The China Study Fallacy

Filed under: General Health, Nutrition

The China Study seems to be referenced just about everyday lately by a fitness or nutrition professional. Usually these people are telling you to avoid animal products all together, that being vegetarian is the healthiest way to eat to avoid degenerative diseases and that animal protein will straight up kill you.

First off, let me explain The China Study to those who have not read it, and for full disclosure neither have I, though it is on my short list. According to wikipedia:

The China Study is a 2005 book by T. Colin Campbell, Ph.D., and his son, Thomas M. Campbell II. Dr. Campbell is a professor of Nutritional Biochemistry at Cornell University and one of the directors of the China Project.

The book examines the relationship between the consumption of animal products and illnesses such as cancers of the breast, prostate, and large bowel, diabetes, coronary heart disease, obesity, autoimmune disease, osteoporosis, degenerative brain disease, and macular degeneration. “The China Study,” referred to in the title is the China Project, a “survey of death rates for twelve different kinds of cancer for more than 2,400 counties and 880 million (96%) of their citizens” conducted jointly by Cornell University, Oxford University, and the Chinese Academy of Preventive Medicine over the course of twenty years.

The authors introduce and explain the conclusions of scientific studies, which have correlated animal-based diets with disease. The authors conclude that diets high in animal protein (including casein in cow’s milk) are strongly linked to diseases such as heart disease, cancer, and Type 2 diabetes.

The authors recommend that people eat a whole food, plant-based diet and avoid consuming beef, poultry, and milk as a means to minimize and/or reverse the development of chronic disease. The authors also recommend that people take in adequate amounts of sunshine in order to maintain sufficient levels of Vitamin D and consider taking dietary supplements of vitamin B12. The authors criticize “low carb” diets (such as the Atkins diet), which include restrictions on the percentage of calories derived from complex carbohydrates.

You might notice some key words in that paragraph, like correlated. Correlation does not equal causation. This is an incredibly important quote to understand. As has been pointed out before by others, there has been correlational research that shows that people who shave the least are the most likely to get heart disease. So does this mean that lack of shaving causes heart disease? No it merely means that people who do not shave maybe care less about their appearance, and maybe about their health or a whole host of their variables, the actual lack of shaving is not the cause of heart disease.

In this China Study there was some work done on rats in which they fed them 20% of their calories from casein (the major protein in dairy). This caused an increased mortality rate, and an increase in degenerative diseases. This is concerning, no question, and one reason why I only recommend whey protein powder to clients, I cover more of this particular topic HERE.

But who actually takes in 20% of their calories from casein, do you know how much dairy that is? Lets say you take in 2,000 calories per day, 20% of that is 400 calories, or 100 grams of casein! Since milk protein is about 80% casein, and their is 1 gram of protein per ounce of milk, so about .8 grams of casein per ounce of milk. That would require 125 ounces of milk to get 100 grams of casein! That is almost 16 cups! Sure some of that casein can come from cheese, yogurt and protein powder, regardless that would take an inordinate amount of milk.

The point I am making is that maybe too much casein can be problematic, but lets not get ahead of ourselves. No one I know is recommending or consuming 16 glasses of milk per day! That same study showed that when rats were fed 5% of their calories from casein, they were free of disease and had longer life expectancies. That gives us 25 grams of casein per day, which is like 4 cups of milk per day. That seems reasonable. For more info on milk consumption and recommendations, read THIS.

To continue some of the misconstrued data:

The authors state that “several studies have now shown, in both experimental animals and in humans, that consuming animal-based protein increases blood cholesterol levels. Saturated fat and dietary cholesterol also raise blood cholesterol, although these nutrients are not as effective at doing this as is animal protein. In contrast, plant-based foods contain no cholesterol and, in various other ways, help to decrease the amount of cholesterol made by the body.”

The authors also state that “these disease associations with blood cholesterol were remarkable, because blood cholesterol and animal-based food consumption both were so low by American standards. In rural China, animal protein intake (for the same individual) averages only 7.1 grams per day whereas Americans average 70 grams per day.”

The authors conclude that “the findings from the China Study indicate that the lower the percentage of animal-based foods that are consumed, the greater the health benefits-even when that percentage declines from 10% to 0% of calories. So it’s not unreasonable to assume that the optimum percentage of animal-based products is zero, at least for anyone with a predisposition for a degenerative disease.”

This is complete and utter crap. Just stop and think critically about those statements for a minute. Think of everything you have seen me blog recently about cholesterol and its minimal role in health problems. That saturated fat and cholesterol raise blood cholesterol significantly? I think not. Maybe in rabbits, but they are vegetarians! Claiming that animal protein is the single greatest cause of increased cholesterol is just plain false. Find me some peer-reviewed double-blind placebo controlled studies repeatedly showing that, then you maybe have something to hang your hat on, otherwise that is ridiculous.

Using the word association again means very little. Correlation does not equal causation. There could be a million other variables in play here. These rural Chinese also most likely eat less sugar, less refined flour, less trans-fats, less McDonald’s, are more active, get more sleep, get more sunshine, have stronger community relationships, want me to keep going? Just looking at simple associations tells us little to nothing! It is not indicative of cause!

The human species has been consuming animal protein throughout its existence. The Inuit have been living on a mainly meat-based diet for thousands of years and yet they are free of modern degenerative diseases, consuming little to no vegetable foods. The Masai of Kenya live mainly on their cattle, the meat, blood and milk. That is the great bulk of their food intake, and yet they too are free of modern degenerative diseases. In his masterpiece, Nutrition and Physical Degeneration, Weston Price travels the world looking at isolated populations eating their indigenous diets. In every case when people were eating real food, including plenty of animal protein, these people were incredibly healthy, only when they replaced these foods with refined flour and sugar did the signs of degenerative diseases manifest.

He saw dairy-based diets where people were long-lived and sturdy (maybe because their cows ate grass, got sunshine and exercise, were only milked at certain times of the year, and the milk was not skimmed nor pasteurized, just a thought), meat-based diets, vegetable based diets, real food, and all these people were healthy. They were all in good physical condition, free of dental caries, resistant to tuberculosis, and free of heart disease, cancer, diabetes and other diseases of civilization. That is until they were exposed to unrefined flour and sugar, and then the story changed.

The China Study may have some relevance, and it might make some good points, but telling people that dropping animal foods altogether is the healthiest course of action is a fallacy. Animal foods are high in fat soluble vitamins, are the only available food source of vitamin D, and are a great source of vitamin B12 that the plant-based foods lack. It has been shown throughout history and evolution that humans have eaten plenty of animal products without harm.The difference is these animals were from an unpolluted world, free from synthetic hormones, antibiotics, corn-based diets, antibiotic-resistant bacteria, etc. Maybe that is the problem, and not animal protein itself, since we have been consuming it in fair amounts for hundreds of thousands of years.

Don’t throw the baby out with the bath water. Don’t take one thing and make it another, extrapolating it to apply generally across the board. That is crappy science that does nothing to advance the field of nutrition, and in fact only holds us back from discovering real information. While I am certainly not suggesting that anyone eat a meat-only diet, dropping animal products down to 0% is not warranted either. Eat real food. Eat a nice blend of grass-fed or pastured animals, lots of veggies, some fruits, a few high quality grains and plenty of healthy fats and you will be incredibly healthy.

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Posted on March 16th, 2010 by Brian St. Pierre


  1. Chris Pothhhier Says:

    Very passionate my friend. You couldn’t be more right.
    This only takes us steps back in our growth, kind of like taking exercise advice from Oprah or Tracey Anderson as TG goes into more detail on his blog!

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  3. Deborah Says:

    I realize you have all of the letters behind your name that make you an expert on nutrition whereas my opinion would be based on living many years, reading everything (nutrition and fitness) that I can get my hands on (your site being an addition in the past year), and using good ole common sense. A 20 year study? Hello…..are these the 20 years where fast food consumption became more prevalent than home cooked meals? Where processed foods in a box with 20+ ingredients no one could pronounce are the norm? Where our lives became so automated that people get winded just walking out their front door to their cars? Where a bariatric surgeon says to an RN, “The reason the 400 pound guy doesn’t look ‘that’ big to you is because we have become desensitized to size”? And are we SERIOUSLY going to blame animal protein for heart disease and type 2 diabetes? Really??!! I’ve lost 35 pounds, gained a bunch of muscle, and I kicked type 2 diabetes in 6 months. And guess what? I ate animal protein every day. I haven’t had fast food once in those 6 months, I work with a trainer every week, and I eat real food. I must be an anomaly….a freak of nature….or maybe I’m really from rural China and I didn’t notice. Thank you for addressing this “study.” There is so much misinformation out there and I appreciate you setting the record straight.

  4. Stuff You Should Read: 3/17/10 | Says:

    [...] The China Study Fallacy – This is a great piece from Brian St. Pierre on how flawed the perspectives of many “experts” is when it comes to interpreting the results of the China Study.  It’s an awesome read. [...]

  5. Yael Grauer Says:

    Check this out, too:

    A fascinating (and long) Cordain vs. Campbell debate.

  6. Steve Payne Says:

    Good piece. Here’s the way I see…and before we start, please understand that I am biased…:
    *God tells me in the Bible that eating meat is O.K.
    *Lots of folks in China are not God fearing, Bible believing people. (I understand this is a generalization, but in this particular instance I believe it has merit. I doubt the Chinese authors of this study read much of the Bible since it must be smuggled into the country…)
    * Since I ain’t Chinese, I go with what God says. Ergo…I eat meat. And lots of it.


  7. Jet-Online Personal Training Says:

    If you prefer to train at home you can save time by not travelling to the gym. As well, you’ll save time by not fluffing around wondering what to do.

  8. Evan Says:

    Amen Brian, keep it coming.

  9. Mark Young Says:

    Great stuff Brian!

    First time I’ve read your blog and I’ll be adding you to my RSS feed.

  10. JP Says:

    @BSP – Great post. It’s sad how so many people make those kinds of leaps from correlation to causation in their minds without any real evidence. It’s equally sad how many ordinary people subsequently jump on a particular bandwagon because somebody with a few letters behind their name made that leap (usually to serve their own personal agenda).

    @Steve Payne – What on earth does being a “God fearing, Bible believing” person have to do with what people eat in China?

    Why do the majority of rural Chinese people not eat a lot of meat? Poverty, NOT religion. Lack of suitable pasture for raising beef cattle, NOT religion.

    Your whole comment is quite possibly the most ignorant, irrelevant bit of drivel I’ve ever read in response to a blog about nutrition.

  11. danny Says:

    hey i have a problem regarding what you said which i quote here and i am curoius what your response is;

    “Using the word association again means very little. Correlation does not equal causation. There could be a million other variables in play here. These rural Chinese also most likely eat less sugar, less refined flour, less trans-fats, less McDonald’s, are more active, get more sleep, get more sunshine, have stronger community relationships, want me to keep going? Just looking at simple associations tells us little to nothing! It is not indicative of cause!”

    it’s true correlation doesn’t equal causation. however aren’t all of the POSSIBLE CONFOUNDING factors you mention already accounted for in the study because it was all done in china? you mention the dichtomy in groups of people who ate animal protein and did not was rural verse urban, it’s been a few years since i read the book, but i don’t believe that was the csae. this survey type study was done before china was westernized so the big idea of the study is that all of the factors you mentioned will largely hold steady over populations, these were all still traditional diets, all the same types of populations and habits, all in china, and the main difference is intake in animal protein.

    compare what we have here, a strong correlation based on a massive and suggestive study… with the weston price book which i have not read, but sounds like a much more anecdotel type of book…

    i agree the china study isn’t rigorous proof of anything, but really is it fair, or helpful to expect that? i don’t know what conclusion to draw but i don’t think you are justified in dismissing the china study so easily.

  12. Barry Bowden Says:

    I have conflicting feelings on this blog entry. I don’t disagree with a single point espoused yet you haven’t read The China Study. Might your opinion change when you do?

  13. Stuff You Should Read: 3/17/10 Says:

    [...] The China Study Fallacy – This is a great piece from Brian St. Pierre on how flawed the perspectives of many “experts” is when it comes to interpreting the results of the China Study.  It’s an awesome read. [...]

  14. Omri Says:

    every time you eat a steak, Jesus cries…

  15. Mr. B Says:

    It really puzzles me how Mr. St. Pierre can comment on a book that he, self-admittedly, never read. It’s akin to me saying, DON’T visit San Francisco because that city SUCKS! People are very unfriendly there, the city is dirty, and every restaurant serves terrible food. Oh, BTW, I’ve never been to San Francisco.

    I’ve ACTUALLY READ the China Study, and I’ve read about 10 of the MANY peer-reviewed studies that came from that study. It’s an epidemiological study, so OF COURSE it can’t lend evidence to cause/effect. These studies uncover patterns and presence of diseases in populations. As with any study design, there are strength and weaknesses. Although this study does not solidly support cause/effect, it uncovers associations that, I think, cannot be ignored. The strength of most epidimiological studies is the inclusion of large numbers of people. I could go on and on about this, but I’ll stop here.

    Mr. St. Pierre, how many peer-reviewed studies have you published? FYI, T. Colin Campbell is one of the most well-published and well-respected biological scientist of our time. He has over 300 PUBLISHED studies – as much as Albert Einstein. He is a professor of Biochemistry at Cornell University. I Googled your name in PubMed, and nothing came up. I Googled T. Colin Campbell’s name, and 7 citations immediately popped up.

    I find it very interesting how a guy who graduated with a degree in FSHN from a mediocre college at best, has the nerve to “critique” a book that he has NEVER READ, who was written by one of the most respected scientist alive today. Wow.

  16. You Asked, I Answered : The Home of BSP Training & Nutrition Says:

    [...] This question was posed about my China Study Fallacy blog post. [...]

  17. Matt G Says:

    @MR B

    I think what gives St. Pierre validity in this issue is the fact that, unlike most scientists, he has hands on experience every single day with people. He sees what actually works as opposed to what theoretically works in a lab.
    I also think slamming a person’s Alma mater is a bizarre approach at discrediting them. That too, seems like a very academic narrow-sightedness.

  18. Mr. B Says:

    @Matt G

    First off, I should not have slammed his alma mater. Very childish. I am sorry for that.

    Let’s get to some questions. Why do a lot of people assume that scientists lack “hands on” experience? Or that they don’t operate in the “real world”? So you’re saying that T. Colin Campbell, actually GOING to China, MEETING people in very rural areas, and LIVING there for months at a time, is not “hands on” experience?

    Let’s put it another way. How would Mr. St. Pierre feel if T. Colin Campbell (who I assume has zero experience in the Strength and conditioining field) shows up at Cressey Performance and criticizes their programming, training methods, and lifting techniques. And then he goes on and disputes the quality of Cressey’s book, “Maximum Strength”, before even reading it? And Dr. Campbell does all of this despite the fact that he never lifted a single barbell in his life? Wouldn’t you agree that this would be a bit ridiculous on Dr. Campbell’s part?

    Yet this is EXACTLY what Brian St. Pierre does. He critiques a book he hasn’t read. Furthermore, he has ZERO “hands on” experience with conducting world-class scientific research, yet he’s questioning the validity of a project done by a world-renowned scientist. Are you still failing to see the ludicrousness in this?

  19. Mr. B Says:

    One more thing. I want to make it known that I don’t have anything personal against Mr. St. Pierre. I don’t even know him. In fact, I have enjoyed reading many of his articles. Also, for those who haven’t seen the video, check out his VERY impressive 600+ lb. hex bar deadlift. Awesome!

    I simply refuse with letting him get away with blasting a book he hasn’t even read. He’s in WAY over his head when it comes to trying to dispute Dr. Campbell’s work. On his blog, Mr. St. Pierre talks about protein. Does he even know much about protein? For a good portion of his career, T. Colin Campbell studied protein! Some of the things we know about protein today, we actually owe to Dr. Campbell!

  20. Mr. V Says:

    Wow, it’s so cool how you can review a book without reading it. That’s an amazing skill. I see you also have acquired advanced knowledge of biochemistry, statistics, and nutrition with no training , and apparently no knowledge as well. It must be great to be so smart that you don’t actually need to know what you’re talking about. The Internet is truly an amazing thing.

  21. hooch turner Says:

    I appreciate the advice about milk protein, as I feel that I could never give it up.
    According to your ideas of avoiding casein, is it better so to stay away from certain micellar casein/whey isolate blends?

  22. Fredrik Gyllensten Says:

    great article! Couldn’t agree more.

  23. Brian St. Pierre Says:


    Maybe. The whey should prevent any issues, but a straight whey protein is cheaper and provides plenty of health benefits of its own, so I tend to just recommend that. If you wanted to combine it with say some Greek yogurt, that would provide some casein so you get a blend, along with health-promoting probiotics.

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  25. Des Says:

    Yeah, it is pretty obvious from this review that you haven’t actually read the book. Many of your objections are addressed. It’s really not that long, and for a site touting a “wealth of fitness and nutrition knowledge” is it not reasonable to expect you to actually read a book?

  26. hooch turner Says:

    Thanks for the reply Brian. Your site is fantastic, I must say. I can’t get greek yoghurt here, but I do mix whey with as high a quality organic yoghurt as I can find. I’m not ready to throw away my ‘don’t be a fairy, eat your dairy’ t-shirt yet.

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