The
fiber	may	bind	with	these	nutrients	and	carry	them	through	our	system	before
we	are	able	to	digest	them. They	say	that	the	maximum	level	of	fiber	intake
should	be	around	thirty	to	thirty-five	grams	per	day,	which	is	only	about	the
average	intake	of	the	rural	Chinese. We	studied	this	iron/fiber	issue	very	carefully	in	the	China	Study. As	it
turns	out,	fiber	is	not	the	enemy	of	iron	absorption	as	so	many	experts	claim	it
to	be. We	measured	how	much	iron	the	Chinese	were	consuming	and	howmuch	was	in	their	bodies. Iron	was	measured	in	six	different	ways	(four	blood
biomarkers	and	two	estimates	of	iron	intake)	and	
when	we	compared	these
measurements	with	fiber	intake,	
there	was	no	evidence	showing	that
increasing	fiber	intake	impaired	iron	absorption	in	the	body. In	fact,	we	found
the	opposite	effect. A	good	indicator	of	how	much	iron	is	in	the	blood,
hemoglobin,	actually	increased	with	greater	intakes	of	dietary	fiber. I
	As	it
turns	out,	high-fiber	foods,	like	wheat	and	corn	(but	not	the	polished	rice
consumed	in	China)	also	happen	to	be	high	in	iron,	meaning	that	the	higher
the	consumption	of	fiber,	the	higher	the	consumption	of	iron. III
	Iron	intake	in
rural	China	(34	mg/day)	was	surprisingly	high	when	compared	to	the	average
American	intake	(18	mg/day)	and	it	was	far	more	associated	with	plant-based
foods	than	with	animal-based	foods. 41
CHART	4.10:	AVERAGE	INTAKES	OF	DIETARY	FIBER,	GM/DAY
The	China	findings	on	dietary	fiber	and	iron,	like	so	many	other
observations	in	this	study,	did	not	support	the	common	view	of	Western
scientists. People	who	consume	more	plant-based	foods,	thus	more	dietary
fiber,	also	consume	more	iron,
III
	all	of	which	results	in	statistically	significant
higher	levels	of	hemoglobin. Unfortunately,	a	bit	of	confusion	has	arisen	over
the	fact	that	some	people	in	rural	China,	including	women	and	children,	have
low	iron	levels. This	is	especially	true	in	areas	where	parasitic	diseases	are
more	common. In	areas	of	rural	China	where	parasitic	diseases	were	more
common,	iron	status	was	lower. 1
	This	has	given	some	the	opportunity	to
claim	that	these	people	need	more	meat,	but	the	evidence	indicates	that	the
problem	would	be	much	better	corrected	by	reducing	parasitism	in	these
areas. Much	of	the	initial	interest	in	dietary	fiber	arose	with	Burkitt’s	travels	in
Africa	and	his	claim	that	large	bowel	cancer	is	lower	among	populations	whoconsume	high-fiber	diets. Burkitt	made	this	claim	popular	but	the	story	is	at
least	200	years	old. In	England	during	the	late	eighteenth	century	and	early
nineteenth	century,	it	was	claimed	by	some	of	the	leading	physicians	that
constipation,	which	was	associated	with	less	bulky	diets	(i.e.,	low-fiber	diets),
was	associated	with	a	higher	risk	of	cancer	(usually	breast	and	“intestinal”
cancers). At	the	beginning	of	the	China	Study,	this	belief	that	fiber	might	prevent
large	bowel	cancer	was	the	prevailing	view,	although	the	1982	National
Academy	of	Sciences	Committee	on	Diet,	Nutrition	and	Cancer,	“found	no
conclusive	evidence	to	indicate	that	dietary	fiber…	exerts	a	protective	effect
against	colorectal	cancer	in	humans.”	The	report	went	on	to	conclude,	“…	if
there	is	such	an	effect,	specific	components	of	fiber,	rather	than	total	dietary
fiber,	are	more	likely	to	be	responsible.”
20
	In	hindsight,	our	discussion	of	this
issue	was	inadequate. The	question,	
the	review	of	the	research	literature	and
the	interpretation	of	the	evidence	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. I,	II
	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	color/health	link. The	colors	of	fruits	and	vegetables	are	derived	from	a	variety	of	chemicals
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	chemistry. 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	between
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	reactor	leaking	radioactive
materials	(free	radicals)	that	can	be	very	dangerous	to	the	surrounding	area. So	how	does	the	plant	manage	these	complex	reactions	and	protect	
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-sounding	crytoxanthins
(oranges). Other	antioxidants	may	be	colorless	and	these	include	chemicals
such	as	ascorbic	acid	(vitamin	C)	and	vitamin	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,	however,	isthat	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	cancer,	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	antioxidants. 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	incredibly	appealing	with	beautiful,	appetizing
colors. Then	we	animals,	in	turn,	are	attracted	to	the	plants	and	eat	them	and
borrow	their	antioxidant	shields	for	our	own	health. Whether	you	believe	in
God,	evolution	or	just	coincidence,	you	must	admit	that	this	is	a	beautiful,
almost	spiritual,	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	most	significant	vitamin	C	association	with	cancer	was	its	relationship
with	the	number	of	cancer-prone	families	in	each	area. 42
	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,
III
	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	disease	and
stroke. II
	Vitamin	C	intake	from	fruits	clearly	showed	a	powerful	protective
effect	against	a	variety	of	diseases. The	other	measures	of	antioxidants,	blood	levels	of	alpha	and	beta-carotene	(a	vitamin	precursor)	and	alpha	and	gamma	tocopherol	(vitamin	E)
are	poor	indicators	of	the	effects	of	antioxidants. These	antioxidants	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	experimental
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	containing
vitamin	C	and	beta-carotene	or	a	fiber	supplement	create	these	health	effects? No. The	triumph	of	health	lies	not	in	the	individual	nutrients,	but	in	the	whole
foods	that	contain	those	nutrients:	plant-based	foods. In	a	bowl	of	spinach
salad,	for	example,	we	have	fiber,	antioxidants	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-based
foods	ever	since	vitamin	supplements	were	introduced	on	a	large	
scale	in	the
marketplace. And	I	have	watched	in	dismay	how	the	industry	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	taking	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	greatest	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	wallowing	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:	according	to	a	report
46
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. In	one	published	study
47
	funded	by	the	Atkins	Center	for	Complementary
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	severelyrestricting	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	calories	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
improve
50
	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	restriction	over	a	period	of	years	or	decades	without	either
becoming	an	invalid	or	melting	away	into	nothing. People	are	notoriously
unsuccessful	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
	Additionally,	they	found	that	the	dieters	had	a	stunning	53%
increase	in	the	amount	of	calcium	they	excreted	in	their	urine,
47
	which	may
spell	disaster	for	their	bone	health. The	weight	loss,	some	of	which	is	simply
initial	fluid	loss,
51
	may	come	with	a	very	high	price. A	different	review	of	low-carbohydrate	diets	published	by	
researchers	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	carbohydrates	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	manages	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-carbohydrate	diets	“make-yourself-sick”	diets,	and	I	think	that’s
an	appropriate	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	“common	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-nutrients	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	held	of	nutrition,	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	carbohydrates. 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	
been	shown	many	times	to	cause
significant	weight	loss. But	it’s	not	quite	as	simple	as	that. At	least	99%	of	the	carbohydrates	that	we	consume	are	derived	from
fruits,	vegetables	and	grains. When	these	foods	are	consumed	in	the
unprocessed,	unrefined	and	natural	state,	a	large	proportion	of	the
carbohydrates	are	in	the	so-called	“complex”	form. This	means	that	they	are
broken	down	in	a	controlled,	regulated	manner	during	digestion. This
category	of	carbohydrates	includes	the	many	forms	of	dietary	fiber,	almost	all
of	which	remain	undigested—but	still	provide	substantial	health	benefits. In
addition,	these	complex	carbohydrates	from	whole	foods	are	packaged	with
generous	amounts	of	vitamins,	minerals	and	accessible	energy. Fruits,
vegetables	and	whole	grains	are	the	healthiest	foods	you	can	consume,	and
they	are	primarily	made	of	carbohydrates. On	the	opposite	side	of	the	spectrum,	there	are	highly	processed,	highly
refined	carbohydrates	that	have	been	stripped	of	their	fiber,	vitamins	and
minerals. Typical	simple	carbohydrates	are	found	in	foods	like	white	bread,
processed	snack	items	including	crackers	and	chips	made	with	white	flour,
sweets	including	pastries	and	candy	bars	and	sugar-laden	soft	drinks. These
highly	refined	carbohydrates	originate	from	grains	or	sugar	plants,	like	sugar
cane	or	the	sugar	beet. They	are	readily	broken	down	during	digestion	to	the
simplest	form	of	the	carbohydrates,	which	are	absorbed	into	the	body	to	give
blood	sugar,	or	glucose. Unfortunately,	most	Americans	consume	voluminous	amounts	of	simple,
refined	carbohydrates	and	paltry	amounts	of	complex	carbohydrates. For
example,	in	1996,	42%	of	Americans	ate	cakes,	cookies,	pastries	or	pies	on
any	given	day,	while	only	10%	ate	any	dark	green	vegetables. 46
	In	another
ominous	sign,	only	three	vegetables	accounted	for	half	of	the	total	vegetable
servings	in	1996
46
:	potatoes,	which	were	mostly	consumed	as	fries	and	chips;
head	lettuce,	one	of	the	least	nutrient-dense	vegetables	you	can	consume,	and
canned	tomatoes,	which	is	probably	only	a	reflection	of	pizza	and	pasta
consumption. Add	to	that	the	fact	that	the	average	American	consumed	
thirty-
two	teaspoons	of	added	sugars	per	day	in	1996
,
46
	and	it’s	clear	thatAmericans	are	gorging	almost	exclusively	on	refined,	simple	carbohydrates,
at	the	exclusion	of	healthful	complex	carbohydrates. This	is	bad	news,	and	this,	in	large	measure,	is	why	carbohydrates	as	a
whole	have	gotten	such	a	bad	rap;	the	vast	majority	of	carbohydrates
consumed	in	America	are	found	in	junk	food	or	grains	so	refined	that	they
have	to	be	supplemented	with	vitamins	and	minerals. On	this	
point,	the
popular	diet	authors	and	I	agree. For	example,	you	could	eat	a	low-fat,	high-
carbohydrate	diet	by	exclusively	eating	the	following	foods:	pasta	made	from
refined	flour,	baked	potato	chips,	soda,	sugary	cereals	and	low-fat	candy	bars. Eating	this	way	is	a	
bad
	idea. You	will	not	derive	the	health	benefits	of	a
plant-based	diet	eating	these	foods. In	experimental	research,	the	health
benefits	of	a	high-carbohydrate	diet	come	from	eating	the	complex
carbohydrates	found	in	whole	grains,	fruits	and	vegetables. Eat	an	apple,	a
zucchini	or	a	plate	of	brown	rice	topped	with	beans	and	other	vegetables.THE	CHINA	STUDY	WEIGHS	IN
With	regard	to	weight	loss,	there	are	some	surprising	findings	from	the	China
Study	that	shed	light	on	the	weight	loss	debate. When	we	started	the	China
Study,	I	thought	that	China	had	the	opposite	problem	from	that	of	the	U.S. I
had	heard	that	China	could	not	feed	itself,	that	it	was	prone	to	famines	and
that	there	was	not	enough	food	for	people	to	attain	their	full	adult	height. Very
simply,	there	were	not	enough	calories	to	go	around. Although	China	has,
during	the	last	fifty	years,	had	its	share	of	nutritional	problems,	we	were	to
learn	that	these	views	on	calorie	intake	were	dead	wrong. We	wanted	to	compare	the	calorie	consumption	in	China	and	America,	but
there	was	a	catch. Chinese	are	more	physically	active	than	Americans,
especially	in	rural	areas,	where	manual	labor	is	the	norm. To	compare	an
extremely	active	laborer	with	an	average	American	would	be	misleading. It
would	be	like	comparing	the	amount	of	energy	consumed	by	a	manual	laborer
at	hard	work	with	the	amount	of	energy	consumed	by	an	accountant. The	vast
difference	in	calorie	intake	sure	to	exist	between	these	individuals	would	tell
us	nothing	of	value	and	only	confirm	that	the	manual	laborer	is	more	active. To	overcome	this	problem,	we	ranked	the	Chinese	into	five	groups
according	to	their	levels	of	physical	activity. After	figuring	out	the	calorie
intakes	of	the	
least	active
	Chinese,	the	equivalent	of	office	workers,	we	then
compared	their	calorie	intake	with	the	
average
	American. What	we	found	was
astonishing. Average	calorie	intake,	per	kilogram	of	body	weight,	was	30%	
higher
among	the	least	active	Chinese	than	among	average	Americans. Yet,	body
weight	was	20%	
lower
	(
Chart	4.11
). How	can	it	be	that	even	the	least	active
Chinese	consume	more	calories	yet	have	no	overweight	problems? What	is
their	secret? CHART	4.11:	CALORIE	CONSUMPTION	(KCAL/KG)	AND	BODY
WEIGHT
There	are	two	possible	explanations	for	this	apparent	paradox. First,	even
the	Chinese	office	workers	are	more	physically	active	than	average
Americans. Anyone	familiar	with	China	knows	that	many	office	workers
travel	on	bicycles. Thus,	they	consume	more	calories. Even	so,	we	cannot	tell
how	much	of	the	extra	calorie	consumption	was	due	to	physical	activity	and
how	much	to	something	else,	perhaps	their	food. We	do	know,	however,	that	some	people	use	the	calories	they	consume
differently	from	other	people. We	often	say	that	“they	have	a	higher	rate	of
metabolism”	or	“it’s	in	their	genes.”	You	know	these	people. They	are	the
ones	who	seem	to	eat	all	they	want	and	still	not	gain	weight. Then	there	are
most	of	us,	who	need	to	watch	our	calorie	intake—or	so	we	think. This	is	the
simplistic	interpretation. I	have	a	more	comprehensive	interpretation	that	is	based	on	our	own
considerable	research	and	on	the	studies	of	others. It	goes	like	this. Provided
that	we	aren’t	restricting	our	calorie	intake,	those	of	us	who	consume	a	high-
fat,	high-protein	diet	simply	retain	more	calories	than	we	need. We	store	these
calories	as	body	fat,	perhaps	weave	it	into	our	muscle	fibers	(we	call	it
“marbling”	in	beef	animals)	and	perhaps	store	it	in	the	more	obvious	places,
like	our	butt,	our	midsection	or	around	our	face	and	upper	thighs. Here’s	the	clincher:	only	a	small	amount	of	calories	needs	to	be	retained
by	our	body	to	cause	significant	change	in	body	weight. For	example,	if	we
retain	only	an	extra	fifty	calories	per	day,	this	can	lead	to	an	extra	ten	pounds
per	year. You	may	not	think	that	this	is	a	lot,	but	over	a	period	of	five	years,
that’s	an	extra	fifty	pounds. Some	people	would	hear	this	and	might	be	inclined	to	just	eat	fifty	fewer
calories	per	day. This,	theoretically,	could	make	a	difference,	but	it	
is	entirely
impractical. It	is	impossible	to	keep	track	of	daily	calorie	intake	with	such
precision. Think	about	eating	a	meal	at	a	restaurant. Do	you	know	how	many
calories	each	meal	has? What	about	the	casserole	you	might	fix? What	about
the	steak	you	might	buy? Do	you	know	the	number	of	calories	they	contain? Of	course	not. The	truth	is	this:	despite	any	short-term	caloric	restriction	regimes	we	may
follow,	our	body	through	many	mechanisms,	will	ultimately	choose	how
many	calories	to	take	in	and	what	to	do	with	them. Our	attempts	to	limit
calorie	intake	is	short-lived	and	imprecise,	whether	we	do	it	by	limiting
carbohydrates	or	fat. The	body	employs	a	delicate	balancing	act	and	some	very	intricate
mechanisms	in	deciding	how	to	use	the	calories	being	consumed. When	we
treat	our	body	well	by	eating	the	right	foods,	it	knows	how	to	partition	the
calories	away	from	body	fat	and	into	the	more	desirable	functions	likekeeping	the	body	warm,	running	the	body	metabolism,	supporting	and
encouraging	physical	activity	or	just	disposing	of	any	excess. The	body	is
using	multiple	intricate	mechanisms	to	decide	how	calories	get	used,	stored	or
“burned	off.”
Consuming	diets	
high
	in	protein	and	fat	transfers	calories	away	from	their
conversion	into	body	heat	to	their	storage	form—as	body	fat	(unless	severe
calorie	restriction	is	causing	weight	loss). In	contrast,	diets	
low
	in	protein	and
fat	cause	calories	to	be	“lost”	as	body	heat. In	research,	we	say	that	storing
more	calories	as	fat	and	losing	less	as	heat	means	being	more	efficient. I	bet
that	you	would	rather	be	a	little	more	inefficient	and	convert	it	into	body	heat
rather	than	body	fat,	right? Well,	simply	consuming	a	diet	lower	in	fat	and
protein	can	do	this. This	is	what	our	China	Study	data	show. Chinese	consume	more	calories
both	because	they	are	more	physically	active	and	because	their	consumption
of	low-fat,	low-protein	diets	shifts	conversion	of	these	calories	away	from
body	fat	to	body	heat. This	is	true	even	for	the	least	physically	active	Chinese. Remember,	it	takes	very	little,	only	fifty	calories	a	day,	to	change	our	storage
of	body	fat	and	thus	change	our	body	weight. 58
We	saw	the	same	phenomenon	in	our	experimental	animals	fed	the	low-
protein	diets. They	routinely	consumed	slightly	more	calories,	gained	less
weight,	disposed	of	the	extra	calories	as	body	heat
59
	and	voluntarily	exercised
more,
60
	while	still	having	far	less	cancer	than	animals	on	standard	diets. We
found	that	calories	were	“burned”	at	a	faster	rate	and	transformed	into	body
heat	as	more	oxygen	was	consumed. 59
Understanding	that	diet	can	cause	small	shifts	in	calorie	metabolism	that
lead	to	big	shifts	in	body	weight	is	an	important	and	useful	concept. It	means
that	there	is	an	orderly	process	of	controlling	body	weight	over	time	that	does
work,	as	opposed	to	the	disorderly	process	of	crash	diets	that	don’t	work. It
also	accounts	for	the	frequent	observations	(discussed	in	chapter	six)	that
people	who	consume	low-protein,	low-fat	diets	composed	of	whole	plant
foods	have	far	less	difficulty	with	weight	problems,	even	if	they	consume	the
same,	or	even	slightly	more,	total	calories.DIET	AND	BODY	SIZE
We	now	know	that	eating	a	low-fat,	low-protein	diet	high	in	complex
carbohydrates	from	fruits	and	vegetables	will	help	you	lose	weight. But	what
if	you	want	to	become	bigger? A	desire	to	be	as	big	as	possible	is	pervasive	in
most	cultures. During	the	colonial	period	in	Asia	and	Africa,	Europeans	even
considered	smaller	people	to	be	less	civilized. Body	size	seems	to	be	a	mark
of	prowess,	manliness	and	dominance. Most	people	think	they	can	be	bigger	and	stronger	by	eating	protein-rich
animal-based	foods. This	belief	stems	from	the	idea	that	consuming	protein
(a.k.a. meat)	is	needed	for	physical	power. This	has	been	a	common	notion
the	world	over	for	a	long	time. The	Chinese	have	even	officially
recommended	a	higher-protein	diet	in	order	to	encourage	bigger	athletes	and
to	better	compete	in	the	Olympics. Animal-based	foods	have	more	protein,
and	this	protein	is	considered	to	be	of	“higher	quality.”	Animal	protein	enjoys
the	same	reputation	in	a	rapidly	modernizing	China	as	everywhere	else. There	is,	however,	a	problem	with	the	idea	that	consuming	animal-based
foods	is	a	good	way	of	becoming	bigger. The	people	who	eat	the	most	animal
protein	have	the	most	heart	disease,	cancer	and	diabetes. In	the	China	Study,
for	example,	animal	protein	consumption	was	associated	with	taller	and
heavier
I
	people,	but	was	also	associated	with	higher	levels	of	total	and	bad
cholesterol. II
	Furthermore,	body	weight,	associated	with	animal	protein
intake,
I
	was	associated	with	more	cancer
II–III
	and	more	coronary	heart
disease. II
	It	seems	that	being	bigger,	and	presumably	better,	comes	with	very
high	costs. But	might	it	be	possible	for	us	to	achieve	our	full	growth	potential,
while	simultaneously	minimizing	disease	risks? Childhood	growth	rates	were	not	measured	in	the	China	Study	but	adult
height	and	weight	were. This	information	proved	surprising. Consuming	more
protein	was	associated	with	greater	body	size	(
III
	for	
men	and	
II
	for	women). 61
However,	this	effect	was	primarily	attributed	to	
plant
	protein,	because	it
makes	up	90%	of	the	total	Chinese	protein	intake. Animal	protein
consumption	was	indeed	associated	with	greater	body	weight,
1
	and
consumption	of	protein-rich	milk	seemed	to	be	effective	as	well. II
	But	the
good	news	is	this:	
Greater	plant	protein	intake	was	closely	linked	to	greater
height
II
	
and	body	weight
. II
	Body	growth	is	linked	to	protein	in	general	and
both	animal	and	plant	proteins	are	effective! This	means	that	individuals	can	achieve	their	genetic	potential	for	growth
and	body	size	by	consuming	a	plant-based	diet. So	why	is	it	that	people	in
developing	nations,	who	consume	little	or	no	animal-based	foods,	areconsistently	smaller	than	Western	people? This	is	because	plant-based	diets	in
poor	areas	of	the	world	usually	have	insufficient	variety,	inadequate	quantity
and	quality	and	are	associated	with	poor	public	health	conditions	where
childhood	diseases	are	prevalent. Under	these	conditions,	growth	is	stunted
and	people	do	not	reach	their	genetic	potential	for	adult	body	size. In	the
China	Study,	low	adult	height	and	weight	were	strongly	associated	with	areas
having	high	mortality	rates	for	pulmonary	tuberculosis,
III
	parasitic	diseases,
III
pneumonia	(
III
	for	height),	“intestinal	obstruction”
III
	and	digestive	diseases. III
These	findings	support	the	idea	that	body	stature	can	be	achieved	by
consuming	a	low-fat,	plant-based	diet,	provided	that	public	health	conditions
effectively	control	the	diseases	of	poverty. Under	these	conditions,	the
diseases	of	affluence	(heart	disease,	cancers,	diabetes,	etc.) can	be
simultaneously	minimized. The	same	low-animal	protein,	low-fat	diet	that	helps	prevent	obesity	also
allows	people	to	reach	their	full	growth	potential	while	working	other
wonders	as	well. It	better	regulates	blood	cholesterol	and	reduces	heart
disease	and	a	variety	of	cancers. What	are	the	odds	that	all	of	these	associations	(and	many	others)	favoring
a	plant-based	diet	are	due	to	pure	chance? It	is	extremely	unlikely,	to	say	the
least. Such	consistency	of	evidence	across	a	broad	range	of	associations	is
rare	in	scientific	research. It	points	to	a	new	worldview,	a	new	paradigm. It
defies	the	status	quo,	promises	new	health	benefits	and	demands	our	attention.CIRCLING	BACK
In	the	beginning	of	my	career,	I	concentrated	on	the	biochemical	processes	of
liver	cancer. Chapter	three	delineates	the	decades-long	laboratory	work	we
did	with	experimental	animals,	work	that	passed	the	requirements	to	be	called
“good	science.”	The	finding:	casein,	and	very	likely	all	animal	proteins,	may
be	the	most	relevant	cancer-causing	substances	that	we	consume. Adjusting
the	amount	of	dietary	casein	has	the	power	to	turn	on	and	turn	off	cancer
growth,	and	to	override	the	cancer-producing	effects	of	aflatoxin,	a	very
potent	Class	IA	carcinogen,	but	even	though	these	findings	were	substantially
confirmed,	they	still	applied	to	experimental	animals. It	was	therefore	with	great	anticipation	that	I	looked	to	the	China	Study	for
evidence	on	the	causes	of	liver	cancer	in	humans. 62
Liver	cancer	rates	are	very	high	in	rural	China,	exceptionally	high	in	some
areas. Why	was	this? The	primary	culprit	seemed	to	be	chronic	infection	with
hepatitis	B	virus	(HBV). On	average,	about	12-13%	of	our	study	subjects
were	chronically	infected	with	the	virus. In	some	areas,	one-half	of	the	people
were	chronically	infected! To	put	this	into	perspective,	only	0.2-0.3%	of
Americans	are	chronically	infected	with	this	virus. But	there’s	more. In	addition	to	the	virus	being	a	cause	of	liver	cancer	in
China,	it	seems	that	diet	also	plays	a	key	role. How	do	we	know? The	blood
cholesterol	levels	provided	the	main	clue. Liver	cancer	is	strongly	associated
with	increasing	blood	cholesterol,
III
	and	we	already	know	that	animal-based
foods	are	responsible	for	increases	in	cholesterol. So,	where	does	HBV	fit	in? The	experimental	mice	studies	gave	a	good
signal. In	mice,	HBV	initiated	the	liver	cancer	but	the	cancer	grew	in	response
to	the	feeding	of	higher	levels	of	casein. In	addition,	blood	cholesterol	also
increased. These	observations	fit	perfectly	with	our	human	findings. Individuals	who	are	chronically	infected	with	HBV	and	who	consume	animal-
based	foods	have	high	blood	cholesterol	and	a	high	rate	of	liver	cancer. The
virus	provides	the	gun,	and	bad	nutrition	pulls	the	trigger. A	very	exciting	story	was	taking	shape,	at	least	to	my	way	of	thinking. It
was	a	story	full	of	meaning	and	suggestive	of	important	principles	that	might
apply	to	other	diet	and	cancer	associations. It	also	was	a	story	that	had	not
been	told	to	the	public,	and	yet	it	was	capable	of	saving	lives. Eventually,	it
was	a	story	that	was	leading	to	the	idea	that	our	most	powerful	weapon
against	cancer	is	the	food	we	eat	every	day. So	there	we	had	it. The	years	of	animal	experiments	illuminated	profound
biochemical	principles	and	processes	that	greatly	helped	to	explain	the	effect
of	nutrition	on	liver	cancer. But	now	we	could	see	that	these	processes	wererelevant	for	humans	as	well. People	chronically	infected	with	hepatitis	B	virus
also	had	an	increased	risk	of	liver	cancer. But	our	findings	suggested	those
who	were	infected	with	the	virus	and	who	were	simultaneously	eating	more
animal-based	foods	had	higher	cholesterol	levels	and	more	liver	cancer	than
those	infected	with	the	virus	and	not	consuming	animal-based	foods. The
experimental	animal	studies	and	the	human	studies	made	a	perfect	fit.PULLING	IT	TOGETHER
Almost	all	of	us	in	the	United	States	will	die	of	diseases	of	affluence. In	our
China	Study	we	saw	that	nutrition	has	a	very	strong	effect	on	these	diseases. Plant-based	foods	are	linked	to	lower	blood	cholesterol;	animal-based	foods
are	linked	to	higher	blood	cholesterol. Animal-based	foods	are	linked	to
higher	breast	cancer	rates;	plant-based	foods	are	linked	to	lower	rates. Fiber
and	antioxidants	from	plants	are	linked	to	a	lower	risk	of	cancers	of	the
digestive	tract. Plant-based	diets	and	active	lifestyles	result	in	a	healthy
weight,	yet	permit	people	to	become	big	and	strong. Our	study	was
comprehensive	in	design	and	comprehensive	in	its	findings. From	the	labs	of
Virginia	Tech	and	Cornell	University	to	the	far	reaches	of	China,	it	seemed
that	science	was	painting	a	clear,	consistent	picture:	we	can	minimize	our	risk
of	contracting	deadly	diseases	just	by	eating	the	right	food. When	we	first	started	this	project	we	encountered	significant	resistance
from	some	people. One	of	my	colleagues	at	Cornell,	who	had	been	involved
in	the	early	planning	of	the	China	Study,	got	quite	heated	in	one	of	our
meetings. I	had	put	forth	the	idea	of	investigating	how	lots	of	dietary	factors,
some	known	but	many	unknown,	work	together	to	cause	disease. Thus	we
had	to	measure	lots	of	factors,	regardless	of	whether	or	not	they	were	justified
by	prior	research. If	that	was	what	we	intended	to	do,	he	said	he	wanted
nothing	to	do	with	such	a	“shotgun”	approach. This	colleague	was	expressing	a	view	that	was	more	in	line	with
mainstream	scientific	thought	than	with	my	idea. He	and	like-minded
colleagues	think	that	science	is	best	done	when	investigating	single—mostly
known—factors	in	isolation. An	array	of	largely	unspecified	factors	doesn’t
show	anything,	they	say. It’s	okay	to	measure	the	specific	effect	of,	say,
selenium	on	breast	cancer,	but	it’s	not	okay	to	measure	
multiple	nutritional
conditions	in	the	same	study,	in	the	hope	of	identifying	important	dietary
patterns. I	prefer	the	broader	picture,	for	we	are	investigating	the	incredible
complexities	and	subtleties	of	nature	itself. I	wanted	to	investigate	how
dietary	patterns	related	to	disease,	now	the	most	important	point	of	this	book. Everything	in	food	works	together	to	create	health	or	disease. The	more	we
think	that	a	single	chemical	characterizes	a	whole	food,	the	more	we	stray
into	idiocy. As	we	shall	see	in	
Part	IV
	of	this	book,	this	way	of	thinking	has
generated	a	lot	of	poor	science. So	I	say	we	need	more,	not	less,	of	the	“shotgun	approach.”	We	need	more
thought	about	overall	dietary	patterns	and	whole	foods. Does	this	mean	that	I
think	the	shotgun	approach	is	the	only	way	to	do	research? Of	course	not. DoI	think	that	the	China	Study	findings	constitute	absolute	scientific	proof? Of
course	not. Does	it	provide	enough	information	to	inform	some	practical
decision-making? Absolutely. An	impressive	and	informative	web	of	information	was	emerging	from
this	study. But	does	every	potential	strand	(or	association)	in	this	mammoth
study	fit	perfectly	into	this	web	of	information? No. Although	most
statistically	significant	strands	readily	fit	into	the	web,	there	were	a	few
surprises. Most,	but	not	all,	have	since	been	explained. Some	associations	observed	in	the	China	Study,	at	first	glance,	were	at
odds	with	what	might	have	been	expected	from	Western	experience. I’ve	had
to	use	care	in	separating	unusual	findings	that	could	be	due	to	chance	and
experimental	insufficiency	from	those	that	truly	offered	new	insights	into	our
old	ways	of	thinking. As	I	mentioned	earlier,	the	range	of	blood	cholesterol
levels	in	rural	China	was	a	surprise. At	the	time	when	the	China	Study	was
begun,	a	blood	cholesterol	range	of	200-300	milligrams	per	deciliter	(mg/dL)
was	considered	normal,	and	lower	levels	were	suspect. In	fact,	some	in	the
scientific	and	medical	communities	considered	cholesterol	levels	lower	than
150	mg/dL	to	be	dangerous. In	fact,	my	own	cholesterol	was	260	mg/dL	in
the	late	1970s,	not	unlike	other	members	of	my	immediate	family. The	doctor
told	me	it	was	“fine,	just	average.”
But	when	we	measured	the	blood	cholesterol	levels	in	China,	we	were
shocked. They	ranged	from	70-170	mg/dL! Their	high	was	our	low,	and	their
low	was	off	the	chart	you	might	find	in	your	doctor’s	office! It	became
obvious	that	our	idea	of	“normal”	values	(or	ranges)	only	applies	to	Western
subjects	consuming	the	Western	diet. It	so	happens,	for	example,	that	our
“normal”	cholesterol	levels	present	a	
significant	risk	for	heart	disease. Sadly,
it’s	also	“normal”	to	have	heart	disease	in	America. Over	the	years,	standards
have	been	established	that	are	consistent	with	what	we	see	in	the	West. We
too	often	have	come	to	the	view	that	U.S.	values	are	“normal”	because	we
have	a	tendency	to	believe	that	the	Western	experience	is	likely	to	be	right. At	the	end	of	the	day,	the	strength	and	consistency	of	the	majority	of	the
evidence	is	enough	to	draw	valid	conclusions. Namely,	whole,	plant-based
foods	are	beneficial,	and	animal-based	foods	are	not. Few	other	dietary
choices,	if	any,	can	offer	the	incredible	benefits	of	looking	good,	growing	tall
and	avoiding	the	vast	majority	or	premature	diseases	in	our	culture. The	China	Study	was	an	important	milestone	in	my	thinking. Standing
alone,	it	does	not	
prove
	that	diet	
causes
	disease. Absolute	proof	in	science	is
nearly	unattainable. Instead,	a	theory	is	proposed	and	debated	until	the	weight
of	the	evidence	is	so	overwhelming	that	everyone	commonly	accepts	that	the
theory	is	most	likely	true. In	the	case	of	diet	and	disease,	the	China	Studyadds	a	lot	of	weight	to	the	evidence. Its	experimental	features	(multiple	diet,
disease	and	lifestyle	characteristics,	and	unusual	range	of	dietary	experience,
a	good	means	of	measuring	data	quality)	provided	an	unparalleled
opportunity	to	expand	our	thinking	about	diet	and	disease	in	ways	that
previously	were	not	available. It	was	a	study	that	was	like	a	flashlight	that
illuminated	a	path	that	I	had	never	fully	seen	before. The	results	of	this	study,	in	addition	to	a	mountain	of	supporting	research,
some	of	it	my	own	and	some	of	it	from	other	scientists,	convinced	me	to	turn
my	dietary	lifestyle	around. I	stopped	eating	meat	fifteen	years	ago,	and	I
stopped	eating	almost	all	animal-based	foods,	including	dairy,	within	the	past
six	to	eight	years,	except	on	very	rare	occasions. My	cholesterol	has	dropped,
even	as	I’ve	aged;	I	am	more	physically	fit	now	than	when	I	was	twenty-five;
and	I	am	forty-five	pounds	lighter	now	than	I	was	when	I	was	thirty	years	old. I	am	now	at	an	ideal	weight	for	my	height. My	family	has	also	adopted	this
way	of	eating,	thanks	in	large	part	to	my	wife	Karen,	who	has	managed	to
create	an	entire	new	dietary	lifestyle	that	is	attractive,	tasty	and	healthy. This
has	all	been	done	for	health	reasons,	the	result	of	my	research	findings	telling
me	to	wake	up. From	a	boyhood	of	drinking	at	least	two	quarts	of	milk	a	day
to	an	early	professional	career	of	scoffing	at	vegetarians,	I	have	taken	an
unusual	turn	in	my	life. However,	it	has	been	more	than	my	own	research	that	has	changed	my
life. Over	the	years,	I	have	gone	well	beyond	our	own	research	
findings	to	see
what	other	researchers	have	found	regarding	diet	and	health. As	our	research
findings	expanded	from	the	specific	to	the	general,	the	picture	has	continued
to	enlarge. We	now	can	look	at	the	work	of	other	scientists	to	put	my	findings
into	a	larger	context. As	you	shall	see,	it	is	nothing	short	of	astonishing.Part	II
DISEASES	OF	AFFLUENCE
H
ERE	IN
	A
MERICA
,	we	are	affluent,	and	we	die	certain	deaths	because	of	it. We
eat	like	feasting	kings	and	queens	every	day	of	the	week,	and	it	kills	us. You
probably	know	people	who	suffer	from	heart	disease,	cancer,	stroke,
Alzheimer’s,	obesity	or	diabetes. There’s	a	good	chance	that	you	yourself
suffer	from	one	of	these	problems,	or	that	one	of	these	diseases	runs	in	your
family. As	we	have	seen,	these	diseases	are	relatively	unknown	in	traditional
cultures	that	subsist	mostly	on	whole	plant	foods,	as	in	rural	China. But	these
ailments	arrive	when	a	traditional	culture	starts	accumulating	wealth	and
starts	eating	more	and	more	meat,	dairy	and	refined	plant	products	(like
crackers,	cookies	and	soda). In	public	lectures,	I	start	my	presentation	by	telling	the	audience	my
personal	story,	just	as	I	have	done	in	this	book. Invariably,	I	get	a	question	at
the	end	of	the	lecture	from	someone	who	wants	to	know	more	about	diet	and
a	specific	disease	of	affluence. Chances	are	that	you	yourself	also	have	a
question	about	a	specific	disease. Chances	are,	too,	that	this	specific	disease	is
a	disease	of	affluence,	because	that’s	what	we	die	of	here	in	America. You	might	be	surprised	to	know	that	the	disease	that	interests	you	has
much	in	common	with	other	diseases	of	affluence,	especially	when	it	comes
to	nutrition. There	is	no	such	thing	as	a	special	diet	for	cancer	and	a	different,
equally	special	diet	for	heart	disease. The	evidence	now	amassed	from
researchers	around	the	world	shows	that	the	same	diet	that	is	good	for	the
prevention	of	cancer	is	also	good	for	the	prevention	
of	heart	disease,	as	well
as	obesity,	diabetes,	cataracts,	macular	degeneration,	Alzheimer’s,	cognitive
dysfunction,	multiple	sclerosis,	osteoporosis	and	other	diseases. Furthermore,
this	diet	can	only	benefit	everyone,	regardless	of	his	or	her	genes	or	personal
dispositions. All	of	these	diseases,	and	others,	spring	forth	from	the	same	influence:	an
unhealthy,	largely	toxic	diet	and	lifestyle	that	has	an	excess	of	sickness-
promoting	factors	and	a	deficiency	of	health-promoting	factors. In	otherwords,	the	Western	diet. Conversely,	there	is	one	diet	to	counteract	all	of	these
diseases:	a	whole	foods,	plant-based	diet. The	following	chapters	are	organized	by	disease,	or	disease	grouping. Each	chapter	contains	evidence	showing	how	food	relates	to	each	disease. As
you	go	through	each	chapter,	you	will	begin	to	see	the	breadth	and	depth	of
the	astonishing	scientific	argument	favoring	a	whole	foods,	plant-based	diet. For	me,	the	consistency	of	evidence	regarding	such	a	disparate	group	of
diseases	has	been	the	most	convincing	aspect	of	this	argument. When	a	whole
foods,	plant-based	diet	is	demonstrably	beneficial	for	such	a	wide	variety	of
diseases,	is	it	possible	that	humans	were	meant	to	consume	any	other	diet? I
say	no,	and	I	think	you’ll	agree. America	and	most	other	Western	nations	have	gotten	it	wrong	when	it
comes	to	diet	and	health,	and	we	have	paid	a	grave	price. We	are	sick,
overweight	and	confused. As	I	have	moved	on	from	the	laboratory	studies	and
the	China	Study	and	encountered	the	information	discussed	in	
Part	II
,	I	have
become	overwhelmed. I	have	come	to	realize	that	some	of	our	most	revered
conventions	are	wrong	and	real	health	has	been	grossly	obscured. Most
unfortunately,	the	unsuspecting	public	has	paid	the	ultimate	price. In	large
measure,	this	book	is	my	effort	to	right	these	wrongs. As	you	will	come	to	see
in	the	following	chapters,	from	heart	disease	to	cancer,	and	from	obesity	to
blindness,	there	is	a	better	path	to	optimal	health.5
Broken	Hearts
P
UT	YOUR	HAND
	on	your	chest	and	feel	your	heart	beat. Now	put	your	hand
where	you	can	feel	your	pulse. That	pulse	is	the	signature	of	your	being. Your
heart,	creating	that	pulse,	is	working	for	you	every	minute	of	the	day,	every
day	of	the	year,	and	every	year	of	your	entire	life. If	you	live	an	average
lifetime,	your	heart	will	beat	about	3	billion	times. 1
Now	take	a	moment	to	realize	that	during	the	time	it	took	you	to	read	the
above	paragraph	an	artery	in	the	heart	of	roughly	one	American	clogged	up,
cut	off	blood	flow	and	started	a	rapid	process	of	tissue	and	cell	death. This
process	is	better	known,	of	course,	as	a	heart	attack. By	the	time	you	finish
reading	this	page,	four	Americans	will	have	had	a	heart	attack,	and	another
four	will	have	fallen	prey	to	stroke	or	heart	failure. 2
	Over	the	next	twenty-
four	hours,	3,000	Americans	will	have	heart	attacks,
2
	roughly	the	same
number	of	people	who	perished	in	the	terrorist	attacks	of	September	11,	2001. The	heart	is	the	centerpiece	of	life	and,	more	often	than	not	in	America,	it
is	the	centerpiece	of	death. Malfunction	of	the	heart	and/or	circulation	system
will	kill	40%	of	Americans,
3
	more	than	those	killed	by	any	other	injury	or
ailment,	including	cancer. Heart	disease	has	been	our	number	one	cause	of
death	for	almost	one	hundred	years. 4
	This	disease	does	not	recognize	gender
or	race	boundaries;	all	are	affected. If	you	were	to	ask	most	women	what
disease	poses	the	greatest	risk	to	them,	heart	disease	or	breast	cancer,	many
women	would	undoubtedly	say	breast	cancer. But	they	would	be	wrong. Women’s	death	rate	from	heart	disease	is	
eight	times	higher
	than	their	death
rate	from	breast	cancer. 5,	6
If	there	is	an	“American”	game,	it	is	baseball;	an	“American”	dessert,
apple	pie. If	there	is	an	“American”	disease,	it	is	heart	disease.EVERYONE’S	DOING	IT
In	1950,	Judy	Holliday	could	be	seen	on	the	big	screen,	Ben	Hogan
dominated	the	world	of	golf,	the	musical	
South	Pacific
	won	big	at	the	Tony
Awards	and	on	June	25,	North	Korea	invaded	South	Korea. The	American
administration	was	taken	aback	but	responded	quickly. Within	days,	President
Truman	sent	in	troops	on	the	ground	and	bombers	overhead	to	push	back	the
North	Korean	army. Three	years	later,	in	July	of	1953,	a	formal	cease-fire
agreement	had	been	signed	and	the	Korean	War	was	over. During	this	period
of	time,	over	30,000	American	soldiers	were	killed	in	battle. At	the	end	of	the	war,	a	landmark	scientific	study	was	reported	in	the
Journal	of	the	American	Medical	Association. Military	medical	investigators
had	examined	the	hearts	of	300	male	soldiers	killed	in	action	in	Korea. The
soldiers,	at	an	average	age	of	twenty-two	years,	had	never	been	diagnosed
with	heart	problems. In	dissecting	these	hearts,	researchers	found	startling
evidence	of	disease	in	an	exceptional	number	of	cases. Fully	77.3%	of	the
hearts	they	examined	had	“gross	evidence”	of	heart	disease. 7
	(In	this
instance,	“gross”	means	large.) That	number,	77.3%,	is	startling. Coming	at	a	time	when	our	number	one
killer	was	still	shrouded	in	mystery,	the	research	clearly	demonstrated	that
heart	disease	develops	over	an	entire	lifetime. Furthermore,	almost	everyone
was	susceptible! These	soldiers	were	not	couch-potato	slouches;	they	were	in
top	condition	in	the	prime	of	their	physical	lives. Since	that	time,	several
other	studies	have	confirmed	that	heart	disease	is	pervasive	in	young
Americans. 8THE	HEART	ATTACK
But	what	is	heart	disease? One	of	the	key	components	is	plaque. Plaque	is	a
greasy	layer	of	proteins,	fats	(including	cholesterol),	immune	system	cells	and
other	components	that	accumulate	on	the	inner	walls	of	the	coronary	arteries. I	have	heard	one	surgeon	say	that	if	you	wipe	your	finger	on	a	plaque-covered
artery,	it	has	the	same	feel	as	wiping	your	finger	across	a	warm	cheesecake. If
you	have	plaque	building	up	in	your	coronary	arteries,	you	have	some	degree
of	heart	disease. Of	the	autopsied	soldiers	in	Korea,	one	out	of	twenty
diseased	men	had	so	much	plaque	that	90%	of	an	artery	was	blocked. 7
	That’s
like	putting	a	
kink	in	a	garden	hose	and	watering	a	desperately	dry	garden
with	the	resulting	trickle	of	water! Why	hadn’t	these	soldiers	had	a	heart	attack	already? After	all,	only	10%
of	the	artery	was	open. How	could	that	be	enough? It	turns	out	that	if	the
plaque	on	the	inner	wall	of	the	artery	accumulates	slowly	over	several	years,
blood	flow	has	time	to	adjust. Think	of	blood	flowing	through	your	artery	as	a
raging	river. If	you	put	a	few	stones	on	the	sides	of	a	river	every	day	over	a
period	of	years,	like	plaque	accumulating	on	the	walls	of	the	artery,	the	water
will	find	another	way	to	get	to	where	it	wants	to	be. Maybe	the	river	will	form
several	smaller	streams	over	the	stones. Perhaps	the	river	will	go	under	the
stones	forming	tiny	tunnels,	or	maybe	the	water	will	flow	through	small	side
streams,	taking	a	new	route	altogether. These	new	tiny	passageways	around	or
through	the	stones	are	called	“collaterals.”	The	same	thing	happens	in	the
heart. If	plaque	accumulates	over	a	period	of	several	years	there	will	be
enough	collateral	development	that	blood	can	still	travel	throughout	the	heart. However,	too	much	plaque	buildup	can	cause	severe	blood	restriction,	and
debilitating	chest	pain,	or	angina,	can	result. But	this	buildup	only	rarely	leads
to	heart	attacks. 9,	10
So	what	leads	to	heart	attacks? It	turns	out	that	it’s	the	less	severe
accumulations	of	plaque,	blocking	under	50%	of	the	artery,	that	often	cause
heart	attacks. 11
	These	accumulations	each	have	a	layer	of	cells,	called	the	cap,
which	separates	the	core	of	the	plaque	from	the	blood	flowing	by. In	the
dangerous	plaques,	the	cap	is	weak	and	thin. Consequently,	as	blood	rushes
by,	it	can	erode	the	cap	until	it	ruptures. When	the	cap	ruptures,	the	core
contents	of	the	plaque	mix	with	the	blood. The	blood	then	begins	clotting
around	the	site	of	rupture. The	clot	grows	and	can	quickly	block	off	the	entire
artery. When	the	artery	becomes	blocked	over	such	a	short	period	of	time,
there	is	little	chance	for	collateral	blood	flow	to	develop. When	this	happens,
blood	flow	downstream	of	the	rupture	is	severely	reduced	and	the	heartmuscles	don’t	get	the	oxygen	they	require. At	this	point,	as	heart	muscle	cells
start	to	die,	heart	pumping	mechanisms	begin	to	fail,	and	the	person	may	feel
a	crushing	pain	in	the	chest,	or	a	searing	pain	down	into	an	arm	and	up	into
the	neck	and	jaw. In	short,	the	victim	starts	to	die. This	is	the	process	behind
most	of	the	1.1	million	heart	attacks	that	occur	in	America	every	year. One
out	of	three	people	who	have	a	heart	attack	will	die	from	it. 9,	10
We	now	know	that	the	small	to	medium	accumulation	of	plaque,	the
plaque	that	blocks	less	than	50%	of	the	artery,	is	the	most	deadly. 11,	12
	
So	how
can	we	predict	the	timing	of	heart	attacks? Unfortunately,	with	existing
technologies,	we	can’t. We	can’t	know	which	plaque	will	rupture,	when,	or
how	severe	it	might	be. What	we	do	know,	however,	is	our	relative	
risk
	for
having	a	heart	attack. What	once	was	a	mysterious	death,	which	claimed
people	in	their	most	productive	years,	has	been	“demystified”	by	science. No
study	has	been	more	influential	than	that	of	the	Framingham	Heart	Study.FRAMINGHAM
After	World	War	II,	the	National	Heart	Institute
13
	was	created	with	a	modest
budget
4
	and	a	difficult	mission. Scientists	knew	that	the	greasy	plaques	that
lined	the	arteries	of	diseased	hearts	were	composed	of	cholesterol,
phospholipids	and	fatty	acids,
14
	but	they	didn’t	know	why	these	lesions
developed,	how	they	developed	or	exactly	how	they	led	to	heart	attacks. In
the	search	for	answers,	the	National	Heart	Institute	decided	to	follow	a
population	over	several	years,	to	keep	detailed	medical	records	of	everybody
in	the	population	and	to	see	who	got	heart	disease	and	who	didn’t. The
scientists	headed	to	Framingham,	Massachusetts. Located	just	outside	of	Boston,	Framingham	is	steeped	in	American
history. European	settlers	first	inhabited	the	land	in	the	seventeenth	century. Over	the	years	the	town	has	had	supporting	roles	in	the	Revolutionary	War,
the	Salem	Witch	Trials	and	the	abolition	movement. More	recently,	in	1948,
the	town	assumed	its	most	famous	role. Over	5,000	residents	of	Framingham,
both	male	and	female,	agreed	to	be	poked	and	prodded	by	scientists	over	the
years	so	that	we	might	learn	something	about	heart	disease. And	learn	something	we	did. By	watching	who	got	heart	disease	and	who
didn’t,	and	comparing	their	medical	records,	the	Framingham	Heart	Study
developed	the	concept	of	risk	factors	such	as	cholesterol,	blood	pressure,
physical	activity,	cigarette	smoking	and	obesity. Because	of	the	Framingham
Study,	we	now	know	that	these	risk	factors	play	a	prominent	role	in	the
causation	of	heart	disease. Doctors	have	for	years	used	a	Framingham
prediction	model	to	tell	who	is	at	high	risk	for	heart	disease	and	who	is	not. Over	1,000	scientific	papers	have	been	published	from	this	study,	and	the
study	continues	to	this	day,	having	now	studied	four	generations	of
Framingham	residents. The	shining	jewel	of	the	Framingham	Study	is	its	findings	on	blood
cholesterol. In	1961,	they	convincingly	showed	a	strong	correlation	between
high	blood	cholesterol	and	heart	disease. Researchers	noted	that	
men	with
cholesterol	levels	“over	244	mg/dL	(milligrams	per	deciliter)	have	more	than
three	times	the	incidence	of	CHD	(coronary	heart	disease)	as	do	those	with
cholesterol	levels	less	than	210	mg/dL.”
15
	The	contentious	question	of
whether	blood	cholesterol	levels	could	predict	heart	disease	was	laid	to	rest. Cholesterol	levels	do	make	a	difference. In	this	same	paper,	high	blood
pressure	was	also	demonstrated	to	be	an	important	risk	factor	for	heart
disease. The	importance	given	to	risk	factors	signaled	a	conceptual	revolution.When	this	study	was	started,	most	doctors	believed	that	heart	disease	was	an
inevitable	“wearing	down”	of	the	body,	and	we	could	do	little	about	it. Our
hearts	were	like	car	engines;	as	we	got	older,	the	parts	didn’t	work	as	well	and
sometimes	gave	out. By	demonstrating	that	we	could	see	the	disease	in
advance	by	measuring	risk	factors,	the	idea	of	preventing	heart	disease
suddenly	had	validity. Researchers	wrote,”…	it	appears	that	a	preventive
program	is	clearly	necessary.”
15
	Simply	lower	the	risk	factors,	such	as	blood
cholesterol	and	blood	pressure,	and	you	lower	the	risk	of	heart	disease. In	modern-day	America	cholesterol	and	blood	pressure	are	household
terms. We	spend	over	30	billion	dollars	a	year	on	drugs	to	control	these	risk
factors	and	other	aspects	of	cardiovascular	disease. 2
	Almost	everyone	now
knows	that	he	or	she	can	work	to	prevent	a	heart	attack	by	keeping	his	or	her
risk	factors	at	the	right	levels. This	awareness	is	only	about	fifty	years	old	and
due	in	large	measure	to	the	scientists	and	subjects	of	the	Framingham	Heart
Study.OUTSIDE	OUR	BORDERS
Framingham	is	the	most	well-known	heart	study	ever	done,	but	it	is	merely
one	part	of	an	enormous	body	of	research	conducted	in	this	country	over	the
past	sixty	years. Early	research	led	to	the	alarming	conclusion	that	we	have
some	of	the	highest	rates	of	heart	disease	in	the	world. One	study	published	in
1959	compared	the	coronary	heart	disease	death	rates	in	twenty	different
countries	(
Chart	5.1
). 16
These	studies	were	examining	Westernized	societies. If	we	look	at	more
traditional	societies,	we	tend	to	see	even	more	striking	disparities	in	the
incidence	of	heart	disease. The	Papua	New	Guinea	Highlanders,	for	example,
pop	up	in	research	quite	a	bit	because	heart	disease	is	rare	in	their	society. 17
Remember,	for	example,	how	low	the	rate	of	heart	disease	was	in	rural	China. American	men	died	from	heart	disease	at	a	rate	almost	seventeen	times	higher
than	their	Chinese	counterparts. 18
CHART	5.1:	HEART	DISEASE	DEATH	RATES	FOR	MEN	AGED	55
TO	59	ACROSS	20	COUNTRIES,	CIRCA	1955
16
Why	were	we	succumbing	to	heart	disease	in	the	sixties	and	seventies,
when	much	of	the	world	was	relatively	unaffected? Quite	simply	it	was	a	case	of	death	by	food. The	cultures	that	have	lowerheart	disease	rates	eat	less	saturated	fat	and	animal	protein	and	more	whole
grains,	fruits	and	vegetables. In	other	words,	they	subsist	mostly	on	plant
foods	while	we	subsist	mostly	on	animal	foods. But	might	it	be	that	the	genetics	of	one	group	might	just	make	them	more
susceptible	to	heart	disease? We	know	that	this	is	not	the	case,	because	within
a	group	with	the	same	genetic	heritage,	a	similar	relationship	between	diet
and	disease	is	seen. For	example,	Japanese	men	who	live	in	Hawaii	or
California	have	a	much	higher	blood	cholesterol	level	and	incidence	of
coronary	heart	disease	than	Japanese	men	living	in	Japan. 19,	20
The	cause	is	clearly	environmental,	as	most	of	these	people	have	the	same
genetic	heritage. Smoking	habits	are	not	the	cause	because	men	
in	Japan,	who
were	more	likely	to	smoke,	still	had	less	coronary	heart	disease	than	the
Japanese	Americans. 19
	The	researchers	pointed	to	diet,	writing	that	blood
cholesterol	increased	“with	dietary	intake	of	saturated	fat,	animal	protein	and
dietary	cholesterol.”	On	the	flip	side,	blood	cholesterol	“was	negatively
associated	with	complex	carbohydrate	intake….”
20
	In	simple	terms,	animal
foods	were	linked	to	higher	blood	cholesterol;	plant	foods	were	linked	to
lower	blood	cholesterol. This	research	clearly	implicated	diet	as	one	possible	cause	of	heart
disease. Furthermore,	the	early	results	were	painting	a	consistent	picture:	the
more	saturated	fat	and	cholesterol	(as	indicators	of	animal	food	consumption)
people	eat,	the	higher	their	risk	for	getting	heart	disease. And	as	other	cultures
have	come	to	eat	more	like	us,	they	also	have	seen	their	rates	of	heart	disease
skyrocket. In	more	recent	times,	several	countries	have	now	come	to	have	a
higher	death	rate	from	heart	disease	than	America.RESEARCH	AHEAD	OF	ITS	TIME
So	now	we	know	what	heart	disease	is	and	what	factors	determine	our	risk	for
it,	but	what	do	we	do	once	the	disease	is	upon	us? When	the	Framingham
Heart	Study	was	just	beginning,	there	were	already	doctors	who	were	trying
to	figure	out	how	to	treat	heart	disease,	rather	than	just	prevent	it. In	many
ways,	these	investigators	were	ahead	of	their	time	because	their	interventions,
which	were	the	most	innovative,	successful	treatment	programs	at	the	time,
utilized	the	least	advanced	technology	available:	the	knife	and	fork. These	doctors	noticed	the	ongoing	research	at	the	time	and	made	some
common-sense	connections. They	realized	that
21
:
excess	fat	and	cholesterol	consumption	caused	atherosclerosis	(the
hardening	of	the	arteries	and	the	accumulation	of	plaque)	in
experimental	animals
eating	cholesterol	in	food	caused	a	rise	in	cholesterol	in	the	blood
high	blood	cholesterol	might	predict	and/or	cause	heart	disease
most	of	the	world’s	population	didn’t	have	heart	disease,	and	these	heart
disease-free	cultures	had	radically	different	dietary	patterns,	consuming
less	fat	and	cholesterol
So	they	decided	to	try	to	alter	heart	disease	in	their	patients	by	having
them	eat	less	fat	and	cholesterol. One	of	the	most	progressive	doctors	was	Dr.	Lester	Morrison	of	Los
Angeles. He	started	a	study	in	1946	(two	years	before	the	Framingham	Study)
to	“determine	the	relationship	of	dietary	fat	intake	to	the	incidence	of
atherosclerosis.”
22
	In	his	study	he	instructed	fifty	heart	attack	survivors	to
maintain	their	normal	diet	and	fifty	different	heart	attack	survivors	to
consume	an	experimental	diet. In	the	experimental	diet	group	he	reduced	the	consumption	of	fat	and
cholesterol. One	of	his	published	sample	menus	allowed	the	patient	to	have
only	a	small	amount	of	meat	two	times	a	day:	two	ounces	of	“cold	roast	lamb,
lean,	with	mint	jelly”	for	lunch,	and	another	two	ounces	of	“lean	meats”	for
dinner. 22
	Even	if	you	loved	cold	roast	lamb	with	mint	jelly,	you	weren’t
allowed	to	eat	much	of	it. In	fact,	the	list	of	prohibited	foods	in	the
experimental	diet	was	fairly	long	and	included	cream	soups,	pork,	fat	meats,
animal	fats,	whole	milk,	cream,	butter,	egg	yolks	and	breads	and	desserts
made	with	butter,	whole	eggs	and	whole	milk. 22
Did	this	progressive	diet	accomplish	anything? After	eight	years,	only
twelve	of	fifty	people	eating	their	normal	American	diet	were	alive	(24%). Inthe	diet	group,	twenty-eight	people	were	still	alive	(56%),	almost	two	and
one-half	times	the	amount	of	survivors	in	the	control	group. After	twelve
years,	every	single	patient	in	the	control	group	was	dead. In	the	diet	group,
however,	nineteen	people	were	still	alive,	a	survival	rate	of	38%. 22
	While	it
was	unfortunate	that	so	many	people	in	the	dietary	group	still	died,	it	was
clear	that	they	were	staving	off	their	disease	by	eating	moderately	less	animal
foods	and	moderately	more	plant	foods	(see	
Chart	5.2
). CHART	5.2:	SURVIVAL	RATE	OF	DR.	MORRISON’S	PATIENTS
In	1946,	when	this	study	began,	most	scientists	believed	that	heart	disease
was	an	inevitable	part	of	aging,	and	nothing	much	could	be	done	about	it. While	Morrison	didn’t	cure	heart	disease,	he	proved	that	something	as	simple
as	diet	could	significantly	alter	its	course,	even	when	the	disease	is	so
advanced	that	it	has	already	caused	a	heart	attack. Another	research	group	proved	much	the	same	thing	at	about	that	time. A
group	of	doctors	in	Northern	California	took	a	larger	group	of	patients	with
advanced	heart	disease	and	put	them	on	a	low-fat,	low-cholesterol	diet. These
doctors	found	that	the	patients	who	ate	the	low-fat,	low-cholesterol	diet	died
at	a	rate	
four	times	lower
	than	patients	who	didn’t	follow	the	diet. 23
It	was	now	clear	that	there	was	hope.
_OceanofPDF.com_The_China_Study__The_Most_Comprehensive_St_-_T_Colin_Campbell.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        The
fiber	may	bind	with	these	nutrients	and	carry	them	through	our	system	before
we	are	able	to	digest	them. They	say	that	the	maximum	level	of	fiber	intake
should	be	around	thirty	to	thirty-five	grams	per	day,	which	is	only	about	the
average	intake	of	the	rural	Chinese. We	studied	this	iron/fiber	issue	very	carefully	in	the	China	Study. As	it
turns	out,	fiber	is	not	the	enemy	of	iron	absorption	as	so	many	experts	claim	it
to	be. We	measured	how	much	iron	the	Chinese	were	consuming	and	howmuch	was	in	their	bodies. Iron	was	measured	in	six	different	ways	(four	blood
biomarkers	and	two	estimates	of	iron	intake)	and	
when	we	compared	these
measurements	with	fiber	intake,	
there	was	no	evidence	showing	that
increasing	fiber	intake	impaired	iron	absorption	in	the	body. In	fact,	we	found
the	opposite	effect. A	good	indicator	of	how	much	iron	is	in	the	blood,
hemoglobin,	actually	increased	with	greater	intakes	of	dietary	fiber. I
	As	it
turns	out,	high-fiber	foods,	like	wheat	and	corn	(but	not	the	polished	rice
consumed	in	China)	also	happen	to	be	high	in	iron,	meaning	that	the	higher
the	consumption	of	fiber,	the	higher	the	consumption	of	iron. III
	Iron	intake	in
rural	China	(34	mg/day)	was	surprisingly	high	when	compared	to	the	average
American	intake	(18	mg/day)	and	it	was	far	more	associated	with	plant-based
foods	than	with	animal-based	foods. 41
CHART	4. 10:	AVERAGE	INTAKES	OF	DIETARY	FIBER,	GM/DAY
The	China	findings	on	dietary	fiber	and	iron,	like	so	many	other
observations	in	this	study,	did	not	support	the	common	view	of	Western
scientists. People	who	consume	more	plant-based	foods,	thus	more	dietary
fiber,	also	consume	more	iron,
III
	all	of	which	results	in	statistically	significant
higher	levels	of	hemoglobin. Unfortunately,	a	bit	of	confusion	has	arisen	over
the	fact	that	some	people	in	rural	China,	including	women	and	children,	have
low	iron	levels. This	is	especially	true	in	areas	where	parasitic	diseases	are
more	common. In	areas	of	rural	China	where	parasitic	diseases	were	more
common,	iron	status	was	lower. 1
	This	has	given	some	the	opportunity	to
claim	that	these	people	need	more	meat,	but	the	evidence	indicates	that	the
problem	would	be	much	better	corrected	by	reducing	parasitism	in	these
areas. Much	of	the	initial	interest	in	dietary	fiber	arose	with	Burkitt’s	travels	in
Africa	and	his	claim	that	large	bowel	cancer	is	lower	among	populations	whoconsume	high-fiber	diets. Burkitt	made	this	claim	popular	but	the	story	is	at
least	200	years	old. In	England	during	the	late	eighteenth	century	and	early
nineteenth	century,	it	was	claimed	by	some	of	the	leading	physicians	that
constipation,	which	was	associated	with	less	bulky	diets	(i. e. ,	low-fiber	diets),
was	associated	with	a	higher	risk	of	cancer	(usually	breast	and	“intestinal”
cancers). At	the	beginning	of	the	China	Study,	this	belief	that	fiber	might	prevent
large	bowel	cancer	was	the	prevailing	view,	although	the	1982	National
Academy	of	Sciences	Committee	on	Diet,	Nutrition	and	Cancer,	“found	no
conclusive	evidence	to	indicate	that	dietary	fiber…	exerts	a	protective	effect
against	colorectal	cancer	in	humans. ”	The	report	went	on	to	conclude,	“…	if
there	is	such	an	effect,	specific	components	of	fiber,	rather	than	total	dietary
fiber,	are	more	likely	to	be	responsible. ”
20
	In	hindsight,	our	discussion	of	this
issue	was	inadequate. The	question,	
the	review	of	the	research	literature	and
the	interpretation	of	the	evidence	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. I,	II
	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	color/health	link. The	colors	of	fruits	and	vegetables	are	derived	from	a	variety	of	chemicals
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	chemistry. 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	between
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	reactor	leaking	radioactive
materials	(free	radicals)	that	can	be	very	dangerous	to	the	surrounding	area. So	how	does	the	plant	manage	these	complex	reactions	and	protect	
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-sounding	crytoxanthins
(oranges). Other	antioxidants	may	be	colorless	and	these	include	chemicals
such	as	ascorbic	acid	(vitamin	C)	and	vitamin	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,	however,	isthat	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	cancer,	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	antioxidants. 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	incredibly	appealing	with	beautiful,	appetizing
colors. Then	we	animals,	in	turn,	are	attracted	to	the	plants	and	eat	them	and
borrow	their	antioxidant	shields	for	our	own	health. Whether	you	believe	in
God,	evolution	or	just	coincidence,	you	must	admit	that	this	is	a	beautiful,
almost	spiritual,	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	most	significant	vitamin	C	association	with	cancer	was	its	relationship
with	the	number	of	cancer-prone	families	in	each	area. 42
	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,
III
	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	disease	and
stroke. II
	Vitamin	C	intake	from	fruits	clearly	showed	a	powerful	protective
effect	against	a	variety	of	diseases. The	other	measures	of	antioxidants,	blood	levels	of	alpha	and	beta-carotene	(a	vitamin	precursor)	and	alpha	and	gamma	tocopherol	(vitamin	E)
are	poor	indicators	of	the	effects	of	antioxidants. These	antioxidants	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	experimental
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	containing
vitamin	C	and	beta-carotene	or	a	fiber	supplement	create	these	health	effects. No. The	triumph	of	health	lies	not	in	the	individual	nutrients,	but	in	the	whole
foods	that	contain	those	nutrients:	plant-based	foods. In	a	bowl	of	spinach
salad,	for	example,	we	have	fiber,	antioxidants	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-based
foods	ever	since	vitamin	supplements	were	introduced	on	a	large	
scale	in	the
marketplace. And	I	have	watched	in	dismay	how	the	industry	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	taking	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	greatest	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	wallowing	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:	according	to	a	report
46
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. In	one	published	study
47
	funded	by	the	Atkins	Center	for	Complementary
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	severelyrestricting	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	calories	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
improve
50
	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	restriction	over	a	period	of	years	or	decades	without	either
becoming	an	invalid	or	melting	away	into	nothing. People	are	notoriously
unsuccessful	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
	Additionally,	they	found	that	the	dieters	had	a	stunning	53%
increase	in	the	amount	of	calcium	they	excreted	in	their	urine,
47
	which	may
spell	disaster	for	their	bone	health. The	weight	loss,	some	of	which	is	simply
initial	fluid	loss,
51
	may	come	with	a	very	high	price. A	different	review	of	low-carbohydrate	diets	published	by	
researchers	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	carbohydrates	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	manages	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-carbohydrate	diets	“make-yourself-sick”	diets,	and	I	think	that’s
an	appropriate	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	“common	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-nutrients	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	held	of	nutrition,	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	carbohydrates. 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	
been	shown	many	times	to	cause
significant	weight	loss. But	it’s	not	quite	as	simple	as	that. At	least	99%	of	the	carbohydrates	that	we	consume	are	derived	from
fruits,	vegetables	and	grains. When	these	foods	are	consumed	in	the
unprocessed,	unrefined	and	natural	state,	a	large	proportion	of	the
carbohydrates	are	in	the	so-called	“complex”	form. This	means	that	they	are
broken	down	in	a	controlled,	regulated	manner	during	digestion. This
category	of	carbohydrates	includes	the	many	forms	of	dietary	fiber,	almost	all
of	which	remain	undigested—but	still	provide	substantial	health	benefits. In
addition,	these	complex	carbohydrates	from	whole	foods	are	packaged	with
generous	amounts	of	vitamins,	minerals	and	accessible	energy. Fruits,
vegetables	and	whole	grains	are	the	healthiest	foods	you	can	consume,	and
they	are	primarily	made	of	carbohydrates. On	the	opposite	side	of	the	spectrum,	there	are	highly	processed,	highly
refined	carbohydrates	that	have	been	stripped	of	their	fiber,	vitamins	and
minerals. Typical	simple	carbohydrates	are	found	in	foods	like	white	bread,
processed	snack	items	including	crackers	and	chips	made	with	white	flour,
sweets	including	pastries	and	candy	bars	and	sugar-laden	soft	drinks. These
highly	refined	carbohydrates	originate	from	grains	or	sugar	plants,	like	sugar
cane	or	the	sugar	beet. They	are	readily	broken	down	during	digestion	to	the
simplest	form	of	the	carbohydrates,	which	are	absorbed	into	the	body	to	give
blood	sugar,	or	glucose. Unfortunately,	most	Americans	consume	voluminous	amounts	of	simple,
refined	carbohydrates	and	paltry	amounts	of	complex	carbohydrates. For
example,	in	1996,	42%	of	Americans	ate	cakes,	cookies,	pastries	or	pies	on
any	given	day,	while	only	10%	ate	any	dark	green	vegetables. 46
	In	another
ominous	sign,	only	three	vegetables	accounted	for	half	of	the	total	vegetable
servings	in	1996
46
:	potatoes,	which	were	mostly	consumed	as	fries	and	chips;
head	lettuce,	one	of	the	least	nutrient-dense	vegetables	you	can	consume,	and
canned	tomatoes,	which	is	probably	only	a	reflection	of	pizza	and	pasta
consumption. Add	to	that	the	fact	that	the	average	American	consumed	
thirty-
two	teaspoons	of	added	sugars	per	day	in	1996
,
46
	and	it’s	clear	thatAmericans	are	gorging	almost	exclusively	on	refined,	simple	carbohydrates,
at	the	exclusion	of	healthful	complex	carbohydrates. This	is	bad	news,	and	this,	in	large	measure,	is	why	carbohydrates	as	a
whole	have	gotten	such	a	bad	rap;	the	vast	majority	of	carbohydrates
consumed	in	America	are	found	in	junk	food	or	grains	so	refined	that	they
have	to	be	supplemented	with	vitamins	and	minerals. On	this	
point,	the
popular	diet	authors	and	I	agree. For	example,	you	could	eat	a	low-fat,	high-
carbohydrate	diet	by	exclusively	eating	the	following	foods:	pasta	made	from
refined	flour,	baked	potato	chips,	soda,	sugary	cereals	and	low-fat	candy	bars. Eating	this	way	is	a	
bad
	idea. You	will	not	derive	the	health	benefits	of	a
plant-based	diet	eating	these	foods. In	experimental	research,	the	health
benefits	of	a	high-carbohydrate	diet	come	from	eating	the	complex
carbohydrates	found	in	whole	grains,	fruits	and	vegetables. Eat	an	apple,	a
zucchini	or	a	plate	of	brown	rice	topped	with	beans	and	other	vegetables. THE	CHINA	STUDY	WEIGHS	IN
With	regard	to	weight	loss,	there	are	some	surprising	findings	from	the	China
Study	that	shed	light	on	the	weight	loss	debate. When	we	started	the	China
Study,	I	thought	that	China	had	the	opposite	problem	from	that	of	the	U. S. I
had	heard	that	China	could	not	feed	itself,	that	it	was	prone	to	famines	and
that	there	was	not	enough	food	for	people	to	attain	their	full	adult	height. Very
simply,	there	were	not	enough	calories	to	go	around. Although	China	has,
during	the	last	fifty	years,	had	its	share	of	nutritional	problems,	we	were	to
learn	that	these	views	on	calorie	intake	were	dead	wrong. We	wanted	to	compare	the	calorie	consumption	in	China	and	America,	but
there	was	a	catch. Chinese	are	more	physically	active	than	Americans,
especially	in	rural	areas,	where	manual	labor	is	the	norm. To	compare	an
extremely	active	laborer	with	an	average	American	would	be	misleading. It
would	be	like	comparing	the	amount	of	energy	consumed	by	a	manual	laborer
at	hard	work	with	the	amount	of	energy	consumed	by	an	accountant. The	vast
difference	in	calorie	intake	sure	to	exist	between	these	individuals	would	tell
us	nothing	of	value	and	only	confirm	that	the	manual	laborer	is	more	active. To	overcome	this	problem,	we	ranked	the	Chinese	into	five	groups
according	to	their	levels	of	physical	activity. After	figuring	out	the	calorie
intakes	of	the	
least	active
	Chinese,	the	equivalent	of	office	workers,	we	then
compared	their	calorie	intake	with	the	
average
	American. What	we	found	was
astonishing. Average	calorie	intake,	per	kilogram	of	body	weight,	was	30%	
higher
among	the	least	active	Chinese	than	among	average	Americans. Yet,	body
weight	was	20%	
lower
	(
Chart	4. 11
). How	can	it	be	that	even	the	least	active
Chinese	consume	more	calories	yet	have	no	overweight	problems. What	is
their	secret. CHART	4. 11:	CALORIE	CONSUMPTION	(KCAL/KG)	AND	BODY
WEIGHT
There	are	two	possible	explanations	for	this	apparent	paradox. First,	even
the	Chinese	office	workers	are	more	physically	active	than	average
Americans. Anyone	familiar	with	China	knows	that	many	office	workers
travel	on	bicycles. Thus,	they	consume	more	calories. Even	so,	we	cannot	tell
how	much	of	the	extra	calorie	consumption	was	due	to	physical	activity	and
how	much	to	something	else,	perhaps	their	food. We	do	know,	however,	that	some	people	use	the	calories	they	consume
differently	from	other	people. We	often	say	that	“they	have	a	higher	rate	of
metabolism”	or	“it’s	in	their	genes. ”	You	know	these	people. They	are	the
ones	who	seem	to	eat	all	they	want	and	still	not	gain	weight. Then	there	are
most	of	us,	who	need	to	watch	our	calorie	intake—or	so	we	think. This	is	the
simplistic	interpretation. I	have	a	more	comprehensive	interpretation	that	is	based	on	our	own
considerable	research	and	on	the	studies	of	others. It	goes	like	this. Provided
that	we	aren’t	restricting	our	calorie	intake,	those	of	us	who	consume	a	high-
fat,	high-protein	diet	simply	retain	more	calories	than	we	need. We	store	these
calories	as	body	fat,	perhaps	weave	it	into	our	muscle	fibers	(we	call	it
“marbling”	in	beef	animals)	and	perhaps	store	it	in	the	more	obvious	places,
like	our	butt,	our	midsection	or	around	our	face	and	upper	thighs. Here’s	the	clincher:	only	a	small	amount	of	calories	needs	to	be	retained
by	our	body	to	cause	significant	change	in	body	weight. For	example,	if	we
retain	only	an	extra	fifty	calories	per	day,	this	can	lead	to	an	extra	ten	pounds
per	year. You	may	not	think	that	this	is	a	lot,	but	over	a	period	of	five	years,
that’s	an	extra	fifty	pounds. Some	people	would	hear	this	and	might	be	inclined	to	just	eat	fifty	fewer
calories	per	day. This,	theoretically,	could	make	a	difference,	but	it	
is	entirely
impractical. It	is	impossible	to	keep	track	of	daily	calorie	intake	with	such
precision. Think	about	eating	a	meal	at	a	restaurant. Do	you	know	how	many
calories	each	meal	has. What	about	the	casserole	you	might	fix. What	about
the	steak	you	might	buy. Do	you	know	the	number	of	calories	they	contain. Of	course	not. The	truth	is	this:	despite	any	short-term	caloric	restriction	regimes	we	may
follow,	our	body	through	many	mechanisms,	will	ultimately	choose	how
many	calories	to	take	in	and	what	to	do	with	them. Our	attempts	to	limit
calorie	intake	is	short-lived	and	imprecise,	whether	we	do	it	by	limiting
carbohydrates	or	fat. The	body	employs	a	delicate	balancing	act	and	some	very	intricate
mechanisms	in	deciding	how	to	use	the	calories	being	consumed. When	we
treat	our	body	well	by	eating	the	right	foods,	it	knows	how	to	partition	the
calories	away	from	body	fat	and	into	the	more	desirable	functions	likekeeping	the	body	warm,	running	the	body	metabolism,	supporting	and
encouraging	physical	activity	or	just	disposing	of	any	excess. The	body	is
using	multiple	intricate	mechanisms	to	decide	how	calories	get	used,	stored	or
“burned	off. ”
Consuming	diets	
high
	in	protein	and	fat	transfers	calories	away	from	their
conversion	into	body	heat	to	their	storage	form—as	body	fat	(unless	severe
calorie	restriction	is	causing	weight	loss). In	contrast,	diets	
low
	in	protein	and
fat	cause	calories	to	be	“lost”	as	body	heat. In	research,	we	say	that	storing
more	calories	as	fat	and	losing	less	as	heat	means	being	more	efficient. I	bet
that	you	would	rather	be	a	little	more	inefficient	and	convert	it	into	body	heat
rather	than	body	fat,	right. Well,	simply	consuming	a	diet	lower	in	fat	and
protein	can	do	this. This	is	what	our	China	Study	data	show. Chinese	consume	more	calories
both	because	they	are	more	physically	active	and	because	their	consumption
of	low-fat,	low-protein	diets	shifts	conversion	of	these	calories	away	from
body	fat	to	body	heat. This	is	true	even	for	the	least	physically	active	Chinese. Remember,	it	takes	very	little,	only	fifty	calories	a	day,	to	change	our	storage
of	body	fat	and	thus	change	our	body	weight. 58
We	saw	the	same	phenomenon	in	our	experimental	animals	fed	the	low-
protein	diets. They	routinely	consumed	slightly	more	calories,	gained	less
weight,	disposed	of	the	extra	calories	as	body	heat
59
	and	voluntarily	exercised
more,
60
	while	still	having	far	less	cancer	than	animals	on	standard	diets. We
found	that	calories	were	“burned”	at	a	faster	rate	and	transformed	into	body
heat	as	more	oxygen	was	consumed. 59
Understanding	that	diet	can	cause	small	shifts	in	calorie	metabolism	that
lead	to	big	shifts	in	body	weight	is	an	important	and	useful	concept. It	means
that	there	is	an	orderly	process	of	controlling	body	weight	over	time	that	does
work,	as	opposed	to	the	disorderly	process	of	crash	diets	that	don’t	work. It
also	accounts	for	the	frequent	observations	(discussed	in	chapter	six)	that
people	who	consume	low-protein,	low-fat	diets	composed	of	whole	plant
foods	have	far	less	difficulty	with	weight	problems,	even	if	they	consume	the
same,	or	even	slightly	more,	total	calories. DIET	AND	BODY	SIZE
We	now	know	that	eating	a	low-fat,	low-protein	diet	high	in	complex
carbohydrates	from	fruits	and	vegetables	will	help	you	lose	weight. But	what
if	you	want	to	become	bigger. A	desire	to	be	as	big	as	possible	is	pervasive	in
most	cultures. During	the	colonial	period	in	Asia	and	Africa,	Europeans	even
considered	smaller	people	to	be	less	civilized. Body	size	seems	to	be	a	mark
of	prowess,	manliness	and	dominance. Most	people	think	they	can	be	bigger	and	stronger	by	eating	protein-rich
animal-based	foods. This	belief	stems	from	the	idea	that	consuming	protein
(a. k. a. meat)	is	needed	for	physical	power. This	has	been	a	common	notion
the	world	over	for	a	long	time. The	Chinese	have	even	officially
recommended	a	higher-protein	diet	in	order	to	encourage	bigger	athletes	and
to	better	compete	in	the	Olympics. Animal-based	foods	have	more	protein,
and	this	protein	is	considered	to	be	of	“higher	quality. ”	Animal	protein	enjoys
the	same	reputation	in	a	rapidly	modernizing	China	as	everywhere	else. There	is,	however,	a	problem	with	the	idea	that	consuming	animal-based
foods	is	a	good	way	of	becoming	bigger. The	people	who	eat	the	most	animal
protein	have	the	most	heart	disease,	cancer	and	diabetes. In	the	China	Study,
for	example,	animal	protein	consumption	was	associated	with	taller	and
heavier
I
	people,	but	was	also	associated	with	higher	levels	of	total	and	bad
cholesterol. II
	Furthermore,	body	weight,	associated	with	animal	protein
intake,
I
	was	associated	with	more	cancer
II–III
	and	more	coronary	heart
disease. II
	It	seems	that	being	bigger,	and	presumably	better,	comes	with	very
high	costs. But	might	it	be	possible	for	us	to	achieve	our	full	growth	potential,
while	simultaneously	minimizing	disease	risks. Childhood	growth	rates	were	not	measured	in	the	China	Study	but	adult
height	and	weight	were. This	information	proved	surprising. Consuming	more
protein	was	associated	with	greater	body	size	(
III
	for	
men	and	
II
	for	women). 61
However,	this	effect	was	primarily	attributed	to	
plant
	protein,	because	it
makes	up	90%	of	the	total	Chinese	protein	intake. Animal	protein
consumption	was	indeed	associated	with	greater	body	weight,
1
	and
consumption	of	protein-rich	milk	seemed	to	be	effective	as	well. II
	But	the
good	news	is	this:	
Greater	plant	protein	intake	was	closely	linked	to	greater
height
II
	
and	body	weight. II
	Body	growth	is	linked	to	protein	in	general	and
both	animal	and	plant	proteins	are	effective. This	means	that	individuals	can	achieve	their	genetic	potential	for	growth
and	body	size	by	consuming	a	plant-based	diet. So	why	is	it	that	people	in
developing	nations,	who	consume	little	or	no	animal-based	foods,	areconsistently	smaller	than	Western	people. This	is	because	plant-based	diets	in
poor	areas	of	the	world	usually	have	insufficient	variety,	inadequate	quantity
and	quality	and	are	associated	with	poor	public	health	conditions	where
childhood	diseases	are	prevalent. Under	these	conditions,	growth	is	stunted
and	people	do	not	reach	their	genetic	potential	for	adult	body	size. In	the
China	Study,	low	adult	height	and	weight	were	strongly	associated	with	areas
having	high	mortality	rates	for	pulmonary	tuberculosis,
III
	parasitic	diseases,
III
pneumonia	(
III
	for	height),	“intestinal	obstruction”
III
	and	digestive	diseases. III
These	findings	support	the	idea	that	body	stature	can	be	achieved	by
consuming	a	low-fat,	plant-based	diet,	provided	that	public	health	conditions
effectively	control	the	diseases	of	poverty. Under	these	conditions,	the
diseases	of	affluence	(heart	disease,	cancers,	diabetes,	etc. ) can	be
simultaneously	minimized. The	same	low-animal	protein,	low-fat	diet	that	helps	prevent	obesity	also
allows	people	to	reach	their	full	growth	potential	while	working	other
wonders	as	well. It	better	regulates	blood	cholesterol	and	reduces	heart
disease	and	a	variety	of	cancers. What	are	the	odds	that	all	of	these	associations	(and	many	others)	favoring
a	plant-based	diet	are	due	to	pure	chance. It	is	extremely	unlikely,	to	say	the
least. Such	consistency	of	evidence	across	a	broad	range	of	associations	is
rare	in	scientific	research. It	points	to	a	new	worldview,	a	new	paradigm. It
defies	the	status	quo,	promises	new	health	benefits	and	demands	our	attention. CIRCLING	BACK
In	the	beginning	of	my	career,	I	concentrated	on	the	biochemical	processes	of
liver	cancer. Chapter	three	delineates	the	decades-long	laboratory	work	we
did	with	experimental	animals,	work	that	passed	the	requirements	to	be	called
“good	science. ”	The	finding:	casein,	and	very	likely	all	animal	proteins,	may
be	the	most	relevant	cancer-causing	substances	that	we	consume. Adjusting
the	amount	of	dietary	casein	has	the	power	to	turn	on	and	turn	off	cancer
growth,	and	to	override	the	cancer-producing	effects	of	aflatoxin,	a	very
potent	Class	IA	carcinogen,	but	even	though	these	findings	were	substantially
confirmed,	they	still	applied	to	experimental	animals. It	was	therefore	with	great	anticipation	that	I	looked	to	the	China	Study	for
evidence	on	the	causes	of	liver	cancer	in	humans. 62
Liver	cancer	rates	are	very	high	in	rural	China,	exceptionally	high	in	some
areas. Why	was	this. The	primary	culprit	seemed	to	be	chronic	infection	with
hepatitis	B	virus	(HBV). On	average,	about	12-13%	of	our	study	subjects
were	chronically	infected	with	the	virus. In	some	areas,	one-half	of	the	people
were	chronically	infected. To	put	this	into	perspective,	only	0. 2-0. 3%	of
Americans	are	chronically	infected	with	this	virus. But	there’s	more. In	addition	to	the	virus	being	a	cause	of	liver	cancer	in
China,	it	seems	that	diet	also	plays	a	key	role. How	do	we	know. The	blood
cholesterol	levels	provided	the	main	clue. Liver	cancer	is	strongly	associated
with	increasing	blood	cholesterol,
III
	and	we	already	know	that	animal-based
foods	are	responsible	for	increases	in	cholesterol. So,	where	does	HBV	fit	in. The	experimental	mice	studies	gave	a	good
signal. In	mice,	HBV	initiated	the	liver	cancer	but	the	cancer	grew	in	response
to	the	feeding	of	higher	levels	of	casein. In	addition,	blood	cholesterol	also
increased. These	observations	fit	perfectly	with	our	human	findings. Individuals	who	are	chronically	infected	with	HBV	and	who	consume	animal-
based	foods	have	high	blood	cholesterol	and	a	high	rate	of	liver	cancer. The
virus	provides	the	gun,	and	bad	nutrition	pulls	the	trigger. A	very	exciting	story	was	taking	shape,	at	least	to	my	way	of	thinking. It
was	a	story	full	of	meaning	and	suggestive	of	important	principles	that	might
apply	to	other	diet	and	cancer	associations. It	also	was	a	story	that	had	not
been	told	to	the	public,	and	yet	it	was	capable	of	saving	lives. Eventually,	it
was	a	story	that	was	leading	to	the	idea	that	our	most	powerful	weapon
against	cancer	is	the	food	we	eat	every	day. So	there	we	had	it. The	years	of	animal	experiments	illuminated	profound
biochemical	principles	and	processes	that	greatly	helped	to	explain	the	effect
of	nutrition	on	liver	cancer. But	now	we	could	see	that	these	processes	wererelevant	for	humans	as	well. People	chronically	infected	with	hepatitis	B	virus
also	had	an	increased	risk	of	liver	cancer. But	our	findings	suggested	those
who	were	infected	with	the	virus	and	who	were	simultaneously	eating	more
animal-based	foods	had	higher	cholesterol	levels	and	more	liver	cancer	than
those	infected	with	the	virus	and	not	consuming	animal-based	foods. The
experimental	animal	studies	and	the	human	studies	made	a	perfect	fit. PULLING	IT	TOGETHER
Almost	all	of	us	in	the	United	States	will	die	of	diseases	of	affluence. In	our
China	Study	we	saw	that	nutrition	has	a	very	strong	effect	on	these	diseases. Plant-based	foods	are	linked	to	lower	blood	cholesterol;	animal-based	foods
are	linked	to	higher	blood	cholesterol. Animal-based	foods	are	linked	to
higher	breast	cancer	rates;	plant-based	foods	are	linked	to	lower	rates. Fiber
and	antioxidants	from	plants	are	linked	to	a	lower	risk	of	cancers	of	the
digestive	tract. Plant-based	diets	and	active	lifestyles	result	in	a	healthy
weight,	yet	permit	people	to	become	big	and	strong. Our	study	was
comprehensive	in	design	and	comprehensive	in	its	findings. From	the	labs	of
Virginia	Tech	and	Cornell	University	to	the	far	reaches	of	China,	it	seemed
that	science	was	painting	a	clear,	consistent	picture:	we	can	minimize	our	risk
of	contracting	deadly	diseases	just	by	eating	the	right	food. When	we	first	started	this	project	we	encountered	significant	resistance
from	some	people. One	of	my	colleagues	at	Cornell,	who	had	been	involved
in	the	early	planning	of	the	China	Study,	got	quite	heated	in	one	of	our
meetings. I	had	put	forth	the	idea	of	investigating	how	lots	of	dietary	factors,
some	known	but	many	unknown,	work	together	to	cause	disease. Thus	we
had	to	measure	lots	of	factors,	regardless	of	whether	or	not	they	were	justified
by	prior	research. If	that	was	what	we	intended	to	do,	he	said	he	wanted
nothing	to	do	with	such	a	“shotgun”	approach. This	colleague	was	expressing	a	view	that	was	more	in	line	with
mainstream	scientific	thought	than	with	my	idea. He	and	like-minded
colleagues	think	that	science	is	best	done	when	investigating	single—mostly
known—factors	in	isolation. An	array	of	largely	unspecified	factors	doesn’t
show	anything,	they	say. It’s	okay	to	measure	the	specific	effect	of,	say,
selenium	on	breast	cancer,	but	it’s	not	okay	to	measure	
multiple	nutritional
conditions	in	the	same	study,	in	the	hope	of	identifying	important	dietary
patterns. I	prefer	the	broader	picture,	for	we	are	investigating	the	incredible
complexities	and	subtleties	of	nature	itself. I	wanted	to	investigate	how
dietary	patterns	related	to	disease,	now	the	most	important	point	of	this	book. Everything	in	food	works	together	to	create	health	or	disease. The	more	we
think	that	a	single	chemical	characterizes	a	whole	food,	the	more	we	stray
into	idiocy. As	we	shall	see	in	
Part	IV
	of	this	book,	this	way	of	thinking	has
generated	a	lot	of	poor	science. So	I	say	we	need	more,	not	less,	of	the	“shotgun	approach. ”	We	need	more
thought	about	overall	dietary	patterns	and	whole	foods. Does	this	mean	that	I
think	the	shotgun	approach	is	the	only	way	to	do	research.
The text does not provide a specific recommendation for daily fiber intake, but it mentions that the average intake in rural China is around 30-35 grams per day.
What is the recommended daily intake of fiber?
The study found that there is no evidence showing that increasing fiber intake impairs iron absorption.
What is the study's conclusion about the relationship between fiber and iron absorption?
The study found that a high-fiber diet is beneficial and that it is linked to a lower risk of various diseases, including heart disease, cancer, and diabetes.
What is the significance of the China Study?
The study found that high blood cholesterol levels are a significant risk factor for heart disease, and that reducing saturated fat and cholesterol intake can help prevent or delay the onset of the disease.
What is the main finding of the Framingham Heart Study?
The author believes that it is not possible to achieve health benefits by consuming a single nutrient or food, but rather it is the overall diet that is important.
What is the author's stance on the idea that a single nutrient or food can be used to achieve health benefits?