and the critique thereof started by Denise Minger here. I read this book with a point of view derived at from having followed nutrition for over 3 decades, having generated over 20 ref's in Medline re nutrients and heart disease and having published a not-for-profit 11 year old website [health-heart.org] about the topic. With this take of the science, I have the following issues with the Campbell "animal foods are bad, vegetable foods are good and don't use a multivitamin supplement" message:
1. Campbell avoids the topic of total mortality. I have never seen data that these people in China in those years lived longer healthier lives than Westerners.
2. Animal foods raise cholesterol which is bad. The reality is different. For example, central Europeans in the lowest group (quartile) for cholesterol die first. This was the result of a massive study on 150,000 people and ~ 1 million blood analysis/examinations: The Vorarlberg Study. MANY studies support that finding but even 1 discordant data point must be considered; it was not. One ugly fact can destroy a pretty hypothesis.
3. If animal foods are so bad, why did original Inuit not have substantial heart disease, have little high blood pressure and no diabetes? This is another discordant data point not considered: almost no plant food and none of these age-related diseases: Bang & Dyerberg in 1980 AJCN.
4. Campbell et al missed THE most important confounder: homocysteine. This is an amino acid that is extremely corrosive to our structural and functional proteins, and it is high when B vitamin intakes are low. The China Study DID HAVE community pooled blood samples but did not measure that toxin. Moreover, it is mankind's best indicator for low B vitamin intakes [B2, B6, folate i.e. B9, B12 and betaine, once called B14]. The China study found very low levels of B2 and stopped there.
I know, mainstream medicine discards homocysteine as important because its reduction does not quickly cure the diseases it is related to, or causes: heart, bone fractures, Alzheimer's and cancer, but it is a, if not the main, cause or premature decline, and statistically a confounder that HAS TO BE included otherwise nonsensical results are found.
A similar problem is that they apparently did not adjust for selenium and that we know varies tremendously across China and is a major cause of cardiomyopathy. A different issue not discussed and that affects diabetes is that rice eaten in China as a kernel does NOT have the same glycemic response as a grain milled into a powder and then cooked or baked. Same chemicals, different response.
5. Campbell had his start preventing or slowing cancer or pre-cancer in rats and mice given a carcinogen using plant [soy, wheat] based protein versus casein, the main protein in milk. Was this defatted [skim] milk powder [??], was this purified casein [??] or did it contain traces of oxidized cholesterol/steroids, known to affect cancer?? I was unable to find anything about that "casein" used. Is it possible that this casein was not chemically pure casein?
The book also does not give the amino acid differences [normally given per 1000 amino residues] between the proteins used, leaving that aspect unexplained and entirely puzzling. Protein is decomposed into amino acids during digestion and after which about the only difference between plant and animal protein is the lower content [about 1/3rd] in plants of the essential amino acid methionine, not known to cause ill health [if the B-vitamin intakes are optimal]. The book does not deal with the methionine = homocysteine = methylation pathways, known to affect cell health and expression at a fundamental level [epigenetics]. Homocysteine is related to well over 100 diseases and conditions; to Campbell's credit, he mentions its discoverer, McCully, but he then does not follow the implications of above minimal homocysteine.
6. Campbell misrepresents study results, for example those of our common hero, Lester M. Morrison's, and his brilliant early heart disease research. Campbell suggests the benefit was from reduced fat and cholesterol while in reality it probably was by supplementing with "massive vitamin-nutritional supplements" that included methionine [!], betaine and lecithin. Morrison's 1958 book recommends ".. each day B complex vitamins in the most potent form". Morrison promotes [non processed] meats: "Meat is the greatest source of animal protein for human consumption" and he promotes the consumption of liver. Rather than fearing milk, he allows "3 cups of cow's milk whole". [Library of congress book # 58-9308]
Campbell, on the other hand, fervently advises AGAINST the use of vitamin supplements with the only but conditional exceptions of B12 and D. But do vegetarians really store "enough" B12 for 3 years? [no reference given and obviously not enough to minimize homocysteine.] In some rare circumstances he recommends to take a "small" B12 supplement (there is no toxic dose) or to get your "B vitamins and homocysteine checked annually", something that would cost hundreds of dollars more than this superb high-dose no child proof cap multivitamin Twinlab-Daily-One-Without-Iron but without solving deficiency problems that are everywhere. Also, why use the "smallest dose of vitamin D you can find" when not getting sufficient [sic] sunshine. In fact, when the sun is below 45 degrees above the horizon, nobody can make any D3 and what is sufficient? [tip: your shadow has to be shorter than your height when not wearing sunscreen or coverings.] At one point Campbell even mocks vitamin B6, an undisputed deficiency shown to cause rapid atherosclerosis in primates …
From the landmark books by Morrison, McCully, Williams, Willett, Atkins and Pauling (and even low-fat Ornish), there is agreement that a good multivitamin is important if not essential to health and it is here that I believe Campbell's outlier advise does the greatest harm. The science of the micro-nutrients has evolved. Any modern [cooked and/or refined] diet requires a multivitamin and probably the use of plant and fish based omega-3 [the latter in a pill] to allow optimal long-term health. Campbell does not deal with the omega-3 prostaglandins, an unfortunate omission yet he promotes doubt about omega-3's benefit [contrary to the AHA and ISSFAL].
These comments are in addition to the various statistical and methodological comments made by others: when confounders and study results are not all considered, the results cannot be relied upon.
To end on a positive note: "The China Study" has nice sections about the corrupting influence of big industry and big medicine and it has some telling inside and personal stories. My suggestion: this book has to be part of a larger picture and without proper supplementation [that has NEVER shown to degrade people's diets or food choices] it is not sufficiently healthy. To its credit, there is no mention of cholesterol-lowering statin drugs or of other medications that do not extend lives.
Try instead McCully's simplest book about nutrition and heart disease: The Heart Revolution. Here is the simplified homocysteine science that was ignored in Campbell's book: homocysteine's role. Signed, Eddie Vos