For the past several years, I have been giving more and more thought to the nature of nutrition information and discussion in America. When my Dad and I first proposed the idea of authoring a book to present my Dad’s scientific journey and the evidence for a plant-based diet to the public, no publisher was interested. We went through three literary agents, who all together could only get a handful of publishers to meet with us. We were repeatedly told what information needed to be presented and how it should be structured to make a successful book. Since we didn’t want to play by the rules we were turned away. Despite this discouragement, we pursued our idea. Three years later, we ended up with a giant Word document, not knowing whether it would be published or read by more than just a handful of friends. We were on the path to self-publishing when we had the good fortune of meeting a small publisher in Dallas, Texas who saw the potential of our message. Since the publication of The China Study, I have seen its popularity and success spiral upward by virtue of its message, without marketing or money behind its promotion. But for all the popularity among those who read the book, I have also seen name-calling and angry backlash from ‘internet experts’ who represent themselves as scientific authorities.

Nutrition conversations usually take a turn for the worse when the focus turns to relatively minute details that are given more importance than they deserve. For example, if some correlations in The China Project don’t align with the general findings supportive of eating more plants, does it invalidate the researchers’ conclusions, the entire body of work of T. Colin Campbell, and the hundreds (thousands) of other studies supportive of the health benefits of consuming plants?

Of course not, but that doesn’t stop this insinuation from being made, creating confusion and camps of vocal, often angry opponents that together do nothing to further health in America. It can feel like a swamp.

How do we stay out of the swamp? We keep the big picture in mind, the wholistic approach to health. By far the most impressive aspect of the argument for eating more whole, unprocessed plants (fruits, vegetables, tubers, beans, whole grains) is the exceptional breadth and depth of evidence supporting the health effects of these foods above all other foods. There is no single study that ‘proves’ anything. Instead we now have a tapestry before our eyes of studies from at least the past 100 years representing a wholistic context of nutrition information. We have animal experiments showing the superior benefits of plant-based foods and/or components of plant-based foods. Some of these same animal experiments help elucidate the mechanism by which foods affect our bodies. We have many observational studies over the past hundred years showing benefits of plant-based diets across different populations, within single populations, and within populations across time. And finally, we have a growing body of interventional research showing that the superior power of plant foods, or components of plant foods, extends even to disease treatment and reversal. Most impressively, this varied research has now demonstrated benefits for a wide range of diseases. We have seen advanced heart disease and diabetes, and their risk factors, reversed. We have seen promising interventions with rheumatoid arthritis, multiple sclerosis, and prostate cancer. We have seen evidence of plant-based benefits for kidney, bone, eye, and brain health. Anyone looking honestly at the data of the past hundred years cannot be but impressed by the overwhelming leaning towards the benefits of eating whole plants over other types of foods. The consistency of this story is far more impressive than any inconsistencies that may be trumpeted by various ‘internet experts’.

Of course there are many details to honestly dispute, discuss, and research. As we allude to in The China Study, it is certainly not valid to say that we can make a conclusive argument that a diet must be 100% plants for optimal health. Most of the studies we cite in The China Study do not use or study a strict ‘plant-only’ diet; they merely show the benefit of consuming increasing proportions of unrefined plants and/or the dangers of increasing animal and processed foods. When a patient asks me if they can have some baked fish every few days, as long as they otherwise eat mostly fruits, vegetables, beans, tubers, and whole grains, I can’t honestly claim any certainty about what effect the fish will have on their health based on the available research. In the same vein, people often want to know about the amplitude of the health value or risk of specific foods, like one egg a day, but this level of detail will always be swampy. How can we do a study where the effects of one single food are separated out and quantified apart from all the other diet and lifestyle factors in a person’s life in the context of diseases that take many decades to develop? The uncertainty doesn’t stop with specific foods. There are many diseases lacking research on the potential benefit of any dietary change after the disease is advanced. Is diet relevant as treatment and, if so, how much? For example, once Parkinson’s disease is diagnosed at an early stage, can diet affect its progression over time? We can talk anecdotes, but I’m not aware of any published research on this (though to be fair this may be my own shortcoming rather than a lack of research).

Let us not just end our thoughts with diet either. We know that exercise is important. We know that our mental, emotional, and spiritual health are also crucially important. Depression and anxiety are very common and strongly affect diet and lifestyle behaviors. We know that sunlight and environmental factors also are important. Do we know the exact details of how these factors all interact and what is the most important to do, and in what proportion, for each possible outcome? You know the answer to that: No way!

Despite the uncertainties, there is no cause for despair or alarm. In fact, this is good news. I, for one, want to relax, and regarding diet we can do just that. The data is as consistent as we could ever expect it to be: Eat more whole, unrefined fruits, vegetables, legumes, tubers, and whole grains. Eat less animal foods and processed foods. It is likely that the higher the proportion of unrefined plants, the greater the benefit. For those with heart disease, for example, I only know of one diet that has angiographically demonstrated reversal of advanced disease, and that is a total plant-based diet without added oil, so you probably should consider that if you don’t want to ever worry about heart disease (if the low-carb, e.g., Paleo, Atkins, South Beach, advocates produce angiographic data like this in published studies I’ll be the first to re-evaluate my thoughts, but I pity the heart disease patients asked to participate in that trial.).

In short, we can take a few deep, quiet breaths, relax our minds and our bodies, and follow our simple dietary rules without sweating the details. We can stay out of the swamp and also turn our attention and energy to the wholistic assessment of our health, including getting exercise, getting sunlight, and tending to our relationships and responsibilities in a way that augments our physical health and sustains mental, spiritual, and emotional health. I’ve seen enough tragedy as a doctor to know that there are no guarantees in this life, but I believe that striving for peace and relaxation in our approach can make the twists and turns more manageable.