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:

  1. 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.
  2. 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.

 

Wholism vs Reductionism – Not Just a War of Words

You may never have heard of these two terms, “wholism” and “reductionism”, but the war between them is not just a war of words, it’s a war of paradigms. One of these paradigms is unfortunately winning most of the battles, and the result is an escalating public health crisis.

First, let’s look at what I mean by “paradigm”. A good example is the difference between geocentric and heliocentric world views that came to a head around the 15th-16th centuries. Before the so-called Copernican Revolution (involving intellectual giants such as Nicolaus Copernicus (1473-1543), Johannes Kepler (1571-1630) and Galileo Galilei (1564-1642), the accepted and, for the most part, unchallenged paradigm was that the Sun and other planets revolved around the Earth, and the stars were all fixed in the heavens, just like it said in the Bible. Post-Revoltion, there was a slow but ultimately complete “paradigm shift” which meant that everyone now accepts that the Earth and other planets revolve around the Sun, and the stars are no longer just pin-pricks in some form of heavenly firmament.

Put simply, in terms of nutrition, wholism (a term adopted by Professor T Colin Campbell from the similar and better-known term “holism”) deals with whole diet and its effects on the whole person; whereas reductionism looks at specific elements of diet and their effect on specific parts of the person (like a specific gene for loving or hating Marmite).

The seemingly unstoppable increase in diet-related chronic diseases, such as type 2 diabetes and obesity, is simply not being addressed by the ever more precise research being undertaken by scientists, whether they are chemists looking at a specific chemical that can target particular cellular behaviour or a geneticist looking at which gene is responsible for the onset of a particular disease.

Of course it’s necessary to narrow one’s visual field to a specific area of investigation when it is appropriate (for instance, using a microscope to distinguish which virus has infected a given tissue sample); but there is a general tendency nowadays within nutritional science to exclusively apply the microscope (metaphorically speaking) to every public health issue.

Let’s look at an example: A recent report revealed that half of our schoolchildren are now dangerously overweight or obese.

A reductionist response could be to look for and try and isolate the gene that causes obesity in children. £millions or even £billions could be poured into expensive genetic research to find this “needle in the haystack”. Whereas a wholistic response could be to look at what societal changes have occurred that might account for this unwelcome change in the health of schoolchildren. You don’t have to be a rocket scientist to see that there has been a significant change in the average diets that schoolchildren are now eating when compared to previous generations.

With the reductionist response, one could expect that years and even decades could pass without anything being discovered, and all the while more and more children are likely to become obese.

With the wholistic approach, a solution could theoretically be found very quickly – legislate to improve school meals, increase junk food taxes, ban advertising of unhealthy foods to children, and so forth. The chances are that obesity statistics would start to improve the more practical efforts were made to change laws, educate parents and improve children’s diets. And whilst it might appear that governments do make some moves in this direction, their efforts to implement substantial solutions end up being quasi-wholistic because they are generally hamstrung by the pressure imposed on them by Big Pharma, Big Medicine and Big Agriculture – and the majority of research funding, whether directly or indirectly (e.g. through universities and other institutions), greatly influences which research is most powerfully supported in government circles and reflected in the media to the public.

But even if simple dietary changes could significantly reduce childhood obesity, it would probably not make the reductionists happy. They would still want to delve down into minutiae and find a biological mechanism that could then be controlled somehow, most likely by a drug that could be patented and sold for profit. There is no profit to be made from people simply changing their diets. And there is certainly no profit to be made by pharmaceutical companies or medical organisations from a population full of healthy people.

But let’s say that the geneticists do find a gene that is strongly associated with childhood obesity. It may still take years or decades of research to transfer that information into a fully-tested and certified treatment, probably in the form of a drug. And even if the obesity pill works in the trials they’ve undertaken, there is no guarantee that it will work within the general population, or that it will be free of serious side-effects only apparent years or decades later (remember Thalidomide?), or if it is too expensive for the majority of people to afford or indeed if the percentage improvement attributable to the drug would bear any comparison with the size of improvement made simply by changing dietary intake.

There is nothing wrong with geneticists exploring the fascinating world of genes, nor is there anything wrong with scientists trying to find what makes one person’s personality different from another’s, or any of the other intriguing questions that beg to be researched and answered by the curious and searching human mind.

What IS a problem, though, is when the ONLY approach to solving scientific problems, particularly those directly linked to public health, is an approach which ignores anything that is “fuzzy” and too…well, human! The funding for most of the scientific research that is undertaken nowadays is only available if there is a tangible and clear hope of achieving a binary, black and white result:

  • 1. A always precedes B.
  • 2. B always follows A.
  • 3. There is no C that could also cause B.

Human behaviour and particularly human nutrition on a population-wide level can never conform to this linear causal pattern. Indeed, even one single cell does not and arguably never can be analysed or understood fully by any amount of analysis – just as can be seen in quantum physics (where electrons can exist in two places at the same time – or cease to exist and reappear elsewhere in ways that can never conform to what we think of as causality), the more we delve into our biochemistry, the more we appreciate how much there is that we can never fully know. Just look at the following diagrammatic representation of just the partial metabolic processes involved in one single cell:

Professor T Colin Campbell explains (1.) the dilemma like this:

“The fact that each nutrient passes through such a maze of reaction pathways suggests that each nutrient also is likely to participate in multiple health and disease outcomes. The one nutrient/one disease relationship implied by reductionism, although widely popular, is simply incorrect. Every nutrient-like chemical that enters this complex system of reactions creates a rippling effect that may extend far into the pool of metabolism. And with every bite of food we eat, there are tens and probably hundreds of thousands of food chemicals entering this metabolism pool more or less simultaneously.”

Whilst it is understandable that the human mind is inquisitive and naturally wants to simplify complexity, is it really essential to map the inter-, intra- and extra-cellular labyrinthine world of the 100 trillion cells comprising the human body before we can identify and apply timely solutions to public health issues?

In any event, our cellular make-up is only one aspect of what constitutes the indefinably complex entity that is a human being. Can we truly ever expect to see a cellular or genetic “cog” that explains what it is to be a friend, a lover, a parent? Why we find beauty in a sunset?

Tackling childhood obesity head-on in the messy “real” world of human populations represents the sort of indeterminate complexity that does not attract large government or institutional funding. More effort goes into producing incomprehensibly complex charts such as the one above than goes into practical measures to help children live full and productive lives. This is not to say that scientists, governments and organisations do not care about the lives of real people – particularly real schoolchildren. Rather, my contention is that they are so wrapped up in doing things the way that things have been done for so long (“stuck inside the paradigm”) that they may, in part, genuinely believe that their way is the ONLY way to solve such public health crises.

This is why I believe it is appropriate to apply the term “paradigm” to the general outlook and approach that science and medicine has been immersed in for at least the past 50 years – probably since the joint effects of two discoveries: the so-called completed list of vitamins and the structure of DNA. It is also the reason why incredibly convincing population studies, such as The China Study, come under attack from reductionist thinkers. They attack such wide-scale population studies because there is no single causal link demonstrated. This is even the case when the study identifies significant differences in health markers (e.g. cancer, heart disease and type 2 diabetes) between those Chinese populations eating the traditional plant-based diets and those Chinese populations that have adopted the Standard American Diet (SAD).

There is good reason for this lack of indisputable causality: and the reason is that it is simply impossible to prove a single causal link between health and diet when, as Professor Campbell indicated above, no single nutritional input ever causes just one single biochemical response. But such linear responses are just what scientists have habitually expected to discover when the overriding world-view they have been exposed to all their academic and professional lives aims to reduce all complexity down to minute and simple mechanics.

You will have heard the saying “The whole is greater than the sum of its parts”. Intuitively obvious, but possibly not so in the majority of research laboratories around the world.

The assumption that it should be possible to find such a causal link is based on a mechanistic reductionist ideal of the Universe. The likes of Ray Kurtzweil et al consider that one day we will be able to understand everything about ourselves – biology, emotions, personality – by drilling down deeper and deeper, smaller and smaller into the world of micro and nano particles until we find all the little “cogs” and see how they are all connected. We will then be able to predict all events in the “macro world” and reproduce them in better ways with far more durable materials than human flesh and blood.

Of course we don’t want to return to an age of religion and mysticism, where all events were caused by unknown and unknowable forces, spirits and demons. Where everything in biology and personality could be accounted for by the four humours – blood, yellow bile, black bile, and phlegm! We all enjoy huge benefits from the application of reductionist approaches to finding causes and cures for TB and smallpox, and without this approach doctors might still be delivering babies with unwashed hands after having chopped up cadavers or been to the toilet, or both.

Also, I can see how a reductionist approach can be very attractive. It’s neat and orderly and avoids that great enemy of the reductionist thinker, namely, uncertainty.

But I propose that the answer to childhood obesity is both complex and simple.

It’s simple because all it requires is that we feed our children the natural diet for our species (ideally consisting completely or in the main part of whole plant foods), while ensuring that they get some regular exercise.

It’s complex because WE – our biochemistry, our personalities, our societies – ARE complex.

But effective and timely solutions to childhood obesity and many other public health crises are much more likely to be found with the help of two eyes rather than the help of a two million pound electron microscope.

Ample evidence already points to dietary change being the major factor needed in order to solve this escalating health problem. So much evidence, indeed, that I have not even bothered to list it in this article. Just scan through the databases of the NCBI or NIHR to see that sufficient research already links obesity to diet. But in spite of this, the main thrust of government and medical policy derives from what is called “Gold Standard” research, where the majority of research funding (and resultant credibility) is assigned to randomised controlled trials (RCT’s) that control all potential extraneous biases. And, clearly, you cannot do with when dealing with the nutritional and behavioural diversity that exists in the wider world of society as a whole.

This situation can be further explained by the analogy of an elephant in a room along with 60,000 blind scientists who are each responsible for describing one individual facet in minute detail. They can talk at length about the life-cycle of one of the thousands of species of bacteria colonising a crack between two toes, or churn out publications on the chemical components of a particular pigment within a hair from its tail. Yes, it’s true that they become incredibly expert in their own field of research, but it takes just one non-visually impaired child running into the room to be able to announce that there’s a bleedin’ great elephant standing there!

And to the surprise of the child, these 60,000 blind researchers with one voice ask “what’s an elephant?”

To those who have their eyes open to the whole picture, they can see that our example of childhood obesity is but one of the many chronic health conditions clearly caused by diet, and it’s always the same diet, the one that contains far too much animal protein, saturated fats, salt, sugar and processed junk, and far too little whole plant foods.

Diet is a “zero-sum” affair. Whenever one unhealthy food item goes into your mouth it means that another more healthy food item didn’t. And it is the cumulative effect of this, meal after meal, day after day, year after year that leads inexorably to the near-epidemic diet-related health issues that are starting to bring our hospitals to a standstill.

A fish is hooked, thrown onto land, flops around for a bit in the air and then escapes back into the water. Eager to tell his fishy buddies about his experience, he starts talking to them about his time out of the water. “What’s water?” they all ask, looking at him as though he’s out of his scaly mind. When water is all that you know, there is no word for it…


You may enjoy another view of this issue by Dr. Michael Greger…


Bibliography

  1. Campbell, T. Colin. Whole: Rethinking the Science of Nutrition (p. 97). BenBella Books, Inc.. 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.