excerpted from the book

The China Study

The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health

by T. Colin Campbell, Ph.D., 2006, paperback

p5
I began coordinating technical assistance for a nationwide project in the Philippines working with malnourished children. Part of the project became an investigation of the unusually high prevalence of liver cancer, usually an adult disease, in Filipino children.

... In this project, however, I uncovered a dark secret. Children who ate the highest-protein diets were the ones most likely to get liver cancer. They were the children of the wealthiest families.

I then noticed a research report from India that had some very provocative, relevant findings. Indian researchers had studied two groups of rats. In one group, they administered the cancer-causing afiatoxin, then fed a diet that was composed of 20% protein, a level near what many of us consume in the West. In the other group, they administered the same amount of aflatoxin, but then fed a diet that was only composed of 5% protein. Incredibly, every single animal that consumed the 20% protein diet had evidence of liver cancer, and every single animal that consumed a 5% protein diet avoided liver cancer. It was a 100 to 0 score, leaving no doubt that nutrition trumped chemical carcinogens, even very potent carcinogens, in controlling cancer.

... What we found was shocking. Low-protein diets inhibited the initiation of cancer by aflatoxin, regardless of how much of this carcinogen was administered to these animals. After cancer initiation was completed, low-protein diets also dramatically blocked subsequent cancer growth. In other words, the cancer-producing effects of this highly carcinogenic chemical were rendered insignificant by a low-protein diet. In fact, dietary protein proved to be so powerful in its effect that we could turn on and turn off cancer growth simply by changing the level consumed.

... But that's not all. We found that not all proteins had this effect. What protein consistently and strongly promoted cancer? Casein, which makes up 87% of cow's milk protein, promoted all stages o e cancer process. What type of protein did not promote cancer, even at high levels of intake? The safe proteins were from plants, including wheat and soy. As this picture came into view, it began to challenge and then to shatter some of my most cherished assumptions.

p7
I went on direct the most comprehensive study of diet, lifestyle and disease ever done with humans in the history of biomedical research.... This project surveyed a vast range of diseases and diet and lifestyle factors in rural China... More commonly known as the China Study, this project eventually produced more than 8,000 statistically significant associations between various dietary factors and disease!

What made this project especially remarkable is that, among the many associations that are relevant to diet and disease, so many pointed to the same finding: people who ate the most animal-based foods got the most chronic disease. Even relatively small intakes of animal-based foods were associated with adverse effects. People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease.

... These findings show that heart disease, diabetes and obesity can be reversed by a healthy diet. Other research shows that various cancer autoimmune diseases, bone health, kidney health, vision and brain disorders in old age are convincingly influenced by diet. Most importantly, the diet that has time and again been shown to reverse and/or prevent these diseases is [a] whole foods, plant-based diet.

p12
Contrary to what many believe, cancer is not a natural event. Adopting a healthy diet and lifestyle can prevent the majority of cancers.

p13
According to the National Center for Health Statistics, almost a third of the adults twenty years of age and over in this country are obese. One is considered obese if he or she is carrying more than a third of a person above and beyond a healthy weight.

p14
One out of thirteen Americans now has diabetes.

p14
Diabetes among people in their thirties has increased 70% in less than ten years and the percentage of obese people has nearly doubled in the past thirty years.

p15
One of the most well regarded voices representing the medical community, the Journal of the American Medical Association (JAMA), included a recent article by Barbara Starfield, M.D., stating that physician error, medication error and adverse events from drugs or surgery kill 225, 400 people per year. That makes our health care system the third leading cause of death in the United States, behind only cancer and heart disease.

p34
Peanuts are rich in protein.

p35
[In the Philippines] we wanted to know which foods contained the most aflatoxin (AF). We learned that peanuts and corn were the foods most contaminated. All twenty-nine jars of peanut butter we had purchased in the local groceries, were contaminated, with levels of AF as much as 300 times the amount judged to be acceptable in U.S. food. Whole peanuts were much less contaminated; none exceeded the AF amounts allowed in U.S. commodities. This disparity between peanut butter and whole peanuts originated at the peanut factory The best peanuts, which filled "cocktail" jars, were hand selected from a moving conveyor belt, leaving the worst, moldiest nuts to be delivered to the end of the belt to make peanut butter.

p36
The children [in the Philippines] who got liver cancer were from the best-fed families. The families with the most money ate what we thought were the healthiest diets, the diets most like our own meaty American diets. They consumed more protein than anyone else in the country (high quality animal protein, at that), and yet they were the ones getting liver cancer.

... At that time, a research paper from India surfaced in an obscure medical journal. It was an experiment involving liver cancer and protein consumption in two groups of laboratory rats. One group was given AF (aflatoxin) and then fed diets containing 20% protein. The second group was given the same level of AF and then fed diets containing only 5% protein.

Every single rat fed 20% protein got liver cancer or its precursor lesions, but not a single animal fed a 5% protein diet got liver cancer or its precursor lesions. It was not a trivial difference; it was 100% versus 0%. This was very much consistent with my observations for the Philippine children. Those who were most vulnerable to liver cancer were those who consumed diets higher in protein.

p59
Controlling cancer through nutrition was, and still is, a radical idea. But if this weren't enough, one more issue would yield explosive information: did it make any difference what type of protein was used in these experiments? For all of these experiments, we were using casein, which makes up 87% of cow's milk protein. So the next logical question was whether plant protein, tested in the same way, has the same effect on cancer promotion as casein. The answer is an astonishing "NO." In these experiments, plant protein did not promote cancer growth even at the higher levels of intake.

p62
Let there be no doubt, cow's milk protein is an exceptionally potent cancer promoter in rats dosed with aflatoxin. The fact that this promotion effect occurs at dietary protein levels (10-20%) commonly used both in rodents and humans makes it especially tantalizing - and provocative.

p
We initiated more studies using several different nutrients, including fish protein, dietary fats and the antioxidants known as carotenoids [and] measured the ability of these nutrients to affect liver and pancreatic cancer. The results of these, and many other studies, showed nutrition to be far more important in controlling cancer promotion than the dose of the initiating carcinogen The idea that nutrients primarily affect tumor development during promotion was beginning to appear to be a general property of nutrition and cancer relationships.

... Furthermore, a pattern was beginning to emerge: nutrients from animal-based foods increased, tumor development while nutrients from plant-based foods decreased tumor development.

p69
In the early 1970s, the premier of China, Chou EnLai, was dying of cancer. In the grips of this terminal disease, Premier Chou initiated a nationwide survey to collect information about a disease that was not well understood. It was to be a monumental survey of death rates for twelve different kinds of cancer for more than 2,400 Chinese counties and 880 million (96%) of their citizens. The survey was remarkable in many ways. It involved 650,000 workers, the most ambitious biomedical research project ever undertaken. The end result of the survey was a beautiful, color-coded atlas showing where certain types of cancer were high and where they were almost nonexistent.'

This atlas made it clear that in China cancer was geographically localized. Some cancers were much more common in some places than in others. Earlier studies had set the stage for this idea, showing that cancer incidence also varies widely between different countries. But these China data were more remarkable because the geographic variations in cancer rates were much greater. They also occurred in a country where 87% of the population is the same ethnic group, the Han people.

Why was there such a massive variation in cancer rates among different counties when genetic backgrounds were similar from place to place? Might it be possible that cancer is largely due to environmental and lifestyle factors, and not genetics? A few prominent scientists had already reached that conclusion. The authors of a major review on diet and cancer, prepared for the U.S. Congress in 1981, estimated that genetics only determines about 2-3% of the total cancer risk.

The data behind the China cancer atlas were profound. The counties with the highest rates of some cancers were more than 100 times greater than counties with the lowest rates of these cancers. These are truly remarkable figures. By way of comparison, we in the U.S. see, at most, two to three times the cancer rates from one part of the country to another.

In fact, very small and relatively unimportant differences in cancer rates make big news, big money and big politics. There has been a longstanding story in my state of New York about the increased rates of breast cancer in Long Island. Large amounts of money (about $30 million') and years and years of work have been spent examining the issue. What sorts of rates were causing such a furor? Two counties in Long Island had rates of breast cancer only 10-20% higher than the state average. This difference was enough to make front-page news, scare people and move politicians to action. Contrast this with the findings in China where some parts of the country had cancer rates 100 times (10,000%) higher than others.

Because China is relatively homogenous genetically, it was clear that these differences had to be explained by environmental causes. This raised a number of critical questions:

* Why was cancer so high in some rural Chinese counties and not in others?

* Why were these differences so incredibly large?

* Why was overall cancer, in the aggregate, less common in China than in the U.S.?

p73
In America 15-16% of our total calories comes from protein and upwards of 80% of this amount comes from animal-based foods. But in rural China only 9-10% of total calories comes from protein and only 10% of the protein comes from animal-based foods. This means that there are major nutritional differences in the Chinese and American diets.

p74
There are massive dietary differences between the Chinese and American [dietary] experiences: much higher overall calorie intake, less fat, less protein, much less animal foods, more fiber and much more iron are consumed in China.

p77
We found that one of the strongest predictors of Western diseases was blood cholesterol.

There are two main categories of cholesterol. Dietary cholesterol is present in the food we eat. It is a component of food, much like sugar, fat, protein, vitamins and minerals. This cholesterol is found only in animal-based food.

... The second type of cholesterol, blood cholesterol, is made in the liver. Blood cholesterol and dietary cholesterol, although chemically identical, do not represent the same thing. A similar situation occurs with fat. Dietary fat is the stuff you eat: the grease on your French fries, for example. Body fat, on the other hand, is the stuff made by your body and is very different from the fat that you spread on your toast in the morning (butter or margarine). Dietary fats and cholesterol don't necessarily turn into body fat and blood cholesterol. The way the body makes body fat and blood cholesterol is extremely complex, involving hundreds of different chemical reactions and dozens of nutrients. Because of this complexity, the health effects of eating dietary fat and dietary cholesterol may be very different from the health effects of having high blood cholesterol or having too much body fat.

As blood cholesterol levels in rural China rose in certain counties, the incidence of "Western" diseases also increased. What made this so surprising was that Chinese levels were far lower than we had expected. The average level of blood cholesterol was only 127 mg/dL, which is almost 100 points less than the American average (215 mgldL). Some counties had average levels as low as 94 mg/dL. For two groups of about twenty-five women in the inner part of China, average blood cholesterol was at the amazingly low level of 80 mgldL.

... In the U.S., our range is around 170-290 mgldL. Our low values are near the high values for rural China. Indeed, in the U.S., there was a myth that there might be health problems if cholesterol levels were below 150 mg/dL. If we followed that line of thinking, about 85% of the rural Chinese would appear to be in trouble. But the truth is quite different. Lower blood cholesterol levels are linked to lower rates of heart disease cancer and other Western diseases even at levels far below those considered "safe" in the West.

At the outset of the China Study, no one could or would have predicted that there would be a relationship between cholesterol and any of the disease rates. What a surprise we got! As blood cholesterol levels decreased from 170 mgldL to 90 mg/dL, cancers of the liver, rectum, colon, male lung, female lung, breast, childhood leukemia, adult leukemia, childhood brain, adult brain, stomach and esophagus (throat) decreased.

... There are several types of blood cholesterol, including LDL and HDL cholesterol. LDL is the "bad" kind and HDL. is the "good" kind. In the China Study higher levels of the bad LDL cholesterol also were associated with Western diseases.

These diseases, by Western standards, were relatively rare in China and that blood cholesterol levels were quite low by Western standards. Our findings made a convincing case that many Chinese had an advantage at the lower cholesterol levels, even below 170 mgldL. Now imagine a country where the inhabitants had blood cholesterol levels far higher than the Chinese average. You might expect that these relatively rare diseases, such as heart disease and some cancers, would be prevalent, perhaps even the leading killers!

At the time of our study, the death rate from coronary heart disease was seventeen times higher among American men than rural Chinese men. The American death rate from breast cancer was five times higher than the rural Chinese rate.

Even more remarkable were the extraordinarily low rates of coronary heart disease.

p80
Animal-based foods were correlated with increasing blood cholesterol. With almost no exceptions, nutrients from plant-based foods were associated with decreasing levels of blood cholesterol.

... Consuming animal-based protein increases blood cholesterol levels. Saturated fat and dietary cholesterol also raise blood cholesterol, although these nutrients are not as effective at doing this as animal protein. In contrast, plant-based foods contain- no cholesterol, and, in various ways, help to decrease the amount of cholesterol made in the body.

... Even small amounts of animal-based food in rural China raised the risk for Western diseases.

... Animal protein consumption by men was associated with increasing levels of "bad" blood cholesterol" whereas plant protein consumption was associated with decreasing levels of this same cholesterol.

p83
Dietary fat is an indicator of how much animal-based food is in the diet. It is almost a perfect match.

p87
Higher dietary fat is associated with higher blood cholesterol and both of these factors, along with higher female hormone levels, are associated, in turn, with more breast cancer and earlier age of menarche.

The much later age of menarche in rural China is remarkable. Twenty-five women in each of the 130 villages in the survey were asked when they had their first menstrual period. The range of village averages was fifteen to nineteen years, with an average of seventeen years. The U.S. average is roughly eleven years.

p87
Many studies have shown that earlier menarche leads to higher risk for breast cancer... Early age of menarche, both in Chinese and in Western women, leads to higher levels of blood hormones such as estrogen. These hormone levels remain high throughout the reproductive years if consumption of a diet rich in animal-based food is maintained. Under these conditions, age of menopause is deferred by three to four years, thus extending the reproductive life from beginning to end by about nine to ten years and greatly increasing lifetime exposure to female hormones. Other studies have shown that an increase in years of reproductive life is associated with increased breast cancer risk.

... Higher fat consumption is associated with higher blood levels of estrogen during the critical years of thirty-five to forty-four years... and higher blood levels of the female hormone prolactin during the later years of fifty-five to sixty-four years. These hormones are highly correlated with animal protein intake and milk and meat.

The strong association of a high-animal protein, high-fat diet with reproductive hormones and early age of menarche, both of which raise the risk of breast cancer, is an important observation. It makes clear that we should not have our children consume diets high in animal-based foods.

p89
Fiber [is] able to pull water from the body into the intestines to keep things moving along. These undigested fibers, like stick-um paper, also gather up nasty chemicals that find their way into our intestines and that might be carcinogenic. If we don't consume enough fiber, we are susceptible to constipation-based diseases -[ including] large bowel cancer, diverticulosis, hemorrhoids and varicose veins.

p90
Dietary fiber is exclusively found in plant-based foods. This material, which gives rigidity to the cell walls of plants, comes in thousands of different chemical variations. It is mostly made of highly complex carbohydrate molecules. We digest very little or no fiber. Nonetheless, fiber, having few or no calories itself, helps dilute the caloric density of our diets, creates a sense of fullness and helps to shut down appetite, among other things. In doing so, it satisfies our hunger and minimizes the overconsumption of calories.

p92
The [China Study] results showed that fiber intake was consistently associated with lower rates of cancers of the rectum and colon. High-fiber intakes were also associated with lower levels of blood -cholesterol. Of course, high fiber consumption reflected high plant-based food consumption. foods such as beans, leafy vegetables and whole grains are all high in fiber.

p92
The colors of fruits and vegetables are derived from a variety of chemicals called antioxidants These chemicals are almost exclusively found in plants. They are only present in animal-based foods to the extent that animals eat them and store a small amount in their own tissues.

... Antioxidants are usually colored.

... Antioxidants in plants work in our bodies the same way they work in plants. It is a wonderful harmony. The plants make the antioxidant shields, and at the same time make them look incredibly appealing with beautiful, appetizing colors. Then we animals, in turn, are attracted to the plants and eat them and borrow their antioxidant shields for our own health.

p98
Fruits, vegetables and whole grains are the healthiest foods you consume and they are primarily made of carbohydrates.

On the opposite side of the spectrum there are highly-processed, highly-refined carbohydrates that have been stripped of their fiber, vitamins and minerals. Typical simple carbohydrates are found in foods like white bread, processed snack items including crackers and chips made with white flour, sweets including pastries and candy bars and sugar-laden soft drinks. These highly refined carbohydrates originate from grains or sugar-laden plants, like sugar cane or the sugar beet.

p99
The health benefits of a high-carbohydrate diet come from eating the complex carbohydrates found in whole grains, fruits and vegetables.

p103
Individuals can achieve their genetic potential for growth and body size by consuming a plant-based diet. So why is it that people in developing nations, who consume little or no animal-based foods, are consistently smaller than Western people? This is because plant-based diets in poor areas of the world usually have insufficient variety, inadequate quantity and quality and are associated with poor public health conditions where childhood diseases are prevalent. Under these conditions, growth is stunted and people do not reach their genetic potential for adult body size.

p104
The finding: casein, and very likely all animal proteins, may be the most relevant cancer-causing substances that we consume. Adjusting the amount of dietary casein has the power to turn on and turn off cancer growth, and to override the cancer-causing producing of aflatoxin, a very potent carcinogen.

p105
Animal-based foods are linked to higher breast cancer rates plant-based foods are linked to lower rates. Fiber and antioxidants from plants are linked to a lower risk of cancers of the digestive tract.

p109
Heart disease, cancer, stroke, Alzheimer's, obesity or diabetes - these diseases are relatively unknown in traditional cultures that subsist mostly on whole plant foods.

p115
In an a 1959 study of heart disease, American men died from heart disease at a rate almost seventeen times higher than their Chinese counterparts.

p116
The cultures that have lower heart disease rates eat less saturated fat and animal protein and more whole grains, fruits and vegetables. In other words, they subsist mostly on plant foods.

p117
Men in Japan, who were more likely to smoke, still had less coronary heart disease than the Japanese Americans. The researchers pointed to diet, writing that blood cholesterol increased "with dietary intake of saturated fat, animal protein and dietary cholesterol. On the flip side, blood cholesterol "was negatively associated with, complex -carbohydrate intake. In simple terms, animal foods were linked to higher blood cholesterol; plant foods were linked to lower blood cholesterol.

p123
Researchers have compared the intellectual capabilities of patients before and after the operation and found that a stunning 79% of patients "showed impairment in some aspect of cognitive function seven days after the operation.

p123
About 70-80% patients who undergo bypass surgery remain free of this crippling chest pain for one year. But this benefit doesn't last. Within three years of the operation, up to one-third of patients will suffer from chest pain again. Within ten years half of the bypass patients will have died, had a heart attack or had their chest pain return. Long-term studies indicate that only certain of heart disease patients live longer because of their bypass operation. Furthermore, these studies demonstrate that those patients who undergo bypass operation do not have fewer heart attacks than those who do not have surgery.

... Angioplasty is a similar story. The procedure is expensive and carries significant risks. After identifying blockages in a coronary artery, a balloon is inserted into the artery and inflated. It pushes the plaque back against the vessel, thereby allowing more blood to flow. Roughly one out of sixteen patients will experience an "abrupt vessel closure" during which can lead to death, heart attack or an emergency bypass operation. Assuming that doesn't happen, there is still a good chance that the procedure will fail. Within four months after the procedure, 40% of the arteries that were "squished" open will close up again, effectively nullifying the procedure.

p126
Dr. Caldwell B. Esselstyn, Jr., the Cleveland Clinic

Dr. Esselstyn started to reexamine the standard medical practice.... Dr. Esselstyn decided to test the effects of a whole foods, plant-based diet on people with established coronary disease. By using a minimal amount of cholesterol-lowering medication and a very low-fat, plant-based diet, he has gotten the most spectacular results ever recorded in the treatment of heart disease.

In 1985, Dr. Esselstyn began his study with the primary goal of reducing his patients' blood cholesterol to below 150 mgldL. He asked each patient to record everything he or she ate in a food diary. Every two weeks, for the next five years, Dr. Esselstyn met with his patients to discuss the process, administer blood tests and record blood pressure and weight. He followed up this daytime meeting with an evening telephone call to report the results of the blood tests and further discuss how the diet was working. In addition, all of his patients met together a few times a year to talk about the program, socialize and exchange helpful information. In other words, Dr. Esselstyn was diligent, involved, supportive and compassionately stern on a personal level with his patients.

The diet they, including Dr. Esselstyn and his wife Ann, followed was free of all added fat and almost all animal products. Dr. Esselstyn and his colleagues report, "[Participants] were to avoid oils, meat, fish, fowl and dairy products, except for skim milk and nonfat yogurt. About five years into the program, Dr. Esselstyn recommended to his patients that they stop consuming any skim milk and yogurt, as well.

Five of his patients dropped out of the study within the first two years; that left eighteen. These eighteen patients, originally had come to Dr. Esseistyn with severe disease. Within the eight years leading to the study, these eighteen people had suffered through forty-nine coronary events, including angina, bypass surgery, heart attacks, strokes and angioplasty. These were not healthy hearts. One might imagine that they were motivated to join the study by the panic created when premature death is near.

These eighteen patients achieved remarkable success. At the start of the study, the patients' average cholesterol level was 246 gIdL. During the course of the study, the average cholesterol was 132 mg/dL, well below the 150 mg/dL target. Their levels of "bad" LDL cholesterol dropped just as dramatically. In the end, though, the most impressive result was not the blood cholesterol levels, but how many coronary events occurred since the start of the study.

In the following eleven years, there was exactly one coronary event among the eighteen patients who followed the diet. That one event was from a patient who strayed from the diet for two years. After straying, the patient consequently experienced clinical chest pain (angina) and then resumed a healthy plant-based diet. The patient eliminated his angina, and has not experienced any further events.

Not only has the disease in these patients been stopped, it has even been reversed. Seventy percent of his patients have seen an opening of their clogged arteries.

p139
Vegetarians and vegans are slimmer than their meat-eating counterparts.

p139
A strict vegetarian diet is not necessarily the same thing as a whole foods, plant-based diet. Some people become vegetarian only to replace meat with dairy foods, added oils and refined carbohydrates, including pasta made with refined grains, sweets and pastries.

p141
Fat has nine calories per gram while carbohydrates and protein have only four calories per gram. In addition, vegetables have a lot of fiber, which makes us feel full, and yet contributes almost no calories to your meal.

p141
Vegetarians consume the same amount or even significantly more calories than their meat-eating counterparts, and yet are still slimmer.

p145
In the eight years from 1990 to 1998, the incidence of diabetes [in the US] increased 33%.

p146
Type 1 diabetics cannot produce adequate insulin because the cells of their pancreas have been destroyed. This is the result of the body attacking itself, making Type diabetes an autoimmune disease.

p160
Women who consume a diet rich in animal-based foods, with a reduced amount of whole, plant-based foods, reach puberty earlier and menopause later, thus extending their reproductive lives. They also have higher levels of female hormones throughout their lifespan.

p161
Increased levels of estrogen and related hormones are a result of the consumption of typical Western diets, high in fat and animal protein and low in dietary fiber... Breast cancer is centered on estrogen exposure

p169
North America, Europe Australia and wealthier Asian countries (Japan, Singapore) have very high rates of colorectal cancer, while Africa, Asia and most of Central and South America have very low rates of this cancer.

p170
One of the strongest links between any cancer and any dietary factor was between colon cancer and meat intake... Countries where more meat, more animal protein, more sugar and fewer cereal grains were consumed had far higher rates colon cancer.

p170
Colorectal cancers [may be] largely the result of low fiber intake. [researcher Denis Burkitt]

p170
Fiber is only in plant foods.

p171
Fiber-containing diets prevent colorectal cancers.

p174
The data clearly show that a whole foods, plant-based diet can dramatically lower colorectal cancer rates.

174
Refined carbohydrates are the starches and sugars obtained from plants by mechanically stripping off their outer layers, which contain most of the plant's vitamins, minerals, protein and fiber.

p179
Vitamin D is not a nutrient that we need to consume. Our body can make all that we need simply by being in sunlight fifteen to thirty minutes every couple of days.

p180
Daily consumption of milk and other dairy products is linked with prostate cancer.

p180
Our institutions and information providers are failing us. Even cancer organizations, at both the national and local level, are reluctant to discuss or even believe the evidence. Food as a key to health represents a powerful challenge to conventional medicine, which is fundamentally built on drugs and surgery.

p183
The most studied autoimmune diseases are multiple sclerosis (MS) rheumatoid arthritis, lupus, Type 1 diabetes and Rheumatic heart disease. These are also the primary autoimmune diseases that have been studied in reference to diet. Others include inflammatory bowel disease, Crohn's disease, rheumatic heart disease and (possibly) Parkinson's disease.

p184
Common Autoimmune Diseases (from most common to least common)

1. Graves' disease (Hyperthyroidism)
2. Rheumatoid arthritis
3. Thyroiditis (Hypothyroidism)
4. Vitiligo
5. Pernicious anemia
6. Glomerulonephritis
7. Multiple sclerosis
8. Type 1 diabetes
9. Systemic lupus
10. Sogren's disease
11. Myasthenia gravis
12. Polymyositis/dermatomyositis
13. Addison's disease
14. Scleroderma
15. Primary biliary cirrhosis
16. Uveitis
17. Chronic active hepatitis erythematosus

The "recruitment center" for the immune system is in the marrow of our bones. The marrow is responsible for generating specialized cells called stem cells. Some of these cells are released into circulation for use elsewhere in the body; these are called B-cells (for bone). Other cells formed in the bone marrow remain immature, or unspecialized until they travel the thymus (an organ in the chest cavity just above the heart) where they become specialized these are called T-cells (for thymus). These "soldier cells along with other specialized cells, team up to create intricate defense plans. They meet at major intersections around the body, including the spleen (just inside the left lower rib cage) and the lymph nodes. These meeting points are like command and control centers, where the "soldier cells" rearrange themselves into teams to attack foreign invaders.

These cells are remarkably adaptable when they form their teams. They are able to respond to different circumstances and different foreign substances, even those they have never before seen. The immune response to these strangers is an incredibly creative process. It is one of the true wonders of nature.

The foreign invaders are protein molecules called antigens.

... To counter these antigens, our immune system must customize its defense to each attack. It does so by creating a "mirror image" protein for each attacker. The mirror image is able to fit perfectly onto the antigen and destroy it. Essentially, the immune system creates a mold for each face it encounters. Every time it sees that face after the initial encounter, it uses the custom-made mold to "capture" the invader and destroy it. The mold may be a B-cell antibody or a T-cell-based receptor protein.

p186
Even though this system is a wonder of nature when it is defending the body against foreign proteins, it is also capable of attacking the same tissues that it is designed to protect . This self-destructive process is common to all autoimmune diseases. It is as if the body were to commit suicide.

p186
It so happens that the antigens that trick our bodies into attacking our own cells may be in food. During the process of digestion, for example, some proteins slip into our bloodstream from he intestine without being fully broken down into their amino acid parts. The remnants of undigested proteins are treated as foreign invaders by our immune system, which sets a out making molds to destroy them and sets into motion the self-destructive autoimmune process.

One of the foods that supply many of the foreign proteins that mimic our own body proteins is cow's milk.

p187
In the case of Type 1 diabetes the immune system attacks the pancreas cells responsible for producing insulin. This devastating, incurable disease strikes children, creating a painful and difficult experience for young families. What most people don't know, though, is that there is strong evidence that this disease is linked to diet and, more specifically to dairy products. The ability-of cow's milk protein to initiate Type 1 diabetes is well documented.

... This process boils down to a truly remarkable statement: cow's milk may cause one of the most devastating diseases that can befall a child. For

... One of the more remarkable reports on this cow's milk effect was published over a decade ago, in 1992, in the New England Journal of Medicine. The researchers, from Finland, obtained blood from Type 1 diabetic children aged four to twelve years... Children who had antibodies to cow's milk protein must have previously consumed cow's milk. It also means that undigested protein fragments of the cow's milk proteins had to have entered the infant's circulation in order to cause the formation of antibodies in the first place.

... The researchers discovered something truly remarkable. Of the diabetic children measured, every single one had antibody levels higher than 3.55. Of the normal children measured, every single one had antibody levels less than 3.55.

... This implies two things: children with more antibodies consumed more cow's milk and second, increased antibodies may cause Type 1 diabetes.

p189
Infants or very young children of a certain genetic background who are weaned from the breast onto cow's milk and who perhaps become infected with a virus that may corrupt the gut immune system, are likely to have a high risk for Type 1 diabetes. A study in Chile considered the first two factors, cow's milk and genes. Genetically susceptible children weaned too early onto cow's milk-based formula had a risk of Type 1 diabetes that was 13.1 times greater than children who did not have these genes and who were breast-fed for at least three months (thus minimizing their exposure to cow's milk). Another study in the U.S. showed that genetically susceptible children fed cow's milk as infants had a risk of disease that was 11.3 times greater than children who did not have these genes and who were breast-fed for at least three months. This eleven to thirteen times greater risk is incredibly large (1,000-1,200%); anything over three to four times is usually considered very important .To put this in perspective, smokers have approximately ten times-greater risk of getting lung cancer and people with high blood pressure and cholesterol have a 2.5-3.0 times greater risk of heart disease.

p190
Cow's milk consumption by children zero to fourteen years of age in twelve countries shows an almost perfect correlation with Type 1 diabetes. The greater the consumption of cows milk, the greater the prevalence of Type 1 diabetes.

p191
When people migrate from areas of the world where disease incidence is low to areas of the world where disease incidence is high, they quickly adopt the high incidence rates as they change their diet and lifestyle. This shows that even though individuals may have the necessary gene(s), the disease will occur only in response to certain dietary and/or environmental circumstances.

p191
When the results of all these studies are combined (both genetically susceptible and not susceptible) we find that children weaned too early and fed cows milk have, on average, a 50-60% higher risk of Type 1 diabetes.

p194
Human breast milk is the perfect food for an infant, and one of the most damaging things a mother can do is to substitute the milk of a cow for her own.

p194
About 400,000 people in the U.S. alone have multiple sclerosis according to the National Multiple Sclerosis Society. It is a disease that is initially diagnosed between twenty and forty years of age, and strikes women about three times more often than men.

Even though there is widespread medical and scientific interest in this disease, most authorities claim to know very little about causes or cures. Major multiple sclerosis Internet Web sites all claim that the disease is an enigma. They generally list genetics, viruses and environmental factors as possibly playing roles in the development of this disease but pay almost no heed to a possible role for diet.

p195
The initial research showing an effect of diet on MS goes back more than half a century to the research of Dr. Roy Swank, who began his work in Norway and at the Montreal Neurological Institute during the 1940s. Later, Dr. Swank headed the Division of Neurology at the University of Oregon Medical School .

Dr. Swank became interested in the dietary connection when he learned that MS appeared to be more common in the northern climates There is a huge difference in MS prevalence as one moves away from the equator: MS is over 100 times more prevalent in the far north than at the equator, and seven times more prevalent in south Australia than in north Australia. This distribution is very similar to the distribution of other autoimmune diseases including Type 1 diabetes and rheumatoid arthritis.

... Dr. Swank conducted his best-known trial on 144 MS patients recruited from the Montreal Neurological Institute. He kept records on these patients for the next thirty-four years. He advised his patients to consume a diet low in saturated fat most of whom did, but many of whom did not. He then classified them as good dieters or poor dieters, based on whether they consumed less than 20 glday or more than 20 glday of saturated fat.

As the study continued, Dr. Swank found that progression of disease was greatly reduced by the low-saturated fat diet which worked even for people with initially advanced conditions.

... More recently, additional studies have confirmed and extended Swank's observations and gradually have begun to place more emphasis on cow's milk These new studies show that consuming cow's milk is strongly linked to MS.

... The consumption of meat high in saturated fat like milk, was also associated with MS in multi-country studies, while the consumption of fish, containing omega-3 fat, was associated with low rates of disease.

p198
As with cancer, heart disease, and Type 2 diabetes, people acquire the risk of the population to which they move, especially if they move before their adolescent years.

... Although MS and Type 1 diabetes share some of the same unanswered questions on the role of viruses and genes and the immune system, they also share the same alarming evidence regarding diet. For both diseases, a "Western" diet is strongly associated with disease incidence.

p199
We can hypothesize that MS, Type 1 diabetes, rheumatoid arthritis, lupus and other autoimmune diseases may share a similar cause.

... All the autoimmune diseases that have been studied have been found to be more common at the higher geographic latitudes where there is less constant sunshine.

... Parkinson's disease, a non-autoimmune disease with auto-immune characteristics is often found with MS.

... Of those diseases studied in relation to nutrition, the consumption of animal-based food - especially cow's milk - is associated with greater disease risk.

... There is evidence that a virus (or viruses) may trigger the onset of several of these diseases

... Sunlight exposure, which decreases with increasing latitude could be important - there are other factors. The consumption of animal-based foods, especially cow's milk, also increases with distance from the equator. In fact, in one of the more extensive studies cow's milk was found to be as good of a predictor of MS as latitude (i.e., sunshine). In Dr. Swank's studies in Norway, MS was less common near the coastal areas of the country where fish intake was more common. This gave rise to the idea that the omega-3 fats common to fish might have a protective effect. What is almost never mentioned,
however, is that dairy consumption (and saturated fat) was much lower in the fish-eating areas it possible that cow's milk and lack of sunshine are having a similar effect on MS and other autoimmune diseases because they operate through a similar mechanism?

p200
Knowing the strength of the evidence against animal foods, cow's milk in particular, for both MS and Type 1 diabetes, and knowing how much in common a o the autoimmune diseases have, it is reasonable to begin thinking about food and its relationship to a much broader group of autoimmune diseases. Obviously caution is called for; more research is needed to make conclusive statements about cross-autoimmune disease similarities. But the evidence we have now is already striking.

Today almost no indication of the dietary connection to these diseases has reached public awareness. The Web site of the Multiple Sclerosis International Federation, for example, reads, "There is no credible evidence that MS is due to poor diet dietary deficiencies.

p204
Americans consume more cow's milk and its products per person than most populations in the world. So Americans should have wonderfully strong bones right? Unfortunately A recent study showed that American women aged fifty and older have one of highest rates of hip fractures in the world. The only countries with higher rates are Europe and in the south Pacific (Australia and New Zealand)' where they consume even more milk than the United States. What's going on?

An excess rate of hip fractures is often used as a reliable indicator of osteoporosis, a bone disease that especially affects women after menopause. It is often claimed to be due to an inadequate intake of calcium.

... Something is amiss, though, because those countries that use the most cow's milk and its products also have the highest fracture rates and the worst bone health. One possible explanation is found in a report showing an impressively strong association between animal protein intake and bone fracture rate for women in different countries... It found that a very impressive 70% of the fracture rate was attributable to the consumption of animal protein.

... Researchers explained that animal protein, unlike plant protein, increases the acid load in the body... In order to neutralize the acid, the body uses calcium which acts as a very effective base. This calcium, however, must come from somewhere. It ends up being pulled from the bones and the calcium loss weakens them putting them at greater risk for fracture.

We have had evidence for well over a hundred years that animal protein decreases bone health. The explanation of animal protein causing excess metabolic acid for example, was first suggested in the 1880s and was documented as long ago as 1920.

... When animal protein increases metabolic acid and draws calcium from the bones the amount of calcium in the urine is increased. This effect has been established for over eighty years and has been studied in some detail since the 1970s. Summaries of these studies were published in 1974 and 1990. Each of these summaries clearly shows that the amount of animal protein consumed by many of us on a daily basis is capable of causing substantial increases in urinary calcium.

... A study, published in 2000, comes from the Department of Medicine at the University of California at San Francisco... A high ratio of vegetable to animal protein consumption was found to be impressively associated with a virtual disappearance of bone fractures... the statistical significance of the association of animal protein with bone fracture rates is truly exceptional.

... The Study of Osteoporotic Fractures Research Group at the University of California at San Francisco published yet another study of over 1,000 women aged sixty-five and up. Like the multi-country study, researchers characterized women's diets by the proportions of animal and plant protein. After seven years of observations the women with the highest ratio of animal protein to plant protein had 3.7 times more bone fracture than, the women with the lowest ratio. Also during this time the women with the high ratio lost bone almost four times as fast as the women with the lowest ratio.

p208
In our rural China study, where the animal to plant ratio was about 10%, the fracture rate is only one-fifth that of the U.S.. Nigeria shows an animal-to-plant protein ratio only about 10% that of Germany and the hip fracture incidence is lower by over 99%.

These observations raise a serious question about the widely advertised claim that protein-rich dairy foods protect our bones.

... In one study of ten countries, a higher consumption of calcium was associated with a higher-not lower-risk of bone fracture.

... Mark Hegsted was a longtime Harvard professor. He worked on the calcium issue beginning in the early 1950s, was a principal architect of the nation's first dietary guidelines in 1980. Professor Hegsted believes that excessively high intakes of calcium consumed over a long time impair the body's ability to control how much calcium it uses and when. Under health conditions, the body uses an activated form of vitamin D, calcitirol, to adjust how much calcium it absorbs from food and how much it excretes and distributes in the bone. Calcitriol is considered a hormone.

... Given these findings, it seems perfectly plausible that animal protein and even calcium - when consumed at excessive levels - are capable of increasing the risk of osteoporosis. Dairy, unfortunately, is the only food that is rich in both of these nutrients. Hegsted ... said in his 1986 paper, ... hip fractures are more frequent in populations where dairy products are commonly consumed and calcium intakes are relatively high.

p210
BMD (bone mineral density) is a measure of bone density that is often used to diagnose bone health. If your bone density falls below a certain level,

... Something is wrong with the idea that BMD reliably represents osteoporosis and, by inference, indicates the kind of diet that would lower fracture rates. In-contrast, an alternative but much better predictor of osteoporosis is the dietary ratio of animal-to-plant protein. The higher the ratio, the higher the risk of disease. And, BMD is not significantly associated with this ratio.

... To minimize your risk of osteoporosis:

* Stay physically active.

* Eat a variety of whole pant foods, and avoid animal foods, including dairy. Plenty of calcium is available in a wide range of plant foods, including beans and leafy vegetables.

* Keep your salt intake to a minimum. Avoid highly processed and packaged foods which contain excess salt.

p212
Professor W.G. Robertson from the Medical Research Council in Leeds, England... Dr. Robertson's research group has investigated the relationship between food and kidney stones.

... One of Robertson's charts depicts a stunning relationship between animal protein consumption and the formation of kidney stones. It shows that consuming animal protein at levels above twenty- one grams per person-per day ... is closely correlated with a high number of kidney stones.

p214
Macular degeneration is the leading cause of irreversible blindness among people over age sixty-five.

...
Two studies, each involving a team of experienced researchers at prestigious institutions, provide compelling evidence that food can protect against macular degeneration... The findings of these two studies suggested that as much as 70-88% of blindness caused by macular degeneration could be prevented if the right foods are eaten.

... The findings of these two studies suggested that as much as 70-88% of blindness caused by macular degeneration could be prevented if the right foods are eaten

... Researchers found that a higher intake of total carotenoids was associated with lower frequency of macular degeneration... especially the carotenoids found in dark green leafy vegetables.

... Green leafy vegetables, carrots and citrus fruits are all good sources... consume carotenoids in their natural context in highly colored fruits and vegetables.

... Eating antioxidant-containing foods, especially those containing the carotenoids, will prevent most blindness cases resulting from macular degeneration.

p217
Cataract formation involves the clouding of the eye lens. Corrective surgery involves removing the cloudy lens and replacing it with an artificial lens. The development of the opaque condition, like the degeneration of the macula and so many other disease conditions in our body, is closely associated with the damage created by an excess of reactive free radicals. Once again, it is reasonable to assume that eating antioxidant-containing foods should be helpful.

Starting in 1988, researchers in Wisconsin began to study eye health and dietary intakes in over 1,300 people. Ten years later, they published a report on their findings... those who consumed the most spinach had 40% less cataracts.

These two eye conditions, macular degeneration and cataracts both occur when we fail to consume enough of the highly colored green and leafy vegetables. In both cases, excess free radicals, increased by animal-based foods and decreased by plant-based foods are likely to be responsible for these conditions.

p218
Memory loss disorientation and confusion are not inevitable parts of aging, but problems linked to that all-important lifestyle factor diet.

... There are two main types of dementia: vascular dementia and Alzheimer's disease. Vascular dementia is caused by multiple little strokes resulting from broken blood vessels in the brain.

... Alzheimer's, occurs when a protein substance called beta-amyloid accumulates in critical areas of the brain rather like the cholesterol-laden plague that builds up in cardiovascular diseases.

... One risk factor is the amount of those free radicals which wreak havoc on brain function in our later years. Because free radical damage is so important to the process of cognitive dysfunction and dementia, researchers believe that consuming dietary antioxidants can shield our brains from this damage. Animal-based foods lack antioxidants shields and tend to activate free radical production
and cell damage, while plant-based foods, with their abundant antioxidants, tend to prevent such damage.

... Rates of Alzheimer's are low in less developed areas. A recent study compared Alzheimer's rate to dietary variables across eleven different countries and found that populations with a high fat intake and low cereal and grain intake had higher rates had higher rates of the disease.

p220
In a publication from the famous Framingham Study, researchers ... found that people who consumed the most total fat and saturated fat had the highest risk of dementia due to vascular problems... greater dietary fat and cholesterol intake tended to increase the risk of Alzheimer's disease specifically and all dementia in general.

p231
There are four nutrients which animal-based foods have that plant-based foods for the most part do not: cholesterol and vitamins A, D and B12.

p232
It is estimated that we hold a three-year store of vitamin B12 in our bodies. If you do not eat any animal products for three years or more, you should consider taking a small B12 supplement on occasion.

p265
The American Cancer Society and the National Dairy Council were showing their true colors. Prevention of cancer with low-cost, low-profit plant foods was not welcomed by the food and pharmaco-medical industries With support from a trusting media, their combined power to influence the public was overwhelming.

p265
In the world of nutrition and health scientists are not free to pursue their research wherever it leads. Coming to the "wrong" conclusions even through first-rate science, can damage your career. Trying to disseminate these "wrong" conclusions to the public for the sake of public health can destroy your career.

p266
The dark side of science the side that harms not just individual researchers who get in the way, but all of society. It does this by systematically attempting to conceal, defeat and destroy viewpoints that oppose the status quo.

p267
Medical Establishment.

The behemoth did not take kindly to the idea of a serious connection between diet and cancer or for that matter, virtually any other disease. Big Medicine in America is in the business of treating disease with drugs and surgery after symptoms appear... The American Cancer Society gives almost no credence to the idea that diet is linked to cancer.

p267
Science is not always the honest search for truth that so many believe it to be. It far too often involves money, power, ego and protection of personal interests above the common good.

p305
The government is saying that animal products, dairy, meat, refined sugar and fat in your diet are good for you. The government is turning a blind eye to the evidence as well as to the millions of Americans who suffer from nutrition-related illnesses The covenant of trust between the U.S. government and the American citizen has been broken.

p211
Industry develops consultancies with a few publicly visible figures in academia, who then take policy positions outside of academia. However, these industry consultants continue to wear their academic hats.

... Academic scientists can receive personal compensation from industry while simultaneously undertaking government-sponsored activities of considerable public importance. Ironically, they can even help set the agenda for the same government authorities who have long been restricted from such corporate associations. It is huge "conflict-of-interest" loophole allowing industries to
exercise their influence through the side door of academia. In effect the entire system is essentially under the control of industry.

p312
The entire system of developing public nutrition information has been invaded and co-opted by
industry sources that have the interest and resources to do so. They run the show. They buy a few academic hacks who have gained positions of power and who exercise considerable influence, both within academia and government.

p316
Dr. Marcia Angell, former editor of the New England Journal of Medicine, 2000

The pharmaceutical industry enjoys extraordinary government protections and subsidies. Much of the early basic research that may lead to drug development is funded by the National Institutes of Health. It is usually only later, when the research shows practical promise, that the drug companies become involved. The industry also enjoys great tax advantages. Not only are its research and development costs deductible, but so are its massive marketing expenses. The average tax rate of major U.S. industries from 1993 to 1996 was 27.3% of revenues. During the same period the pharmaceutical industry was reportedly taxed at a rate of only 16.2%. Most important, the drug companies enjoy seventeen-year government-granted monopolies on their new drugs - that is, patent protection. Once a drug is patented, no one else may sell it, and the drug company is free to charge whatever the traffic will bear.

p318
When it comes to health, government is not for the people; it is for the food industry and the pharmaceutical industry at the expense of the people. It is a systemic problem where industry, academia and government combine to determine the health of the country. Industry provides funding for public health reports, and academic leaders with industry ties play key roles in developing them A revolving door exists between government jobs and industry jobs, and government research funding goes to the development of drugs and devices instead of healthy nutrition.

p326
Dr. Caldwell Esselstyn

Cardiologists are supposed to be expert in diseases of the heart and yet they have no expertise in treating heart disease, and when that awareness strikes them, they get very defensive. They can treat symptoms, the they can take care of arrythmias, they can get you interventions, but they don't know how to treat the disease which is a nutritional treatment.

p326
Dr. Caldwell Esselstyn

It's absolutely daunting, the lack of physician knowledge that there is about the fact that disease can be reversed. You wonder, what is the literature that these guys read?

... What does the twentieth century of medicine have to offer? We have pills and we have procedures. Right? But who ever says, 'Maybe we ought to stop disease'?"

p327
The medical status quo relies heavily on medication and surgery at the exclusion of nutrition and lifestyle. Doctors have virtually no training in nutrition and how it relates to health.

p327
Nutrition is often not taught [to physicians] in relation to public health problems, like obesity, cancer, diabetes, etc.

p328
You should not assume that your doctor has any more knowledge about food and its relation to health than your neighbors and coworkers. It's a situation in which nutritionally untrained doctors prescribe milk and sugar-based meal-replacement shakes for overweight diabetics, high-meat, high-fat diets for patients who ask how to lose weight and extra milk for patients who have osteoporosis.
The health damage that results from doctors' ignorance of nutrition is astounding.

p334
The only type of research that is funded and recognized is research on drugs. Research on the causes of disease and non interventions simply doesn't occur in medical education settings.

p335
A recent study found that one in five new drugs will either get a "black box warning", indicating a previously unknown serious adverse reaction that may result in death or serious injury, or will be withdrawn from the market within twenty-five years. Twenty percent of all new drugs have serious unknown side effects, and more than 100,000 Americans die every year from correctly taking their properly prescribed medication.

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