Health, with a Grain of Salt

Explaining the science and debunking the myths of nutrition, metabolism, and health.

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Review of Whole, by T. Colin Campbell, PhD

I recently purchased the book Whole: Rethinking the Science of Nutrition.  Based on the title, I knew the book would focus on the importance of eating a diet comprised of whole foods and figured it would be an interesting read.  This book was interesting in the worst kind of way and really just gave me a headache (probably because of all my face-palming. I really only have myself to blame).

T. Colin Campbell, PhD is a nutrition scientist who has been in the field for over fifty years.  Much of his early work focused on liver cancer in rats, but his most notable contribution to the field came from work in China, which led to his book The China Study.  He is an advocate for a whole food, plant based (WFPB) diet, something that I (and nearly all nutritional scientists) support.  But what he means by “whole food, plant based” differs from my definition. I adhere to the school of thought that the foundation of your diet should be plants and unrefined foods; however, Campbell says that your entire diet (or at least 95%) of it should be that. This means no animal products as well as no added sugar, salt, or fat (i.e. taste makers and smile producers).

cover of wholeBut the purpose of Whole was not to discuss the diet that Campbell recommends, specifically.  The China Study goes into that in significantly more detail.  I disagree with the conclusions he drew regarding his work in China and his animal based research, but won’t be able to go into the issues with his scientific approach in any detail here. The purpose of Whole is to describe how nutrition research is carried out and the issues therein.

[Aside: The author of Raw Food SOS, Denise Minger, does an exhaustive review of the issues with the claims made in The China Study that go hand-in-hand with some of the claims made in the documentary Forks Over Knives that I highly recommend reading. Seriously, Denise knocks it out of the park, and I’d like to be her friend. Anyways, one such issue includes using a single animal protein (casein) in an animal model (rat) of only one kind of cancer (liver) and concluding that all animal protein causes cancer. *face, meet palm* Another one includes using the model of A is related to B which is related to C – and spuriously concluding that A causes C (science 101, associations do not equal causation). While I haven’t read the book, I did read one review that said The China Study includes over 8,000 correlations. While I don’t know how many are appropriate, I have a sneaking suspicion that most of them are not grounded in legit statistical approaches.]

Unfortunately, Whole is essentially a 290 page long rant.  The first word I used to describe Campbell in my notes of Whole was “evangelist.” Indeed, at one point he does refer to himself as “enlightened” (red flag!). The book is redundant to the point of exhaustion and is 2-3 fold too long.  Towards the end (ok, middle), I started to simply skip paragraphs and even entire sections that I felt I had already read before.  For most of the book, Campbell’s prose resembles that of a petulant schoolboy who didn’t get picked for the National Institutes of Health’s kickball team and is here to tell you just how unfair the world is. However, amidst the rant, there were some points of clarity with which I really agreed.

  • “Majoring in minor things.” The nutrition science field is obsessed with minutiae.  When we consume a whole food (i.e. a grapefruit), there are many nutrients in that food. There are vitamins, minerals, sugars, phytochemicals, etc., but many nutrition studies only focus on a single nutrient.  This is an issue because nutrients act in synergistic ways and affect nearly every tissue in the body, which makes food difficult to study.  Campbell points out that “virtually nothing in biology is as precise as we try to make it seem” (pg. 11).  I only sort of agree with that point, because almost everything in biology is extremely precise, but how we study biology and how nutrients impact our biology is not as well understood as many people think/pretend.  For example, it is extremely difficult to quantify nutrient absorption and delivery to tissues, let alone determine the nutrient content of a given food, which depends on season, soil conditions, harvesting, storage conditions, etc.  Colin seems to find no utility in the kind of research that attempts to parse these concepts out, which I do not agree with (more on that in a minute).  Just because we haven’t figured out how to do those studies yet doesn’t mean we should never try.  He seems to think we shouldn’t.
  • We shouldn’t eat so many animals and things that come from animals. Agreed. For the sake of our health, our planet’s health, the economy, and so on, we should eat less meat.  While he claims that his beliefs have been met with resistance from other people in the field, I’ve never met a nutrition scientist that would argue with this idea.  The resistance likely comes from his assertions that veganism is the only means to achieve health because (1) it’s not and (2) the data don’t support the idea that it is.  But eat less meat? Yes. Definitely.
  • Money corrupts everything. Probably not, but it’s not far from the truth.  Industry (food, supplement, pharmaceutical companies) provides a lot of funding to health regulatory bodies and also have some pretty powerful lobbyists that to drive health policy in a way that supports their bottom line.  This doesn’t make them inherently evil and untrustworthy, but it does require that we are aware of their presence and understand how powerful they can be. And you can bet on the fact that no matter what their message, they are concerned about profit more than human health. Campbell spends a third of the book saying just that.  While I think it’s important to recognize this, I also think that it’s important to figure out how to work within a capitalistic system in order to get our messages about health heard.  We can shake our fists at corporations and the system, or we can form partnerships with the ones that have products that actually do have a place in a healthy lifestyle and use that as a platform to get our messages out there.  Maybe I’m naive, but I don’t think it has to be as doom and gloom as Campbell alleges.

Outside of those few items, I took issue with essentially the rest of the book. While there are only a few bullet points here, I do feel like all of this should be underlined, bolded, and probably written in caps lock. But I didn’t write it that way because I know no one wants to read that.

  • Reductionism. If I had the time or energy, I’d like to count how many times Campbell used this word in the book.  It was obnoxious.  Reductionism is the practice of taking a complex system and breaking it down into individual parts in an attempt to understand it at its most basic level. Campbell abhors it and not entirely without reason.  I, myself, have to shake my head at some reductionist science due to the old adage of “losing sight of the forest for the trees.” That is, getting bogged down in the details of something that ultimately doesn’t matter.  But that isn’t inherent or exclusive to reductionist approaches to science. That happens at all levels of science. Campbell goes so far as to say that reductionism is “wearing the guise of science,” which is absolutely ridiculous.  It is science. It is one approach to science, and is an essential piece to understanding the whole (you know, the topic of the book). While scientists can lose sight of this, that doesn’t mean an entire approach should be vilified. An issue that happens in all approaches to science is making broad stroke claims about findings in order for the impact of one’s work to look much greater than it is.  Scientists who make these kinds of inappropriate conclusions, the peer reviewers who don’t catch them, and the journals that subsequently publish them are the issue, not the science in and of itself.  In my opinion, this underscores the importance of a better, more stringent peer review system than anything.
    One of the more comical things that I noticed while reading Whole was that Campbell spent nearly the entire book harping on reductionism, but then explained molecular concepts in nutrition, metabolism and disease that we understand solely because reductionist methodology was employed to study these processes. *face palm*
  • The Scientific Method. There were times reading Whole that I flipped from being flabbergasted to angry.  Again, in his crusade against reductionism, Campbell attacks pretty much all types of science other than observational studies. A lot of scientists have big egos and they think that their type of science is the absolute best and most important. I typically have to laugh at this because the truth is that all general approaches to science are important. Observational or epidemiological studies determine trends in health and disease, basic or reductionist science aims to determine the how and why, and randomized controlled trials intervene by changing a behavior or providing a treatment to a human with the goal of modifying health.  Campbell seems to believe that observational science is the only science that matters, which is not only incorrect, but also harmful if his readers now believe that.
  • No means of change. While Campbell spends close to 300 pages bemoaning the state of research and health in America, he misses an opportunity to actually teach people. He throws information at the reader, but at the end of the book, the reader is likely left feeling a little lost and hopeless. Campbell attacks the National Institutes of Health, the American Cancer Society, the American Society for Nutrition, the Academy of Nutrition and Dietetics, and so on. So whom should consumers trust? What I find most unfortunate about this book is that he provides no tools or resources for his readers. They’ve likely come to believe that they can’t trust anyone, but is that actually true and what good does that do? He had such a golden opportunity to teach people how to think critically and thoughtfully about the science presented in the media that they will encounter, but he didn’t. He also didn’t provide an organization or a group that consumers can trust. After reading this book, I think most readers are only slightly more informed than they were before starting it, but they are more than likely just very frustrated. That is, if they can manage to get through the whole thing.

Final Grade: C

Bottom Line: If you happen to come across this book, skip the entire thing except for the last chapter called “Making Ourselves Whole.” It’s only five pages long and it provides a nice summary, written in the most moderate, reasonable prose of the entire book. In fact, after spending the whole book complaining about reductionism, Campbell finally says what he should have said all along: “…we must stop seeing reductionism as the only method by which to achieve progress and start seeing it as a tool, the results of which can only be properly evaluated within a wholistic framework.” – pg. 286
If you decide to read the entire thing, take it with a grain of salt and be sure to read other works on the topic.

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caitlindowphd • November 19, 2015

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