Nutrition and Health It is no exaggeration to state that this is one of the most important books on nutrition and health ever written. Not only does the research content have enormous and far reaching implications, but also readers will find themselves challenged to adapt their diets in the light of Campbell’s findings and recommendations – as he himself has done. Campbell grew up on a farm, convinced that a high intake of meat, dairy and eggs was the ideal healthy diet. Experience and research have proved otherwise. His first research project was in the Philippines, where he was initially concerned to plug the so-called protein gap on the basis that childhood malnutrition was caused by lack of protein. Instead, he found the highest prevalence of liver cancer in the very Filipino children who ate the highest protein diets. Around the same time he noticed a research report from India where two groups of rats were being administered the cancer causing aflatoxin then fed a diet composed of 20% protein. The other group was administered the same amount of aflatoxin but fed a 5% protein diet. Results showed that every single animal on the 20% protein diet had evidence of liver cancer, while every single animal on the 5% protein diet avoided liver cancer. These two studies proved seminal to the future development of Campbell’s research career.

The book is divided into four parts: the China Study, Diseases of Affluence, the Good Nutrition Guide and a section entitled why haven’t you heard this before? on science and politics. Campbell describes how he set out to replicate the Indian rat study: ‘what we found was shocking. Low-protein diets inhibited the initiation of cancer by aflatoxin, regardless of how much of this carcinogen was administered to these animals. After cancer initiation was completed, low-protein diets also dramatically blocked subsequent cancer growth. In other words, the cancer producing effects of this highly carcinogenic chemical were rendered insignificant by a low protein diet. In fact, dietary protein proved to be so powerful in its effect that we could turn on and turn off cancer growth simply by changing the level consumed.’ He found that low protein intake markedly decreases enzyme activity and prevents dangerous carcinogens binding to DNA. Also that ‘in these experiments, plant protein did not promote cancer growth, even at the higher levels of intake. Gluten, a protein of wheat, did not produce the same result as casein (milk protein), even when fed at the same 20% level.’ An important implication of this research is that the level and type of protein intake affects the expression of cancer genes. In other words, even if one has a genetic predisposition to cancer, this research indicates that the plant based diet will help prevent its manifestation.

The next chapter provides details of the China Study itself. It is based on a monumental survey initiated in the 1970s on death rates for 12 different kinds of cancer covering more than 2400 Chinese counties and 880 million (then 96%) of their citizens. Campbell and colleagues were able to follow this with a detailed study of the relationship between diet and disease, resulting in more than 8,000 statistically significant associations between lifestyle, diet and disease variables. Differences between diseases of affluence and diseases of poverty and became very clear - he calls the former ‘diseases of nutritional extravagance’. He found that death rates from coronary heart disease were 17 times higher among American men than rural Chinese and that the American death rate from breast cancer was five times higher than the rural Chinese rate. It also became clear that the average blood cholesterol level among rural Chinese was around 127mg/dL while the comparable figure in the US is 215mg/dL. Campbell concludes that ‘lower blood cholesterol levels are linked to lower rates of heart disease, cancer and other Western diseases, even at levels far below those considered safe in the West.’ He also found that ‘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. Fibre and antioxidants from plants are linked to a lower risk of cancers of the digestive tract.’ As readers can imagine, the Atkins diet is given short shrift.

Part Two considers research into a variety of diseases of affluence and their preconditions: obesity, heart disease, diabetes, cancers, autoimmune diseases and various other diseases of bone, kidney, eye and brain. At the beginning of the section he states: ‘there is no such thing as a special diet for cancer and a different, equally special diet for heart disease. 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.’ The chapter on heart disease explains that the incidence is similar to the 1970s, but survival rates have improved: ‘we have got slightly better at postponing death from heart disease, but we have done nothing to stop the rate at which our hearts become diseased.’

Campbell reports an extraordinary study begun in 1985 by Dr Caldwell Esselstyn Jr. He originally had 23 patients of whom five dropped out within two years. Of the other 18, these people had suffered 49 coronary events in the previous eight years. Esselstyn put his patients and himself on a low-fat plant-based wholefood diet. The average cholesterol level at the start of the study was 246 mg/dL which fell during the study to 132mg/dL. In the following 11 years, there was only one coronary event among these 18 people. This one person had strayed from the diet for two years. Since going back on the diet, he has experienced no further problems. 70% of these patients have seen an opening of their clogged arteries. Equally significantly, the five dropout patients had experienced a further 10 coronary events by 1995. As of 2003, 17 years into the study, all but one of the original 18 patients was still alive. Campbell asks: can any sane person dispute these findings? Sadly, the answer is yes. When Esselstyn tried to introduce a programme into the Cleveland clinic where he had been a cardiac surgeon, he was simply blocked. The reason? ‘The healthcare establishment is still structured to profit from chemical and surgical intervention.’ Later he adds: ‘food as a key to health represents a powerful challenge to conventional medicine, which is fundamentally built on drugs and surgery.’ Similar data are adduced for the other diseases of affluence.

Part Three sets out Campbell’s eight principles of food and health:
1) Nutrition represents the combined activities of countless substances. The whole is greater than the sum of its parts
2) Vitamin supplements are not a panacea for good health (they are isolated nutrients)
3) There are virtually no nutrients in animal based foods that are not better provided by plants
4) Genes do not determine disease on their own. Genes function only by being activated, or expressed, and nutrition plays a critical role in determining which genes good and bad, are expressed. (biochemical dormancy) (genes as ‘seeds’)
5) Nutrition can substantially control the adverse effects of noxious chemicals
6) The same nutrition that prevents disease in its early stages can also halt or reverse disease in its later stages (disease takes time to develop)
7) Nutrition that is truly beneficial for one chronic disease will support health across the board
8) Good nutrition creates health in all areas of our existence. All parts are interconnected. (we have more energy if we eat well – hence more exercise capacity)

He then provides advice on how to put these principles into practice, drawing on his own experience and that of others.

Part Four asks why you haven’t heard this before? The short answer is that ‘the entire system – government, science, medicine, industry and media – promotes profits over health, technology over food and confusion over clarity.’ The first chapter – Science – the Dark Side explains how many national bodies are in fact fronts for industry and apparently independent academics are retained by industry interests who also sponsor some of their research. So the job of committee members is to protect the reputation of the American diet: ‘this means that in the world of nutrition and health, scientists are not free to pursue their research wherever it leads. Coming to the wrong conclusions, even through first rate science, can damage your career. Trying to disseminate these wrong conclusions to the public, for the sake of public health, can destroy your career.’ Campbell explains that some people in very influential government and university positions operate under the guise of being scientific ‘experts’, whose real jobs are to stifle open and honest scientific debate. They do this by systematically attempting to conceal, defeat and destroy viewpoints that oppose the status quo: ‘the medical establishment does not take kindly to the idea of a serious connection between diet and cancer or, for that matter, virtually any other disease. Big medicine in America is in the business of treating disease with drugs and surgery after symptoms appear.’ In addition, the food and drug industries closely monitor (and defame where necessary) individuals whose research might undermine their future profitability.

The next chapter takes on scientific reductionism in nutritional research. In this context, it is the mistake of characterising whole foods by the health effects of specific nutrients. This goes to the heart of the scientific method, which tries to isolate the effect of specific factors. Campbell provides a detailed critique of the Nurses’ Health Study, which is often cited to show that there is no relationship between diet and breast cancer. However, it is clear that the whole cohort of nurses was consuming a high risk diet centred on animal based foods: ‘hence there is no way to study the diet and breast cancer relationship.’ Ironically, it turns out that ‘the low-fat meal contains more than double the protein of the high-fat meal – and mostly from animal based food and high in cholesterol.’ He adds: ‘virtually all the subjects under study consume the very diet that causes diseases of affluence.’ Since information is taken out of context ‘studies looking at the differences in consumption of one nutrient at a time are all flawed, so the combined results only give a more reliable picture of the flaw.’ He concludes that ‘this method of investigating details out of context and trying to judge complex relationships from the results is deadly.’

The next chapter on government-industry links is highly revealing. As previously noted, industry consultants wear academic hats. ‘In effect, the entire system is essentially under the control of industry. The entire system of developing public nutrition information has been invaded and co-opted by industry sources that have the interest and resources to do so. The purpose of basic research is to discover products that the pharmaceutical industry can develop and market.’ However, ‘the alarming fact is that this litany of research into drugs, genes, devices and technology research will never cure our chronic diseases. Our chronic diseases are largely the result of infinitely complex assaults on our bodies resulting from eating bad food.’ Campbell sums up the situation: ‘I have come to the conclusion that when it comes at a health, government is not for the people; it is for the food industry and the pharmaceutical industry at the expense of the people. It is a systemic problem where industry, academia and government combine to determine the health of this country. Industry provides funding for public health reports, and academic leaders with industry ties play key roles in developing them. A revolving door exists between government jobs and industry jobs, and government research funding goes to the development of drugs and devices instead of healthy nutrition….the system is a waste of taxpayer money and is profoundly damaging to our health.’ It is a damning and fully justified indictment.

I noticed a few gaps in Campbell’s book. Although he refers to an earlier nutritional research, he does not mention the work either of Sir Robert McCarrison or Max Gerson. He could also have made a connection with the research of Sir Albert Howard on the relationship between the health of soil, plant, animal and human being. Nor is it clear whether there is a difference between cow and goat or sheep produce – is all dairy equivalent?

At the end of the book, Campbell summarises the health problems of the US with a series of alarming figures, most of which are still showing upward trends. This can only mean that health care will continue to become more and more expensive. And yet, as he observes, ‘we now have a deep and broad range of evidence showing that a whole foods, plant based diet is best for the heart….and all other chronic diseases.’ He believes that the situation has reached a critical point when people are ready to listen and to change. The vitality of a culture cannot be maintained or expressed in by a sick population. We now have an unprecedented situation where a greater proportion of the world population is overweight than undernourished. This can only produce the nemesis of diseases of nutritional extravagance, which, according to the thesis of this book, is largely preventable. Moreover, the whole food plant based diet recommended by Campbell has a far lower impact on the environment. As I said at the beginning, this is a seminal book that should be read by everyone interested in the future of health – their own included. It should also be required reading in ministries of health and on undergraduate medical curricula.