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The China Study
Is Animal Food Really Unhealthy?

By Vin Miller © 2012

This article was originally published on

Few nutritional topics spark as much heated debate as veganism and vegetarianism. A common theme in such debates is the supposed moral, environmental, and health implications of consuming animal food. In response to reading The China Study, I’ve done my best to write a balanced and evidence based review of why I think the claims made against animal food are grossly overstated and why animal food can indeed be part of a health promoting diet.

I fully respect the right of any individual to choose what they eat and I have no interest in denouncing veganism or vegetarianism. In fact, if I believed one of these approaches would improve my health and quality of life, I’d switch in a heartbeat. While I do believe that some people can indeed thrive on a vegan or vegetarian diet, I also believe that this is not the case for everyone. Either way, the primary purpose of this article is to provide support for the role of animal food in a healthful diet. Ultimately, you’ll have to come to your own conclusion, and I hope I can provide you with enough valuable information to help you do so.

With the exception of one small paragraph, this article is strictly about the nutritional aspects of animal food as they relate to health and wellness. Although I find the environmental and moral arguments behind veganism and vegetarianism to be both compelling and interesting, I have no intention of debating them here. If you’re curious to know where I stand, reading The Omnivore’s Dilemma by Michael Pollan will give you a pretty good idea.

By necessity, this is a very long article that touches on many aspects of nutrition, so be prepared!

What The China Study Claims

Based on the name of this book, as well as its publicity, I had high expectations of it being a thorough analysis of a well documented and convincing study supporting the superiority of a vegan diet. It’s not, and it’s even stated in the book that only an overview of the evidence is provided. Nonetheless, some very strong claims are made.

In case you haven’t read the book, the overall message is that the consumption of animal food is the cause of most modern disease and consuming it in any amount whatsoever is harmful. Let’s see if the existing evidence supports the strength of this claim.

Nature and the “Western” Diet

It’s no secret that the modern diet, often referred to as the Western diet, is associated with many of today’s most common and serious health problems. Although it’s emphasized in The China Study that a vegan diet should exclude refined foods, even of plant origin, the book gives the impression that this unhealthy Western diet is any diet containing animal food. To say the Western diet is unhealthy is one thing, but in my opinion, neglecting to consider animal food independently of other aspects of the Western diet is a huge oversight. Doing so comes at the risk of associating poor health with animal food when it may really be caused by other unrelated aspects of the Western diet such as excessive intake of refined foods, exposure to food additives, or suboptimal intake of essential nutrients. As you’ll soon see, this calls into question much of the evidence supposedly implicating animal food as a cause of poor health.

Although many vegans and vegetarians will disagree, it’s well established that the digestive anatomy and physiology of humans is that of an omnivore. This means we’re well adapted to eat both plants and meat. Based on a variety of archaeological evidence, it’s practically undeniable that humans have been eating meat for a very long time.1-4 In fact, a compelling theory called the Expensive Tissue Hypothesis has been proposed to explain how meat eating is likely to have been the driving force behind the significant advancement of the human brain.5,6Even though limitations of archaeological evidence make it difficult to know the extent to which meat was a part of the early human diet, even researchers who argue against the significance of meat in human development acknowledge that the evidence of meat consumption can’t be denied.7,8

As I describe in my article about the basic principles of healthy eating, traditional cultures isolated from modern technology have given us the best and most recent opportunity to look at what a natural human diet is and what kind of influence it has on health. Many researchers have documented the striking absence of chronic disease in these populations. Even more telling is that many of these populations have been observed to succumb to modern diseases once introduced to modern foods. This has led to the classification of many modern illnesses as “diseases of civilization,” or as described in The China Study, “diseases of affluence.”

One of the prominent themes in The China Study that I really appreciate is the emphasis on the intelligence of nature, and in turn, an emphasis on whole foods. Part of this theme is based on the robustness of the traditional cultures described above. However, on several occasions, The China Study gives the impression that the diets of these cultures were primarily plant based. This is far from true.

Although there’s a variety of documentation on the diets and health of traditional cultures, arguably the most compelling and comprehensive source is Nutrition and Physical Degeneration by Weston Price. Contrary to what’s suggested in The China Study, Dr. Price found that these cultures tended to favor animal food, and the cultures with limited access to animal food tended to be less healthy. In agreement with Price’s observations, an evaluation of ethnographic data on 229 hunter-gatherer societies indicated that for 73% of them, more than half of the food consumed was from animal sources.9 In fact, according to Price’s observations, cultures such as the Inuit, North American Indians, and Nilotic tribes of Africa thrived on a diet consisting almost exclusively of animal food.

Modern medicine, and even today’s excessive emphasis on natural supplements, are rightfully criticized in The China Study as a misguided attempt at “mastering nature.” However, based on the information above, it seems to me as if the claim that animal food promotes poor health is also in disagreement with nature.

And while on the topic of nature, if you read The Omnivore’s Dilemma, you might come to realize why monocrop agriculture is not sustainable, that it destroys entire ecosystems, and that it’s one of the most prominent examples of humans manipulating nature for the worse. Yet, The China Study makes no mention of how difficult it would be to follow its recommended vegan diet without relying on this destructive system of farming.

One Size Doesn’t Fit All

Many of the diets of the isolated cultures described above are radically different. While this can be interpreted to mean that humans can thrive despite significant variations in nutritional intake, a more thoughtful explanation suggests that as humans spread across the globe, each culture underwent genetic adaptation in response to the sources of food that were locally available. In support of this, Roger William’s book, Biochemical Individuality, thoroughly illustrates how much anatomical, physiological, and biochemical variation exists among humans, all of which can have a significant influence on nutritional requirements.

Modern knowledge of genetics has confirmed this individuality as well as its significant relation to nutrition.10 In fact, two relatively new fields of nutrition science called nutrigenomics and nutrigenetics are entirely based on this relationship and are believed to have tremendous potential for preventing and treating disease.11-13

Despite the abundant evidence of individuality, The China Study claims that all people should entirely avoid a very broad range of nutritious food that’s deeply rooted in human history.

Does Protein Really Kill Rats?

In The China Study, a series of studies on rats is presented in a way that seems to clearly suggest protein promotes the initiation and progression of cancer. In these studies, rats were provoked to develop cancer through exposure to a toxin called aflatoxin. According to the book, all of the rats consuming a 20% protein diet died while all of the rats consuming 5% protein survived. In addition, the advancement of cancer on a 20% protein intake is said to have been reversed with a 5% protein intake.

A closer look at this research, however, reveals that the results aren’t nearly as compelling or clear cut as the book suggests. In one of the earlier studies done to identify the influence of protein intake on enzyme activity, the 5% protein intake was regarded as a blatant deficiency that severely restricted the physical development of the rats and caused them to have fatty livers.14 In a later study done to assess the influence of protein intake on aflatoxin induced cancer development, the dose of aflatoxin given to the rats on the 5% protein diet had to be reduced by half in order to prevent them from dying. The rats fed the 20% protein diet, however, were still given the full dose.15 Also not disclosed is the observation in another study that rats first fed 20% protein and then 5% protein were much more protected from cancer than rats fed 5% protein all along.16

In The China Study, concerns that the nitrites added to processed meat products may cause cancer are belittled. In regard to the animal studies these concerns are based on, the book states that the dosages of nitrites used would be the equivalent of a human eating a ridiculously large number of bologna sandwiches. Ironically, the dosages of aflatoxin used in the protein studies mentioned above appear to be equally ridiculous. For example, the study that evaluated the variation of protein intake on the carcinogenic effects of aflatoxin used a daily dosage of 250 micrograms per kilogram of rat body weight.16 Based on the FDA’s limit for aflatoxin in food, which is 20 parts per billion,17 you’d need to eat more than 1,000 pounds of maximally contaminated food per day to get the same dosage.

Chris Masterjohn, a PhD student at the University of Connecticut, has provided a more in depth review of this research providing even more reason to be skeptical of it.

Cutting Off Your Nose to Spite Your Face

Detoxification primarily occurs in the liver through two stages of reactions. As described in The China Study, some of the first stage reactions can ironically make a compound more toxic than it was originally, and in turn, cause the DNA damage that leads to cancer. As with most reactions in the body, these detoxification reactions are made possible by enzymes, and enzymes happen to be proteins. As such, the supposed benefit of the low protein intake in the rat studies above is most likely the result of a reduction in enzyme production due to deficient protein intake. Reduced production of detoxification enzymes leads to reduced detoxification of aflatoxin, and in turn, reduced conversion of aflatoxin into a more toxic substance.

Not all detoxification enzymes have the undesirable potential to increase the toxicity of the substances they act on. More importantly, human life is dependent on the actions of thousands of enzymes, and only a portion of them are involved in detoxification. In addition, enzymes aren’t the only important substances in the body that require protein for synthesis. Protein is also required for the synthesis of hormones, neurotransmitters, antibodies, cell membrane receptors and transporters, and is also needed for the maintenance of connective tissue and muscle.18 Therefore, when protein intake doesn’t satisfy the body’s demands, overall health can be negatively affected in many ways. This leads to the question of how much protein is needed to support optimal function.

A variety of genetic, lifestyle, and physiological factors, as well as factors relating to the source of protein itself, can influence intake requirements, all of which further illustrates the significance of individuality. The best method currently available for assessing protein requirements is nitrogen balance, but it has limitations. The basic idea is that if you’re excreting more nitrogen than you consume, then it’s likely that you’re not consuming enough protein to support optimal function. Research has shown that 0.65 grams of protein per kilogram of body weight is sufficient to achieve even nitrogen balance in half the population while 0.83 grams per kilogram of body weight should achieve even balance in the majority of the population.19

It’s stated in The China Study that 5% to 8% of total calories as protein should be adequate to meet the body’s needs. However, even the lower rate of 0.65 grams per kilogram of body weight, which is estimated to only be adequate for half of the population, can easily exceed this amount. And this doesn’t even take into account the increased protein requirements associated with aging physical activity.20

It’s currently not possible to precisely identify human protein requirements, especially on an individual level, and even if it was, manipulating consumption to match a precise amount would be extremely difficult. Therefore, the question that becomes important is if it’s better to error on the side of consuming too much protein or too little.

The body is very efficient at processing and eliminating any protein consumed in excess and can even use it for energy production. However, unlike carbohydrate and fat, unneeded protein can’t be stored for future use and must be excreted instead. Since there’s no reserve to draw from, other than the breakdown of functional body tissue, insufficient protein intake will likely impair physiological function to at least some extent. Based on this, I think the more conservative and healthful approach is to error on the side of consuming more protein rather than less. However, based on how the results of the aflatoxin research are presented in The China Study, you might think you’d be better off risking some impairment of function to protect yourself from cancer just in case you happen to eat 1,000 pounds of contaminated food each day.

Protein and Cancer Growth

The above discussion of enzymes only applies to the initiation of cancer. The China Study also claims that protein fuels cancer growth after it’s been initiated.

For the most part, cancer results from a combination of genetic mutation, reduced capacity for the repair of these mutations, and reduced capacity of the immune system to detect and eliminate affected cells.21 It’s important to realize that many aspects of lifestyle unrelated to protein intake have a significant influence on the presence of these factors. Despite this, The China Study isolates animal protein as if it were the only concern.

In the book, the tendency for protein to increase circulating levels of insulin like growth factor (IGF) is said to be the mechanism through which protein facilitates cancer growth. And, of course, this is said to apply primarily to animal protein. However, regardless of the source of protein, the evidence associating IGF with cancer is far from concrete, and there are many additional factors involved.22

Like animal protein, plant protein has also been shown to increase IGF, 23especially soy.24-26 But the evidence lacks consistency. For example, one study found protein intake to have no significant effect on IGF, even when animal protein was considered separately from plant protein.27 In fact, some researchers claim that protein deficiency decreases IGF as opposed to an excessive intake increasing it.23 Therefore, increases in IGF may simply be the result of reducing protein deficiency.

Some research has specifically isolated dairy protein as having the most influence on IGF.28 Dairy also happened to be the sole source of protein in the rat studies used in The China Study to implicate all animal protein. But this is merely a distraction from the fact that IGF levels are a weak indicator of cancer risk. As I’ll explain later, there are also some other important considerations that need to be made prior to blaming dairy for all of the diseases The China Study claims it to be associated with.

Regardless of whether protein comes from animal or plant sources, the role of IGF in the development of cancer is much more complicated than described in The China Study. While it’s true that IGF promotes cell growth and proliferation and inhibits cell death, all of which facilitate the progression of cancer, there are multiple types of IGF to consider, and their interaction with binding proteins and receptors must be considered as well. In fact, the amount and type of IGF binding proteins and receptors may be equally as important, or even more so, than levels of IGF itself.29,30

An important fact not mentioned in The China Study is that insulin can bind to some of the same receptors as IGF, and in turn, have the same effect of initiating cell growth and proliferation.31,32 Insulin is also associated with the development of cancer independently of IGF, although to a weaker extent.33 In addition, insulin is believed to reduce production of several IGF binding proteins which increases the availability of IGF.32,34 Based on these roles of insulin, carbohydrate intake may also play an important role in facilitating cancer development. Yet, according to The China Study, you can eat all the insulin stimulating potatoes and brown rice you’d like. In fact, a high carbohydrate intake is even recommended as the ideal without any mention of this association between insulin and cancer.

Finally, although this is briefly acknowledged in The China Study, it’s important to realize that IGF is critical to health, particularly in regard to the development and maintenance of bone and muscle.35 In fact, low levels of IGF have even been associated with increased mortality and increased heart disease risk.36 As such, the decline in IGF associated with age has led to the recommendation for older people to increase protein intake to more than twice the amount recommended in The China Study.35,37

Animal Food and Human Health Outcomes

It’s generally understood that vegans and vegetarians tend to follow healthier lifestyle habits than most of the population. When considering findings of reduced mortality in vegetarians and vegans, such as with The Oxford Vegetarian Study,38this makes it difficult to determine if the reduced mortality is a result of avoiding animal food or if it’s a result of other lifestyle habits. Furthermore, such results aren’t consistent. For example, a combined analysis of 5 different vegetarian studies, totaling to over 70,000 people, found no statistically significant difference in overall mortality or mortality from a variety of cancers and other diseases, but did find that vegetarians had a lower mortality from ischemic heart disease.39However, contrary to the claims made in The China Study, vegans had a higher rate of mortality from ischemic heart disease than fish eating vegetarians and lacto-ovo vegetarians.40

A German study that followed more than 1,700 people for 21 years attempted to reduce the influence of lifestyle habits by comparing vegetarians and vegans to health conscious non-vegetarians.41 Despite this effort, the non-vegetarian group still had a smoking rate twice that of the vegetarian and vegan group which shows how difficult it is to eliminate the influence of other lifestyle factors. Nonetheless, no differences were found for overall mortality or for mortality from any specific conditions. Vegans and vegetarians did have reduced mortality from ischemic heart disease, but the difference wasn’t statistically significant. Again, in contrast to the claims made in The China Study, vegans were found to have a higher mortality than lacto-ovo vegetarians, but in this study, vegans only represented a small percentage of the study group.

Providing further illustration of how difficult it is to isolate the impact of animal food on health, the same study found exercise to have a more significant impact on reduced mortality than any other factor, including consumption of animal food. Yet, the Oxford Vegetarian Study mentioned above didn’t take exercise into account at all, and the combined analysis on more than 70,000 people didn’t include enough data to make a fair assessment of the influence that exercise may have had.

Despite this influence of exercise, another study including more than 64,000 people found no statistically significant differences in mortality between vegetarians and non-vegetarians without considering any other lifestyle influences besides smoking and alcohol consumption. Although non-vegetarians had a non-significant increase in mortality from heart disease, vegetarians had a non-significant increase in mortality from stroke.42 Unfortunately, this study didn’t consider vegans separately from vegetarians, and the authors interestingly noted that even a study population of this size is inadequate to draw solid conclusions from.

As you can see, much of this research is focused on the supposed association between meat eating and heart disease. However, the evidence supporting this association is not nearly as strong as conventional wisdom may lead you to believe. In his book, Good Calories, Bad Calories, Gary Taubes has provided an excellent and extremely thorough critical review of the evidence.

Many lifestyle factors are likely to contribute to the development of heart disease and all other “diseases of affluence.” The German study mentioned above demonstrates that a lack of exercise is a significant one, which most people already realize. Stress is a major factor as well, but in regard to diet, consumption of refined foods is arguably the greatest risk factor. And even when whole foods are eaten, nutritional quality, contamination, and cooking methods are additional factors that can still have a significant impact. For example, cooking meat at unnecessarily high temperatures promotes the formation of advanced glycation end products (AGEs) which are implicated in aging as well as the complications of diabetes.43,44 In regard to the associations between meat eating and ischemic heart disease, it’s important to consider that heart disease is one of the most prominent and serious complications of diabetes, and that AGEs play an important role.45

Most of the evidence above is based on mortality which doesn’t always give an accurate representation of quality of life. Unfortunately, it appears that there isn’t much evidence available to determine if this is the case when comparing vegans and vegetarians to non-vegetarians. A study on Seventh-day Adventists found vegetarians to have less chronic disease, a lower reliance on medication, and less need for health care services than non-vegitarians, but they were also found to have a greater prevalence of allergy, and the only other lifestyle factors taken into consideration were smoking, age, and education.46 In contrast, data from the Stanford Five-City Project showed no differences between vegetarians and non-vegetarians for physician visits, sick days, or days spent in the hospital.47

In my opinion, this research comparing the health of vegans and vegetarians to that of non-vegetarians provides, at best, only inconsistent support for the claim that animal food promotes poor health, and even this limited amount of support is likely to be influenced by the tendency for vegans and vegetarians to live healthier lifestyles in general.

The China Study Itself

Expecting The China Study to be a dedicated in depth review of the study itself, I was sorely disappointed. All that’s provided is a brief overview of the study’s conclusions and a couple of pages about its design.

The book makes the study appear to be of grand proportion. For example, a quote from the New York Times referring to the study as the “grand prix of epidemiology” is recited several times, and the subtitle on the front cover refers to it as “the most comprehensive study of nutrition ever conducted.” The Framingham Heart Study, the results of which are in my opinion overemphasized in the book, is a true example of a major study. It’s very easy to find hundreds, if not thousands, of peer reviewed journal publications based on this study. In contrast, I was only able to find a handful of such publications relating to The China Study. Apparently, this “grand prix of epidemiology” didn’t draw much interest from the scientific community.

In the book, there’s a major emphasis on the importance of peer reviewed evidence. However, very little information about the results of The China Study is published in peer reviewed journals. Many of the claims made in the book cite the full publication of the study’s data as a reference, but the data was published in a book rather than in a peer reviewed journal, and the book is now out of print. Although regression analysis wasn’t used, Denise Minger has done an extremely thorough analysis of this data that failed to support many of the claims made in The China Study.

I only found two published articles from The China Study that discussed the potential harm of consuming animal food.48,49 Despite the claim that more than 8,000 statistically significant correlations were made, the entire premise of these articles is based on the questionable notion that animal food promotes disease through elevations in total cholesterol.

There are also three other published articles I found relating to The China Study, but they’re only indirectly related to the general message of the book. The first compares sex hormones in Chinese women to British women and shows Chinese women to have lower estrogen levels.50 This finding is used in the book to support the idea that animal food promotes breast cancer, but very little is mentioned in the article about diet. The second identifies a reduction in esophageal cancer with increased fruit intake and increased blood levels of vitamin C,51 none of which has much relevance to animal food. The third study is almost amusing. Increased intake of salted vegetables and eggs were found to have a statistically significant association with an increase in stomach cancer while increased intake of green vegetables and increased blood levels of selenium and beta-carotene were associated with a reduction.52 However, the study also showed an increased intake of meat to be associated with a reduction in stomach cancer, and to a greater extent than blood levels of beta-carotene!

Does Cholesterol Really Cause Disease?

The generally low cholesterol levels of the Chinese are routinely mentioned in The China Study and are the primary focus of the two primary journal articles mentioned earlier. However, low cholesterol isn’t as favorable as these these articles and the book might lead you to believe.

Stroke is the most common cause of death in China, and about a third of the strokes are caused by hemorrhage. This type of stroke is associated with low cholesterol, and when you consider only rural areas of China, cholesterol tends to decrease while hemorrhagic stroke tends to increase.53 In addition, low cholesterol levels have been associated with violent behaivor54,55 which isn’t surprising when you consider the importance of cholesterol in brain function.56 Also associated with low cholesterol is an increased susceptibility to infection.57 In addition, a study on 12 rural areas of Japan found low cholesterol levels to be associated with increased mortality from cancer, hemorrhagic stroke, and heart failure not associated with heart attack.58 In regard to cancer, however, whether the association with low cholesterol is a cause or an effect is still being debated.59

Over the past couple of decades, a lot of important information regarding cholesterol has surfaced. We now know that the LDL to HDL ratio of cholesterol is a much more important measure of risk than total cholesterol or even LDL cholesterol alone.60 It’s also been established that inflammation plays an important role in the development of atherosclerosis61,62 and that LDL may only be a concern when the lipids it contains are oxidized.63 Finally, it’s becoming clear that LDL particle size and count may be more important than the measure of LDL cholesterol. Small LDL particle size is the primary concern and is closely associated with elevated triglycerides levels.64,65

With the exception of extremely low or high values, the information above strongly suggests that total cholesterol values are of limited use in predicting health risk, especially beyond the scope of heart disease. Furthermore, a certain dietary pattern has been found to promote the high risk profile of elevated triglycerides and small LDL particle size. And it’s not consumption of animal food. In fact, it’s a high carbohydrate and low fat diet66,67 very similar in macronutrient ratios to the recommendations in The China Study. The unfavorable response to this diet was especially noted in individuals with genetic predisposition which further supports the significance of individuality.

A low carbohydrate diet containing a significant amount of animal food, the opposite of what’s recommended in The China Study, has been repeatedly shown to effectively reverse this pattern of elevated triglycerides and small LDL particle size, and it also tends to promote a desirable increase in HDL cholesterol.68-70Although total cholesterol usually increases as well, this is typically in conjunction with an improvement in the overall lipid profile that’s indicative of reduced risk.

Finally, like protein, cholesterol is absolutely necessary for optimal physiological function. In addition to its previously mentioned role in brain function, it’s also the precursor for vitamin D, bile, and a number of hormones, and it’s both a structural and functional component of cell membranes.71 More information about cholesterol, as well as a thorough critical review of the evidence supposedly implicating it in the development of disease, can be found in Uffe Ravnskov’s book,The Cholesterol Myths.

Diseases of Affluence

Although cancer is the primary focal point of The China Study’s claim that animal food promotes disease, many other conditions are considered as well. As previously mentioned, these conditions represent most of the chronic health problems that are prominent today, and because of their strong association with lifestyle factors, the book refers to them as “diseases of affluence.”

One factor believed to play a foundational role in chronic disease is oxidative stress. Without going into detail, oxidative stress is counteracted by antioxidants which is why they’ve become such a popular nutrition topic.

In The China Study, it’s stated that the body doesn’t produce its own antioxidants and that we must therefore obtain them from plant food in order to protect ourselves from disease. Although plant foods certainly do provide a wide variety of valuable nutrients, including antioxidants, the body does indeed produce its own. In fact, effective antioxidant defense is dependent on the synergistic outcome of the body’s innate antioxidant defense system interacting with dietary antioxidants.72 And because much of the body’s innate defense system is dependent on the actions of proteins, many of which are enzymes, protection against disease is dependent on protein intake.

Glutathione is an example of such a protein and is one of the most important antioxidants in regard to health and human function. In addition to its pivotal role as an antioxodant, it’s also of critical importance to detoxification. The synthesis and subsequent effectiveness of glutathione is clearly dependent on protein intake, and more specifically, on the intake of the sulfur containing amino acids methionine and cysteine.73

Dairy and Disease

Although The China Study is strongly biased against all animal food, there’s a particular emphasis on dairy and its association with chronic disease. However, evidence indicates that this association may be the result of a specific protein component that exists in some, but not all, sources of dairy.

Certain breeds of cattle are known to produce a unique milk protein called A1 beta-casein which breaks down into a peptide capable of promoting disease and acting as an opioid. A1 beta-casein is associated with heart disease and type 1 diabetes,74 both of which are discussed in The China Study, and it’s even associated with neurological disorders including autism and schizophrenia.75 In his book, Devil in the Milk, Keith Woodford provides a thorough explanation of the concerns surrounding A1 beta-casein.

Pasteurization and the quality of care for dairy cattle are two other important considerations. However, despite the challenges associated with dairy, the point is that it can still be part of a healthful diet for people willing to make the effort to get it from a quality source. Support for dairy as a component of a healthful diet has been clearly demonstrated by the isolated Swiss cultures and Nilotic tribes of Africa observed by Weston Price.

Type 2 Diabetes

Most chronic disease is associated at some level with poorly regulated blood sugar and insulin levels. With no other disease is this association as critical as it is with type 2 diabetes. As I mentioned earlier, the progression of this disease is very much based on dietary glycemic load.76,77 While the vegan diet recommended in The China Study may provide enough fiber to offset the high carbohydrate load, it’s debatable. And regardless of how much fiber is consumed, it’s likely that the high carbohydrate load will be too much for some people. For example, Australian Aborigines have been shown to have a glucose and insulin response to the common potato that’s 2.5 times greater than that of Caucasians, and this helps to explain why the prevalence of type 2 diabetes in Aborigines is up to 10 times higher.78

It’s well known that ethnicity can be a risk factor for type 2 diabetes. For many ethnicities, the disease is much more prominent in the United States, and some ethnicities are much more prone to this susceptibility than others.79 Like the Australian Aborigines, the ethnicities most prone to type 2 diabetes are likely to have a genetic tendency for a more pronounced glucose and insulin response to carbohydrates. These people probably won’t do well on the high carbohydrate diet recommended in The China Study, even if it’s based on whole food, and even if it’s high in fiber. In contrast, a low carbohydrate diet containing significant amounts of animal food has been shown to be very effective for the treatment and even reversal of type 2 diabetes.80,81

Autoimmune Diseases

One aspect of autoimmune disease that aligns well with the diet promoted by The China Study is that protein is the primary component of food capable of provoking immune activity. However, with the exception of a few intestinal diseases, this won’t happen unless protein passes into circulation prior to being fully digested. For this to occur, the integrity of the intestinal lining must be compromised.

Vegans and vegetarians tend to rely heavily on grain based foods, and as I described in my article about gluten sensitivity, gluten containing grains such as wheat, barley, and rye are notorious for not only increasing intestinal permeability, but also for triggering autoimmune disease.82,83 In fact, gluten is even capable of increasing intestinal permeability in people who aren’t sensitive to it, although to a lesser extent.84 Legumes, which vegans and vegetarians also tend to rely heavily on, contain lectins that can also increase intestinal permeability and promote autoimmune disease.85-87

Finally, there’s the fascinating case of Terry Wahls, MD. After succumbing to a slow decline from multiple sclerosis and eventually being reduced to a wheelchair, she miraculously reversed her disease through a nutritionally dense diet including wild fish and meat from pasture raised animals.88,89 If the claims in The China Study against animal food were correct, Dr. Wahls’ diet should have worsened her condition.

Breast Cancer and Fat

In The China Study, the supposed association between fat intake and breast cancer is used to support the books promotion of a low fat diet. Although two major studies in the United States have failed to show an association between fat intake and breast cancer,90,91 the book regards them as being irrelevant due to the high protein intake in America. However, similar results have been produced in Europe as well.92

As discussed earlier, insulin is an important consideration in regard to cancer, and it’s been shown to promote the growth of cultured breast cancer cells.93 In addition, elevated levels of fasting insulin have been found to be associated with poor prognosis for breast cancer.94 Given the information on insulin and cancer discussed earlier, this is not a surprise, but it’s a reminder that if macronutrient ratios play a role in the development of cancer, a high carbohydrate intake could easily be just as much of a concern, if not more so, than a high intake of protein or fat.

Food Acidity and Bone Health

A common claim made about animal foods is that they promote acidity, and in turn, promote a number of health concerns including bone loss. However, it’s been estimated that our hunter-gatherer ancestors consumed more animal food than plant food9 while, on average, also having an alkaline acid-base status.95Archaeological evidence indicates they had strong and healthy bones as well.96

When projected food intake was considered for each individual hunter-gatherer society, however, up to half of the societies were suggested to have an acidic acid-base status.97 But African societies, believed to provide the truest representation of a natural human diet, have been estimated to maintain an alkaline acid-base status.98 Either way, the influence of diet on acidity and bone health is controversial and has been seriously questioned. Evidence exists indicating that protein intake promotes bone growth rather than bone loss, that the kidneys are more than capable of buffering protein acid load before it can promote bone loss, that animal proteins don’t promote acidity any more so than plant proteins, and that calcium excretion is more a function of calcium absorption than protein intake.99

Despite the claims made against animal food, some studies have shown vegetarians and especially vegans to have a higher occurrence of bone fractures.100-102 Although the increased rate of osteoporosis in the Inuit can be used to counter this evidence, reduced levels of calcium in the Inuit, as indicated by elevated levels of calcitriol, are more likely to promote bone loss than a high intake of animal food.103

Even if dietary acid load does contribute to bone loss, an alternate explanation indicates that it has more to do with sodium, chloride, and potassium than protein.104 Sodium and chloride are the constituents of salt, and a large majority of the salt in the modern diet comes from processed foods.105,106 In contrast, animal foods are naturally low in sodium and chloride. Potassium is abundant in both animal and plant foods, but the reduction of plant food in the modern diet has led to a reduction in potassium intake. The increase in sodium intake increases calcium excretion while the increase in chloride and decrease in potassium reduce the body’s capacity to buffer acidity,104 all of which indicates that processed foods promote acidity much more so than whole animal foods. In addition, plant foods can promote acidity as well. This is especially the case with grains,99 and many vegans and vegetarians rely on grain based foods as a dietary staple.

Animal protein is often argued to promote acidity because of its sulfur containing amino acids methionine and cysteine. However, plant protein can contain just as much, if not more, sulfur.99 And as I mentioned previously, sulfur containing amino acids are needed to support the body’s capacity for detoxification and antioxidant defense.

Another related claim is that increased protein intake increases the risk of kidney stones, but it appears that this only applies to people with pre-existing metabolic disorders predisposing them to stone formation.107 In fact, protein restriction has been shown to be ineffective for reducing stone formation in such people.108

Carbohydrates and Weight Gain

Throughout The China Study, it’s suggested that the high carbohydrate content of the vegan diet is the reason why vegans tend to be lean. However, the book also clearly states that vegans and vegetarians can just as easily be overweight if they consume a lot of refined plant foods. This leaves a major hole in the argument that animal food is the cause of weight gain. If this argument were true, it would be very difficult to explain the excellent weight loss results associated with low carbohydrate diets that include significant amounts of animal food.109-114

The China Study basically claims that a low carbohydrate diet is nothing more than an unhealthy weight loss fad. However, the nutrient dense animal and plant foods that the isolated cultures discussed earlier are known to have thrived on are mostly low in carbohydrates. These cultures obviously weren’t following a fad, but simply consuming the best food available to them. For many of them, a low carbohydrate diet was the norm rather than a fad, but compared to the modern diet, it’s extreme. It’s really the modern diet, however, that’s extreme. We’ve just become accustomed to it. All of this is supported by the estimation that carbohydrate intake among 229 hunter-gatherer societies was within the range of 22% to 40%.9For cultures that relied almost exclusively on animal food, the reliance on carbohydrate was obviously even lower.

Based on the premise of eating the foods our genome is most likely to have adapted to, a hunter-gatherer type of diet is steadily gaining support as a logical way to improve health.115-119 As indicated above, this way of eating tends to be low in carbohydrates compared to the modern diet. However, this is a result of emphasizing nutrient dense whole foods rather than a deliberate attempt to restrict carbohydrate intake. As such, I consider the weight loss often associated with this type of diet to be nothing more than a secondary benefit that indicates the return of healthy metabolic function.

In The China Study, it’s stated that a high carbohydrate diet promotes weight loss because excess carbohydrate is burned as heat rather than stored as fat. This may be true for some of the excess, but certainly not all of it, especially when the excess is significant. For vegans and vegetarians who primarily consume whole foods, a more likely explanation for their leanness is the fact that a significant amount of the carbohydrate in low starch plant food is undigestible and also impairs the digestion and absorption of other carbohydrates.18 In other words, a significant proportion of the carbohydrates a vegan or vegetarian consumes will simply pass right through the gastrointestinal tract, but this isn’t as harmless as it may seem.

For the carbohydrate that does make its way into circulation, there’s no doubt that once muscle and liver glycogen stores are full, which is likely for sedentary or mildly active people, the liver will convert excess carbohydrate into fat through a process called de novo lipogenesis.120-124 This is precisely why a high carbohydrate diet often leads to elevated triglyceride levels.120,121,123,125 Because fat storage is regulated by insulin, the levels of which are increased by carbohydrate consumption, the fat produced from carbohydrate by the liver is very likely to be stored as body fat. In conjunction with this, insulin also inhibits subsequent usage of fat for energy production.126-128 In short, a meal high in digestible carbohydrate promotes fat storage and inhibits its use for energy production. This is why carbohydrate restricted diets, even if very high in fat, are so effective for weight loss and reducing triglyceride levels. They allow the body to more consistently rely on fat for energy production. This may seem paradoxical, but when you consider how these nutrients are metabolized at the biochemical level, it makes perfect sense.

This is not to say that everyone should go out of their way to moderate their intake of sugary fruits and starchy vegetables. As I’ve now mentioned numerous times, individuality is important, and I’ve already noted the variation that exists in glucose, insulin, and triglyceride response as well as in the predisposition to type 2 diabetes. The point is that while a high carbohydrate diet may be appropriate for some people, it’s clearly not appropriate for everyone, and contrary to what’s suggested in The China Study, it’s certainly not a universal solution for weight loss.

Nutrient Insufficiencies

One of the most challenging aspects of following a vegan or vegetarian diet is avoiding nutrient insufficiencies. As is the case for anyone, I think it’s prudent for vegans and vegetarians to complete a basic dietary analysis to identify what nutrients they may need to consume more of. In contrast, The China Study recommends the very loose approach of simply taking a B12 supplement once in a while after three years of avoiding meat. In general, I think the importance of B12 and other important vitamins and minerals is understated. Even though it can be obtained from plant food, riboflavin is another B vitamin that can easily be deficient in the diet of a vegan,129 and this is just one of several examples.

Vegans in particular are prone to insufficient intake of the essential minerals calcium, zinc, and iron.129 Like riboflavin, these nutrients are all available from plant foods, but extra attention is needed to ensure adequate intake. The potential for deficiency is increased by the fact that the grains and legumes so heavily relied on by many vegans and vegetarians contain antinutrients such as phytate and oxalate which bind to and inhibit the absorption of these minerals.130-132

The iron in plant foods is the non-heme form which is absorbed less efficiently than the heme iron in animal foods. Although non-heme iron can be absorbed almost as effectively as heme iron when body stores are low, this can be offset by the amount of phytate common in the vegan and vegetarian diet. Based on this, the USDA recommends that vegans and vegetarians increase their iron intake by 80%.130

In The China Study, measures of hemoglobin levels are used to suggest that the reduced absorption of non-heme iron isn’t a real concern for vegans. However, hemoglobin levels are only affected in late stage iron deficiency and fail to identify a large portion of people who are deficient.133,134 Unfortunately, the book doesn’t provide any information about the other measures that were supposedly made to support its claim, nor is any information provided about dietary factors such as intake of grain and legumes that may have influenced iron status.

Fiber is another dietary factor that can impair absorption of essential nutrients.131In fact, this is the primary reason why iron status is discussed in The China Study. The potential for fiber to impair absorption is trivialized in the book based on the hemoglobin measures described above. Ironically, this is the same mechanism through which fiber can reduce cholesterol levels and keep blood sugar regulated, both of which are touted in the book as benefits of high fiber intake.

Fortunately, if you’re set on following a vegan or vegetarian diet, these absorption issues can be reduced by soaking or fermenting whole grains, legumes, nuts, and seeds prior to eating them. Although far from being a pro-vegan resource,Nourishing Traditions by Sally Fallon provides great information on how and why to do this.

Omega-3 Fatty Acids

Along with vitamin B12, long chain omega-3 fatty acids are easily one of the most significant nutrient concerns for vegans and vegetarians. However, in The China Study, this concern is trivialized. Although there has been a lot of hype surrounding omega-3 fatty acids, there’s no doubt that they’re needed for optimal physiological function, particularly in regard to vision, brain function, and the regulation of inflammation.135-137

Alpha-linolenic acid (ALA), which is the essential omega-3 fatty acid that must be obtained through diet, can be obtained from plant foods. However, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the physiologically important omega-3 fatty acids, and they can only be obtained from animal food or through conversion from ALA. But in humans, the conversion from ALA is inefficient, especially in men.137-139 Furthermore, this conversion relies on zinc135,140 which vegans and vegetarians tend to not consume or absorb enough of. As such, they’re often found to have reduced levels of EPA and DHA, and the reduction tends to be more pronounced in vegans.140-143

Based on the higher omega-6 content of common vegetarian and vegan foods such as vegetable oils, grains, legumes, nuts, and seeds, vegans and vegetarians are also commonly found to have an unfavorably high ratio of omega-6 to omega-3 fatty acids. A growing body of evidence is continuing to implicate this imbalance in the progression of the many chronic diseases associated with inflammation and neurological dysfunction. Even in the absence disease, there’s good reason to believe that an adequate intake of EPA and DHA can help promote optimal cognitive function144 and reduce common mood disturbances such as depression and anxiety.145

Because of the role of the omega-3 fatty acid DHA in visual and brain development, adequate levels are especially important during pregnancy and lactation. The breast milk of vegan and vegetarian mothers has been found to have low levels of DHA, and infants of vegan mothers have been found to have low levels as well.146

The tendency for vegans and vegetarians to be healthier has been used as an argument against the importance of the long chain omega-3 fatty acid DHA.147However, this tendency for better health certainly isn’t universal, especially when other aspects of a healthy lifestyle are considered. Obviously, vegans and vegetarians still succumb to all of the health issues associated with reduced and imbalanced levels of omega-3 fatty acids. Even if this is the case to a lesser extent, it doesn’t mean that an improvement in omega-3 status couldn’t still promote an improvement in overall health.

Seafood is the best source of EPA and DHA. For the vegan or vegetarian concerned about omega-3 fatty acid intake, the best option would be to make an exception for seafood. If this is unfavorable, which I assume it will be for some people, these omega-3 fatty acids can also be obtained from marine algaes in whole or supplement form.140

Nutritional Reductionism

A common theme throughout The China Study, and one I appreciate, is the problematic nature of placing too much emphasis on individual nutrients. This is also a major theme in Michael Pollan’s great book, In Defense of Food. One common but misguided tendency that results from this perspective is the attempt to resolve health complaints with supplements while neglecting to address fundamental inadequacies in the diet. Another is the belief that fortifying or enhancing processed foods with essential nutrients makes them part of a healthful diet.

These problems, however, don’t necessarily mean that a narrow focus on individual nutrients is always bad. In fact, it’s often necessary in research to prevent additional variables from having an influence. It also helps us to understand the roles and importance of certain nutrients which ultimately helps us make more informed dietary choices.

One could easily use reductionism as an argument against many of the points I made in this article. In fact, this is the approach used in The China Study to trivialize the importance of essential fatty acids as well as a number of other concerns relating to vegan and vegetarian diets. Such concerns are disregarded as nothing more than excessive details that cause confusion. As confusing as the science of nutrition can be, we’re obviously much better off when we consider it than when we don’t. It may require you to think and to come to your own conclusions, but in my opinion, this is something many of us should be doing more of anyway, and not just in regard to nutrition and health.

While the criticism of reductionism provides great insight into many of the major problems associated with the modern diet, it can also be counterproductive when taken too far. To argue for or against any claim, we must consider details, but if we disregard these details to avoid reductionism, we’ll never be able to come to an informed conclusion. For example, the entire premise of The China Study can be disregarded based on the simple fact that the isolated focus on animal food is a case of reductionism that fails to consider diet as a whole, but what would this accomplish?


It was never my intention to criticize vegan or vegetarian diets or the people who follow them. Although I do believe these diets pose a number of challenges, there’s no question that we each have the right to choose how we eat, and I also believe that with dedication, a vegan or vegetarian diet can adequately support excellent health for many people.

There are really only two points I wanted to make with this article. The first is that animal food can indeed be part of a diet that promotes excellent health. The overall message of The China Study is that consumption of animal food, even in the smallest amounts, is nothing but bad. I think the information I’ve presented in this article makes it abundantly clear that this claim is not supported nearly as well as the book suggests. In fact, it’s debatable if such a strong claim is even supported at all.

The second point is the significance of individuality. Whether it be a low carbohydrate diet including plenty of animal food, a vegan diet excluding all animal food, or any variation in between, there are cases of both success and failure associated with all of them. While some dietary choices may present more concern than others, it’s undeniable that we each respond to food in a different manner and have unique requirements. In fact, even the DRI system established by the USDA, which is the foundation of nutritional evaluation, is based on this principle. The Recommended Dietary Allowance (RDA) is calculated based on the Estimated Average Requirement (EAR) which is the amount of a particular nutrient believed to meet the needs of 50% of the population. Even the RDA, which is projected to meet the needs of 98% of the population, is not adequate for everyone.133Similarly, the fact that some people can thrive on a vegan or vegetarian diet certainly doesn’t mean that everyone can.

Vin Miller is a health advocate and creator of RageWellness. You can reach his website at and the original article at Special thanks to Vin for allowing HumanaNatura to re-publish this thoughtful article.


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