Should Cancer Patients Avoid Raw Fruits and Vegetables?

Should Cancer Patients Avoid Raw Fruits and Vegetables?.jpeg

Back in the 1960s, a patient isolator unit was developed for cancer patients undergoing chemotherapy. Because our immune system cells were often caught in the friendly fire, up to 50% of cancer patients died of infections before they could even complete the chemo because their immune systems had become so compromised. So, a bubble boy-like contraption was developed. The patient was shaved, dipped in disinfectant, rinsed off with alcohol, rubbed with antibiotic ointment into every orifice, and placed on a rotating regimen of a dozen of the most powerful antibiotics they had. Procedures were performed through plastic sleeves on the sides of the unit, and everything in and out had to be sterilized and passed through airlocks. So, the patient wasn't allowed any fresh fruits or vegetables.

People went crazy cooped up in these bubble-like units, with 38% even experiencing hallucinations. Fifteen years later the results were in: it simply didn't work. People were still dying at the same rate, so the whole thing was scrapped--except the diet. The airlocks and alcohol baths were abandoned, but they continued to make sure no one got to eat a salad.

Neutrophils are white blood cells that serve as our front line of defense. When we're immunocompromised and don't have enough neutrophils, we're called "neutropenic." So, the chemotherapy patients were put on a so-called neutropenic diet without any fresh fruits and vegetables. The problem is there's a glaring lack of evidence that such a neutropenic diet actually helps (see my video Is a Neutropenic Diet Necessary for Cancer Patients?).

Ironically, the neutropenic diet is the one remaining component of those patient isolator unit protocols that's still practiced, yet it has the least evidence supporting its use. Why? The rationale is: there are bacteria in salads, bacteria cause infections, immunocompromised patients are at increased risk for infections, and therefore, no salad. What's more, they were actually glad there aren't any studies on this because it could be way too risky to give a cancer patient an apple or something. So, its continued use seems to be based on a ''better safe than sorry'' philosophy.

The problem is that kids diagnosed with cancer are already low in dietary antioxidants, so the last thing we should do is tell them they can't have any fresh fruit or veggies. In addition to the lack of clinical evidence for this neutropenic diet, there may be some drawbacks. Restricting fruits and vegetables may even increase the risk of infection and compromise their nutritional status.

So, are neutropenic diets for cancer patients "reasonable prudence" or "clinical superstition"? Starting in the 1990s, there was a resurgence of research when greater importance was placed on the need to "support clinical practice with evidence."

What a concept!

Three randomized controlled trials were published, and not one supported the neutropenic diet. In the biggest study, an all-cooked diet was compared to one that allowed raw fruits and veggies, and there was no difference in infection and death rates. As a result of the study, the principal investigator at the MD Anderson Cancer Center described how their practice has changed and now everyone is allowed to eat their vegetables--a far cry from "please don't eat the salads" 31 years earlier.

Today, neither the Food and Drug Administration, the Centers for Disease Control and Prevention, nor the American Cancer Society support the neutropenic diet. The real danger comes from pathogenic food-poisoning bacteria like Campylobacter, Salmonella, and E. coli. So we still have to keep patients away from risky foods like undercooked eggs, meat, dairy, and sprouts. At this point, though, there really shouldn't be a debate about whether cancer patients should be on a neutropenic diet. Nevertheless, many institutions still tell cancer patients they shouldn't eat fresh fruits and veggies. According to the latest survey, more than half of pediatric cancer doctors continue to prescribe these diets, though it's quite variable even among those at the same institution.

Why are doctors still reluctant to move away from the neutropenic diet? There are several reasons why physicians may be hesitant to incorporate evidence-based medicine into their practices. They may have limited time to review the literature. They'd like to dig deep into studies, but simply don't have the time to look at the evidence. Hmm, if only there was a website... :)

Bone marrow transplants are the final frontier. Sometimes it's our immune system itself that is cancerous, such as in leukemia or lymphoma. In these cases, the immune system is wiped out on purpose to rebuild it from scratch. So, inherent in the procedure is a profound immunodeficiency for which a neutropenic diet is often recommended. This has also had never been tested--until now.

Not only did it not work, a strict neutropenic diet was actually associated with an increased risk for infection, maybe because you don't get the good bugs from fruits and vegetables crowding out the bad guys in the gut. So not only was the neutropenic diet found to be unbeneficial; there was a suggestion that it has the potential to be harmful. This wouldn't be the first time an intervention strategy made good sense theoretically, but, when put to the test, was ultimately ineffective.

Unfortunately, there's an inertia in medicine that can result in medical practice that is at odds with the available evidence. Sometimes this disconnect can have devastating consequences. See, for example, Evidence-Based Medicine or Evidence-Biased? and The Tomato Effect.

The reason it is so important to straighten out the neutropenic diet myth is that fruits and vegetables may actually improve cancer survival:

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: Sally Plank

Original Link

Should Cancer Patients Avoid Raw Fruits and Vegetables?

Should Cancer Patients Avoid Raw Fruits and Vegetables?.jpeg

Back in the 1960s, a patient isolator unit was developed for cancer patients undergoing chemotherapy. Because our immune system cells were often caught in the friendly fire, up to 50% of cancer patients died of infections before they could even complete the chemo because their immune systems had become so compromised. So, a bubble boy-like contraption was developed. The patient was shaved, dipped in disinfectant, rinsed off with alcohol, rubbed with antibiotic ointment into every orifice, and placed on a rotating regimen of a dozen of the most powerful antibiotics they had. Procedures were performed through plastic sleeves on the sides of the unit, and everything in and out had to be sterilized and passed through airlocks. So, the patient wasn't allowed any fresh fruits or vegetables.

People went crazy cooped up in these bubble-like units, with 38% even experiencing hallucinations. Fifteen years later the results were in: it simply didn't work. People were still dying at the same rate, so the whole thing was scrapped--except the diet. The airlocks and alcohol baths were abandoned, but they continued to make sure no one got to eat a salad.

Neutrophils are white blood cells that serve as our front line of defense. When we're immunocompromised and don't have enough neutrophils, we're called "neutropenic." So, the chemotherapy patients were put on a so-called neutropenic diet without any fresh fruits and vegetables. The problem is there's a glaring lack of evidence that such a neutropenic diet actually helps (see my video Is a Neutropenic Diet Necessary for Cancer Patients?).

Ironically, the neutropenic diet is the one remaining component of those patient isolator unit protocols that's still practiced, yet it has the least evidence supporting its use. Why? The rationale is: there are bacteria in salads, bacteria cause infections, immunocompromised patients are at increased risk for infections, and therefore, no salad. What's more, they were actually glad there aren't any studies on this because it could be way too risky to give a cancer patient an apple or something. So, its continued use seems to be based on a ''better safe than sorry'' philosophy.

The problem is that kids diagnosed with cancer are already low in dietary antioxidants, so the last thing we should do is tell them they can't have any fresh fruit or veggies. In addition to the lack of clinical evidence for this neutropenic diet, there may be some drawbacks. Restricting fruits and vegetables may even increase the risk of infection and compromise their nutritional status.

So, are neutropenic diets for cancer patients "reasonable prudence" or "clinical superstition"? Starting in the 1990s, there was a resurgence of research when greater importance was placed on the need to "support clinical practice with evidence."

What a concept!

Three randomized controlled trials were published, and not one supported the neutropenic diet. In the biggest study, an all-cooked diet was compared to one that allowed raw fruits and veggies, and there was no difference in infection and death rates. As a result of the study, the principal investigator at the MD Anderson Cancer Center described how their practice has changed and now everyone is allowed to eat their vegetables--a far cry from "please don't eat the salads" 31 years earlier.

Today, neither the Food and Drug Administration, the Centers for Disease Control and Prevention, nor the American Cancer Society support the neutropenic diet. The real danger comes from pathogenic food-poisoning bacteria like Campylobacter, Salmonella, and E. coli. So we still have to keep patients away from risky foods like undercooked eggs, meat, dairy, and sprouts. At this point, though, there really shouldn't be a debate about whether cancer patients should be on a neutropenic diet. Nevertheless, many institutions still tell cancer patients they shouldn't eat fresh fruits and veggies. According to the latest survey, more than half of pediatric cancer doctors continue to prescribe these diets, though it's quite variable even among those at the same institution.

Why are doctors still reluctant to move away from the neutropenic diet? There are several reasons why physicians may be hesitant to incorporate evidence-based medicine into their practices. They may have limited time to review the literature. They'd like to dig deep into studies, but simply don't have the time to look at the evidence. Hmm, if only there was a website... :)

Bone marrow transplants are the final frontier. Sometimes it's our immune system itself that is cancerous, such as in leukemia or lymphoma. In these cases, the immune system is wiped out on purpose to rebuild it from scratch. So, inherent in the procedure is a profound immunodeficiency for which a neutropenic diet is often recommended. This has also had never been tested--until now.

Not only did it not work, a strict neutropenic diet was actually associated with an increased risk for infection, maybe because you don't get the good bugs from fruits and vegetables crowding out the bad guys in the gut. So not only was the neutropenic diet found to be unbeneficial; there was a suggestion that it has the potential to be harmful. This wouldn't be the first time an intervention strategy made good sense theoretically, but, when put to the test, was ultimately ineffective.

Unfortunately, there's an inertia in medicine that can result in medical practice that is at odds with the available evidence. Sometimes this disconnect can have devastating consequences. See, for example, Evidence-Based Medicine or Evidence-Biased? and The Tomato Effect.

The reason it is so important to straighten out the neutropenic diet myth is that fruits and vegetables may actually improve cancer survival:

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: Sally Plank

Original Link

Meat Industry Wins Right to Sell Tainted Meat

NF-Mar10 Meat Industry Successfully sued to sell tainted meat.jpg

In my last post, I talked about a particularly virulent strand of Salmonella traced to Foster Farms. But while even Mexico banned the importation of Foster Farms' chicken on public health grounds, it was still sold in the United States. Why wasn't there a recall? How could Foster Farms continue to legally sell chicken contaminated with this virulent strain of Salmonella? It all goes back to Supreme Beef v. USDA, a court case in which the meat industry sued the USDA after they had the audacity to try to shut down a slaughter plant that was repeatedly found violating Salmonella standards. The meat industry won. The Federal Appeals Court ruled that it wasn't illegal to sell contaminated meat; what was illegal was the USDA trying to protect the public by shutting down the plant. Because normal cooking practices destroy Salmonella, the presence of Salmonella in meat does not render the meat "injurious to health." Salmonella-infected meat is thus legal to sell to the consumer.

We can get infected no matter how well the meat is cooked though. According to researchers, even though consumers "may eliminate Salmonella on ready-to-cook chicken by proper cooking, they could still be exposed to and acquire a Salmonella infection from cross-contamination of other foods with Salmonella from raw chicken during meal preparation." If we measure the transfer rate from naturally contaminated poultry legs purchased in supermarkets to cutting boards in the kitchen, overall, 80% of the leg skins in contact with the cutting board for ten minutes transferred Campylobacter (another dangerous bacteria found in chicken feces) infection to the cutting board. And then if we put cooked chicken back on that same cutting board, there's about a 30% chance it too will become contaminated.

Even though people know that washing hands can decrease the risk of food poisoning, only about 2/3 say they actually do it. Even though most people know about cross contamination, 1/3 don't even say they wash their cutting boards. Though awareness appears to be growing, even when people wash the cutting boards with hot soapy water we can still find Salmonella and Campylobacter (see Avoiding Chicken to Avoid Bladder Infections). The reason most people have more bacteria from feces in their kitchen than their bathroom is because people rinse their chickens in the sink, not the toilet .

Foster Farms swore they'd try to reduce the number of chickens they were producing with this virulent strain of Salmonella from 1 in 4 to just 1 in 20. Why not a zero tolerance policy in countries such as Sweden? Because then, as the head of food safety for Costco noted, "you wouldn't have a poultry industry."

Other countries have been able to raise chickens without Salmonella. One industry-funded scientist complained that if the entire onus to produce safe products is placed on industry, "it then gives the consumer no personal responsibility to handle their product correctly." That's like a car company saying we can't make safe cars because then no one will wear a seat belt.

I've touched on this topic before in my videos Salmonella in Chicken and Turkey Deadly but Not Illegal, Zero Tolerance to Acceptable Risk, and Unsafe at Any Feed.

More on the issue of cross-contamination in:

Note when it comes to egg-borne infection the issue is not just cross-contamination, given Salmonella can survive the most common egg cooking methods. Check out my video Total Recall.

Though some meat additives may make meat safer (Viral Meat Spray and Maggot Meat Spray), others may increase the food safety risk. See my video Phosphate Additives in Chicken.

-Michael Greger, M.D.

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

Image Credit: Danny Huizinga / Flickr

Original Link

Phosphate Additives in Chicken Banned Elsewhere

NF-Oct14 Banned in Europe but Not the US- Phosphate Additives in Chicken.jpg

In my video Phosphate Additives in Meat Purge and Cola, I talked about the danger of phosphorus additives in food. However, when surveyed, most future medical professionals were insufficiently aware--in fact, two-thirds had no clue--of the risks related to prolonged high dietary phosphate intake. Even if they knew it was a problem, they didn't know which foods had added phosphates. 99% knew that sugar was added to soda, but only 7% knew that phosphates were added. I bet even fewer knew that it's injected into most packages of meat.

Though this practice remains banned in Europe, 11 different phosphate salts are currently allowed to be injected into meat and poultry in the United States. This despite the fact that phosphate is considered an arterial toxin--causing our arteries to stiffen up within just two hours of consumption. Phosphate additives may also make poultry more dangerous from a food safety standpoint.

Phosphate additives may increase the number of Campylobacter bacteria in chicken exudates. Chicken exudate is the same as poultry purge (colloquially known as chicken "juice"), "the fluid that seeps out from processed poultry carcasses and is often found to be contaminated with considerable numbers of Campylobacter bacteria. It is comprised of water, blood, fats, and other materials added to the poultry during processing." If chicken isn't injected with phosphate, the exudates seeping into the package may grow about 100 Campylobacter bacteria. But, add some phosphate to the carcass, and up to a hundred million bacteria may grow.

Why does adding phosphate to poultry increase the number of Campylobacter bacteria? It may be because phosphates increase the survival of Campylobacter--by 100 fold or more. The infectious dose for Campylobacter has been shown to be as little as 500 organisms. How much might there be in chicken? 100,000 can be easily recovered from washes of whole chicken carcasses.

So what does a million times more food-poisoning bacteria mean for the risk to consumers? A mere hundred fold increase in these fecal matter bacteria can mean a thirty fold difference in the number of human outbreaks of Campylobacter, which can leave patients paralyzed (see my video Poultry and Paralysis). But, if the poultry industry doesn't add phosphates, how are they (in their words) going to "enhance the moisture absorbance, color, and flavor of the meat and reduce product shrinkage?"

Other concerning additives used by the meat industry include asthma-type drugs (Ractopamine in Pork), bacteria-eating viruses (Viral Meat Spray), larvae (Maggot Meat Spray), Arsenic in Chicken, nitrosamines (Prevention Is Better Than Cured Meat), and antibiotics (Drug Residues in Meat).

Since phosphate additives don't have to be listed on the nutrition label, how do we avoid them? All in my video How to Avoid Phosphate Additives.

-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 From Table to Able.

Images thanks to snowpea&bokchoi / Flickr

Original Link

Cayenne for Irritable Bowel

 

 

 

 

 

 

 

 

Cayenne for Irritable Bowel

Nearly 50 million Americans come down with food poisoning every year. Over a hundred thousand are hospitalized and thousands die every year just because of something they ate. If they had ordered something different on the menu or chosen something else at the grocery store, they or their loved one might be alive today. But in the vast majority of cases, food poisoning manifests itself as little more than a case of “stomach flu”—a few days of pain, vomiting, diarrhea, and then it’s gone. So what’s the big deal?

Well, as described in this recent editorial in the American Journal of Gastroenterology, in many cases, that acute infection can trigger a chronic “postinfectious functional gastrointestinal disorder” that can last for years or even forever. The two most common of which are irritable bowel syndrome and functional dyspepsia (chronic indigestion).

Up to 10% of people stricken with Salmonella, E. coli, or Campylobacter are left with irritable bowel syndrome. The thought is that the "transitory inflammation during the infection leads to subtle but permanent changes in the structure and function of the digestive system," causing the lining of the gut to become hyper-sensitized. How do they determine if someone’s rectum is hypersensitive?

Innovative Japanese researchers developed a device to deliver "repetitive painful rectal distention." Basically, the researchers hooked up a half-quart balloon to a fancy bicycle pump that was lubricated with olive oil, inserted it into the rectum and inflated it until the patients couldn’t stand the pain anymore. As you can see in my video, Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion, those with IBS had a significantly lower pain threshold, significantly less “rectal compliance.”

Healthy people felt the pain where we’d expect to feel the pain with, effectively, a balloon animal up their tush. But many with IBS also experienced abdominal pain, indicating a hypersensitivity of the entire gut wall. Well, if that’s the problem, how can we desensitize the gut?

In my video, Hot Sauce in the Nose for Cluster Headaches?, we learned about the ability of hot pepper compounds to deplete pain fibers of substance P, a neurotransmitter used for transmitting pain. It’s bad enough to have to rub hot peppers up our nose, where do we have to stick them for irritable bowel? Thankfully researchers chose the oral route.

The researchers concluded that “the chronic administration of red pepper powder in IBS patients with enteric-coated pills was significantly more effective than placebo in decreasing the intensity of abdominal pain and bloating, and was considered by the patients more effective than placebo," suggesting a "novel way of dealing with this frequent and distressing functional disease.”

After 48 million cases of annual food poisoning, 10% may end up with IBS. Even more may end up with chronic indigestion. How do peppers work against that? We can’t use whole peppers because then we couldn’t blind a placebo, but if we give capsules of red pepper powder to folks suffering from chronic indigestion—about one and a half teaspoons a day worth—and compare that to an identical-looking sugar pill, within a month their overall symptoms improved, including their stomach pain and their feelings of being bloated. They had less nausea, too. The frequently prescribed drug, Propulsid (cisapride), worked almost as well as the red pepper powder, and was considered generally well tolerated… that is, until it killed people. Propulsid was pulled from the market after causing dozens of deaths.

I explore another natural treatment for IBS in Kiwi Fruit for Irritable Bowel Syndrome.

I’ve covered some of the long-term consequences of food poisoning in videos such as Poultry and Paralysis, Fecal Bacteria Survey, and Amnesic Seafood Poisoning. The meat industry is all over it, though: Check out my videos  Viral Meat Spray and Maggot Meat Spray. Why is it legal to sell meat tainted with our leading foodborne killer? Find out in Salmonella in Chicken & Turkey: Deadly But Not Illegal and  

-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: Jennifer C. / Flickr

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How Avoiding Chicken Could Prevent Bladder Infections

 

 

 

 

 

 

 

 

How Avoiding Chicken Could Prevent Bladder Infections

Where do bladder infections come from? Back in the ’70s, longitudinal studies of women over time showed that the movement of rectal bacteria into the vaginal area preceded the appearance of the same types of bacteria in the urethra before they were able to infect the bladder. However, it would be another 25 years before genetic fingerprinting techniques were able to confirm this so-called fecal-perineal-urethral theory, indicating that E. coli strains residing in the rectal flora serve as a reservoir for urinary tract infections.

And it would be another 15 years still before we tracked it back another step and figured out where that rectal reservoir of bladder infecting E. coli was coming from—chicken. Researchers were able to capture these extraintestinal (meaning outside of the gut), pathogenic, disease-causing E. coli straight from the slaughterhouse, to the meat, to the urine specimens obtained from infected women. We now have “proof of a direct link between farm animals, meat, and bladder infections,” solid evidence that urinary tract infections can be a zoonosis (an animal-to-human disease). Millions of women are infected with bladder infections every year, at a cost of more than a billion dollars.

Even worse, researchers have detected multidrug resistant strains of E. coli in chicken meat resistant to some of our most powerful antibiotics.

The best way to prevent bladder infections is the same way we can prevent all types of infections, by not getting infected in the first place. It’s not in all meat equally—beef and pork, for example, appear significantly less likely to harbor bladder-infecting strains than chicken.

Can’t one just use a meat thermometer and cook the chicken thoroughly? We’ve known for 36 years that it’s not always the meat, but the cross-contamination, that causes the infection. If you give people frozen chickens naturally contaminated with antibiotic resistant E. coli and let people prepare and cook it in their own kitchen as they normally would, the bacteria ends up in their rectum even if they don’t actually consume the meat. That’s how they know it was cross-contamination, because the jump happened after the animal was prepared but before it was eaten. In one study five different strains of antibiotic resistant E. coli jumped from the chicken to the volunteer.

So not only did it not matter how well the chicken was cooked, it didn’t even matter if one eats any! It was the bringing of the contaminated carcass into the home and handling it. Within days, the drug resistant chicken bacteria had multiplied to the point of becoming a major part of the person’s fecal flora. If you check out my 6-min video Avoiding Chicken To Avoid Bladder Infections, you can see all this drug resistant bacteria colonizing this person’s colon, yet the person hadn’t taken any antibiotics—it’s the chickens who were given the drugs. That’s why the industry shouldn’t be routinely feeding chickens antibiotics by the millions of pounds a year. It can end up selecting for and amplifying superbugs that may end up in our bodies.

More on the threat of feeding antibiotics to farm animals by the ton in:

What if we’re really careful in the kitchen, though? The pivotal study in this area was entitled “The Effectiveness of Hygiene Procedures for Prevention of Cross-Contamination from Chicken Carcasses in the Domestic Kitchen.” Researchers went into five dozen homes, gave each family a chicken, and asked them to cook it. I expected to read that they inoculated the carcass with a specific number of bacteria to ensure everyone got a contaminated bird, but no. They realized that fecal contamination of chicken carcasses was so common that they just went to the store and bought any random chicken.

After the participants were done cooking it, there was bacteria from chicken feces (Salmonella and Campylobacter–both serious human pathogens) all over the kitchen—on the cutting board, the utensils, on their hands, on the fridge handle, on the cupboard,  the oven handle doorknob. Obviously people don’t know what proper handling and disinfection protocols entail. So the researchers took another group of people and gave them specific instructions. After they cooked the chicken they had to wash everything with hot water and detergent. They were told specifically to wash the cutting board, knobs on the sink, the faucet, the fridge, the doorknobs—everything. And the researchers still found pathogenic fecal bacteria all over.

Fine. Last group. This time they were going to insist that people bleach everything. The dishcloth used to wipe up was to be immersed in bleach disinfectant. Then they sprayed the bleach on all kitchen surfaces and let it sit there for 5 minutes. And… they still found Campylobacter and Salmonella on some utensils, a dishcloth, the counter around the sink, and the cupboard. Definitely better, but unless our kitchen is like some biohazard lab, the only way to guarantee we’re not going to leave infection around the kitchen is to not bring it into the house in the first place.

The good news is that if we eat chicken once, we’re not colonized for life. In the study I profile in Avoiding Chicken To Avoid Bladder Infections, the chicken bacteria only seemed to last about 10 days in peoples' guts before our good bacteria could muscle it out of the way. The problem is that people tend to eat chicken more than once every ten days, so they may be constantly re-introducing these chicken pathogens into their system. For example, a study found that if people are fed only sterilized meat that’s been boiled for an hour, within 3 weeks there’s a 500 fold drop in the number of antibiotic-resistant bacteria passing through their bodies.

I originally explored this topic in Chicken Out of UTIs, but decided I needed to take a much deeper dive, especially in light of the cross-contamination issue, which I also  touched on in Food Poisoning Bacteria Cross-Contamination and Fecal Contamination of Sushi.

Other videos about diseases that one might not initially associate with food include:

More on urinary tract health in:

What if you already have a urinary tract infection? See Can Cranberry Juice Treat Bladder Infections?

-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: epSos.de / Flickr

Original Link