The China Study

If you already know about The China Study then you will know how important a milestone it is for nutritional research. It’s such an important study that I thought it would be worth taking a quick look at its background, method and conclusions.

Background

Protein Consumption in Rats

Professor T Colin Campbell observed a relationship between the amount of dietary protein consumed and the promotion of cancer in rats. The animal protein used was casein (the main protein in milk and cheese), along with a variety of plant proteins. Distinct differences between the effects of animal vs. plant-based protein were observed:

animal protein tended to promote disease conditions
plant protein tended to have the opposite effect

Early 1970’s in China

The Chinese premier Zhou Enlai was dying of cancer. He had organised a survey called the Cancer Atlas which gathered details on about 880 million people. The survey revealed cancer rates across China to be geographically localised, suggesting dietary/environmental factors—not genes—accounted for differences in disease rates.

1983-1984 Survey

Dr. Campbell with researchers from Cornell University, Oxford University, and the Chinese government, conducted a major epidemiological study (i.e. a study of human populations to discover patterns of disease and the factors that influence them). This was called The China Project (from which the book The China Study derived some of its data). Researchers investigated the relationship between disease rates and dietary/lifestyle factors across the country.

Why China?

large population of almost one billion
very little migration within China
rural Chinese mostly lived where they were born
strict residential registration system existed
food production was very localised
the Cancer Atlas had revealed diseases were localised and so dietary and environmental factors (not genes) would be likely to account for disease rate variation by area (whether affluent and eating Western diet, or rural and eating traditional plant-based diet)

Method

Research Questions

1. Is there an association between environmental factors, like diet and lifestyle, and risk for chronic disease?

2. Would the patterns observed in a human population be consistent with diet and disease associations observed in experimental animals?

Hypothesis

Researchers hypothesised generally that an association between diet/lifestyle factors and disease rates would indeed exist. A specific hypothesis was that animal product consumption would be associated with an increase in cancer and chronic, degenerative disease.

Hypothesis Testing

6,500 adults in 65 different counties across China were surveyed in the 1983-4 project. These counties represented the range of disease rates countrywide for seven different cancers. The survey process with each participant included:

three-day direct observation
comprehensive diet and lifestyle questionnaires
blood and urine samples
food samples from local markets analysed for nutritional composition
survey of geographic factors

1989-1990 Survey

same counties and individuals resurveyed plus a survey of 20 additional new counties in mainland China and Taiwan.
10,200 adults surveyed
socioeconomic information collected
data combined with new mortality data for 1986-88

Analysis of Data from both 1983-1984 & 1989-1990 Surveys

data was analysed at approximately two dozen laboratories around the world to reduce chances of error in data analysis
researchers could be confident that if results were consistent, then they would be correct

Conclusion

diseases more common in Western countries clustered together geographically in richer areas of China
diseases in richer areas of the world were thus likely to be attributed to similar “nutritional extravagance”
diseases in poorer areas of the world were likely to be attributed to nutritional inadequacy/poor sanitation
blood cholesterol (strongly associated with chronic, degenerative diseases) was higher in those consuming more animal foods
lower oestrogen levels in women (associated with fewer breast cancers) related to increased plant food consumption
higher intake of fibre (found only in plants) associated with lower incidence of colon and rectal cancer

The consistency of the results led the researchers to make the overall conclusion that the closer people came to an all plant-based diet, the lower their risk of chronic disease.

Published Data

The data on both the 1983-1984 survey and the 1989-1990 survey can be seen in more detail here.
More detail on the experimental study design of the China Project (covered in Appendix B) plus a full copy of The China Study in pdf format is available here.
Professor T Colin Campbell’s complete CV (including published papers analysing data from the China Project) is available here.

Plant Protein vs Animal Protein Webinar from Professor T Colin Campbell

If you have any comments or require further information on this topic, please let me know.

Bibliography:

Chen J, Campbell TC, Li J, Peto R. Diet, Life-Style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK: Oxford University Press; 1990.
Chen J, Peto R, Pan W-H, Liu B-Q, Campbell TC, Boreham J, Parpia B. Mortality, Biochemistry, Diet and Lifestyle in Rural China: Geographic Study of the Characteristics of 69 Counties in Mainland China and 16 Areas in Taiwan. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press, Cornell University Press; People’s Medical Publishing House, 1990.

A Fat to Forget

Eating cakes and biscuits appears to impair memory.

Research (1.) suggests that there is relationship between consumption of dietary trans-fats and word-memory.

1018 individuals were given word recall tests that were scored and matched against the amount of trans-fats consumed by each individual.

The results are worth remembering next time you reach for the cookie jar. Every gram of dietary trans-fats consumed per day was associated with an estimated 0.76 fewer words recalled.

Is this causation or just correlation? The researchers consider that the pro-oxidant (2.) and energetic detriments of dietary trans-fats (3.) are evidence of causation. They used triangulation (4.) with other evidence to ensure that other causal factors were not being mistakenly included. (See charts below if you are interested in the statistical data).

Trans-fats are found in many biscuits, cakes and other processed foods. They are made by pumping hydrogen into liquid vegetable oil so that the oil becomes more solid. Food manufacturers do this in order to increase the shelf life of the products and to improve flavour and texture. You will know that they are present in products if you see the words “partially hydrogenated oils” on the ingredients list.

The leader of this study, Dr Beatrice Golomb, said: “Trans fats were most strongly linked to worse memory, in young and middle-aged men, during their working and career building years…From a health standpoint, trans fat consumption has been linked to higher body weight, more aggression and heart disease…As I tell my patients, while trans fats increase the shelf life of foods, they reduce the shelf life of people.” (5.)

What does this mean for our love affair with biscuits and cakes?

Well, it appears that we love them but they don’t love us. Maybe the best thing to do is to forget about eating them before they make us forget that we have eaten them…

References, Definitions & Data

1. Beatrice Alexandra Golomb, A lexis K. Bui. https://doi.org/10.1371/journal.pone.0128129. June 17, 2015. A Fat to Forget: Trans Fat Consumption and Memory.

2. Pro-oxidants are substances that accelerate the oxidation of another substance. This process can produce free radicals which are associated with many chronic health problems such as cardiovascular and inflammatory disease, cataract, and cancer. Antioxidants prevent free radical induced tissue damage by preventing the formation of radicals, scavenging them, or by promoting their decomposition. Berries are a great source of antioxidants.

3. Ascherio A, Willett WC. Am J Clin Nutr. 1997 Oct;66(4 Suppl):1006S-1010S. Health effects of trans fatty acids.

4. Triangulation means using more than one method to collect data on the same topic. This is a way of assuring the validity of research through the use of a variety of methods to collect data on the same topic, which involves different types of samples as well as methods of data collection.

5. https://www.medpagetoday.com/primarycare/dietnutrition/52263.

The Problem with Protein

“How do you plant-eaters get enough protein?”

You might think that this is a question only asked by people who don’t know much about nutrition; but it is surprising just how many nutritionists, GP’s and writers of nutrition courses ask the same question. In this article, I would like to look at two aspects of protein: firstly, a comparison of protein content in animal and plant foods and, secondly, a look at the dangers of too much (animal) protein in the diet. But first, a quick definition of what protein actually is.

What is protein?

Protein is a nitrogen-containing chemical used to create body tissue as well as other chemicals (for instance, enzymes and hormones) that are very important in terms of participating in metabolism and maintaining the body in working order. Protein molecules are large and composed of long chains (polymers) of carefully sequenced amino acids. There are a huge number of different kinds of proteins, all of which are distinguished by the order that exists for the amino acids in that chain or polymer. The primary function of protein is as the basis for the almost unlimited number of enzymes, and enzymes are the molecules within the body that control metabolism. It is one of the three so-called macronutrients, the other two being fats (lipids) and carbohydrates which are composed of hydrogen and carbon.

It’s useful to understand that these macronutrients – and micronutrients (vitamins and minerals), for that matter – do not exist or function in isolation within the body. They work together as combinations, not as distinctly different entities, also working together within individual molecules. For example, glycoproteins are molecules where proteins and carbohydrates are joined together, while glycolipids are molecules where carbohydrates and lipid-containing substances are joined together. And, of course, you will be familiar with molecules that have a combination of lipids and proteins (lipoproteins) – namely, cholesterol in the form of LDL (low density lipoprotein) and HDL (high density lipoprotein) known as “bad” and “good” cholesterol respectively.

How much protein do I need?

Probably less than you would imagine. Opinions differ from authority to authority, but Professor T Colin Campbell, an expert in the field co-author of The China Study, suggests that calories derived from protein should ideally represent around 8-10% of total daily calorie (kcal) intake. So, for instance, if your daily calorie intake is 2000 calories, this would mean between 160 and 200 calories from protein. And since a gram of protein has 4 kcal of energy, this would be 40-50 grams of protein. Again, as a general rule, most authorities recommend we consume around 0.75 grams of protein for each kilogram of lean body weight. So, if you weigh 60 kilograms, this would imply that you need 45 grams (or 180 kcal) of protein a day. I will cover this subject in more detail in future articles – particularly whether protein intake has to be increased when you increase your levels of physical exercise.

What about protein-deficiency?

As far as my research goes, I have never found a single medical recording of protein deficiency within average western populations. The biggest problem is quite the opposite – excessive protein intake. Regarding the traditional and misinformed idea that people eating an exclusively plant-based diet should be very careful about combining proteins in order to get the right balance of essential amino acids, this is covered in my video The Protein Combining Myth – A Rat’s Tale.

COMPARISON OF PROTEIN CONTENT IN ANIMAL AND PLANT FOODS

For those of you who are making the transition from animal foods to plant foods, the following may well encourage you to ignore the ill-informed warnings about protein deficiency – especially in light of the fact that the greatest danger related to protein is over- not under-consumption.

To show how easy it is to get more than enough protein from plants, the following is a list of the foods and drinks taken from my diary three days ago. You will see that I consumed only 1420 kcal on this particular day, whilst on normal days my calorie intake would be between 2000 and 2500 kcal:

The above foods contained a total of 51.2 grams of protein, which represented 12% of total calories (fats made up 21% and carbohydrates 66%). I chose this day as an example because of the relatively low intake of calories. Normally, even with my usual macronutrient ratios (protein 10%/fat 20%/carbohydrate 70%), my protein intake from plant foods is more than necessary for optimal health and energy levels.

THE DANGERS OF TOO MUCH (ANIMAL) PROTEIN IN THE DIET

Kidney Disease

Most people don’t realise that high animal protein intake and kidney disease have been clearly linked for over 100 years ^{(1., 2.)}. It’s one of the oldest known nutrition links and it has been proven repeatedly that if you take animals with reduced kidney function and give them extra amounts of protein, there is a significant acceleration in the decline of their kidney function. Research has also shown a relationship between increased protein consumption and increased development of kidney cancer. And the relationship between kidney cancer and animal protein consumption is about as strong as any other nutrition cancer linkage. This is why, for a long time, a recommendation for kidney health has been to reduce protein intake.

Cardiovascular Disease

Dr Thomas Campbell mentions a 2016 study ^(3.)which shows that “among two very large American study populations (female nurses and male health professionals), those that consumed the most animal protein compared to plant protein had a higher risk of death, particularly cardiovascular disease. Researchers found that when 3% of energy from plant protein was substituted for an equivalent amount of processed red meat protein, there was a 34% lower risk of death.

These findings are even more impressive when you consider the fact that researchers controlled for age, intake of different types of fat, total energy intake, glycemic index, and intake of whole grains, fiber, fruits and vegetables, smoking, body mass index, vitamin use, physical activity, alcohol intake, history of high blood pressure. In other words, they statistically eliminated many of the beneficial components of plant-based diets to try to isolate the sole effect of dietary protein and still found an effect. When data was adjusted only for age, total energy and fat intake, those consuming the most plant protein were found to have 33% reduced risk of death, 40% reduced risk of cardiovascular death, and 28% reduced risk of cancer death.

This is even more remarkable given the meat-centered diets that study subjects were consuming. Researchers divided the population into groups based on the amount of protein consumed. Even those consuming the most plant-protein consumed almost 60% more animal protein than they did plant protein. None of these groups were consuming anything remotely similar to the whole-food plant-based diet that has been shown to halt or reverse advanced heart disease, diabetes, and early stage prostate cancer.”

Osteoporosis

Can protein have a detrimental effect on bone? Optimal amounts of protein are not only beneficial but essential for bone health since they improve bone mass – as long as sufficient calcium is also in the diet – and thus reduce potential fractures. However, too much dietary protein can have a detrimental effect on bone – that is if protein (in meat, fish and dairy products) is consumed well in excess of bodily needs. This is because excess protein will increase the acidity of bodily fluids and compartments. The knock-on effect of this is that, over an extended period of time, the alkaline minerals (including calcium and phosphorus) will leach from the bones in an attempt to recreate the ideal state of pH homeostasis. During this process some of this calcium released into the bloodstream will be lost in the urine. This situation is further complicated by factors such as the acid/base status of other foods in the diet, the source of the proteins consumed, and the amount of overall calcium intake.

SAD (Stand American Diets) or modern western diets increase the risk of osteoporosis and associated fractures ^(4.)because they are so high in animal proteins – affecting the pH balance as indicated above. Not all proteins are equal in relation to the effect they have on bone. Meat, fish and eggs are thought to be particularly linked to increased urinary excretion of calcium because they are particularly acid-forming in their effects on the body. However, consuming alkaline plant-based foods (which will still contain protein) has a decreasing effect on the amount of calcium excreted as urine. Another factor is the calcium-potassium balance: being found mainly in fruits and vegetables, potassium has an additional alkalising effect, thereby reducing calcium excretion and maintaining bone health. Thus, it is not just a matter of reducing the amount of protein consumed, but ensuring that the appropriate sources and amounts of proteins are balanced with increased fruit and vegetable consumption.

References

1. Robertson, W. G. Miner Electrolyte Metab., 13: 228-234, 1987.

2. Robertson, W. G. et al. Chron. Dis., 32: 469-476, 1979.

3. Song M, Fung T, Hu FB, et al.Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med 2016.

4. Sellmeyer DE , Stone KL , Sebastian A , Cummings SR. The American Journal of Clinical Nutrition [01 Jan 2001, 73(1):118-122]. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group.

Diabetes – The Medical Facts. (WARNING – Disturbing Images)

You hear a lot about diabetes, but you possibly do not get detailed information about the actual processes involved in its development, nor about the specific and, frankly, disturbing consequences of living with this debilitating disease.

This blog goes into some detail and shows some disturbing photos of the results of diabetes. If you do not wish to see these images, you can contact me for a copy of this blog without any images.

I have a very specific reason for covering this issue in such vivid detail: It is no exaggeration to claim that diabetes, particularly but not exclusively type 2 diabetes, is becoming an epidemic in the western world, and not just starting in middle age, but appearing in younger generations. There is solid and reliable evidence that this is due to the western diet – dependent on animal products, low-fibre, high-sugar and fat processed foods, and deficient in whole plant foods.

I will present other articles in defence of this assertion but, for the time being, I want to focus on the disturbing reality of those people who live with diabetes – a largely avoidable chronic disease which has been shown to be both avoidable and reversible by eating a whole food plant-based diet.

Diabetes mellitus ^(1.) (DM) is caused by complete absence, relative deficiency of, or resistance to the hormone insulin.

The most common forms of DM are categorised as type 1 diabetes mellitus or type 2 diabetes mellitus.

Definitions

Type 1 diabetes mellitus

previously known as insulin-dependent diabetes mellitus (IDDM)
mainly occurring in children and young adults
onset is usually sudden and can be life threatening
severe deficiency or absence of insulin secretion due to destruction of β-islet cells of the pancreas
treatment with injections of insulin is required
usually evidence of an autoimmune mechanism that destroys the β-islet cells
genetic predisposition and environmental factors, including viral infections. Diet/lifestyle are also implicated

Type 2 diabetes mellitus

previously known as non-insulin-dependent diabetes mellitus (NIDDM)
most common form of diabetes, accounting for about 90% of cases
causes are multifactorial and predisposing factors include:
- obesity
- sedentary lifestyle
- increasing age: predominantly affecting middle-aged and older adults but increasingly affecting younger groups
- genetic factors
onset is gradual, often over many years
frequently undetected until signs are found on routine investigation or a complication occurs
insulin secretion may be below or above normal
deficiency of glucose inside body cells occurs despite hyperglycaemia (high blood sugar) and high insulin level, possibly because of:
- insulin resistance, i.e. changes in cell membranes that block insulin-assisted movement of glucose into cells.
treatment involves diet and/ or drugs, although sometimes insulin injections are required

Pathophysiology (disease processes) ^(2.) of DM

1. Raised plasma glucose level

After eating a carbohydrate-rich meal the plasma glucose level remains high because:

cells are unable to take up and use glucose from the bloodstream, despite high plasma levels
conversion of glucose to glycogen in the liver and muscles is diminished
gluconeogenesis (non-carbohydrate glucose production) ^(3.) from protein, in response to deficiency of intracellular glucose.

2a. Glycosuria (sugar in urine) ^(4.)and 2b. Polyuria (excessive urination) ^(5.)

a. Glycosuria results in electrolyte imbalance and excretion of urine with a high specific gravity.

b. Polyuria leads to dehydration, extreme thirst (polydipsia) and increased fluid intake.

3. Weight loss

Cells “starved” of glucose – leading to:

gluconeogenesis from amino acids/body protein, causing muscle wasting/tissue breakdown/further increases in blood glucose
catabolism of body fat, releasing some of its energy and excess production of ketone bodies ^(6.)
- very common in type 1 DM
- sometimes occurs in type 2 DM

4. Ketosis ^(7.)and ketoacidosis ^(8.)

generally affects people with type 1 DM – in absence of insulin to promote normal intracellular glucose metabolism, alternative energy sources must be used instead and increased breakdown of fat occurs. Results in:
- excessive production of weakly acidic ketone bodies, which can be used for metabolism by the liver
- ketosis develops as ketone bodies accumulate.
- excretion of ketones is via the urine (ketonuria) and/ or the lungs giving the breath a characteristic smell of acetone or ‘pear drops’.
- ketoacidosis develops owing to increased insulin requirement or increased resistance to insulin.
- if untreated it can lead to:
  - increasing acidosis (↓ blood pH) due to accumulation of ketoacids
  - increasing hyperglycaemia
  - hyperventilation as the lungs excrete excess hydrogen ions as CO2
  - acidification of urine – the result of kidney buffering
  - polyuria as the renal threshold for glucose is exceeded
  - dehydration and hypovolaemia ^(9.)(↓ BP and ↑ pulse) – caused by polyuria
  - disturbances of electrolyte balance accompanying fluid loss:
    - hyponatraemia ^(10.) (↓ plasma sodium) and hypokalaemia ^(11.)(↓ plasma potassium)
    - confusion, coma and death

5, Acute complications of DM

Effects and consequences of diabetic ketoacidosis are outlined above
Hypoglycaemic coma:
- occurs when insulin administered is in excess of that needed to balance the food intake and expenditure of energy
- sudden onset and may be the result of:
  - accidental overdose of insulin
  - delay in eating after insulin administration
  - drinking alcohol on an empty stomach
  - strenuous exercise
  - insulin-secreting tumour
- Common signs and symptoms of hypoglycaemia include:
  - drowsiness
  - confusion
  - speech difficulty
  - sweating
  - trembling
  - anxiety
  - rapid pulse.
  - May progress rapidly to coma without treatment
  - Rapid recovery with treatment M

6. Long-term complications of DM (Type 1 and type 2)

Cardiovascular disturbances
- DM is a significant risk factor for cardiovascular disorders
- Blood vessel abnormalities (angiopathies) may still occur even when the disease is well controlled by medication
- Diabetic macroangiopathy ^(12.). Most common lesions are:
  - atheroma
  - calcification of the tunica media of the large arteries. Resulting in:
    - Often serious and fatal consequences for Type 1 diabetes at a relatively early age.
    - For both Type 1 and Type 2, the most common consequences are serious and often fatal:
      - ischaemic heart disease (angina and myocardial infarction)
      - stroke
      - peripheral vascular disease.

Diabetic microangiopathy ^(13.). This affects small blood vessels and can result in:
- thickening of the epithelial basement membrane of arterioles, capillaries and, sometimes, venules. Leading to:
  - Peripheral vascular disease, progressing to gangrene and ‘diabetic foot’
  - Diabetic retinopathy ^(14.)
  - Visual impairment
  - Diabetic nephropathy ^(15.) and chronic renal failure
  - Peripheral neuropathy ^(16.)causing sensory deficits and motor weakness
- Infection
  - DM predisposes to infection, especially by bacteria and fungi, possibly because phagocyte activity is depressed by insufficient intracellular glucose. Infection may cause:
    - boils and carbuncles
    - vaginal candidiasis ^(17.)
    - pyelonephritis ^(18.)
    - diabetic foot
- Renal failure
  - This is due to diabetic nephropathy ^(15.)and is a common cause of death.

Visual impairment and blindness
- Diabetic retinopathy ^(14.)
  - commonest cause of blindness in adults between 30 and 65 years in developed countries
  - increases the risk of early development of cataracts
  - increase the risk of early development of other visual disorders

Diabetic foot
- Many factors commonly present in DM contribute to the development of this serious situation:
  - disease of large and small blood vessels impairs blood supply to and around the extremities
  - if peripheral neuropathy ^(16.)is present:
    - sensation is reduced
    - a small injury to the foot may go unnoticed, especially when there is visual impairment
    - in DM healing is slower and injuries easily worsen if aggravated, e.g. by chafing shoes
    - often become infected
    - an ulcer may form
    - healing process is lengthy, if at all
    - in severe cases the injured area ulcerates and enlarges
    - may become gangrenous
    - sometimes to the extent that amputation is required.

Why risk or suffer from this truly dreadful disease if the most effective prevention and cure (a WFPB diet) has no side-effects other than improved overall health?

What an unfathomable species we are…

Glossary

” Of or pertaining to honey” – https://en.wiktionary.org/wiki/mellitus.
“The physiological processes associated with disease or injury” – https://en.wiktionary.org/wiki/pathophysiology
“The metabolic process in which glucose is formed, mostly in the liver, from non-carbohydrate precursors” – https://en.wiktionary.org/wiki/gluconeogenesis
“The presence of sugars (especially glucose) in the urine, often as a result of diabetes mellitus” – https://en.wiktionary.org/wiki/glycosuria
“The production of an abnormally large amount of urine; one symptom of diabetes” – https://en.wiktionary.org/wiki/polyuria
“Any of several compounds that are intermediates in the metabolism of fatty acids” – https://en.wiktionary.org/wiki/ketone_body#English.
“A metabolic state in which the body produces ketones to be used as fuel by some organs so that glycogen can be reserved for organs that depend on it. This condition occurs during times of fasting, starvation, or while on a ketogenic weight-loss diet” – https://en.wiktionary.org/wiki/ketosis.
“A severe form of ketosis, most commonly seen in diabetics, in which so much ketone is produced that acidosis occurs” – https://en.wiktionary.org/wiki/ketoacidosis.
“A state of decreased blood volume” – https://en.wiktionary.org/wiki/hypovolemia#English.
“An abnormally low concentration of sodium (or salt) in blood plasma” – https://en.wiktionary.org/wiki/hyponatremia#English.
“The condition of having an abnormally low concentration of potassium ions in the blood” – https://en.wiktionary.org/wiki/hypokalemia#English.
“Angiopathy of the larger blood vessels” – https://en.wiktionary.org/wiki/macroangiopathy.
“Angiopathy of the small blood vessels” – https://en.wiktionary.org/wiki/microangiopathy.
“Non-inflammatory disease of the retina” – https://en.wiktionary.org/wiki/retinopathy.
“Damage to, disease of, or abnormality of the kidneys” – https://en.wiktionary.org/wiki/nephropathy.
“Any disease of the peripheral nervous system” – https://en.wiktionary.org/wiki/neuropathy.
“A fungal infection of any of the Candida (yeast) species” – https://en.wiktionary.org/wiki/candidiasis. Also called “thrush”.
“An ascending urinary tract infection that has reached the pelvis of the kidney” – https://en.wiktionary.org/wiki/pyelonephritis.

Main source of material: Waugh, Anne; Grant, Allison. Ross & Wilson Anatomy and Physiology in Health and Illness E-Book (p. 236-8). Elsevier Health Sciences. Kindle Edition.

Is all scientific research equally valid?

I don’t know about you, but I often get into discussions with people and end up citing research that backs up my claims. It is not uncommon for the other person to say something like “Yea, but I bet there’s other research that says the opposite” or “I don’t trust any research – it’s all biased one way or another…”

So, if you do consider that some research is worthy of respect but get a bit frustrated trying to find research that you can really trust, where do you go to find it?

Some of my usual favourites for nutritional research are PubMed, Nutritionfacts.org, Physicians Committee for Responsible Medicine, Centre for Nutrition Studies, British Journal of Nutrition, There are also lots of nutrition journals, such as The British Journal of Nutrition, Food and Nutrition Sciences, Nutrition Journal, and the Journal of Human Nutrition and Food Science.

But, and it’s a big BUT…There are times when bias can be detected in some of the research that we come across.

For instance, we might discover that the research was funded by an organisation that wanted to see an outcome which was favourable for their purposes – whether academic or financial. Also, it is quite possible that individual researchers within the studies may have had personal or professional bias. And whilst the process of peer-review is meant to ensure a high level of transparency and honesty with the reviewed research, this is sadly not always the case.

However, there is an interesting organisation called the USPSTF (United States Preventive Services Task Force) that I would like to talk about with you. I am not stating any opinion about individual research projects that they have covered, nor am I claiming that they are the gold standard in research that everyone should trust implicitly; however, they have a really interesting method of reviewing current research findings on a given subject and it is this that I want to share with you.

It is their function to review all available published research and then publish a paper that states, in their considered opinion, whether the overall results found (for instance, on the effectiveness of mammograms or prostate cancer screening) suggest that current medical/health practices are helpful, harmful or neutral in their impact on individuals in particular and on society in general. Based on this, they then make recommendations to governments, organisations and individuals.

Their way of doing this is as close to people-power (that is, the empowerment of the average person in the street) as I have found recently in this academic field. This is how it works (cartoons are my addition!):

Recommendations Development Process: A Graphic Overview

Step 1. Topic Nomination

Anyone can nominate a new topic or an update to an existing topic at any time, via the Task Force Web site. The Task Force prioritises topics based on several criteria, including the topic’s relevance to prevention and primary care, importance for public health, potential impact of the recommendation, and whether there is new evidence that may change a current recommendation.

Step 2. Draft and Final Research Plans

Once a topic is selected, the Task Force and researchers from an Evidence-based Practice Centre (EPC), develop a draft research plan for the topic. This plan includes key questions to be answered and target populations to be considered. The draft research plan is posted on the Task Force’s Web site for four weeks, during which anyone [that includes you and me] can comment on the plan. The Task Force and the EPC review all comments and consider them while making any necessary revisions to the research plan. The Task Force then finalises the plan and posts it on its Web site.

Step 3. Draft Evidence Review and Draft Recommendation Statement

Using the final research plan as a guide, EPC researchers gather, review, and analyse evidence on the topic from studies published in peer-reviewed scientific journals. The EPC then develops one or more draft evidence reviews summarising the evidence on the topic. Members discuss the evidence reviews and use the information to determine the effectiveness of a service by weighing the potential benefits and harms. Members then develop a draft recommendation statement based on this discussion. The draft evidence review and draft recommendation statement are posted on the Task Force Web site for four weeks.

Step 4. Final Evidence Review and Final Recommendation Statement

The Task Force and EPC consider all comments on draft evidence reviews and the Task Force considers all comments on the draft recommendation statement. The EPC revises and finalises the evidence reviewed and the Task Force finalises the recommendation statement based on both the final evidence review and the public comments.

All final recommendation statements and evidence reviews are posted on the Task Force’s Web site. The final recommendation statement and a final evidence summary, a document that outlines the evidence it reviewed, are also published in a peer-reviewed scientific journal.

Interesting eh?

Final Comment

Never underestimate the tactics used by both organisations and individuals to misrepresent information in order to mislead the public for their own agendas.

If you come across conflicting and troubling opinions about nutrition (whether expressed by friends and family, in newspapers and magazine, on the TV or internet sites, in research papers or books), you can send me links to the information and I will take a look at it and help you to analyse it in a way that allows you to form your own opinion about the validity of the claims made.

There’s no better way to ensure that you have the motivation to continue with the optimal WFPB dietthan when you know intellectually that your nutrition and lifestyle decisions are backed-up by solid and reliable scientific research.

In future posts, I will outline and review various research methods, as well as introduce some intriguing alternative opinions about nutritional research as expressed by Prof. T Colin Campbell.