The China Study
By: T. Colin Campbell and
Thomas M. Campbell II, M.D.
Book Review By: David Lorimer,
Program Director of the Scientific and
This is an important book on nutrition and
health. Not only does the research content have enormous and far-reaching
implications, but also readers will find themselves challenged to adapt their
diets in the light of Campbell's findings and recommendations – as he himself
Campbell grew up on a farm, convinced that a high intake of meat, dairy and
eggs was the ideal healthy diet. Experience and research have proved
His first research project was in the Philippines, where he was initially
concerned to plug the so-called protein gap on the basis that childhood
malnutrition was caused by lack of protein. Instead, he found the highest
prevalence of liver cancer in the very Filipino children who ate the highest
Around the same time he noticed a research report from India where two
groups of rats were being administered the cancer causing aflatoxin then fed a
diet composed of 20% protein. The other group was administered the same
amount of aflatoxin but fed a 5% protein diet.
Results showed that every single animal on the 20% protein diet had evidence
of liver cancer, while every single animal on the 5% protein diet avoided liver
cancer. These two studies proved seminal to the future development of
Campbell's research career.
The book is divided into four parts: the China Study, Diseases of Affluence,
the Good Nutrition Guide and a section entitled Why haven't you heard this
before? on science and politics.
Campbell describes how he set out to replicate the Indian rat study:
"What we found was shocking. Low-protein diets inhibited the initiation of
cancer by aflatoxin, regardless of how much of this carcinogen was
administered to these animals. After cancer initiation was completed, low-
protein diets also dramatically blocked subsequent cancer growth. In other
words, the cancer producing effects of this highly carcinogenic chemical were
rendered insignificant by a low protein diet. In fact, dietary protein proved to be
so powerful in its effect that we could turn on and turn off cancer growth simply
by changing the level consumed."
He found that low protein intake markedly decreases enzyme activity and
prevents dangerous carcinogens binding to DNA.
Also that: "in these experiments, plant protein did not promote cancer growth,
even at the higher levels of intake. Gluten, a protein of wheat, did not produce
the same result as casein (milk protein), even when fed at the same 20% level."
An important implication of this research is that the level and type of protein
intake affects the expression of cancer genes. In other words, even if one has
a genetic predisposition to cancer, this research indicates that the plant-based
diet will help prevent its manifestation.
The next chapter provides details of the China Study itself. It is based on a
monumental survey initiated in the 1970s on death rates for 12 different kinds
of cancer covering more than 2400 Chinese counties and 880 million (then
96%) of their citizens.
Campbell and colleagues were able to follow this with a detailed study of the
relationship between diet and disease, resulting in more than 8,000 statistically
significant associations between lifestyle, diet and disease variables.
Differences between diseases of affluence and diseases of poverty became
very clear. He found that death rates from coronary heart disease were 17
times higher among American men than rural Chinese and that the American
death rate from breast cancer was five times higher than the rural Chinese
The average blood cholesterol level among rural Chinese was around
127mg/dL while the comparable figure in the US is 215mg/dL.
Campbell concludes that:
"Lower blood cholesterol levels are linked to lower rates of heart disease,
cancer and other Western diseases, even at levels far below those considered
safe in the West."
He also found that:
"Plant based foods are linked to lower blood cholesterol; animal based foods
are linked to higher blood cholesterol. Animal based foods are linked to higher
breast cancer rates; plant based foods are linked to lower rates. Fibre and
antioxidants from plants are linked to a lower risk of cancers of the digestive
As readers can imagine, the Atkins diet is given short shrift.
Part Two considers research into a variety of diseases of affluence and their
preconditions: obesity, heart disease, diabetes, cancers, autoimmune
diseases and various other diseases of bone, kidney, eye and brain.
At the beginning of the section he states:
"There is no such thing as a special diet for cancer and a different, equally
special diet for heart disease. The same diet that is good for the prevention of
cancer is also good for the prevention of heart disease, as well as obesity,
diabetes, cataracts, macular degeneration, Alzheimer's, cognitive dysfunction,
multiple sclerosis, osteoporosis and other diseases."
The chapter on heart disease explains that the incidence is similar to the
1970s, but survival rates have improved:
"We have got slightly better at postponing death from heart disease, but we
have done nothing to stop the rate at which our hearts become diseased."
Campbell reports an extraordinary study begun in 1985 by Dr. Caldwell
Esselstyn Jr. He originally had 23 patients of whom five dropped out within
two years. Of the other 18, these people had suffered 49 coronary events in
the previous eight years.
Esselstyn put his patients and himself on a low-fat plant-based wholefood
diet. The average cholesterol level at the start of the study was 246 mg/dL,
which fell during the study to 132mg/dL.
In the following 11 years, there was only one coronary event among these 18
people. This one person had strayed from the diet for two years. Since going
back on the diet, he has experienced no further problems.
70% of these patients have seen an opening of their clogged arteries. Equally
significantly, the five dropout patients had experienced a further 10 coronary
events by 1995. As of 2003, 17 years into the study, all but one of the original
18 patients was still alive.
Part Three sets out Campbell's eight principles of food and health:
1- Nutrition represents the combined activities of countless substances. The
whole is greater than the sum of its parts.
2- Vitamin supplements are not a panacea for good health (they are isolated
3- There are virtually no nutrients in animal based foods that are not better
provided by plants.
4- Genes do not determine disease on their own. Genes function only by
being activated, or expressed, and nutrition plays a critical role in determining
which genes good and bad, are expressed.
5- Nutrition can substantially control the adverse effects of noxious
6- The same nutrition that prevents disease in its early stages can also halt or
reverse disease in its later stages (disease takes time to develop).
7- Nutrition that is truly beneficial for one chronic disease will support health
across the board.
8- Good nutrition creates health in all areas of our existence. All parts are
interconnected. We have more energy if we eat well – hence more exercise
He then provides advice on how to put these principles into practice, drawing
on his own experience and that of others.
Part Four asks why you haven't heard this before? The short answer is that:
"The entire system – government, science, medicine, industry and media –
promotes profits over health, technology over food and confusion over clarity."
The first chapter Science – the Dark Side explains how many national bodies
are in fact fronts for industry and apparently independent academics are
retained by industry interests who also sponsor some of their research.
The next chapter takes on scientific reductionism in nutritional research. It is
the mistake of characterizing whole foods by the health effects of specific
Campbell provides a detailed critique of the Nurses' Health Study, which is
often cited to show that there is no relationship between diet and breast
However, it is clear that the whole cohort of nurses was consuming a high-risk
diet centered on animal based foods. Ironically, it turns out that "the low-fat
meal contains more than double the protein of the high-fat meal – and mostly
from animal based food and high in cholesterol."
The next chapter on government-industry links is highly revealing. As
previously noted, industry consultants wear academic hats. Campbell sums
up the situation:
"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. A
revolving door exists between government jobs and industry jobs, and
government research funding goes to the development of drugs and devices
instead of healthy nutrition… the system is a waste of taxpayer money and is
profoundly damaging to our health."
It is a damning and fully justified indictment.
At the end of the book, Campbell summarizes the health problems of the US
with a series of alarming figures, most of which are still showing upward
This can only mean that health care will continue to become more and more
expensive. And yet, as he observes:
"We now have a deep and broad range of evidence showing that a whole foods,
plant based diet is best for the heart…and all other chronic diseases."
He believes that the situation has reached a critical point when people are
ready to listen and to change.
The vitality of a culture cannot be maintained or expressed in by a sick
population. We now have an unprecedented situation where a greater
proportion of the world population is overweight than undernourished.
This can only produce the nemesis of diseases of nutritional extravagance,
which, according to the thesis of this book, is largely preventable.
Moreover, the whole food plant based diet recommended by Campbell has a
far lower impact on the environment. This is a seminal book that should be
read by everyone interested in the future of health – their own included.
It should also be required reading in ministries of health and on undergraduate
Book Review by: David Lorimer
Programme Director of the Scientific and Medical Network