You Asked, I Answered

Filed under: General Health, Nutrition

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

Q. 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.

A. Here is the problem. I dismiss the China Study so easily because Dr. Campbell, while he is a highly published researcher, has become a zealot against protein. Not because there is real, actual evidence, but because it was his hypothesis and he will do what it takes to make the data fit his hypothesis.

I compare it to Ancel Keys and the Seven (or Six) Country Study. The data of all 22 countries that were available did not fit his hypothesis, so he chose the 7 countries where the data did fit. Campbell chooses to ignore data from all over the world perfectly refuting his “data”. Like I mentioned in the post, there are civilizations all over the world who have eaten an inordinate amount of animal protein and yet have little to no incidence of degenerative diseases. Again I refer you to the Masai and the Inuit. While they could probably use more vegetables in their diet, they are not dying are enormous rates of heart disease from all their animal protein.

These diseases only became truly apparent when traditional diets were abandoned for a more Western diet. This has been observed all over the world. Look at the research on the Tokelau Islanders. When sugar, refined flour and the like replaced foods that had been eaten for thousands of years only then did modern degenerative diseases enter the population. The human species in one form or another has been eating animal protein for over 2 million years.

As many, and I mean many, other people have noted about The China Study, Dr. Campbell simply makes leaps of logic that do not follow.

Campbell points to research showing that high intakes of straight casein caused cancer in rats. What he doesn’t point out is the research that shows that high intakes of whey protein (the other protein in dairy) greatly reduced incidence of tumor formation. Since whey and casein come packaged together, I don’t know if it makes perfectly logical sense to just state that all animal protein is deadly. I guess since the actual health benefits, and potential for whey to decrease cancer incidence (which requires more research) does not fit his hypothesis, it is not worth mentioning.

The point is that taking some direct research on huge intakes of casein, which do not reflect real-world intake not only due to amount but also since casein usually comes packaged with whey, and large scale observational research in one country and trying to extrapolate that data into a one-size-fits-all recommendation for all people is ridiculous. The cause of cancer and degenerative diseases is multi-factorial and attempting to lay the blame solely on animal protein takes the focus off the real problems. Just like trying to blame heart disease solely on cholesterol (and saturated fat) has not actually decreased incidence of heart disease, it has just taken focus off the real potential causes of the disease.

I won’t even get into the fact that he states that people should take vitamin B-12 supplements because his all-vegetable diet unfortunately does not contain any! Plants simply do not contain B-12 unless you make sauerkraut or natto. If the human species is meant to live on plants alone, how exactly did we survive all this time without some B-12 supplements kicking around? Just some food for thought.

The major problem with the book is that it does not even stay true to the study on which it was based. When looking at the actual data provided by the study, intakes of animal protein, fish protein, meat intake, saturated fat and fat calories were negatively associated overall mortality! Meaning they decreased mortality risk! Though to be fair it was not statistically significant, it certainly did not raise risk. Eggs statistically decreased risk of overall mortality by 43%! Total protein intake had a 29% negative association with all-cause mortality. More food for thought I guess.

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Posted on March 22nd, 2010 by Brian St. Pierre


  1. Mr. B Says:

    Mr. St. Pierre:

    Let’s forget about T. Colin Campbell and the China Study for a moment. Instead, I direct you to the work of Dr. Caldwell Esselstyn. Dr. Esselstyn was a top surgeon at the very prestigious Cleveland Clinic. He also earned a Bronze Star as a surgeon in the Vietnam War. In addition to being a surgeon, he is ALSO a scientist, publishing over 150 papers in peer-reviewed journals, many of his studies involved nutrition and chronic disease. Several have been longitudinal, case-controlled studies looking at diet and the reversal of coronary artery disease.

    So this is a guy who ACTUALLY operates and fixes people FOR A LIVING. So I’d call that “real world” experience. This is a guy who you would want to have on duty if you happen to blow a blood vessel attempting a 650 lb. deadlift. In addition to this experience, Dr. Esselstyn has conducted and PROVED that heart disease can be REVERSED with a vegan diet. Not correlations and associations, my friend. Instead, he showed DIRECT evidence and reversal of CHD via angiography.

    You would be very hard-pressed to find another person who has so much experience both as a physician/surgeon and as a scientist as Dr. Esselstyn.

    Mr. St. Pierre, I encourage you to have an open mind. To be humble and to allow yourself to be open to knowledge that you haven’t been taught in nutrition school. Don’t simply look to validate the things that you believe in. Instead, realize that there may be a huge amount of things that YOU DO NOT KNOW OR UNDERSTAND about nutrition. Most importantly, READ. Actually take the time to READ the books that you will comment on.

    So I encourage you to Google Dr. Esselstyn and learn all you can about him. Then, actually go an pull all the peer-reviewed publications that he has on nutrition and chronic disease. Read them THOROUGHLY, digest the information, and THEN tell me what you think. Tell me if anyone else out there has put in as much time as Dr. Esselstyn in the subject of cardiovascular disease – both as a surgeon and as a scientist.

  2. Chris Pothhhier Says:

    In respect to keeping an open mind on this topic, I feel BSP does just this. There are many ways to skin a cat in the world of nutrition and fitness, and for a major percentage of humans for the past 2000 years and more have eaten meat, and lots of it.
    Yes this one Dr you speak of has done great research and reversed heart disease…that’s just one Dr…we are talking billions of people who have followed just the opposite and have never had heart disease to begin with.
    It would be like saying we have a cure for diabetes or CVD…so first develop diabetes and or CVD so we can reverse it….doesn’t make sense?
    Makes more sense to follow a diet that you won’t develop either in the first place.
    I’m not coming to Brian’s defense here, I think he is more than capable of defending himself as a professional, but to attack his “know how” or “what he should be doing” isn’t professional on your part. BSP knows how to read, does plenty of it, knows how to “digest” or “analyze” what he is reading and writes accordingly…I speak of this because I have personally worked with him and learned from him, you haven’t.
    Don’t be an internet jockey.

  3. Mr. B Says:

    @Chris Pothhhier

    Yes, I am sure that, as you put it, Brian “knows how to read”. My question is, “Why didn’t he actually READ the China Study before attempting to pick it apart??

    Is it too much to ask someone to ACTUALLY READ a book before he/she comments on it??????????

  4. Chris Pothhhier Says:

    His blog post was directed towards direct quotes from the book…that is what he was commenting on, no?
    I don’t think he was out of line in his analysis of the books exerts…he did let the reader’s know he was planning on reading the full story…which I feel he has a good grasp on from not even reading it.

    There may be several points, hypotheses or heck even movie trailers that you can absolutely disagree on without having read, seen or tried it. Yet from what you know of it, have heard others talk on and read about, can make a reasonable judgment based on limited knowledge.

    Ill end with a quote from a good friend and part mentor of mine…”cutting folks open doesn’t make you a specialist in preventing their problem”…

  5. Mr. B Says:

    Well, Chris, if you feel that a person can get a “good grasp” of a 400-page book without reading it, then I guess I really need to find out how to aquire that skill. It sure would have come in handy when I was in school. As for myself, I guess I’m just a mere mortal. For me, I have to actually READ a book before I can get a good grasp of the information that it contains.

    Let me ask you: Have YOU read The China Study? Or am I the only one on this blog that has actually read the book from cover-to-cover?

  6. Chris Pothier Says:

    Grasp, gist, whatever you want to call it…a basic understanding. What is so hard to understand, BSP didn’t read the book cover to cover, he does KNOW what the book is about, and solely comments on direct quotes on the book in his blog; NOT from something he hasn’t read…I think you are taking BSP’s point of his post out of context, and can’t come up with a better argument proving otherwise so you fall back on “he didn’t read the entire book” or ” this ONE Dr. did this…”
    BSP is arguing point A and you are arguing in left field some where’s…makes no sense.
    My one point to you is that you were un-professional in your first comment and this blog, or anyone’s blog isn’t for some internet guru to berate the author in an unprofessional way by telling someone to “read” or “google” something…

    Brian I apologize for the comments! I will leave it at that. My email is if you want to discuss further Mr. B.

  7. Javier Olah Says:

    It’s pretty awesome having nutrition as my life. I always tell people when they ask me what kind of supplements to take. Start with the basics and get some whey protein as a body building supplement then if you want, try an EFA stack for weight loss. As always throw in a multivitamin.

  8. Brian St. Pierre Says:

    OK, well clearly things got a little heated, but a little debate is never a bad thing. Speaking of debate below is a link to a PDF article debate between Dr. Loren Cordain and Dr. T. Colin Campbell.

    In my opinion Dr. Cordain utterly demolishes Dr. Campbell’s assertion that animal protein is the bane of our existence. He actually provides solid research, and cites it, whereas Dr. Campbell spends most of his time trying to discredit Dr. Cordain, not refute the data presented in the counter-argument. He is merely grasping at straws.

    Here are my two favorite quotes from the entire debate:
    Dr. Cordain – “Finally, if vegetarian diets are “as near to an ideal diet as one can get” why then do meta-analyses of all cause mortality (including cancers) in vegetarians show them to be no better off than the general public?”

    Dr. Campbell quoting a contemporary of Dr. Cordain , and a quote that totally refutes Dr. Campbell’s whole argument…priceless – “that some of these “societies are largely free of diseases of civilization regardless of whether a high percentage of dietary energy is supplied by wild animal foods, wild plant foods, or domesticated plant foods taken from a single cultivar”.
    He appears to be talking in circles to me.

    Check out the whole debate here:

  9. Mr. B Says:

    I read this debate a few years ago. I don’t know where to start. Let’s just start with a point that I agree with.

    Yes, I fully admit that the majority of the studies done in the U.S. (and other developed countries) on the effects of vegetarian diets and chronic diseases risks have been quite disappointing. This may be a reason why:

    Without going into great detail, I think the reasons many studies have not shown vegetarian diets to be highly protective is because the average vegetarian in the U.S. still eats a crappy diet – full of fat, sodium, white flour, white sugar, excessive dairy and excessive eggs. This “vegetarian diet” is likely to be as harmful as the typical American’s diet. So when studies are done with subjects following an “American idea of a vegetarian diet”, you will see little, if any, improvements on outcomes.

    It’s kinda like if they set the speed limit at 125 mph on the freeway. There would be lots of gruesome accidents, and the death rate from collisions would be very high. If you lower that speed limit to 100 mph, do you think that would help much? Probably not. What if you lower it to 90 mph? Would the death rate decrease? I say, maybe a little, but not by much. What about lowering it to 85 mph. I’d say death rate still would not decrease by much; however, now you could, maybe, have an open casket funeral vs. a closed casket funeral because, at 85 mph, you probably will still die, but your body probably won’t be as mangled as if you crashed at 100 mph. So does that mean that we can conclude that “speed has no effect on highway accident death rate”? Of course not. Speed does play a huge role, but, in order for us to realize this, we need to reach a THRESHOLD. Drop that speed limit down to 55 mph, and death rate will decrease significantly. Although not practical, if you drop that speed limit down to 20 mph, death from accidents will be virtually eliminated.

    Same with diet. Eating just a tad more fruits and vegetables, and cutting back only moderately on fat, cholesterol, and animal protein may have a very minimal impact on health outcomes.

    Dean Ornish showed this in his Lifestyle Heart Trial. It was a vegetarian diet, with less than 10% of kcals from fat and that included very little animal products (in the form of fat free dairy and egg whites) that caused reversal of coronary artery disease to occur (as demonstrated by angiography).

    In contrast, a more “moderate” diet, which was the standard American Heart Association diet of that time – i.e., approximately 55% of kcals from CHO, 30% of kcals from fat, and 15% of kcals from PRO, did nothing to stop the progression of coronary artery disease. In fact, the occlusions got WORSE.

    This classic study conducted by Ornish was a breakthrough. He wasn’t assessing RISK FACTORS for heart disease such as cholesterol, LDL, HDL, C-reactive protein, or triglyceride levels. In contrast, he was looking DIRECTLY at the blood flow and the diameter of the occluded coronary arteries of his subjects.

    Just some food for thought. Thank you for allowing me to post.

  10. Brian St. Pierre Says:

    Mr. B,

    Your point is well taken, but that same rule applies to meat eating diets as well! Sure I doubt that all the vegetarians in the study were truly eating a high quality vegetarian diet. I am sure plenty were eating lots of refined carbs and some trans fats.

    The problem with your argument is that you could take this same stance with studies on meat eaters, because the average American who eats meat also eats lots of refined carbs, trans fats, etc.

    So the research does show that people who eat a lot of processed foods, whether they eat animal products or not, the rate of all-cause mortality is equal. Even with the drastic difference in animal protein intake in these two groups, that does not seem to affect the outcome.

    With the Dean Ornish program, I am certainly not denying his results, but there is much more to the story than just the diet. It is a 5 part program that involved anger management, exercise, meditation, no smoking, and his low-fat diet. It worked, but was it the diet, was it the no smoking and meditation, or was it a combination of all the changes? No one knows and likely these people were eating very poorly to begin with, so getting them to eat tons of fruits and veggies and the removal of processed foods was enormously helpful, not necessarily just because it was low-fat.

    Dr. Ornish is not the only person claiming to have reversed heart disease in his patients. Dr. Campbell himself references Dr. Lester Morrison and his success in preventing heart disease recurrence. Dr. Morrison put his subjects on a “high protein, low fat diet” along with a regimen of nutritional supplements, while restricting calories that resulted in weight loss. This program was very successful, and it not only contained a good amount of protein, he actually encouraged milk drinking! Oh my.

    The point still stands people have been consuming animal products for a very long time without incidence of heart disease or cancer, so trying to lay the blame at the feet of animal protein is propaganda nonsense. Lets focus on the real problems, like man-made pseudo food and highly refined carbohydrates, and maybe we can actually halt this epidemic of diabetes and obesity.

  11. Mr. B Says:

    I agree with, actually, the majority of what you have said. Yes, the average American who consumes meat and dairy is probably also consuming a lot of other junk. Not good.

    Before I go on, let me say that my criticism of your initial post on the China Study was solely due to the fact that you called something a “fallacy” without reading the book. I simply had a problem with that one post. Everything else I’ve read on your website is great stuff!

    In full disclosure, I would like to say that, personally, I am not a vegan. I do eat SMALL amounts of animal products. The best way to describe my diet is that I, basically, follow the DASH way of eating. So please don’t think I’m some kind of crazed vegan. Because, trust me, I’m not.

    About the Ornish study. Yes, as the title of the study clearly shows, it was a LIFESTYLE heart trial. So, you are correct, it could have been other factors (or a combination of factors) that helped reverse HD.

    However, here’s my problem with Ornish critics. NONE of them have placed their dietary recommendations through the type of scrutiny that Dr. Ornish has. NONE. Instead, they are armchair QB’s, and they criticize by saying stuff like – “Too few subjects; Was it the exercise? Was it the stress management? Or was it the diet?, etc.”

    I say, fair enough. Those are legit questions. However, why don’t these people go out there, get in the trenches, and actually DO some HARDCORE reasearch?

    If the “Paleo Diet” is such a great thing, put it to the test. And I’m not talking about looking at dependent varibles such as LDL, Total Cholesterol, HDL, etc. Rather, do what Ornish did, and ACTUALLY measure vessel diameter and/or blood flow to the heart. To my knowledge (I could be wrong; if I am please let me know) Atkins, Sears, Cordain, Eades, Agatston, etc. have, NEVER attepted a study of this nature. They talk the talk, but they don’t walk the walk.

    Dean Ornish walks the walk. Caldwell Esselstyn walks the walk. As Dr. Ornish once told Dr. Atkins, “Do the research before you write your books.”

    FINALLY, with all that I’ve said, I think it is best to look at what we actually AGREE on. And I agree 100% with your last sentence of your post. Let’s stop eating all of that freaking white, devitalized and demineralized carbohydrates. I agree – that is the #1 cause of all of this obesity in this country. Sad.

  12. Linda Says:

    I agree that any comparison with a “vegetarian” can be misleading. Alot of vegetarians I know are what I call “junkfood vegetarians”. Tons of white bread, pasta, refined crap in their diet. I would love to see a study comparing a Raw Vegan. Glad you’re not a crazed vegan ;) whats that?

  13. Random Friday Thoughts : The Home of BSP Training & Nutrition Says:

    [...] As I am sure many of you read my review of the atrocious China Study, along with my follow up post answering the questions that it raised. I feel this book is just injecting a massive fear of meat [...]

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