Striving for Alkaline Pee and Acidic Poo

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More than 30 years ago, an idea was put forward that high colonic pH promoted colorectal cancer. A high colonic pH may promote the creation of carcinogens from bile acids, a process that is inhibited once you get below a pH of about 6.5. This is supported by data which shows those at higher risk for colon cancer may have a higher stool pH, and those at lower risk have a low pH. There was a dramatic difference between the two groups, with most of the high risk group over pH 8, and most of the low risk group under pH 6 (see Stool pH and Colon Cancer).

This may help explain the 50-fold lower rates of colon cancer in Africa compared to America. The bacteria we have in our gut depends on what we eat. If we eat lots of fiber, then we preferentially feed the fiber eating bacteria, which give us back all sorts of health promoting substances like short-chain fatty acids that have anti-inflammatory and anti-cancer properties. More of these organic acids were found in the stools of native Africans than African Americans. More acids, so lower pH. Whereas putrefactive bacteria, eating animal protein, are able to increase stool pH by producing alkaline metabolites like ammonia.

The pH of the stools of white versus black children in Africa was compared. Children were chosen because you can more readily sample their stools, particularly the rural black schoolchildren who were eating such high fiber diets--whole grains, legumes, nuts, vegetables, fruits, and wild greens--that 90% of them could produce a stool on demand. Stuffed from head to tail with plants, they could give you a stool sample at any time, just as easy as getting a urine sample. It was hard to even get access to the white kids, though, who were reluctant to participate in such investigations, even though they were given waxed cartons fitted with lids while all the black kids got was a plate and a square of paper towel.

The researchers found significantly lower fecal pH in those eating the traditional, rural plant-based diets compared to those eating the traditional Western diet, who were eating far fewer whole plant foods than the black children. But, remove some of those whole plant foods, like switch their corn for white bread for just a few days and their stool pH goes up, and add whole plant foods like an extra five to seven servings of fruit every day, and their stool pH goes down even further and gets more acidic. It makes sense because when you ferment fruits, veggies, and grains, they turn sour, like vinegar, sauerkraut, or sourdough, because good bacteria like lactobacillus produce organic acids like lactic acid. Those who eat a lot of plants have more of those good bugs. So, using the purple cabbage test highlighted in my video, Testing Your Diet with Pee & Purple Cabbage, we want blue pee, but pink poo.

If you compare the fecal samples of those eating vegetarian or vegan to those eating standard diets, plant-based diets appear to shift the makeup of the bacteria in our gut, resulting in a significantly lower stool pH, and the more plant-based, the lower the pH dropped. It's like a positive feedback loop: fiber-eating bacteria produce the acids to create the pH at which fiber-eating bacteria thrive while suppressing the group of less beneficial bugs.

It might taken even as little as two weeks to bring stool pH down on a plant-based diet. In a study published in the British Journal of Cancer, a dozen volunteers carefully selected for their trustworthiness and randomized to sequentially go on regular, vegetarian, or vegan diets and two weeks in, a significant drop in fecal pH was achieved eating completely plant-based.

But there are differing qualities of plant-based diets. For example, the two groups followed in the study I mentioned earlier had dramatically different stool pH, yet both groups were vegetarian. The high risk group was eating mostly refined grains, very little fiber, whereas the low risk group was eating whole grains and beans, packed with fiber for our fiber-friendly flora to munch on.

Just as a "reduction of high serum cholesterol contributes to the avoidance of coronary heart disease," a fall in the fecal pH value may contribute to the avoidance of bowel cancer and through the same means, eating more whole plant foods.

More on colon cancer prevention in:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Kitti Sukhonthanit © 123RF.com. This image has been modified.

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Striving for Alkaline Pee and Acidic Poo

Stool pH and Colon Cancer.jpg

More than 30 years ago, an idea was put forward that high colonic pH promoted colorectal cancer. A high colonic pH may promote the creation of carcinogens from bile acids, a process that is inhibited once you get below a pH of about 6.5. This is supported by data which shows those at higher risk for colon cancer may have a higher stool pH, and those at lower risk have a low pH. There was a dramatic difference between the two groups, with most of the high risk group over pH 8, and most of the low risk group under pH 6 (see Stool pH and Colon Cancer).

This may help explain the 50-fold lower rates of colon cancer in Africa compared to America. The bacteria we have in our gut depends on what we eat. If we eat lots of fiber, then we preferentially feed the fiber eating bacteria, which give us back all sorts of health promoting substances like short-chain fatty acids that have anti-inflammatory and anti-cancer properties. More of these organic acids were found in the stools of native Africans than African Americans. More acids, so lower pH. Whereas putrefactive bacteria, eating animal protein, are able to increase stool pH by producing alkaline metabolites like ammonia.

The pH of the stools of white versus black children in Africa was compared. Children were chosen because you can more readily sample their stools, particularly the rural black schoolchildren who were eating such high fiber diets--whole grains, legumes, nuts, vegetables, fruits, and wild greens--that 90% of them could produce a stool on demand. Stuffed from head to tail with plants, they could give you a stool sample at any time, just as easy as getting a urine sample. It was hard to even get access to the white kids, though, who were reluctant to participate in such investigations, even though they were given waxed cartons fitted with lids while all the black kids got was a plate and a square of paper towel.

The researchers found significantly lower fecal pH in those eating the traditional, rural plant-based diets compared to those eating the traditional Western diet, who were eating far fewer whole plant foods than the black children. But, remove some of those whole plant foods, like switch their corn for white bread for just a few days and their stool pH goes up, and add whole plant foods like an extra five to seven servings of fruit every day, and their stool pH goes down even further and gets more acidic. It makes sense because when you ferment fruits, veggies, and grains, they turn sour, like vinegar, sauerkraut, or sourdough, because good bacteria like lactobacillus produce organic acids like lactic acid. Those who eat a lot of plants have more of those good bugs. So, using the purple cabbage test highlighted in my video, Testing Your Diet with Pee & Purple Cabbage, we want blue pee, but pink poo.

If you compare the fecal samples of those eating vegetarian or vegan to those eating standard diets, plant-based diets appear to shift the makeup of the bacteria in our gut, resulting in a significantly lower stool pH, and the more plant-based, the lower the pH dropped. It's like a positive feedback loop: fiber-eating bacteria produce the acids to create the pH at which fiber-eating bacteria thrive while suppressing the group of less beneficial bugs.

It might taken even as little as two weeks to bring stool pH down on a plant-based diet. In a study published in the British Journal of Cancer, a dozen volunteers carefully selected for their trustworthiness and randomized to sequentially go on regular, vegetarian, or vegan diets and two weeks in, a significant drop in fecal pH was achieved eating completely plant-based.

But there are differing qualities of plant-based diets. For example, the two groups followed in the study I mentioned earlier had dramatically different stool pH, yet both groups were vegetarian. The high risk group was eating mostly refined grains, very little fiber, whereas the low risk group was eating whole grains and beans, packed with fiber for our fiber-friendly flora to munch on.

Just as a "reduction of high serum cholesterol contributes to the avoidance of coronary heart disease," a fall in the fecal pH value may contribute to the avoidance of bowel cancer and through the same means, eating more whole plant foods.

More on colon cancer prevention in:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Kitti Sukhonthanit © 123RF.com. This image has been modified.

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Why Smoothies are Better Than Juicing

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Studies such as a recent Harvard School of Public Health investigation found that the consumption of whole fruits is associated with a significantly lower risk of type 2 diabetes, whereas fruit juice consumption is associated with a higher risk, highlighting the dramatic difference between eating whole fruits and drinking fruit juice. Cholesterol serves as another example. If we eat apples, our cholesterol drops. On the other hand, if we drink apple juice, our cholesterol may actually go up a little. Leaving just a little of the fiber behind--as in cloudy apple juice--was found to add back in some of the benefit.

We used to think of fiber as just a bulking agent that helps with bowel regularity. We now know fiber is digestible by our gut bacteria, which make short chain fatty acids (SCFAs) out of it. SCFAs have a number of health promoting effects, such as inhibiting the growth of bad bacteria and increasing mineral absorption. For example, experimentally infused into the rectum of the human body, SCFAs can stimulate calcium absorption, so much so that we can improve the bone mineral density of teenagers just by giving them the fiber naturally found in foods like onions, asparagus, and bananas.

Our good bacteria also uses fiber to maintain normal bowel structure and function, preventing or alleviating diarrhea, stimulating colonic blood flow up to five-fold, and increasing fluid and electrolyte uptake. The major fuel for the cells that line our colon is butyrate, which our good bacteria make from fiber. We feed them, and they feed us right back.

If the only difference between fruit and fruit juice is fiber, why can't the juice industry just add some fiber back to the juice? The reason is because we remove a lot more than fiber when we juice fruits and vegetables. We also lose all the nutrients that are bound to the fiber.

In the 1980's, a study (highlighted in my video, Juicing Removes More Than Just Fiber) found a discrepancy in the amount of fiber in carob using two different methods. A gap of 21.5 percent was identified not as fiber but as nonextractable polyphenols, a class of phytonutrients thought to have an array of health-promoting effects. Some of the effects associated with the intake of dietary fiber in plants may actually be due to the presence of these polyphenols.

Nonextractable polyphenols, usually ignored, are the major part of dietary polyphenols. Most polyphenol phytonutrients in plants are stuck to the fiber. These so-called missing polyphenols make it down to our colon, are liberated by our friendly flora and can then get absorbed into our system. The phytonutrients in fruit and vegetable juice may just be the tip of the iceberg.

For those that like drinking their fruits and vegetables, these findings suggest that smoothies may be preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing. But we may be losing more than we think.

For those that like drinking their fruits and vegetables, this suggests smoothies are preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing, but they may be losing more than they think.

Why are polyphenol phytonutrients important? See, for example, my video How to Slow Brain Aging by Two Years

Not that fiber isn't important in its own right. Check out:

For more on smoothies, check out:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Craig Sunter / Flickr

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A Simple Yet Neglected Cure for Childhood Constipation

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Back in the 1950s, it was suggested that some cases of constipation among children might be due to the consumption of cow's milk. But it wasn't until 40 years later that it was finally put to the test. We used to think that most chronic constipation in infants and young children was all in their head--they were "anal retentive"--or had some intestinal disorder, but a group of Italian researchers studied 27 consecutive infants who showed up in their pediatric gastroenterology clinic with chronic "idiopathic constipation" (meaning they had no idea what was causing it), and tried removing cow's milk protein from their diet.

Within three days on a cow's milk protein-free diet, 21 out of the 27 children were cured. There were clinical relapsea during two subsequent cow milk challenges, meaning when they tried giving the children back some cow's milk, the constipation reappeared within 24 to 48 hours. The subjects came back after a month and stayed cured, and their eczema and wheezing went away, too! The researchers concluded that many cases of chronic constipation in young children--more than three quarters it seemed, may be due to an underlying cow's milk protein allergy.

Chronic constipation is a common problem in children, for which fiber and laxatives are prescribed. If those don't work, several laxatives at progressively higher dosages can be used, and that still may not work. Five years later, a considerable number of kids are still suffering. In fact, chronic constipation may even extend into adulthood. To cure the disease in just a few days by eliminating cow's milk was a real breakthrough.

But it was an open trial, meaning not blinded or placebo-controlled. We didn't have such a trial until a landmark study was published in the New England Journal of Medicine--a double-blind, crossover study, comparing cow's milk and soy milk. The study enrolled 65 kids suffering from chronic constipation, all previously treated unsuccessfully with laxatives; 49 had anal fissures and inflammation and swelling. The researchers gave them either cow's milk or soy milk for two weeks and then switched it around.

In two thirds of the children, constipation resolved while they were receiving soy milk, and the anal fissures and pain were cured. None of the children receiving cow's milk had a positive response. In the 44 responders, the relation with cow's milk protein hypersensitivity was confirmed in all cases by a double-blind challenge with cow's milk. All those lesions, including the most severe anal fissures, disappeared on a cow's milk-free diet, yet reappeared within days after the reintroduction of cow's milk back into their diets.

This may explain why children drinking more than a cup of milk a day may have eight times the odds of developing anal fissures. Cutting out milk may help cure anal fissures in adults, too. Cow's milk may also be a major contributor to recurrent diaper rash as well.

Why does removing cow's milk treat these conditions? Studies that have looked at biopsy tissue samples in patients with chronic constipation because of cow's milk protein hypersensitivity have found signs of rectal inflammation, suggesting that cow's milk protein was inducing an inflammatory response.

Studies from around the world have subsequently confirmed these findings, curing up to 80 percent of kids' constipation by switching to soy milk or rice milk. A common problem with the studies, though, is when they switched kids from cow's milk to non-dairy milk, the kids could still have been eating other dairy products. That is, they didn't control the background diet...until recently. A 2013 study (highlighted in my video, Childhood Constipation and Cow's Milk, got constipated kids off all dairy products and 100 percent were cured, compared with 68 percent in the New England Journal study.

Isn't this amazing? I just kept thinking, "why didn't I learn this in medical school?" Is the dairy lobby so persuasive that a cheap, simple, safe, life-changing intervention like this remains buried?

Until now!

If you appreciate learning what your child's pediatrician probably never did, please consider making a donation to the 501c3 nonprofit charity that keeps this website going. I don't make a penny off the site, but it does require substantial server and logistics costs.

Make sure to check out tomorrow's video: Treating Infant Colic by Changing Mom's Diet.

Avoiding dairy may be important for infant health too. Watch my 3-part video series:

Then the effects on adolescents and beyond:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Melissa Wiese / Flickr

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Bile Acids and Breast Cancer

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Why do constipated women appear to be at higher risk for breast cancer? The results of a 1989 study out of the American Journal of Public Health suggested a slight increased risk of breast cancer for both decreased frequency of bowel movements and firm stool consistency. Women who had three or more bowel movements a day appeared to cut their risk of breast cancer in half. This could be because constipation means a greater contact time between our waste and our intestinal wall, which may increase the formation and absorption of fecal mutagens--substances that cause DNA mutations and cancer--into our circulation, eventually ending up in breast tissue.

The concept that more frequent bowl movements decrease breast cancer risk dates back more than a century, where severe constipation, so-called "chronic intestinal stasis," was sometimes dealt with surgically. Figuring that the colon was an inessential part of the human anatomy, why not cure constipation by just cutting it out? After the surgery, they noticed that potentially precancerous changes in the breasts of constipated women seemed to disappear.

It would take another 70 years before researchers followed up on the clues by those distinguished surgeons who claimed breast pathology cleared when constipation was corrected. A 1981 study published in The Lancet investigated the relation between potentially precancerous changes in the breast and the frequency of bowl movements in nearly 1,500 women (See Breast Cancer and Constipation). The researchers found that the risk of precancerous changes was four times greater in women reporting two or fewer bowel movements a week compared to more than once daily.

We know that even the non-lactating breast actively takes up chemical substances from the blood. We also know that there are mutagens in feces. It is not unreasonable to suggest that potentially toxic substances derived from the colon have damaging or even carcinogenic effects upon the lining of the breast. Toxic substances like bile acids. Bile acids were first shown to promote tumors in mice in 1940, but subsequent experiments on rats led to the mistaken belief that bile acids just promoted existing cancers and couldn't initiate tumors themselves. However, there is a fundamental difference between the rodent models and human cancer. Rats only live a few years while humans can live dozens, so the opportunity for cancer causing mutations may be at least 30 times greater in humans. We now have at least 15 studies that show that bile acids can damage DNA, strongly suggesting they can initiate new cancers as well.

Bile acids are formed as a way of getting rid of excess cholesterol. Our liver dumps bile acids into the intestine for disposal, assuming our intestines will be packed with fiber to trap it and flush it out of the body. But if we haven't been eating enough fiber-rich whole plant foods, bile acids can be reabsorbed back into the body and build up in the breast.

Carcinogenic bile acids are found concentrated in the fluid of breast cysts at up to a hundred times the level found in the bloodstream. By radioactively tagging bile acids, researchers were able to show that intestinal bile acids rapidly gain access to the breast, where they can exert an estrogen-like cancer-promoting effect on breast tumor cells. This would explain why we see 50% higher bile acid levels in the bloodstream of newly diagnosed breast cancer victims. These findings support the concept of a relationship between intestinally-derived bile acids and risk of breast cancer. So how can we facilitate the removal of bile acids from our body?

Slowed colonic transit can increase bile acid levels. Therefore, to decrease absorption of bile acids, we can speed up the so-called "oro-anal transit time," the speed at which food goes from mouth to toilet, by eating lots of fiber. A diet packed with plants greatly increases bile acid excretion.

Fiber can bind up and remove other toxic elements like lead and mercury as well as cholesterol and bile acids. But plants can bind bile acids even independent of fiber. Vegan diets bind significantly more bile acid than lacto-ovo or non-vegetarian diets even at the same fiber intake, which could explain why individuals eating vegetarian might excrete less mutagenic feces in the first place.

I touched on this in my live presentation From Table to Able: Combating Disabling Diseases with Food, but what I didn't get to discuss is the relative bile acid binding abilities of different foods. I cover that in my video Which Vegetable Binds Bile Best?

What intestinal transit time should we be shooting for? See Food Mass Transit. That may be why Stool Size Matters. Also, How Many Bowel Movements Should You Have Every Day? We can improve speed and size by Bulking Up on Antioxidants and eating lots of whole plant foods (Prunes vs. Metamucil vs. Vegan Diet).

Fiber may also help women remove excess estrogen from their body. See my video Fiber vs. Breast Cancer. For more on the wonders of fiber, see Dr. Burkitt's F-Word Diet.

For more of my latest videos on breast cancer prevention and survival, see:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and Food as Medicine.

Image Credit: Photocapy / Flickr

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How Probiotics Affect Mental Health

 

 

 

 

 

 

 

 

 How Probiotics Affect Mental Health

Before Thorazine was invented in 1950, mental illness was often treated surgically. In fact, in 1949 the inventor of the lobotomy was awarded the Nobel Prize. Before tens of thousands were lobotomized, however, colectomy was all the rage. There was a theory that bad bacteria in the gut­ was the cause of mental illness. So the cure was to surgically remove the colon. Yes, the surgery killed about one in three–but when they didn’t die, surgeons claimed positive results. Some, for example, bragged that when they resected the colons of schoolchildren as a preventive measure there was a cessation of “abnormal sex practices” like masturbation (which was viewed at the time as a precursor for mental illness later in life). Reminds me of the mastectomies they used to perform for menstrual breast pain (Plant-Based Diets For Breast Pain).

Others, though, suggested a less drastic approach, proposing that one could instead treat this "intestinal putrefaction" by changing the intestinal flora. Indeed, over a century ago there were reports of successfully treating psychiatric illnesses like depression with a dietary regimen that included probiotics. Doctors perceived a connection between depression and “feces deficient in quantity and moisture and very offensive in odor.” Reportedly, after the probiotic regimen not only did people feel better psychologically, but they had their “feces increase in quantity, become softer, and of regular consistency, and the offensive smell diminish….” Concurrent with the probiotics, however, all patients were started on a vegetarian diet—so it may not have been the probiotics at all.

Why might the vegetarian diet alone have improved mood? Check out my videos Plant-Based Diet & Mood and the follow-up Improving Mood Through Diet as well as my serotonin series starting with Human Neurotransmitters in Plants.

This entire field of inquiry remained dormant for about a hundred years, but a new discipline has recently emerged known as enteric (meaning intestinal) neuroscience. Our enteric nervous system—the collection of nerves in our gut—has been referred to as a “second brain” given its size, complexity, and similarity. We have as many nerves in our gut as we do in our spinal cord! The size and complexity of our gut brain is not surprising when considering the challenges posed by the interface. We have a hundred times more contact with the outside world through our gut than through our skin. We also have to deal with our 100 trillion little friends down there. That takes a lot of processing power.

Anyone who’s had butterflies in their stomach knows that our mental state can affect our gut. Studies show that every day stresses can actually affect gut flora populations. An innovative study out of Australia looked at feces scraped from toilet paper used by undergrads during exam week. If you check out my 5-min video Gut Feelings: Probiotics and Mental Health, you can see how many bacteria the undergrads had in their feces before and after the exam. You’ll notice the effect lasted the whole week. Their findings show that our mental state can indeed affect our gut, but can our gut affect our mental state? We didn’t know until recently.

Many suffering from chronic fatigue syndrome complain of gut dysfunction, so researchers tried giving sufferers probiotics to see if their mental and emotional state could be improved and it did appear to help. You can learn more about treating chronic fatigue syndrome in:

What about for healthy people, though? A study entitled “Assessment of the Psychotropic Properties of Probiotics” marked a turning point in our thinking. Researchers found that one month of probiotics appeared to significantly decrease symptoms of anxiety, depression, anger and hostility. Until that study was published, the idea that probiotic bacteria administered to the intestine could influence the brain seemed almost surreal–like science-fiction. Well, science yes, but maybe not fiction. 

Might people suffering from certain forms of mental health problems benefit from a fecal transplant from someone with more happy-go-lucky bacteria? We don’t know, but this apparent ability of probiotics to affect brain processes is one of the most exciting recent developments in probiotic research.

Gut Feelings: Probiotics and Mental Health closes out my 4-part video series on the latest in probiotic science. I started with the two most established indications for their use in Preventing and Treating Diarrhea with Probiotics, then moved onto a more speculative use in Preventing the Common Cold with Probiotics?, and then offered practical advice on how to best take probiotic supplements in Should Probiotics Be Taken Before, During, or After Meals?

What else might our good bacteria be doing for us? They may help with weight control (Fawning Over Flora and Gut Flora & Obesity) and serve up anti-cancer compounds! (Flax and Fecal Flora and Sometimes the Enzyme Myth Is True).

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: Ana_Cotta / Flickr

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Best Treatment for Constipation

Constipation is a common problem that affects up to 20 percent of the world’s population. Nearly 60 million Americans suffer from chronic constipation, which is particularly a problem in women and the elderly. It is a pathological condition that is often severe enough to disrupt daily activities and derange quality of life. It responds poorly to available medical remedies and may prompt sophisticated and potentially harmful surgical procedures. Despite all this, it is still frequently considered a trivial issue and affected individuals tend to self-medicate either using over-the-counter laxatives or ‘natural’ remedies, none of which had been adequately investigated. Until now. Fiber supplements can be inconvenient, taste nasty, and cause bloating—even choking. Prunes could present a natural, convenient, tasty alternative, but do they work?

A randomized clinical trial of prunes vs. Metamucil was recently published. I present the results in my 4-min video Prunes vs. Metamucil vs. Vegan Diet. Each dot on the graph represents a complete spontaneous bowel movement. You'll notice when you watch the video how many had zero a week. Study participants went from an average of 1.7 a week up to 3.5 on prunes (at least one every other day), then back to baseline when prunes were removed. On Metamucil they got up to 2.8  a week. Not as good as the prunes, and a significantly better stool consistency was also noted when using the prunes, as measured by the famous Bristol Stool Scale.

The researchers concluded that treatment with dried plums resulted in a greater improvement in constipation symptoms than the commonly used fiber supplement. Given their palatability, tolerability, and availability, dried plums should be “considered as a first line therapy for chronic constipation.”

If that’s what adding one plant can do, though, what if all you ate was plants? Vegans are off the charts, averaging 10.9!

For more on optimizing bowel function, see:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: Alexander Ekman / Flickr

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