As I mentioned in the previous post on dairy consumption and disease in China, there’s a fascinating little county by the name of “Tuoli” situated in northwest China—a place quite worthy of nutritional study, due to their unique diet.
They live here:
Which looks like this:
Where they eat a lot of this:
But not a lot of this:
The Tuoli diet is so abnormal for China, in fact, that T. Colin Campbell et al omitted this county from analysis in several China Study papers—such as “Vitamin A and cartenoid status in rural China,” published in the British Journal of Nutrition:
One county (Tuoli County in Xinjiang Autonomous Region), composed primarily of an ethnic minority population of herdspeople, had disproportionately high values for retinol, lipid and protein intake due to an exceptionally high intake of animal foods. This ‘outlier’ was not included in the analysis, to characterize more accurately the average intakes of the rural Chinese population and to avoid the undue influence of one data point on the results.
Given the prevailing beliefs about nutrition and health—such as saturated fat and cholesterol as a cause of heart disease, the necessity of fiber for colon health, the immunity-boosting properties of fruits and vegetables, and the dangers of a diet high in animal fat—it would seem the Tuoli should showcase the health woes that come from breaking every rule in the diet book.
But is that the case?
Tuoli diet
First, let’s take a closer look at what he China Project data has to say about these Tuoli folks.
In terms of macronutrients, the Tuoli consumed an average of 185.6 grams of fat, 172.5 grams of protein, and 322 grams of carbohydrates per day. Average energy intake was a whoppin’ 3704 calories, and average fiber intake was 17.9 grams per day—only slightly more than your run-of-the-mill American.
The average diet of all counties studied in the China Project is clearly carb-based, low in fat and protein (as a percent of total calories):
In contrast, the Tuoli diet is nearly half fat:
Main items on the Tuoli menu included:
- Dairy: 856.5 grams per day (almost two pounds)
- Wheat flour: 371.6 grams per day (0.82 pounds)
- Meat: 121 grams per day (a bit over a quarter of a pound)
Sparse and non-existent items included:
- Potatoes: five to six times per year
- Green vegetables: twice per year
- Fruit: less than once per year
- Legumes: never
- Sea vegetables: never
- Nuts: never
- Eggs: never
- Fish: never
- Plant oils (rapeseed, soybean, sesame, corn): never
- Soy sauce: never
Basically, these folks live on dairy, meat, and wheat, and refuse to eat their vegetables. Sounds like some Americans I know.
Tuoli blood markers and diseases
If the Tuoli’s meat-and-dairy-heavy diet is the source of disease, we’d expect to see these folks facing more chronic conditions than the regions eating plant-based diets. To test whether this is the case, let’s compare Tuoli with the 13 counties in the China Project that consumed less than 1 gram of animal protein per day—the closest thing we have to Chinese vegans.
I’ll be putting these all in a bar graphs, but to prevent an uber-cluttered x-axis, I’ll just use numbers corresponding to each county:
- Cixian
- Jingxing
- Huguan
- Jiangxian
- Jiexiu
- Linxian
- Songxian
- Jianhu
- Taixing
- Qingzhen
- Cangxi
- Shanyang
- Longxian
- Tuoli
The first 13 counties will always be blue bars; Tuoli will always be red.
Before getting to the mortality statistics, let’s look at some basic blood markers for heart disease. Here we have total cholesterol of the above counties, lined up side-by-side for comparison.
As you might expect, Tuolians* have higher total cholesterol than most of the near-vegan counties, although it’s still a healthy number by American standards. However, the difference between a couple of those counties isn’t all that profound: Tuoli’s cholesterol is tied with that of Shanyang and lags a bit behind Taixing, both of which consume only trivial amounts of animal products. Curious, indeed. Obviously, something other than animal product consumption affects blood cholesterol.
*”Tuolian” may or may not be an actual term.
Next, let’s peek at triglycerides—a type of blood fat that, in high amounts, can raise your risk of heart disease.
It seems Tuoli is pretty much neck-and-neck with the plant-eating counties. By American standards, triglyceride levels between 150 and 199 are considered borderline high, and lower numbers are considered normal—so only one county, a near-vegan one, had values outside a healthy range.
Disease rates
First up: Death from all causes (per 1000 people under the age of 65). Remember, Tuoli county is the red bar; the blue bars represent the near-vegan counties in the China Project that consumed less than 1 gram of animal protein per day on average.
Okay, so the Tuoli don’t have a higher death rate than the near-vegans. In fact, Tuoli’s total mortality rate is lower than 11 of the other counties and higher than only two.
But what about cancer? Let’s look at mortality from all cancers for Tuoli and the plant-lovin’ regions. Again, Tuoli is the red bar, and the near-vegan counties are the blue ones.
How ’bout them apples? Tuoli doesn’t appear to have higher cancer rates than the near-vegan areas. Eight counties have higher rates and only five have lower ones, leaving Tuoli hovering near the lower-middle end of the spectrum.
Next we have mortality from myocardial infarction (heart attacks) and coronary heart disease, per 1000 people. Tuoli is red, near-vegan counties are blue… you know the drill.
Surprised? Despite a massive intake of cholesterol, saturated fat, calories, animal protein, and all those other horrors ascribed to declining heart health, the Tuoli have relatively low levels of coronary heart disease and heart attacks. Seven near-vegan counties have higher rates than Tuoli, and six have lower rates.
And now for stroke mortality (per 1000 people).
Again, no significantly higher stroke rates for the Tuolians. Seven near-vegan counties have more incidences of stroke, and six have fewer incidences of stroke.
And since lack of fiber is supposed to harm colon health, here is a comparison of colon cancer and rectal cancer mortality (per 1000 people) between the plant-noshing counties and the vegetable-phobic Tuolians.
Looks like they’re doing pretty dandy without much fiber, right?
But what about leukemia? Let’s check it out:
As you can see, Tuoli isn’t significantly worse off than the near-vegan counties in terms of chronic disease. Total mortality rate is lower, cancer rates are lower or similar, heart attacks aren’t more common than usual, stroke rates are average. From this data alone, we’d have no basis for claiming that eating two pounds of dairy per day (and minimal vegetation, aside from wheat flour) is less healthful than consuming a mostly vegetarian diet. For sure, this data fails to support Campbell’s claim that chronic disease rates climb when animal protein intake rises.
(And as you’ll see in an upcoming post, it’s pretty surprising that the Tuoli had low rates of cardiovascular disease while eating high levels of wheat—but we’ll get to that later.)
Why aren’t these people sick and diseased?
We have plenty of evidence showing hormone-pumped dairy, grain-fed meat, pasteurized and homogenized milk, processed lunch meats, and other monstrosities are bad for the human body. No debate there. But we do have a woeful lack of research on the effects of “clean” animal products—meat from wild or pastured animals fed good diets, milk that hasn’t been heat-zapped, antibiotic-free cheeses and yogurts, and so forth. Perhaps the best data we have is from observational studies of isolated or primitive peoples (such as those studied by Weston A. Price), but those lack detailed documentation about mortality rates and don’t usually meet standards of scientific rigor.
In other words, this is one area where nutritional research is pretty deficient.
Is it possible the diseases we ascribe to animal products aren’t caused by animal products themselves, but by the chemicals, hormones, and treatment processes we expose them to? If the Tuoli are any indication, this may be the case. Hopefully future research will shed more light on the matter.
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Thanks for writing, I’m enjoying the blog. You’ve made some great observations (intestinal length, wild vs. farmed) that really resonate with me as I work on improving my own diet. Cheers!
Cogent and concise, as usual. I often wonder though, if the conclusions reached by looking at statistics alone, could be somewhat misleading. In other words, it’s not so much that the Tuolians ( I like it even it’s a made up word) eat dairy/meat etc. but that they eat what’s native to their environment, that could be a contributing factor to good health or otherwise. They don’t eat veggies because it may not be possible to cultivate veggies in their environment and/or given their occupations as nomadic herdsmen. It’s interesting how so many nomadic pastoral tribes, in different parts of the world, seem to indulge in a surfeit of raw milk/fermented milk/blood etc. Which of course, doesn’t help when you live Stateside and everything is available all the time. Sigh! Some day we’ll have this diet thang figured out.
Great observations as usual! It would be interesting to compare the Tuolians (I like this word) with the Inuit tribes of Alaska. They too eat a lot of meat, but primarily from the ocean. I wonder what effect all the exercise they get from herding plays in this. They have to have a high caloric intake to maintain their active lifestyle. Maybe exercise plays a larger role in warding off disease than we think.
Excellent reviews, Denise!
I think YOU should write a book about the China Study too
No really. You should. This is extraordinary stuff.
After all this, I have to wonder. Why did Campbell write the book the way he did?
What do you think?
Great site. A lot of useful information here. I’m sending it to some friends!
[...] does Campbell overlook the unique Tuoli peoples documented in the China Study,who eat twice as much animal protein as the average American [...]
The evidence is so strong that wheat is an inferior food, the Tuoli make a very good case for unprocessed dairy and meat. Even with all that wheat, the fact that they are still in good health is impressive.
…or perhaps their wheat is a local variety that Monsanto hasn’t been allowed to “improve”. o.O
[...] Oh look. Tuoli: China’s Mysterious Milk Drinkers Raw Food SOS: Troubleshooting on the Raw Food Diet [...]
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If the Tuolians removed the pound-a-day wheat habit from their diets they would likely have the lowest markers in every single category. Great post.
[...] [5] Denise Minger, http://rawfoodsos.com/2010/06/23/tuoli-chinas-mysterious-milk-drinkers/. [...]
[...] Why does Campbell overlook the unique Tuoli peoples documented in the China Study, who eat twice as much animal protein as the average American [...]
“We have plenty of evidence showing hormone-pumped dairy, grain-fed meat, pasteurized and homogenized milk, processed lunch meats, and other monstrosities are bad for the human body.”
Where, exactly, is the evidence that grain-fed meat is “bad” for the human body? The only so-called evidence I have ever ran across comes from poorly controlled (i.e failing to control variables, using low confidence levels so real results are even harder to distinguish from noise, etc) and poorly designed research papers.
Other than that, good post!
“Is it possible the diseases we ascribe to animal products aren’t caused by animal products themselves, but by the chemicals, hormones, and treatment processes we expose them to?”
You are jumping to conclusions. It is possible the diseases we ascribe to animal products are caused by refined sweeteners, polyunsaturated vegetable oils, and hydrogenated oils. You say that pasteurized homogenized milk is bad, but also say there’s no single optimal diet. Isn’t it possible that some people have adapted to pasteurized homogenized dairy and thrive on it, while failing to thrive on raw? It’s definitely possible. I’ve seen a lot of fat people drinking sodas, but I’ve also seen skinny people carrying 24-packs of Coke. People can adapt to anything. Primitive people would probably drop dead in a month if they ate the typical modern diet.
DML: “Where, exactly, is the evidence that grain-fed meat is “bad” for the human body? The only so-called evidence I have ever ran across comes from poorly controlled (i.e failing to control variables, using low confidence levels so real results are even harder to distinguish from noise, etc) and poorly designed research papers. ”
Where is the evidence that hormone-pumped milk, pasteurized homogenized milk, and processed lunch meats are “bad” for the human body? The only evidence I am aware of comes from poorly controlled studies (mostly epidemiology). It’s possible processed meats are to blame when meat is “associated” with some disease, but I would simply dismiss the whole thing. Correlation is not causality.
I’m curious as to what the Qingzhen people die of and what their average life span is?
Very good study. Someone should give you millions of dollars for follow research to extensively investigate this further.
“[M]eat consumption for one of the counties, Tuoli, was clearly not accurate on the 3 days that the data were being collected. On those days, they were essentially eating as if it were a feast to impress the survey team but on the question of frequency of consumption over the course of a year, it was very different.”
-Dr. Campbell (http://tynan.net/chinastudyresponse)
If the data was only collected for 3 days, how did they know and how did you know how many times a year a food was consumed?
Fascinating post Denise, thanks. A few points:
This diet is not unlike that of the former isolated Loetschental Valley inhabitants in Switzerland. One thing that bear in mind with isolated populations is that very likely have adaptations to their particular diet; these are genetic adaptations, which don’t take that long to evolve in a population:
http://healthcorrelator.blogspot.com/2010/01/how-long-does-it-take-for-food-related.html
This is a minor point, but the total cholesterol number is a bit low, and the triglycerides suggest a large-buoyant LDL particle pattern (see links below). I say this is a minor point because of the point made above – specific adaptations may make these comparisons worthless.
http://healthcorrelator.blogspot.com/2009/12/total-cholesterol-and-cardiovascular.html
http://healthcorrelator.blogspot.com/2010/04/low-fasting-triglycerides-marker-for.html
Finally, we need to look at the patterns of exercise of these folks, particularly glycogen-depleting exercise. Based on the caloric intake, I’d guess that they exercise heavily, causing severe glycogen depletion on a regular basis (this is generally good). With depleted glycogen stores, the carbs consumed do not lead to excessive triglyceride formation or fat deposition.
Having said that, I agree with you regarding the effect of modern processing on foods. It is generally a bad thing.
[...] China’s Mysterious Milk Drinkers [...]
@Ned Koch. I don’t think the Tuoli exercised as much as you imply. They are muslim pastoralists that herd goats and weave rugs for a living. My wife is from Xinjiang, and she has many times described the minority group (now that the Han have overrun the place) that lives here. They are related to the Turks and other muslim groups in that part of Asia. I think the pastoralist lifestyle involves lots of sitting and slow walking (to move the herd around as they forage). It’s not the back-breaking, day-labor you see among the farmers. This should add some perspective and context to interpreting the Tuoli data. I do agree with you that microadaptation can happen very rapidly after dietary (or other environmental) shifts, as described in the book “The 10k year explosion.” So it is especially important to keep in mind that the Tuoli are a different ethnic group than the Han (i.e., they are mostly reproductively isolated for thousands of years).
Hi Aaron.
I think the calorie intake of the Tuoli might have been exaggerated. Campbell included this in his response to Denise’s post on the China Study. Denise highlighted this in her new post:
http://rawfoodsos.com/2010/07/16/the-china-study-my-response-to-campbell/
It seems that the Tuoli were “feasting” during the three-day diet survey, brining their calorie intake way higher than it would normally be.
Hi Ned,
Thanks for pointing that out. I don’t think the “calorie” hypothesis of weight set-point has much merit (I could be wrong, though), so I’m not sure that the average daily calorie intake is very meaningful unless you know where those calories are coming from. People have reported evidence that people can lose weight on high calorie diets that have few carbs, especially fructose, and mostly saturated fat rather than polyunsaturated fats, especially O6 heavy plant seed oils. While a low-cal diet that has a large portion coming from refined carbs (sugar, flour), industrial seed oils, and etc. can result in weight gain. I forget who’s quote this is, but I like the “You aren’t what you eat, you are what you do with what you eat.” I’ve come up with a similar saying for epigenetics: “You aren’t your genes, you are what you do with your genes.”
Btw, Denise, thank you so much for all of the hard and brilliant work you’ve put into deconstructing the China Study and the data on which it was based. That probably took more intellectual effort than my dissertation! You really should consider publishing your analysis in a top-tier peer-reviewed journal (if they let you). Kudos!
[...] have? I suppose this excludes the Europeans who have adapted to dairy, and the Chinese Mongols and Tuoli who consume massive amounts…and who else in the world am I leaving [...]
[...] have? I suppose this excludes the Europeans who have adapted to dairy, and the Chinese Mongols and Tuoli who consume massive amounts…and who else in the world am I leaving out? Last edited by [...]
Nomadic herders, um no chance the fact these people probably burn 3000 to 4000 calories a day just to survive doesn’t have an effect? High fat high calorie diet while living a high impact high enery lifestyle versus citified populations eating a low energy diet with lots of oils, and salts; while smoking like chiminies? Also, what is the life expectancy in this population? Low cancer rates don’t mean much if they die in their 50s from falling off of horses.
“Is it possible the diseases we ascribe to animal products aren’t caused by animal products themselves, but by the chemicals, hormones, and treatment processes we expose them to?”
My guess: NO. I bet these people tend to get a lot of exercise in per day. I bet it is frequent and sustained excess energy consumption that hurts.
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