Organic versus Conventional: Which has More Nutrients?

Organic versus Conventional - Which has More Nutrients?.jpeg

Are organic foods safer and healthier than conventional alternatives? Those are two separate questions. Some consumers are interested in getting more nutrients; others are more concerned about getting fewer pesticides. Let's do nutrition first.

As seen in my video, Are Organic Foods More Nutritious?, hundreds of studies have been reviewed and researchers didn't find significant differences for most of the traditional nutrients like vitamins and minerals. They concluded that despite the widespread perception that organically produced foods are more nutritious, they didn't find robust evidence to support that perception. They did, however, find higher levels of phenolic phytonutrients in organic.

These so-called "secondary metabolites" of plants are thought to be behind many of the benefits ascribed to eating fruits and vegetables. Organic fruits and vegetables had between 19 and 69% more of a variety of these antioxidant compounds. The theory was that these phytonutrients are created by the plant for its own protection. For example, broccoli releases the bitter compounds like sulforaphane when the plant is chewed to ward off those who might eat it. Bugs take one bite and say, "Ew, this tastes like broccoli!" But pesticide-laden plants are bitten less by bugs and so may be churning out fewer of these compounds. Plants raised organically, on the other hand, are in a fight for their lives and may necessarily have to produce more protection. That was the theory anyway, but we don't have good evidence to back it up. The more likely reason has to do with the fertilizer; plants given high dose synthetic nitrogen fertilizers may divert more resources to growth rather than defense.

These antioxidants may protect the plant, but what about us? More antioxidant phytonutrients are found in organic vegetables and so yes, they displayed more antioxidant activity, but also more antimutagenic activity. Researchers exposed bacteria to a variety of mutagenic chemicals like benzopyrene, the polycyclic aromatic hydrocarbon found in barbecued meat, or IQ, the heterocyclic amine found in grilled/broiled/fried meats (as well as cigarette smoke), and there were fewer DNA mutations in the petri dishes where they added organic vegetables compared to the petri dishes where they added conventional vegetables.

Preventing DNA damage in bacteria is one thing, but what about effects on actual human cells? Organic strawberries may taste better, and have higher antioxidant activity and more phenolic phytonutrients, but what happens when you stack them up head-to-head against human cancer cells? Extracts from organically grown strawberries suppressed the growth of colon cancer cells and breast cancer cells significantly better than extracts from conventional strawberries. Now this was dripping strawberries onto cancer cells growing in a petri dish, but as I showed in Strawberries versus Esophageal Cancer, there are real life circumstances in which strawberries come into direct contact with cancerous and precancerous lesions, and so presumably organic strawberries would work even better, but they haven't yet been tested in clinical trials.

Although in vitro studies show higher antioxidant and antimutagenic activity as well as better inhibition of cancer cell proliferation, clinical studies on the impact of eating organic on human disease simply haven't been done. Based on antioxidant phytonutrient levels, organic produce may be considered 20 to 40% healthier, the equivalent of adding one or two serving's worth to a five-a-day regimen. But organic produce may be 40% more expensive, so for the same money you could just buy the extra servings worth of conventional produce. From a purely nutrients-per-dollar standpoint, it's not clear that organic foods are any better. But people often buy organic foods to avoid chemicals, not because they are more nutritious. For more on the best available science comparing the nutritional content, pesticide risk, heavy metal toxicity, and food poisoning risk of organic versus conventionally raised foods )including practical tips for making your own DIY fruit and veggie wash), see:

I imagine that the reaction to this series will be similar to that for the one I did on GMO foods, riling up critics on both sides of the debate:

More on the nutritional implications of stressed-out plants here:

Production method aside, in vitro, Which Fruit Fights Cancer Better?

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 / Flickr. This image has been modified.

Original Link

Organic versus Conventional: Which has More Nutrients?

Organic versus Conventional - Which has More Nutrients?.jpeg

Are organic foods safer and healthier than conventional alternatives? Those are two separate questions. Some consumers are interested in getting more nutrients; others are more concerned about getting fewer pesticides. Let's do nutrition first.

As seen in my video, Are Organic Foods More Nutritious?, hundreds of studies have been reviewed and researchers didn't find significant differences for most of the traditional nutrients like vitamins and minerals. They concluded that despite the widespread perception that organically produced foods are more nutritious, they didn't find robust evidence to support that perception. They did, however, find higher levels of phenolic phytonutrients in organic.

These so-called "secondary metabolites" of plants are thought to be behind many of the benefits ascribed to eating fruits and vegetables. Organic fruits and vegetables had between 19 and 69% more of a variety of these antioxidant compounds. The theory was that these phytonutrients are created by the plant for its own protection. For example, broccoli releases the bitter compounds like sulforaphane when the plant is chewed to ward off those who might eat it. Bugs take one bite and say, "Ew, this tastes like broccoli!" But pesticide-laden plants are bitten less by bugs and so may be churning out fewer of these compounds. Plants raised organically, on the other hand, are in a fight for their lives and may necessarily have to produce more protection. That was the theory anyway, but we don't have good evidence to back it up. The more likely reason has to do with the fertilizer; plants given high dose synthetic nitrogen fertilizers may divert more resources to growth rather than defense.

These antioxidants may protect the plant, but what about us? More antioxidant phytonutrients are found in organic vegetables and so yes, they displayed more antioxidant activity, but also more antimutagenic activity. Researchers exposed bacteria to a variety of mutagenic chemicals like benzopyrene, the polycyclic aromatic hydrocarbon found in barbecued meat, or IQ, the heterocyclic amine found in grilled/broiled/fried meats (as well as cigarette smoke), and there were fewer DNA mutations in the petri dishes where they added organic vegetables compared to the petri dishes where they added conventional vegetables.

Preventing DNA damage in bacteria is one thing, but what about effects on actual human cells? Organic strawberries may taste better, and have higher antioxidant activity and more phenolic phytonutrients, but what happens when you stack them up head-to-head against human cancer cells? Extracts from organically grown strawberries suppressed the growth of colon cancer cells and breast cancer cells significantly better than extracts from conventional strawberries. Now this was dripping strawberries onto cancer cells growing in a petri dish, but as I showed in Strawberries versus Esophageal Cancer, there are real life circumstances in which strawberries come into direct contact with cancerous and precancerous lesions, and so presumably organic strawberries would work even better, but they haven't yet been tested in clinical trials.

Although in vitro studies show higher antioxidant and antimutagenic activity as well as better inhibition of cancer cell proliferation, clinical studies on the impact of eating organic on human disease simply haven't been done. Based on antioxidant phytonutrient levels, organic produce may be considered 20 to 40% healthier, the equivalent of adding one or two serving's worth to a five-a-day regimen. But organic produce may be 40% more expensive, so for the same money you could just buy the extra servings worth of conventional produce. From a purely nutrients-per-dollar standpoint, it's not clear that organic foods are any better. But people often buy organic foods to avoid chemicals, not because they are more nutritious. For more on the best available science comparing the nutritional content, pesticide risk, heavy metal toxicity, and food poisoning risk of organic versus conventionally raised foods )including practical tips for making your own DIY fruit and veggie wash), see:

I imagine that the reaction to this series will be similar to that for the one I did on GMO foods, riling up critics on both sides of the debate:

More on the nutritional implications of stressed-out plants here:

Production method aside, in vitro, Which Fruit Fights Cancer Better?

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 / Flickr. This image has been modified.

Original Link

Which Dietary Factors Affect Breast Cancer Most?

Sept27.jpg

One of my favorite cancer-specific charities, the American Institute for Cancer Research, lauds the China Study and the documentary Forks Over Knives, with which they share the same bottom-line message: The healthiest diets are those that revolve around whole plant foods.

They then translate that advice into their Ten Recommendations for Cancer Prevention, featured in my video Which Dietary Factors Affect Breast Cancer Most? We now have evidence that those who follow such advice are actually protected against cancer. Breast cancer risk was reduced by 60% in women who met at least five recommendations compared with those who met none. The most important dietary advice was to be as lean as possible within the normal range of body weight, eat mostly foods of plant origin, and limit alcoholic drinks.

What about other cancers? Greater adherence to the AICR dietary guidelines was also associated with significantly less endometrial, colorectal, lung, kidney, stomach, oral, liver, and esophageal cancer. In other words, adherence to dietary recommendations for cancer prevention may lower the risk of developing most types of cancer. The drop in bladder cancer did not reach statistical significance, but a larger follow-up study following 469,000 people for 11 years (the largest to date) found that just a 3% increase in the consumption of animal protein calories was associated with a 15% higher risk of bladder cancer, whereas just a 2% increase in plant protein was associated with a 23% lower risk.

AICR recommendation number ten is that cancer survivors should follow the recommendations for cancer prevention. The same diet that can help prevent cancer in the first place can be used to help save our life after diagnosis. Adherence to the guidelines for cancer prevention was found to be associated with lower mortality among older female cancer survivors, or breast cancer and other cancers in general.

A cancer diagnosis is considered a teachable moment to get people eating and living healthier. Oncologists revel at the growth in the number of cancer survivors in this country, now ten million strong and growing. It's great that those with cancer are living longer, but even better to prevent it in the first place so we can all live longer. Not only does adherence to the guidelines lower cancer risk, but extends our lifespan because the guidelines are also significantly associated with a lower hazard of dying from heart disease and respiratory disease, suggesting that following the recommendations could "significantly increase longevity."

Just like eating to prevent cancer helps to prevent heart disease, eating to protect our heart helps prevent cancer. It sounds self-evident, but adherence to a healthy lifestyle is therefore associated with a lower risk of mortality overall. And the more healthy behaviors we have, the longer we get to live. Such factors included not smoking, walking every day, or eating green leafy vegetables almost daily.

To help differentiate the effects of diet from other lifestyle behaviors like smoking and drinking on cancer incidence, Adventists were recently compared to Baptists. Both discourage alcohol and tobacco, but the Adventists go further, encouraging a reduction of meat. In general, the Adventists had lower cancer hazard rates than the Baptists, and within Adventist populations, the vegetarians did even better, and those eating the most plants, did the best.

Why do plant-based diets appear to lower the risk of cancer? A number of fascinating mechanisms:

Specific to breast cancer:

Though plant-based beverages may be harmful: Breast Cancer and Alcohol: How Much Is Safe?

In terms of foods associated with breast cancer 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--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: MesserWoland

Image Credit: [Lev Kropotov] © 123RF.com

Original Link

Why Deep Fried Foods May Cause Cancer

NF-Jul21 Cancer Risk from French fries.jpg

In the latest study on dietary patterns and breast cancer risk among women, healthier eating was associated with eliminating three-quarters of the odds of breast cancer, whereas less healthy eating was associated with up to nearly eight times the odds. Included in the unhealthy eating pattern was the consumption of deep-fried foods, which have previously been linked to breast cancer, pancreatic cancer, lung cancer, oral and throat cancers, esophageal cancer, and cancer of the voicebox. No deep fried foods? What's a Southern belle to do? Instead of deep fried foods, how about the traditional Southern diet, characterized by high intakes of cooked greens, beans, legumes, cabbage, sweet potatoes and cornbread, which may reduce the risk of invasive breast cancer significantly.

What about the consumption of deep-fried foods and risk of prostate cancer? Researchers at the Fred Hutchinson Cancer Research Center and the University of Washington found that eating French fries, fried chicken, fried fish, and doughnuts was associated with about a third greater odds of prostate cancer. After stratifying for tumor aggressiveness, they found slightly stronger associations with more aggressive disease, suggesting that regular intake of deep-fried foods may contribute to the progression of prostate cancer as well.

What in deep fried foods is so bad for us? Just heating oil that hot can generate potentially carcinogenic compounds, and then known carcinogens such as heterocyclic amines and polycyclic aromatic hydrocarbons form when the muscles of chickens and fish are cooked at that temperature. Deep-fried plants, on the other hand, can form acrylamide.

I did a video about acrylamide back in 2008, suggesting it's a probable human carcinogen (See Acrylamide in French Fries). Since then, studies have suggested pregnant women may want to cut back on French fries to protect the growth of their baby's body and brain. Based on a study (highlighted in my video, Cancer Risk from French Fries) feeding people a little bag of potato chips every day for a month, it now seems acrylamide may also cause inflammation as well, which could explain its purported role in cancer progression.

Acrylamide intake has been associated with endometrial cancer, ovarian cancer, lung cancer, kidney cancer, and esophageal cancer. How much cancer risk are we talking about? Taiwanese researchers examined lifetime cancer risk and French fry consumption. The researchers picked on French fries because they comprise by far the greatest percentage contribution of acrylamide to the diets of children. They estimated that, at most, one or two boys and girls out of every ten thousand would develop cancer eating French fries that they would otherwise not have developed if they hadn't eaten French fries. So it's not as bad as eating something like fried fish, or fried chicken, but how much is that saying?

The level of cancer risk in both boys and girls associated with French fries depends on how long and hot they're fried. In Europe, the food industry swore that they'd self-regulate and control fry times to decrease acrylamide levels, but we've yet to see any subsequent change in acrylamide levels in French fries.

Researchers continue to urge that the cooking temperature should be as low as possible and the cooking time should be as short as possible, "while still maintaining a tasty quality" of course. We wouldn't want to reduce cancer risk too much--they might not taste as good!

Blanching the potatoes first reduces acrylamide formation, but potato chip companies complain that, not only would it muck with the flavor, but it would reduce the nutritional properties by leaching away some of the vitamin C. But if we're relying on potato chips to get our vitamin C, acrylamide is probably the least of our worries.

More on heterocyclic amines:

There are some things we can do to counteract the effects of these carcinogens, though:

I touch on polycyclic aromatic hydrocarbons in Meat Fumes: Dietary Secondhand Smoke and Is Liquid Smoke Flavoring Carcinogenic?
Certain fats may play a role in breast cancer survival as well: Breast Cancer Survival, Butterfat, and Chicken and Breast Cancer Survival and Trans Fat.

-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.

Image Credit: Kim Love / Flickr

Original Link

Breast Cancer and Wine

 

 

 

 

 

 

 

 

NF-Mar20 Breast Cancer Risk - Red Wine vs. White Wine.jpg

After diagnosis, women with breast cancer may cut their risk of dying nearly in half by just instituting simple, modest lifestyle changes—5 or more servings of fruits and veggies a day and walking 30 minutes a day, 6 days a week. But what about preventing breast cancer in the first place?

If we follow the advice of the official dietary guidelines for cancer prevention, does it actually reduce our risk of cancer? If we manage our weight, eat more plant foods, less animal foods, less alcohol and breastfeed, based on the largest prospective study on diet and cancer in history, we may significantly lower our risk of breast cancer, endometrial cancer, colorectal cancer, lung cancer, kidney cancer, stomach cancer, oral cancer, liver cancer, esophageal cancer, and all cancers combined.

Of all the recommendations, the “eat mostly foods of plant origin” appeared the most powerful. For example, a study in the UK found that in just one year in Britain there were 14,902 excess cases of cancer caused by something participants were exposed to 10 years earlier. What was that something that ended up causing thousands of cancers?  

Deficient intake of fruit and vegetables.

If that was instead, some chemical spill causing 14,000 cancers, people would be up in arms to ban it—but instead when that killer carcinogen is not eating their “fruit and veg” (as the Brits would say), it hardly gets anyone’s attention.

What if we throw in smoking, too? Researchers created a healthy lifestyle index, defined by four things: 1) exercise;  2) a dietary shift away from the standard American diet high in meat, dairy, fat, and sugar towards a more prudent dietary pattern—for instance more green and yellow vegetables, beans, and fruits;  3) avoidance of tobacco; and 4) avoidance of alcohol. Young women scoring higher on those four things cut their odds of getting breast cancer in half, older women cut their odds of breast cancer by 80%!

We’ve covered how even light drinking can increase breast cancer risk (see my video Breast Cancer and Alcohol: How Much is Safe?), but for women who refuse to eliminate alcohol, which is less carcinogenic: red wine or white? Some studies, outlined in my four minute video, Breast Cancer Risk: Red Wine vs. White Wine, actually suggest less or even no risk from red wine, and we may have just figured out why. Remember how mushrooms were the vegetable best able to suppress the activity of aromatase, the enzyme used by breast tumors to produce its own estrogen? (from my video Vegetables Versus Breast Cancer). Well, if we run the same human placenta experiments with fruit, strawberries get the silver, but grapes get the gold.

For more on the aromatase story, see:

But what kind of grapes? The wimpy green grapes used to make white wine barely worked compared to those used for making red.  Bottom line: “red wine may serve as a nutritional aromatase inhibitor, which may ameliorate the elevated breast cancer risk associated with alcohol intake.” But why accept any elevated risk? Just eat whole grapes! And if you do, choose ones with seeds if you can, as they may work even better. More on grapes in Fat Burning Via Flavonoids and Best Fruit Juice.

Wasn’t there a study that found that fruits and vegetables weren’t protective against cancer, though? See my video on the EPIC Study.

What if you already have breast cancer? Well, Cancer Prevention and Treatment May Be the Same Thing, but I do have a few studies on breast cancer survival and diet:

-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: TonalLuminosity / Flickr

Original Link

Raspberries Reverse Precancerous Lesions

 

 

 

 

 

 

 

 

Black Raspberries May Help Prevent Cancer

More berried treasure! A story similar to the strawberries and esophageal cancer revelation I documented in Strawberries versus Esophageal Cancer has emerged with black raspberries and oral cancer.

Oral cancer is one of the 10 most common cancers in the US with a flip-of-the-coin death rate. We can reduce our risk of oral cancer by avoiding all forms of tobacco, restricting alcohol consumption, avoiding obesity, and eating at least five servings of vegetables and fruits each day. Other risk factors include having more than 5 lifetime oral sex partners and prolonged (more than 20 years) marijuana use. But what if we already have precancerous changes in your mouth?

Black raspberries appear to selectively inhibit the growth of both malignant and premalignant cells in a petri dish while leaving normal cells alone, but what about in an actual person? Researchers at Ohio State University took some folks with precancerous growths in their mouths (so called oral “intraepithelial neoplasia”) and had them apply a black raspberry gel for 6 weeks.

Like the esophageal study with strawberries, most of the patients’ lesions improved, including cases of complete clinical regression. If you click to watch my 4-min video Black Raspberries versus Oral Cancer you can see the disease disappear–thanks to just berries! They were able to follow a reversal of genetic changes that had led to the silencing of tumor suppressor genes.

If you aren’t near a pick-your-own farm, black raspberries can be ordered online frozen but they’re about 20 bucks a pound with shipping. Black raspberry freeze-dried powder is comparatively cheaper, but I’ve always wondered about how much nutrition is lost. Well, there’s finally been a study.

The antioxidant concentration was measured in fresh, frozen, and freeze-dried strawberries and strawberry jam, with the intent of measuring antioxidant content of foods typically available to consumers in grocery stores. On a consumed weight basis, the freeze-dried do shine, but just because an ounce of dried is equivalent to about a cup and a half of fresh. Jam, though, presumably because of the heat processing, really takes a hit (chart in my video Black Raspberries versus Oral Cancer).

For more on what berries can do, see my videos Cranberries versus Cancer and Which Fruit Fights Cancer Better?

I’ve previously covered the clinical trials of black raspberries (though in a different orifice) in Best Fruits For Cancer Prevention. I also touched on the adverse effects of breathing smoke from any source in Cannabis Receptors & Food.

Berries in general are the healthiest fruits and I encourage everyone to try to fit them into their daily diet. Here are a few of my 37 other videos on berries:

-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: Maggie Hoffman / Flickr

Original Link

Strawberries Can Reverse Precancerous Progression

 

 

 

 

 

 

 

 

Strawberries Can Reverse Precancerous Progression

In my last two posts, Which Fruit is Best at Fighting Cancer? and Anti-Cancer Nutrient Synergy in Cranberries I described what various common fruits could do to human cancer cells in a petri dish.  Studies showing which foods can best suppress the growth of cancer in a test tube are all well and good, but we need to know if they can do the same thing within the human body. It’s considered unethical to withhold conventional cancer therapies to test out some fruit or vegetable, so what do you do?

One direction researchers have taken is to use so-called “combinatorial strategies,” for example adding phytonutrients from the spice turmeric and green tea along with chemotherapy to see if that works better than chemo alone, but this gets complicated because chemo and radiation often work by killing cancer cells with free radicals and so though antioxidants may certainly reduce the toxicity of the treatment there’s a theoretical concern it could reduce the efficacy as well.

Another way you can study the effects of plants on cancer is by testing dietary interventions on slow growing cancers like prostate, which is how Ornish and colleagues were able to show his apparent reversal in cancer growth with a plant-based diet (see Cancer Reversal Through Diet?). They could get away with treating cancer with a vegan diet alone (no chemo/surgery/radiation) because prostate can be such a slow growing cancer that patients with early disease can be placed in a holding pattern. So if you’re not going to do anything but watch and wait, you might as well test out a dietary intervention. Are there other cancers like that we can try plants on?

Esophageal cancer is not the cancer to get. Five-year survival is only about 13 percent, with most people dying within the first year of diagnosis, but the development of esophageal cancer is a multistage process. We start out with a normal esophagus (the tube that connects you mouth to your stomach), then precancerous changes start to take place, then localized cancer starts to grow, then eventually it spreads and we most likely die.

Because of the well-defined, stepwise progression of esophageal, researchers jumped on it as a way to test the ability of berries—the healthiest fruits—to reverse the progression of cancer. A randomized phase 2 clinical trial of strawberries for patients with precancerous lesions of the esophagus was undertaken. Six months of eating the equivalent of over a pound of fresh strawberries a day, and the progression of disease was reversed in 80 percent of the high dose strawberry treatment.

At the beginning of the study, no subjects had a normal esophagus. They either had mild or moderate precancerous disease. But by the end of the study most lesions either regressed from moderate to mild, or disappeared completely. If you watch my 5-min video Strawberries versus Esophageal Cancer you can see some representative before and after pictures of the lesions literally disappearing. By the end of the study half of those on the high dose of strawberries walked away disease free.

This landmark study is one of the most important papers I’ve seen recently. Why isn’t this headline news? If there was instead some new drug that reversed cancer progression, you can bet it would be all over the place. But who’s going to profit from revelations about berries? Other than, of course, the millions of people at risk for this devastating cancer.

The findings were heralded as groundbreaking in an editorial in the journal of the American Association for Cancer Research. Given that it was written by a pair of pharmacy professors, though, they of course concluded “that the active components and molecular targets responsible for the efficacy of strawberries must be identified.” Instead of just eating strawberries they suggested that Big Pharma should try to make a strawberry-derived drug.

Recent population studies suggest that other plant foods may be protective against esophageal cancer as well. Diets with lots of meat and fat appear to double the odds of cancer; and lots of fruits and vegetables may cut one’s odds of esophageal cancer in half. Studies have shown diets rich in foods from animal origin and poor in plant foods appear to increase esophageal cancer risk. And now we know at least one plant that may even reverse the course of disease if caught early enough.

I touched previously on esophageal cancer in Bacon and Botulism and Poultry and Penis Cancer.

More on strawberries in Cancer Fighting Berries and Maxing Out on Antioxidants. My favorite way to eat them? My chocolate ice cream recipe.

Ornish’s line of anti-cancer work was continued by the Pritikin Foundation in an elegant series of experiments that I describe starting with Ex Vivo Cancer Proliferation Bioassay (along with the “prequel” Engineering a Cure).

For more berried treasure, see Black Raspberries versus Oral Cancer.

-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: Manchester-Monkey / Flickr

Original Link