Saturation be damned

Night time reading

I love interacting with this informed and educated community of ours who take responsibility for own health, read and interpret scientific articles, ask intelligent and incredibly tricky questions and look at the world through a prism of human evolution. It’s really really cool. I also don’t own a television or read newspapers. I know, I am missing out on the vital information on the recent exciting advances in the field of laundry detergents, easily foldable exercise equipment and female hygiene products. But I’ll take my chances.

So when I was approached recently by an Australian reporter to comment on why saturated fat might not be as bad as everyone thinks, I was temporarily stunned. Everyone still thinks that? An hour-long lunch outside in the company of co-workers brought me back to reality. Listening to the less-than-lithe lady lecturing a younger employee that “pasta is perfectly healthy as long as you avoid creamy sauces and stick with tomato-based ones and add psyllium husks to increase fibre” plunged me back to earth from the AHS12-induced heights.

Oh boy. On this planet, margarine is still a health food.

So I thought I’d write down some thoughts on fats, why we still need to talk about them, the strength of evidence and where we go from here. The article ended up being published at The Age and I was amused to see our hour-long phone conversation and the exchange of several emails with attached studies reduced to one sentence quoted from me, but I am not complaining since I think the article was quite well-balanced and hopefully gives people some food for thought. Here is the link.

If you are totally new to all this, I recommend that you read my post on fat basics and the slightly more complicated polyunsaturated fat primer.

Don’t all scientists and doctors agree that saturated fat is bad?

My main gripe with conventional advice to reduce saturated fat in the diet is that it makes it sound that everyone in science and medicine agrees that it is the right thing to do. They say “scientists” and you imagine a group of nerdy-looking men and women in lab coats and glasses with clipboards, all nodding in unison: “Saturated fat will kill you”.

Bad cow, bad!

Sorry, no. Far from it. In the year 2012 we still run trials on dietary fat and its effect on mortality, cardiovascular disease and weight. In fact, a Pubmed search on “dietary fat” yields close to 700 article from 2010 to present date.

If “saturated fat will kill you” is a done deal why do all these folks get research grants and waste years of their life on the pointless pursuit of the truth that has long been discovered and incorporated into every government-led nutrition advice?

And yet, the consensus is farther away than ever. Nutrition and Metabolism Society publishes critiques of the American Dietary Guidelines, as well as scores of papers on the subject. Then there is THINCS, The International Network of Cholesterol Skeptics, which really sounds like an evil mad scientist organisation from a Bond movie, but in fact has respected members like a biochemist Dr Mary Enig and a scientific researcher Dr Uffe Ravnskov.

Not to mention a fine gathering of clinicians, scientists, nutritionists, researchers, physiotherapists, bloggers at Harvard Law School this year for 2012 Ancestral Health Symposium, most of whom seemed to think that bacon is rad and margarine is bad.

Can you refute XYZ study and the rest of the body of evidence on saturated fat?

Yawn. I have no intention on memorising every study conducted in the last 50 years, no matter how bad or good they are. We have been eating fat, lard, meat, eggs, butter, ghee, coconut oil for thousands of years. I think the burden of proof lies on those who say that these traditional foods have been our silent killer all along. All I can do is to politely present the vast body of scientific evidence that does not support the lipid hypothesis (YES! IT IS STILL A HYPOTHESIS!)

Sarcasm alert. Lipid Hypothesis 2.0 = we have come to realise that total fat intake has no bearing on heart disease or weight (sorry! Our bad!) But it’s all about the type of fat. There are only 2 types of fat: saturated (=evil, comes from animals, eating animals is bad, you immoral cruel self-serving glutton) and unsaturated (=pure good, comes from vegetables, like cottonseed, soybean, canola and sunflower, botany be damned). Substituting unsaturated for saturated fat is the real reason why we are healthier, thinner and fitter than thousands of generations of traditional cultures because they couldn’t work out how to get 10% of their daily calories from PUFA, suckers.

 

He needs to be told how unhealthy he is from his 40% SAFA intake. Those coconuts will kill you, buddy! (Source: http://www.thatpaleoguy.com)

Several studies have shown improvement in CV markers and mortality when saturated fats were replaced with PUFA. Regardless of how good/bad sat fats are, shouldn’t we make the substitution just in case anyway?

This is a very common reasoning from many educated doctors and academics. They are now aware that sat fats are not much of a problem. Great. But what’s the harm in tinkering our diets if all we have is improvement, right?

Wrong.

I have a real problem with a blanket advice to increase PUFA in general as if they are all the same. PUFA are not all created equal, they have different physiological functions and effects on the body! (go back to basics). At the very least they should be differentiated into omega-3 and omega-6. However, even that’s too simplistic.

If you are planning on dividing fats on the basis of the biochemical structure and biological function, you have just only scratched the surface. Behold! All saturated fats are actually not the same either. Lauric fatty acid is metabolised differently and has different effects on serum lipid profiles than stearic. Even omega-3 are not a homogenous group (gasp!). The intake of the shorter-chained ALA (alpha-linolenic acid) does not come close to providing the same benefit as the long-chained DHA due to inefficient conversion.

Jacobsen’s analysis of 11 cohort studies, quoted in the article as the final proof of the miracle qualities of PUFA,  showed that substituting PUFA for SAFA seemed to reduce CV events and mortality. However, simplification, as usual, can only take you this far. The analysis lumped omega-3 and omega-6 PUFA together and did not take into account the deleterious effect of trans fatty acids separately from SAFA.

“Linoleic acid selective PUFA interventions produced no indication of benefit but rather a fairly consistent, but non-significant, signal toward increased risk of coronary heart disease and death. ” (Kuipers ER al, 2011, hyperlinked above)

That’s what happens when you simplify a complex concept. Why? Because the public are so dumb they won’t get it? Because 2 types of fat is quite enough to remember? And to make things even more visually and conceptually appealing let’s represent them as ying and yang, bad and good, dark and light?

So you have some studies, “they” have some studies. How do lay people know who to trust?

As much as I respect Evidence Based Medicine, I am well aware of its limitations. You can pull apart every study, point out the confounders, small sample size, confirmation bias, lack of double-blinding, the grant approved by a completely impartial third party with key investments in related area. Let’s not reduce the process to “Mine is bigger than yours.”

Nothing in biology makes sense except in the light of evolution“. Repeat this 5 times before going to bed every night.

How much omega-6 was available in our diet as Homo sapiens for 2 million years up to the advent of industrial processing? How much oil can you get out of a soybean without the benefit of extraction chemicals?

Aaaaaaah! Would you just tell me how much PUFA/SAFA/Carbs I should be eating?

Talking about macronutrients (fatty acids, carbs, etc) is useless unless it applies to food. If the advice to increase PUFA translates into “eat more fish” I will be the first one to shout it from the rooftops! But what if it translates into “eat more peanut butter”? Still PUFA! But are you going to get the same benefits? You don’t need to read an insightful review by Christopher Ramsden on omega-3 vs omega-6 to know that peanut butter ain’t gonna make you healthier than salmon. But sometimes we really really want to believe it. And deluding ourselves is oh so easy when somebody in a position of authority gives you the green light.

Yum

Focusing too much on macronutrients is what allowed abominations like “low fat banana bread” to become a healthy morning tea snack. The “reductionism” approach has successfully indicted natural foods such as eggs, coconut, avocado, butter. At the same time we have low fat sausage rolls, sugary cereal, margarine and other foods devoid of any nutrition, riding on the coat tails of the lipid hypothesis 2.0.

One of the benefits of using the evolutionary approach is that it allows you to make rational decisions about your life choices without having to double-check them with Pubmed. And it doesn’t involve re-enactment of Paleolithic times, although heaven knows, I find some modern social conventions really tedious (like people requesting to know how I am going on a Monday morning prior to my first cup of coffee). As the opponents of the Paleo approach correctly point out, we don’t really know what our ancestors ate. But I sure as hell know what they DIDN’T eat: excessive amounts of sugar, grains, seed oils and other industrially produced food-like substances. Not even almond flour cupcakes. Sorry.

Regulating your fat intake is easy: eat fish, seafood, meat (preferably grass-fed), eggs, some nuts, seasonal fruit and veggies.

Go back to eating food, not labels.

48 thoughts on “Saturation be damned

    • Steve, that’s exactly what they say. Lipid profiling is also stuck in the 70s with most graduates/PCPs/cardiologists still hung up on total cholesterol. It’s mind-blowing how the wealth of scientific information is not getting through to the actual practice of medicine, let alone government guidelines.
      Awesome list by the way. Thanks for the link.

    • A dean of one of our medical schools told me I was a stupid, stupid woman because I didn’t accept his grains are great, saturated fat is bad overly simplistic approach to nutrition. He was the expert and he wasn’t about to discuss the literature with a fellow health researcher. He was right, I must, by definition be wrong.

  1. It is what a registered dietitian http://www.lowcarbdietitian.com/blog.html who has a favorable opinion about LC diets said in her comments “I know an RD who was threatened with having her credentials taken away by the Commission on Dietetic Registration because a couple of dietitians in her area complained that she was advising people to use butter instead of margarine. Speaking out in favor of very low carb ketogenic diets is even more controversial.” So, officially not only seed oils but even a margarine is still belong to a healthy food category.

  2. There was a good line that I picked up from one of those Australia’s-got-the-X-Factor-Voice shows that I, ahem, didn’t and don’t ever watch (it’s the kids, honest, and before you scoff too hard, we also don’t technically have a TV, it’s a re-purposed computer) which reduced the value of a performance down to one thing: Did it leave the audience wanting more? I saw the title of this article and went yay, another article about saturated fats, rolls eyes, what’s next, carbs?! However, despite the hackneyed topic (at least in some circles) this article left me wanting more (I could almost hear the “less-than-lithe lady lecturing a younger employee”). If it wasn’t itself such a hackneyed comment, I’d say you should write a book, in your “spare” time.

    Your rhetorical “Everyone still thinks that?” is one we face almost every day as the kids come home from school with conflicting info from schoolmates, teachers, etc. In fact, on the note of conflicting dietary advice, I’ve been meaning to ask you how you and your daughter cope with school trip food? A recent camp our eldest went on had a menu that consisted of cereal/toast/juice for breakfast, a sticky bun and popper for morning break (fruit was offered apparently but wasn’t very fresh), bread wrap/sausage roll for lunch, cupcake and popper for afternoon break, spaghetti bolognese for dinner, biscuits and milo for supper. In one day she likely had as much wheat, sugar, etc, as she might have in a month or more! It seems almost every week there is another reason to have some kind of cake stall yet they’re also doing the “Premier’s sporting challenge” in the hope of getting kids active?!

    Oh and another quick, possibly nosy, question: You seem to have gone private on Twitter, I can respect that of course, but as a former follower also entertained and informed by your tweets, I’m curious as to why? High noise ratio? Idiotic @’s from people like me?

    • Thank you Nick. I was really conflicted writing this post. I think we get caught up in the community of like-minded people and forget to come up for less-than-refreshing air of the real world. Plus there has been more gossip and drama rather than science addressed on the interwebz recently.
      Yeah, school tucker is probably the worst realisation of the current advice. The only way I can mitigate the damage without much hand-wringing is to declare my daughter a coeliac. This way at least she avoids fairy bread, lamingtons and afternoon bikkies. I recommend a thorough post-camp detox complete with cod liver oil.
      Twitter lockdown was a private issue that had nothing to do with genuine followers. It also helped to identify “noise” and people whose opinion I actually value. Feel free to send a request, I’m sorry if I haven’t approved you yet.
      Really appreciate your thoughts, Nick.

      • You’re right, there is still plenty of need for articles like this for those in the real world. As an example, I’ve directed friends to Andreas Eenfeldt’s AHS11 (I think it was) presentation mostly because it was entertaining (by that I mean accessible as well as amusing), and it did get watched for that reason. If all you write for is the like-minded it’s just preaching to the choir. So, keep at it.

        As far as “detox” goes (and I’m somewhat raising my eyebrows at a medical doctor using that term. What’s next? Tribal crystal chakra healing up here in Byron?) our kids are generally so happy to get home to eat “real” food that there is no need for any out of the ordinary intervention.

        On that topic, though off topic from this article: Not sure how much time you get to listen to Robb Wolf’s podcasts but there is something he said that I think potentially applies to kids too. He was responding to a question from someone in the military pointing out that they often need to eat whatever is available so paleo purity isn’t an option for them. Robb’s reply was to agree and point out that it’d likely be a mistake to even try. Doing so would potentially make their digestive systems oversensitive to the odd occasions when they have a wheat based MRE ration pack or local food, etc. I’d say this is unavoidably the case with kids too. Even if you request special meals it’s very hard to stop the kids exchanging foods with one another, random birthday cupcake sessions, etc. Nor do I think it’s really healthy, socially, to do so unless for good medical reasons. I think Mark Sisson’s 80/20 approach is also highly applicable too.

        As for Twitter, yep, I’ll send a request through.

        • Definitely watch Andreas’s talk at 2012. Yes, it’s about carbs (yawn) but it’s simple, visual and very entertaining.
          Re “detox”: sorry, I forgot my tongue-in-cheek font.
          Like you, I don’t obsess about what my daughter eats outside the house. Out of my control. And it may build some physiological resiliency. I control what she eats here. And it’s probably a shade stricter than I do for myself because she is more exposed to the toxic effects of conventional kids diet (shudder) than I am.

        • I tend to do that with my kids too. 80/20 ish
          It is becoming hard as they are teenagers. I don’t buy bread or wheat based food or have it in the house. I feed them paleo dinners and breakfasts (or at least gluten free), but I can’t control the food they buy with their own money. Fortunately they dont react to wheat, although they would be better off without it. So the best I can do is keep it minimal. Much better than a wheat based diet. A

  3. Yes, people still believe sat fat = bad and that all sat fats are created equal and that PUFA = good. I feel like I’m beating my head against the wall when I tell people the omega-3 to omega-6 ratio is way more impt than 10% sat fat. I’ll be linking to this wonderful rant of yours over at AdHocGourmet.

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  5. Well you are funny, which made me want to read some of this. Oh and by the way…you are speaking the truth. That doesn’t hurt either. ;)

    I will tweet this out. Thanks for the effort you put into this.

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  8. I find it rather awkward that you open with a statement that you love science and intelligent discussion, and then go on to display a severe lack of understanding for both of those.

    1. Those studies into saturated fat still exist because nothing in science is ever decided on then left to never be tested ever again. Very few things are beyond reasonable doubt; we’re humans, not all knowing, sentient beings.

    2. We also evolved to be incredibly adaptable omnivores, so you CANNOT base your dietary decisions off of “what we evolved to eat”, because news flash – we can eat pretty much anything we like! Yes, that includes processed foods! One thing you CAN take away from our origins, is that in order to survive in the variety of environments you find homo sapiens in, we need to be able to get by on what we can find. You obviously just get by better if you ensure optimal nutritional intake. Nutrition aka Micro-nutrients. NOT what form they come in.

    I, for one, am sick of people squabbling over what we should or shouldn’t eat, when we’ve gotten by just fine despite what we eat.

    What difference do you think consuming different fats, and cutting out others will do to a person like me, who eats pretty much whatever the hell I like (maybe I’m lucky, but I have very little desire to consume sweet things, nor processed junk) and feels great? Extend my life possibly by a few years, even though my family has a history of hitting the 100yr mark, and all the variables that affect when you die? (dont even get me started on Japan having the world’s highest average life expectancy despite a diet high in white rice oh staunch paleo advocate) Make me feel even better than the happy, healthy person I am, who has no health issues whatsoever?

    I think the developed world has been in such a backward state of eating themselves obese for so long, that you’ve lost touch with the reality of how easy it is to live a healthy lifestyle. I grew up in a developing nation. We didn’t have a mcdonalds till I was 14, I always ate unprocessed foods, and notably never thought about what I ate; and have never had health problems, 30yrs on – nor have my parents, now in their 60’s. Heck, my mom cycles 16km to work, then 16km back, every day.

    I’m all for looking at our evolutionary progress for ideas on how and why things work, but it is a foundation that can point you in the right direction, not a conclusion. We have done so much that is no longer in line with our origins, it boggles my mind that people think we must need take cues from where we came from – especially since it completely ignores the very core purpose of evolution: to change and adapt to a new environmental niche created by a changing environment, in order to survive.

    • Wow, you really don’t understand the template of evolutionary medicine, do you? Paleo is about looking at health and disease through the lense of our evolutionary past, in order to generate hypothesis which can then be tested. This template might guide us towards interventions that can help us to live functional – not longer – lifes. I haven’t seen Anastasia making the claim that our evolutionary past dictates a fixed set of rules. She just points out that some relatively recent changes – like heavy reliance on wheat and sugar and the introduction of pharmacological amounts of highly bioactive fatty acids – might harm us. There is mounting hard core evidence that they do.

      Your mother is healthy and rides her bicycle to work everyday. Congratulations. But what has this to do with the points made in this article?

    • Ash, you’ve written a lot there but it does sound a lot like you’ve had a series of rants that you wanted to say no matter what this article said and it’s therefore hard to understand what specific point you’re trying to make. It’s harder still when your last paragraph appears to contradict itself. You’re “all for” the evolutionary approach as “a foundation that can point you in the right direction” yet it “boggles” your mind that that “people think we must need take cues from where we came from”?

      You also seem to be having an argument with yourself for a lot of it, e.g. “despite a diet high in white rice oh staunch paleo advocate”. This article isn’t discussing white rice, Japanese longevity or the now extremely tiresome paleo diet equals low-carb misconception. Or, “I, for one, am sick of people squabbling over what we should or shouldn’t eat, when we’ve gotten by just fine despite what we eat.” but that is, in a sense, exactly what this article is about. My great grandmother and my grandmother (currently in her 90s) never “squabbled” about saturated fat and they did and have “gotten by just fine” on a diet that had plenty of it. It’s only in very recent history that we’ve started so dramatically tampering with our diet, so recently that you can hardly call it “evolution”.

      Despite being a confusing comment I think what you’re saying actually isn’t at odds with this article: It shouldn’t be that hard to remain healthy yet we have “lost touch with the reality of how easy it is to live a healthy lifestyle”. Low fat bran muffins spread with low-salt, cholesterol-free, margarine are a perfect example of that.

    • Hi Ash.
      Not sure about your first point. I don’t see many studies on mercury ingestion in humans. Looks like some things in science are quite settled, huh?
      Other than that, forgive me, but have you actually read the article? You seem to be arguing against your own version of what you think I am saying.
      But I will definitely go back and edit those paragraphs where I talk about starch, white rice and being a prescriptive “staunch Paleo advocate”…
      …still looking for those…
      Um…
      I’ll get back to you…

    • So what you’re saying here Ash is “I’m OK, forget doctoring everyone else”?

      A species only adapts to the new diet of crap-in-a-bag if the non-adapted members die off. It’s not some cosy “change hurts a little, like a caterpillar changing into a beautiful butterfly” paradigm. It involves a lot of people dying for humanity to adapt to anything radically new, so it should only be attempted when we have no choice.

      I’m better off eating the way my grandparents ate, i.e. with plenty of saturated fats and no oils – never mind paleo – but paleo is even better.

    • Ash, you speak in contradictions: on one hand you say we can eat anything, then you seem to attribute your health to eating nonprocessed foods and the obesity epidemic to the developed world eating processed junk. Which is it? Your diatribe sounds like self-puffery to me.
      As for the persistance of previous studies against sat fats, that is easily understood from their poor design and (intentional or not) misuse of statistics. Like my stats professor said, most medical studies are riddled with analytical errors – even today. If you want to see good statistics, go read an ecology paper.

  9. Speaking as someone who is currently taking a break after 3 years as a student in the department of Nutrition in one of the top schools of public health in America, like paleo in general, any level of acceptance of saturated fat is still, as you put it, for “weird hippies and charlatans.” Saturated fat “causes” heart disease; obesity “causes” diabetes; and eating too much (whatever that means) “causes” obesity–to question these basic tenets is to run the risk of being considered a dangerous whack job. We have a long way to go.

    • You needed to come up for air after 3 years? Interestingly, there was an International Convention of Dietetics in Sydney this week. The tweets coming out from our top dieticians and nutritionists attending the talks could have been the tweet from the AHS. Same studies, similar reasoning. Not sure why it doesn’t translate to the advice on the ground though.
      Hang in there, Adele. It feels like we are getting somewhere.

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  12. I’m in Post grad nutrition science currently – and maybe we are further ahead or more enlightended in NZ, but we had an assignment on saturated fat, we had to look at the recent large meta-analysis, and use this as a starting point to write about sat fat using current clinical studies / reviews. It is virtually impossible to vilify it using current research. I didn’t – and got an A for my work.

    I imagine though – it will take some years for the enlightenment to reach the general public.

    • And Stephan Guyenet’s recent review paper on dairy fat got into the evening news in NZ a few weeks ago.
      But will the Health Dept change its advice to “fill up on grains, pasta and potatoes” (is that so you don’t have room left for the “fattening” foods)?
      When a government department admits to being wrong, it will be a cold day in Hell.
      At the moment kids who come to school hungry in NZ are being given free low-fat milk.
      Because, presumably, the reason they’re coming to school hungry is, that they’re getting too many calories from fat.
      Jesus wept.

  13. we went primal/paleo about 4 years ago in response to a massive relearning about nutrition triggered by our \”healthy\” daughters diet resulting in tooth decay.

    although i love your post and the style/substance, and although all this science makes this subject seem like rocket science – it simply is not.

    did our evolving ancestors as a group – looking at HG, horticultural HG, pastoralists, seafaring HG – all of em – did any of them get genetically selected to survive cooking with sunflower/rapeseed oil or dashing generous amounts of ANY seed oils on their salads?

    no.

    then don\’t eat them. they are not human selected food.

    next subject please. ( )

  14. This is a great article. I love your approach to nutrition. Too many people in the paleo/low-carb/primal, etc. worry obsessively about lipid values. I think that in itself can harm your health. If we eat correctly, our bodies will take care of the lipids. And, by the way, on a SAD I had killer lab values. HDL-92/LDL-92/TRIGS-49. I do not know what they are now that I eat REAL food, nor do I care. Keep the good information coming.

    • Thanks Stacie. Elevating your cortisol while developing a nutritionism-related OCD doesn’t sound healthy to me either. Unfortunately we do have to be more vigilant with what we put in our mouths than our greatgrandparents but people rely too much on numbers.

  15. Agree Stacy. If I like what I eat and have a good life my lipids are only ever “interesting”.
    The thing is, low LDL is a risk factor in many diseases; stroke, cancer, viral hepatitis, sepsis. For some reason we let the Heart Police impose their simple-minded solution on the whole of society.
    Do you realise that when the advice to use seed oils was first disseminated, in the 1970s, nutritionists a) didn’t know that omega 3 was essential or important at all, b) hadn’t even identified EPA or DHA as nutrients?
    So the seed-oil fad was started rolling with a serious information deficit, one that changes everything and now reveals it to be a really bad idea – but it’s too late to stop now…

  16. Great post!…although check out this latest link –

    http://www.health.com/health/gallery/0,,20477647,00.html

    And we wonder why our co-workers are f-ing clueless!!

    With recommendations to increase intake of veggie oils like corn, safflower, and peanut those who rely on CW and the mainstream media are doomed!

    Inflammation here we come! Agh…

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  20. SAT FATS ARE A MAJOR FACTOR IN THE DEVELOPMENT OF MULTIPLE SCLEROSIS – Reference DR ROY SWANK 60+ Years Research

  21. Swank held that theory, but do people with MS get better on vegetarian diets? Don’t they get better by cutting out grains, eating coconut oil (sat fat), going ketogenic, and getting enough vitamin D? MS in unknown in some (sunny) parts of the world where fats are highly saturated. Do kitavans, for example, get MS? The fats in their diet are highly saturated (coconut); ditto with Africans cooking with palm oil. Given that MS is one of the conditions that seems to respond to VLC paleo diets that may be high in SFA, the theory seems mmisplaced, and Swanks diet probably confused multiple interventions, some of which were unnecessary.
    “his research interests were multifaceted. These included work that led to some of the original findings on the relationship between diet and cardiovascular disease and arthrosclerosis.”
    Findings which have not been borne out by subsequent research.

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