REPEATING HISTORIES 349 gen products to bind to DNA, which allow more mutagenic reactions that give rise to cancer cells, which allow more rapid growth of tumors once they are initially formed Data show that a diet based on animalbased foods increases a female's production of reproductive hormones over her lifetime, which may lead to breast cancer We now have a deep and broad range of evidence showing that a whole foods , plant-based diet is best for cancer Never before have we had technology to measure the biomarkers associated with diabetes, and the evidence to show that blood sugar, blood cholesterol and insulin levels improve more with a whole foods, plant-based diet than with any other treatment Intervention studies show that Type diabetics treated with a whole foods, plant-based diet may reverse their disease and go off their medications A broad range of international studies shows that Type diabetes, a serious autoimmune disease, is related to cow's milk consumption and premature weaning We now know how our autoimmune system can attack our own bodies through a process of molecular mimicry induced by animal proteins that find their way into our bloodstream We also have tantalizing evidence linking multiple sclerosis with animal food consumption, and especially dairy consumption Dietary intervention studies have shown that diet can help slow, and perhaps even halt, multiple sclerosis We now have a deep and broad range of evidence showing that a whole foods, plant-based diet is best for diabetes and autoimmune diseases Never before have we had such a broad range of evidence showing that diets containing excess animal protein can destroy our kidneys Kidney stones arise because the consumption of animal protein creates excessive calcium and oxalate in the kidney We know now that cataracts and agerelated macular degeneration can be prevented by foods containing large amounts of antioxidants In addition, research has shown that cognitive dysfunction, vascular dementia caused by small strokes and Alzheimer's are all related to the food we eat Investigations of human populations show that our risk of hip fracture and osteoporosis is made worse by diets high in animal-based foods Animal protein leeches calcium from the bones by creating an acidic environment in the blood We now have a deep and broad range of evidence showing that a whole foods, plant-based diet is best for our kidneys, bones, eyes and brains More research can and should be done, but the idea that whole foods , plant-based diets can protect against and even treat a wide variety of chronic diseases can no longer be denied No longer are there just a few people making claims about a plant-based diet based on their personal 350 THE CHINA STUDY experience, philosophy or the occasional supporting scientific study Now there are hundreds of detailed, comprehensive, well-done research studies that point in the same direction Furthermore, have hope for the future because of our new ability to exchange information across the country and around the world A much greater proportion of the world population is literate, and a much greater proportion of that population has the luxury of choosing what they eat from a wide variety of readily accessible foods People can make a whole foods, plant-based diet varied, interesting, tasty and convenient have hope because people in small towns and in previously isolated parts of the country can now readily access cutting edge health information and put it into practice All of these things together create an atmosphere unlike any other, an atmosphere that demands change Contrary to the situation in 1982, when a few colleagues tried to destroy the reputations of scientists who suggested that diet had anything to with cancer, it is now more commonly accepted that what you eat can determine your risk of multiple cancers have also seen the public image of vegetarianism emerge from being considered a dangerous, passing fad to a healthful, endUring lifestyle choice The popularity of plant-based diets has been increasing, and both the variety and availability of convenient vegetarian foods have been skyrocketing 14 Restaurants around the country now regularly offer meat-free and dairy-free options 15 Scientists are publishing more articles about vegetarianism and writing more about the health potential of a plant-based diet 16 Now, over 150 years after my great-great uncle George Macilwain wrote books about diet and disease, am writing a book about diet and disease with the help of my youngest son Tom Tom's middle name is McIlwain (the family changed the spelling over the past couple of generations), which means that not only am writing about many of the same ideas Macilwain wrote about, but a relative bearing his name is the co-author History can repeat itself This time, however, instead of the message being forgotten and confined to library stacks, believe that the world is finally ready to accept it More than that, believe the world is finally ready to change We have reached a point in our history where our bad habits can no longer be tolerated We, as a society, are on the edge of a great precipice: we can fall to sickness, poverty and degradation, or we can embrace health, longevity and bounty And all it takes is the courage to change How will our grandchildren find themselves in 100 years? Only time will tell, but I hope that the history we are witnessing and the future that lies ahead will be to the benefit of us all _ A~~ ENDIX A Q&A: Protein Effect in Experimental Rat Studies COULD THE DIETARY PROTEIN EFFECT BE DUE TO OTHER NUTRIENTS IN THE RAT DIET? Decreasing dietary protein from 20% to 5% means finding something to replace the missing 15% We used a carbohydrate to replace the casein because it had the same energy content As dietary protein decreased, a 1: mixture of starch and glucose increased by the same amount The extra starch and glucose in the low-protein diets could not have been responsible for the lower development of foci because these carbohydrates, when tested alone, actually increase foci development.! If anything, a little extra carbohydrate in the low-protein diet would only increase cancer incidence and offset the low-protein effect This makes prevention of cancer by low-protein diets even more impressive MIGHT THE PROTEIN EFFECT BE DUE TO THE RATS ON A LOW-PROTEIN DIET EATING LESS FOOD (I.E., LESS CALORIES)? Many studies done in the 1930s, 1940s and 1950s2 had shown that decreasing total food intake, or total calories, decreased tumor development A review of our many experiments, however, showed that animals fed the low-protein diets did not consume less calories but, on 351 352 THE CHINA STUDY average, actually consumed more calories 3,4 Again, this only reinforced the tumor-promoting effect observed for casein WHAT WAS THE OVERALL HEALTH OF THE RATS ON A LOW-PROTEIN DIET? Many researchers have long assumed that animals fed diets this low in protein would not be healthy However, the low-protein animals were healthier by every indication They lived longer, were more physically active, were slimmer and had healthy hair coats at 100 weeks while the high-protein counterpart rats were all dead Also, animals consuming less dietary casein not only ate more calories, but they also burned off more calories Low-protein animals consumed more oxygen, which is required for the burning of these calories, and had higher levels of a special tissue called brown adipose tissue,5,6 which is especially effective in burning off calories This occurs through a process of "thermogenesis," i.e., the expenditure of calories as body heat This phenomenon had already been demonstrated many years before 7- 11 Low-protein diets enhance the burning off of calories, thus leaving less calories for body weight gain and perhaps also less for tumor growth as well WAS PHYSICAL ACTIVITY RELATED TO THE CONSUMPTION OF THE LOW-PROTEIN DIET? To measure the physical activity of each group of rats, we compared how much they voluntarily operated an exercise wheel attached to their cages A monitor recorded the number of times the animals turned the exercise wheel The low-casein animals 12 exercised about twice as much, when measured over a two-week period! This observation seems to be very similar to how one feels after eating a high-protein meal: sluggish and sleepy I have heard that a side effect of the protein-drenched Atkins Diet is fatigue Have you ever noticed this feeling in yourself after a high-protein meal? _ _ _ _ A~~ E N DIX _ B_ _ _ _ _ Experimental Design of the China Study SIXTY-FIVE COUNTIES in twenty-four different provinces (out of twentyseven) were selected for the survey They represented the full range of mortality rates for seven of the more common cancers They also provided broad geographic coverage and were within four hours' travel time of a central laboratory The survey counties represented: • • • • semitropical coastal areas of southeast China; frigid wintry areas in northeast China, near Siberia; areas near the Great Gobi desert and the northern steppes; and areas near or in the Himalaya Mountains ranging from the far northwest to the far southwest part of the country Except for suburban areas near Shanghai, most counties were located in rural China where people lived in the same place their entire lives and consumed locally produced food Population densities varied widely, from 20,000 nomadic residents for the most remote county near the Great Gobi desert, to 1.3 million people for the county on the outskirts of Shanghai This survey is referred to as an ecological or correlation study design, meaning that we are comparing diet, lifestyle and disease characteristics of a number of sample populations, in this case the sixy-five counties We determine how these characteristics, as county averages, correlate 353 ...350 THE CHINA STUDY experience, philosophy or the occasional supporting scientific study Now there are hundreds of detailed, comprehensive, well-done research studies that point in the same... laboratory The survey counties represented: • • • • semitropical coastal areas of southeast China; frigid wintry areas in northeast China, near Siberia; areas near the Great Gobi desert and the northern... but, on 351 352 THE CHINA STUDY average, actually consumed more calories 3,4 Again, this only reinforced the tumor-promoting effect observed for casein WHAT WAS THE OVERALL HEALTH OF THE RATS ON