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evolution0706aThe Institute of Medicine’s (IOM) seminal study of preventable medical errors showed that in the United States side effects from prescription drugs kill an estimated 106,000 Americans a year, the sixth leading cause of death. This is from adverse drug reactions alone. If you add in medical mistakes (which the Institute of Medicine estimates kills at least 44,000 Americans) and in hospital-acquired infections we are talking about approximately 187,000 Americans dead every year, with millions injured, by medical care!

The best way to avoid the adverse effects of medical and surgical treatments and tests is not to avoid doctors, but to avoid getting sick in the first place, and for this reason we have today’s post. Here is a simple question: what are the top dozen reasons people visit their doctors? Are they avoidable by changing your diet?

The answer to this question is available in the phenomenal talk “more than an apple a day” by Dr. Michael Greger. This talk reached more than one million views in just a few weeks, making it one of the most successful nutrition talks on the web, if not the most successful one ever.

Dr. Greger is a physician who specializes in clinical nutrition. He is a known author and internationally recognized speak on nutrition, food safety and public health issues. He NutritionFactsis the maker of NutritionFacts.org, a website which just like Nutrino aims to address the issue of conflicting and contradicting nutritional advice. In NutritionFacts.org, Dr. Greger scours the world of nutrition-related research, and brings that information to you in short, easy-to-understand videos. They also provide links to the original journal articles whenever possible so that you can source the information directly if you wish. And the best thing about it is that it is completely freeNutritionFacts.org is a non-profit organization that runs on donations to avoid conflicts of interest.

If you find NutritionFacts.org useful, you can subscribe to it for free and receive emails daily, weekly, or monthly highlighting all their new content. Here is a message from Dr. Greger.

But before you go anywhere, don’t forget to watch this great talk!

References

Preventable medical errors – the sixth biggest killer in America

Kohn, Linda T., Janet M. Corrigan, and Molla S. Donaldson, eds. To err is human: building a safer health system. Vol. 627. National Academies Press, 2000.

Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. 

Lifestyle and the use of health services. 

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Cancer is recognized as one of the world’s biggest killers. Every year more than 10 million people are diagnosed with cancer worldwide. Yet, despite the enormous amount of research done on cancer, it still kills millions every year. In the USA alone, cancer is responsible for about 23% of the total deaths. This led to the famous declaration of “war on cancer” by U.S. President Richard Nixon in the 70′s. Today, the search for a cure for cancer is considered to be the holy grail of modern medicine.

In previous posts, we discussed the best anticancer vegetables, how one can slow the growth of cancer, and of the importance of antioxidants in cancer prevention. But who said that cancer is related to lifestyle at all? Perhaps, cancer is in our genes and we cannot do much to prevent it.

This brings us to today’s question – why do so many people get cancer? How often do people get cancer due to their genetics, and how often is it because of lifestyle?

Different studies tried to answer this important question. Today we will focus on an excellent recent review by the MD Anderson Cancer Center at the University of Texas, which analyzed the link between the agents/factors that cause cancer and the agents that prevent it. This review is based on more than 100 studies and trials done on this topic.

Cancer is caused by both internal factors (such as inherited mutations or hormones) and environmental/acquired factors (such as diet and tobacco). Studies performed on identical twins showed that only 5%-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90%-95% are due to either lifestyle or environmental factors. The main lifestyle factors that influence cancer growth are:

  • Diet (fried foods, red meat, excessive consumption of alcohol and other foods that contains carcinogens)
  • Obesity
  • Cigarette smoking
  • Physical inactivity
  • Sun exposure
  • Environmental pollutants
  • Infections
  • Stress
CausesOfCancer

The figure shows the role of genes and environmental factors in the development of cancer (in A). B shows the family risk ratios for selected cancers, while C shows the percentage contribution of each environmental factor to cancer mortality.

The evidence indicates that of all cancer-related deaths, 30%-35% are linked to diet, 25%-30% are due to tobacco, 10%-20% are linked to obesity, about 15%-20% are due to infections, and the remaining percentages are due to other factors like radiation, alcohol consumption, stress, physical inactivity, environmental pollutants etc. At least half of all cases of prostate, colorectal, breast, gall bladder and endometrial cancer were caused directly because of the food people chose to eat! If one also considers the links between obesity and alcohol to our diet, it is clear that diet is the main cause of cancer in the world today. The extent to which diet contributes to cancer deaths varies greatly, depending on the type of cancer (see the figure below for some stats).

DietAndCancer

Cancer deaths (%) linked to diet according to the type of cancer.

ObesityAndCancer

The various cancers that are linked to obesity. In the USA obesity could account for 14% of all deaths from cancer in men, and 20% of those in women.

The same study also reveals what cancer prevention requires in terms of diet:

  • Increased consumption of plant-based foods, especially fruits and vegetables (here is a list of foods that seem to prevent cancer)
  • Moderate use of alcohol
  • Minimal meat consumption
  • Caloric restriction
  • Use of whole grains

and in terms of lifestyle:

  • Smoking cessation (Tobacco use increases the risk of developing at least 14 types of cancer, and accounts for 87% of deaths from lung cancer. Tobacco contains at least 50 carcinogens, the effects of which can be reduced by certain foods like turmeric).
  • Exercise
  • Wise exposure to sunlight

To conclude with a smile, in almost all cases cancer is a preventable disease! You can learn more about the topic here and by watching the following video by Dr. Michael Greger:

References

Anand, Preetha, et al. “Cancer is a preventable disease that requires major lifestyle changes.” Pharmaceutical research 25.9 (2008): 2097-2116.

All the images in this post are taken from this article.

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Beverages are an essential part of our diet, both for hydration and other purposes (e.g. waking up in the morning…). We drink all the time. So here is an important question. Which, from all the dozens of beverages out there, is the healthiest?Set of different drinks, cocktails and beer

When speaking of health, there are different ways of quantifying which food is healthiest. One of the most important factors can be considered to be the level of antioxidants. As we discussed here, antioxidants are useful in preventing cancer, coronary heart disease, inflammation and many more diseases one wishes to avoid. It seems like the more antioxidants one consumes, the better. It is for these two reasons that we will use the level of antioxidants in a beverage to quantify how healthy it really is.

An exciting recent study tested more than 3,000 foods for their antioxidant content. Out of the thousands of foods they tested were 283 beverages. This is a remarkable number (think about it – can you even name 100 beverages?). The study included virtually every beverage, from fruit juices to Red Bull… So what did it find?

Red Bull has zero antioxidantsPepsi, Coke, and cow’s milk have one unit (1 unit = 1/10 mmol/serving). Next on the list are white wine and black tea. Red wine has 7 times the antioxidant power of white wine, and grape juice beats them both. A shot of espresso or a cup of coffee have slightly more antioxidants than red wine.

This brings us to the two healthiest beverages in the world.

Second on the list with 2.5 times the amount of antioxidants of black coffee is Matcha tea (tea made out of powdered green tea leaves). Beyond just the quantity of antioxidants in green tea, several other studies showed that it has many other health benefits that will be discussed in future posts. But which is our winner? What beverage can possibly beat green tea as the healthiest beverage on earth?

In terms of antioxidant power, the healthiest thing to drink on planet earth appears to be… hibiscus tea!

Click on the video below to learn more about it and get a delicious homemade hibiscus tea recipe!

References

Carlsen MH, Halvorsen BL, Holte K, Bøhn SK, Dragland S, Sampson L, Willey C, Senoo H, Umezono Y, Sanada C, Barikmo I, Berhe N, Willett WC, Phillips KM, Jacobs DR Jr, Blomhoff R. The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutr J. 2010 Jan 22;9:3. 

Draženka Komes, , Dunja Horžić, Ana Belščak, Karin Kovačević Ganić, Ivana Vulić.. Green tea preparation and its influence on the content of bioactive compounds. Food Research International Volume 43, Issue 1, January 2010, Pages 167–176 

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competitionA long duration strenuous exercise can easily deplete one’s glycogen stores, our body’s source of quick energy. Already in the 30′s, studies showed that providing athletes on treadmill with sugar water can delay their fatigue. Based on that, today there is an array of products like energy shots, energy gels, energy bars, energy chews and even sports jelly beans to enhance one’s performance. Such products tend to be expensive and not easily available. Are this “specially designed” supplements essential for optimal performance? Or perhaps there is a simple, cost-effective and natural alternative to this kind of energy supplements?

Two recent studies (see below) compared raisins, sports gel and sports jelly beans in their effect on endurance. The studies were designed to examine potential differences in metabolism and cycling performance. The studies were extremely thorough, and included measurements of the time to complete 10-km time trials; power output; blood concentrations of glucose, insulin, lactate, free fatty acids (FFAs), triglycerides, beta-hydroxybutyrate; respiratory exchange ratio during glycogen depletion period; rate of perceived exertion (RPE) and even a “hedonic score” test (namely, how tasty each energy snack is :-)).

In both studies, minor differences in metabolism and no difference in performance were detected between the trials. Raisins are a natural, tasty and cost-effective source of carbohydrate in comparison to sports gel and/or jelly beans before moderate- to high-intensity endurance exercise. In fact, the only significant difference in the studies was in “hedonic scores”, where raisins beat out the jelly beans!

Want to learn more? Watch this 3-minute video about the studies!

References

A. R. Coggan, E. F. Coyle. Reversal of fatigue during prolonged exercise by carbohydrate infusion or ingestion. J Appl Physiol 1987 63(NA):2388-2395 

M. Kern, C. J. Heslin, R. S. Rezende. Metabolic and performance effects of raisins versus sports gel as pre-exercise feedings in cyclists. J Strength Cond Res 2007 21(4):1204 – 1207 

H. L. Rietschier, T. M. Henagan, C. P. Earnest, B. L. Baker, C. C. Cortez, L. K. Stewart. Sun-dried raisins are a cost-effective alternative to Sports Jelly Beans in prolonged cycling. J Strength Cond Res 2011 25(11):3150 – 3156

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The World Health Organization (WHO) declared the #1 killer in the world to be heart disease.

The best way to prevent a massive heart attack (atherosclerosis) is to start at step number one: blocking the buildup of cholesterol. Buildup of cholesterol is a direct result of having too much LDL cholesterol (“bad” cholesterol) in our bloodstream, which is a direct result of eating three things:

  1. Saturated fat: found mostly in meat, dairy and eggs (here is a list of sources from Harvard’s school of public health)
  2. Trans fat: found in processed junk food (also hydrogenated oils like margarine are junk…) and animal products. Note that naturally trans fat are found in animal products alone. However, since the beginning of the 20th century scientists found ways of hydrogenating plant-oils so that their molecular structure turns into trans fat as well. Both sources of trans fat are equally bad!
  3. Cholesterol itself: found in meat, dairy, sea food and eggs (best sources of cholesterol, and therefore worst foods in that aspect are egg yolks, caviar, liver, butter and shrimp).

Elevated LDL cholesterol levels is also caused by insufficient consumption of fiber, which can be found in all whole plant foods. In general, whole plant foods tend to lower our risk of dying from our number one killer, and animal foods tend to raise our risk. There are, however, some exceptions to this rule that you should know of. Skim milk and egg whites don’t appear to increase cholesterol level. On the other side of the food spectrum, certain processed plant foods like hydrogenated vegetable oil (margarine) do raise cholesterol

Bottom line, to block that first step of heart disease we should eat more fiber (coming from plant-based foods such as vegetables, fruits, nuts, grains and legumes). Nutrino recommends at least 3 different fruit servings per day, 5 different vegetable servings per day and 1 handful of nuts a day. In future posts we will discuss Dr. Dean Ornish‘s revolutionary studies on reversing the effects of heart disease.

Want to learn more on the subject? Watch this 2-minute video below by Dr. Michael Greger!

References

Meinertz H, Nilausen K, Faergeman O. Effects of dietary proteins on plasma lipoprotein levels in normal subjects: interaction with dietary cholesterol. J Nutr Sci Vitaminol (Tokyo). 1990 Oct; 36 Suppl 2:S157-64. 

Samman S, Kurowska EM, Khosla P, Carroll KK. Effects of dietary protein on composition and metabolism of plasma lipoproteins in rabbits. J Nutr Sci Vitaminol (Tokyo). 1990 Oct; 36 Suppl 2:S95-9. 

Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005 Apr 21; 352(16):1685-95. 

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The Nutrino team created this blog and the educational tool in the Nutrino app to provide you with the best knowledge available in nutrition today. Our goal is to empower you so that you can make better food choices more easily!

We would love to hear more about what you care about. Please fill out the following form to help us help you live healthier! Feel free to go wild with your questions and topics related to nutrition, and our experts will dig in the literature to find the answers for you.

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If you there is anything else you would like to add and tell us – now is the time! You can also contact the Nutrino team directly at info@nutrino.co

Have a healthy week!

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The Harvard Nurses’s Health Study is considered to be the largest and longest investigation ever done of factors that influence women’s health. The study started in 1976 and involved more than 100,000 participants(!). Interestingly, the study is based on a competing risks analysis, which allows comparison between factors as diverse as lifestyle, physical activity and food consumption. So what can you learn from this extensive study?

Just as it is the case in the general population, the leading causes of death were coronary heart disease (CHD) and cancer. As one would expect, consumption of cholesterol was the most significant risk factor for death from heart disease, while most cancer deaths were smoking-related cancer deaths. How do these two risk factors compare? What can you do to reduce such risks?

Amazingly, the competing risks analysis showed that consuming the amount of cholesterol found in just a single egg a day (~187 mg) appears to cut a woman’s life short as much as smoking 5 cigarettes a day!

From all the nutrients out there, the best source of protection against coronary heart disease was found to be: fiber. Eating the amount of fibers found in just one cup of oatmeal a day appears to extend a woman’s life as much as 4 hours of jogging a week!

In terms of specific foods, the one food most tied to longevity in the study was found to be nuts. Eating just two handfuls of nuts a week appears to be equivalent to 4 hours of jogging a week. If you recall our previous post, this means that nuts won’t only help you lose weight, but also aid in extending longevity :-).

In future posts we will explore other competing risks studies, including ones performed on men. In the meantime, don’t forget to click on the share buttons below to share what you’ve just learned with your female friends and relatives.

References

Baer HJ, Glynn RJ, Hu FB, Hankinson SE, Willett WC, Colditz GA, Stampfer M, Rosner B. Risk factors for mortality in the nurses’ health study: a competing risks analysis. Am J Epidemiol. 2011 Feb 1; 173(3):319-29. 

Spence JD, Jenkins DJ, Davignon J. Egg yolk consumption and carotid plaque. Atherosclerosis. 2012 Oct;224(2):469-73. 

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Nuts are packed with nutrients, but they are also packed with calories and fat. For example, only 14 walnut halves have 185 calories and 83% of their calories come from fat.

Many people who are dieting choose to avoid nuts exactly because of this fact. If nuts are so rich in calories and fat they are probably fattening! This leads us to today’s question: are nuts fattening?

To date, there have been 18 clinical trials on nuts and weight gain/loss. In the trials, scientists added entire handfuls of various nuts to people’s daily diet and observed what happened to their weight. In 2 of the 18 studies people did actually gain a few pounds, but much less than expected. However, in 14 of the studies there was no significant weight change reported. Moreover, in the other two studies people actually lost weight!

To comprehend the significance of this result consider one of the 14 studies who showed no weight gain. They added 3/4 of a cup of pecans a day for 8 weeks. This is more than 3,000 calories added every week! They expected to see a gain of about 6 pounds at the end of the study, yet there was no weight gain at all.

These clinical trials where all tested for just a few weeks or months. What about long-term? After all, perhaps in the short run nuts don’t lead to weight gain, but then after years of eating nuts weight gain becomes apparent. This question was analyzed in 6 different ways, in studies lasting from one year to 8 years – the famous Harvard nurses health study. One of these studies found no significant change, while the other 5 out of 6 found significantly less weight gain and risk of abdominal obesity due to additional consumption of nuts.

How is it possible that 90% of studies ever done on nuts and weight gain showed at the very least no weight gain? Where did the nut calories go? We will explore this fascinating question in future posts.

In the meantime, remember that even if you’re dieting, you should eat at least one handful of nuts a day.

References

Natoli S, McCoy P. A review of the evidence: nuts and body weight. Asia Pac J Clin Nutr. 2007;16(4):588-97. 

Martínez-González MA, Bes-Rastrollo M. Nut consumption, weight gain and obesity: Epidemiological evidence. Nutr Metab Cardiovasc Dis. 2011 Jun;21 Suppl 1:S40-5. 

Alper CM, Mattes RD. Effects of chronic peanut consumption on energy balance and hedonics. Int J Obes Relat Metab Disord. 2002 Aug;26(8):1129-37. 

Sabaté J, Cordero-Macintyre Z, Siapco G, Torabian S, Haddad E. Does regular walnut consumption lead to weight gain? Br J Nutr. 2005 Nov;94(5):859-64. 

Fraser GE, Bennett HW, Jaceldo KB, Sabaté J. Effect on body weight of a free 76 Kilojoule (320 calorie) daily supplement of almonds for six months. J Am Coll Nutr. 2002 Jun;21(3):275-83. 

Almario RU, Vonghavaravat V, Wong R, Kasim-Karakas SE. Effects of walnut consumption on plasma fatty acids and lipoproteins in combined hyperlipidemia. Am J Clin Nutr. 2001 Jul;74(1):72-9. 

Lovejoy JC, Most MM, Lefevre M, Greenway FL, Rood JC. Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes. Am J Clin Nutr. 2002 Nov;76(5):1000-6. 

Morgan WA, Clayshulte BJ. Pecans lower low-density lipoprotein cholesterol in people with normal lipid levels. J Am Diet Assoc. 2000 Mar;100(3):312-8. 

Garg ML, Blake RJ, Wills RB. Macadamia nut consumption lowers plasma total and LDL cholesterol levels in hypercholesterolemic men. J Nutr. 2003 Apr;133(4):1060-3. 

Rajaram S, Burke K, Connell B, Myint T, Sabaté J. A monounsaturated fatty acid-rich pecan-enriched diet favorably alters the serum lipid profile of healthy men and women. J Nutr. 2001 Sep;131(9):2275-9. 

Jenkins DJ, Kendall CW, Marchie A, Parker TL, Connelly PW, Qian W, Haight JS, Faulkner D, Vidgen E, Lapsley KG, Spiller GA. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002 Sep 10;106(11):1327-32. 

Claesson AL, Holm G, Ernersson A, Lindström T, Nystrom FH. Two weeks of overfeeding with candy, but not peanuts, increases insulin levels and body weight. Scand J Clin Lab Invest. 2009;69(5):598-605. 

Foster GD, Shantz KL, Vander Veur SS, Oliver TL, Lent MR, Virus A, Szapary PO, Rader DJ, Zemel BS, Gilden-Tsai A. A randomized trial of the effects of an almond-enriched, hypocaloric diet in the treatment of obesity. Am J Clin Nutr. 2012 Aug;96(2):249-54. 

Casas-Agustench P, Bulló M, Ros E, Basora J, Salas-Salvadó J; Nureta-PREDIMED investigators. Cross-sectional association of nut intake with adiposity in a Mediterranean population. Nutr Metab Cardiovasc Dis. 2011 Jul;21(7):518-25. 

Li Z, Song R, Nguyen C, Zerlin A, Karp H, Naowamondhol K, Thames G, Gao K, Li L, Tseng CH, Henning SM, Heber D. Pistachio nuts reduce triglycerides and body weight by comparison to refined carbohydrate snack in obese subjects on a 12-week weight loss program. J Am Coll Nutr. 2010 Jun;29(3):198-203. 

Vinson JA, Cai Y. Nuts, especially walnuts, have both antioxidant quantity and efficacy and exhibit significant potential health benefits. Food Funct. 2012 Feb;3(2):134-40. 

Wang X, Li Z, Liu Y, Lv X, Yang W. Effects of pistachios on body weight in Chinese subjects with metabolic syndrome. Nutr J. 2012 Apr 3;11(1):20. 

Fogelholm M, Anderssen S, Gunnarsdottir I, Lahti-Koski M. Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review. Food Nutr Res. 2012;56. 

Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011 Jun 23;364(25):2392-404. 

Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, Covas MI, Schröder H, Arós F, Gómez-Gracia E, Fiol M, Ruiz-Gutiérrez V, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Muñoz MA, Wärnberg J, Ros E, Estruch R; for the PREDIMED Study Investigators. A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial. PLoS One. 2012;7(8):e43134. 

O’Neil CE, Keast DR, Nicklas TA, Fulgoni VL 3rd. Out-of-hand nut consumption is associated with improved nutrient intake and health risk markers in US children and adults: National Health and Nutrition Examination Survey 1999-2004. Nutr Res. 2012 Mar;32(3):185-94. 

O’Neil CE, Keast DR, Nicklas TA, Fulgoni VL 3rd. Nut consumption is associated with decreased health risk factors for cardiovascular disease and metabolic syndrome in U.S. adults: NHANES 1999-2004. J Am Coll Nutr. 2011 Dec;30(6):502-10. 

Jornayvaz FR. Diet, lifestyle, and long-term weight gain. N Engl J Med. 2011 Sep 15;365(11):1058-9; author reply 1059.

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In 2008, the World Health Organisation (WHO) identified cancer as one of the four leading threats to human health and development (along with cardiovascular diseases, chronic respiratory diseases and diabetes). We previously saw that in most cases cancer is a preventable disease, and that plant-based foods slow and may even reverse the growth of cancer cells. But from all the plant-based foods out there, which is best at blocking human cancer cells growth? Moreover, in terms of nutrient density (nutrients per calorie) what is the best food out there?

The most nutrient-dense class of foods is by far vegetables. In 2009 a fascinating study was published, checking the effect of 34 common vegetables against 8 different types of human cancers: breast cancer, brain tumors, kidney cancer, lung cancer, childhood brain tumors, pancreatic cancer, prostate cancer, and stomach cancer. The scientists checked the effect of each one of the vegetables on the various cancer cells in a petri dish.

The study showed that the vegetables that people typically eat, like potatoes, tomatoes, cucumbers, carrots, iceberg lettuce barely affect the growth of cancer cells. The study, however, revealed one clear winner. There is one vegetable that completely 100% stopped cancer growth in 7 out of the 8 tumors: garlic! It is #1 against breast cancer and brain tumors, #2 against kidney cancer, lung cancer, childhood brain tumors, pancreatic cancer, prostate cancer and stomach cancer.

Does this mean that garlic is toxic to all cells, including healthy human cells? They tested for that. Vegetables, and in particular garlic, are selective in their effect. They go after the cancer cells but leave the normal cells alone.

The study showed that there are two superfood classes of vegetables most adept at blocking human cancer cell growth in a petri dish. Cruciferous vegetables (including kale, cauliflower, cabbage, cress, bok choy and broccoli) and allium vegetables like onion, garlic, chives and leeks. Remember this fact next time your picking your veggies ;). The video below discusses further the results of the study – highly recommended!

Read more

Cancer worldwide – a global picture

References

D. Boivin, S. Lamy, S. Lord-Dufour, J. Jackson, E. Beaulieu, M. C^ote, A. Moghrabi, S. Barrette, D. Gingras, and R. Beliveau. Antiproliferative and antioxidant activities of common vegetables: A comparative study. Food Chem., 112(2):374{380, 2009.