Dr. Esselstyn may be doing great work with patients whose illnesses result from diet. He may be accomplishing things that could be accomplished in no other way for those patients. That doesn't mean it would work for all patients or that all such illnesses result from diet.TexasScientist said:I would have responded earlier, but I was not available until today to respond:Sam Lowry said:Esselstyn admits that the limitations of his study make it impossible (or "challenging," in his words) to establish causation. See p. 363 of the JFP article you linked earlier.TexasScientist said:I don't think you understand the point or the significance of Esselstyn's study. Not all studies need control groups, or random selection of participants etc. It's not that kind of study. The Framingham Heart study is another example of a longitudinal epidemiologic study, that did not have control groups or random participants. In his first study, the Cleveland Clinic only gave him people that they had determined there was nothing further they could for them with conventional treatment options. In other words, they could go home and wait for the disease to run its course i.e. die. The significance of Esseltsyn's work is he took patients who were already confirmed with CAD, were on meds, some had undergone surgery but still had CAD. (BTW surgery doesn't cure CAD). The point of the study was to see if you could take patients with confirmed CVD or CAD, reverse their disease, get them off of meds. In > 95% of diet compliant patients, there was no clinical evidence of disease, and in those who had angiograms before and after, there was complete resolution of arterial occlusions. You don't need a random trial for that kind of study. You can't find any drug protocol that produces a result like that. Go look at Dean Ornish's work if you want to ingore Esselstyn.Sam Lowry said:
The issues with Esselstyn's studies include lack of control groups, non-random selection of participants, use of statins during the test, and the fact that many of the participants had already undergone surgery.
It would take a whole thread to scratch the surface of the problems with the China Study. As one example, Campbell claims that meat protein is linked to liver cancer because meat consumption raises cholesterol. But when you look at the numbers, there's no direct, statistically significant correlation between liver cancer and meat protein (in fact the correlation with plant protein is slightly stronger). It gets even better, though. Another analysis of the same data found that liver cancer was associated with lower cholesterol. One of the co-authors of that paper (which was peer-reviewed, unlike Campbell's book) was none other than T. Colin Campbell.
Again, this is not to deny the benefit of whole foods. I'm not that keen on processed foods, myself. But humans evolved and/or were designed as omnivores, not vegetarians.
With regard to Dr. Campbell, it would take volumes of books to begin to scratch the number of people his work has helped. I'm not familiar with the assertion that he claims meat protein is causing liver cancer. Would you direct me to where he makes that claim? I think your characterization may not be in context. I can tell you that there are studies that link casein, a protein found in dairy with breast cancer and prostate cancer. I don't think you understand his work or his claims. Have you read his book? Are you talking about his publication in the "peer reviewed" Journal of Nature and Science, Cancer Prevention and Treatment by Wholistic Nutrition, 2017 Oct. 3(10): e448, where he make reference to his work for the government on liver cancer and his observations on why certain children in the Philippines were coming down with liver cancer?
In 1967, based on his work at MIT, he was asked to coordinate a research project in the Philippines. It was a study that spanned ten years. The results changed the way he looked at protein for the rest of his career. There were two major health issues in the children around Manila and Cebu. One serious issue concerned the high incidence of malnutrition. Another serious concern was over a significant rise is liver cancer among very young children- some as young as four years old. Campbell's group noticed that children of the wealthiest families who consumed the highest protein diets were the ones most likely to get cancer of the liver. Rural poorer children did not seem to have the cancer incidence of the wealthy city children.
While looking into peanuts as a possible solution to the malnutrition problem, he found that local peanut growers were sorting out the good peanuts for "cocktail" nuts, and the moldy (aflatoxin) peanuts were being made into peanut butter. The children in Manila were eating the peanut butter and being exposed to high levels of aflatoxin. Then, while looking into the liver cancer issue, he found that the children under ten years old who had been diagnosed with cancer were not from the malnourished families, rather they were from the wealthy well fed families, whose diets most closely resembled a standard diet here in the U.S. This contradicted what he had previously believed, that liver cancer was caused by inadequate protein intake.
While his research was going on in the Philippines, he was made aware of a controlled study in India, similar to a controlled study he was conducting on the relationship of protein and liver cancer, using aflatoxin, a known carcinogen associated with mold in peanuts and corn, to induce liver cancer in rats.
In both studies, there were two groups of rats that were each fed equal amounts of aflatoxin, then one group was fed a diet containing 20 percent protein, while the other group was fed a diet of 5 percent protein. The protein used was casein, a protein found in milk. By the end of the test, every single rat in the 20 percent group had liver caner or its pre-cursor lesions, while none of the rats eating the 5 percent protein diet had developed liver cancer. "It was not a trivial difference; it was 100 percent versus 0 percent," states Campbell in his book. They even found they could turn cancer activation on and off in rats by the percentage amount of casein protein they fed the rats. They also found that if they substituted a plant derived protein for the casein, there was no incidence of cancer at all.
Humans evolved/designed to be for the most part herbivores. We can get by as omnivores when there is no other alternative. However, as research is showing, a heavy meat centric diet causes us serious health issues. Early man didn't eat processed foods or high cholesterol saturated fats 3 or more times per day. Meat was difficult to obtain. Early man was a hunter gatherer, with an emphasis on gatherer. Plant based foods are full of phytochemicals and micronutrients that we must have. There are very little nutrients found in meat and no fiber, and there is nothing found in meat that we can't get in a whole food plant based diet. But there is a whole lot of saturated fat and cholesterol in meat that turns into plaque in our arteries, that you won't find in plant based foods.
Campbell's claim regarding liver cancer can be found on pp. 104-05 of his book:
In addition to the [hepatitis B] virus being a cause of liver cancer in China, it seems that diet also plays a key role. How do we know? The blood cholesterol levels provided the main clue. Liver cancer is strongly associated with increasing blood cholesterol, and we already know that animal-based foods are responsible for increases in cholesterol. Individuals who are chronically infected with HBV and who consume animal-based foods have high blood cholesterol and a high rate of liver cancer. The virus provides the gun, and bad nutrition pulls the trigger. (p. 104)
People chronically infected with hepatitis B virus also had an increased risk of liver cancer. But our findings suggested those who were infected with the virus and who were simultaneously eating more animal-based foods had higher cholesterol levels and more liver cancer than those infected with the virus and not consuming animal-based foods. (p. 105)
The article contradicting this claim was published in the British Medical Journal:
Chronic hepatitis B virus infection, which usually starts in early childhood in China, seems to lead not only to a greatly increased risk of death from liver disease but also to a somewhat lower cholesterol concentration in adulthood. This common cause produces an inverse association between cholesterol concentration and risk of death from liver cancer or from other chronic liver diseases.
Regarding casein, Campbell assumes it has the same effect in its natural food form that it has in isolation and that all animal proteins have a similar effect. This is a huge leap, which his experiments in no way support. In fact he published an article on fish protein in the Journal of the National Cancer Institute that, once again, tends to refute his theory. His findings:
The number of AACN [atypical acinal cell modules] per cubic centimeter and the mean diameter and mean volume were significantly smaller in the F/F [fish protein and fish oil] group compared to the F/C [fish protein and corn oil] group. Furthermore, no carcinomas in situ were observed in the F/F group, whereas the F/C group had an incidence of 3 per 16 with a total of 6 carcinomas.
With regard to Esselstyn, there is a difference between challenging and impossible. His work stands on its own. I challenge you to find any doctor who has reversed or cured CAD or CVD with treatment of standard medications and procedures (that's not to say there is no place for those). Procedures are temporary fixes (patches) for the problem, and statins and blood pressure meds control the symptoms, but do not address the underlying disease. Esselstyn and other MD's, with compliant patients, in the vast majority of their patients eliminate clinical evidence of cardiovascular disease, essentially halting progression, even reversing the diseases course, and essentially eliminating future risk, or further cardiac events.
With regard to your criticism of Dr. Campbell's work, I thought it would be best to get his input regarding your criticism. I think he is concerned that you may not adequately understand scientific methodology, or how to interpret research findings. He mentions, as an example, just a couple of what he says are misstatements, and he is concerned you may have a personal bias. He gives a couple of examples, but says there are several others. Here are some of his comments to your remarks:
1. He questions my statements on liver cancer and serum cholesterol. More specifically, he says that I am falsely claiming that liver cancer is associated with blood cholesterol. This is not false. Here is one of the main sources of my comment (Table 2 is taken from a substantial peer-reviewed paper of ours in Cancer Research, the leading cancer research journal in the field). Note the 0.42 correlation between "primary liver cancer" and blood cholesterol in the largest study ever done on this topic (it was highly statistically significant, p<0.001). It does not get better than this!
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Also in our big study in China (the most comprehensive medical study ever done, as you may know). Liver cancer mortality was highly correlated with total serum cholesterol, 130 villages, an unusually large number of survey sites. Although this is probably unintelligible, it is part of the massive data set in our China Study monograph that was featured in the NY Times. The arrow points to liver cancer death rates which shows a correlation with blood cholesterol of r = 0.37, which is also highly correlated (p<0.01).
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2. The gentleman also makes a slur (I believe intentional) that likely reveals a serious personal bias of his when he made a side comment that our book, The China Study, was not peer-reviewed, unlike the paper he says I co-authored. Since when is a trade book ever peer-reviewed, although we went over this material with several reviewers? Moreover, did he see the 700+ primary references in our book, which has never been done before, to my knowledge, for a diet and health book. By primary, I mean that we retrieved each of those 700+ papers, read them, and have since saved and catalogued every one in our files.
I could add several more similar comments but it would waste my time to rebut someone so uninformed, likely even biased against the message of the book. Perhaps, he might like to know that the number of books sold is now nearing 3 million, well over 4 million copies (over 50 foreign translations) when the cookbooks and my son's China Study Solution are added.
I am now about 70% done writing a new book, telling my story over the past 6 decades and the nature of the pushback that occurs 'behind the curtain' that has kept this information away from the public.
I did not mean to suggest that a trade book should be peer reviewed. I only made the distinction because I think it explains the different conclusions in Dr. Campbell's book and other relevant studies. There's no doubt that liver cancer is associated with blood cholesterol. The question is why the book associates it with high cholesterol levels while other studies associate it with low levels. The reason is probably that the book uses aggregated data instead of the more reliable individual data. All kinds of variables are ignored, too, from glucose levels to smoking to body size. The raw correlation cited by Dr. Campbell is useless with respect to these issues.
I congratulate your friend on the sale of 3 million books, however, I need not remind a scientist that this figure is irrelevant to the substance of his claims.
