Registered Dietitian Nutritionist's Book Club Review: The China Study


Registered Dietitian Nutritionist's Book Club Review: The China Study

09, July 2013 7:51 AM

Dietitians Review the China StudyI belong to a book club with registered dietitian nutritionists from the San Jose, California area. We recently gathered to discuss the China Study, by T. Colin Campbell. In spite of the fact that this book is almost 10 years old, it continues to be discussed among consumers and health professionals. 

Here are a few of the main ideas from the book:

  • Chinese villages that consumed the least amount of animal protein had less cancer than the villages that consumed more animal protein.
  • Casein consumption (protein found in milk) promotes cancer in rats.
  • Nutrition must be considered holistically; “Nutrition represents the combined activities of countless food substances. The whole is greater than the sum of its parts.”
  • The How to Eat section of the book recommends a vegan eating pattern.

Our group strongly agreed with a few principles in the book: that eating more whole and unprocessed foods and plant-based foods like fruits, vegetables and beans will improve the health of most Americans. We also agreed that you can’t look at nutrients in isolation, that the overall pattern of food choices and diets over time are what matter.

However, we also observed many holes in Campbell’s arguments. Here are just a few:

  • The China Study is an observational study, in other words it only identifies relationships between different variables. It does not prove that a particular behavior or food choice causes a certain outcome. There are many other variables in the Chinese villages studied that could increase cancer risk that were overlooked—such as industrialization, exposure to chemicals, sugar and refined carbohydrate consumption. These could easily have been the culprits responsible for differences in cancer risk among groups.
  • Although individuals in the counties studied may have been vegan, whole counties did not follow vegan food patterns, so it is difficult to understand how Campbell came up with his conclusions that all animal products should be omitted.
  • Campbell’s experiments with casein were conducted with laboratory rats and mice. His hypothesis that casein behaves the same way in a whole food as when fed in isolation is flawed and violates his own philosophy to look at diets holistically. In milk, casein and whey are paired together. Newer studies suggest that calcium, milk and/or dairy consumption may actually reduce the risk of certain types of cancer, however experts do not agree on the mechanism of any effect.
  • Campbell is very selective in building his bibliography. A more comprehensive review of the  literature reveals scientific research confirming the many health benefits that milk and milk products provide. For this reason the 2010 Dietary Guidelines for Americans recommends that Americans consume three servings of milk and milk products per day.
  • A long term study conducted in Taiwan published in 2014 found that increased dairy consumption meant lower risks of mortality from cardiovascular disease, especially stroke, but found no significant association with the risk of cancer.1

Finally, and perhaps one of the most significant flaws of the book, is that the recommendations are so extreme. Diets that remove entire food groups have the potential for unintended consequences of under-consuming essential nutrients. Bringing food choices into better alignment with the Dietary Guidelines is a preferred approach—specifically eating more under-consumed foods such as vegetables, fruits, low-fat dairy products, whole grains, beans, lean meats and fish while also reducing the consumption of refined grains, fats and sugars. These changes will go a long way toward promoting health.

While we found this book interesting, our club members are sticking with a more balanced approach to nutrition. Just as important, we equipped each other with talking points to use when someone—friend, neighbor, relative, client or colleague—asks questions about the China Study. It is important for consumers to understand the basis for Campbell’s flawed conclusions and the potential negative consequences of following diets that omit whole food groups.


Maureen Bligh, MA, RDN
Director, Resource Development and Marketing


Maureen is a  registered dietitian nutritionist and member of the Academy of Nutrition and Dietetics.



1. Optimal Dairy Intake Is Predicated on Total, Cardiovascular, and Stroke Mortalities in a Taiwanese Cohort, Lin-Yuan Huang MPH, Mark L. Wahlqvist MD, Yi-Chen Huang MPH & Meei-Shyuan Lee DrPH, Journal of the American College of Nutrition, DOI:10.1080/07315724.2013.875328, published 31 July 2014.

Tags: Dietitians Book Review healthy eating patterns Maureen Bligh registered dietitian book club


  • Paul Davis 3 years 82 days ago
    Health is a thing which cannot be purchased from a shop. It is acquired through an active regular process. It includes regular exercise, balanced and nutritional diet.

  • Jonathan 3 years 207 days ago
    The China Study challenges a lot of assumptions on diet held by the western world - The beliefs that animal products are the best source of protein, that we need milk from another mammal to get the proper amount of calcium, and that a plant-based diet is unhealthy or incomplete. I think the burden of proof needs to be shifted to those promoting the consumption of animal products. By proof, I mean, when the countries that promote the consumption of animal products aren't the leaders in obesity, heart disease, diabetes, and cancer, then I will look at incorporating animal products into my diet. The US has been promoting its diet through the education system, tv ads, and other media for 50+ years and we are one of the most unhealthy, obese nations on earth.
    A holistic approach to nutrition also needs to consider the environmental impact of raising animals for human consumption. I also think it's funny that we will prosecute someone for killing a dog or a cat, but eating a hamburger or chicken nuggets is promoted during our Saturday morning cartoons.
    I used to think that avoiding animal products was extreme too. That was 30 lbs, 100+ cholesterol points, and 30+ blood pressure points ago.

    • julia 2 years 239 days ago
      just FYI

      • Alex 1 years 328 days ago
        FYI julia: Denise's statistical methods are not reliable. Me myself being a PhD student of statistics I can say that analyzing such a complex matter only using univariate analyses (and to some extent some undocumented linear multivariate ones) is not suitable for analyzing such a complex matter!
        I would rather trust a group of the best epidemiologists in the US who published their work in peer-reviewed journals than a - indeed very motivated and eager (I mean this in a very positive way!) - person, who is however not well-trained in statistical and epidemiological analyses.

        I agree that the China Study (like every major epidemiological study) has its flaws and that the book is in my opinion over-promoting vegan diet to some extent. But if you want to criticize their work don't use an article based on unscientific approaches!
        Plus: As Jonathan states (and so does Mr. Campbell in his rebuttals to the China Study critics) we should not focus too much on single studies, but look at the holistic picture. And it is quite obvious that obesity, heart attacks, diabetes etc. would not be so much of a problem in the Western world if all of us would eat much less animal products.

  • Chaz Sharpley 3 years 257 days ago
    However you want to dress it up or pick holes in the Study. a plant based whole food diet is better for you. Fact !

  • Milan 3 years 259 days ago
    Dear author. You site is clearly named as "Dairy Council of California". Is this intentional? I hope not! #awkward.

    Might I remind you that the very nature of a hidden agenda is that it should be hidden from plain sight and require a great deal of effort for a person to uncover.

    The consequence of not hiding your agenda is that you divulge upfront to the reader your conflict of interest in publishing a critique of a book that has the potential to drastically affect your bottom line. If you were the ceo of any company you would be fired for such a rookie error.

    For your own sake (and that of others with the same intentions) do a better job of covering up your affiliations and conflicts - you are giving the game away!

  • essayreviews 3 years 310 days ago
    The post is useful and i have make more writing papers

  • Olivia 3 years 350 days ago
    Whats interesting to me is in the top left corner of this website is a banner for the Dairy Council of California. You may not agree with every single word that he says but his ideas would save millions of peoples lives and take away power from corrupt industries who are in the business of making money regardless of the consequences.

  • james Grimes BA, MD, FAAOS, FACS 4 years 172 days ago
    i appreciate the review and the comments. i believe Dr Campbell is creating a controversial point to "wake up" our complacent society. He is huge on assumption of facts not in evidence but does provide a new starting point for those not educated in nutrition. Vegans clearly have the lowest cholesterol levels-a good thing. with B supplementation this can be a "healthy diet. however dairy has been shown to be healthy for bones (Ca+), brain (glutathione), muscles (casein and whey) and its exclusion from a healthy diet is an error. Im talking skim--theres no need for the fat. Unless you live in Fl. Texas or Ariz. etc--There is rarely enough Vit D in your diet.
    Omega -3 is a huge protector of the heart and brain and must be diligently provided in a Vegan diet.
    thank you for the concise review

    • Carlos 4 years 72 days ago
      The way I would encourage people to consume some dairy is in places where they lack proper sources for a balanced plant based diet, or during transitional periods of diet change. Mr Campbell does an excellnt job in presenting the negative affects of dairy on our bones in chapter 10. According to his studies the United States, Australia, and New Zealand has the highest rate of osteoporosis and they are the ones that consume the most dairy in comparison with other countries.
      Casein is not easily digested or not digested, and is not found in human breast milk. Dr. Barnard from Phisicians Committee for Responsible Medicine proves how dairy is the primary cause for type 1 diabetes. The flaws you are pointing out does not fool many of us.

  • Jonathan 4 years 202 days ago
    Thank you for your post however, you are not an academic researcher. Should you have been one and have found any issues with the data, you could have contacted the university and asked them to issues a retraction or amend the report.
    Commenting from a distance really does detract from your authority and professionalism.

  • Michael Lyons 4 years 268 days ago
    Please stop pretending that you are the unbiased source of information that the author Dr Campbell is not. YOU are a lobby group for the consumption of animal products. HE has been one of the most respected researchers and authorities on health and nutrition in the United States for more than 40 years. YOU are by definition a propaganda machine that exists to keep the milk flowing. HE is Professor Emeritus in nutritional biochemistry at Cornell University. Cornell! When he puts his reputation on the line and puts out a book of his beliefs and understandings of a nutritional study that he was directly involved in, I am infinitely more likely to believe his work and conclusions than your nit pickings to intentionally sew seeds of doubt.
    And I challenge you not to pull this post down!

    • Janet Gamache 4 years 96 days ago
      Bravo!. He has no financial interest in promoting his findings. Many who oppose his findings do have a financial interest. He has a big challenge ahead of him, and he realizes there will be plently of opposition. I can only imagine how incredibly low our health care costs would be if people would follow his recommendations by even 50%. But no, lets just spend billions researching new cholesterol and diabetes meds. For a smart country we can be very dumb.

    • stephanie 4 years 253 days ago
      Wow I think you are a bit harsh on your post about the book review, which was just that a review of the book along with references that challenge some of the findings. In fact many people have critiqued the China Study with similar complaints. I was one of the dietitians that reviewed the book, am not affiliated with any industry group, and agree with the review.

  • Marcia Crawford 4 years 270 days ago
    I appreciated your succinct professional summary of the China Study. It has been a few years and I couldn't quite remember its details. I will be sitting on a panel evaluating a high school student's "independent project" on the benefits of a whole food plant-based diet and noticed, as I'm reading her paper, that she references the China Study.I recalled it had so many flaws but none specifically...your paper was a good starting point for me. Also appreciated Lana pointing out that "pooled" blood was evaluated. Thanks for getting me started on my homework.

  • Victoria 4 years 358 days ago
    I don't think that eliminating every animal product is a good idea. There are a lot of aminoacid what the body needs and can't produce them without help. (If you afraid of casein, you can find milk products without casein too) Animal protein is a must have. Maybe Chinese people live heathier in many other way, and eat a lot of others stuffs we don't have. It's not mean that animal products is the only difference... When they said "we are what we eat"... I don't want to be a vegetable.

  • Lana Olsson, MS RD CSG 5 years 355 days ago
    I appreciated this review and want to add that the study "pooled blood". Individual differences would not have been recognized, and there may have been more individual variation in blood results than acknowledged. Also, one incorrect claim in the book is that Burkitt proved that dietary fiber prevents cancer. This was never proven; in fact, it has never been proven in controlled studies. Campbell is loose with facts, strong with anecdote, and what was his son doing as a co-author? Was this a project to put junior through medical school? And there is a cookbook to follow, based on the diet, written by a Campbell! Its a shame that people think that this is a real controlled scientific study; its really an epidemiologic survey.


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