It is clear that breast and ovarian cancer is directly correlated to levels of estrogen exposure throughout a woman’s lifetime.  (7)  And high levels of inflammation are associated with an unhealthy high ratio of omega-6 fats to omega-3 fats. (8)  Furthermore, as the environment changes with more pollutants in our waterways, seafood is being contaminated with heavy metals and other endocrine disruptors.  Many chemicals used in industry have infiltrated what we eat, and many of them are recognized as harmful to our health. (9)  It’s difficult to discern if some of the high protein adverse effects on health are solely due to animal protein or the detrimental effects from the bioaccumulation of harmful chemicals.  Nevertheless, these facts are also good reasons for limiting the amount of animal products consumed.

This book is essential for every health professional to read.  Your experience working with people will allow you to use the facts presented in this book and make it actually applicable in practice.  For the health conscious reader, this book samples many studies and makes a strong argument for eating only plants, but does not detail how to implement this type of diet.  You can find more resources that offer guidance on how to eat by Dr. Campbell’s diet recommendations on the links above.

Each person has their own path in reaching health.  For those that have a special circumstance or need additional guidance, a nutritional counselor, a naturopathic doctor or a medical doctor specifically trained in nutrition is the best person to seek.

(1)  Campbell, T. Colin.  The China Study.  Ebook.  Benbella Books:  Dallas, TX, 2006.  p217-218. (1a) p648

(2)  Chainani-Wu N, Weidner G, Purnell DM, Frenda S, Merritt-Worden T, Pischke C, Campo R, Kemp C, Kersh ES, Ornish D.  Changes in emerging cardiac biomarkers after an intensive lifestyle intervention.  Am J Cardiol. 2011 Aug 15;108(4):498-507. doi: 10.1016/j.amjcard.2011.03.077. Epub 2011 May 31.

(3) Rodriguez NR.  Optimal quantity and composition of protein for growing children.  J Am Coll Nutr. 2005 Apr;24(2):150S-154S.

(4) Ch’ng CL, Jones MK, Kingham JG.  Celiac disease and autoimmune thyroid disease.  Clin Med Res. 2007 Oct;5(3):184-92.

(5)  Swan SH, Liu F, Overstreet JW, Brazil C, Skakkebaek NE.  Semen quality of fertile US males in relation to their mothers’ beef consumption during pregnancy.  Hum Reprod. 2007 Jun;22(6):1497-502. Epub 2007 Mar 28.

(6) Cynthia A Daley, Amber Abbott, Patrick S Doyle, Glenn A Nader, and Stephanie Larson.  A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef.  Nutr J. 2010; 9: 10.  Published online 2010 March 10. doi:  10.1186/1475-2891-9-10

(7)  Hilakivi-Clarke L, de Assis S, Warri A.  Exposures to synthetic estrogens at different times during the life, and their effect on breast cancer risk.  J Mammary Gland Biol Neoplasia. 2013 Mar;18(1):25-42. doi: 10.1007/s10911-013-9274-8. Epub 2013 Feb 8.

(8)  Calder PC.  Fatty acids and inflammation: the cutting edge between food and pharma.  Eur J Pharmacol. 2011 Sep;668 Suppl 1:S50-8. doi: 10.1016/j.ejphar.2011.05.085. Epub 2011 Jul 28.

(9)  Mrema EJ, Rubino FM, Brambilla G, Moretto A, Tsatsakis AM, Colosio C.  Persistent organochlorinated pesticides and mechanisms of their toxicity.  Toxicology. 2013 May 10;307:74-88. doi: 10.1016/j.tox.2012.11.015. Epub 2012 Dec 3.

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