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Book Review: Good Calories, Bad Calories

by | Jan 6, 2010

good calories bad calories cover

Good nutrition advice is not easy to come by, but we have to start somewhere.

It is probably obvious to most of you that public education on diet and health is vastly inadequate. We learn virtually nothing in school, and what they do manage to pass on is less-than-useful or just simply wrong.

Advice changes from year to year, sometimes drastically.

Everyone claims to be a nutrition expert, but very few people are actually trained enough to understand the complex and sometimes contradictory findings made by scientists in the field.

But although there are few sources you can trust, some books do stand out as valuable for understanding the basics of health and nutrition. Good Calories, Bad Calories by Gary Taubes is by far the most thorough I’ve found, and is essential reading for anyone who has an honest desire or need to understand how diet impacts health.

Taubes makes a detailed and compelling case that refined carbohydrates are the primary cause of weight gain and “diseases of civilization” such as heart disease, hypertension and diabetes. In my view, any honest and opened-minded scientist would have to largely agree with him.

GradeAGood Calories, Bad Calories is 468 pages and contains over 100 additional pages of references, which is nothing short of astonishing. Taubes explores every aspect of the science behind weight control including the most puzzling and frequently ignored evidence, which he argues is the most important.

Scientists depend on statistics, but have a tendency to ignore outliers which can make data difficult to interpret. Taubes instead points to these anomalies as evidence of flawed or incomplete theories, and suggests that isolated populations (outliers) such as the Inuit and Maasai tribes actually help the most in explaining diet-related health patterns.

Taubes argues extensively (sometimes a bit heavy-handedly) against lazy scientific thinking that relies too heavily on conventional wisdom and the appeal of simple ideas. This point is a major theme of the book and is exemplified by chapter 2, “The Inadequacy of Lesser Evidence.” He goes to great lengths to explain how our tendency not to scrutinize established theories breeds scientific closed-mindedness and can perpetuate flawed ideas for decades.

Ultimately Taubes uses this argument to directly challenge one of the most prevailing health theories in Western civilization: the cholesterol–heart disease hypothesis.

Taubes provides hundreds of pages of data and analysis to make the point that total cholesterol is not a good predictor of heart disease or mortality. Specifically LDL cholesterol is only loosely associated with heart disease (at best) and HDL cholesterol (the higher the better) is a much better indication of vascular health. (Read more: How To Raise Your HDL Cholesterol)

Once this basic premise of health is thrown into question, Taubes carries you through the logic of why a high-fat diet cannot be responsible for heart disease (remember the Inuit) and instead presents why quickly digesting carbohydrates are the most likely culprit.

Fundamental to this argument is the tie between heart disease and type 2 diabetes (along with other “disease of civilization” or metabolic syndrome), which are both inextricably linked to carbohydrate consumption. The logical conclusion from his analysis is that all calories are not created equal, despite what we are told daily by the nutrition community and the media. Understanding the logic behind this argument can fundamentally change the way you approach food and is the best reason to read Good Calories, Bad Calories.

Despite this, Taubes’ book is rarely the first I recommend to people who come to me for nutrition advice. There are a few reasons for this, but the main one is that Good Calories, Bad Calories is not an easy read. I’m a scientist and nutrition data junkie, and this book still took me months to get through (I normally read 4-5 per month). For your average eater, a book like this can quickly become a burden and many people will give up before getting to the good part (about half way through it starts to pick up substantially).

In the first few chapters I was put off by the book’s almost defensive tone. A large part of the first section is dedicated to discrediting the character of a pioneering scientist and father of the dietary fat–heart disease hypothesis, Ancel Keyes. Presumably this depiction is intended as background so the reader understands why Keyes so aggressively disseminates a theory that isn’t fully proven. However, I found the extensive character attack unbecoming for a book espousing science and experimental data, and it seemed unnecessary.

Another reason I resist recommending this book as nutrition advice is that it doesn’t offer much in the way of actual advice. Taubes certainly provides compelling evidence that carbohydrates are best avoided and that dietary fat is safer than presumed, but how much of this knowledge can be translated directly to daily life isn’t clear. For practical advice, I prefer Michael Pollan’s In Defense of Food (based largely on the same data).

Scientifically I also have a few issues with Good Calories, Bad Calories. First, the vast majority of the experiments Taubes cites are early diet studies, many from the turn of the century. While these experiments are clearly important, most of them do not reflect long-term (more than 6 months), real life dietary habits. These studies were also almost entirely dependent upon self-reported dietary intake, which is known to be quite inaccurate.

Much of Taubes’ argument about calories is based on the premise that overweight people eat the same amount or less than lean people. This was once thought to be the case, but recently more thorough studies have shown that overweight and obese people do indeed eat more. The problem is that all people (both lean and obese) are poor judges of food intake, and this discrepancy is largest with the biggest meals consumed. This means people who eat the largest meals tend to underestimate their calories the most, and meal size is correlated with body weight.

This does not mean that I disagree entirely with Taubes’ theory on calories. I was more convinced by the rodent studies he presented where dietary intake was tightly controlled and measured. In some of these, obese animals did seem to eat the same or less than leaner animals (always be careful reading too much into rodent data). Interestingly, the difference in body weight was always accounted for by differences in physical activity, a point I find extremely fascinating.

Since mice obviously do not exercise for the purpose of fitting into skinny jeans, the activity differences observed between obese and lean mice is clearly a fundamental change in metabolism (balance of energy use and intake). If this is true and can be manipulated by diet composition rather than voluntary exercise (which causes overeating), as Taubes suggests, this has tremendous implications for treating obesity and disease through selective diets and metabolic manipulation. I think Taubes makes a strong case for this and it is a point that should be taken very seriously by the scientific community.

My final issue with the book is how the data was presented to seemingly support a diet of almost entirely meat and animal products. While Taubes does not come out directly and say “the healthiest diet is 100% meat,” people without a knack for thinking like a scientist can easily come away with this impression (I’ve seen it).

[note: My guess is this is why I get so many emails from people asking me to help them choose between this book and The China Study (click for review), which both come off as scientific but also as diametric opposites. Personally I do not see a huge conflict between the data presented in the two books, but see it as an issue of interpretation. On this point, my vote goes to Taubes for his superior logic and reasoning.]

My own interpretation of the data presented in this book, however, is not that all carbohydrates are the enemy, but rather that quickly digesting (processed) carbs are the real problem. Taubes never refutes this as far as I could tell, though he does glorify meat-based diets (again remember the Inuit) as the best for optimal nutrition, while belittling the case for a balanced diet. But there is an important difference between saying “meat is good” and “all plants are bad,” which he never directly asserts.

Yet many people still take from this book that a protein and fat-based diet is the healthiest option, which is a flawed interpretation. Vegan diets with no animal products whatsoever can be perfectly healthy, as can largely meat-based diets, and that both are perfectly legitimate is a point that is easily forgotten by the end of Good Calories, Bad Calories.

But while the value of eating plants is an important question for the practical implications of Taubes’ theory of calories, it is not fundamental it.

Summary

Taubes’ meticulous research and overly-thorough analysis represent both the strengths and weaknesses of this book. His case for the role of metabolism in health and obesity, and against the dogma that “a calorie is a calorie” is a tremendous contribution to the field of nutrition. However, this depth can make Good Calories, Bad Calories cumbersome and difficult to read.

Final Grade: A

What did you think of Good Calories, Bad Calories?


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Quick Fix: Summer Squash, Peppers & Zürsun Heirloom Beans Recipe

by | Oct 21, 2009
Squash, Peppers and Beans

Squash, Peppers and Beans

A few weeks ago I was contacted by someone from Zürsun Idaho Heirloom Beans and was immediately intrigued. I’m regularly approached with requests to review (aka endorse) products and my answer is almost always the same,

“Thanks, but no thanks.”

Companies that contact health bloggers like me are usually selling energy bars, supplements or some other kind of “functional food”–the exact same junk I’m always reminding you not to bother with. Not only do I think this stuff is useless, I actually consider it dangerous and contrary to your health goals.

If it has a health claim on it, you probably shouldn’t be eating it.

But heirloom beans and lentils are not junk food, and I jumped at the opportunity to sample what Zürsun had to offer. A few days later I received a shipment of assorted beans and lentils and have been thoroughly enjoying them ever since.

Heirloom beans are special, and if you’ve never tried them I highly recommend you do. The flavor and texture of high-quality beans does not compare to the cans you get at the grocery store.

To prepare, I soak my beans overnight then cook them 10-12 minutes in the pressure cooker (this is the one I use) with a bouillon cube–preferably beef flavored, but any will do. A big batch of beans can last weeks if you freeze it in 2 or 3 portions.

What has been the most surprising to me is how fantastic I’ve felt since I’ve started eating legumes nearly everyday. Though beans are famous for causing digestive problems, I have not had even the slightest issue with dried heirloom beans. I’ve read that this is probably due to the overnight soak, but I haven’t seen the science to back this claim.

My energy levels have been especially high (even for me!) and the past few weeks have been some of the best times I’ve ever spent in the gym. Oddly, I also weigh less than I have in my adult life (I was so surprised I double checked the calibration on the scale at the gym).

I don’t know if I can attribute all this amazingness to the beans, but I can tell you they have made for some tasty and satisfying meals.

I’m happy 🙂

My favorite bean so far has been the fawn bean. Zürsun calls these “rice beans,” probably because they are long and slender. Fawn beans are very versatile and I used them in salads, stir fries and on their own.

For me the simplest way to eat beans is to toss them in a pan at the last minute when cooking my usual vegetables. This makes for a simple, delicious, one-pan meal perfect for a busy week night.

In this recipe I used some of the season’s last zephyr squash and some Basque frying peppers. It might have been better with cilantro, but I only had basil so that’s what I used. It turned out delicious.

Summer Squash, Peppers & Zürsun Heirloom Beans

Serves 1 main course or 2 sides. Total time ~15 minutes.

Ingredients:

Zursun Beans & Lentils

Zürsun Beans & Lentils

  • 1 cup cooked Zürsun fawn beans
  • 2 medium zephyr squash or zucchini, cut in half and into 1/2 in. slices
  • 1-2 Basque frying peppers or 1/2 cup chopped bell pepper
  • 1 cippolini onion or shallot, diced
  • 1 clove garlic, minced
  • Chopped basil or cilantro

Heat a pan on medium flame and add 1 tbsp olive oil. Add onions and peppers and cook until starting to brown, about 5 minutes.

Add squash, salt and pepper to taste. Cook until the squash turns bright colored, has stopped sweating and is starting to gently brown on the edges, 4-5 minutes.

When the squash is nearly done, clear space in the center of the pan and add the garlic in a single layer. When it becomes fragrant (about 30 seconds), mix it in with the rest of the vegetables.

Add the beans to the pan and mix. Continue to cook until the beans are heated through. Do not allow the beans to sit long enough to stick to the bottom of the pan.

Toss in herbs and serve immediately.

This dish is great on its own or as an accompaniment to fish or light protein. You can also use also use this same basic recipe to cook any standard vegetables with beans or lentils. I made it one day with beet greens and it was awesome.

Do you ever cook beans together with vegetables?

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Top 10 Food and Health Podcasts

by | Oct 14, 2009

podcastFor busy urbanites, audio resources are priceless. Here I’ve ranked the 10 Food and Health podcasts I can’t live without.

The amount of time I spend each day commuting, doing lab work, shopping, cooking, waiting for people and avoiding pointless conversations would be unbearably painful without my trusty headphones. Now instead of wasting all this time, I use it to learn about my favorite things: food and health.

Podcasts are wonderful audio resources, perfect for keeping up on foodie news and finding inspiration for new culinary adventures. (I’m also addicted to audiobooks from Audible.)

Great podcasts are defined by the personality of their host. Foodies are passionate people and the best hosts effortlessly broadcast their love of everything culinary through a medium that transmits neither taste nor smell. Amazing when you think about it.

These podcasts are truly inspiring and always leave me hungry for more.

ST_symbol_25x25 Tip! Set your iTunes settings to play back at 2x speed to cut your listening time in half. Videos only play at standard speed.

Top 10 Food and Health Podcasts

Times listed are at standard play speed

1. KCRW’s Good Food

(1 hour)

KCRW Santa Monica has an amazing weekly podcast exploring all things food. Host Evan Kleiman shares stories and food narratives from around the country, while Pulitzer Prize winning food critic Jonathan Gold explores the vibrant LA food scene. I especially like Laura Avery’s Market Report from the Santa Monica farmers market, a glimpse into what ingredients LA chefs are excited about through the seasons.

2. Gourmet’s Diary of a Foodie

(30 minutes video)

Though we were all devastated by the news of Gourmets closing, it hit me extra hard when I thought we might be losing their brilliant podcast as well. Luckily, Diary of a Foodie is scheduled to stay. If you love to travel and explore international cooking you will be instantly hooked on this utterly brilliant glimpse into native cuisines around the globe. But be warned, this podcast is a video and can make short time of your player’s battery.

3. APM: The Splendid Table

(50 minutes)

Lynne Rossetto Kasper is an enchanting radio personality with a seemingly limitless knowledge and appreciation for food. Some of the most fascinating bits of information come from her answering callers’ questions about interesting dishes they’ve discovered or what to do with a special ingredient.

4. Nutrition Diva

(5-10 minutes)

I have yet to find a nutrition expert on the internet I trust more than Monica Reinagel, the Nutrition Diva. This quick and informative podcast is a fun and convenient supplement to her spectacular Nutrition Data blog.

5. The Restaurant Guys

(40 minutes)

Smart and irreverent, Mark Pascal and Francis Schott, tackle food issues big and small. The New Jersey based radio team has been described as “Car Talk for food.”

6. Munchcast

(30-60 minutes)

Though far from healthy, this junk food based podcast with San Francisco radio personality Cammy Blackstone and geek foodie Leo Laporte is both hilarious and informative, and definitely worth working into your listening schedule. Haven’t you ever wondered who invented the Jello shot?

7. The Minimalist

(3-5 minutes video)

I love Mark Bittman (New York Times) for many reasons, not the least of which is his ability to bridge the gap between culinary decadence and mostly-healthy delicacies. These short videos are perfect mini cooking lessons for urbanites on the go.

8. NPR: Food Podcast

(5-40 minutes)

National Public Radio has a knack for putting together quality radio shows, and NPR Food is no exception. Food stories from around the nation are interesting, informative and inspiring.

9. Epicurious

(3 minutes video)

Guest chefs and mixologists share their quick lessons on how to cook, shop, mix drinks and live like a foodie.

10. NPR: Your Health

(15-30 minutes)

Not exclusively food-related, but filled with useful health news and information.

What food and health podcasts do you love?

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Food, Inc. Shows How Your Food Choices Can Change the World

by | Jun 15, 2009

foodincIt is fair to say I’m a bit obsessed with food.

To me this is perfectly natural, because few things are as important or bring as much pleasure to my life. I eat at least three times a day, and each meal is an opportunity to revel in the bounty of nature and ensure my health for (5? 6? 7?) decades. What confuses me is why more people aren’t so obsessed with food.

I admit that my personal history with food is long and intimate, but at this stage in my life what makes me passionate about eating well is what I know about the impact of my daily meal choices on myself and the world.

Food is the cause of almost every modern disease, and is in the midst of creating some new ones.

Food is destroying the planet faster than anything in human history.

Food threatens our national security and the health of the global economy.

But food is not all doom and gloom, nor should it be. Real food is a celebration of life and brings people together. Real food is an art. Real food is health.

My personal favorite reason to eat the way I do is that real food tastes amazing, nothing like the processed junk most of us grew up eating.

When it comes down to it, real food makes my life better.

If you are like most people I talk to, this all sounds wonderful but is a little too abstract to move you to action. Sure we would all love to make it to the farmers market this weekend, but when Saturday rolls around there are 1,001 excuses not to go. Right?

In my world though, the earth has to be collapsing for me to miss my market trip and even then I’ll probably find another one. I don’t see it as a choice. For me my weekly trip to the farmers market determines how well I will eat for the entire week. I know it is possible to eat healthy without going but it won’t taste nearly as good, is less exciting and more expensive. These things make it harder to eat healthy at all, and that is not okay.

My resolve comes from the knowledge that there is no more important decision I can make each week than where I buy my food.

If you aren’t convinced yet, you should definitely see the new film Food, Inc.

Food, Inc. will help you see food as a priority, a solution to and not the cause of our problems. It is a journey through our modern food system, how it works and the tremendous impact it has on our lives.

One of my favorite quotes comes early in the film as Michael Pollan, one of the film’s narrators and hero of the “real food” movement, describes the disappearance of seasonal produce at the grocery store. His quintessential example is the perfectly red, perfectly round tomatoes that can be found year-round in American supermarkets.

“Although it looks like a tomato, it is a notional tomato. It’s the idea of a tomato.”

This is because, as you all know by now, real tomatoes only exist in the summer.

Food, Inc. gives you an intimate look at where these artificial foods come from and the how they affect our lives. It also explores the government policies that have encouraged and protected these practices at the expense of good food and health.

If you have read (and you should) Michael Pollan’s landmark book, The Omnivore’s Dilemma, you will find many similarities in this film. However, Food, Inc. preferentially emphasizes the results of our food system and the toll it takes on our health and economy.

Central to Food, Inc. are the stories of people who were the honest victims of our toxic system. These stories are heartbreaking and will make you think twice the next time you are tempted to order a Quarter Pounder.

Importantly, Food, Inc. offers more than just criticism, it also gives us a solution: vote with your fork.

The message of the movie is almost entirely aligned with the philosophy of this blog: shop at farmers markets, cook your own meals, pass on the processed foods.

These simple acts are enough to change the way the system works, because ultimately consumers decide what is produced. If you stop buying it, they will stop selling it and find another way to satisfy your needs. We are the ones with the real power.

It is completely possible to opt out of our current food system by reducing and even eliminating processed, industrial foods from your diet. Amazingly, once you start on this journey you learn that you don’t actually give anything up in the process, but in fact regain a world of lost flavors and the joys of eating real food.

If you like Food, Inc. and want to know more there are numerous resources:

Have you seen Food, Inc. yet? What did you think?

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What’s For Dinner? Ask Your iPhone

by | May 11, 2009

locavore-app

Healthy eating can sometimes seem like a daunting task. You know you should be eating local, seasonal ingredients and lots of vegetables, but how do you know what to get? Once you have it, how do you cook it?

Enter iPhone. I can confidently say that my iPhone has made my life more convenient than any single electronic device since my first laptop. Sure plain cell phones are great, but honestly text messages annoy me more than they improve my quality of life.

An iPhone offers so much more than calls and texts, especially when you delve into the world of applications or “apps.” Apps are third party software programs that can be downloaded to your phone to perform specific (usually awesome) functions. Apps are what set iPhone apart from all other phones. Today I’m going to tell you about two apps in particular–Locavore and Epicurious–that can be used together to help you decide what to do for dinner.

Locavore ($3) is an app that finds all the farmers markets near you along with the produce in season in your area. It does this according to your physical location on earth using the built in iPhone GPS. Isn’t that brilliant? (Yes, I’m totally jealous that I didn’t make this app myself.)

I get questions every week about how to find a good farmers market in a given area. Honestly I had never had an answer much better than “Google it.” With Locavore’s “Markets” feature, you get a list of farmers markets in your area ranked by their distance to you. If you click on the market you want to visit it gives you all the essential information, such as what time of year it runs and its hours of operation. Locavore also allows you to browse by region (U.S. only) or specific food to find seasonal availability.

The farmers market information used by Locavore is from a website called Local Harvest. Even if you do not have an iPhone Local Harvest is a fantastic resource for finding farms, markets and CSAs near you. When you have located the market you would like to go to be sure to check near the bottom of the information paragraph for the last time the site was updated. In my experience farmers are not particularly tech savvy and often forget to update their websites. I always recommend calling before you go, just to confirm the market still exists and hasn’t changed its hours.

In the Locavore app, once you have found your market you can check the “In Season” feature. This will give you a list of items that are supposed to be in season in your area (information gathered from the Natural Resources Defense Council website).

Unfortunately, the list is more an approximation of reality than a true market browse through. I’ve been following my own market on Locavore since I first downloaded the app several weeks ago, and I’d say it is about 90% accurate. Definitely I have seen the list include some items that are not available and I would not expect to be available this time of year in my area (e.g. boysenberries). Also, my market is large and specialized enough that there are always unique finds that the NRDC does not know about.

You can, however, get an idea of items that should be easy to find. To avoid hunting down ingredients that may not be available, be sure to check the pie graph icons to the left of each item. These represent the number of months left until that specific vegetable or fruit goes out of season (again, this is approximate and depends substantially on the weather). If there is less than one month left, you probably shouldn’t plan your entire meal around that one ingredient since there is a good chance it won’t be there. If the pie is full (green), that means you can find the item year round in your area. In general, the Locavore produce list is fairly thorough and accurate and can be used to create a seasonal dinner menu.

One of the coolest features of Locavore is its connection to the recipe website Epicurious. If you find a seasonal ingredient you would like to try but need ideas on how to prepare it, simply click the item and a page will open to show you all the states it is available along with the its Wikipedia listing (in case you aren’t sure exactly what it is) and a link to Epicurious. If you follow the Epicurious link it takes you to a list of recipes using your ingredient. Click the dish that sounds the most delicious and get a complete recipe and shepicurious-appopping list. Use this to make sure you get all the ingredients you need at the market.

Conveniently Epicurious has its own app (free) if you already know the ingredient you want to use and do not need to find a farmers market. You can search by meal, event or specific ingredient, and create shopping lists for your favorite recipes. As you can imagine, I’m particularly fond of the “Healthy Lunches” option. Another bonus is the Epicurious app contains the entire contents of the Big Yellow Cookbook by Gourmet.

Overall Locavore and Epicurious are both fantastic apps for anyone interested in cooking local, seasonal meals. Together they are a powerful resource for finding ingredients and cooking the best seasonal meals possible.

Have you used either the Locavore or Epicurious iPhone apps?

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Summer Tomato Book Review: The China Study

by | May 6, 2009

the-china-studyIn the first official book review at Summer Tomato I examine Dr. Colin Campbell’s The China Study. Several readers have asked about this book since I wrote last week about who you can trust for diet advice, so I think it is a perfect subject for my first review.

The China Study was published in 2006 and branded itself as “The most comprehensive study of nutrition ever conducted.” It is written by Colin Campbell, PhD, a highly accomplished scientist that has worked for decades in the fields of nutrition and disease research. It was co-authored by his own son, Thomas Campbell.

Clearly both these men care deeply about health and nutrition and believe the information they provide can relieve a huge proportion of the world’s suffering. Their sincerity is apparent and, given the current dietary trends in Western culture, I am sure their recommendations would help the vast majority of people become healthier. Yet there are several logical flaws in The China Study that prevent me from giving it an A grade. Overall, however, The China Study offers a compelling view of nutrition and health from one of the leaders in the field and is worth reading.

gradebMy biggest disappointment with The China Study is how little of the book is devoted to the study itself–a large ecological-style research project, conducted by Dr. Campbell and his colleagues, examining the relationship between diet and health in rural China. As a scientist, I am a bit of a data junkie and always most impressed by strong statistics and rigorous logic.

UPDATE: [Denis Minger has taken it upon herself to re-analyzed the data from The China Study, and makes it pretty clear that Campbell vastly overstates his case. I agree with everything Denise writes, and every educated person who cares about these findings should read her analysis.]

Only a single chapter in the book is specifically dedicated to the work done in China (Chapter 4), and it conveys little new information. Most of Chapter 4 is spent reiterating the links between diet and chronic diseases such as cancer, heart disease and diabetes, discoveries that did not surprise me in the least. The two most important novel findings reported in the China study are discussed below.

The China Study is divided into four major sections. The first section describes Dr. Campbell’s original research and is the part I enjoyed most. It begins by discussing his work in the Philippines where he discovered a tight link between animal protein consumption and a specific kind of liver cancer induced by aflatoxin, a dangerous poison that is sometimes found in contaminated peanuts. He follows up this work with extensive studies in his U.S. laboratory elucidating the mechanisms of cancer promotion by the main protein found in cow’s milk, casein. Dr. Campbell makes a compelling case that this protein can influence cancer development in the presence of an extremely potent carcinogen, and his work should be taken very seriously in this regard. However,  he goes on to argue that this finding can be generalized to support the view that all animal proteins promote cancer and he recommends they be completely eliminated from your diet.

This was a logical leap I was not able to make after reading through his evidence. What about the benefits of fish for the heart and brain?

As mentioned above, the final chapter of the first section describes the China study. According to the book, the Chinese consume much less fat and protein than Americans, but more fiber and iron. Nothing too surprising there. It also reports that rural Chinese have substantially less heart disease, cancer and diabetes than Americans, but in more urban areas where diets follow more Western patterns the incidences of these diseases are higher. Again, not surprising.

Two pieces of information out of the China study did pique my interest. The first is that participants in the China study reportedly consume more, not fewer calories than Westerners. This was true even for Chinese office workers who consume 30% more calories but weigh 20% less than average Americans.

Part of this difference was accounted for by differences in physical activity (even office workers in China get more exercise than we do), but not all of it. Data in the China study suggests that Chinese have a more active metabolism and burn more calories than typical Americans. Dr. Campbell argues that this is because they eat less animal protein and fat, but the China study is observational (non-intervention) and cannot prove cause and effect.

Isn’t it possible that the Chinese metabolize their food differently because it is less processed than Western food (no matter the source)? From the literature I have read, this seems like a more plausible explanation. But regardless of the reason, the data from China suggests that all calories are not created equal in terms of both health and metabolism. This argues against the dogma offered by most nutrition experts that a calorie is a calorie.

The other surprising finding from the China study is the degree to which blood cholesterol levels predict heart disease. Although most Americans assume there is some connection between blood cholesterol and heart disease, there is still debate regarding how strong this connection is. Data from the China study suggests lower total cholesterol levels decrease risk of heart disease and death. Moreover, the data suggests that optimal cholesterol levels are far below what are recommended by Western medicine (150 mg/dL to 180 mg/dL). The healthiest Chinese had total cholesterol levels from 170 mg/dL to as low as 90 mg/dL. In the China study, lower cholesterol levels were also linked to decreased rates of several cancers. However, some scientists question the validity of this data.

The second section of the book is titled “Diseases of Affluence” and discusses the role of nutrition in the various chronic diseases that plague Western culture. In the third section Dr. Campbell offers his ideal (i.e. vegan) diet. If you are not familiar with the literature on diet and nutrition Dr. Campbell does a decent job going over it, particularly with respect to the role of dairy in prostate cancer, type 1 diabetes and multiple sclerosis. However, most of this information is available in other books that are easier to follow and less dogmatic about the need to eliminate all animal protein from the diet, which even Dr. Campbell admits “has not been absolutely proven” (p. 242).

In my opinion the most incongruous part of The China Study is the fourth section titled, “Why Haven’t You Heard This Before?” Here Dr. Campbell goes into great detail explaining the ties between food industries, drug companies, our government and, sadly, our education system from K1 through post graduate medical residency. While this section of The China Study is fascinating, it dilutes the primary nutrition message of the book with a disconcerting illustration of the roles money and politics play in our education system. But despite the jumbled message, the facts provided in this final section of The China Study are eye-opening and may be the best reason to read the book. It is shocking to learn how deeply opposed to and uneducated most of the medical community is about the life-saving benefits of dietary intervention for chronic diseases. Personally I would have liked this section to be an entirely separate book, as I would recommend it more often.

To summarize, The China Study provides an interesting but not entirely compelling argument for adopting a vegan diet. It also offers a hefty dose of skepticism about who you can trust for nutrition advice, particularly when it comes to the medical community. Overall I enjoyed reading the book and, despite my criticisms, agree with most of it. I have no doubt that for the vast majority of Americans Dr. Campbell’s advice and recommendations would be immensely beneficial.

Final Grade: B

Please add your thoughts on The China Study in the comments below.

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