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{{short description|2005 non-fiction book by T. Colin Campbell and Thomas M. Campbell II}}
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The authors conclude that people who eat a predominantly whole-food, [[vegan diet]]—avoiding animal products as a source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined [[carbohydrate]]s—will escape, reduce, or reverse the development of numerous diseases. They write that "eating foods that contain any [[cholesterol]] above 0 mg is unhealthy."<ref>{{harvnb|Campbell|Campbell II|2005|p=132}}</ref> The book recommends sunshine exposure or [[dietary supplements]] to maintain adequate levels of [[vitamin D]], and supplements of [[vitamin B12|vitamin B<sub>12</sub>]] in case of complete avoidance of animal products.<ref>{{harvnb|Campbell|Campbell II|2005|pp=232, 242, 361ff}}</ref> It criticizes [[Low-carbohydrate diet|low-carb diets]], such as the [[Atkins Nutritional Approach|Atkins diet]], which include restrictions on the percentage of [[calories]] derived from carbohydrates<ref>{{harvnb|Campbell|Campbell II|2005|pp=95–96}}</ref> The authors are critical of [[Reductionism|reductionist]] approaches to the study of nutrition, whereby certain nutrients are blamed for disease, as opposed to studying patterns of nutrition and the interactions between nutrients.<ref>{{cite book|last1=Scrinis |first1=Gyorgy |title=Nutritionism: The Science and Politics of Dietary Advice |publisher=Columbia University Press |year=2013 |page=16}}</ref>
The authors conclude that people who eat a predominantly whole-food, [[vegan diet]]—avoiding animal products as a source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined [[carbohydrate]]s—will escape, reduce, or reverse the development of numerous diseases. They write that "eating foods that contain any [[cholesterol]] above 0 mg is unhealthy."<ref>{{harvnb|Campbell|Campbell II|2005|p=132}}</ref> The book recommends sunshine exposure or [[dietary supplements]] to maintain adequate levels of [[vitamin D]], and supplements of [[vitamin B12|vitamin B<sub>12</sub>]] in case of complete avoidance of animal products.<ref>{{harvnb|Campbell|Campbell II|2005|pp=232, 242, 361ff}}</ref> It criticizes [[Low-carbohydrate diet|low-carb diets]], such as the [[Atkins Nutritional Approach|Atkins diet]], which include restrictions on the percentage of [[calories]] derived from carbohydrates<ref>{{harvnb|Campbell|Campbell II|2005|pp=95–96}}</ref> The authors are critical of [[Reductionism|reductionist]] approaches to the study of nutrition, whereby certain nutrients are blamed for disease, as opposed to studying patterns of nutrition and the interactions between nutrients.<ref>{{cite book|last1=Scrinis |first1=Gyorgy |title=Nutritionism: The Science and Politics of Dietary Advice |publisher=Columbia University Press |year=2013 |page=16}}</ref>

== Contents ==
''The China Study'' is divided into four parts. In the first, ''The China Study'', the authors describe some of the health problems faced by Americans, early lab work by T. Colin Campbell, and the epidemiological study known as the China Study. In Part II, ''Diseases of Affluence'', the authors discuss each of the diseases separately along with scientific studies of their links to diet. In Part III, ''The Good Nutrition Guide'', they give their recommendations for a healthy diet. Finally, in Part IV, ''Why Haven't You Heard This Before?'', they argue that there are systemic problems in science, academia and government that tend to suppress information on the role of diet in preventing disease.<ref name=CampbellRev2>{{harvnb|Campbell|Campbell II|2016}}</ref>

=== Part I: The China Study ===
==== Chapter 1: ''Problems We Face, Solutions We Need'' ====
In Chapter 1, the authors describe worsening epidemics of cancer, [[Obesity in the United States|obesity]] and [[diabetes]] in the United States. They note that the medical system is the third highest cause of death. It is also the most expensive in the world and rapidly becoming more expensive. While good nutrition can solve many of these problems, the American public is getting a lot of contradictory advice on nutrition and is harmed by a series of [[diet fads]]. The authors introduce their recommendation, which is to avoid animal-based foods and eat whole, plant-based foods.<ref name=CampbellRev2/>{{rp|Chapter 1}}

==== Chapter 2: ''A House of Proteins'' ====
Chapter 2 examines the history of [[protein (nutrient)|protein]] research and the emphasis on protein in dietary recommendations. In particular, animal protein is described as "high quality" because it comes close to matching the balance of [[amino acid]]s in human protein, while vegetarians believe that they must carefully match ingredients to get all the amino acids they need. However, the authors state that the human body can synthesize all the amino acids it needs from a varied plant diet. Colin Campbell describes how he began with a traditional view of the importance of protein, but some research changed his mind. A study of nutrition in the Philippines found that fungus in peanuts and corn was producing [[aflatoxin]], a potent carcinogen; and the highest rates of liver cancer were in affluent families where the children had abundant protein. He also found a research paper from India that showed a strong association between protein consumption and liver cancer in rats. The rest of the chapter describes topics in research methodology, including the [[Correlation does not imply causation|difference between correlation and causation]], [[statistical significance]], [[mechanism of action|mechanisms of action]] and [[meta-analysis]].<ref name=CampbellRev2/>{{rp|Chapter 2}}

==== Chapter 3: ''Turning off cancer'' ====
Chapter 3 begins with a description of the deep public interest in [[carcinogen]]s. An example is [[nitrite]]s, chemicals found in foods such as [[hot dog]]s, [[bacon]] and canned meat. In the rats, these were "anticipated to be human carcinogens" based on laboratory studies with rats. The authors emphasize that these studies exposed the rats to enormous quantities of nitrites, and the effect on cancer rates was modest (in one study, rising from 5% to 10%). Colin Campbell then describes coming across an Indian research paper in which lowering the intake of protein reduced cancer from 100% to 0%.<ref name=CampbellRev2/>{{rp|Chapter 3}}

The rest of the chapter discusses research that Campbell and colleagues did on the relationship between diet and cancer. He describes three stages of cancer. In the ''initiation'' phase, a carcinogen enters a cell and is metabolized by an enzyme called [[mixed-function oxidase]] (MFO). Although the products of this metabolism are mostly safe, there are some toxic byproducts that can damage DNA. In the ''promotion'' phase, tumors grow from tiny clusters of cells called ''foci''. This phase is reversible, depending on the balance between ''promoters'' that feed growth and ''anti-promoters'' that inhibit it. Finally, ''progression'' is the spreading of the cancer from its source to neighboring parts of the body, at which point it is considered [[malignancy|malignant]].<ref name=CampbellRev2/>{{rp|Chapter 3}}

Rats were fed aflatoxin and varying amounts of protein (between 5% and 20% of their diet). A low-protein diet greatly reduced tumor initiation by several mechanisms; for example, enzyme activity dropped and fewer toxins binded to DNA.<ref name=CampbellRev2/>{{rp|44–45}} In the promotion phase, the development of foci was "almost entirely dependent on how much protein was consumed, regardless of how much aflatoxin was consumed."<ref name=CampbellRev2/>{{rp|46}} They developed if the protein content exceeded the amount (12%) that their bodies required to grow, and focal growth could be switched on or off by varying the protein.<ref name=CampbellRev2/>{{rp|48}} Finally, a population of several hundred rats were studied over 100 weeks, close to the normal lifetime of a rat. At the end of this period, all rats on the 5% diet were "alive and active, with sleek hair coats"<ref name=CampbellRev2/>{{rp|52}} while all those on the 20% diet were dead.<ref name=CampbellRev2/>{{rp|52}} Much the same results were obtained in studies of liver cancer and diet in mice.<ref name=CampbellRev2/>{{rp|54}}

In the above experiments, the rats were fed [[casein]], the dominant protein in cow's milk. However, plant proteins such as [[gluten]] (from wheat) and soy protein did not promote the growth of tumors, even at the higher levels.<ref name=CampbellRev2/>{{rp|51}} The conclusion is that animal-based foods increase tumor development while plant-based foods decrease it. However, the chapter ends by noting that experiments involving rats do not provide quantitative information on the effect of diet on humans. This serves as an introduction to the next chapter.<ref name=CampbellRev2/>{{rp|Chapter 3}}

==== Chapter 4: ''Lessons From China'' ====
Chapter 4 discusses the [[China–Cornell–Oxford Project]], a massive epidemiological study conducted in the 1980s, also referred to as the China Study. The book takes its title from this study.{{refn|Over the strong objections of the authors, who proposed 200 alternate titles but were overruled by the publisher.<ref name=ReplyToMinger>{{cite web |last1=Campbell |first1=T. Colin |title=A Response to Denise Minger's Critique of The China Study |url=https://nutritionstudies.org/minger-critique/ |website=T. Colin Campbell Center for Nutrition Studies |access-date=27 August 2020 |date=11 July 2010}}</ref>}} It built on a national survey in the 1970s that collected data on mortality for 96% of Chinese citizens and produced an atlas of rates for each kind of disease (of which there were more than four dozen)<ref name=CampbellRev2/>{{rp|65}} cancer by region. Rates for some cancers varied by a factor of over 100, a far greater variation than in the United States.<ref name=CampbellRev2/>{{rp|60–61}}

With colleagues Junshi Chen and Junyao Li from China and [[Richard Peto]] of Oxford University, Colin Campbell led a study that encompassed 65 counties in China with 100 adults per county. This involved questionnaires, blood tests, urine samples and [[food sampling|food samples]] from local marketplaces.<ref name=CampbellRev2/>{{rp|62}} They found that diseases tended to be in one of two groups: diseases of affluence (cancer, diabetes, and heart disease) and diseases of poverty (such as [[pneumonia]], [[Peptic ulcer disease|peptic ulcer]], and pulmonary [[tuberculosis]]).<ref name=CampbellRev2/>{{rp|65–66}}

One of the strongest predictors of the diseases of affluence (also referred to as Western diseases) was blood cholesterol. The average level in China was 127&nbsp;mg/dL (far less than the American average of 215&nbsp;mg/dL) and the county averages were as low as 94&nbsp;mg/dL. The death rate from heart disease was 17 times lower than in America, yet still was strongly dependent on cholesterol level. The blood cholesterol was in turn strongly correlated with animal protein intake, even though Chinese consumed about ten time less on average than Americans.<ref name=CampbellRev2/>{{rp|67–68}} In particular, liver cancer was strongly associated with cholesterol level, as well as chronic infection with the [[hepatitis B virus]] ("the virus provides the gun, and bad nutrition pulls the trigger.") The association with cholesterol was consistent with the lab studies described in the previous chapter.<ref name=CampbellRev2/>{{rp|93–94}}

The chapter examines the role of various components of animal and plant food. Previous international studies had shown a correlation between dietary fat and breast cancer, although only with fat from animals. The China Study found a consistent web of correlations between consumption of animal-based foods and breast cancer as well as a host of risk factors for breast cancer, including age of [[menarche]], [[estrogen]] levels and cholesterol.<ref name=CampbellRev2/>{{rp|71–78}} Dietary fiber, which is found only in plants, has benefits including an ability to gather up harmful chemicals from the intestines, but there were claims that it inhibited the uptake of iron. The China Study provided evidence for an increase in iron absorption with an increase in fiber because high-fiber foods are also high in iron. Where iron levels were low, in some rural areas, the problem was associated with parasitic diseases.<ref name=CampbellRev2/>{{rp|78–80}}

Another class of chemicals found almost exclusively in plants is the [[antioxidant]]s such as [[carotenoid]]s, [[ascorbic acid]] (vitamin C) and vitamin E. These provide much of the color in plant food and are designed to combat [[free radical]]s, a harmful byproduct of photosynthesis but also present in the human body for a variety of reasons. In the China Study, strong links were seen between increased levels of vitamin C in the blood (mainly due to fruit consumption) and lower risk of several kinds of cancer (by factors of up to 8). Blood levels of other kinds of antioxidant were more difficult to measure, so few correlations were seen.<ref name=CampbellRev2/>{{rp|81–83}}

Many fad diets are [[low-carbohydrate diet]]s that restrict the consumption of carbohydrates. This includes the [[simple carbohydrate|refined carbohydrates]] in products like sugar and [[white flour]], but also the [[complex carbohydrate]]s in fruits, vegetables and whole grains. In their place are increased fat and protein. The authors argue that people who follow these diets lose weight because their calorie intake is restricted. They add that this is unsustainable and cite research that shows adverse health effects.<ref name=CampbellRev2/>{{rp|83–87}} They also argue that one of the main justifications for increasing dietary fat is false: a claim that Americans have had a mania for reducing fat, yet they are fatter than ever. However, Americans have actually increased their consumption of fats, and even more rapidly increased their consumption of refined carbohydrates in junk food.<ref name=CampbellRev2/>{{rp|84,88}} In the China Study, the least active Chinese consumed 30% more calories than their American counterparts yet their body weight was 20% lower. The excess calories were lost as heat rather than being stored as fat.<ref name=CampbellRev2/>{{rp|88–91}}

The China Study also found that protein intake is associated with height and body weight, whether the source of protein is animals or plants. They also find strong correlations between low body size and diseases of poverty, which explains why people in developing nations are smaller than people in wealthy nations.<ref name=CampbellRev2/>{{rp|92–93}}

=== Part II: Diseases of Affluence ===
Part II looks at the diseases (like heart disease, cancer, stroke, Alzheimer's, obesity and diabetes) that were classified as diseases of affluence in Chapter 4. Each chapter summarizes research on one or more closely related diseases and the role of diet.<ref name=CampbellRev2/>{{rp|99–100}}

==== Chapter 5: ''Broken Hearts'' ====
Chapter 5 looks at heart disease and diet. It begins by noting that heart disease is the leading source of mortality in Americans, killing about 40% of them. It is pervasive even in young, active Americans in the form of [[Atheroma|plaque]] buildup that partially blocks arteries. If this occurs slowly, the body can compensate by finding new pathways. However, if a plaque deposit ruptures, this can lead to rapid clotting and sometimes full blockage of an artery downstream, and the body does not have time to compensate. The result is a heart attack.<ref name=CampbellRev2/>{{rp|102–103}}

The [[National Heart Institute]] was created shortly after [[World War II]]. They decided to start a study tracking the health records of the population of [[Framingham, Massachusetts]] to observe who which individuals got heart disease.<ref>{{Cite book|last=Campbell & Campbell II|first=|title=The China Study|publisher=BenBella Books, Inc.|year=2006|isbn=1-935251-00-7|pages=114}}</ref> Starting in 1948, the [[Framingham Heart Study]] followed over 5,000 volunteers and developed the concept of a [[risk factor]]. For heart disease, risk factors included cholesterol, blood pressure, physical activity, cigarette smoking and obesity.<ref name=CampbellRev2/>{{rp|104–105}} Multiple studies showed that fat and cholesterol are harmful, although they could be "merely indicators of animal food intake".<ref name=CampbellRev2/>{{rp|105–109}} Others, dating back as far as the beginning of the 20th century, implicated animal protein, but such claims have been very controversial, with detractors mocking plant eaters as effeminate.<ref name=CampbellRev2/>{{rp|109}} The main aim of research has been to develop technology such as [[Coronary artery bypass surgery|coronary bypass surgery]], [[Percutaneous coronary intervention|coronary angioplasty]], [[defibrillation|defibrillators]], [[Artificial cardiac pacemaker|pacemakers]] and [[Heart transplantation|heart transplants]]. Such methods have lowered the death rate but not the incidence rate of heart disease.<ref name=CampbellRev2/>{{rp|111–113}} They save lives when a heart attack is in progress, but are costly and have dangerous side effects such as [[stroke]].<ref name=CampbellRev2/>{{rp|111–113}} "When used for stable disease, bypass surgery, angioplasty, and stents do not address the cause of heart disease, prevent heart attacks, or extend the lives of any but the sickest heart disease patients."<ref name=CampbellRev2/>{{rp|114}}

The remainder of the chapter describes research by two doctors: [[Caldwell Esselstyn]] and [[Dean Ornish]]. While at the [[Cleveland Clinic]], a center for cardiac care, Esselstyn tested the effect of a WFPB diet on 23 of his patients who had severe heart disease. Over 11 years, one of the 17 who stuck with the diet had any further coronary events and one who strayed from the diet for 2 years had a single event. Several had reduced blockages in their arteries. Meanwhile, five who dropped off the diet had ten new events. In a subsequent study of 198 patients, 177 who adhered to a WFPB diet and stopped taking medicine had a total of only one cardiac event, while 62% of the other 21 patients had events.<ref name=CampbellRev2/>{{rp|115–119}} Dean Ornish conducted a controlled study in which 28 heart disease patients were treated with lifestyle changes only and twenty with a standard approach. The former group had dramatic reductions in cholesterol and a 91% reduction in chest pains, and blockages in their arteries shrank. Members of the control group had a 165% increase in chest pains, their cholesterol levels were worse and their blockages increased.<ref name=CampbellRev2/>{{rp|119–121}}

==== Chapter 6: ''Obesity'' ====

Chapter 6 discusses the problem of [[obesity in America]]. Overweight children suffer both psychological and social challenges. They have been found to be more prone to behavioral and learning struggles, and the resulting low self-esteem can become a permanent issue.<ref name=":0">{{Cite book|last=Campbell & Campbell II|title=The China Study|publisher=BenBella Books, Inc.|year=2006|isbn=1-935251-00-7|pages=136-139}}</ref> For both adults and children, this is associated with reductions in quality of life as well as myriad health problems, including diabetes, [[sleep apnea]] and bone problems. Costs of medical treatment rose from $70 billion in 1999 to more than $147 billion in 2006, while weight management treatments cost another $60 billion, yet obesity is on the rise.<ref name=CampbellRev2/>{{rp|125–127}} Multiple intervention studies are cited that show rapid weight loss when a WFPB diet is followed. This is sustainable because there is no need for [[calorie restriction]]; vegetarians tend to have a higher metabolic rate, burning more calories.<ref name=CampbellRev2/>{{rp|128–132}} [[T. Colin Campbell|Campbell]] and Campbell concluded that eating a whole food, plant-based diet, along with a good amount of exercise, is the solution to obesity. This lifestyle change can create sustained weight loss and lower the risk of chronic disease. In a study conducted at the Pritikin Center, 4,500 patients showed results of a 5.5% decrease in their body weight over a three-week span.<ref name=":0" />

==== Chapter 7: ''Diabetes'' ====

Chapter 7 begins with a description of Types 1 and 2 [[diabetes]], which as of 2012 afflicted 9.3% of adults in the U.S. and is associated with much greater risk of heart, kidney and nervous system diseases as well as blindness and other complications. The economic impact was over $245 billion in 2013.<ref name=CampbellRev2/>{{rp|135–138}} Multiple epidemiological studies showed that high-fiber, plant-based diets protect against diabetes.<ref name=CampbellRev2/>{{rp|138–141}} Experimental studies, particularly those by James Anderson and [[Nathan Pritikin]], also showed that almost all patients on such a diet could stop using insulin medication after a few weeks and stay off it, while less strict diets also showed benefits.<ref name=CampbellRev2/>{{rp|141–145}}

==== Chapter 8: ''Common Cancers'' ====

Chapter 8, with the full title ''Common cancers: Breast, prostate, large bowel (colon and rectal)'' begins by noting that these three cancers represent a broader range of cancers for which similar analyses apply.<ref name=CampbellRev2/>{{rp|147}} Breast cancer is associated with risk factors including early age of [[menarche]], late age of [[menopause]], high levels of [[female hormone]]s (including [[estrogen]] and [[progesterone]]), and high blood cholesterol. All these factors are worsened by a diet high in animal proteins and refined carbohydrates.<ref name=CampbellRev2/>{{rp|148–151}} However, the medical establishment has focussed most of its attention on genetic mutations [[BRCA1]] and [[BRCA2]], which are rare; [[Breast cancer screening|screening]], which can lead to earlier treatment but may not improve survival rate; and anti-estrogen drugs such as [[tamoxifen]] that do not address the causes of high estrogen.<ref name=CampbellRev2/>{{rp|152–154}} Environmental chemicals that can promote cancer include [[Dioxins and dioxin-like compounds|dioxins and PCB's]], which are primarily found in animal-based foods; and [[Polycyclic aromatic hydrocarbon]]s (PAHs), which are pollution products. Laboratory studies have shown that the rate at which they cause cancer is controlled by diet; but epidemiological studies have not adequately accounted for the role of diet.<ref name=CampbellRev2/>{{rp|154–158}}

[[Colorectal cancer]] is the fourth most common cancer worldwide and second most common in the U.S. There are large differences in rates between countries, and studies of migrants favor environment over genetics as the reason. A 1975 study of 32 countries found a particularly strong link between colon cancer and meat intake. A study by Denis Burkitt in Africa found that low-fiber diets increased the risk of colon cancer.<ref name=CampbellRev2/>{{rp|160–162}} However, most studies cannot separate the effects of the hundreds of kinds of fiber from each other, from other benefits of eating fiber-rich foods, or from reduced consumption of animal products. A 1985 study in South Africa does show that animal products contribute to the risk.<ref name=CampbellRev2/>{{rp|162–165}}

[[Prostate cancer]] is a slow-growing cancer that is one of the most commonly diagnosed forms of cancer. Reviews of the literature show a strong association with consumption of animal-based foods, with higher consumption of dairy doubling or quadrupling the risk.<ref name=CampbellRev2/>{{rp|167–169}} Animal protein increases the production of [[insulin-like growth factor 1]], disturbing the balance between growth and removal of cells, and suppresses the [[Calcitriol|activated form of Vitamin D]], suppressing its multiple health benefits.<ref name=CampbellRev2/>{{rp|170–171}} Research by Dr. Ornish, after the first edition of the book, showing that a WFPB diet could "halt and even reverse" prostate cancer.<ref name=CampbellRev2/>{{rp|172–173}}

==== Chapter 9: ''Autoimmune diseases'' ====

Autoimmune diseases, which include [[multiple sclerosis]], [[rheumatoid arthritis]], [[lupus]] and Type 1 diabetes, afflict 7–10% of the world's population. The highest incidences often occur in the same populations. They occur when the body's [[immune system]], which normally protects the body from foreign cells, attacks the body's own cells. This can occur when the foreign protein cells, or [[antigen]]s, are difficult to distinguish from the body's proteins. Many such [[molecular mimicry|molecular mimics]] are found in food, particularly cow's milk.<ref name=CampbellRev2/>{{rp|175–178}} In type 1 diabetes, the immune system mistakes cells of the [[pancreas]] for improperly digested protein fragments such as [[bovine serum albumin]]. This can happen if an infant is switched from [[breastfeeding]] to cow's milk prematurely. Multiple studies show a strong association between consumption of cow's milk and type 1 diabetes. However, there are strong commercial interests in cow's milk production, and this (or a prejudice in favor of milk) motivates some scientists to overstate the controversy in these results.<ref name=CampbellRev2/>{{rp|178–185}}

Multiple sclerosis (MS) occurs when the immune system attacks the [[myelin sheath]]es around nerves. Without the insulation a sheat provides, electric currents go astray and "burn" nearby cells. A long-term study by Roy Swank showed that when MS patients had diets low in saturated fats, about 95% remained only mildly impaired over a period of 30 years. By contrast, 80% of those who consumed more saturated fats died. Milk is high in saturated fat, and subsequent studies have found a strong association of MS with milk consumption. Based on migrant studies, the role of genetics appears small, while attempts to link MS with a virus have not succeeded.<ref name=CampbellRev2/>{{rp|186–189}}

Autoimmune diseases have a lot in common, including a strong increasing trend with latitude and consumption of cow's milk, a tendency to affect the same people, and a possible role of viruses as triggers. Many of the factors are linked. Cow's milk consumption increases with latitude, while vitamin D production from exposure to sunlight declines. In experimental models, activated vitamin D prevents many of the autoimmune diseases. Diets high in calcium and acid-producing animal proteints inhibit this activation.<ref name=CampbellRev2/>{{rp|190–192}}

==== Chapter 10: Wide-ranging effects: Bone, kidney, eye, and brain diseases ====

At the beginning of Chapter 10, the authors emphasize the breadth and quantity of studies supporting the claim that plant-based foods reduce the rates of a great variety of diseases. To underscore the breadth, they discuss five more seemingly unrelated diseases that are often considered "inevitable consequences of aging".<ref name=CampbellRev2/>{{rp|193–194}}

To promote bone strength, health policies often recommend a high calcium intake, and because milk is rich in calcium they recommend drinking a lot of milk. Yet rates of [[hip fracture]] are highest in the countries that have the highest milk consumption. Rates of hip fracture are highly correlated with the ratio of animal to plant protein in diets. Nigeria, with a 10% ratio, has only 1% of the fracture rate that the U.S. has. Animal protein increases the body's acid load. The body neutralizes this with calcium, which it pulls from bones, so they are weakened. A high consumption of calcium can also impair the body's ability to regulate the use of calcium.<ref name=CampbellRev2/>{{rp|194–199}}

The debate over [[osteoporosis]], or bone disease, is complicated by the influence of the dairy industry. Adding to the confusion, low [[bone mineral density]] (BMD) is often used to diagnose osteoporosis, but it is a questionable biomarker. High BMD is associated with higher rates of osteoarthritis, breast cancer, obesity, and even (in some places) higher rates of hip fracture.<ref name=CampbellRev2/>{{rp|200–201}}

[[Kidney stone disease|Kidney stones]] cause a variety of symptoms, one of which (acute [[renal colic]]) is "probably one of the worst pains humans experience."<ref name=CampbellRev2/>{{rp|201}} Most stones are made of calcium or [[oxalate]]. When animal protein is consumed, levels of both rise sharply within hours. Extensive research by W. G. Robertson at the [[University of Toronto]] has shown that a high meat protein intake is the dominant factor in kidney stone formation.<ref name=CampbellRev2/>{{rp|200–203}}


== Publication ==
== Publication ==

Revision as of 12:47, 16 June 2021

The China study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health
AuthorT. Colin Campbell and Thomas M. Campbell II
SubjectNutritional science
PublisherBenBella Books
Publication date
2005[1]
Publication placeUnited States
Pages417 (first edition)
ISBN1-932100-38-5
Websitehttps://www.benbellavegan.com/book/the-china-study/

The China study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health is a book by T. Colin Campbell and his son, Thomas M. Campbell II. The book argues for health benefits of a vegan diet. It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition.[2][3]

Synopsis

The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease, diabetes, breast cancer, prostate cancer, and bowel cancer.[4] The book is "loosely based"[5] on the China–Cornell–Oxford Project, a 20-year study which looked at mortality rates from cancer and other chronic diseases from 1973 to 1975 in 65 counties in China, and correlated this data with 1983–84 dietary surveys and blood work from 100 people in each county.

The authors conclude that people who eat a predominantly whole-food, vegan diet—avoiding animal products as a source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates—will escape, reduce, or reverse the development of numerous diseases. They write that "eating foods that contain any cholesterol above 0 mg is unhealthy."[6] The book recommends sunshine exposure or dietary supplements to maintain adequate levels of vitamin D, and supplements of vitamin B12 in case of complete avoidance of animal products.[7] It criticizes low-carb diets, such as the Atkins diet, which include restrictions on the percentage of calories derived from carbohydrates[8] The authors are critical of reductionist approaches to the study of nutrition, whereby certain nutrients are blamed for disease, as opposed to studying patterns of nutrition and the interactions between nutrients.[9]

Contents

The China Study is divided into four parts. In the first, The China Study, the authors describe some of the health problems faced by Americans, early lab work by T. Colin Campbell, and the epidemiological study known as the China Study. In Part II, Diseases of Affluence, the authors discuss each of the diseases separately along with scientific studies of their links to diet. In Part III, The Good Nutrition Guide, they give their recommendations for a healthy diet. Finally, in Part IV, Why Haven't You Heard This Before?, they argue that there are systemic problems in science, academia and government that tend to suppress information on the role of diet in preventing disease.[10]

Part I: The China Study

Chapter 1: Problems We Face, Solutions We Need

In Chapter 1, the authors describe worsening epidemics of cancer, obesity and diabetes in the United States. They note that the medical system is the third highest cause of death. It is also the most expensive in the world and rapidly becoming more expensive. While good nutrition can solve many of these problems, the American public is getting a lot of contradictory advice on nutrition and is harmed by a series of diet fads. The authors introduce their recommendation, which is to avoid animal-based foods and eat whole, plant-based foods.[10]: Chapter 1 

Chapter 2: A House of Proteins

Chapter 2 examines the history of protein research and the emphasis on protein in dietary recommendations. In particular, animal protein is described as "high quality" because it comes close to matching the balance of amino acids in human protein, while vegetarians believe that they must carefully match ingredients to get all the amino acids they need. However, the authors state that the human body can synthesize all the amino acids it needs from a varied plant diet. Colin Campbell describes how he began with a traditional view of the importance of protein, but some research changed his mind. A study of nutrition in the Philippines found that fungus in peanuts and corn was producing aflatoxin, a potent carcinogen; and the highest rates of liver cancer were in affluent families where the children had abundant protein. He also found a research paper from India that showed a strong association between protein consumption and liver cancer in rats. The rest of the chapter describes topics in research methodology, including the difference between correlation and causation, statistical significance, mechanisms of action and meta-analysis.[10]: Chapter 2 

Chapter 3: Turning off cancer

Chapter 3 begins with a description of the deep public interest in carcinogens. An example is nitrites, chemicals found in foods such as hot dogs, bacon and canned meat. In the rats, these were "anticipated to be human carcinogens" based on laboratory studies with rats. The authors emphasize that these studies exposed the rats to enormous quantities of nitrites, and the effect on cancer rates was modest (in one study, rising from 5% to 10%). Colin Campbell then describes coming across an Indian research paper in which lowering the intake of protein reduced cancer from 100% to 0%.[10]: Chapter 3 

The rest of the chapter discusses research that Campbell and colleagues did on the relationship between diet and cancer. He describes three stages of cancer. In the initiation phase, a carcinogen enters a cell and is metabolized by an enzyme called mixed-function oxidase (MFO). Although the products of this metabolism are mostly safe, there are some toxic byproducts that can damage DNA. In the promotion phase, tumors grow from tiny clusters of cells called foci. This phase is reversible, depending on the balance between promoters that feed growth and anti-promoters that inhibit it. Finally, progression is the spreading of the cancer from its source to neighboring parts of the body, at which point it is considered malignant.[10]: Chapter 3 

Rats were fed aflatoxin and varying amounts of protein (between 5% and 20% of their diet). A low-protein diet greatly reduced tumor initiation by several mechanisms; for example, enzyme activity dropped and fewer toxins binded to DNA.[10]: 44–45  In the promotion phase, the development of foci was "almost entirely dependent on how much protein was consumed, regardless of how much aflatoxin was consumed."[10]: 46  They developed if the protein content exceeded the amount (12%) that their bodies required to grow, and focal growth could be switched on or off by varying the protein.[10]: 48  Finally, a population of several hundred rats were studied over 100 weeks, close to the normal lifetime of a rat. At the end of this period, all rats on the 5% diet were "alive and active, with sleek hair coats"[10]: 52  while all those on the 20% diet were dead.[10]: 52  Much the same results were obtained in studies of liver cancer and diet in mice.[10]: 54 

In the above experiments, the rats were fed casein, the dominant protein in cow's milk. However, plant proteins such as gluten (from wheat) and soy protein did not promote the growth of tumors, even at the higher levels.[10]: 51  The conclusion is that animal-based foods increase tumor development while plant-based foods decrease it. However, the chapter ends by noting that experiments involving rats do not provide quantitative information on the effect of diet on humans. This serves as an introduction to the next chapter.[10]: Chapter 3 

Chapter 4: Lessons From China

Chapter 4 discusses the China–Cornell–Oxford Project, a massive epidemiological study conducted in the 1980s, also referred to as the China Study. The book takes its title from this study.[12] It built on a national survey in the 1970s that collected data on mortality for 96% of Chinese citizens and produced an atlas of rates for each kind of disease (of which there were more than four dozen)[10]: 65  cancer by region. Rates for some cancers varied by a factor of over 100, a far greater variation than in the United States.[10]: 60–61 

With colleagues Junshi Chen and Junyao Li from China and Richard Peto of Oxford University, Colin Campbell led a study that encompassed 65 counties in China with 100 adults per county. This involved questionnaires, blood tests, urine samples and food samples from local marketplaces.[10]: 62  They found that diseases tended to be in one of two groups: diseases of affluence (cancer, diabetes, and heart disease) and diseases of poverty (such as pneumonia, peptic ulcer, and pulmonary tuberculosis).[10]: 65–66 

One of the strongest predictors of the diseases of affluence (also referred to as Western diseases) was blood cholesterol. The average level in China was 127 mg/dL (far less than the American average of 215 mg/dL) and the county averages were as low as 94 mg/dL. The death rate from heart disease was 17 times lower than in America, yet still was strongly dependent on cholesterol level. The blood cholesterol was in turn strongly correlated with animal protein intake, even though Chinese consumed about ten time less on average than Americans.[10]: 67–68  In particular, liver cancer was strongly associated with cholesterol level, as well as chronic infection with the hepatitis B virus ("the virus provides the gun, and bad nutrition pulls the trigger.") The association with cholesterol was consistent with the lab studies described in the previous chapter.[10]: 93–94 

The chapter examines the role of various components of animal and plant food. Previous international studies had shown a correlation between dietary fat and breast cancer, although only with fat from animals. The China Study found a consistent web of correlations between consumption of animal-based foods and breast cancer as well as a host of risk factors for breast cancer, including age of menarche, estrogen levels and cholesterol.[10]: 71–78  Dietary fiber, which is found only in plants, has benefits including an ability to gather up harmful chemicals from the intestines, but there were claims that it inhibited the uptake of iron. The China Study provided evidence for an increase in iron absorption with an increase in fiber because high-fiber foods are also high in iron. Where iron levels were low, in some rural areas, the problem was associated with parasitic diseases.[10]: 78–80 

Another class of chemicals found almost exclusively in plants is the antioxidants such as carotenoids, ascorbic acid (vitamin C) and vitamin E. These provide much of the color in plant food and are designed to combat free radicals, a harmful byproduct of photosynthesis but also present in the human body for a variety of reasons. In the China Study, strong links were seen between increased levels of vitamin C in the blood (mainly due to fruit consumption) and lower risk of several kinds of cancer (by factors of up to 8). Blood levels of other kinds of antioxidant were more difficult to measure, so few correlations were seen.[10]: 81–83 

Many fad diets are low-carbohydrate diets that restrict the consumption of carbohydrates. This includes the refined carbohydrates in products like sugar and white flour, but also the complex carbohydrates in fruits, vegetables and whole grains. In their place are increased fat and protein. The authors argue that people who follow these diets lose weight because their calorie intake is restricted. They add that this is unsustainable and cite research that shows adverse health effects.[10]: 83–87  They also argue that one of the main justifications for increasing dietary fat is false: a claim that Americans have had a mania for reducing fat, yet they are fatter than ever. However, Americans have actually increased their consumption of fats, and even more rapidly increased their consumption of refined carbohydrates in junk food.[10]: 84, 88  In the China Study, the least active Chinese consumed 30% more calories than their American counterparts yet their body weight was 20% lower. The excess calories were lost as heat rather than being stored as fat.[10]: 88–91 

The China Study also found that protein intake is associated with height and body weight, whether the source of protein is animals or plants. They also find strong correlations between low body size and diseases of poverty, which explains why people in developing nations are smaller than people in wealthy nations.[10]: 92–93 

Part II: Diseases of Affluence

Part II looks at the diseases (like heart disease, cancer, stroke, Alzheimer's, obesity and diabetes) that were classified as diseases of affluence in Chapter 4. Each chapter summarizes research on one or more closely related diseases and the role of diet.[10]: 99–100 

Chapter 5: Broken Hearts

Chapter 5 looks at heart disease and diet. It begins by noting that heart disease is the leading source of mortality in Americans, killing about 40% of them. It is pervasive even in young, active Americans in the form of plaque buildup that partially blocks arteries. If this occurs slowly, the body can compensate by finding new pathways. However, if a plaque deposit ruptures, this can lead to rapid clotting and sometimes full blockage of an artery downstream, and the body does not have time to compensate. The result is a heart attack.[10]: 102–103 

The National Heart Institute was created shortly after World War II. They decided to start a study tracking the health records of the population of Framingham, Massachusetts to observe who which individuals got heart disease.[13] Starting in 1948, the Framingham Heart Study followed over 5,000 volunteers and developed the concept of a risk factor. For heart disease, risk factors included cholesterol, blood pressure, physical activity, cigarette smoking and obesity.[10]: 104–105  Multiple studies showed that fat and cholesterol are harmful, although they could be "merely indicators of animal food intake".[10]: 105–109  Others, dating back as far as the beginning of the 20th century, implicated animal protein, but such claims have been very controversial, with detractors mocking plant eaters as effeminate.[10]: 109  The main aim of research has been to develop technology such as coronary bypass surgery, coronary angioplasty, defibrillators, pacemakers and heart transplants. Such methods have lowered the death rate but not the incidence rate of heart disease.[10]: 111–113  They save lives when a heart attack is in progress, but are costly and have dangerous side effects such as stroke.[10]: 111–113  "When used for stable disease, bypass surgery, angioplasty, and stents do not address the cause of heart disease, prevent heart attacks, or extend the lives of any but the sickest heart disease patients."[10]: 114 

The remainder of the chapter describes research by two doctors: Caldwell Esselstyn and Dean Ornish. While at the Cleveland Clinic, a center for cardiac care, Esselstyn tested the effect of a WFPB diet on 23 of his patients who had severe heart disease. Over 11 years, one of the 17 who stuck with the diet had any further coronary events and one who strayed from the diet for 2 years had a single event. Several had reduced blockages in their arteries. Meanwhile, five who dropped off the diet had ten new events. In a subsequent study of 198 patients, 177 who adhered to a WFPB diet and stopped taking medicine had a total of only one cardiac event, while 62% of the other 21 patients had events.[10]: 115–119  Dean Ornish conducted a controlled study in which 28 heart disease patients were treated with lifestyle changes only and twenty with a standard approach. The former group had dramatic reductions in cholesterol and a 91% reduction in chest pains, and blockages in their arteries shrank. Members of the control group had a 165% increase in chest pains, their cholesterol levels were worse and their blockages increased.[10]: 119–121 

Chapter 6: Obesity

Chapter 6 discusses the problem of obesity in America. Overweight children suffer both psychological and social challenges. They have been found to be more prone to behavioral and learning struggles, and the resulting low self-esteem can become a permanent issue.[14] For both adults and children, this is associated with reductions in quality of life as well as myriad health problems, including diabetes, sleep apnea and bone problems. Costs of medical treatment rose from $70 billion in 1999 to more than $147 billion in 2006, while weight management treatments cost another $60 billion, yet obesity is on the rise.[10]: 125–127  Multiple intervention studies are cited that show rapid weight loss when a WFPB diet is followed. This is sustainable because there is no need for calorie restriction; vegetarians tend to have a higher metabolic rate, burning more calories.[10]: 128–132  Campbell and Campbell concluded that eating a whole food, plant-based diet, along with a good amount of exercise, is the solution to obesity. This lifestyle change can create sustained weight loss and lower the risk of chronic disease. In a study conducted at the Pritikin Center, 4,500 patients showed results of a 5.5% decrease in their body weight over a three-week span.[14]

Chapter 7: Diabetes

Chapter 7 begins with a description of Types 1 and 2 diabetes, which as of 2012 afflicted 9.3% of adults in the U.S. and is associated with much greater risk of heart, kidney and nervous system diseases as well as blindness and other complications. The economic impact was over $245 billion in 2013.[10]: 135–138  Multiple epidemiological studies showed that high-fiber, plant-based diets protect against diabetes.[10]: 138–141  Experimental studies, particularly those by James Anderson and Nathan Pritikin, also showed that almost all patients on such a diet could stop using insulin medication after a few weeks and stay off it, while less strict diets also showed benefits.[10]: 141–145 

Chapter 8: Common Cancers

Chapter 8, with the full title Common cancers: Breast, prostate, large bowel (colon and rectal) begins by noting that these three cancers represent a broader range of cancers for which similar analyses apply.[10]: 147  Breast cancer is associated with risk factors including early age of menarche, late age of menopause, high levels of female hormones (including estrogen and progesterone), and high blood cholesterol. All these factors are worsened by a diet high in animal proteins and refined carbohydrates.[10]: 148–151  However, the medical establishment has focussed most of its attention on genetic mutations BRCA1 and BRCA2, which are rare; screening, which can lead to earlier treatment but may not improve survival rate; and anti-estrogen drugs such as tamoxifen that do not address the causes of high estrogen.[10]: 152–154  Environmental chemicals that can promote cancer include dioxins and PCB's, which are primarily found in animal-based foods; and Polycyclic aromatic hydrocarbons (PAHs), which are pollution products. Laboratory studies have shown that the rate at which they cause cancer is controlled by diet; but epidemiological studies have not adequately accounted for the role of diet.[10]: 154–158 

Colorectal cancer is the fourth most common cancer worldwide and second most common in the U.S. There are large differences in rates between countries, and studies of migrants favor environment over genetics as the reason. A 1975 study of 32 countries found a particularly strong link between colon cancer and meat intake. A study by Denis Burkitt in Africa found that low-fiber diets increased the risk of colon cancer.[10]: 160–162  However, most studies cannot separate the effects of the hundreds of kinds of fiber from each other, from other benefits of eating fiber-rich foods, or from reduced consumption of animal products. A 1985 study in South Africa does show that animal products contribute to the risk.[10]: 162–165 

Prostate cancer is a slow-growing cancer that is one of the most commonly diagnosed forms of cancer. Reviews of the literature show a strong association with consumption of animal-based foods, with higher consumption of dairy doubling or quadrupling the risk.[10]: 167–169  Animal protein increases the production of insulin-like growth factor 1, disturbing the balance between growth and removal of cells, and suppresses the activated form of Vitamin D, suppressing its multiple health benefits.[10]: 170–171  Research by Dr. Ornish, after the first edition of the book, showing that a WFPB diet could "halt and even reverse" prostate cancer.[10]: 172–173 

Chapter 9: Autoimmune diseases

Autoimmune diseases, which include multiple sclerosis, rheumatoid arthritis, lupus and Type 1 diabetes, afflict 7–10% of the world's population. The highest incidences often occur in the same populations. They occur when the body's immune system, which normally protects the body from foreign cells, attacks the body's own cells. This can occur when the foreign protein cells, or antigens, are difficult to distinguish from the body's proteins. Many such molecular mimics are found in food, particularly cow's milk.[10]: 175–178  In type 1 diabetes, the immune system mistakes cells of the pancreas for improperly digested protein fragments such as bovine serum albumin. This can happen if an infant is switched from breastfeeding to cow's milk prematurely. Multiple studies show a strong association between consumption of cow's milk and type 1 diabetes. However, there are strong commercial interests in cow's milk production, and this (or a prejudice in favor of milk) motivates some scientists to overstate the controversy in these results.[10]: 178–185 

Multiple sclerosis (MS) occurs when the immune system attacks the myelin sheathes around nerves. Without the insulation a sheat provides, electric currents go astray and "burn" nearby cells. A long-term study by Roy Swank showed that when MS patients had diets low in saturated fats, about 95% remained only mildly impaired over a period of 30 years. By contrast, 80% of those who consumed more saturated fats died. Milk is high in saturated fat, and subsequent studies have found a strong association of MS with milk consumption. Based on migrant studies, the role of genetics appears small, while attempts to link MS with a virus have not succeeded.[10]: 186–189 

Autoimmune diseases have a lot in common, including a strong increasing trend with latitude and consumption of cow's milk, a tendency to affect the same people, and a possible role of viruses as triggers. Many of the factors are linked. Cow's milk consumption increases with latitude, while vitamin D production from exposure to sunlight declines. In experimental models, activated vitamin D prevents many of the autoimmune diseases. Diets high in calcium and acid-producing animal proteints inhibit this activation.[10]: 190–192 

Chapter 10: Wide-ranging effects: Bone, kidney, eye, and brain diseases

At the beginning of Chapter 10, the authors emphasize the breadth and quantity of studies supporting the claim that plant-based foods reduce the rates of a great variety of diseases. To underscore the breadth, they discuss five more seemingly unrelated diseases that are often considered "inevitable consequences of aging".[10]: 193–194 

To promote bone strength, health policies often recommend a high calcium intake, and because milk is rich in calcium they recommend drinking a lot of milk. Yet rates of hip fracture are highest in the countries that have the highest milk consumption. Rates of hip fracture are highly correlated with the ratio of animal to plant protein in diets. Nigeria, with a 10% ratio, has only 1% of the fracture rate that the U.S. has. Animal protein increases the body's acid load. The body neutralizes this with calcium, which it pulls from bones, so they are weakened. A high consumption of calcium can also impair the body's ability to regulate the use of calcium.[10]: 194–199 

The debate over osteoporosis, or bone disease, is complicated by the influence of the dairy industry. Adding to the confusion, low bone mineral density (BMD) is often used to diagnose osteoporosis, but it is a questionable biomarker. High BMD is associated with higher rates of osteoarthritis, breast cancer, obesity, and even (in some places) higher rates of hip fracture.[10]: 200–201 

Kidney stones cause a variety of symptoms, one of which (acute renal colic) is "probably one of the worst pains humans experience."[10]: 201  Most stones are made of calcium or oxalate. When animal protein is consumed, levels of both rise sharply within hours. Extensive research by W. G. Robertson at the University of Toronto has shown that a high meat protein intake is the dominant factor in kidney stone formation.[10]: 200–203 

Publication

The book was first published in 2005.[1][15] A revised and expanded edition was published in 2016.[16] The book has also been published in German, Polish, Slovenian, Italian, Chinese, Japanese, Korean, Romanian, Swedish and Urdu.[17]

Companion volumes

  • Campbell, Thomas (2015). The Campbell Plan : the simple way to lose weight and reverse illness, using the China Study's whole-food, plant-based diet. Rodale Books. ISBN 9781623364106.
  • Campbell, Thomas (2016). The China study solution : the simple way to lose weight and reverse illness, using a whole-food, plant-based diet. Rodale Books. ISBN 9781623367572.
  • Campbell, LeAnne; Campbell, T. Colin; Disla, Steven Campbell (2013). The China study cookbook : over 120 whole-food, plant-based recipes. BenBella Books. ISBN 9781937856762.[18]

Reception

Sanjay Gupta, CNN's chief medical correspondent, said in his documentary The Last Heart Attack in 2011 that The China Study had changed the way people all over the world eat.[19] Former American President Bill Clinton became a supporter when he adopted a plant-based diet after a heart attack.[4][20]

Wilfred Niels Arnold, professor of biochemistry at the University of Kansas Medical Center, reviewed the book in Leonardo reviews in 2005: "[T]he authors anticipate resistant and hostile sources, sail on with escalating enthusiasm, and furnish a working hypothesis that is valuable. In fact, the surprising data are difficult to interpret in any other way."[21]

The book was reviewed by Harriet Hall, a physician and skeptic who writes about alternative medicine, in a blog entry posted on the Science-Based Medicine website in 2009. Hall argued that the book had references which do not support directly the claims made by the authors. She also stated that the book does not explain the exceptions to his data, such as high rates of stomach cancer in China.[22]

See also

References

  1. ^ a b "The China Study - T. Colin Campbell Center for Nutrition Studies". Center for Nutrition Studies. Retrieved June 24, 2020.
  2. ^ Parker-Pope, Tara (January 7, 2011). "Nutrition Advice From the China Study". The New York Times. Retrieved June 19, 2020.
  3. ^ For over one million copies sold, "The China Study", the chinastudy.com, archived October 18, 2013.
  4. ^ a b Sherwell, Philip (October 3, 2010). "Bill Clinton's new diet: nothing but beans, vegetables and fruit to combat heart disease".
  5. ^ Scrinis, Gyorgy (2013). Nutritionism: The Science and Politics of Dietary Advice. Columbia University Press. p. 182.
  6. ^ Campbell & Campbell II 2005, p. 132
  7. ^ Campbell & Campbell II 2005, pp. 232, 242, 361ff
  8. ^ Campbell & Campbell II 2005, pp. 95–96
  9. ^ Scrinis, Gyorgy (2013). Nutritionism: The Science and Politics of Dietary Advice. Columbia University Press. p. 16.
  10. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg Campbell & Campbell II 2016
  11. ^ Campbell, T. Colin (July 11, 2010). "A Response to Denise Minger's Critique of The China Study". T. Colin Campbell Center for Nutrition Studies. Retrieved August 27, 2020.
  12. ^ Over the strong objections of the authors, who proposed 200 alternate titles but were overruled by the publisher.[11]
  13. ^ Campbell & Campbell II (2006). The China Study. BenBella Books, Inc. p. 114. ISBN 1-935251-00-7.
  14. ^ a b Campbell & Campbell II (2006). The China Study. BenBella Books, Inc. pp. 136–139. ISBN 1-935251-00-7.
  15. ^ Campbell, T. Colin; Campbell II, Thomas M. (2005). The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health. BenBella Books.
  16. ^ Campbell, T. Colin; Campbell II, Thomas M. (2016). The China study : the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss, and long-term health (Revised and expanded ed.). BenBella Books. ISBN 9781942952909.
  17. ^ "Formats and Editions of The China study : the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health". Worldcat.org. Retrieved June 24, 2020.
  18. ^ Lefferts, Daniel (February 23, 2018). "'The China Study Cookbook' Makeover: Cookbooks 2018". Publishers Weekly. Retrieved June 29, 2020.
  19. ^ "Gupta: Becoming heart attack proof". August 25, 2011.
  20. ^ Martin, David S. (August 18, 2011). "From omnivore to vegan: The dietary education of Bill Clinton". CNN.
  21. ^ Arnold, Wilfred Niels (February 2005). "The China Study". Leonardo Reviews. Retrieved August 29, 2011.
  22. ^ Hope, Harriet (April 9, 2009). "The China Study".

Further reading

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