54 Does Eating a Raw Food Diet Cause Spleen Qi Deficiency?

Journal of Chinese Medicine • Number 97 • October 2011

Does Eating a Raw Food Diet

Cause Spleen Qi Deficiency?
By: Joseph Abstract
Jennings and Studies show that eating a diet high in raw food can be beneficial for health, yet from a traditional Chinese medicine
Ming Cheng (TCM) perspective such diets are thought to damage the Spleen qi. This article documents a small pilot study that
put this notion to the test. Forty one people were recruited - 20 of whom ate a diet high in raw food (over 50 per
Keywords: cent of their food intake) and 20 of whom ate their normal diet - and were assessed over six months. TCM tongue
Raw food, and pulse diagnosis were used together with a questionnaire to assess participants, by a practitioner who was
diet, nutrition, blind to their dietary status. These results were then analysed by another blinded practitioner, who assessed the
Spleen qi degree of Spleen qi deficiency in each case. Thirty-five per cent of the raw food group were found to exhibit a
deficiency, pattern of Spleen qi deficiency, compared to 52 per cent of the control group. Those eating the most raw food (91
traditional to 100 per cent of their diet) for the longest period of time (more than five years) had the least evidence of Spleen
Chinese qi deficiency (11 per cent), which was statistically significant when compared to the control group (P<0.05). It
medicine, is concluded that a diet high in raw food does not necessarily cause Spleen qi deficiency. However, two distinct
TCM. physiological patterns were common within the raw food group that warrant further investigation. Also, this was
a pilot study with a small number of participants, and thus further research is needed to substantiate such claims.

I
Background
n recent years there has been a growing trend
towards raw food diets, advocates of which eat
a diet comprising 75 to 100 per cent raw food
(Evans, 2010). The most widely accepted theory
used to justify such diets is that heating food above
40 degrees Celsius diminishes its nutritional value
(Kenton, 2001). This theory has been verified with
regard to many vitamins and minerals, although it
is not clear whether it is the case with all nutrients
(McCance and Widdowson, 2002). The structure
of proteins and protein-bound minerals may also
be altered or damaged by heat, as enzymes are
denatured above 38 degrees Celsius - which ‘raw
fooders’ believe renders them less assimilable
(Howell, 1985). Healing centres around the world,
such as the Gerson Institute and The Tree Of Life
Rejuvenation Centre report positive results in the
treatment of chronic conditions such as cancer,
diabetes and heart disease by utilising these dietary
principles (Gerson & Walker, 2001; Cousens &
Rainoshek, 2008). The Gerson Institute website (2009)
claims that ‘Over 200 articles in respected medical
literature and thousands of people cured of their
"incurable" diseases document the Gerson Therapy's
effectiveness’. Whilst most of these articles are case
studies - and as such not acceptable as conclusive
evidence - the sheer number of them indicates some
positive therapeutic effects of a raw food diet.
Raw food and TCM
In TCM terms eating excessive raw food is thought
to be disadvantageous for health as it causes Spleen
qi or yang deficiency due to its cold and damp nature
(Maciocia, 2005). This can result in many digestive
disorders, as well as anxiety and other issues (Larre
& Rochat de la Vallee, 2004). Classics such as the Nei
Jing (Yellow Emperor’s Inner Classic) and Pi Wei Lun
(The Spleen and Stomach Classic) state that an excess of
cold and/or damp-forming food can cause digestive
problems:
‘Eating a cold diet causes diarrhoea’ - Su Wen, chapter 42.
(Veith, 2002)
However, these classics do not explicitly relate
a large intake of raw food to such issues. In fact,
upon searching Chinese classic texts in both English
translation and the original Chinese no reference to
‘raw’, ‘uncooked’, ‘untreated’ or ‘unprepared’ food
could be found. The quote above from the Su Wen
clearly states that cold food - which could mean cold
in nature or temperature - causes diarrhoea and thus
likely affects the Spleen (Veith, 2002; Li [Translated
by Flaws], 1993). However not all raw food is cold
in nature and is not necessarily eaten when cold in
temperature; for instance, oranges, cherries, pungent
greens like mustard leaves, ginger, the onion family
and other spices are all considered warm or hot in
nature and are often present in raw diets (Pitchford,
2003). Thus the belief that raw food causes Spleen
Journal of Chinese Medicine • Number 97 • October 2011
qi deficiency may be an over-simplification,
generalisation or wrong interpretation by modern
writers and practitioners. The aim of this research
was therefore to investigate the question ‘Does eating
a diet high in raw food cause Spleen qi deficiency.’
Literature review
The following search terms were used both
independently and in combination to search the
Science Direct, PubMed, Medline, AMED and
Google scholar databases: ‘raw’, ‘raw food’, ‘Chinese
medicine’ and ‘uncooked’. Papers were included
that were or could be readily translated into English,
were published in peer reviewed journals and were
pertinent to raw food. Papers were excluded that
could not be translated into English, were not in a
peer reviewed journal or had nothing to do with raw
food. No time limit for publication was stipulated.
Unfortunately the search did not identify any papers
that were related to raw food from the perspective of
Chinese medicine. However, one unpublished paper
was identified through personal communication
- a case-control study by a student at Westminster
University (UK) with 30 participants, in which the
health status of a raw food group who consumed over
80 per cent raw food was assessed via TCM tongue
diagnosis. This paper found that whilst there were
no signs of Spleen qi deficiency amongst this group,
signs of Stomach yin deficiency were clearly present
(evidenced by a lack of tongue coating).
The other literature identified suggests that
consuming a diet high in raw food over a long period
of time has potential nutritional benefits. The increase
in nutritional intake in such a diet - particularly
in terms of antioxidants - is considered cardio-
protective and preventative for cancer (Micozzi et al.,
1990; Rauma et al., 1995; Hanninen et al., 2000). Cross-
sectional studies showed that groups who consume
more raw food in their diet have fewer incidences
of some cancers (Buiatti et al., 1989; Adzersen et
al., 2003). Some studies reported reduced immune
markers, suggesting a healthy immune system with
lower levels of inflammation (Fontana et al., 2005;
Link et al., 2008). Douglass et al. (1985) showed that
eating an average of 62 per cent raw food for a period
of 6.7 months produced a reduction in hypertension
and obesity, as well as which the participants in this
trial spontaneously abstained from drinking and
smoking. A study by Ling and Hanninen (1992)
showed beneficial changes in bowel bacteria. A diet
high in raw food also seemed to improve mental
health in two studies (Hanninen et al., 1992; Link et
al., 2008). Other studies report the benefits of raw food
diets for specific diseases. Kaartinen et al. (2000) and
Donaldson et al. (2001) both showed that participants
Does Eating a Raw Food Diet Cause Spleen Qi Deficiency? 55
The belief that raw food causes Spleen qi deficiency
may be an over-simplification, generalisation
or wrong interpretation by modern writers and
practitioners.
experienced relief from symptoms of fibromyalgia.
Other studies show benefits for rheumatoid arthritis
sufferers (Nenonen et al., 1998), and diabetics through
increasing insulin sensitivity (Song et al., 2005).
Some studies were equivocal with regard to the
benefits of raw food. Koebnick et al. (2005) reported
reduced LDL and triglyceride levels but also lowered
HDL and increased homocysteine levels (an indicator
of inflammation) due to low B12 levels, a common
problem in long-term vegan diets. Similar effects
were reported in a study by Donaldson (2000).
A small number of studies report negative effects.
One study showed that dental erosion is a potential
problem in long-term raw food eaters due to higher
consumption of fruit acids that erode tooth enamel
(Ganss et al., 1999). Another study showed that 15 per
cent of male and 25 percent of female raw food eaters
were underweight, and that 30 per cent of women
experienced amenorrhoea (Koebnick et al., 1999).
The weight loss and incidence of amenorrhoea were
positively correlated to the dietary percentage and
duration of raw food consumption.
The popularity of raw food diets is a relatively
recent phenomenon and this way of eating has not yet
recieved significant scientific scrutiny, so little is know
about the long-term effects of such diets. Although
the literature seems to suggest that there are benefits
to raw food diets, the quality of the papers identified
here was relatively low: the duration of many of the
intervention studies was short, there were often few
participants and some of the studies omitted a control
group.
Method
The methodology chosen was that of a case-control
study, in which both the study group and control group
were assessed using TCM tongue and pulse diagnosis
and a standardised questionnaire. The questionnaire
(not included here for reasons of space) was based on
two pre-validated questionnaires from the TCM field
(Tan et al., 2005; Hou et al., 2009) and supplemented
with additional questions from TCM textbooks (for
example Maciocia, 2005). The questionnaire was
checked by two experienced practitioners of TCM
and tested on five separate individuals, after which
changes were made to increase its user-friendliness. It
was then face-validated by four practitioners of TCM.
Inclusion criteria for the test group were: eating a
56 Does Eating a Raw Food Diet Cause Spleen Qi Deficiency? Journal of Chinese Medicine • Number 97 • October 2011

diet of at least 50 per cent raw food for six months

Raw (n=20) Control (n=21) or more and having lived in the UK for at least six
months prior to the start of the research. Patients were
excluded if they suffered from any chronic disease
Age 37.2 30.8 state (i.e. cancer, coronary heart disease, Parkinson’s,
diabetes etc.) that might skew the diagnostic
BMI 20.3 22.3 process. The inclusion criterion for the control
group was anyone in relatively good health, with
Gender 8 men, 12 women 8 men, 13 women patients suffering from chronic diseases excluded
as stated above. Raw food eaters were recruited via
Raw Food advertisements to raw food groups and at raw food
86.5 16.5
Consumption (%) events. The control group were a convenience sample
of students and affiliates of Middlesex University.
Table 1: Demographic data averages All participants were recruited over a three-month
period at the beginning of 2011. Ethical approval was
granted from Middlesex University Health Studies
Ethics Sub-Committee.
The practitioners who assessed the tongues and
pulses (using standard TCM methods) of participants
were blind to their dietary status, as was the
practitioner who subsequently assessed the data.
This practitioner decided whether the participants
exhibited a pattern of Spleen qi deficiency, and rated
the severity of Spleen qi deficiency on a scale of one to
five. This was then used to split the raw and control
groups into those with and those without Spleen qi
deficiency. All practitioners involved in the research
had at least 20 years TCM experience. T-tests were
used to check the difference in severity of Spleen qi
deficiency between the study group and the control
group, and Z-tests to test whether or not there was
statistical significance between the different groups.
Figure 2: Percentage of participants presenting specific pulse
characteristics. Results
49 questionnaires were distributed, 26 for the study
group and 23 for the control group. 41 people were
enrolled (83.7 per cent of those asked), 20 for the study
group and 21 for the control group. The demographic
data is presented in Table 1, which shows that on
average the raw group were 6.4 years older than the
control group. They also had a lower BMI (by two
points) and on average ate 70 per cent more raw food
than the control group. The spread of men and women
was similar, with 60 per cent of the raw group and 62
per cent of the control group comprising of women.
The complete results of the questionnaires are not
included here for reasons of brevity, but showed
a higher incidence of Spleen qi deficiency in the
control group compared to the raw group. The largest
difference was in the desire for warm food and drink,
to which those on a raw diet were significantly less
prone than those in the control group (although
this sign was given less weight when assessing the
Figure 3: Percentage of participants presenting specific tongue incidence and extent of Spleen qi deficiency than
characteristics. other key signs such as a slippery pulse or loose
Journal of Chinese Medicine • Number 97 • October 2011 Does Eating a Raw Food Diet Cause Spleen Qi Deficiency? 57

stools). There was also a significant difference

between the mental welfare of the participants. Both Those eating the most raw food for the longest period
those with Spleen qi deficiency and those without
of time had significantly lower levels of Spleen qi
in the control group had similar average levels of
anxiety and worrying, whilst those on the raw diet deficiency than those eating a typical Western diet.
without Spleen qi deficiency were much less prone
to anxiety and worrying. A similar pattern occurred
Raw group (n=20) Control group (n=21)
in relation to consistency of bowel movements and
energy levels, where both subgroups in the control Incidence of Spleen qi
group had significantly higher scores (indicating a 35 52
deficiency (%)
worse state) than those in the raw food group without
Spleen qi deficiency. Severity of Spleen qi
Figures 2 and 3 display a mixed set of results. deficiency (1-5) Mean ± 1.29 ± 0.647 1.45 ± 0.838
The most common pulse characteristics were wiry, standard deviation
slippery and thready, with the thready pulse common Table 3: Incidence and severity of Spleen qi deficiency.
in both subgroups of the raw food eaters but almost
unseen in the control groups. Interestingly, the group
with the highest percentage of slippery pulses was
the raw food group without Spleen qi deficiency, Percentage
91-100 76-90 51-75 26-50 11-25 <10
followed by the control group with Spleen qi of raw food
(n=12) (n=4) (n=4) (n=3) (n=11) (n=7)
deficiency, and then the raw group with Spleen qi in diet
deficiency (to be expected given the nature of these Incidence
patterns). It is noteworthy that weak and deep pulses of Spleen qi 33 50 25 67 55 43
were not observed in the raw group without Spleen deficiency (%)
qi deficiency at all, and were more common in the
control group without Spleen qi decifiency than they Table 4: Incidence of Spleen qi deficiency versus raw food in diet.
were in the control group with Spleen qi deficiency.
The control group had more people with normal
pulses than the raw group. groups consuming the least quantity of raw food had
One of the most common signs of Spleen qi deficiency higher incidences of Spleen qi deficiency than the
in terms of tongue diagnosis is a swollen, pale tongue group consuming the highest quantity of raw food.
with teeth marks. Two of these characteristics - There is a 22 per cent difference when comparing
swollen and tooth-marked - were common, especially the 91 to 100 per cent raw food eaters to the 11 to
in the control group with Spleen qi deficiency. The 25 per cent raw food consumers, and a 10 per cent
most common tongue characteristic seen in the raw difference when comparing the 91 to 100 per cent raw
group - with or without Spleen qi deficiency - was food eaters to those eating less than 10 per cent raw
a red tongue. Cracks were also common in the raw food. However, these differences were not statistically
group without Spleen qi deficiency (a finding that significant. When those eating 91 to 100 per cent of
concurs with the unpublished study mentioned their diet raw for less than 5 years were removed from
above). Again, the normal tongue was most common the 91-100 per cent group (leaving 11 participants
in the control group without Spleen qi deficiency. eating 91-100 per cent raw for more than 5 years) the
Table 3 shows that there was a lower incidence of percentage of Spleen qi deficiency lowers to 11 per
Spleen qi deficiency in the raw food group than the cent. When this was compared to the control group
control group (35 per cent compared to 52 per cent, a as a whole - a difference of 41 per cent - this reached
difference of 17 per cent). The severity of the Spleen statistical significance (P<0.05). In other words those
qi deficiency was also less in the raw group by 16 eating the most raw food for the longest period of time
per cent. However, neither of these statistics were had significantly lower levels of Spleen qi deficiency
statistically significant. than those eating a typical Western diet.
Table 4 shows how the incidence of Spleen qi
deficiency correlates with the amount of raw food in Discussion
the diet. The group consuming the highest amount The raw food group was found to have a lower
of raw food (91 to 100 per cent) had one of the lowest incidence of Spleen qi deficiency compared to the
incidences of Spleen qi deficiency. The middle ranges control, and raw food eaters were found to experience
(from 26 to 76 per cent) did not have enough people better mental wellbeing, energy levels and bowel
enrolled in them to draw firm conclusions. The two habits than those eating a normal diet. On top of this
58 Does Eating a Raw Food Diet Cause Spleen Qi Deficiency? Journal of Chinese Medicine • Number 97 • October 2011

the raw food cohort was, on average, si years older than the results. Another limitation was the narrow approach:
the control group. When comparing these results to other a full diagnosis, assessing all clinical manifestations and
studies some correlations can be drawn. The most clear patterns, would be necessary to see whether or not other
of these is the increase in wellbeing associated with raw patterns - that may or may not be secondary to Spleen qi
food consumption observed in some of the previously deficiency - were also present.
mentioned studies (Nenonen et al., 1998; Kaartine et al.,
2000; Donalds et al., 2001). Another is the improvement in Conclusion
bowel habits; a study (Ling & Hanninen, 1992) that looked The results of this study suggest that eating a diet high in
into faecal activities one month after adopting a diet high raw food does not damage the Spleen qi, and conversely
in raw food found that - rather than the loose bowels might actually benefit the digestive system. This suggests
associated with Spleen qi deficiency - an ‘uncooked that the warnings typical in modern Chinese medicine
extreme vegan diet’ actually benefits bowel habits. texts of the adverse effects of raw food may be a result
However, the tongues and pulses of those eating a high of misinterpretation and/or oversimplification. However,
raw food diet without Spleen qi deficiency seemed to some physiological patterns were present in the raw
show two distinct physiological patterns that may show group that need to be investigated further to clarify the
other physiological effects of a raw diet. The slippery/ effects of a raw food diet from a TCM perspective. Also
wiry pulse and the swollen tongue with teeth marks that the validity of this research is limited due to the small
were common in this group appear to show a sub-clinical samples size and a less than ideal control group. Therefore
Spleen qi deficiency accompanied by with damp/phlegm further research needs to be conducted in this area with
or qi stagnation. The thready pulse and red, cracked larger, more representative samples and full diagnoses to
tongue that were also common appear to indicate a assess whether or not this conclusion is true.
pattern of blood and/or yin deficiency. Unfortunately the
questionnaire used here was only tailored to assess Spleen Joe Jennings studied TCM at Middlesex University
qi deficiency, so it is unclear whether there were any (UK). He integrates nutritional therapy with TCM and
rebirthing breathwork in Oxfordshire, UK.
further symptoms and signs supporting diagnosis of such
patterns. These findings may suggest Spleen qi deficiency
Ming Cheng studied Medicine at Guangzhou University of
amongst the raw food group was damaging the blood, or Chinese Medicine, Oxford University (MSc) and London
perhaps those with yin deficiency and heat are attracted to University (PhD). He is the principal lecturer in TCM at
the cooling effects of raw food (it should be noted that it Middlesex University, a Governing Board member for the British
not possible to tell whether these relatively symptomless Acupuncture Council, and chairs the Professional Conduct
patterns were getting better or worse). Committee for the Association of Traditional Chinese Medicine.
Assuming that the data gathered here are correct, eating An observational study.” BMC
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