Book SummaryThe China Study, by T. Colin Campbell and Thomas M. Campbell

1-Page Summary1-Page Book Summary of The China Study

As a nation, we’re fascinated by diets. We spend billions of dollars every year trying to lose weight, feel better, and get healthier. But most of us are failing. Americans are some of the sickest and most overweight people in the world, and yes, our diet is to blame. But sugar and fat, the usual culprits, might not be the only, or even the worst, offenders.

In The China Study, T. Colin Campbell, Ph.D., and his son Thomas M. Campbell II, MD offer evidence that suggests that the foods we should actually be avoiding are animal-based. In hundreds of studies, eggs, cheese, milk, and meat have all been shown to increase your risk of everything from obesity and diabetes to cancer and autoimmune diseases. The authors’ goals are to 1) provide you with the evidence that a whole foods, plant-based (WFPB) diet can prevent and even reverse disease, and 2) explain why these findings aren’t better known.

The benefits of a WFPB diet include:

• Losing weight
• Living a longer life
• Looking and feeling younger and more energetic
• Lowering cholesterol and blood pressure
• Reducing the need for expensive surgeries
• Reducing your risk of heart disease, cancer, diabetes, autoimmune diseases, Alzheimer’s, and osteoporosis, among other illnesses.

The China Study is based, in part, on the research project of the same name, one of the most extensive nutrition studies ever done. For the project, T. Colin Campbell’s Cornell team partnered with Oxford University and the Chinese Academy of Preventive Medicine to study the diets, lifestyles, and diseases of inhabitants of rural China. What they discovered shocked them: Eating plant foods may be one of the leading determiners of health in rural China, and eating animal protein may be one of the leading causes of disease in the Western world.

The China Study has chapters devoted to individual diseases and disease groups, but regardless of the illness, the message is the same: Eat more plant foods and avoid animal foods.

The Principles of the Whole Foods, Plant-Based Diet

The Campbells distill their research findings and the findings of hundreds of other nutrition and disease studies into eight basic principles.

Principle #1: Various nutrients work together to achieve health.

No single nutrient is responsible for good health. What matters most is how the various nutrients in foods work together to create change in the body and maintain good health. This is why eating whole foods rather than taking nutrition supplements is so important, which brings us to Principle #2.

Principle #2: Avoid supplements—get your nutrients from food, not pills.

Supplements are problematic because they’re poorly regulated, often have side effects, and aren’t always effective. Further, the way nutrients function in the body is complex, and it’s not always clear whether certain benefits come from a single nutrient or from the whole food, so you’re better off eating the whole food.

Principle #3: Almost any nutrient you can find in animal-based foods, you can find in a healthier form in plant-based foods.

Plant foods have more of almost every nutrient, including fiber, vitamins, minerals, and antioxidants. Animal foods have fewer nutrients and more fat. The only exception to this principle is vitamin B₁₂, which is only present in animal foods.

Principle #4: Genes alone don’t cause disease—we have considerable control over which genes get expressed.

Genes only affect us when they’re activated, and diet is one of the biggest triggers of gene activation. This explains why, in...

Shortform Exercise: Your Health Beliefs (Part I)

Before diving into the findings presented in The China Study, take stock of your own beliefs and knowledge about diet and nutrition.

Make a brief list of foods you know are good for you.

The China Study Summary Introduction

Diet books are frequent bestsellers and America’s health industry is worth billions of dollars. Clearly, we want to be healthy.

But even though there’s a huge amount of health information out there, most of us still aren’t really sure what we should be eating to be our healthiest.

The China Study has the answer: Eat a whole foods, plant-based (WFPB) diet.

Whole Foods: Throughout the book, the authors (T. Colin Campbell, Ph.D., and his son Thomas M. Campbell II, MD) recommend eating foods in their least processed forms.

For example, rather than eating potato chips, eat a potato. Substitute whole-grain pasta for your usual white pasta.

Plant-Based: The authors also recommend a diet that’s free of all animal products, including meat, fish, dairy, and eggs. Just as importantly, they recommend eating lots of antioxidant- and fiber-rich plant foods, such as fruits, vegetables, and whole grains, to protect against disease.

The WFPB diet is relatively simple. If eating well and preventing illness is really this straightforward, why are we so bewildered about what it means to eat well?

The Confusion Surrounding Diet

Is gluten bad for us? Do eggs increase...

The China Study Summary Part I: The China Study | Chapter 1: Problems and Solutions

America spends more money on healthcare, per capita, than any country in the world. So Americans must be the healthiest, right? Not quite.

Two-thirds of our population is overweight, 25 million Americans are diabetic (up by 10 million since the book was first published in 2005), and half of Americans take a prescription drug every week. The authors believe that all of these issues are caused by, and can be solved with, food.

The Health Problems of Americans

Problem #1: As a Country, We’re Sick

We struggle with obesity, diabetes, cancer, and heart disease at alarmingly high rates.

For example, in 2005, more than one-third of American adults were obese. This percentage has been increasing for decades.

A related problem, one out of eleven Americans is diabetic, and that number keeps rising too, even though as a community we’re more knowledgeable about this disease than ever before. Even more sobering is the fact that 34% of people with diabetes don’t even know they have it. Diabetes is particularly serious because it can lead to issues such as blindness, heart disease, limb amputation, and early death. Further, this disease is expensive: 20% of our...

Shortform Exercise: Our Health Care System

Reflect on your experiences with the healthcare system to evaluate its flaws and merits for yourself.

Think of your last experience at the doctor’s office or hospital. Why were you there?

The China Study Summary Chapter 2: The Problem with Protein

One thing we think we know about nutrition is that we need lots of protein to be strong and healthy. But we may not need as much as we think, and we probably don’t need animal protein at all.

The Importance of Protein

Protein is a chemical made up of chains of hundreds of amino acids. It’s an essential part of our biological makeup—proteins function as enzymes, hormones, tissues, and transport molecules, among other roles.

Our bodies need to replace proteins when they get old and wear out. You can imagine a protein as a string of different colored beads, each color representing a different amino acid. When the string of beads breaks, we need to build a new one from new beads.

Our bodies make many of these “beads,” or amino acids, on their own, but there are eight they can’t produce. We need to consume these “essential” amino acids in order to replace some of our bodily proteins.

Protein “Quality”

The highest quality proteins are the ones that provide us with all eight of the amino acids our bodies can’t make themselves. The best quality proteins come from animal foods, particularly milk and eggs. The protein in plants is generally lower quality because a single...

The China Study Summary Chapter 3: Cancer (Part I)

Cancer is one of the most feared diseases in America. We’re swift in responding to carcinogen discoveries, decrying the use of DDT, Red Dye Number 2, nitrates, and artificial sweeteners.

But we’re not swift in the face of discoveries that are much more impressive and substantial, like the research linking casein with cancer. These findings are so counter to what we’ve always been told that they’re hard to take seriously.

Another discovery that gets ignored is the fact that cancer is, for the most part, preventable. Genetics only determine 2-3% of your cancer risk.

Campbell added to the growing body of research that suggested we have control over our cancer risk. He conducted his own studies with rats to determine how protein intake affects cancer development, and what kinds of proteins have this effect.

In his studies, in which rats were administered AF, Campbell confirmed and deepened the findings of the Indian study. He found that animal-protein consumption increased the risk of various cancers (including liver, pancreatic, and breast) at different stages of the cancer’s development. The results remained consistent when the rats were dosed with other...

The China Study Summary Chapter 4: The China Study

Now that he had evidence that animal protein causes liver cancer in rats, Campbell wanted to see if the findings also applied to humans.

This was one of the aims of the China Study, the most comprehensive survey of its kind.

In collaboration with the Chinese Academy of Preventive Medicine and the University of Oxford, Campbell’s team traveled to 65 rural and semi-rural Chinese counties, collecting blood and administering questionnaires to 6,500 adults.

Once for every subject over the course of a year, researchers obtained urine samples, measured what families ate over a three-day period, visited marketplaces to analyze food samples, and accumulated data on 367 variables.

They examined 48 different diseases and found more than 8,000 statistically significant associations among disease variables, diet, and lifestyle.

Why China?

Studying people in rural China allowed researchers to rule out genetics as a major factor in disease formation because, compared to other areas of the world, rural China contains populations with homogeneous genes. 87% of the Chinese are of the same ethnic group, the Han.

Additionally, 90-94% of the adults studied were living in the...

Shortform Exercise: The China Study Lessons

Reflect on the dietary issues that are most important to you and manage your expectations regarding the China Study’s findings.

Which lessons from the China Study are most meaningful to you?

The China Study Summary Part II: Diseases of Affluence | Chapter 5: Heart Disease

Part II dives into the diseases of affluence that afflict Westerners in particular: heart disease, obesity, diabetes, cancer, and autoimmune diseases. Each chapter discusses the ways in which the rich diets of our Western privilege are killing us. These chapters also detail how a whole foods, plant-based diet can heal us.

Heart Disease

The first disease of affluence discussed is heart disease. Heart disease has been the leading cause of death in the U.S. for almost 100 years, killing 40% of Americans and leading to 3,000 heart attacks in America every day.

Still, women tend to worry more about breast cancer, even though they’re eight times more likely to die of heart disease. Young people should also be vigilant—heart disease exists even in those who are in their 20s and seemingly healthy. One study examined 300 soldiers killed in the Korean War, none of whom had been diagnosed with heart problems. Their average age was 22. When researchers dissected their hearts, they found that 77.3% had major evidence of heart disease.

The Risk Factors and Mechanisms of Heart Disease

High cholesterol, high blood pressure, obesity, smoking, and lack of physical activity are...

The China Study Summary Chapter 6: Obesity

Perhaps the most famous disease of affluence is obesity, a symbol of our privilege and the excesses it fosters.

More than two-thirds of American adults are overweight, and one-third are obese, and this isn’t just a problem for adults. Obesity in children is on the rise as well. Of children ages 6 to 11, 18% are overweight, and of children ages 12 to 19, 21% are overweight. A further 15% are at risk of becoming overweight.

Aside from making many everyday tasks uncomfortable or painful, obesity is a problem because it’s linked to numerous health issues, including diabetes and heart disease.

How We Treat Obesity in America

Going on diets and popping weight-loss pills have become national pastimes. In 2006, we spent $147-$210 billion on obesity-related medical treatments and an additional $60 billion out-of-pocket on weight-loss programs and supplements. So why are one-third of us still obese?

Problem #1: We rely on gimmicks.

Everyone wants a quick fix, and companies know that to get customers, they need to promise rapid results.

And sometimes, we can lose weight quickly from certain diets, pills, and methods. But these programs often damage our health (and...

Shortform Exercise: Your Weight-Loss Strategy

Make a plan to lose weight for good.

If one of your health goals is to lose weight, which of the above strategies would be easiest for you to adopt? What roadblocks do you anticipate?

The China Study Summary Chapter 7: Diabetes

Another disease of affluence is diabetes. In 2012, 9.3% of American adults were diabetic, and over 200,000 kids had Type 1 or Type 2 diabetes. Almost one-third of diabetics don’t even know they have this serious disease.

Complications of diabetes include heart disease, kidney disease, damage to the nervous system, high blood pressure, blindness, and amputation.

Type 1 Versus Type 2 Diabetes

Type 1 diabetes used to be called juvenile-onset diabetes and Type 2 was called adult-onset diabetes. But now, 45% of childhood diabetes diagnoses are Type 2, so the original terms no longer apply.

As we’ll see, both types are associated with the consumption of animal foods and both involve a malfunctioning metabolism.

The Metabolism

A functional metabolism involves four steps:

1. We consume food.
2. Our bodies break down carbs into simple sugars like glucose (blood sugar).
3. Glucose enters the blood. In response, the pancreas produces [restricted term].
4. [restricted term] lets glucose into cells, where it’s used as energy.

In both types of diabetes, the breakdown of this system wreaks havoc on the body.

People with Type 1 diabetes (5-10% of all diabetes...

The China Study Summary Chapter 8: Cancer (Part II)

Campbell, who won the American Institute for Cancer Research’s Research Achievement award in 1998, believes that the nutritional principles discussed in this book have the same effect on many cancers, as discussed in Chapter 3. In this chapter, we look at the research on diet and three groups of cancer in particular: breast cancer, large bowel cancers, and prostate cancer.

Breast Cancer

One out of eight American women will get breast cancer in her lifetime. Like most cancers, this is yet another disease of affluence.

There are multiple risk factors and animal foods are linked to almost all of them.

Breast Cancer Risk Factors

1. High Blood Cholesterol

As we’ve seen, both dietary fat (found in greater quantities in animal foods than in plant foods) and animal proteins have been shown to increase cholesterol.

2. Prolonged Exposure to Female Hormones

These hormones include estrogen and progesterone. The earlier a female starts menstruating, and the later she starts the process of menopause, the greater her exposure to estrogen over her lifetime.

Animal foods seem to play a part in increasing cancer risk at every stage of a woman’s life:

*...

The China Study Summary Chapter 9: The Autoimmune System

Most people, doctors included, agree that autoimmune diseases are some of the hardest to treat because their cause isn’t well understood and there’s no cure. Is it possible that our food choices affect even these stubborn and grim illnesses?

In people with autoimmune disease, the body attacks itself. The immune system thinks it’s assaulting foreign invader cells, but it’s actually destroying normal body cells. Tens of millions of Americans have autoimmune diseases, including multiple sclerosis (MS), Type 1 diabetes, lupus, and rheumatoid arthritis.

Before looking at food’s role in the development of autoimmune diseases, let’s look at their bodily source, the immune system.

How the Immune System Works

We can think of the immune system as our body’s military. White blood cells are the soldiers, keeping us safe by attacking foreign invaders like bacteria and viruses.

Whenever it confronts a new invader, the immune system creates a protein that mirrors the invader protein. This mirror protein molds itself onto the invader and destroys it.

The Problem: Some invaders look a lot like our own cells. The molds that fit and destroy invaders can also fit and destroy the...

The China Study Summary Chapter 10: Other Diseases

No matter what your pet idea is, you’re almost guaranteed to find a study, somewhere, that supports it.

Is the belief in the healing power of a whole foods, plant-based diet a pet idea? How do we know it’s not just another fad diet? The answer is in the thousands of studies providing evidence that plant-based diets prevent and cure a multitude of health issues. Chapter 10 explores some of these various issues, including osteoporosis, kidney stones, vision problems, and brain health.

We tend to think of these health issues as the natural consequences of aging. But they might actually be the natural consequences of our diets.

Osteoporosis

The Calcium Myth

We all know that calcium builds strong bones. Americans consume more calcium, in the form of dairy products, than most people in the world. So our bones should be stronger than everyone else’s.

But they’re not. Americans age 50 and older have one of the highest hip fracture rates in the world. The few countries with higher rates, like Australia and New Zealand, eat more dairy than we do. How can this be?

Reason #1: Animal Protein in Milk Increases Acid in the Body

When our blood and tissues become...

Shortform Exercise: Your Health Beliefs (Part II)

Before starting Part III and reading about the Campbells’ dietary principles, reflect on your own principles, the beliefs that consciously or subconsciously dictate how you eat. Have they changed since reading Parts I and II?

What are the benefits of eating animal foods? What are the benefits of eating plant foods?

The China Study Summary Part III: Guide to Good Nutrition | Chapter 11: Principles

Part III makes the findings from the studies detailed in Parts I and II actionable. A more comprehensive guide to nutrition, with meal plans and recipes, is available in Thomas M. Campbell’s companion book, The China Study Solution, but this section also offers guidance on how to make a whole foods, plant-based diet work for you. The Campbells start by outlining eight key principles.

The Eight Principles

Principle #1

Various nutrients work together to achieve health.

No single nutrient is responsible, on its own, for good health. The way food chemicals function in the body and the way they interact with each other are too complex to ever fully understand. The sum of all these chemicals working together is greater than the actions of each individual chemical.

This is why the “whole foods” part of the whole foods, plant-based diet is important. How nutrients are packaged together in food matters more than the specific nutrients themselves. This brings us to Principle #2.

Principle #2

Avoid supplements—get your nutrients from food, not pills.

Supplements are problematic for a variety of reasons. First of all, the whole concept of a supplement...

The China Study Summary Chapter 12: How to Eat a Plant Diet

If you’ve made it this far in the book, you might be convinced by the extensive data associating animal foods with disease. The problem now is imagining yourself actually giving up meat and dairy. Is this feasible? Could you really stop eating animal foods?

Chapter 12 is here to hold your hand as you start your meat-and-dairy-free journey. Although the biology of why and how the WFPB diet works is complex, eating a WFPB diet is simple: Eat unrefined plant foods and limit added salt and fats.

What to Eat

• Eat as much as you want of fruits, vegetables, legumes, mushrooms, nuts, and whole grains (this includes whole-grain bread and pasta).
• Limit refined foods (white bread, cakes, pastries, crackers), fish, and added oils (including corn, peanut, and olive oils).
• Avoid meat, poultry, dairy, and eggs.

Four Discoveries

Not eating animals is such a strange idea in America that most of us don’t take it seriously. But if you try it for a month, you might be surprised by the discoveries you make.

Discovery #1: Plant foods are delicious. You may miss meat and cheese, but you’ll also discover some enticing new foods you wouldn’t have tried...

Shortform Exercise: The WFPB Diet

Take stock of your feelings so far about the WFPB diet. Are you all-in, ready to change your diet today? Are you merely curious? Anticipate your own possible foray into plant-based eating.

If you’re considering trying a WFPB diet, which of the above suggestions do you find most helpful?

The China Study Summary Part IV: Institutions That Obscure | Chapter 13: Problems with Science

In previous chapters, the Campbells hint at the skepticism, and even antagonism, of doctors, scientists, industries, and governments when it comes to the dangers lurking in meat and dairy. In Part IV, the Campbells flesh out some of the reasons the public doesn’t hear more about these dangers.

Part IV is divided into discussions about resistance to the link between animal products and disease in the worlds of science (Chapter 13), industry (Chapter 15), government (Chapter 16), medicine (Chapter 17), and academia (Chapter 18).

While each institution gets its own chapter, the Campbells stress that it’s increasingly hard to see where one ends and another begins, as industry especially has a huge influence over the other sectors.

The overarching issue is that we live in a system that prioritizes the profits of a few over the health of all. Even so, there are few “bad guys” in the stories in the coming chapters—industries, understandably, have a product to sell, government workers have elections to win, doctors lack training in nutrition, and well-intentioned journalists and health organizations spread bad information. The bad conduct of the few is rarely illegal, but it’s...

The China Study Summary Chapter 14: The Problem of Reductionism

When Campbell talks about reductionism, he means the practice of doctors, researchers, and reporters focusing on the health benefits of specific nutrients rather than the food as a whole. This is an approach opposite to the one implied by Principle #1, the idea that various nutrients work together to achieve health, in Chapter 11.

Because the whole food is more than the sum of its nutritional parts, changing your diet one nutrient at a time isn’t going to make you healthier. You need to look at the bigger picture, your dietary and lifestyle patterns as a whole, to understand how to be healthier.

Studies or companies that zero in on one particular nutrient lead to misleading information and confusion. You can’t isolate a chemical and then make sweeping assumptions about the food it’s in. Foods, the chemicals they contain and the way they work in the body, are too complex for that.

Two examples show the dangers of focusing on one nutrient in isolation.

Example #1: The Marketing of Lycopene

Often, scientists will use whole foods in their research and then supplement companies will use their findings to promote a specific nutrient. Lycopene is one example...

The China Study Summary Chapter 15: Industry

Food costs consume a huge percentage of our budget. Because we’re dependent on food, we’re also fairly dependent on those who market and sell it. “Health” industries take advantage of this. By making claims about the proven nutritional value of their products, food and drug companies and advocacy groups blur the line between science and marketing.

Organizations like the National Dairy Council, the American Meat Institute, and Florida Citrus Processors Association each have annual budgets in the hundreds of millions of dollars. With this money comes power over research, medical education, and government decisions.

Problems for the Consumer

Let’s look at some of the problems of a system in which industry and science merge.

Problem #1: The consumer can’t always tell which claims are based on rigorous research and which are marketing ploys.

It’s the job of industries to sell a product. But when they clothe their marketing in scientific language, they make it hard for the consumer to understand the truth of a product’s health claims.

Problem #2: Consumers are particularly vulnerable to food and drug industries.

Our lives literally depend on the foods we eat and the...

The China Study Summary Chapter 16: Government

Food is one of the biggest threats facing the American people. Our eating habits kill more of us than tobacco use, accidents, or any other lifestyle factor. Yet the government promotes the consumption of meat and dairy, foods that hundreds of studies say cause disease. Why? Is the government for the people, or at the expense of the people?

Problems with the Government’s Approach to Health:

Problem #1: The government is closely tied to the food industry, and elected officials need to represent their constituents to get reelected.

For example, in 1976, Senator George McGovern headed a committee that drafted dietary goals based on a survey of the science linking diet to heart disease. He recommended that Americans decrease their consumption of fatty animal products and increase their consumption of fruits and vegetables.

But the goals were so controversial in the senate (because of their recommendation to decrease consumption of animal products) that the committee had to substantially revise them. McGovern and five other senators from agriculture states lost their 1980 reelections, in part because of their involvement with the dietary goals.

Keeping donors and...

The China Study Summary Chapter 17: Medicine as an Institution

Doctors rarely give nutrition or dietary advice. Why not? The Campbells cite ego, bias, inadequate training, incorrect assumptions, and the influence of the drug industry as potential issues.

The Problems with Medicine as an Insititution

Problem #1: Many doctors see a plant-based diet as too “extreme” to recommend. Presumably, they don’t feel the same way about chemotherapy or life-threatening surgeries.

Problem #2: Many doctors don’t think their patients will actually adopt a plant-based diet, so they don’t suggest it, or they suggest it in passing. It’s not offered as a serious recommendation.

Problem #3: Many doctors feel threatened by the idea that foods can cure as well as (or better than) they can. They’ve spent years developing their skills and learning how to execute extremely complicated procedures. It’s demoralizing to think that a patient could choose between eating more greens and having bypass surgery, and eating more greens might be the more effective choice.

Problem #4: Medical students get almost no training in nutrition.

In 2010, medical students got an average of 20 hours of nutrition education. This is miniscule compared to their...

The China Study Summary Chapter 18: The Failed Ideals of Academia

Although the Campbells highlight serious problems in the government, food and drug industries, and the medical establishment, they understand their motivations: Government officials need to be reelected to do their jobs, industries have a product to sell, and the medical establishment often depends on industries to finance education and research.

The Source and the Link

What sector carries the most blame? According to the Campbells, it’s academia. As the source of information, it may hold the most power. Food industries, medical centers, and the government rely on the research provided by the academic sector. They may exploit, disregard, bury, or manipulate that information, but academia is its origin.

Academia also has ties to these other institutions, its members helping develop health policies and working closely with the U.S. Department of Agriculture through outreach programs. It could use these ties to initiate change.

Universities are places valued for intellectual freedom, collaboration, and original, unbiased research. University members are in the ideal position to influence the quality and spread of information. Are they falling short?

The Problem:...

The China Study Summary Chapter 19: Is History Doomed to Repeat Itself?

Eating a whole foods, plant-based diet isn’t a new idea. Socrates, via Plato, predicted that a society that indulged in the luxury of meat would lead to a society plagued with inflammation and disease. The winning athletes in the ancient Olympics also knew that eating a plant-based diet was the key to good health and performance. So how did we get here, promoting meat’s health benefits and worrying that vegetarians don’t get enough protein?

Despite the detour we’ve taken as a society, there’s reason to believe that we’re slowly returning to a culture that values plant foods.

Reasons for Hope

These reasons provide a summary of the book’s main arguments.

Reason #1: The body of evidence supporting a WFPB diet, from hundreds of rigorous studies, keeps growing.

Reason #2: We have a better understanding of how animal proteins usher carcinogens into...

Shortform Exercise: Your Health Beliefs (Part III)

Reflect on how your ideas about what makes food healthy and unhealthy have changed over the course of learning about the China Study and other research on animal foods.

Take a look at your responses to the exercise questions before the Introduction. How have your beliefs about what makes a diet healthy or unhealthy changed as you explored the evidence of the China Study?