This book is certainly worth the read, due to its relevance and popularity, and the massive epidemiological study after which it was named is certainly deserving of attention, due to the magnitude of its its scope. But both must be done with a critical eye, because Dr. Campbell presents his evidence very selectively, jumps to unwarranted conclusions, and appears to distort his presentation of the China Study's data to make the case for a vegan diet.

I reviewed this book in greater detail (including 48 footnotes)in the quarterly journal of the Weston A Price Foundation, which can be found online by doing an internet search, in which I was able to make points beyond the space available here. In summary, those points are:

-- Dr. Campbell's laboratory research indicted an isolate of the milk protein casein as contributing to cancer promotion, but Dr. Campbell generalizes this to all animal protein and even all "animal nutrients." But casein is a unique protein and is problematic for many people for unique reasons, so generalizations cannot be made from it to all animal proteins or nutrients.

-- Dr. Campbell asserts that the China Study found a compelling association between animal protein intake and all cancers. But the original monograph of the study show animal protein to have a non-statistically significant 3% correlation with all cancers, which is only one quarter the correlation shown with plant protein. Carbohydrates had the correlation of the greatest magnitude, and fat was the only macronutrient that had a protective effect. The protective effect of fat was also the only correlation between cancer and a macronutrient that was statistically significant (meaning the probability of the correlation being attributable to chance was less than 5%).

-- Dr. Campbell presents the research of others with great selectivity to make his point. He does not address the fact that many non-modernized cultures have been found to thrive with vibrant health on diets rich in animal products-- for one example, the Masai, who have been studied extensively and found to be free of heart disease despite eating a diet based around red meat and fermented, unpasteurized, whole milk. He pays little attention to the harmful effects of refined plant-based products in the modern diet like white flour and white sugar (though he does rightfully caution against their use), and ignores current research illumining the benefits of many animal-based nutrients.

The book's title gives one the impression that the book is a general guide to health and nutrition based on the findings of the study after which it is named. But, in fact, the actual China Study is only discussed for 39 of its 350 pages. The true theme of the book is an argument for vegetarianism, and a critical eye should find that argument less than compelling.


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Despite it's title, only a small portion of The China Study is actually devoted to discussing the giant epidemiological study of the same name; the rest of the book simply reads like an extended sales brochure for veganism.

Beginning in the early eighties, Campbell was part of a group of Chinese, British and US researchers that presided over the massive epidemiological study known as the China Project, or China Study. The New York Times dubbed it "the Grand Prix of epidemiology," and it gathered data on 367 variables across sixty-five counties and 6,500 adults. After the study data was compiled, the researchers had calculated "more than 8,000 statistically significant associations between lifestyle, diet and disease variables."

According to Campbell, the China Study data showed that: "People who ate the most animal-based foods got the most chronic disease. . . . People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease."[p. 7]

In reality, the China Study showed nothing of the sort.

"The China Study" does not contain the actual data gathered from its namesake study. So when Campbell claims that the China Study found a consistent relationship between animal foods and various diseases, readers have no way of verifying this information for themselves.

Unless of course, they get up off their butts and go retrieve the actual China Study data for themselves. To do this, they will need to check their local libraries (university libraries are the best bet) for a book titled Diet, life-style, and mortality in China: A study of the characteristics of 65 Chinese counties[Chen J]. Once readers have this book in their possession they will quickly discover that there is a galaxy-sized gap between the actual findings of the China Study and the claims made by Campbell in his popular book version.

Overall mortality

Let's start with overall mortality, unarguably the most important mortality statistic of all. Animal protein, fish protein, meat intake, saturated fat, and fat calories were all negatively associated with all-cause mortality in infants, children, teenagers and adults, although none of the associations reached statistical significance (for those unfamiliar with research-speak, a negative correlation means that as intake of these foods increased, mortality risk decreased; failure to reach statistical significance means that researchers can't be sure these findings were not due to chance).

Among those aged 0-64, total protein returned a 29% negative association with overall mortality. This finding was statistically significant (p=0.05).

In all age groups, egg consumption was negatively associated with all-cause mortality, with a statistically significant 43% decrease (p=0.01) in overall mortality among those aged 0-64.

No statistically significant relationships, protective or otherwise, were found for milk intake, fiber, cereal grains, legumes, and vegetables among those aged 0-64.

The only other dietary factor that was significantly associated with overall mortality among those aged 0-64 was soy sauce (not soy products), which showed a 43% decrease in mortality risk (p=0.001)

Cancer

Neither total protein (+12%), animal protein (+3%), fish protein (+7%), plant protein (+12%), meat intake (-20%), saturated fat (+2%), fat calories (-17%), eggs (+19%), nor milk (+6%) demonstrated any statistically significant association with mortality from all cancers. Rice (-26%, p=0.05) and green vegetables (-28%, p=0.05) were statistically associated with reduced cancer mortality, as were the use of alcohol (-27%, p=0.05), home-made cigarettes (-32%, p=0.01), and total tobacco use (-25%, p=0.05).

(Readers can now see why clinical research is superior to epidemiological research--if we were to treat the findings of the China Study proactively, then we would all go out and start drinking and smoking cigarettes in order to improve our odds against cancer! Despite his obvious enthrallment with the results of the China Study, Campbell for some reason doesn't recommend this...)

With regards to specific types of cancer, no statistically significant associations were observed for total protein, animal protein, fish protein, meat intake, milk intake, saturated fat, total fat, fiber, cereal grains, legumes, vegetables and mortality from colorectal or breast cancers.

Heart Disease

No statistically significant associations were observed for total protein, animal protein, fish protein, meat intake, milk intake, saturated fat, total fat, fiber, legumes, and mortality from coronary heart disease.

Rice was associated with a statistically significant decrease (-58%, p=0.001) in CHD risk, while wheat flour was associated with a statistically significant increase in CHD risk (+67%, p=0.001). A similar phenomenon was noted for stroke mortality, with a statistically significant risk decrease noted for rice (-44%, p=0.01), and a statistically significant increase in risk observed for wheat flour (+55%, p=0.001) (again, despite his apparent rapture with the China Study results, nowhere does Campbell recommend the avoidance of wheat or wheat flour; in fact, he encourages the consumption of whole grain cereals).

So there you have it...the "Grand Prix" study that supposedly showed "People who ate the most animal-based foods got the most chronic disease. . . . People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease" actually showed that animal-based foods imparted no increased risk of all-cause mortality, cancer deaths, or cardiovascular mortality.

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Is Campbell deliberately lying to us? Or is he merely suffering from an inability to cast aside his own personal prejudices and present a full and objective presentation of the facts, because the facts conflict with what he wants to believe?

The facts, as anyone who actually peruses the data produced by the study Campbell claims to have drawn his conclusions from (which can be found in Chen J, et al. Diet, life-style, and mortality in China: A study of the characteristics of 65 Chinese counties. Oxford, UK; Ithaca, N.Y. Oxford University Press; Cornell University Press, 1990.), show that consumption of animal protein - especially meat - was associated with a 29% REDUCED risk of mortality, not an increased risk, as Campbell claims. For that matter, the study also shows a reduced risk of cancer in those who consume alcohol and tobacco use.

So where did Campbell get his claims? Who knows. Wherever he got them, it's definitely not from the study he named his book after.

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Unfortunately, T. Colin Campbell has published a book that makes a mockery of what is (could be?) one of the most important health studies ever done. I agree with Dr. Campbell that the "China Study" is a ground breaking study. It studies and correlates the diet and disease patterns of 65 rural counties in China. The wonderful thing about this is that the people in the Chinese counties have presumably eaten a similar diet their whole lives and their disease patterns are relatively well characterized. Therefore, it gives a unique look at correlations between diet, lifestyle and disease.

And it could have been so interesting. Instead, Dr. Campbell has chosen to publish a book that says that veganism is best DESPITE the evidence. I could go on and on about the problems with this book from a scientific perspective. For now I'll direct you to <a href="https://bradmarshall.blogspot.com/2005/12/is-wheat-killing-us-introduction-maybe.html">the article about this study from my blog</a>.

This book is a shame. It held so much promise. If you are REALLY interested in disease and dietary patterns in China, look for the raw data - "Diet, Life-style and Mortality in China", also by T. Colin Campbell, among others.

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I was very interested to read this book, but I was disappointed because there were omissions. There was selective reporting of the survey results to advocate a whole foods vegan diet.

We are not told what chinese people actually eat vs their cancer rate by province. The author advocates a vegan diet and uses the china study to justify this, but the chinese are not vegans. They may be ALMOST wholefoods vegan, but this is not the same as totally vegan. I would like to have seen included a percentage of animal products in the diet of the rural chinese, broken up by meat(non fish), fish, dairy, egg. I have assumed that dairy is zero due to lactose intolerance but this is just a guess.
The author believes supplements are not necessary (I agree), but then states that a B12 supplement is necessary. Of course on a vegan diet it is necessary. Doesn't this indicate humans need enough animal products in their diet to avoid a B12 deficiency (there would not be much animal product required), I believe we only need 2 mcg of B12 per day. He claims that organically grown plants would have b12 naturally, but offers no evidence of this. I do not believe this to be true, I want proof.

In summary, I do not like the incomplete reporting of data to suit someones philosophy, but I do believe that the best diet is wholefoods about 80% derived from plants, with enough meat/fish to be healthy and stave off a b12 deficiency. I ageee that dairy is not suitable for humans. In fact, our closest relatives the chimpanzee eat mostly leaves, fruits and other parts of plants, insects and meat when it is available, they don't get much meat but they will hunt smaller animals if given the opportunity.

I wish the original text of the published study had been included as part of the book, now I have to locate a copy,aarg!!!

Some Time Later ... Now I have actually read the actual Study that this book is talking about.


(...)

Cancer Mortality is not correlated to meat eating or total protein or the intake of animal fat.!!!

So the actual study doesn't support the vegan diet at all, in fact non of the people studied were vegan. In fact the longest lived people on earth (okinawans and japanese) are not vegans, but they eat heaps of vegetables and a wide variety, legumes, rice, fish, small amounts of meat, and no dairy.

One thing I noticed from the REAL China Study was that the rural chinese are more likely to die from infectious disease such as TB and Pneumonia than westerners. They do not have a life expectancy greater than ours! I think we should be looking at the japanese/okinawa diet.

A good book on this is by Bradley Wilcox

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Back in the 1980s, T. Colin Campbell and a team of researchers traveled to China to survey the dietary habits of 6,500 adults in 130 rural villages. Although they gathered data on a whopping 367 food variables,they somehow neglected to note how much soy people were eating. Yet soy is widely reputed to be a "miracle food" and the reason that the Chinese have lower rates of some cancers and other chronic diseases. So it's "startling" indeed to find that ALL legume consumption came to a grand total of only 12 grams per day, which is NOT very much. However, what's truly "startling" about this book is not the researchers' failure to be "comprehensive" -- they gathered plenty of good data though readers will have to go to earlier publications to get it -- but the many ways Campbell massages, misuses and misreports that data. Although he clearly thinks that it's all for a good cause, this is a textbook case of "Lies, Damn Lies and Statistics." I recommend that the publisher follow up with a sequel -- a companion volume in which researchers without any dietary agenda take the same data and reach statistically justified conclusions. Now that would give readers food for thought!


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The most comprehensive aspect of this book is the extent to which T Colin Campbell misuses data to prop up the inflated health claims he makes for vegetarian, low-fat diets. The implications are "startling" all right. Fortunately, enough data is included so that those with a thorough grounding in statistics can figure this out. Unfortunately, readers without the training or the motivation to do so and so will make dietary choices based on the author's dubious conclusions.

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