The China Study (3 page)

TH E CH I NA STU DY
4
More than forty years ago, at the beginning of my career, I would have
never guessed that food is so closely related to health problems. For years
I never gave much thought to which foods were best to eat. I just ate what
everyone else did: what I was told was good food. We all eat what is tasty or
what is convenient or what our parents taught us to prefer. Most of us live
within cultural boundaries that define our food preferences and habits.
So it was with me. I was raised on a dairy farm where milk was
central to our existence. We were told in school that cow's milk made
strong, healthy bones and teeth. It was Nature's most perfect food . On
our farm, we produced most of our own food in the garden or in the
livestock pastures.
I was the first in my family to go to college. I studied pre-veterinary
medicine at Penn State and then attended veterinary school at the Uni-
versity of Georgia for a year when Cornell University beckoned with
scholarship money for me to do graduate research in "animal nutrition."
I transferred, in part, because they were going to pay me to go to school
instead of me paying them. There I did a master's degree. I was the last
graduate student of Professor Clive McCay, a Cornell professor famed
for extending the lives of rats by feeding them much less food than they
would otherwise eat. My Ph.D. research at Cornell was devoted to find-
ing better ways to make cows and sheep grow faster. I was attempting
to improve on our ability to produce animal protein, the cornerstone of
what I was told was "good nutrition."
I was on a trail to promote better health by advocating the consump-
t i o n of more meat, milk and eggs. It was an obvious sequel to my own
life on the farm and I was happy to believe that the American diet was
the best in the world. Through these formative years, I encountered a
recurring theme: we were supposedly eating the right foods, especially
plenty of high-quality animal protein.
Much of my early career was spent working with two of the most
toxic chemicals ever discovered, dioxin and aflatoxin. I initially worked
at MIT, where I was assigned a chicken feed puzzle. Millions of chicks
a year were dying from an unknown toxic chemical in their feed, and
I had the responsibility of isolating and determining the structure of
this chemical. After two and one-half years, I helped discover dioxin,
arguably the most toxic chemical ever found. This chemical has since
received widespread attention, especially because it was part of the her-
bicide 2,4,5-T, or Agent Orange, then being used to defoliate forests in
the Vietnam War.

5
INTRODUCTION
After leaving MIT and taking a faculty position at Virginia Tech, I
began coordinating technical assistance for a nationwide project in the
Philippines working with malnourished children. Part of the project
became an investigation of the unusually high prevalence of liver can-
cer, usually an adult disease, in Filipino children. It was thought that
high consumption of aflatoxin, a mold toxin found in peanuts and corn,
caused this problem. Aflatoxin has been called one of the most potent
carcinogens ever discovered.
For ten years our primary goal in the Philippines was to improve
childhood malnutrition among the poor, a project funded by the U.S.
Agency for International Development. Eventually, we established about
llO nutrition "self-help" education centers around the country.
The aim of these efforts in the Philippines was simple: make sure that
children were getting as much protein as possible. It was widely thought
that much of the childhood malnutrition in the world was caused by a
lack of protein, especially from animal-based foods . Universities and
governments around the world were working to alleviate a perceived
"protein gap" in the developing world.
In this project, however, I uncovered a dark secret. Children who ate
the highest-protein diets were the ones most likely to get liver cancer! They
were the children of the wealthiest families.
I then noticed a research report from India that had some very pro-
vocative, relevant findings. Indian researchers had studied two groups
of rats. In one group, they administered the cancer-causing aflatoxin,
then fed a diet that was composed of 20% protein, a level near what
many of us consume in the West. In the other group, they administered
the same amount of aflatoxin, but then fed a diet that was only com-
p o s e d of 5% protein. Incredibly, every Single animal that consumed the
20% protein diet had evidence of liver cancer, and every single animal
that consumed a 5% protein diet avoided liver cancer. It was a 100 to 0
score, leaving no doubt that nutrition trumped chemical carcinogens,
even very potent carcinogens, in controlling cancer.
This information countered everything I had been taught. It was
heretical to say that protein wasn't healthy, let alone say it promoted
cancer. It was a defining moment in my career. Investigating such a
provocative question so early in my career was not a very wise choice.
Questioning protein and animal-based foods in general ran the risk of
my being labeled a heretic, even if it passed the test of "good science."
But I never was much for following directions just for the sake of

THE CHINA STUDY
6
following directions. When I first learned to drive a team of horses or
herd cattle, to hunt animals, to fish our creek or to work in the fields ,
I came to accept that independent thinking was part of the deal. It had
to be. Encountering problems in the field meant that I had to figure out
what to do next. It was a great classroom, as any farm boy can tell you.
That sense of independence has stayed with me until today.
So, faced with a difficult decision, I decided to start an in-depth labora-
tory program that would investigate the role of nutrition, especially pro-
tein, in the development of cancer. My colleagues and I were cautious in
framing our hypotheses, rigorous in our methodology and conservative
in interpreting our findings . I chose to do this research at a very basic sci-
ence level, studying the biochemical details of cancer formation. It was
important to understand not only whether but also how protein might
promote cancer. It was the best of all worlds. By carefully follOwing the
rules of good science, I was able to study a provocative topic without pro-
voking knee-jerk responses that arise with radical ideas. Eventually, this
research became handsomely funded for twenty-seven years by the best-
reviewed and most competitive funding sources (mostly the National In-
stitutes of Health (NIH), the American Cancer SOciety and the American
Institute for Cancer Research). Then our results were reviewed (a second
time) for publication in many of the best scientific journals.
What we found was shocking. Low-protein diets inhibited the initia-
t i o n of cancer by aflatoxin, regardless of how much of this carcinogen
was administered to these animals. After cancer initiation was com-
pleted , low-protein diets also dramatically blocked subsequent cancer
growth. In other words, the cancer-producing effects of this highly car-
cinogenic chemical were rendered insignificant by a low-protein diet. In
fact, dietary protein proved to be so powerful in its effect that we could tum
on and tum off cancer growth simply by changing the level consumed.
Furthermore, the amounts of protein being fed were those that we
humans routinely consume. We didn't use extraordinary levels, as is so
often the case in carcinogen studies.
But that's not all. We found that not all proteins had this effect. What
protein conSistently and strongly promoted cancer? Casein, which
makes up 87% of cow's milk protein, promoted all stages of the cancer
process. What type of protein did not promote cancer, even at high lev-
els of intake? The safe proteins were from plants, including wheat and
soy. As this picture came into view, it began to challenge and then to
shatter some of my most cherished assumptions.

7
INTRODUCTION
These experimental animal studies didn't end there. I went on to
direct the most comprehensive study of diet, lifestyle and disease ever
done with humans in the history of biomedical research. It was a mas-
sive undertaking jointly arranged through Cornell University, Oxford
University and the Chinese Academy of Preventive Medicine. The New
York Times called it the "Grand Prix of Epidemiology." This project
surveyed a vast range of diseases and diet and lifestyle factors in rural
China and, more recently, in Taiwan. More commonly known as the
China Study, this project eventually produced more than 8,000 statisti-
cally significant associations between various dietary factors and disease!
What made this project especially remarkable is that, among the
many associations that are relevant to diet and disease, so many pointed
to the same finding: people who ate the most animal-based foods got
the most chronic disease. Even relatively small intakes of animal-based
food were associated with adverse effects. People who ate the most
plant-based foods were the healthiest and tended to avoid chronic dis-
ease. These results could not be ignored. From the initial experimental
animal studies on animal protein effects to this massive human study
on dietary patterns, the findings proved to be consistent. The health
implications of consuming either animal or plant-based nutrients were
remarkably different.
I could not, and did not, rest on the findings of our animal studies
and the massive human study in China, however impressive they may
have been. I sought out the findings of other researchers and clinicians.
The findings of these individuals have proved to be some of the most
exciting findings of the past fifty years.
These findings-the contents of Part II of this book-show that heart
disease, diabetes and obesity can be reversed by a healthy diet. Other
research shows that various cancers, autoimmune diseases, bone health,
kidney health, vision and brain disorders in old age (like cognitive dys-
function and Alzheimer's) are convincingly influenced by diet. Most im-
portantly, the diet that has time and again been shown to reverse and/or
prevent these diseases is the same whole foods, plant-based diet that I
had found to promote optimal health in my laboratory research and in
the China Study. The findings are consistent.
Yet, despite the power of this information, despite the hope it gener-
ates and despite the urgent need for this understanding of nutrition and
health, people are still confused. I have friends with heart disease who
are resigned and despondent about being at the mercy of what they

8                            THE CHINA STUDY
consider to be an inevitable disease. I've talked with women who are so
terrified of breast cancer that they wish to have their own breasts, even
their daughters' breasts, surgically removed, as if that's the only way to
minimize risk. So many of the people I have met have been led down a
path of illness, despondence and confusion about their health and what
they can do to protect it.
Americans are confused, and I will tell you why The answer, dis-
c u s s e d in Part IV, has to do with how health information is generated
and communicated and who controls such activities. Because I have
been behind the scenes generating health information for so long, I
have seen what really goes on-and I'm ready to tell the world what is
wrong with the system. The distinctions between government, indus-
try, science and medicine have become blurred. The distinctions be-
t w e e n making a profit and promoting health have become blurred. The
problems with the system do not come in the form of Hollywood-style
corruption. The problems are much more subtle, and yet much more
dangerous. The result is massive amounts of miSinformation, for which
average American consumers pay twice. They provide the tax money to
do the research, and then they proVide the money for their health care
to treat their largely preventable diseases.
This story, starting from my personal background and culminating
in a new understanding of nutrition and health, is the subject of this
book. Six years ago at Cornell University, I organized and taught a new
elective course called Vegetarian Nutrition. It was the first such course
on an American university campus and has been far more successful
than I could have imagined. The course focuses on the health value of a
plant-based diet. After spending my time at MIT and Virginia Tech, then
coming back to Cornell thirty years ago, I was charged with the task
of integrating the concepts and principles of chemistry, biochemistry,
physiology and toxicology in an upper-level course in nutrition.
After four decades of scientific research, education and policy making
at the highest levels in our society, I now feel I can adequately integrate
these disciplines into a cogent story That's what I have done for my
most recent course, and many of my students tell me that their lives are
changed for the better by the end of the semester. That's what I intend
to do for you; I hope your life will be changed as well.

.
_____ [t___
I    -
~a
THE CHINA STUDY

._..__.._.._____........._______~___ .._ ..______._._.._... __
_____... ....... .__ ..1 .___ _..__ ... ...._
._
Problems We Face,
Solutions We Need
"He who does not know Jood, how can he
understand the diseases oj man?"
-Hippocrates, the father of medicine (460--357 B. C.)
ON A GOLDEN MORNING IN 1946, when summer was all tuckered out and
fall wanted to be let in, all you could hear on my family's dairy farm was
quiet. There was no growl from cars driving by or airplanes burning
trails overhead. Just quiet. There were the songbirds, of course, and the
cows, and the roosters who would chime in once in a while, but these
noises merely filled out the quiet, the peace.
Standing on the second floor of our bam, with the immense brown
doors gaping open, allowing the sun to soak through, I was a happy
twelve-year-old. I had just finished a big country breakfast of eggs, ba-
con, sausage, fried potatoes and ham with a couple of glasses of whole
milk. My mom had cooked a fantastic meal. I had been working up my
appetite since 4:30 A.M., when I had gotten up to milk the cows with my
father Tom and my brother Jack.
My father, then forty-five, stood with me in the quiet sun. He opened
a fifty-pound sack of alfalfa seed, dumped all the tiny seeds on the
11