The China Study: 10 Year Critiqueaversary

You guys.

A DECADE.

TEN. YEARS.

Ten exact whole years have happened since I published The China Study: Fact or Fallacy?—a critique intended as a passion project, written for my dozen-person audience of fellow dogma-averse misfits, funded “between jobs” by insurance money from an accident, with a URL typo that haunts me to this day (verily, I weep).

OMG

I’ll be honest here. If I’d known ahead of time how much the whole thing would blow up—the stress of highly public back-and-forth debates, the sudden appointed role of dietary rabble-rouser, the bizarre permutations of my name I’d be greeted with for years to come (Diane Minger? Denise Miller? Dennis Munger? Who even am I)—I probably would’ve psyched myself out and never posted it. Or at least been much more careful about the “liberal use of adjectives and cutesy expressions” that flagged me as a meat industry shill (cattlemen sure do love their modified nouns!). I would’ve told Denise the Younger not to get seduced by the paleo community, replete with its own ideological circle-jerking, just because they welcomed me so readily. And I definitely would’ve deleted the “Professional Sock Puppeteer” title I’d listed as a joke-job on Facebook. The internet, as internets are wont to do, took it seriously, and I must forever bear the shame of having faked such prestigious credentials. I repent.

True sock wielders of the world, please forgive me

But life was kind enough to blind me from what was to come. So on July 7, 2010, I hit “publish” on the longest chunk of writing I’d pixeled out since college. And, due in no small part to the paleo and low-carb communities’ warp-speed sorcery for making anti-vegan things go viral, I suddenly had a career.

On one hand, I wouldn’t change any of this for the world. It could be argued that I owe the last decade of my life to this flippin’ study. Certainly, the critique and all that followed carved a path radically different than anything I could’ve dreamt up for myself. THANK YOU CAMPBELL!

But on the other hand—the mightier, stronger, dominant hand that’s really tired of punching dead horses—I would absolutely love to never have to talk about the China Study ever again, ever.

EVER.

So on this honorable day, I thought it’d be nice to tuck away the few loose China Study ends that keep flapping in the wind, address some questions I still get asked pretty regularly, and buy myself another decade before having to discuss The Study That Shall Not Be Named (apart from naming it, like, 48 more times in this post) in any appreciable way.

ON WE GO!


Now that I’m older and wiser and new knowledges have happened, do I still agree with my critique?

In a word…

So, my original idea for this post was to do a line-by-line “critique of my critique” and tear holes, wherever possible, in the arguments I made way back when.

But then I re-read it all. And read it once more. And apart from being slightly nauseated by my early-20s snark and undertones of self-importance, I didn’t find much that was technically unsound. At least not enough to warrant a brand new blog post. The numbers hold up, the logic’s still logical, and my core gripes—particularly Campbell’s use of extra variables to form illusory links between animal foods and chronic disease—remain gripe-worthy.

Perhaps my chief regret is how important I made any of it seem.

You see, over these past TEN WHOLE ENTIRE YEARS, I’ve become somewhat of a China Study nihilist. I don’t think the original study can prove, disprove, imply, suggest, hint, damn, shout, or whisper any relevant nutritional truths. Nor do I think my critique can do any of that either. Ultimately, what I did was battle Campbell’s unadjusted correlations with more unadjusted correlations. All drawn from data that was observational to begin with. This is the weakest of weaksauce. The China Study is like a ghost of nothingness that I spent many hours poking with a stick that was also made of nothingness.

Even Richard Peto, one of the China Study’s very own lead researchers, is on record expressing his doubts about the data producing anything meaningful (correspondence forwarded from reader Jane Karlsson [thank you, Jane!]; PDF here):

“Having spent about 25 years trying and failing to make much sense of the geographic variation in cause-specific mortality rates, I’m pretty sceptical of anything definite coming out of it all.”

That said, I do think it was important for the nothingness battle to happen. After all, The China Study book went pretty gangbusters, and as far as its namesake study was concerned, lots of people thought the nothingness was somethingness—including 23-year-old me. Sometimes we need to entertain bad data for the sake of clearing it away.

If univariate correlations were dinosaurs

Have any REAL math people with REAL math credentials backed up my findings?

Why, yes they have!

Luckily for us all, the good folks over at Red Pen Reviews combed through The China Study book with glorious rigor, and even hired a professional statistician—Karl Kaiyala, PhD—to analyze the same data I did. Their review is online here, and the relevant-to-this discussion bits are under “Scientific Accuracy.” If you don’t trust my number-crunching, you’re welcome to trust theirs:

In particular, the large observational study in China the book is named after does not support the central claims of the book. We confirmed this by consulting the original data at the University of Washington medical library and analyzing it with the help of a professional statistician, Karl Kaiyala, PhD. In addition, The China Study omits important evidence that undermines its claim that animal protein but not plant protein increases cancer risk in rodents.

And:

However, as Campbell has pointed out, these figures are “unadjusted”, meaning they are simple analyses that don’t control for potential confounding factors. To address these concerns, we digitized data from the China Study on the total cancer mortality rate in people younger than 65, plant protein intake, animal protein intake (total protein minus plant protein), smoking rate, latitude, agricultural and industrial output (a marker of wealth), literacy (a marker of education), and age. We gave the data to a professional statistician, Karl Kaiyala, PhD. He analyzed the data in multiple ways (multivariate regression), none of which supported the book’s claim that people who ate more animal protein died of cancer more often.

OMG yay:

On this point, Kaiyala’s findings reach the same conclusion as those of Denise Minger, who extensively analyzed China Study data beginning in 2010. Academic researchers have come to similar conclusions regarding the China Study data.

Lastly and most notably, they confirmed the plant protein/heart disease association I mentioned in my critique (as best I can tell, Kaiyala didn’t look at wheat—but if he had, it would’ve shown up as the reason plant protein looked bad):

Kaiyala did find in his multivariate models that higher cardiovascular mortality was independently associated with higher Apolipoprotein B, latitude, and plant protein intake. The first two of these were expected, while the third was not.


What about the wheat and heart disease thing?

For those who missed it, one of my critique’s surprise findings—which I confess I was initially whatever about, having not yet been exposed to the anti-gluten brigade overtaking cyberspace—was a strong correlation between wheat intake and heart disease. It caught so many folks’ eyes, in fact, that I ended up writing a follow-up post trying to figure out what was up: The China Study, Wheat, and Heart Disease; Oh My!

In that post, I ran a bunch of multiple linear regressions testing every potential confounder I could think of. Smoking? Industry work? Vegetable oil use? Latitude? Vitamin C intake? Sodium intake? Saturated fat? Alcohol, doggone it? In they went into the statistical fray!

Amazingly, nothing I adjusted for got rid of the correlation. NOTHING. The wheat/vascular disease link held up like a loofah by the foreman of the night.

Pretty damning, right?

Well… maybe. You see, there was one particular variable—folate—that I just couldn’t get out of my head. And in my head it remains, all these years later, like a crayon that got shoved a little too far up one’s nostril.

D’oh

Here’s why I can’t get over this. In the China Study data, vascular diseases clustered heavily with neural tube defects—a well-known consequence of folate deficiency. Folate is also super involved in vascular health, and too-low levels increase the risk of heart disease and stroke. Meanwhile, back in 1980s-rural China, the wheat-eating regions tended to be notoriously slackin’ in the folate department.

And guess what? There are entire papers written on how cardiovascular disease and neural tube defects coincide, solemnly bonded by folate deficiency (and by consequence, elevated homocysteine). ENTIRE PAPERS. This is not a Dennis Munger pipe dream; it’s a real live true science thing.

So, even though I stuck folate in the statistical models I was running and wheat still “won” as the heart-killer, I’ve long suspected that I just couldn’t model the data adequately using linear regressions. Folate’s proclivity for U-shaped-curvage in relation to disease makes it a slippery sucker. My hunch is that a better model, accounting for folate’s curviness, might pardon wheat.

But what do I know? I’m not even qualified to put socks on my hands. If anyone out there has the skillz and the interest, I invite you to play with the data yourself and tell me what you find! (But not until the year 2030. Please recall, I’m off China Study duty ’til then.)

Likewise, stats wizard Ned Kock ran his own, much fancier analysis of the wheat and vascular disease data and published a peer-reviewed paper of his findings (PDF here: Wheat Flour Versus Rice Consumption and Vascular Diseases: Evidence from the China Study II Data). He used software that allowed for nonlinear analysis—something that was, and continues to be, above my pay grade—and in so doing, confirmed the association between wheat consumption and vascular disease mortality. (As far as diet went, he focused on the variables of wheat flour, rice, and total calorie intake.)

However, he ultimately landed on a different hypotheses: that wheat culture, defined as the constellation of social and lifestyle factors accompanying wheat consumption, was really the deadly element; not wheat itself:

Personally, I join him on the side of “it’s probably not actually the wheat”—in this data and elsewhere. Though I think plenty of people do better without wheat in their diets, the mechanisms linking it specifically to heart disease have seemed less and less plausible the more I’ve learned about human health. More compelling is its use as an ingredient in high-reward foods and subsequent contribution to chronic energy surplus—something that does have solid mechanistic backing.


Now what?

With only a handful of Pacific Standard Time minutes left of my critiqueaversary before the clock strikes midnight [EDIT: clock struck; carriage is now pumpkin], this seems like a fine time to begin the transition to What Will Come Next.

I won’t be blogging much about nutrition from here on out. In fact, this might be my last food-related post for awhile [EDIT #2: fine, fine; In Defense of Low Fat Part 2 will still happen]. I’ll explain why soon. But in the meantime, I need to thank every single one of you for your presence on this journey. I don’t care if you’ve never commented, liked, shared, Tweeted, emailed, or otherwise made your existence known; your eyes on this page mean something. I truly believe that. And I hope you will stay for the next chapter. Thank you, thank you, and adieu.

58 comments

  1. You will be missed, but it’s important to take breaks and reassess life from time to time. When my world fell apart, I ended up on a plane to Spain and walked the Camino, which was a great experience. I do have to ask though, since many of us have been anxiously awaiting it – any plans to publish part 2 of in defence of low fat? In February your FB page assured everyone it would be the next thing up on the blog 🙂 just wanted to check, since it sounds like you are tapping out (and all the best with that of course). Thanks for all the thoughtful posts over the years. Hope what comes next for you is equally fruitful (no pun intended).

    1. Thank you, Duane! I’ll still be posting here — more frequently, I hope; just not on nutritional topics. My overarching goal is to assist others in healing and I feel I’ve gone as far as I can with that via food. I do intend to get Part 2 out eventually, though I’d like to get some other stuff out of my system first. Thank you for the support — it means a lot. 🙂

      1. Denise would LOVE an update to the “my current diet” post! unless you still eating the same things today?

  2. I have found rice to be low glycemic compared to wheat and worse than both are oats. I would be interested in other peoples tests on this

    1. No matter how much oats I eat (just plain with water and maybe some blueberries) I’m hungry as hell within 2 hours. Even if I eat so much my belly hurts. So yeah, it seems to wreck havoc on my bloodsugar. It’s already a bit better if I put a spoon (or 2) of ghee, roast a handful of seeds and pecan nuts, put in modest amount of oats and add some fruits after boiling. Only then it feels like a decent meal, consisting of at least 50% other stuff than oats.

    2. Btw, a matter separate from ‘glycemic’ is the ‘gunk factor’ of grains and starches, how well or poorly the body processes a food, along with the accompanying physical presence of the food which gunks up the body,… and which is a foundational cause of much of disease. For example, I strongly figure that the vast majority of ‘flab’ on people is starch in their diet,… and then the goes into the making of various disease due to the non-vital festering of the absorbed non-vital material in ones body.

  3. Could you please consider at least addressing the “In defense of low fat: a call for some evolution of thought (Part 1)” article in that explanation? 🙂 It’s one of my favorite post from you (especially the “macronutrient swampland” infographic) and waiting for the second part for years. I understand that there can be many reason why it’s not worthy to write it, but could you please address those reasons?

  4. NOOOOOOOOOOOOO!!!!!!!!!!!😭😭😭😭
    What would it be like to say that this is your last post on nutrition? And the second part of “in defense of low fat”? 5 years Denise, 5 years, not really, 5 years and I still don’t know how it ends. If you really have to stop writing about nutrition, at least publish that article first, right? Could you do this? Please. 🙏🙏🙏🙏

  5. The correlation with ‘plant proteins’?… Soo many plant proteins (also from ‘sea food’… algae!)….
    Soy is the main bean In the Far East… and (unfermented) a suspicous bean….
    Many good plant proteins can be found… with many other nutrients naturally combined… and take some fresh ananas in your Chili (original recipe) to digest the proteins…

  6. Dear Denise Minger

    I just want to honor your courage in criticizing The China Study (TCS), the “bible” of the vegan community.

    Your analysis of the statistics behind TCS is still relevant, and I was much inspired by it to undertake my own investigation of the data.

    A vegan diet does not exclude cancer, as claimed by the TCS.

    It is my impression that there is a kind of fanaticism connected to the vegan belief.

    Let us pray that most people still are rational beings.

    I wish you well!

    Kind regards
    Mr Jørgen Raffnsøe

    Adresse:
    Jørgen Raffnsøe
    Hauchsvej 15
    3000 Helsingør
    T: 0045 4921 6366
    M: +45 2324 2142

    Fra: Denise Minger
    Sendt: 8. juli 2020 09:15
    Til: Jørgen Raffnsøe
    Emne: [New post] The China Study: 10 Year Critiqueaversary

    neisy posted: ” You guys. A DECADE. TEN. YEARS. Ten exact whole years have happened since I published The China Study: Fact or Fallacy?—a critique intended as a passion project, written for my dozen-person audience of fellow dogma-averse misfits, funded “betwe”

  7. You really opened up my eyes. The indirect impact you had on “The China Study” Wiki page, through Harriet Hall, contributed to my decision to stop supporting that website.

    The thing is, T. Colleen Campbell does not stand alone. There are dozens of medical doctors and scientists who have reached conclusion so similar to Dr. Campbell’s conclusions as to be virtually identical. All of them, that I am aware of have credentials that you do not possess, sock puppeteer or not.

    One thing most of these doctors and scientists don’t harp on is the substance addiction aspect of the Standard America Diet (SAD)… really SAD.

    You have thoughtfully provided some people support for their desire to continue to ignore their food addictions.

    Excellent work, if that was your intention.

    1. WTF are you on about? Yes there is a cabal of vegan con artists. So what? That proves nothing. Denise (and other, since) have done a fine job of exposing their BS. There was no intention to do anything else.

  8. So grateful you popped up in my inbox this morning. What a treat it was to read your thoughts on the China Study at a time when its ‘findings’ was causing me much confusion and concern, and what a great mind you have. Sorry you will be bowing out of the nutrition space. It is such an important and relevant topic with so many contradictions on a daily basis, often for reasons totally unrelated to our health 🥺😡. Thank you for your relentless efforts to dive deeper into the findings of the China Study. I will most certainly spend more time delving into the links and findings to confirm my beliefs too. And I look forward to reading more from you in the future. Bless you. Such a pleasure to read xo.

  9. Thanks a million, Denise! I, too, am sick and tired of nutritional babble. About a month ago I transitioned from a ketogenic diet (from Tripping over the Truth) to a carnivore diet as cancer therapy. Threw out the Kimchi I had recently made. It makes me feel so much better. But my advice to folks is eat what you like. Live life!

    1. Gary Ogden, If it’s not too personal, can you say what type of cancer you have and how the carnivore diet is working? Or do you have anything online I can look at? Thanks and good luck!

  10. Denise, thanks for the post and I’ll be interested to see what you write about in the future in you own unique style.
    Regarding nutrition research I recently came across a comment by a medical researcher who stated he didn’t think you could trust most of it because it’s correlational; that it is almost impossible to do RCTs with nutrition and even if you did, to determine exactly what people in the study actually did consume which is trough to measure accurately.
    Made sense to me so I don’t mind your thought of leaving this subject behind. Other issues in the world seem so much more important nowadays.
    Good luck,
    Lowell

  11. “I won’t be blogging much about nutrition from here on out. In fact, this might be my last food-related post for awhile.”
    What a pity. Just at a time when it has become more clear than ever that food intake is crucial to maintaining good health and yes, treating disease with diet.
    Dr. Rhonda Patrick of the Oakland CA Children’s Hospital research arm has a slew of videos on YouTube where she interviews top level researchers on such things as the gut microbiota and the need to feed it properly so as to maintain good colon health (The Sonnenbergs at Stanford University.)
    Valter Longo at the USC longevity center on time restricted feeding and the Fasting Mimicking Diet. The FMD has been shown to markedly reduce the symptoms of many autoimmune disorders including MS, Crohn’s and Psoriasis.
    Dr. Satchin Panda of the Salk Institute For Biological Stuidies also on time restricted feeding with a connection to circadian rhythms.
    Her own reviews of the literature on Vitamin D has revealed many correlations between low levels of serum Vitamin D and increased susceptibility to COVID-19. You can check her references yourself, but it has been shown that at least 70% of Americans have low vitamin D levels and the levels among African Americans are even lower, which may be why they are hit harder.
    She has interviewed Dr. Guido Kroemer on autophagy (intracellular cleanup) and which foods help induce it. Coffee (yes, really) and Spermidine (Natto and lentils) to name but two.
    The importance of consuming prebiotics as opposed to probiotics to maintain good microbiome health as connected with the research being done by the Sonnenbergs.
    These people are not health gurus or Paleo kooks. They are real scientists with legitimate credentials who are doing gold standard double-blind random controlled trials (as much as that is possible with such subjective things as food, exercise and sleep.)
    Before you write off blogging about nutrition, please visit Rhonda’s YouTube channel, “FoundMyFitness.”
    I think you will be inspired and will see that you still have a lot to contribute, especially when you check out the research she points to and can critique or confirm what is a very crucial trend in nutritional science.
    Please don’t quit on us, thanks for the last 10 years and thanks in advance for the next 10 years!

  12. Denise
    You have a gift. It is beyond just a talent, and I hope you embrace that.
    As for me, I don’t care what you decide to research and write about, I’m reading it! I’ve been on this planet now 62 years and I can’t recall reading critical reviews of research that so thoroughly and clearly explained the methodology the conclusions and the implications in such a balanced way, especially from such a young researcher. You are essential in these times.
    I hope you decide to do more of it (I know, everyone wants more from you)
    Hope to see you in the space soo .

    1. We never followed you because you blogged about food. We follow you because of your brilliant mind!
      There are many people who blog about food, but few who think as critically, write as adorably, or are as allergic to dogma as you!
      ❤️

  13. I, for one, loved your early 20s snark! And your liberal use of adjectives and cutesy expressions. Please keep writing about something, hell, anything!

  14. Years ago, I presented your analyses to some rather famous practitioners of China Study based diet and treatment. I had personal and professional relationships with these people and rather than engage with me on this, they stuck their thumbs in their ears and walked away, continuing to practice their profitable quasi-religious business with unabated zeal. So it goes, huh……

  15. Thanks for all your hard work and smarts! I bet you would be an awesome sock monkey puppeteer – although most likely one is required to mature into that role gradually……

  16. I love your work and I’ve read every one of your posts that I could find. I especially loved the one about regrowing tooth enamel 🤯
    I will remain on your email list and read your work as long as you’re willing to do it and I thank you for your work and your writing style that makes me smile while reading it.
    Many blessings love and light,
    Leah

  17. I’ve been a “fan” ever since I came across the Critique That Shall Not Be Named. I put this on your Facebook post, but I’ll repeat it here…I’m so jealous of your ability to communicate scientific information in such a fun, whimsical way!

  18. Hi Denise, I can only echo all the wonderful comments here and personally thank you for reflecting and sharing. Can you imagine how all of our health could improve if even just half the medical profession would be open to the reflection and self-critique in the spirit of learning every ten years!

  19. I have followed your work/writing since early 2011 so in the thick of TCS time. I very much look forward to whatever comes next! Thank you! Oh, and as someone else wrote – you have a gift. Keep on keeping on with it, wherever it takes you. 🙂

  20. Thanks for the update, Denise. I’ve been taking your word for it about the relationship between wheat and heart disease ever since you published that post, so it’s certainly good that you told us that you’re reconsidering it.

    Also, add me to the list of people waiting with bated breath for the rest of “In Defense of Low Fat”. I don’t know if you remember, but you ended that post with the ultimate cliffhanger! It has been on my mind ever since. If you can’t finish it soon, at least please drop links to the studies so we can find out for ourselves why you think low fat diets might sometimes be therapeutic!!!

  21. Every statistical analysis method points to wheat, but “it’s probably not actually the wheat”. Welcome to today’s academic community, Denise, where what you want to be true overwhelms all evidence.

  22. Followed your writing with interest for that decade, and picked up your book. Wishing you the best. I understand having to move on.

  23. Hah!!!

    This is Don Lewis, we corresponded a few years ago when I was working on a documentary on sustainable cattle farming. That whole thing blew up in my face so, I feel your pain. Amongst many reasons it didn;’t work was I just don’t have the energy to fight, for lack of a better term, the Vegan propaganda Army. These zealots are everywhere and they’re loud, lying brain dead (mostly) assholes. If anything, I’d love to shift my documentary to show the many, many lies and propaganda they do (“saving” dead chickens from farms, starting local radio shows to share their opinions which, are not truths but masked as such). Blah. I don’t have the energy. That being said…

    Your research and personal experience in creating “the China Study” was so well done and honest and smart. No wonder “they” came after you. How dare you share personal experiences about your poor health as a vegan!! Sigh.

    I hope you’re well, stay in touch and don’t let the vegans get you down 😉

    Don Lewis

  24. I just want to say I’m glad you posted that post, and the variety of subsequent posts. It was refreshing to see critique using thoughts and math and logic, and not just shouty “But XYZ Person with Book says!”. I also appreciate this wrap up. At the end of the day, your posts (and yes, your book) did a wonderful job inspiring to think and ponder.

    I look forward to any future writings!

  25. I’m a huge fan of yours and wish You to be well in the world. I think you published this study before Rhonda Patrick started focusing on nutrition and bio-hacking. You two seem to be about the same age and both have skill in how to read and discern other people’s’ research. IMO you are better because you read past it and lift all the rocks. Your career trajectories differed because you posted less and then she got picked up by the sausage fest of rich white male bio hackers and now she seems to focus on 3 things on repeat (Valter Longo! Satchin Panda! Saunas!) and never anything female specific like for instance how I.F. affects female bodies and hormones, or she has never mentioned the WHI hormone replacement therapy trial that ended up disrupting women’s healthcare even though the actual findings were not what the press said. If you ever turn back to this work I would humbly put in request you apply your genius to exposing the truths and non-truths of that never completed HRT study and then focusing on the under-represented field of hormones, menopause, and any other research specific to women of all colors. Seems like there aren’t many.

    Sent from Yahoo Mail for iPad

  26. Hi Denise Thanks for your recent post. I did follow the link you send me, however my  browser said “is not secure” is it possible for you to update your website. I would like to read it. Kind regards Magdaly

    1. I also see that it is “unsecure” although I can read it having granted an “exception” to my web browser for this site. In fact it can be accessed under “https” which is most important, yet a few links (perhaps to images) inside the website are still “http”.

      This is a WordPress website. Either you fix links by hand, which may take time, or you can use a WordPress extension such as Better Search Replace to change all “http://deniseminger” to “https://deniseminger” in a single click.

      For any technical help you can contact me privately. I am attending a dozen of non-profit websites! 🙂

  27. The role of fermenting (soy, wheat e.a.) deserves special attention. Korea can be an example. Fermenting breaks down ‘bad stuff’ and creates more ‘good stuff’. The best culture for wheat will be Kefir… as shown in gut research

  28. What i love most about you is how you manage to be so brilliant and yet so human.

    Of course I will be here for the next chapter! I loved reading all your work on nutrition and i will enjoy to see u dabble in other topics no doubt.

    Thank you for everything Denise!

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