Rest in peace, China Study

July 8, 2010 in Food & Nutrition, Myths & Truths | 49 comments

coffinI know this was all over the blogosphere yesterday but I think it’s important enough for a repost.

One thing I can count on every time I write an article extolling the health benefits of animal products is someone sending me an email or posting a comment like this:

I think you’re absolutely wrong. You should read: The China Study, by Dr. T. Collin Campbell.

Sorry to be contrary, but T. Colin Campbell’s “The China Study” should put this issue to rest. Please consider the information presented there. The methodology is impressive.

Campbell recommends a vegan diet–no animal based food at all. He claims that population studies demonstrate that vegan populations do not suffer from the high incidence of cardiovascular disease and cancer that we in the West do with our diets heavy on animal protein.

In fact, those are direct quotes from comments that have been left on my blog over the past year. I can’t even show you some of the emails people have sent because the language might offend you.

Usually I direct those folks to Chris Masterjohn’s excellent critique of the China Study. Now, however, I’ll be sending them over to read Denise Minger’s freshly published China Study smackdown.

Here’s the introduction:

When I first started analyzing the original China Study data, I had no intention of writing up an actual critique of Campbell’s much-lauded book. I’m a data junkie. Numbers, along with strawberries and Audrey Hepburn films, make me a very happy girl. I mainly wanted to see for myself how closely Campbell’s claims aligned with the data he drew from—if only to satisfy my own curiosity.

But after spending a solid month and a half reading, graphing, sticky-noting, and passing out at 3 AM from studious exhaustion upon my copy of the raw China Study data, I’ve decided it’s time to voice all my criticisms. And there are many.

Denise got hold of the raw study data and took it apart with a fine-toothed comb. And what she found is that the claims Campbell made in his China Study book are not supported by the data. She also found important data points Campbell never bothered to mention in the book because they didn’t support his vegan agenda.

For example, Campbell conveniently fails to mention the county of Tuoli in China. The folks in Tuoli ate 45% of their diet as fat, 134 grams of animal protein each day (twice as much as the average American), and rarely ate vegetables or other plant foods. Yet, according to the China Study data, they were extremely healthy with low rates of cancer and heart disease; healthier, in fact, than many of the counties that were nearly vegan.

This is just one of many cases of the selective citation and data cherry picking Campbell employs in the China Study. Denise’s critique masterfully reveals the danger of drawing conclusions from epidemiological studies, which can only show correlations between variables – not causal relationships. Campbell should be well aware of this. After all, in his book he rails against the nutritional bias rampant in the scientific community. Yet nowhere is such bias more evident than in Campbell’s own interpretation of the China Study data.

Denise concludes:

Ultimately, I believe Campbell was influenced by his own expectations about animal protein and disease, leading him to seek out specific correlations in the China Study data (and elsewhere) to confirm his predictions.

Campbell’s response to previous critics of the China Study has been something to the effect of: “I’m a trained scientist. Therefore you should believe me and not my critics.” That is a weak argument – to put it mildly. You don’t need six years of graduate school to learn to think critically. Nor does having a lot of letters after your name make you immune to biased thinking or intellectual blindness. A lot of smart, educated people believed the cholesterol hypothesis for decades. But that never made it true.

You can read more – and I mean a lot more – over at Denise’s blog. I recommend starting with her article China Study: Fact or Fallacy? For many of you, it will be more than enough. But if you’re interested in this stuff, she has written several other articles worth reading.

There are also reviews of Denise’s article at Free the Animal, Whole Health Source, Robb Wolf and PaNu. If you don’t have time to read Denise’s article, read Dr. Harris’s review at PaNu. It’s the next best thing.

Rest in peace, China Study.

P.S. You might also want to check out this debate between T. Colin Campbell and Loren Cordain on human protein requirements. Notice that Cordain’s articles contain 164 citations of research studies. How many references do Campbell’s articles contain? Zero. And Campbell’s typical “I’m more educated than the other guy” won’t fly here. Dr. Cordain has some serious chops.


Lynne Parker July 9, 2010 at 6:43 am

Interesting. I think it important that if one does eat meat, one should strive for the most humanely raised animal—grass fed beef for example. Cows were never meant to eat corn. ( I actually wish corn had never been invented) We buy our chicken from a local farmer who uses no hormones, antibiotics, etc. The birds are all free ranging. When we can afford beef we do get grass fed and what an amazing difference between that and the stuff you get at the grocery store. Not only the taste but the texture itself is better.

Chris Kresser July 9, 2010 at 6:49 am

I couldn’t agree more, and I’ve said as much on the blog several times.

Nevertheless, in China the evidence still shows that eating meat (regardless of where it comes from) is not unhealthy and that the strongest correlation between a dietary variable and disease was not meat, but wheat.

megan July 9, 2010 at 7:30 am

I’ve never been healthier since switching to an almost all meat/fat diet 10 months ago. I eat almost no plants, absolutely no starches or sugars and high fat. My skin is good, my colour is good, my memory is better, my sense of direction is better, I’ve lost a ton of weight, my cavities don’t hurt anymore, I have more stamina, I’m not hungry all the time, my hair and nails are strong and shiny, I don’t get pms anymore, my mood is dead stable & calm……
Ditch the grains. Ditch the sugar. Eat the animals. and sure, do it ethically and support ethical husbandry.

Isaac Rivera July 9, 2010 at 8:16 am

Mysterious absence of China Study pushers on the comments of this post…

Chris Kresser July 9, 2010 at 8:34 am

Mysterious absence of China Study pushers on the comments of this post…

Yes, they’ve gone awfully quiet all of a sudden.

Don’t worry, I’m sure Campbell will publish a completely unconvincing and unsubstantiated response soon.

Carole Crisp July 9, 2010 at 9:23 am

Very interesting! I cannot tell you how many books, dvd’s, and online information I have read in the past few years trying to resolve what I believe about this subject. Ironically, while in the airport last week (returning from a MonaVie conference where at the same time Suzanne Somers was having an alternative conference and I ran into Dr. Julian Whitaker), I saw the China Study in the bookstore and “almost” bought it realizing that is one of the last books I hadn’t picked up to read but had heard so much about!
Shame on me for straying from my own faith. 1 Timothy 4:3-5… They forbid people to marry and order them to abstain from certain foods, which God created to be received with thanksgiving by those who believe and who know the truth. For everything God created is good, and nothing is to be rejected if it is received with thanksgiving, because it is consecrated by the word of God and prayer.
That being said, I do believe this refers to “real, wholesome, unadulterated” food, not the garbage so readily available to us.
Thanks for clarification once and for all!

Jen July 9, 2010 at 10:53 am

Thanks for this post!  I’m currently taking a class where I have to read The China Study and write a paper.  Oy!  You’ve given me some great sources for the paper ; ).

Chris Kresser July 9, 2010 at 11:06 am

I hope your teacher isn’t vegan! Or if she is, that she’s open minded.

FoodRenegade July 9, 2010 at 11:27 am

Thanks for the link to the debate between Campbell and Cordain. I haven’t seen it before (which surprises me!).
(AKA FoodRenegade)

jamie July 9, 2010 at 12:39 pm

Yes, I do believe that some people need to eat meat. If not most people. Those are just my beliefs, but I this, is interesting, to say the least. Veganism is ok, but I do not think you can take ANY diet and say that it is the right one for every human being. Veganism is plain not healthy, for some people. The fact of the matter is that some people just cannot absorb enough nutrients from vegan diets alone.

Pdazzler July 9, 2010 at 1:21 pm

High Chris,
Excellent post.   For years I supported reduced animal protein but that changed when I found certain nutrients were lacking in my diet.   I now eat red meat at least once weekly although it is usually lamb, buffalo, wild game or grass feed & finished beef.
I have searched for years for John Yudkin’s research works on sugar and animal protein all to no avail.  Seems some of the wonderful research accomplished in the 1950′s & 60′s has mysteriously disappeared from the public arena.  I did find significant reference to it in Linus Pauling’s “How to Live Longer and Feel Better” from the 1980′s.
Keep tweaking the thought processes.   -  Pdazzler

Nick July 9, 2010 at 2:17 pm

I have not studied or even read the China report I really do not have to I am in the best shape of my life since I stopped eating meat,dairy and WHeat!  I eat mainly raw fruit,vegtables nuts and seeds.  That is what is good for me.  I do not have an agenda but it does not take a study by a vegan or the meat and dairy industry to see who is the fatest and unhealthy people and what they eat;  Sugar and wheat yes but to counter that what is healthier meat or vegtables?
Each person is different but the higher the acid producing food the higher the chance of cancer and  heart disease which re the 2 hihgest rates of death in the US.  Which foods are high in acid and which are high in Alkaline no sudy or industry can hide the facts!

jamie July 9, 2010 at 5:52 pm

to Nick: I found the video on youtube “Is Meat Always Acidifying?” to be very insightful.

Khrystyna July 9, 2010 at 6:40 pm

Uggh I have to admit I used to be a big fan of the china study back in my vegetarian days (before I knoew better basically). No I look at it and wonder how I could have been so easily won by some sensationalist writing, but as a veggie I like Campbell himself saw what I wanted to see. Been primal for about 4 months now after a over a decade of vegetarianism and often veganism and I feel fantastic! No more IBS for me yay!
Denise is such an inspiration, what a talented woman, I wish I had a fraction of her abilities :(

Todd S. July 9, 2010 at 8:19 pm

Sounds suspiciously like the same “methodology” used by one Ancel Keys – which started us down this whole low-fat highway to unhealth.

Todd S. July 9, 2010 at 8:23 pm

what is healthier meat or vegtables?

Well, I would say look at evidence and you tell me.  I don’t think a case can be made that one is healthier than the other.  Both provide many of the same nutrients, but both also provide many things the other cannot.  Completely eliminating one or the other will eventually lead to problems as most hardcore vegans find out after a while.  I’ve yet to meet someone who has eaten nothing but meat for more than a couple weeks at a time so I can’t speak to that.

Khrystyna July 10, 2010 at 4:06 am

@ Todd
I came across someone on a nutrition forum who was trying a meat only diet, they had only been on it a few months and seemed to be enjoying themselves and feeling good. You’d have to get plenty of organ meat into you though I’d say.
If it were me and I had to choose, I’d go for meat, as far as i know vitamin C is one of the only nutrients you can’t get from meat and if you’re low carb enough you need very little anyway so I’d say you’d fare better a bit longer. You wouldn’t last long if you weren’t eating any real protein.

Sue July 12, 2010 at 5:01 am

Mysterious absence of China Study pushers on the comments of this post…

They’re all posting somewhere over at 30 Banananas!

freelee July 13, 2010 at 5:30 am

Couldn’t let you guys down.
Take a read of the discussions, unfortunately Denise did not perform the study correctly, actually far from it.

Chris Kresser July 13, 2010 at 7:41 am

Ah, it was inevitable. Unfortunately, none of those critiques you linked hold water. Denise’s analysis was impeccable, as many working physicians and researchers in the field have attested to. “Robert” makes so substantive criticism about her work other than to say it should be peer reviewed. By his own admission, he hasn’t “checked her math”.

This is all so predictable. It’s just human nature. People will go to great lengths to defend their worldview, regardless of what the evidence shows. I’ve said it a million times before: “you can’t fight faith with facts.”

Todd S. July 13, 2010 at 10:28 am

Sue called it on the 30 Bananas bit.  Too funny.
“you can’t fight faith with facts.”
I would argue that’s the only way to fight it.  Sadly, you can’t fight the faithful with facts.  Or rather, you can’t get them to observe.

Tuoli July 13, 2010 at 12:24 pm

Maybe it would be good to look at the raw data yourself. Here is what happened with the Tuoli:

“[M]eat consumption for one of the counties, Tuoli, was clearly not accurate on the 3 days that the data were being collected. On those days, they were essentially eating as if it were a feast to impress the survey team but on the question of frequency of consumption over the course of a year, it was very different.”
-Dr. Campbell (
They only collected data for 3 days…and they were feasting to show off to the westerners. I wonder why Denise looked over this part? And if she wants to make herself credible I hope she is working to submit a peer review of her study to publish.

Chris Kresser July 13, 2010 at 4:05 pm

Ah, yes. Data collection. Interesting that you’d bring up possible inconsistencies with the Tuoli without mentioning the many other cases in the China Study where data collection was also questionable or inconsistent. That is one of the major reasons we can’t draw conclusions from epidemiological studies, as Daniel pointed out. Campbell should know this. It’s one of the first things taught in Research Methodology 101. But somehow even experienced researchers seem to forget it – especially when amnesia is expedient.

And as long as we’re talking about population based studies, what of the several traditional cultures around the world (i.e. Masai, Inuit, etc.) whose diets are composed almost entirely of animal products – and who eat little, if any, plant food? If Campbell were right, these would be among the unhealthiest people in the world. But these populations are relatively free of the modern diseases killing us today. That suggests animal products are not the culprit.

Denise made several important points in her analysis about how the data were collected, but more importantly, how they were interpreted (and which data were left out of the analysis entirely). I haven’t seen one critique of Denise’s work that addresses her points directly. Until that happens, you can’t expect us to take any of it seriously.

And I’d be careful about making the argument that we should ignore her analysis because it isn’t peer reviewed. Because then we might ask you to start showing us well-designed, peer-reviewed trials proving that animal products are harmful and that a plant-based diet is beneficial.

Daniel July 13, 2010 at 2:16 pm

I couldn’t agree more with you, Chris. You can’t reason with a faithful, no matter what the religion is.
@ Tuoli: What a convenient explanation by Dr. Campbell to nullify any data or “black swans” that does not agree with his point of view. Does he do the same for the other counties?  He should instead make public his methodology so we can compare his results and methods with Denise Minger’s. It’s surprising that that Denise is held to a higher degree of scrutiny and standard than Dr. Campbell.
China study is just epidemiology, and epidemiology cannot prove cause and effect. China study is only at best a hypothesis that animal food causes disease. As shown by Denise, it is cherry picking at it’s best and lots of leap of logic. Like casein cause cancer => animal proteins cause cancer.

Todd S. July 13, 2010 at 6:55 pm

Not to mention the modern cultures like the Swiss and Scandinavians who consume large amounts of dairy and don’t exhibit the preponderance of “diseases of civilization” that we do.

Chris Kresser July 13, 2010 at 6:59 pm

And not to mention the lack of evidence that ANY traditional cultures followed a vegan diet. In fact, even those cultures that were predominantly vegetarian went to great lengths to obtain animal products (like shellfish or insects) to supplement their diet with.

Since evolutionary biology tells us humans evolved eating animal products, the burden of proof is on those who claim our natural diet is somehow “unhealthy”.  And so far there’s absolutely no such proof.

hans keer July 14, 2010 at 12:42 am

What a frightening coffin Chris. Makes it a little obnoxious. And what to do with the coffin when the study is in there? Burry or burn it? Couldn’t we just file and forget about this observational study and the often irrelevant, multi interpretable underlying data?

Khrystyna July 14, 2010 at 10:24 am

I’d never heard of 30 bananas before seeing it mentioned in the comments here and then they showed up on my blog spamming my post (where I recommended people to visit Denise’s blog) with a load of links to criticisms of her analysis! Visited the site, pretty hardcore stuff.

Daniel July 14, 2010 at 12:21 pm

I am wandering if they are cutting their own foot by criticizing Denise “over-simplified” method because she’s trying to replicate Campbell’s method.

Chris Kresser July 14, 2010 at 1:21 pm

I am wandering if they are cutting their own foot by criticizing Denise “over-simplified” method because she’s trying to replicate Campbell’s method.

Exactly.  All Minger is doing is what Campbell should have done – but didn’t – in the first place.  Any criticism of the weakness of drawing conclusions fro epidemiological studies simply strengthens Minger’s critique.

Durianrider July 15, 2010 at 10:45 pm

Gday crew,nice blog.
How come NONE of these pro meat bloggers have any real muscle with all that protein talk? :)
Come and see if ANY of you guys can out bench press/dead lift us at
Here is the website for the doubters.
Mike Arnstein ran a 2:28 marathon this year at Boston. He is the FASTEST runner in the raw food movement today. Long time vegan and now powered by sweet fruit. How come there is no competitive athletes eating this ‘paleo fat diet?’ Please shut me up and show me cos Im sick of seeing cardio and muscle deficient paleo crew trying to debunk the china study that us elite athletes are thriving on.
Can you debunk me with a high fat eating  paleo athlete?
Didnt think so.. :)
Love, peace and banana grease.

Chris Kresser July 16, 2010 at 8:23 am

What a fantastically unscientific way of looking at it. But if it makes you feel better…

khrystyna July 16, 2010 at 8:25 am

@ Durianrider; why are you going around spamming blogs? It’s pathetic. The exact same message was posted on mine today.

Todd S. July 16, 2010 at 8:54 am

Well, first off, paleo eschews chronic cardio (see “marathon running”).  Second, I’d like to see these muscle-bound vegan marathoners myself.  Equating competitive athletics with actual health is such a fallacy to begin with.

Daniel July 16, 2010 at 10:54 am

You guys can just ignore them. Since they can’t reason or argue properly with logic, they are now resorting to spamming all the paleo or health blogs that they can find.

anneh July 24, 2010 at 4:39 pm

I happened upon this website and saw this blog. First of all what a nasty bunch of people you are but perhaps thats from all that meat you are eating! I am 70yo mostly raw vegetarian for the last 20 years. I feel great. I don’t need the China Study, just one look at a slaughter house was enough for me to realize I don’t need to eat the blood and flesh of animals. Have you ever heard of Scott and Helen Nearing? I think they both lived to be in their 90″s and were vegetarians. One can eat meat or not and be healthy as long as diet has plenty of alternative proteins (I don’t personally eat soy) and plenty of fruits and veggies.

Igor August 27, 2010 at 3:17 am

<BLOCKQUOTE>”I hope your teacher isn’t vegan! Or if she is, that she’s open minded.”</BLOCKQUOTE>

If vegans had the capacity to be open-minded, they wouldn’t be vegan.

Igor August 27, 2010 at 3:18 am

“If it were me and I had to choose, I’d go for meat, as far as i know vitamin C is one of the only nutrients you can’t get from meat…”

Some organ meats are high in vitamin C. Personally, I’m perfectly happy being an omnivore and getting my vitamin C from fruits and vegetables.

I’ve experimented with both extremes and arrived at the conclusion that I feel best when there are both plant and animal foods in my diet. Note that Dr. Weston Price’s own findings don’t support the idea that a carnivorous diet is the healthiest (though I’d certainly choose a carnivorous diet over a vegan one).

Igor August 27, 2010 at 3:29 am

“First of all what a nasty bunch of people you are but perhaps thats from all that meat you are eating!”
Hey, I’m sure Hitler would agree with you! He was vegetarian too.

Igor August 27, 2010 at 3:40 am

“I am 70yo mostly raw vegetarian for the last 20 years. I feel great.”
I’d be more impressed if you were 70, in great health, and had been a vegan your entire life.
“I don’t need the China Study, just one look at a slaughter house was enough for me to realize I don’t need to eat the blood and flesh of animals.”
You don’t have to kill animals in order to add animal products to your diet. Animals don’t die when you consume eggs and dairy products taken from humanely-raised animals.
You might also want to note that producing the plants you like to eat (which are themselves living things) involves killing or displacing the wildlife that inhabited the fields they’re grown in.
Any way you dice it, if you want to eat, something is going to have to die.

jaakko September 18, 2010 at 4:07 pm

Louis and Clark were feeding their men 20-30 lbs of meat per day as I recall from reading their reports–this is public record. Could that have been true? Did some soldiers eat that much meat in the 19th century? Maybe that was simply a cow per day for 10 men and as such total weight of an animal or something? Anybody ever eat 20 lbs of meat in one day here?

Susan September 21, 2010 at 7:05 pm

Denise Minger is totally out of her league. She isn’t a scientist at all, just an English major who’s bored and wants to sell you raw animal products. Get someone credible to dispute the China Study, I might actually believe it.

Kathy January 18, 2011 at 1:42 pm

Thanks for the link, and I’ll be sure to read the article as well as Susan’s link to the response.

However, I don’t get where all the anger is coming from. If you want to eat meat, or even lots of meat, you should go ahead. Even doctors not advocating a vegan diet are almost unanimous in what the likely consequences will be. But we all need to make our choices based on what’s most important to us.

As for me, I won’t switch away from the China Diet because it dropped my way too high cholesterol 70 points in a few months. My doctor had insisted I start on cholesterol lowering-drugs immediately, but when I retested she didn’t ask what technique I’d used to achieve such dramatic results – she just said I should keep it up, and that’s just what I plan to do

Chris Kresser January 18, 2011 at 2:11 pm

High cholesterol is not an issue in most cases, and low cholesterol (<150 mg/dL) is actually associated with increased mortality, cognitive decline (including Alzheimer's), depression, low libido and several other problems. The American public has been sold a bill of goods when it comes to saturated fat, cholesterol and heart disease.

It's all covered here:

Kathy January 18, 2011 at 7:57 pm

One reason I didn’t want to go on statins is that it seems like they somehow lower serum cholesterol readings without preventing heart attacks. That’s not to say that they don’t somewhat improve a person’s odds of dying from a heart attack, but not by as much as you’d think. And it makes sense to me that the statins could improve that one statistic without curing the disease – sounds like they treat the symptoms more than the cause of heart disease.

However, it doesn’t mean that high cholesterol readings should be disregarded. It still means that I had a much higher risk of dying of a heart attack. If I didn’t want the statins it’s because I don’t think they help all that much, but more importantly, they have miserable side effects.

The trouble with your reasoning (I watched the video linked above) and with Denise Minger’s (now I’ve read her article) is that neither one of you seems to understand how statistics are used to isolate risk factors. High blood cholesterol readings are just one element of risk; others include family history, smoking, etc. I’ve no doubt that if a person smokes a couple of packs a day going on a low-fat diet isn’t going to help a whole lot, but you can only sort that out from the data on heart disease by using statistics.

Statistics are used to discover patterns. So it could be that for some reason an ethnic group, like the aborigines cited in the video, have very high cholesterol and a low incidence of heart disease. But it may be that schlepping across Australia all day in the hot sun for some reason prevents the problem. The statistics, however, show that *on average* there is a strong connection between high serum cholesterol and heart disease. Therefore, until I too make it part of my daily routine to trek across the desert, eat roasted ‘roo meat, and whatever all else may make aborigines less susceptible to heart attack (and somebody really should do a study and find out what that is), I’ll continue to watch my cholesterol.

But truly, it’s your life, your health, and your decision. You should do what makes you happiest.

Chris Kresser January 18, 2011 at 8:06 pm

The statistics, however, show that *on average* there is a strong connection between high serum cholesterol and heart disease.

This statement is false, as I’ve shown with several articles on this blog with citations from major peer-reviewed journals. There is a very weak correlation between total and LDL cholesterol and heart disease. Most researchers in the field now agree that heart disease is caused by oxidative damage and inflammation – not high total cholesterol levels.

I understand very well how statistics are used to isolate risk factors. That’s exactly my point. When other factors are controlled for, high cholesterol is not a significant risk factor for heart disease. Period.

Kathy January 18, 2011 at 8:59 pm

Could you give me those links?

My answer was based on the video you directed me to view.

Chris Kresser January 19, 2011 at 10:34 am
Kathy January 19, 2011 at 6:48 pm

Thanks for the info.

Your articles are nicely written and so not too difficult to read in spite of the complexity of the topic, but of course the medical links present more of a challenge. But it’s an important topic to me, so I’ll give it some time and attention and keep your blog bookmarked.

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