The China Study (15 page)

92                          THE CHINA STUDY
the review of the research literature and the interpretation of the evi-
dence were too focused on looking for a specific fiber as the responsible
cause. Finding none, the fiber hypothesis was dismissed.
It was a mistake. The China Study provided evidence that there is
a link with certain cancers. The results showed that high-fiber intake
was consistently associated with lower rates of cancers of the rectum
and colon. High-fiber intakes also were associated with lower levels of
blood cholesterol. l •1I Of course, high-fiber consumption reflected high
plant-based food consumption; foods such as beans, leafy vegetables
and whole grains are all high in fiber.
ANTIOXIDANTS, A BEAUTIFUL COLLECTION
One of the more obvious characteristics of plants is their wide range
of bright colors. If you admire how food is presented, it's hard to beat
a plate of fruits and vegetables. The reds, greens, yellows, purples and
oranges of plant foods are tempting and very healthy. This link between
nicely colored vegetables and their exceptional health benefits has often
been noted. It turns out that there is a beautiful, scientifically sound
story behind this colorlhealth link.
The colors of fruits and vegetables are derived from a variety of chem-
icals called antioxidants. These chemicals are almost exclusively found
in plants. They are only present in animal-based foods to the extent that
animals eat them and store a small amount in their own tissues.
Living plants illustrate nature's beauty, both in color and in chemis-
try. They take the energy of the sun and transform it into life through
the process of photosynthesis. In this process, the sun's energy is first
turned into simple sugars, and then into more complex carbohydrates,
fats and proteins.
This complex process amounts to some pretty high-powered activity
within the plant, all of which is driven by the exchange of electrons be-
tween molecules. Electrons are the medium of energy transfer. The site
at which photosynthesis takes place is a bit like a nuclear reactor. The
electrons zooming around in the plant that are changing the sunlight
into chemical energy must be managed very carefully. If they stray from
their rightful places in the process, they may create free radicals, which
can wreak havoc in the plant. It would be like the core of a nuclear reac-
tor leaking radioactive materials (free radicals) that can be very danger-
ous to the surrounding area.
So how does the plant manage these complex reactions and protect

LESSONS FROM (HINA                            93
against errant electrons and free radicals? It puts up a shield around
potentially dangerous reactions that sponges up these highly reactive
substances. The shield is made up of antioxidants that intercept and
scavenge electrons that might otherwise stray from their course.
Antioxidants are usually colored because the same chemical property
that sponges up excess electrons also creates visible colors. Some of
these antioxidants are called carotenoids, of which there are hundreds.
They vary in color from the yellow color of beta-carotene (squash), to
the red color of lycopene (tomatoes), to the orange color of the odd-
s o u n d i n g crytoxanthins (oranges). Other antioxidants may be colorless
and these include chemicals such as ascorbic acid (vitamin C) and vita-
m i n E, which act as antioxidants in other parts of plants that need to be
protected from the hazards of wayward electrons.
What makes this remarkable process relevant for us animals, howev-
er, is that we produce low levels of free radicals throughout our lifetime.
Simply being exposed to the sun's rays, to certain industrial pollutants
and to improperly balanced nutrient intakes creates a background of
unwanted free radical damage. Free radicals are nasty. They can cause
our tissues to become rigid and limited in their function. It is a bit like
old age, when our bodies become creaky and stiff. To a great extent, this
is what aging is. This uncontrolled free radical damage also is part of the
processes that give rise to cataracts, to hardening of the arteries, to can-
cer, to emphysema, to arthritis and many other ailments that become
more common with age.
But here's the kicker: we do not naturally build shields to protect
ourselves against free radicals. As we are not plants, we do not carry
out photosynthesis and therefore do not produce any of our own anti-
oxidants. Fortunately the antioxidants in plants work in our bodies the
same way they work in plants. It is a wonderful harmony. The plants
make the antioxidant shields, and at the same time make them look in-
credibly appealing with beautiful, appetizing colors. Then we animals,
in turn, are attracted to the plants and eat them and borrow their antiox-
i d a n t shields for our own health. Whether you believe in God, evolution
or just coincidence, you must admit that this is a beautiful, almost spiri-
tual, example of nature's wisdom.
In the China Study, we assessed antioxidant status by recording the
intakes of vitamin C and beta-carotene and measuring the blood levels
of vitamin C, vitamin E and carotenoids. Among these antioxidant bio-
markers, vitamin C provided the most impressive evidence.

THE CHINA STUDY
94
The most significant vitamin C association with cancer was its re-
l a t i o n s h i p with the number of cancer-prone families in each areaY
When levels of vitamin C in the blood were low, these families were
more likely to have a high incidence of cancer. III Low vitamin C was
prominently associated with higher risk for esophageal cancer,Ill for
leukemia and cancers of the nasopharynx, breast, stomach, liver,
rectum, colon and lung. It was esophageal cancer that first attracted
NOVA television program producers to report on cancer mortality in
China. It was this television program that spurred our own survey
to see what was behind this story. Vitamin C primarily comes from
fruit, and eating fruit was also inversely associated with esophageal
cancer. II 43 Cancer rates were five to eight times higher for areas where
fruit intake was lowest. The same vitamin C effect existing for these
cancers also existed for coronary heart disease, hypertensive heart dis-
ease and strokeY Vitamin C intake from fruits clearly showed a power-
ful protective effect against a variety of diseases.
The other measures of antioxidants, blood levels of alpha and beta-
c a r o t e n e (a vitamin precursor) and alpha and gamma tocopherol (vita-
m i n E) are poor indicators of the effects of antioxidants. These antioxi-
d a n t s are transported in the blood by lipoprotein, which is the carrier of
"bad" cholesterol. So anytime we measured these antioxidants, we were
Simultaneously measuring unhealthy biomarkers. This was an experi-
m e n t a l compromise that diminished our ability to detect the beneficial
effects of the carotenoids and the tocopherols, even when these benefits
are known to exist. 44 We did, however, find that stomach cancer was
higher when the blood levels of beta-carotene were lower.45
Can we say that vitamin C, beta-carotene and dietary fiber are solely
responsible for preventing these cancers? In other words, can a pill con-
t a i n i n g vitamin C and beta-carotene or a fiber supplement create these
health effects? No. The triumph of health lies not in the individual nu-
trients, but in the whole foods that contain those nutrients: plant-based
foods. In a bowl of spinach salad, for example, we have fiber, antioxi-
d a n t s and countless other nutrients that are orchestrating a wondrous
symphony of health as they work in concert within our bodies. The
message could not be Simpler: eat as many whole fruits, vegetables and
whole grains as you can, and you will probably derive all of the benefits
noted above as well as many others.
I have been making this point about the health value of whole plant-
b a s e d foods ever since vitamin supplements were introduced on a large

95
LESSONS FROM CHINA
scale in the marketplace. And I have watched in dismay how the indus-
try and the media convinced so many Americans that these products
represent the same good nutrition as do whole, plant-based foods. As
we shall see in the later chapters, the promised health benefits of tak-
i n g Single-nutrient supplements are proving to be highly questionable.
The "take-home message": if you want vitamin C or beta-carotene, don't
reach for the pill bottle-reach for the fruit or leafy green vegetables.
THE ATKINS CRISIS
In case you haven't noticed, there is an elephant in the room. It goes by
the name "low-carb diet," and it has become very popular. Almost all
diet books on store shelves are variations of this one theme: eat as much
protein, meat and fat as you want, but stay away from those "fatty"
carbs. As you have seen already in this book, my research findings and
my point of view show that eating this way is perhaps the single great-
e s t threat to American health we currently face. So what is the story,
anyway?
One of the fundamental arguments at the beginning of most low-
carbohydrate, high-protein diet books is that America has been wallow-
ing in low-fat mania at the advice of experts for the past twenty years,
yet people are fatter than ever. This argument has an intuitive appeal,
but there is one inconvenient fact that is consistently ignored: accord-
ing to a report46 summarizing government food statistics, "Americans
consumed thirteen pounds [my emphasis] more [added] fats and oils
per person in 1997 than in 1970, up from 52.6 to 65.6 pounds. " It is
true that we have had a trend to consuming fewer of our total calories
as fat, when considered as a percentage, but that's only because we have
outpaced our gorging on fat by gorging on sugary junk food. Simply by
looking at the numbers, anybody can see that America has not adopted
the "low-fat" experiment-not by any stretch of the imagination.
In fact, the claim that the low-fat "brainwashing" experiment has
been tried and failed is often the first of many statements of fact in
current diet books that can be described either as severe ignorance or
opportunistic deceit. It is difficult to know where to begin to refute the
maze of misinformation and false promises commonly made by authors
completely untrained in nutrition, authors who have never conducted
any peer-reviewed, professionally based experimental research. And
yet these books are immensely popular. Why? Because people do lose
weight, at least in the short term.

96                            THE CHINA STUDY
In one published study47 funded by the Atkins Center for Comple-
m e n t a r y Medicine, researchers put fifty-one obese people on the Atkins
diet. 48 The forty-one subjects who maintained the diet over the course
of six months lost an average of twenty pounds. In addition, average
blood cholesterol levels decreased slightly,47 which was perhaps even
more important. Because of these two results, this study was presented
in the media as real, scientific proof that the Atkins diet works and is
safe. Unfortunately, the media didn't go much deeper than that.
The first sign that all is not rosy is that these obese subjects were
severely restricting their calorie intake during the study. The average
American consumes about 2,250 calories per day.49 When the study
participants were on the diet, they consumed an average of 1,450 calo-
ries per day. That's 35% fewer calories! I don't care if you eat worms
and cardboard; if you eat 35% fewer calories, you will lose weight and
your cholesterol levels will improve50 in the short run, but that is not to
say that worms and cardboard form a healthy diet. One may argue that
those 1,450 calories are so satisfying that people feel full on this diet,
but if you compare calorie input and calorie expenditure, it's a matter
of simple math that a person cannot sustain this amount of calorie re-
s t r i c t i o n over a period of years or decades without either becoming an
invalid or melting away into nothing. People are notoriously unsuccess-
ful at significantly restricting their energy intake over any long period of
time, and that is why there has yet to be a long-term study that shows
success with the "low-carb" diets. This, however, is only the beginning
of the problems.
In this same study, funded by the Atkins group, researchers report,
"At some point during the twenty-four weeks, twenty-eight subjects
(68%) reported constipation, twenty-six (63%) reported bad breath,
twenty-one (51%) reported headache, four (10%) noted hair loss, and
one woman (1%) reported increased menstrual bleeding. "47 They also
refer to other research, saying, "Adverse effects of this diet in children
have included calcium oxalate and urate kidney stones ... vomiting,
amenorrhea [when a girl misses her period], hypercholesterolemia
[high cholesterol] and ... vitamin deficiencies (ref. cited). "47 Addition-
ally, they found that the dieters had a stunning 53% increase in the
amount of calcium they excreted in their urine,47 which may spell di-
s a s t e r for their bone health. The weight loss, some of which is simply
initial fluid 10SS,51 may come with a very high price.
A different review of low-carbohydrate diets published by research-

LESSONS FROM (HINA                               97
ers in Australia concludes, "Complications such as heart arrhythmias,
cardiac contractile function impairment, sudden death, osteoporosis,
kidney damage, increased cancer risk, impairment of physical activity
and lipid abnormalities can all be linked to long-term restriction of car-
b o h y d r a t e s in the diet."51 One teenage girl recently died suddenly after
being on a high-protein diet. 52,53 In short, most people will be unable to
maintain this diet for the rest of their lives, and even if anybody man-
ages to do so, they may be asking for serious health problems down the
road. I have heard one doctor call high-protein, high-fat, low-carbohy-
d r a t e diets "make-yourself-sick" diets, and I think that's an appropri-
ate moniker. You can also lose weight by undergoing chemotherapy or
starting a heroin addiction, but I wouldn't recommend those, either.
One final thought: the diet is not all that Atkins recommends. Indeed,
most diet books are merely one part of huge food and health empires.
In the case of the Atkins diet, Dr. Atkins states that many of his patients
require nutrient supplements, some of which are used to combat "com-
m o n dieters' problems."54 In one passage, after making unsubstantiated
claims about the efficacy of antioxidant supplements that contradict
recent studies,55 he writes, "Add to the [antioxidants] the vita-nutri-
ents known to be useful for each of the myriad medical problems my
patients face , and you'll see why many of them take over thirty vitamin
pills a day."56 Thirty pills a day?
There are snake oil salesmen, who have no professional research,
professional training or profeSSional publications in the field of nutri-
tion, and there are scientists, who have formal training, have conducted
research and have reported on their findings in professional forums.
Perhaps it is a testament to the power of modern marketing savvy that
an obese man with heart disease and high blood pressure 57 became one
of the richest snake oil salesmen ever to live, selling a diet that promises
to help you lose weight, to keep your heart healthy and to normalize
your blood pressure.
THE TRUTH ABOUT CARBOHYDRATES
An unfortunate outcome of the recent popularity of diet books is that
people are more confused than ever about the health value of carbo-
hydrates. As you will see in this book, there is a mountain of scientific
evidence to show that the healthiest diet you can possibly consume is
a high-carbohydrate diet. It has been shown to reverse heart disease,
reverse diabetes, prevent a plethora of chronic diseases, and yes, it has