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Getting Rich Can Kill You! A Warning to Developing Countries

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Title: Getting Rich Can Kill You! A Warning to Developing Countries


1
Getting Rich Can Kill You! A Warning to
Developing CountriesLearn from Our Mistakes!
  • Robin Carr, Ph.D.

2
3 Requirements of Science
  1. Look for evidence! (Especially peer-reviewed.)(
    And dont accept just evidence that fits your
    theories.)
  2. Dont believe any one individual or any one
    scientific finding. Assess the weight of
    evidence.
  3. While its sometimes necessary to focus on narrow
    questions and specific details, always step back
    now and then to see the broader picture.

3
Investigate the research yourself!
  • PubMed Central (PMC) is the U.S. National
    Institutes of Health (NIH) free digital archive
    of biomedical and life sciences journal
    literature.http//www.ncbi.nlm.nih.gov/pubmed/
    http//www.ncbi.nlm.nih.gov/pmc/
  • Abstracts are almost always provided along with
    the references, and sometimes the entire article
    is provided free on-line, from a provided link.

4
http//www.ncbi.nlm.nih.gov/pubmed/
5
http//www.ncbi.nlm.nih.gov/pmc/
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NextAbout Correlations
  • A correlation is a measure of how closely 2
    variables are related to each other.
  • Correlations are the most frequently used tool in
    epidemiological and human dietary research. But
    they must be used with caution.

9
Example
  • Did you know that a positive correlation was
    found between eating ice cream and getting
    divorced?

10
Which is the cause? Which is the effect?
Summer
Does eating more ice cream increase your risk of
divorce?
11
Which is the cause? Which is the effect?
Or, do you eat more ice cream when you get
divorced?
12
The answer
Summer increases the chances of both!
13
When Cause Effect is Assumed
Sometimes the context makes cause and effect
obvious. But assumptions can sometimes be wrong.
14
He who does not know food, how can he understand
the diseases of man?
  • Hippocrates, the father of medicine (460-357 BC)

15
A Story about Proteins
  • Protein is one of the basic components of food
    and makes all life possible. All of the
    antibodies and enzymes, and many of the hormones
    in the body are proteins. They provide for the
    transport of nutrients, oxygen and waste
    throughout the body. They provide the structure
    and contracting capability of muscles. They also
    provide collagen to connective tissues of the
    body and to the tissues of the skin, hair and
    nails. There are hundreds of thousands of
    different kinds of protein.
  • 20 amino acids make up protein.
  • essential amino acids (9/8) must be included in
    the diet.
  • nonessential amino acids (11/12) the body can
    manufacture.
  • For normal adults 1.0 g protein / kg body mass
    per day.For active athletes 1.4 g protein / kg
    body mass per day.

16
The Amino Acids
Essential Amino Acids(must be obtained through the diet) Isoleucine Phenylalanine Leucine Threonine Lysine Tryptophan Methionine Valine
Conditional Amino Acids(cant be made fast enough to support rapid growth) Arginine Histidine
Nonessential Amino Acids(can be made by the body) Alanine Glutamine Asparagine Glycine Aspartic Acid Proline Cysteine Serine Glutamic Acid Tyrosine
17
Protein in Cultural History
  • In the 19th century, protein was synonymous with
    meat.
  • Early scientists like the German Carl Voit
    (1831-1908) found that man needed only 48.5
    grams/day, but he recommended 118 grams/day. (If
    something is good, more is better!)
  • Well-known nutrition researcher Max Rubner stated
    that protein intake (meaning meat) was a symbol
    of civilization. A large protein allowance is
    the right of civilized man.
  • The cultural bias was set. If you were rich, you
    ate meat. If you were poor, you ate staple plant
    foods like potatoes and bread.

18
The Protein Gap
  • In the 1960s and 1970s, it was constantly
    asserted that there was a protein gap in the
    developing world.
  • M. Autret of the Food and Agriculture
    Organization (FAO) of the United Nations reported
    a very strong association (correlation) between
    the consumption of animal-based foods and annual
    income, and he implied causation.

What else could explain the association
(correlation)?
19
A More Realistic Explanation!
20
Philippine Connection
  • In 1967, while on the faculty at Virginia Tech,
    Dr. T. Colin Campbell began working on a ten-year
    project in the Philippines (funded by the U.S.
    Agency for International Development) to improve
    childhood nutrition among the poor.
  • Ultimately, 110 nutrition mothercraft self-help
    education centers were established around the
    country, focussed on educating mothers of
    malnourished children about healthy local
    foods.
  • The aim was to make sure that children of the
    poor were getting as much protein as possible,
    since there was a perceived protein gap in the
    developing world.

21
Protein and Cancer?
  • Part of this project involved investigating the
    high prevalence of liver cancer, usually an adult
    disease, in Filipino children. It was thought to
    be caused by aflatoxin, a mould found in peanuts
    and corn, which is one of the most potent
    carcinogens known.
  • Children who ate the highest-protein diets were
    the ones most likely to get liver cancer. They
    were the children of the wealthiest
    families.Campbell TC and Campbell TM (2006)
    The China Study. Dallas, Texas Benbella Books,
    p.5

22
The Indian Study
  • One group of rats was given aflatoxin and then
    fed diets of 20 protein. The other group was
    also given aflatoxin and then fed diets of only
    5 protein.
  • Every single animal fed a 20 protein diet got
    liver cancer or its precursor lesions.
  • Not a single animal fed a 5 protein diet got
    liver cancer or its precursor lesions.
  • 100 versus 0? This seldom occurs in biological
    sciences. It was a very provocative finding!
  • Madhavan TV and Gopalan C (1968) The effect of
    dietary protein on carcinogenesis of aflatoxin.
    Arch Path 85133-7.

23
Three Stages of Cancer
  • Initiation - A carcinogen enters a cell and is
    converted by cellular enzymes to highly reactive
    products that bind to the cells DNA, forming
    carcinogen-DNA complexes (adducts) that are often
    repaired. If not repaired before the cell
    divides, the daughter cells will have this new
    genetic defect (mutation). This occurs quickly
    and is usually irreversible. It represents a
    potential for cancer.
  • Promotion - Some factors (promoters) may act to
    increase the growth and multiplication of these
    mutant cells over a longer period of time, while
    other factors (anti-promoters) work against
    this.
  • Progression - Large foci (clusters of mutant
    cells) progress in the growth and may wander from
    their initial site (metastasize).

24
The Promotion Stage
  • Many animal studies have shown that nutrition may
    be far more important in controlling the cancer
    promotion stage than the dose of the initiating
    carcinogen.OConnor TP, Roebuck BD and Campbell
    TC (1985) Dietary intervention during the
    post-dosing phase of L-azaserine-induced
    preneoplastic lesions. Journal of the National
    Cancer Institute 75955-957 (cover article).
  • Nutrients (esp. casein) from animal-based foods
    increased tumour development while nutrients from
    plant-based foods decreased tumour
    development.Hawrylewicz EJ, Huang HH et al.
    (1982) Enhancement of the 7,12-dimethylbenz(a)
    anthracene (DMBA)mammary tumorigenesis by high
    dietary protein in rats. Nutr. Reps. Int.
    26793-806.

25
What about the type of protein?
  • What protein consistently and strongly promoted
    cancer?
  • Casein (87 of cows milk protein) promoted all
    stages of the cancer process.
  • What type of protein did not promote cancer, even
    at high levels of intake?
  • The safe proteins were from plants, including
    wheat and soy.

26
Protein Excesses?
  • Peer-reviewed biochemical research, funded by the
    National Institutes of Health, the American
    Cancer Society and the American Institute for
    Cancer Research, resulted in dozens of articles
    published in some of the best scientific
    journals. The results were shocking
  • Low protein diets inhibited the initiation of
    cancer by aflatoxin, regardless of how much of
    this carcinogen was administered In fact,
    dietary protein proved to be so powerful in its
    effect that we could turn on and turn off cancer
    growth simply by changing the level
    consumed.The China Study, p.6

27
The Human Question
  • So far, most of this research had involved
    laboratory studies performed on animals rats and
    mice.
  • Would similar results be found with humans?

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The China Study Scientific Team
  • Dr. T. Colin Campbell was Project Director
  • Dr. Junshi Chen, deputy director of Chinas
    premier diet health research laboratory
  • Dr. Junyao Li, one of the authors of the China
    Cancer Atlas Survey and a key scientist in
    Chinas Academy of Medical Sciences
  • Dr. Richard Peto of Oxford University, one of the
    leading epidemiologists in the world, who has
    been knighted for his work.Campbell TC and
    Campbell TM (2006) The China Study.Dallas,
    Texas Benbella Books.

30
Findings of the China Study
  • The largest and most comprehensive study of human
    diet, lifestyle and disease in the history of
    biomedical research was organized through Cornell
    University, Oxford University and the Chinese
    Academy of Preventive Medicine, and involved 367
    variables taken from questionnaires, blood tests,
    urine samples and 3-day diet inventories taken
    from 6500 adults from 65 Chinese counties.
  • Called the Grand Prix of epidemiology by the
    New York Times, it produced more than 8,000
    statistically significant correlations between
    various dietary factors and disease.
  • People who ate the most animal-based foods got
    the most chronic disease.
  • People who ate the most plant-based foods were
    the healthiest.

31
Disease Groupings in the China Study
Diseases of Poverty (Nutritional Inadequacy Poor Sanitation) Pneumonia, intestinal obstruction, peptic ulcer, digestive disease, pulmonary tuberculosis, parasitic disease, rheumatic heart disease, metabolic and endocrine disease other than diabetes, diseases of pregnancy and many others
Diseases of Affluence (Nutritional Extravagance) Cancer (colon, lung, breast, leukemia, childhood brain, stomach, liver), diabetes, coronary heart disease
(from The China Study, p. 76)
32
Rural Chinese versus U.S. Diets(normalized for a
body mass of 65 kg)
NUTRIENT RURAL CHINA UNITED STATES
Calories (kcal/day) 2641 1989
Total Fat ( of calories) 14.5 34-38
Dietary fiber (g/day) 33 12
Total Protein (g/day) 64 91
Animal Protein ( of calories) 0.8 10-11
Total Iron (mg/day) 34 18
(age-standardized rates from The China Study, p.
74)
33
From Underfed to Overfed
  • In the year 2000, for the first time in human
    history, the number of overweight people in the
    world rivalled the number of underweight people.
    (While the world's underfed population had
    declined slightly since 1980 to 1.1 billion, the
    number of overweight people had surged to 1.1
    billion.) Both the overweight and the underweight
    suffer from malnutrition.
  • "Often, nations have simply traded hunger for
    obesity, and diseases of poverty for diseases of
    excess. Worldwatch (2000) Underfed and
    Overfed The Global Epidemic of Malnutrition.
    Paper 150 Worldwatch Institute, Washington, DC.

34
Countries Developing to Developed
  • Major trends usually occur during this shift
  • increased longevity (life expectancy at
    birth) e.g. Canada 81.23, U.S. 78.11,
    Philippines 71.09 CIA World Fact
    Book https//www.cia.gov/library/publications/the
    -world-factbook/
  • improved sanitation and drinking water
  • improved access to high quality medical care
  • decrease in amount of daily physical activity
  • shift from a plant-based diet to an animal-based
    diet
  • increase in levels of obesity
  • nutrient deficiencies infectious diseases give
    way to chronic sedentary and degenerative
    diseases of excess

35
Diseases of Affluence
  • hypoglycemia
  • hyperglycemia
  • type II diabetes
  • high blood pressure
  • coronary artery disease
  • strokes
  • autoimmune diseases(e.g. rheumatoid arthritis,
    gout, bursitis, neuritis, and some sciatica)
  • osteoporosis
  • many cancers

36
Cancer in China
  • Counties with the highest incidence of some
    cancers had rates more than 100 times greater
    than counties with the lowest rates of those
    cancers. (In the U.S., cancer rates in one area
    are never more than about 3 times higher than in
    the lowest incidence areas.)
  • Since 87 of Chinas population is the same
    ethnic group (the Han), why is there such a
    variation in the rates of cancer? It had to be
    due to environmental factors like poor nutrition,
    lack of exercise and unhealthy living
    environments.
  • (Some U.S. scientists had already estimated that
    genetics only determines about 2-3 of the total
    cancer risk.)Doll R and Peto R (1981) The causes
    of cancer quantitative estimates of avoidable
    risks of cancer in the United States today. J
    Natl Cancer Inst 661192-1265.

37
Blood Cholesterol Cancer
  • Blood cholesterol levels in rural China were far
    lower than expected (measured in mg/dL)Av.
    Rural China Av. U.S. Minimal Safety (assumed)
  • 127 215 150
  • As levels dropped from 170 to 90, there were
    associated decreases in cancers of the liver and
    colon (plt0.01), and rectum, male lung, adult
    leukemia and adult brain (plt0.5).
  • NOTEThis correlation even at very low levels is
    surprising, due to a statistical phenomenon. Real
    relationships between 2 variables sometimes
    cannot be seen when the range of data is limited!

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Breast Cancer
  • The American death rate from breast cancer was 5
    times higher than the rural Chinese rate. In
    fact, from an international perspective, breast
    cancer can clearly be seen as a disease of
    affluence that is highly related to animal fat
    (and, possibly just by association, animal
    protein).
  • Carroll KK, Braden LM et al. (1986) Fat and
    cancer. Cancer 581818-25
  • This finding has been confirmed many times since
    then.

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Colorectal Cancer
  • A major American Cancer Society study finds
    people who reported the highest consumption of
    red and processed meat had a significantly higher
    risk of colorectal cancer than those who reported
    the least consumption. The study of nearly
    150,000 Americans, the largest and most
    comprehensive to date, adds substantially to
    previous evidence linking highest consumption of
    red and processed meat to intestinal cancer.
  • Chao et al. (2005) Meat Consumption and Risk of
    Colorectal Cancer. JAMA (Journal of the American
    Medical Association) 293 172-182.

46
A Major Recent Study!
  • Red and processed meat intakes were associated
    with modest increases in total mortality, cancer
    mortality, and cardiovascular disease
    mortality.Sinha R, Cross AJ et al. (2009) Meat
    Intake and Mortality A Prospective Study of Over
    Half a Million People. Archives of Internal
    Medicine 169(6), 562-571.

47
Nitrites and Nitrosamines
  • Sodium nitriteA meat preservative used since
    the 1920s, it kills bacteria, colours meat pink
    and adds to the taste.
  • NitrosaminesA family of chemicals of which at
    least 17 are reasonably anticipated to be human
    carcinogens.National Toxicology Program (2001)
    Ninth report on carcinogens, revised January
    2001. Washington, DC U.S Dept of Health and
    Human Services.http//ntp.niehs.nih.gov/index.cfm
    ?objectid72016262-BDB7-CEBA-FA60E922B18C2540

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Value of a Plant-Based Diet
  • Recent scientific findings are suggesting that
    diets largely based on plant foods, such as some
    vegetarian, Mediterranean, or rural Asian diets,
    could best prevent nutrient deficiencies as well
    as diet-related chronic diseases. These diets
    contain no or very little meat.
  • Diets largely based on plant foods, such as
    well-balanced vegetarian diets, could best
    prevent nutrient deficiencies as well as
    diet-related chronic diseases.Sabaté, Joan
    (2003) The contribution of vegetarian diets to
    health and disease a paradigm shift? American
    Journal of Clinical Nutrition, Vol. 78, No. 3,
    502S-507S.

50
1960s Perspective
from Sabaté, Joan (2003)
51
Current Perspective
from Sabaté, Joan (2003)
52
Well-Planned Diets
from Sabaté, Joan (2003)
53
Plant Protein
  • Plant protein can meet requirements when a
    variety of plant foods is consumed and energy
    needs are met. Research indicates that an
    assortment of plant foods eaten over the course
    of a day can provide all essential amino acids
    and ensure adequate nitrogen retention and use in
    healthy adults, thus complementary proteins do
    not need to be consumed at the same meal.
  • ADA Reports Position of the American Dietetic
    Association and Dietitians of Canada Vegetarian
    diets Journal of the American Dietetic
    Association Online June 2003, Volume 103, Number
    6.Young VR, Pellett PL. Plant proteins in
    relation to human protein and amino acid
    nutrition. Am J Clin Nutr 1994591203S-1212S.
  • Beans rice together provide plenty of all the
    essential amino acids.

54
Nutritional adequacy of plant-based diets
  • Energy and protein intakes are similar for
    plant-based diets compared with those containing
    meat. Fe and vitamin B12 are the nutrients most
    likely to be found lacking in such diets.
    Bioactive substances present in foods of plant
    origin significantly influence the
    bioavailability of minerals and requirements for
    vitamins. Well-balanced vegetarian diets are able
    to support normal growth and development. It is
    concluded that meat is an optional rather than an
    essential constituent of human diets.
  • Sanders TA (1999) Nutritional adequacy of
    plant-based diets. Proc Nutr Soc.
    May58(2)265-9.

55
Phytochemicals
  • Phytochemicals (there are thousands) are found
    naturally in plants, helping them to protect
    themselves from bacteria and disease. Some act as
    antioxidants, limiting and repairing cell damage
    caused by free radicals. Others act as
    hormone-like substances to prevent cancer or
    block the enzymes that promote the development of
    cancer and other diseases.
  • Flavonoids, found in apples, strawberries,
    grapes, onions, green and black tea and red wine,
    may decrease atherosclerotic plaque and DNA
    damage related to cancer development.
  • Carotenoids (beta-carotene, lutein, zeaxanthin,
    crytoxanthin and lycopene) protect the eye from
    harmful oxidation reactions.
  • Lignans, found in flaxseed, seaweed, soybeans,
    bran and dried beans, are phytoestrogens that
    interfere with the action of the sex hormone
    estrogen and may help prevent hormone-related
    cancers, slow the growth of cancer cells, and
    lower the risk for heart disease.

56
Position of the American Dietetic Association and
Dietitians of Canada Vegetarian diets
  • It is the position of the American Dietetic
    Association and Dietitians of Canada that
    appropriately planned vegetarian diets are
    healthful, nutritionally adequate, and provide
    health benefits in the prevention and treatment
    of certain diseases.ADA Reports Position of
    the American Dietetic Association and Dietitians
    of Canada Vegetarian diets Journal of the
    American Dietetic Association Online June 2003,
    Volume 103, Number 6.256 mostly peer-reviewed
    references

57
The Mediterranean Diet
  • The weight of evidence suggests that a
    Mediterranean style of eating may be the
    healthiest approach.
  • In a population-based, prospective investigation
    involving 22,043 adults in Greece who completed
    an extensive, validated, food-frequency
    questionnaire
  • CONCLUSIONS Greater adherence to the traditional
    Mediterranean diet is associated with a
    significant reduction in total mortality.Trichop
    oulou A et al. (2003) Adherence to a
    Mediterranean diet and survival in a Greek
    population. N Engl J Med. 26348(26) 2599-608.

58
Mediterranean Diet and Longevity
  • First, there appears to exist sufficient evidence
    that diet does indeed influence longevity.
  • Second, an optimal diet for the prevention of
    both coronary heart disease and cancer is likely
    to extensively overlap with the traditional
    Mediterranean diet. It is not yet clear which
    components in the Mediterranean diet are more
    important for its apparent health effects, but
    olive oil, plant foods and moderate wine
    consumption are likely candidates.
  • Trichopoulou A, Critselis E (2004) Mediterranean
    diet and longevity. Eur J Cancer Prev. 2004
    Oct13(5)453-6.

59
Mediterranean Diet Leads To Longer Life
  • The Mediterranean diet has been associated with
    longer life expectancy among elderly Europeans.
    The diet typically involves a high intake of
    vegetables, legumes, fruits, and cereals a
    moderate to high intake of fish a low intake of
    saturated fats a high intake of unsaturated fats
    (especially olive oil) a low intake of dairy
    products and meat and a modest intake of
    alcohol, mostly wine. Current evidence suggests
    that such a diet may be beneficial to health.
  • This study involved over 74,000 healthy men and
    women, aged 60 or more, living in nine European
    countries. When dietary exposures were calibrated
    across countries, the reduction in mortality
    averaged 7 (1 to 12).
  • Trichopoulou A, Orfanos P et al. (2005) Modified
    Mediterranean diet and survival EPIC-elderly
    prospective cohort study. British Med J 330
    (7498) 991.
  • http//www.bmj.com/cgi/content/full/330/7498/991

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Mediterranean Diet CHD
  • Epidemiological studies as well as randomised
    dietary trials suggest that Mediterranean diet
    may be important in relation to the pathogenesis
    and prevention of coronary heart disease (CHD). A
    striking protective effect of a Mediterranean
    diet rich in alpha-linolenic acid (ALA) was
    reported in the Lyon Diet Heart Study with a 50
    to 70 reduction of the risk of recurrence after
    four years of follow-up in CHD patients.
  • de Lorgeril M, Salen P (2006) The Mediterranean
    diet in secondary prevention of coronary heart
    disease.Clin Invest Med. June 29(3) 154-8.

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Mediterranean Diet Obesity
  • The sample included 17,238 women and 10,589 men
    not obese and aged 29-65 y at baseline
    (1992-96)High MD adherence was associated with
    significantly lower likelihood of becoming obese
    among overweight subjectsMD adherence was not
    associated with incidence of overweight in
    initially normal-weight subjectsresults suggest
    that promoting eating habits consistent with MD
    patterns may be a useful part of efforts to
    combat obesity.
  • Mendez MA, Popkin BM (2006) Adherence to a
    Mediterranean diet is associated with reduced
    3-year incidence of obesity.J Nutr. Nov.
    136(11) 2934-8.

62
Organizations Supporting Vegetarianism
  • The American Institute for Cancer Research and
    the World Cancer Research Fund call for choosing
    predominantly plant-based diets rich in a variety
    of vegetables and fruits, legumes, and minimally
    processed starchy staple foods and limiting red
    meat consumption, if at all.
  • The American Cancer Society recommends choosing
    most food from plant sources.
  • The American Heart Association recommends
    choosing a balanced diet with an emphasis on
    vegetables, grains, and fruits.
  • The Heart and Stroke Foundation of Canada
    recommends using grains and vegetables instead of
    meat as the centerpiece of meals.
  • The Unified Dietary Guidelines developed by the
    American Cancer Society, the American Heart
    Association, the National Institutes of Health,
    and the American Academy of Pediatrics call for a
    diet based on a variety of plant foods, including
    grain products, vegetables, and fruits to reduce
    risk of major chronic diseases.

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What is stopping the change?
  • Most evidence suggests that a shift to largely
    plant-based diets would reduce chronic disease
    risks among industrialized and rapidly-industriali
    zing populations. The accomplish this shift, it
    will be necessary to overcome market-place
    barriers and to develop new policies that will
    encourage greater consumption of fruits,
    vegetables and grains as a means to promote
    public health.
  • Nestle M. (1999) Animal versus plant foods in
    human diets and health is the historical record
    unequivocal? Proc Nutr Soc 1999582118.

64
The Broader Picture
  • Rearing cattle produces more greenhouse gases
    than driving cars.Steinfeld H et al. (2006)
    Livestocks Long Shadow Environmental Issues and
    Options. FAO (Food and Agriculture Organization)
    of the United Nations.
  • On average, land requirements for meat-protein
    production are 10 times greater than for
    plant-protein production.Leitzmann C (2003).
    Nutrition ecology the contribution of vegetarian
    diets. American Journal of Clinical Nutrition 78
    (Suppl), 658S.
  • Producing one kilogram of animal protein
    generally requires nearly 100 times more water
    than producing one kilogram of grain
    protein.Pimentel D, Piemental M (2003).
    Sustainability of meat-based and plant based
    diets and the environment. Am J Clin Nutrition
    78(Suppl), 662S.
  • Less than half the harvested acreage in the U.S.
    is used to grow food for people. For every
    sixteen pounds of grain and soybeans fed to beef
    cattle, we get back only one pound of meat on our
    plates.Gussow JD (1994). Ecology and vegetarian
    considerations does environmental responsibility
    demand the elimination of livestock? American
    Journal of Clinical Nutrition 59 (Suppl), 1111S.

65
For your healthfor your environmentfor
compassion to animals
  • Pleaseeat less meat!
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