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Children’s Health

An increasing number of parents, teachers, and community organizations are concerned with the effects of the modern way of eating on children.  Medical studies have begun to link hyperactivity, learning disabilities, and other syndromes with improper food. See Attention-Deficit Disorder Breast-feeding, Chocolate, Cholesterol, Dairy, Food Guide Pyramid, Heart Disease, Japanese Diet, Macrobiotics, Obesity, Pesticides, Prenatal Nutrition, Rice, Sea Vegetables.


• Processed Foods

In testimony before the Senate Select Committee on Nutrition and Human Needs over 20 years ago, Dr. Carolyn Brown, director of a school for learning disabled children in Berkeley, Calif., pointed to the social effects of changes in diet and lifestyle since World War II: “Let us look for a moment at a few interesting health and social statistics. The members of this committee know well the evidence of the increase in synthetic foods, and other nutritional changes. . . . What do we know about what has happened to the children that grew up during these twenty-five years? We know that there was a sixfold increase in arrests of children under 15 suspected of murder, non-negligent manslaughter, aggravated assault, and rape. The factor increase was three for 15- to 17-year-olds, two for 18- to 25-year-olds. We know that ‘accidents’ resulting in death rose dramatically among the young, that divorce rates have continued to increase, that suicides have been rising among young people in comparison to the rest of the population. And we know that there has been an unprecedented 14-year decline in the scores of our most gifted children on the Scholastic Aptitude Tests. . . During the eight years from 1958 to 1966, children under seventeen with chronic health problems increased from 18.8 to 24.6 percent. Those from 17 to 24 showed an increase from 39 to 44.4 percent. . . .

     “I would like to ask you senators, when we know what has happened during the past 25 years in terms of the increase in non-nutritous foods, radiation exposure, television exposure, and exposure to environmental toxins—and when we know that children born during that period show a dramatic increase in juvenile delinquency, arrest for serious crimes, chronic health problems, and low scores on Scholastic Aptitude Tests—is it not at least a fair question whether we are exposing our children on the whole to an increasingly powerful set of environmental stressors that is producing a broad range of forms of biosocial decline?”

Source: Testimony of Carolyn Brown, Senate Select Committee on Nutrition and Human Needs, 1977.


• Learning Disabilities

In a study of learning disabilities in children, researchers reported that diets high in refined carbohydrates raised cadmium levels, which have been associated with reduced cognitive functioning. Intellectual ability was also negatively correlated with refined food independent of cadmium, age, race, sex, and socioeconomic status.

Source: M.L. Lester et al., “Refined Carbohydrate Intake, Hair Cadmium Levels and Cognitive Functioning in Children,” Journal of Nutrition & Behavior 1:3-13, 1982.


• Macrobiotic vs. Conventional Diet

A British nutritionist found that a macrobiotic day-care center in London not only “supported normal growth” in nursery school children but also could be used as a model to implement national dietary guidelines. Comparing the nutritional adequacy of macrobiotic meals provided preschool children by the Community Health Foundation with ordinary meals at a nursery in Notting Hill, the investigator found that the macrobiotic food consisting of brown rice and other whole grains, miso soup, vegetables, beans, sea vegetables, and other supplemental foods met current U.K.-R.D.I. dietary, energy, and nutrient standards and that the children’s anthropometric measurements including weight, height, and skinfold thicknesses were normal.

     In contrast, the ordinary nursery school diet was high in dairy food, lard, and other saturated fats that have been associated with the development of atherosclerosis beginning in childhood. “The diet composition of children in Group I [standard nursery] could be made more desirable by a reduction in the amount of full-cream milk and meat and an increase in the amount of cereal foods . . .,” the researcher concluded. “The total diet of Group II [macrobiotic nursery] met the U.S. Dietary Goals for fat, sugar, and carbohydrate content, although the home diets of the children were similar to that of the general population. This illustrates the power and potential of nursery meals to contribute to the adoption of a nutritionally sound and beneficial national diet.”

Source: Valerie Ventura, “A Comparative Study of the Meals Provided for Pre-School Children by Two Day Nurseries,” Department of Nutrition, Queen Elizabeth College, 1980.


• Whole Grain Diet Improves Children with Learning Disabilities

When put on a diet centered on whole grains, complex carbohydrates, and unprocessed foods, 16 children with learning and behavioral problems showed significant improvements in behavior, learning, and intelligence compared to 16 controls over a 22-week trial period. Further, cadmium and iron levels, which have been linked to learning disabilities, fell 28 and 49 percent respectively.

Source: M. and L. Colgan, “Do Nutrient Supplements and Dietary Changes Affect Learning and Emotional Reactions of Children with Learning Difficulties? A Controlled Series of 16 Cases,” Nutrition and Health 3:69-77, 1984.


•  Macrobiotic Approach

In Raising Health Kids, Michio and Aveline Kushi offer a macrobiotic approach to bringing up children, incorporating insights from traditional Far Eastern medicine and philosophy. Topics covered include family health and happiness; how children develop; diet and daily care; and keeping children happy. Much of the book is devoted to using diet to treat common conditions including simple fever, headaches, stom-ach ache, colds and flu, earaches, sore throats and tonsillitis, measles, roseola, mumps, chicken pox,  rickets, bed-wetting and sleeping difficulties, whooping cough, pinworms, skin disorders, hyperactivity and behavioral problems, accidents, emergencies, and first aid. The book also includes recipes, a home care guide, and palm healing for children.

Source: Michio and Aveline Kushi, Raising Healthy Kids (Garden City Park, N.Y.: Avery, 1994).


• Normal Development Among Macrobiotic and Vegetarian Children

In a study of vegetarian preschool children, researchers at New England Medical Center Hospital in Boston found that the growth of macrobiotic youngsters did not significantly differ from those of non-macro-biotics before age two. After age two, macrobiotic children tended to put on weight more quickly than the children brought up on yoga diets, Seventh-Day Adventist diets, or other vegetarian regimes. Nearly all the children had been breast-fed, and it was found that macrobiotic children who had been weaned did not differ in caloric intake from nonmacrobiotics.

Source: M.W. Shull et al., “Velocities of Growth in Vegetarian Preschool Children,” Pediatrics 60:410-17, 1977.


• Low-Fat Diet Benefits Babies

Babies 7 to 13 months benefit from a diet low in saturated fat. In a case control study in Finland, researchers found that healthy infants who ate more polyunsaturated fat and less saturated fat than controls had 6 to 8 percent lower cholesterol in their blood. Both groups developed at a similar rate. The Finnish researchers noted that in earlier studies, the arteries of babies showed signs of early atherosclerosis in modern society and that exposure to a healthful diet "at the earliest possible age" would more likely adhere in future years.

Source: H. Lapinleimu, “Prospective Randomised Trial in 1062 Infants of Diet Low in Saturated Fat and Cholesterol,” Lancet 345(8948):471-76, 1995.


• Heart Disease in Teens and Young Adults

By their teens, most Americans have fatty deposits in their blood vessels, according to the largest autopsy study conducted on adolescents and young adults. The results show that most youths are at risk for heart disease, said Dr. William H. Dietz, director of clinical nutrition at New England Medical Center. The study of 1532 autopsies of young people who died from trauma found that half had coronary arteries showing evidence of early heart disease by age 19, while all 100 percent had fatty patches in the aorta, the main artery leading from the heart. "Aortic fatty streaks are universal by age 15 and increase rapidly in extent during the following decade," the researchers concluded.

     The scientists further reported that the fatty streaks had progressed to tough, fibrous deposits that narrowed coronary arteries in the vast majority of both men and women by their early thirties. Interestingly, young females aged 15 to 19 had slightly higher fat deposits in the right coronary artery than young males. However, by the mid-twenties and early thirties males surpassed females.

Source: Richard A. Knox, "Fatty Deposits Found in All Young Americans in Study," Boston Globe, September 10, 1993.


• Atherosclerosis in Youth

Early stages of atherosclerosis commonly appear in youth. In a study of lifestyle modifications in 19 overweight children, age 8 to 17 years old, were given a high-fiber, low-fat diet and daily exercise. After two weeks on the regimen, significant reductions in serum lipids, C reactive protein, nitric oxide, and other risk factors were observed.  “These results indicate amelioration of several traditional as well as novel factors associated with atherosclerosis after lifestyle modification, even in youth without documented disease,” the study concluded.

Source: C. K. Roberts et al., “Effect of a Short-Term Diet and Exercise Intervention in Youth on Atherosclerotic Risk Factors,” Atherosclerosis, Oct. 18, 2006.


Children’s Lunch Programs

Many school systems around the United States have introduced healthier foods, including whole grains, soy products, and fresh fruits and vegetables and limited animal foods, dairy, sugar, and highly processed foods.

       • Pioneer Nutritional Programs in Nation’s Schools Schools around the United States that have implemented better nutrition include:

       • Berkeley Unified The Berkeley, California public schools serving 9000 students in the San Francisco Bay area has adopted what is widely regarded as the most progressive dietary program in the country. Students grow their own organic crops in the school gardens, International Food Courts in each school serve balanced menus from around the world with organic and natural ingredients, and fried foods, sugar desserts, and soda are banned

        • The Los Angeles Leadership Academy, located in one of the city’s poorest neighborhoods, offers a salad bar in the school cafeteria with tofu and beans; hydrogenated oils, sugar, soda, and refined flour have been eliminated; and menus are centered on whole grains and vegetables

       • At the Ross School on Long Island in New York, nutritional innovations have inspired 75 percent of the students’ parents to change their way of cooking at home in a more organic, sustainable, regional, and seasonal direction

       • The Fairfax Country Public Schools, in Fairfax, Virginia, one of the largest school districts in the nation, offers vegetarian and vegan entrees and nutritional advice is offered students and parents

       • The Albemarle Country Schools in Charlottesville, Virginia have launched an all-vegan “Food Is Elementary” Curriculum developed by Antonia Demas, Ph.D.

       • The Clark Country School District in Las Vegas, Nevada, has introduced low-fat meals including vegetarian and vegan options

       • The Hempfield School District in Landisville, PA has developed a “Produce Pentathlon” contest to encourage students to eat more fruits and vegetables

       • The Marblehead Community Charter Public School in Marblehead, MA offers veggie burgers daily, gourmet veggie treats such as roasted butternut squash, and healthful cooking classes

       • The Santa Monica/Malibu Unified School District in California uses gardens and visits to local farmers’ markets to teach children about healthy nutrition and to get them to eat more fresh food

       • The South Oregon Education Service/Talent Transition Site in Phoenix, Oregon utilizes community resources to educate kids in better health, including a live-in program for developmentally disabled kids

Source: “Sowing Veggie Seeds in School Foodservice,” Good Medicine 16(1):6-7, 2005.


• Soy Approved for School Lunch Programs

In 1983 the U.S.D.A. approved the use of soy products and other vegetable protein products as partial substitutes for meats in school lunch and some other feeding programs, noting:

       • Soy products were comparable with milk in protein quality for preschool and older children.

       • Except for premature infants, soy protein can serve as a sole protein source in the human diet.

       • Soy foods are high in protease inhibitors that inhibit the action of various enzymes that have been associated with causing cancer.

       • Soy formulas are lactose free and may benefit infants and small children who are sensitive to cow-milk protein which can cause diarrhea, emesis, vomiting, and weight loss.

       • Soy products can reduce cholesterol and triglycerides in subjects with high lipid levels and protect against heart disease.

       • Soy foods are useful in decreasing blood glucose responses compared with other high-fiber foods and may prevent  diabetes.

       “One desirable way to alter typical American diet patterns to meet the above [National Academy of Science, WHO, USDA] dietary recommendations involves partial replacement of foods of animal  origin with cereals and legumes. . .

       “Although at the present time soy protein makes up only a small component of the American diet, it is expected that the many positive aspects of soy will result in increasingly greater human use of this legume. A whole variety of low-cost, highly functional soy-protein products are available for use.”    

Source: John W. Erdman, Jr. and Elizabeth J. Fordyce, “Soy Products and the Human Diet,” American Journal of Clinical Nutrition 49:725-37, 1989.


• Daily Salad Bar

The Oak Grove School in Ojai, California offers students a daily salad bar with steamed and fresh vegetables and fresh fruit platters for dessert. Irmgard James, the food service director, helps students grow and harvest produce in the school’s organic garden and orchard.


• Kids Get Healthy

The Physicians Committee for Responsible Medicine has released two television public service announcements as part of its “Kids Get Healthy” program. One announcement advises parents about the dangers of poor childhood nutrition, including obesity, and the other features physicians who rescue customers at a typical fast-food restaurant by substitution veggies and fruits for greasy French fries and hamburgers. The messages have appeared on 72 cable stations and aired more than 7300 times.

     In its fifth annual School Lunch Report Card in 2006, the PCRM surveyed major school districts around the country and found that some are increasingly serving a vegan main dish and a nondairy beverage daily and making a variety of fresh or low-fat foods available. Twelve  of the 18 school districts examined received a B- or higher.


• Natural Foods in School Cafeterias

The Food Studies Institute in Trumansburg, N.Y., initiates programs in school cafeterias to teach children natural foods cooking and the value of wholesome nutritious foods from around the world. Organizer Antonia Demas reports that children who have a “hands-on sensory experience” of cooking brown rice, lentils, and other healthful foods together “eat things their parents swear they’d never touch.” Her curriculum has been adopted by several schools across the country. For Martin Luther King Day, children made a Soul Stew with black-eyed peas, corn, and kale, after sampling eight different greens. "The rest of the year, I kept hearing from parents that their kids were begging them to buy dandelion greens," Dr. Demas said.

Source: Karen Baar, "School Lunches: When They Love Even the Greens, New York Times, Sept. 3, 1997 and The Food Studies Institute, 60 Cayuga St., Trumansburg NY 14886; (607) 387-6884.


• The Healthy School Lunch Program

The Healthy School Lunch Program is a network of volunteers around the country that meets with students, teachers, and food service personnel, providing them with information on healthful foods, offering recipes, and assisting in meal preparation. Part of John Robbin’s EarthSave Foundation, the project publishes Healthy School Lunch Action Guide by Susan Campbell and Todd Winant , offering a comprehensive, step-by-step approach to changing school lunch programs in local communities.

Source: The Healthy School Lunch Program, EarthSave, 706 Frederick St., Santa Cruz CA 95062; (408) 423-4069.


• Nutritional Curriculum for Junior High Students

The Rite Bite is a nutritional curriculum designed for junior high students to examine their own lifestyles and learn about vegetarian and natural foods. The 141-page notebook includes teacher lesson guides, background information, and posters, as well as handouts, activities, and fix-at-school recipes for six fun, informative sessions.

Source: The Rite Bite, Physicians Committee for Responsible Medicine, Washington, DC.


• Preschoolers Like Tofu

In tests of the acceptability of tofu in the lunch menus of preschoolers, analysis showed that the nutritional quality of the nine tofu recipes adhered more closely to dietary guidelines than the beef, chicken, eggs, and cheese originally served. The children accepted the tofu well, preferring it to dairy and meat in several dishes including macaroni and cheese, lasagna, tuna casserole, and quiche.

Source: H. L. Ashraf et al., , “Use of Tofu in Preschool Meals,” Journal of the American Dietetic Association 90:114-16, 1990.


• College Students Respond to Tofu

When tofu replaced meat, eggs, and dairy food as the main protein source in twelve recipes in a college cafeteria, researchers found that it increased nutrition and was well accepted by the students.  The only two recipes found lacking were those for tofu nuggets, which had a poor texture, and tofu chocolate mint pie.  In the latter recipe, students disliked not the tofu but the mint flavoring.

Source: H. L. Ashraf and D. Luczycki, “Acceptability of Tofu-Containing Foods among College Students,” Journal of Nutrition Education 22:137-40, 1990.


China Health Study

The China Health Study, touted as the grand prix of epidemiology studies, challenged modern dietary assumptions in the early 1990s.  Sponsored by the U.S. National Cancer Institute and the Chinese Institute of Nutrition and Food Hygiene, the study correlated average food and nutrient intakes with disease mortality rates in 65 rural Chinese counties.  The typical Chinese diet included a high proportion of cereals and vegetables and a low amount of meat, poultry, eggs, and milk. Less than 1 percent of deaths were caused by coronary heart disease, and breast cancer, colon cancer, lung cancer, and other malignancies common in the West were comparatively rare. Among the researchers’ chief findings:

       • Fat consumption should ideally be reduced to 10 to 15 percent of calories to prevent degenerative disease, not 30 percent as usually recommended. 

       • The lowest risk for cancer is generated by the consumption of a variety of fresh plant products.

       • Eating animal protein is linked with chronic disease. Compared to the Chinese who derive 11 percent of their protein from animal sources, Americans obtain 70 percent from animal food.

       • A rich diet that promotes early menstruation may increase a woman’s risk of cancer of the breast and reproductive organs.

       • Dairy food is not needed to prevent osteoporosis, the degenerative thinning of the bones that is common among older women.

       • Meat consumption is not needed to prevent iron-deficiency anemia. The average Chinese consumes twice the iron Americans do, primarily from plant sources, and shows no signs of anemia.         

       Dr. T. Colin Campbell, a Cornell biochemist and principal American director of the project, noted, “Usually, the first thing a country does in the course of economic development is to introduce a lot of livestock. Our data are showing that this is not a very smart move, and the Chinese are listening. They’re realizing that animal-based agriculture is not the way to go.”

Source: Chen Junshi, T. Colin Campbell, Li Junyao, and Richard Peto, Diet, Life-Style, and Mortality in China (Ithaca, N.Y.: Cornell University Press, 1990). and Jane Brody, “Huge Study of Diet Indicts Fat and Meat,” New York Times, May 8, 1990.


Chili Peppers

Chili peppers are associated with higher stomach cancer rates, epidemiologists from the Mexico National Institute of Public Health and Yale University concluded. In a study of the dietary habits of Mexico City residents, people who described themselves as "heavy" eaters of hot chili peppers were 17 times for likely to have stomach cancer than those who did not consume hot peppers. "Medium" consumers had four times as much stomach cancer. Previous laboratory and cell tissue studies indicated that capsaicin, a substances in hot peppers that makes them hot, is a carcinogen.

Source: "Hot Peppers Linked to Stomach Cancer," Berkshire Eagle, February 26, 1994.



Chocolate is native to Central and South America and has been enjoyed for centuries for its intoxicating qualities. High in caffeine, chocolate raises blood sugar and gives feelings of emotional satisfaction. It is the number one binge food among modern women and associated with hyperactivity in children. See Attention-Deficit Disorder, Children’s Health, Sugar.


• Chocolate Linked to Migraines

In a study of migraine headaches, British researchers reported that 16.5 percent of patients surveyed reported that chocolate could precipitate these painful, throbbing attacks. Other precipitating foods included cheese and alcoholic drinks, especially beer and wine.

Source: R. C. Peatfield, “Relationships Between Food, Wine, and Beer-Precipitated Migrainous Headaches,” Headache 35(6):355-57, 1995.


• Chocolate Increases Risk of Bowel Disease

Investigating the relationship between dietary factors and inflammatory bowel disease, Dutch researchers reported that in a case-control study of 290 patients with Crohn’s disease, 398 patients with ulcerative colitis, and 616 controls, consumption of chocolate was associated with two and a half more times the rate of these disorders.

Source: M. G. Russel et al., “‘Modern Life’ in the Epidemiology of Inflammatory Bowel Disease,” European Journal of Gastroenterology and Hepatology 10(3):243-49, 1998.


• Chocolate Increases Risk of Colic

In a study of maternal nutrition and its effect on babies, University of Minnesota researchers reported that breast-feeding women consuming higher amounts of chocolate had nearly a 50 percent higher risk of their infants developing colic than those with lower intake of this item.

Source: K. D. Lust et al., “Maternal Intake of Cruciferous Vegetables and Other Foods and Colic Symptoms in Exclusively Breast-Fed Infants,” Journal of the American Dietetic Association 96(1):46-48, 1996.



Cholesterol, a waxy, fatlike substance produced in the liver, contributes to cell membranes, vitamin D, sex and adrenal hormones, bile production, and other metabolic processes. However, in excess, it causes atherosclerosis, or the build up of plaque in artery walls, that can cause a heart attack, stroke, or peripheral artery disease. High serum cholesterol is associated with consumption of foods high in saturated fat and dietary cholesterol, including eggs, meat, poultry, and dairy foods. Whole grains, beans, soy products, sea vegetables, and other plant quality foods can suppress or lower cholesterol in the blood. Risk of cardiovascular disease is commonly measured by total cholesterol, the ratio of total cholesterol to “good” HDL cholesterol, and various cholesterol fractions. See Beans, Complex Carbohydrates, Heart Disease, High Blood Pressure, Oats, Sesame, Soy Foods, Tarahumara Diet, U.S. Surgeon-General’s Report, Vegetarians, Vitamin B-12, Wakame, Wheat, Whole Grains.


• Pioneer Study Links Diet, Blood Pressure, and Cholesterol

In one of the first studies to show the direct effects of animal food on raising blood pressure, a study of 21 macrobiotic persons by Harvard Medical School researchers found that the addition of 250 grams of beef per day for four weeks to their regular diet of whole grains and vegetables raised serum cholesterol levels 19 percent. Systolic blood pressure also rose significantly. After returning to a low-fat diet, cholesterol and blood pressure values returned to previous levels.

Source: F. M. Sacks et al., “Effects of Ingestion of Meat on Plasma Cholesterol of Vegetarians,” Journal of the American Medical Association 246:640-44, 1981.


• Soy Lowers Cholesterol

Soy protein in tofu, tempeh, and other soy products can significantly lower cholesterol levels in people with moderately high to high levels, according to a review of 38 trial studies. The higher the cholesterol, researchers said, the greater the ability of soy protein to bring it down. The report found that a diet including 47 grams of soy protein a day cut cholesterol levels by an average of 9.3 percent in a month. For those with cholesterols over 300, the count dropped 20 percent. Harmful triglycerides are also blocked by soy protein, the scientists observed. "Even a 10 to 15 percent reduction in blood cholesterol levels results in a 20 to 30 percent reduction in the risk of coronary heart disease," said Dr. James W. Anderson of the University of Kentucky and one of the authors of the report. "This has the potential of making a huge impact on American public health."

Source: Natalie Angier, "Health Benefits from Soy Protein," New York Times, August 3, 1995.


• Reducing Cholesterol in Children

Top American health officials joined in calling for a low-fat, low-cholesterol diet for everyone over age two to prevent heart disease in later life, not just for adults at risk for heart attacks and other cardiovascular disease. The recommendations, sponsored by a panel convened by the National Heart, Lung and Blood Institute and the Cholesterol Education Program and endorsed by a coalition of forty-two major health and medical organizations, called for the cholesterol testing of all children whose parents or grandparents had heart attacks or other cardiovascular problems, including a parent with blood cholesterol over 240. The panel called for reductions in fat consumption and for intake of more grains, vegetables, and fruit. Groups that endorsed the report included the American Medical Association, the American College of Physicians, the American Public Health Association, the U.S. Food and Drug Administration, the U.S. Department of Agriculture, and the U.S. Department of Health and Human Services.

Source: Warren E. Leary, “Cholesterol Tests Are Recommended for a Quarter of Children,” New York Times, April 9, 1991.


• Low-Fat Diet Reduces Cholesterol

In a study of 1,232 men aged 40 to 49 with high cholesterol who were put on a low-fat diet, researchers found a 13 percent reduction in mean total cholesterol levels in comparison to a control group. At the end of 7.5 years, the incidence of heart attack and sudden death was 47 percent lower in the experimental group. The scientists attributed the changes to reduced cigarette smoking and diet.

Source: I. Hjermann, “Effect of Diet and Smoking Intervention on the Incidence of Coronary Heart Disease: Report from the Oslo Study Group of a Randomised Trial in Healthy Men,” Lancet 2:1303-10, 1981.


• Heart Deaths Decline

America’s declining cholesterol levels and change to a diet lower in fat have coincided with a 54 percent decline in heart disease deaths between 1978 and 1990. During this period, the average cholesterol level in adults dropped from 213 milligrams per deciliter of blood to 205, a 4 percent decline, according to figures compiled by the National Center for Health Statistics. Studies have shown that for every 1 percent drop in cholesterol level, there is almost a 2 to 4 percent drop in coronary heart disease. The proportion of adults with high cholesterol (over 240) fell from 26 percent to 20 percent during this period.

Source: “Study Shows Drop in Cholesterol Levels in U.S.,” Boston Globe, June 16, 1993.


Chronic Fatigue Syndrome

Chronic fatigue is a crippling immune-deficiency disorder that particularly strikes young adults. In 1998, the Centers for Disease Control reported that it afflicted 183 persons out of every 100,000 in the U.S. between the ages of 18 and 69. The previous CDC study found that it affected 4 to 9 cases per 100,000. CFS is considered incurable medically, but often responds to dietary therapy.



Caffeine, the active ingredient in coffee, is a stimulant associated with affecting the nervous system. In medical studies, coffee is generally not associated with cardiovascular disease or most cancers, except possibly pancreatic cancer, but it may affect blood pressure and decrease infertility in women. See Caffeine, Myopia.


• Coffee Raises Blood Pressure and Heart Rate

In a study of the effects of caffeine, researchers at the University of Iowa reported that coffee raised systolic and diastolic blood pressure 3.6 and 5.6 mm/Hg respectively, most notably shortly after ingestion, and heart rate was higher overnight following caffeine consumption.

Source: P. J. Green and J. Suis, “The Effects of Coffeine on Ambulatory Blood Prfessure, Heart Rate, and Moon in Coffee Drinkers,” Journal of Behavioral Medicine 19(2):111-28, 1996.


• Unfiltered Coffee Raises Cholesterol

In a study of different brewing methods, researchers in the Netherlands reported that boiling coffee in the Turkish or Scandinavian way raises LDL cholesterol, the “bad” cholesterol, while filtered coffee does not affect cholesterol. The scientists identi-fied cafestol and kahweol, diterpene lipids, in coffee beans as the cholesterol-raising ingredients, which are retained by a paper filter but extracted by hot water.

Source: R. Urgert and M. B. Katan, “The Cholesterol-Raising Factor from Coffee Beans,” Annual Review of Nutrition 17:305-24, 1997.


• Coffee and Lifestyle

In a study associating lifestyle factors with coffee and tea consumption, researchers reported that coffee drinking is "positively associated with factors that promote coronary heart disease, while drinking tea is associated with a preventive lifestyle." The survey of 2,400 men and women aged 25 to 64 found that coffee intake was associated with a higher frequency of meat dinners including more fat, more sausages, and more eggs and less fruit. Tea drinking was linked to higher fish, salad, vegetable and fruit consumption. Coffee drinks also exercised less, while tea drinkers exercised more.

Source: Bernhard Schwarz, M.D., et al. "Coffee, Tea, and Lifestyle," Preventive Medicine 23: 377-384, 1994.


Colitis, a prevalent intestinal disorder, is often incurable. Dietary therapy has proven beneficial for some people with this persistent, fatiguing disease. See Sugar.


• Fat and Colitis

In a study of dietary factors associated with the risk of ulcerative colitis, researchers in Japan found that consumption of Western foods, including bread for breakfast, butter, margarine, cheese, meats, and ham/sausage, was related to the disease, while no appreciable association was found for consumption of Japanese foods, vegetables, and fruits.  The scientists concluded that margarine or chemically modified fat could play a causative role in the development of colitis.

Source: “A Case-Control Study of Ulcerative Colitis in Relation to Dietary and Other Factors in Japan,” Journal of Gastroenterology 30 Supplement 8:9-12, 1995.


Collard Greens

Collard greens, a traditional Native American, African-American, and Southern delicacy, are popular in the natural foods community and modern health-conscious society. Tender, sweet, and mild, the freshest varieties melt in the mouth. High in antioxidants as well as calcium and other minerals, collards are especially strengthening for the liver, gallbladder, heart, and small intestine. Like other green leafy vegetables, they help reduce the risk of cardiovascular disease, cancer, osteoporosis, and other disorders.


Colon Cancer 

Colon cancer is the second leading cause of cancer mortality in the United States, accounting for 56,000 deaths each year. Consumption of foods high in saturated fat and cholesterol increase the risk for this disease. Alcohol and smoking are associated with causing polyps, benign growths in the large intestine that may become malignant. Low intake of whole grains, high in fiber, and vegetables, especially those high in folate, are also linked to colon cancer. See Broccoli, Cabbage, Polyps, Water, Whole Grains, Women’s Health.


• Plant-Based Diet Protects Against Colorectal Cancer

In a review of prospective cohort studies and a metaanalysis, researchers at the University of Hannover in Germany reported that consumption of fruit, vegetables, and whole grains was associated with reduced risk for colon cancer, while intake of refined white flour products, sweets, milk and dairy products, eggs, and red meat enhanced the likelihood of the disease. “As primary prevention, a diet rich in vegetables, fruits, whole grain products, and legumes added by low-fat dairy products, fish, and poultry can be recommended,” they concluded. “In contrast the consumption of sweets, refined white flour products, and meat products should be reduced.”

Source: A. Strohle et al., “Nutrition and Colorectal Cancer,” Med Monatsschr Pharm 30(1):25-32, 2007.


• Meat Raises Risk of Colon Cancer

Women who eat beef, lamb, or pork as a daily main dish are at two and a half times the risk for developing colon cancer as women who eat meat less than once a month. The conclusion, drawn from a study of 88,751 nurses, over a ten-year period, found that the more fish and poultry in the diet the less chances of getting colon cancer. “The substitution of other protein sources, such as beans or lentils, for red meat might also be associated with a reduced risk of colon cancer in populations that consume more legumes,” researchers concluded. Investigators also found that eating the fiber from fruit appeared to reduce the risk of colon cancer. The fruits mentioned as possibly protective included apples and pears. “The less red meat the better,” recommended Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health, who directed the study. “At most, it should be eaten only occasionally. And it may be maximally effective not to eat red meat at all.”

Sources: Walter C. Willett et al., “Relation of Meat, Fat, and Fiber Intake to the Risk of Colon Cancer in a Prospective Study among Women,” New England Journal of Medicine 323:1664-72, 1990 and Anastasia Toufexis, “Red Alert on Red Meat,” Time, December 24, 1990.


• Whole Grains Protective Against Colon Cancer

In a population-based case-control study of over 4000 people in California, Utah, and Minnesota, cancer researchers reported that high whole grain intake was associated with up to 60 percent less risk for this disease, while intake of refined grains increased the risk one and a half to two times. Foods high in fiber, vitamin B-6, thiamine, and niacin were also protective.

Source: M. L. Slattery, “Plant Foods and Colon Cancer; An Assessment of Specific Foods and Their Related Nutrients,” Cancer Causes Control 8(4):575-90, 1997.


Complex Carbohydrates

Complex carbohydrates (polysaccharides), found in whole grains, beans, vegetables, and sea vegetables, enter the bloodstream gradually and contribute to overall health and balance. Because of their protective effect in the development of cardiovascular disease, cancer, and other serious disorders, scientific and medical guidelines all call for substantial increases in complex carbohydrates and corresponding decreases in intake of simple carbohydrates such as sugar, white flour, and white rice. See Paleolithic Diet, Premenstrual Syndrome, Whole Grains, World Health Organization.


• Energetic Difference Between Refined and Unprocessed Grains

In a review of whole grains and cardiovascular risk, a British scientist concluded that consuming grain in whole form was fundamentally different from ingesting processed food. “Wholegrain foods are rich sources of many nutrients and phytochemicals, including complex carbohydrates, dietary fibre, minerals, vitamins, antioxidants, and phytoestrogens such as lignans. Many of these components are lost from the grain during processing and although some may be replaced (such as the mandatory fortification of white flour), this practice ignores the possible synergistic effects of the ‘natural’ constituents.”

Source: C. J. Seal, “Whole Grains and CVD Risk,” Proc Nutri Soc 65(1):24-34, 2006.


• Complex Carbs Protect Against Disease

In a review of carbohydrates, dietary fiber, and disease, a researcher at the University Hospital Zurich, Switzerland concluded there is growing evidence of the high impact of complex carbohydrates, especially whole grains, on reducing the risk of atherosclerosis and other forms of cardiovascular disease, as well as diabetes, inflammation, endothelial function, and other symptoms and disorders. Conversely, “fast” carbohydrates, or those with a high glycemic index, may have a deleterious effect.  “The increase of glucose, fructose, or sucrose intake is directly and independently associated with an increased risk of atherosclerosis or coronary heart disease,” the researcher concluded.

Source: P. M. Suter, “Carbohydrates and Dietary Fiber,” Handb Exp Pharmacol 170:231-61, 2005.


• Whole Grains and Legumes Protect Against Diabetes

In a review of the role of whole grains and legumes in preventing and relieving diabetes, a researcher at the University of Otago in New Zealand reported that epidemiological and dietary intervention studies strongly support the protective effect of whole grains against the development of type II diabetes. While the role of legumes is less clear, “a substantial increase in dietary intake of legumes as replacement food for more rapidly digested carbohydrate might therefore be expected to improve glycaemic control and thus reduce incident diabetes.”

Source: B. J. Venn and J. I. Mann, “Cereal Grains, Legumes, and Diabetes,” European Journal of Clinical Nutrition 58(11):1443-61, 2004.


• Saturated Fat and Cholesterol

Comparing the blood values of middle-aged Irishmen living in Ireland, their brothers who had migrated to Boston, and unrelated men of Irish descent living in Boston, researchers at Harvard School of Public Health found that mean total blood cholesterol levels were strongly correlated with intake of saturated fatty acid and dietary cholesterol from meat and other animal food. Fiber intake and vegetable consumption were also lower among those who died from coronary heart disease, leading the researchers to speculate that a decrease in complex carbohydrates rather than a change in fat consumption was the main causative factor in increased mortality from heart disease.

     “Although the risk of coronary heart disease has been reported to be related to the intake of dietary lipids, an equally consistent finding has been the relation with starches and complex carbohydrates,” the scientists noted. “. . . The principal nutritional change that has occurred since the early 1900s has been a decrease in the consumption of dietary carbohydrates, not including sugar, of about 45 percent during the period from 1909 to 1976. In contrast, changes in the consumption of dietary lipids have been much smaller.”

Source: L. H. Kushi et al., “Diet and 20-Year Mortality from Coronary Heart Disease. The Ireland-Boston Diet-Heart Study,” New England Journal of Medicine 312:811-18, 1985.


• Complex Carbohydrates Stimulate Mental Development

At Massachusetts Institute of Technology (MIT), researchers have investigated the effects of food on the brain and nervous system. “It is becoming increasingly clear that brain chemistry and function can be influenced by a single meal. That is, in well-nourished individuals consuming normal amounts of food, short-term changes in food composition can rapidly affect brain function,” explained Dr. John Fernstrom. According to scientists, whole grains and other foods high in complex carbohydrates have the capacity to increase the brain’s intake of tryptophan, an amino acid that aids in relief of pain and in lowering blood pressure. Tryptophan has also been associated in studies with lifting depression and improving sleep. In contrast to grains and vegetables, meals high in animal protein lower levels of tryptophan reaching the brain. This “growing body of information now points to new clinically useful applications of tryptophan and thus also for the use of specific meals that would increase tryptophan levels,” Fernstrom concluded.

Source: Tom Monte, “A Nutritional Approach to Mental Health,” Michio Kushi et al., Crime and Diet (Tokyo & New York: Japan Publications, 1987), pp. 146-47.



Cooking, the primary art, is found in all cultures and cuisines. It is essential to digestion and helps the body assimilate and metabolize food more smoothly. Scientific studies are beginning to investigate the benefits and risks of different cooking methods.


• Obesity Linked to Cooking Practices

In a study of meal patterns and cooking practices in Central England and Mediterranean France, researchers at the WHO Nutrition Collaborating Centre found that the French cooked from fresh ingredients more often, ate together as a household more regularly, and were more likely to follow a regular meal pattern of three meals daily. In contrast, the English relied more on ready-prepared and take away meals, as well as on energy-dense snack foods. The researchers concluded that these differences may help account for the greater prevalence of obesity in Britain than in France.

Source: C. Pettinger et al., “Meal Patterns and Cooking Practices in Southern France and Central England,” Public Health Nutri 9(8):1020-6, 2006.


• Acrylamide in Fried and Baked Foods Damages DNA

Acrylamide, a compound found in some fried and baked foods, may damage DNA by causing a variety of mutations, according to scientists at the City of Hope National Medical Center in Duarte, Calif. The chemical appears to form from exposing high-carbohydrate foods to high temperatures. In laboratory studies, previous studies found that acrylamide can cause cancer.

Source: “Fried Food Ingredient Mutates DNA, Study Finds,” Reuters, June 17, 2003.


• Hospital Food Goes Natural

In a review of the nutritional quality of 80 hospital menus from 1986 to 2001, researchers in Australia reported that more than 90 percent of hospitals allowed patients to select their own menu, offered wholemeal breads and high-fiber breakfast cereals, fresh fruit, polyunsaturated margarine, and two or more hot options at the midday meal. In contrast to cook-fresh food services, hospital food services that used cook-chill processes had menus with a higher proportion of unhealthy meat dishes and desserts.

Source: A. McClelland and P. Williams, “Trend to Better Nutrition on Australian Hospital Menus 1986-2001 and the Impact of Cook-Chill Food Service Systems,” Journal Hum Nutri Diet 16(4):245-56, 2003.


• Light Cooking Reduces Harmful Acids in Raw Vegetables

In a study on the effect of lightly cooking green leafy vegetables, researchers in Tanzania reported that blanching significantly reduced the level of phytic and tannic acid in collard, cabbage, turnip, sweet potato, and peanut greens. “In general, blanching is recommended as an effective method for reducing the antinutritional factors in green vegetables,” the scientists concluded.

Source: T. C. Mosha, “Effect of Blanching on the Content of Antinutritional Factors in Selected Vegetables,” Plant Foods and Human Nutrition 47(4):361-67, 1995.



Native to Central and South America, corn (or maize) is enjoyed eaten on the cob, ground into whole corn dough (masa), or made into grits, flour, or oil. Corn provides light, expansive energy and is especially strengthening for the heart and small intestine.


• Corn and Other Plant Foods Protect Against Atherosclerosis

In a randomized case control study, laboratory animals given a diet rich in corn, dried peas, green beans, broccoli, and carrots exhibited less total cholesterol, less VLDL and ILDL choleserol, less body weight, and less serum amyloid than mice given a plant-free diet. “A diet rich in green and yellow vegetables inhibits the development of atherosclerosis and may therefore lead to a reduction in the risk of coronary heart disease,” researchers at the Bell Institute of Health and Nutrition, General Mills Co., in Minneapolis concluded.

Source: M. R. Adams et al., “A Diet Rick in Green and Yellow Vegetables Inhibits Atherosclerosis in Mice,” Journal of Nutrition 136(7):1886-9, 2006.


• Corn Has Highest Antioxidant Activity of Any Grain

In a review of the health benefits of whole grains, researchers at the Department of Food Science, Cornell University, reported that corn had the highest total antioxidant activity of all grains (181 micromol of vitamin C equiv/g of grain), followed by wheat (77, oats 75, and rice 56). It also had the highest total phenolic content, a phytochemical associated with protection against chronic diseases. The researchers theorized that corn’s high amount of bound phytochemicals could survive stomach and intestinal digestion to reach the colon. “This may partly explain the mechanism of grain consumption in the prevention of colon cancer, other digestive cancers, breast cancer, and prostate cancer,” the scientists concluded.

Source: K. K. Adom and R. H. Liu, “Antioxidant Activity of Grains,” Journal Agri Food Chem 50(21):6182-7, 2002.


• Corn Protects Against Colorectal Cancer

In a case-control study on the risk of colorectal cancer, researchers at the University of Hawaii Cancer Research Center reported that consumption of corn, as well as other plant-quality foods, reduced risk for this disease independent of its fiber content, which is also a protective factor.

Source: L. Le Marchand et al., “Dietary Fiber and Colorectal Cancer Risk,” Epidemiology 8(6):658-65, 1997.


Cornaro, Luigi

In 1558 Luigi Cornaro, a Venetian-born architect and counselor, wrote The Art of Living Long, a memoir on health and diet describing how he suffered from a terminal stomach disorder in middle-age which he overcame by adopting a grain-based diet and avoiding certain kinds of animal food, raw salads, fruit, pastries, and sweets. Stating that we cannot partake of a “more natural food” than plain dark bread, Cornaro lived to age 102, and his book became one of the most influential books on health and diet during the Renaissance.

Source: Luigi Cornaro, The Art of Living Long (Milwaukee: William F. Butler, 1935). 

Crime and Diet

In Erewhon, Samuel Butler’s satirical 19th century novel, criminals are sent to the hospital and treated with proper diet, while the sick are put in jail because they have violated the laws of nature and health. The wisdom of treating crime and anti-social behavior as an illness has been increasingly demonstrated in macrobiotic and natural foods prison projects and in nutritional studies and research. The U.S. federal prison system now serves vegetarian entrees at every meal, and correctional systems around the world are making healthier food available.


• Nutritional Change Reduces Violence by 40%

In a double blind placebo controlled trial, Oxford University researchers reported that the number of violent incidents at Aylesbury young offenders’ institution dropped up to 40 percent when the inmates were given multivitamins, minerals, and essential fatty acids. Better nutrition would have a “huge impact” on prison life, Lord Ramsbotham, the former chief inspector of prisons in Britain, stated. “If the correct mix of diet reduces offending behaviour—and I am absolutely conviced there is a direct link between diet and antisocial behaviour—it’s hugely important for prisoners, it frees up staff time for rehabilitation.” The government is committed to offering all prisoners a healthy diet, including one low-fat, low-sugar option on every menu.

Source: Felicity Lawrence, “Delayed: The Food Study That Could Cut Prison Violence by ‘Up to 40%’”, The Guardian, London, October 17, 2006.


• Sugar and Theft

In a double-blind study, Doris J. Rapp, M.D. reported that four young persons with a history of stealing stopped altogether after being place on a restricted diet. However, when the therapy was discontinued and the former diet high in sugar and other refined carbohydrates was resumed, stealing resumed.

Source: Doris J. Rapp, M.D., “Food Allergy Treatment for Hyperkinesis,” Journal of Learning Disabilities 12(9):42-50, 1979.


• Sugar Linked to Violent Behavior

Frank Kern, assistant director at Tidewater Detention Center in Chesapeake, Virginia, a state facility for juvenile offenders, decided to initiate some dietary reforms in a macrobiotic direction. In 1979 he arranged an experiment in which sugar was taken out of the meals and snacks of 24 inmates. The boys, aged 12 to 18, were jailed for offenses that ranged from disorderly conduct, larceny, and burglary to alcohol and narcotics violations. Coke machines were removed from the premises and fruit juice substituted in vending machines for soft drinks, while honey and other milder sweeteners were substituted for refined sugar. The three-month trial was designed as a double-blind case-control study so that neither the detention center personnel nor the inmates knew that they were being tested. At the end of the trial period, the regular staff records on inmates’ behavior were checked against a control group of 34 youngsters who had been institutionalized previously. Researchers found that the youngsters on the modified diet exhibited a 45 percent lower incidence of formal disciplinary actions and antisocial behavior than the control group.

     Follow-up studies over the next year showed that after limiting sugar there was an 82 percent reduction in assaults, 77 percent reduction in thefts, 65 percent reduction in horseplay, and 55 percent reduction in refusal to obey orders. The researchers also found that “the people most likely to show improvement were those who had committed violent acts on the outside.”

Source:  S. Schoenthaler, Ph.D., “The Effect of Sugar on the Treatment and Control of Antisocial Behavior,” International Journal of Biosocial Research 3(1):1-9, 1982.


• Macrobiotics in a Portuguese Maximum-Security Prison    

In 1979 several inmates at the Central Prison in Linho outside of Lisbon, Portugal, began eating macrobiotically and attending lectures on Oriental philosophy and medicine. Soon 30 prisoners had become macrobiotic, and prison officials allowed them to use a large kitchen where they cooked and ate together several times a week. Linho, a maximum security institution, housed Portugal’s most dangerous criminals, including José Joaquim (known as “Al Capone”), a celebrated safecracker, and Antonio (To Zé) José Aréal, mastermind of a gang of armed robbers and kidnappers that had been the object of a nation-wide manhunt. As a result of attitude and behavioral changes, To Zé and most of the other prisoners attending classes received commutations and were released early.

       “[T]here is a great difference in them, especially in those who have left the prison,” Senhor Alfonso, a prison administrator, noted, commenting on the macrobiotic group. “It is not easy to describe—for one thing I can say that now they take more initiative. Actually, there is no problem here with anyone who is macrobiotic; this way of life enjoys a very good reputation. I believe the food and the outside stimulus both helped. The food can change people.” To Zé went on to study at the Kushi Institute in Boston and taught macrobiotics in New Bedford, site of a large Portuguese-speaking population, before returning to teach and help other prisoners in Portugal.

Source: Meg Seaker, “Fighting Crime with Diet: Report from a Portuguese Prison,” East West Journal, July, 1982, pp. 26-34.    


• Diet Reduces Recidivism

A Cleveland probation official reported a low rate of recidivism among youthful offenders given nutritionally balanced meals. Barbara Reed of the Cuyahoga Falls Municipal Probation Department reported that of 318 offenders, 252 required attention to their diet, and “we have not had one single person back in court for trouble who has maintained and stayed on the nutritional diet.” Later, Reed reported that more than a thousand ex-offenders had completed her dietary program, and of those who remained on the diet, 89 percent had not been rearrested over the past five years.

Sources: Barbara Reed, statement before the Select Committee on Nutrition and Human Needs of the U.S. Senate, June 22, 1977 and in Michio Kushi et al., Crime and Diet (Tokyo and New York: Japan Publications, 1987), p. 149.


• Milk Consumption Linked to  Juvenile Delinquency

High milk consumption was connected with juvenile delinquency in a study by criminologists. Researchers at the University of Washington monitored the die-tary intake of 30 chronic youthful offenders and compared them to a group of behaviorally disordered children from the local school district in Tacoma, Wash. They found that the male offenders consumed an average of 64 ounces of milk a day, while the control group rank an average of 30 ounces. For girls, the figures were 35 and 17 ounces respectively. “In some situations,” they concluded, “eliminating milk from the diet can result in dramatic improvements in behavior, especially in hyperactive children.” They cited other studies showing that up to 90 percent of offenders had a history of milk intolerance or allergy.

Source: Alexander Schauss, Diet, Crime, and Delinquency (Berkeley, Calif.: Parker House, 1981), pp. 13-14.


Crohn’s Disease

Crohn’s disease, a chronic inflammation of the intestinal wall, occurs in both sexes, especially among younger people aged 14 to 24. Medically, Crohn’s disease is considered an irreversible, often fatal disorder that can be treated only by recurrent surgery to remove sections of the small intestine. See Chocolate.


• Case History

Virginia Harper completely recovered from Crohn’s disease and Takayasu Arteritis after adopting a macrobiotic way of eating. She now teaches and cooks in Tennessee.

Source: Gale Jack and Wendy Esko, Editors, Women’s Health Guide (Becket, MA: One Peaceful World Press, 1997).


• High-Fat, High-Sugar Diet Associated with Crohn’s Disease

People with Crohn’s disease eat more sugar and sweets than normal and increased amounts of dietary fat. In a review of nutritional factors associated with this disease, a researcher found that a diet that limits dairy products, yeast, and refined cereals contributed to prolonged remission in some studies.

Source: J. O. Hunter, “Nutritional Factors in Inflammatory Bowel Disease,” European Journal of Gastroenterology and Hepatology 10(3):235-37, 1998.


Cropland Loss

The area of grain land supporting each person on the planet has fallen to less than one sixth the size of a soccer field, according to Shrinking Fields, a study by the Worldwatch Institute. In the U.S., net losses of cropland between 1982 and 1992 covered an area the size of New Jersey. In China during the same period, at least 5 percent of the nation's cropland was lost to urban expansion and industrialization. Large expanses of Kazakhstan and Iran are also exhausted. Main causes of shrinking cropland are urbanization, depletion or diversion of irrigation water, and degradation of agricultural lands, especially from severe erosion and salination. The shift to nonfood crops such as cotton, coffee, tobacco, corn for ethanol, and commodity crops for the affluent global market, were also cited as contributing factors. "If policymakers do not see cropland as a key strategic resource—no less important than oil reserves or armed forces—then they will not take steps to halt these losses or protect the quality of remaining farmland," the report concluded.

Source: Gary Gardner, Shrinking Fields (Washington, D.C.: Worldwatch Institute, 1996)


Cruciferous Plants

The Brassica or cruciferae family of plants has “crosslike” formations on its buds and includes broccoli, cauliflower, brussels sprouts, cabbage, bok choy, kale, kohlrabi, turnips, collards, mustard greens, and rutabaga. High in antioxidant (such as vitamins A and C), calcium, and dietary fiber, the cruciferous plants also include phytochemicals that are protective against cancer and other serious disease. See Broccoli, Cauliflower, Collards, Kale, Vegetables.


• Brassica Veggies Protect Against Breast Cancer

In a study of 34 healthy postmenopausal women, researchers at the University of Massachusetts Medical Center in Worchester reported that for each 10 gram a day increase in consumption of Brassica vegetables, there was a significant shift in estrogen metabolism protective against the development of breast cancer. “Future research should consider Brassica vegetable consumption as a potentially effective and acceptable dietary stgrategy to prevent breast cancer,” the scientists concluded.

Source: J. H. Fowke et al., “Brassica Vegetable Consumption Shifts Estrogen Metabolism in Healthy Postmenopausal Women,” Cancer Epidemiol Biomarkers Prev 9(8):773-9, 2000.

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