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  What About The China Study?

[Editor: We don’t use names on frequently asked questions, but this query is based on a series of emails from a health-and-fitness minded professor at the University of Texas.  It's long but chock-full of critical information. Hang in there. You’ll be glad you did.]

Q: THE CHINA STUDY:  Startling Implications for Diet, Weight Loss and Long-Term Health (BenBella 2005) is a fascinating, well-written, extremely well referenced book by one of the most famous (perhaps the most famous) nutrition researchers in the world.  T. Colin Campbell, PhD, is a Chaired Professor (emeritus) of Nutrition at Cornell University.  He worked with the McGovern panel in 1980 and chaired the National Science Foundation Panel (and white paper) on health and nutrition in 1982.  He cites only peer-reviewed research and draws upon his own illustrious career, including being Director of the China Study--the largest, most comprehensive nutrition study ever.

The problem is that the conclusions drawn are extremely troubling to me, particularly those involving animal-based proteins.  His experiments are truly startling.  He and his students were involved in repeatable, decades-long experiments that were published in the absolute best peer-reviewed journals.  He basically showed that diets with 22% protein directly enabled the initiation and progression of cancer and heart disease, while diets with 5% protein completely avoided the initiation of (or stopped the progression of) cancer and heart disease - REGARDLESS OF THE LEVEL OF CARCINOGENS ADMINISTERED.  His results are pretty unambiguous.  He states (but does not provide experimental details) that vegetable-based proteins did not have the same negative effect as animal-based proteins.  He also provides epidemiological evidence from the enormous China Study that this same effect (animal-based protein vs. vegetable-based protein) holds true for cancer/heart disease in rural China.  What to make of this?

 I am not able to find alternative explanations for what appear to be rock-solid results.  Basically, I can't find a way around his basic conclusion that a low protein (essentially vegan), low fat, high complex-carbohydrate diet is clearly the best way to prevent any form of heart disease and most all cancers.

This conclusion is at odds with the basic idea that lean meat and poultry and nonfat dairy and omega-3 fatty fish should be an important component of one's diet.  From everything I have read (approaching 200 books at last count), small but reasonable amounts of lean animal-based proteins combined with good fat, lots of fresh fruits and vegetables, and whole-grain low-glycemic carbohydrates are supposed to be the way to go.  The proteins and especially the fats are supposed to be critical building blocks for key hormones and an important aspect of anti-aging.  Nevertheless, here are some pretty convincing experiments that suggest this is a bad course of action from a heart health and cancer prevention perspective.

A tremendous amount of evidence supports the idea of increasing Omega-3 fats, decreasing Omega-6 fats, moderating Omega-9 (monounsaturated fats) fats, limiting saturated fats, and eliminating trans-fats in the American diet.  In fact, I had basically assumed that most authorities were in agreement that very low-fat diets were probably not a good idea.  That's another reason why Campbell's conclusions are surprising.   To be fair, however, he acknowledges the need for some level of Omega-3 and Omega-6 fats (hence the term "essential" fats), but believes in severely limiting or eliminating all other fats, including the so-called "good" Omega-9 fats (olive oil and avocados).  Surprising and I believe a bit controversial.

What I can't understand is how/why his results on cancer and heart disease are not better known.  I checked the journal citations for his work--these really are top-notch journals.  He was inducted to the National Academy of Science at a young age--this is a huge, huge honor at any age (very few prominent researchers make it) and almost unheard of at his age.  He is a chaired professor at a great university--and it is very unusual to have a Chair dedicated to nutrition (I don't know of another one).  This all screams, "shining academic star" and should suggest that everyone knows his work. But they either don't know or don’t recognize his work for some reason. Frankly, I am baffled[Campbell offers a somewhat conspiratorial explanation in the last part of the book, titled “Why Haven’t You Heard This Before?”]

What do you think?  This is a fascinating but very troubling book.

A: We’ve encountered Professor Campbell before (see FAQ 3, item 4, What About Milk?) and I’ve just finished reading his impressive new book. He presents a powerful case that a vegan (strict vegetarian) diet will prevent or cure a large number of modern man’s ailments, including obesity, diabetes, autoimmune diseases, a wide range of bone, kidney, eye and brain diseases, and, of course, heart disease and many forms of cancer. I’m a strong believer in the benefits of plant-based food, but Dr. Campbell may take it a bit too far.

As Campbell acknowledges in the book, even very-low-fat proponent Dean Ornish, MD, allowed egg white and a cup of non-fat milk or yogurt in his landmark Lifestyle Heart Trial in which 82% of the patients had regression in their heart disease. (For more details, see the Longevity & Health Issues chapter in Challenge Yourself.) Dr. K Lance Gould, another very-low-fat advocate (<10%), also allows nonfat yogurt, cottage cheese, and milk, and fish and chicken as protein sources in the “Preventing and Reversing Heart Disease” program he developed at the University of Texas Medical School in Houston. What’s more, the landmark 25-year study of Okinawans, reputed to be the world’s longest lived people, found that these super-healthy people include omega-3 rich fish several times a week, along with small amounts of meat, poultry and dairy products (THE OKINAWA PROGRAM (Potter 2001).

Like you, I’m sold on the value of consuming the right kind of fat. Adding good fat to my diet did wonderful things for my lipid profile. (See article 18, Diet and Nutrition category, and the “Diet Philosophy Revisited” chapter in Challenge Yourself.)

Perhaps we should stop focusing on Dr. Campbell’s all-or-nothing, one-size-fits-all approach, and concentrate on the massive amount of evidence he presents on the benefits of plant-based food. While Campbell’s unwavering belief in the value of a vegan diet, and the dangers residing in animal foods, are worth careful consideration, dwelling on his never-eat-any-animal food prescription may cause a loss of valuable perspective.

Campbell’s lifetime of work highlights the dangers presented by the mostly animal food diet eaten by most Americans. His solution may be too much of a good thing, but the general direction seems right.

Reading The China Study has made me go for the veggies more often. I believe that’s a good thing.

While I’m not ready to accept everything Colin Campbell says, I have no reservations about recommending his book. By all means, read The China Study. Think about it. Discuss it with your doctor. Buy all, part or none of what Campbell recommends. Take what makes sense to you, put it to work in your program for health and fitness--and leave the rest.

If you still have doubts or questions (I know you do), you’ll find a comprehensive and well-written “Thumbs Down” review of  The China Study on the The Weston A. Price Foundation website (www.westonaprice.org/bookreviews). The WPF believes that humans need animal foods, particularly animal fats, for optimum health. For a supportive view of Colin Campbell’s work, visit the pro-vegan website of the Physicians’ Committee for Responsible Medicine (http://www.pcrm.org). Campbell is on the advisory board of the PCRM. If these sites leave you more confused then ever, just remember that no one has all the answers. Unfortunately, I did not find a balanced review of The China Study.

Ripped 3 “Tool Kit” for New Dietary Guidelines

Q: I would like to refine my eating and thin my waistline. People at my local health food store promote being a vegetarian. On the other hand, I subscribe to a newsletter written by a doctor who recommends over consuming protein at every meal. He says carbohydrates in any form (even whole grains) cause weight gain and health problems. I don’t think either one is entirely right, or entirely wrong. Your recipes in Ripped 3 suggest small amounts of beef, chicken and fish. Do you still subscribe to the eating regimen you wrote about in that book? It seems to be the most sensible compromise. I think I feel best when I follow this regimen.

A: Yes. I believe the Ripped 3 approach is best for both health and leanness. (The only thing I’ve added is more good fat, such as that found in salmon, flax seeds and nuts.) The Dietary Guidelines for Americans 2005 just released by the departments of Agriculture and Health and Human Services suggest that Ripped 3 (recently reprinted for the sixth time) was--and is--on the cutting edge.

The 2005 guidelines are essentially a watered down version of the approach described in Ripped 3. That’s to be expected, of course. The government has many constituencies, while Ripped 3 is for bodybuilders and fitness-minded individuals.

In a nutshell, Ripped 3 suggests eating whole foods with nothing removed or added. Whole grains, fruits and vegetables are the backbone of the diet. The new federal guidelines not only recommend eating more fruit (4 servings versus 3 in 2000) and vegetables (6 servings versus 4), they for the first time suggest that at least three of the seven recommended servings of breads and cereals be whole-grain rather than refined-grain products.

If you want to look better and feel better, Health and Human Services Secretary Tommy Thompson said: “You eat more fruits and vegetables, more whole grains and you exercise.” Exercise is emphasized more than ever before. Where the previous guidelines called for 30 minutes a day, the new version says 60 minutes for people struggling to control their weight and 60 to 90 minutes (walking, gardening or more vigorous activities such as running or playing basketball) for people trying to lose weight.

Ripped 3 says it’s almost impossible to control your body fat level without exercise. It explains that best results come from a balanced diet of natural foods, combined with aerobic exercise and weight training.

  Tool Kit

Dr. David Katz, director of the Yale University Prevention Research Center, told The Associated Press: “[Losing weight isn’t] complicated, but it’s hard…We need a tool kit that’s about how. Exactly what do I buy when I go shopping, what do I order when I go out, how do I make good choices.”

Ripped 3 is the tool kit. Not only does it give 22 sample recipes (breakfast, lunch and dinner), it explains the good and bad points of each meal, including what to look for when shopping for the ingredients. The explanations are probably the most important part of the book. Taken together, the commentaries make up a whole nutritional philosophy that will enable you to build muscle, stay lean and be healthy. Ripped 3 also includes a section explaining how to chose wisely when eating out.

The Agriculture Department is also conducting a parallel overhaul of the country’s “food pyramid” nutritional chart, now called the “food guidance system” (because the shape may change) to be released in February. We’ve written about a new and improved pyramid (article 82) and may revisit the issue when the new chart is made public.

For an executive summary and the complete text of the 2005 Dietary Guidelines, visit www.healthierus.gov.

Vitamin E Concerns

Q: What is your opinion on vitamin E in light of the new study finding that high doses may increase mortality risk? Do you take vitamin E? If so, how much?

A: I’ve taken vitamin E for years, usually 800 IU on rest days and 1200 on workout days. Dr. Kenneth Cooper, founder of the Cooper Clinic, has long recommended that hard training athletes take antioxidant supplements, including vitamin E, to control the production of free radicals during exercise; see “Overtraining May Be Deadly” in Challenge Yourself.

The new study published in the online edition of the Annals of Internal Medicine (www.annals.org) and widely reported in the press does give me pause for concern. The study was an analysis of 19 previous studies involving a total of 136,000 people who took vitamin E alone or in combination with other vitamins. Those taking 400 IU or more per day were 10% more likely to die than those taking 200 units or less. At 2000 IU, the risk increased to 20%.

Annette Dickinson, PhD, president of the Council for Responsible Nutrition, a trade group that lobbies for the supplement industry, told WebMD,  “Eighteen of the 19 studies in the analysis showed no statistically significant increase in total mortality.” She continued, “I believe [the researchers] pooled the data to arrive at a conclusion that is based on a statistical artifact.” She also pointed out that all the people in the 19 studies were “already sick. They had heart disease or cancer or Alzheimer’s disease. The definitive study to test vitamin E in a healthy population has not been done.” It sounds to me like the issue is far from settled.

Dr. Cooper has posted a message on www.cooperaerobics.com about the study, which helps to sort out the current state of knowledge and lessens my concern somewhat. Confirming the comments of Dr. Dickinson, Cooper says the authors of the “meta-analysis” pointed out that the 19 studies, “were often small and were performed on patients with chronic diseases. The generalization of the finding to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult.” Cooper adds, “There are many previous studies that point to not only the safety, but the efficacy of vitamin E supplementation.”

According to Dr. Cooper, a “double-blind, placebo-controlled, prospective clinical trail” using the original formula of the Cooper Complete supplements containing 800 IU of E was shown to “lower oxidation of LDL cholesterol by 14 percent, homocysteine by 17 percent, and inflammation, as measured by C-reactive protein, by 32 percent.”

He sees no reason to modify the current Cooper Complete formulas, which contain from 400 to 1200 IU of E. He suggests that those who have concerns regarding vitamin E dosage, cut back to 400 IU daily.

Based on that suggestion, I’m going to reduce my vitamin E supplementation to 400 IU on rest days and 800 on training days. As always, I recommend that readers decide what to do based on their own judgment and circumstances. Talk to your own doctor, if you still have concerns. As I wrote in Ripped 2, “The quickest path to disillusionment is the one blazed by someone else.”


 Bob Delmonteque, Octogenarian Wonder

Q: I read good things about 80-something Bob Delmonteque. Do you know him? Have you read his new book Lifelong Fitness 2004?

A: I’ve never met Dr. Bob Delmonteque, but I’ve followed him in the Weider publications for about 40 years. He’s a former bodybuilder and owner of health clubs worldwide, and famous for training Hollywood legends such as John Wayne, Errol Flynn, Marilyn Monroe, and Clark Gable and contemporary stars like Matt Dillon. He and Joe Weider have been friends since their youth. I’ve paid more attention to him in the last decade because of his outstanding physique at over 80-years-of-age. The photos at 17, 67 and 80 on the back of his book (see below) show remarkably little change; he actually looks fitter at 80. He may be the best-built octogenarian in the world. As you can see, he also has great teeth and hair to die for (sure has me beat there).

I have paged through his book--which he graciously autographed to Carol and me--but haven’t had time to read it carefully. Whatever he’s been doing sure seems to be working, especially in the last decade or so. His outstanding physique is obviously due to a lifetime of regular exercise, healthy diet, positive attitude and generally taking care of himself. While Delmonteque doesn’t say so directly, he implies in the book that he’s also benefited from hormone replacement therapy. A testimonial by Dr. Ron Klatz, MD, president of A4M Academy of Anti Aging (see article 53), hails him as “the poster boy of the anti aging movement.” Other doctors quoted in the book say essentially the same thing. Delmonteque himself calls hormone therapy along with proper lifestyle “the wave of the future.”

I sent Bob an email asking what role, if any, HRT has played in his success in recent years, and whether he has suffered any ill effects. I haven’t received an answer, but he travels a lot and may be away from his computer. He may also have said all he wants to say about HRT in his book. That’s his right, and I certainly respect his right of privacy. If I receive new information, we will add it here.

In the meantime, check out Dr. Bob’s information-packed website: www.BobDelmonteque.com. You’ll also find information there on Lifelong Fitness 2004, which is filled with wonderful photos taken over the course of Bob's long career. 

Ripped Enterprises, 528 Chama, N.E., Albuquerque, New Mexico 87108, Phone (505) 266-5858, e-mail:  cncbass@aol.com, FAX:  (505) 266-9123.  Office hours:  Monday-Friday, 8-5, Mountain time.  FAX for international orders: Please check with your local phone book and make sure to include the following: 505 2669123

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