‘High-Fat’ Diets: Of Mice and Men

Take a look at these headlines from reports of a study that recently made a splash in the media.

From Science Daily:

Eating a High-Fat Diet May Rapidly Injure Brain Cells That Control Body Weight

From the Sydney Morning Herald:

Fat affects brain’s ability to control weight: study

From Stuff (New Zealand):

Fatty foods may damage brain

Pretty scary, huh?  There you are, trying to lose weight on a low-carb/ high-fat diet, and now media headlines are warning that you may be damaging the part of your brain that controls weight.  Two of the articles were also accompanied by photos to represent the brain-damaging high-fat diets.  Here they are:

A cheeseburger, fish and chips.  Just keep those images in mind.

If you actually read the articles, you’ll quickly discover that the subjects of the study were mice and rats, not humans:

Thaler and his colleagues studied the brains of rodents for the short-term and long-term effects of eating a high-fat diet. After giving groups of six to 10 rats and mice a high-fat diet for periods from one day to eight months, the researchers performed detailed biochemical, imaging and cell sorting analyses on the animals’ brains.

If you keep reading, you’ll also discover that the brain-banging diet wasn’t exactly what you or I would consider high-fat:

Researchers studied rats and mice fed a high-fat diet – that is, one with a similar fat content to the average American diet – for periods varying between one day and eight months

Within the first three days of consuming a diet that had a similar fat content to the typical American diet, rats consumed nearly double their usual daily amount of calories, Thaler reported. Rats and mice fed the high-fat diet gained weight throughout the study. These rodents developed inflammation in the hypothalamus, the part of the brain containing neurons that control body weight.

So “high fat” in this case means “similar fat content to the typical American diet.”  That would put it somewhere around 40%, which also happens to be around the same percentage of fat in many traditional diets around the world — diets that somehow failed to induce obesity or brain damage among the populations consuming them.

When readers began sending me links to articles about this study, I remembered that somewhere in my folders of downloads and bookmarks, I had a PDF document listing the ingredients in the “typical American diet” fed to laboratory rodents.  Took some time, but I located it.  The lab-animal diets are produced by TestDiet.com.  This description is from their own literature:

Western Diet For Rodents

A “Western” diet for rodents based on AIN-93G, providing 30% of fat from lard, 30% from butterfat, 30% from Crisco (hydrogenated vegetable oil), and for EFA, 7% from soybean oil and 3% from corn oil.  Approximate energy from fat 40%, carbohydrate 44%, protein 16%.

That’s not a high-fat diet by my standards — I probably get 60% of my calories from fat– but it’s certainly a high horrible-fat diet.  Of the fat calories, 40% come from hydrogenated oil, corn oil, and soybean oil.  In other words, oils that wouldn’t exist without the wonders of industrial extraction.  That may indeed represent the fat content of a typical American diet, but it sure doesn’t represent anything close to what typical low-carbers or paleo dieters would consume.  Nor does it represent the fat content of a cheeseburger.  (I don’t know about the fish and chips in Australia.  One of you down-under types can fill me in.)

The protein in this “typical American diet” comes almost entirely from casein.  That’s the isolated dairy protein T. Colin Campbell fed to rats to induce cancer, which inspired him to take an extreme leap in logic and declare that animal proteins (all of them, mind you) are bad for human health.  Rats, of course, don’t naturally consume dairy products … and they certainly don’t isolate one dairy protein and eat it.  They’re too lazy.

The carbohydrate in the lab-rat diet is nearly all corn starch, with the remainder consisting of sugar.  Other than that poor soul featured on Freaky Eaters who’s addicted to corn starch, I don’t believe this in any way represents a typical American diet.

So the headlines warn us a “high-fat diet” injures the brain cells that control weight.  In reality, it’s a diet in which nearly half of the calories come from sugar or corn starch, the protein is nearly all a single isolated dairy protein already known to cause cancer in rats, and 40% of the fat is industrial-grade vegetable sludge, most of it hydrogenated.

Sounds just like a cheeseburger, doesn’t it?

p.s. — I looked up the ingredients for the “Atkins diet” the company produces for rodent experiments as well.  The breakdown on the fats is the same:  30% lard, 30% butterfat, 30% Crisco, 7% soybean oil, 3% corn oil.  The protein is nearly all casein, all the carbohydrate is nearly all corn starch.  Same junk, different proportions.


68 thoughts on “‘High-Fat’ Diets: Of Mice and Men

  1. Ricardo

    I found this interesting section of a article i was reading on Wikipedia for anyone interested. Basically saying fat is not linked to disease i guess. I wouldn’t suggest anyone go eat sausages and bacon though…

    A few studies have suggested that total dietary fat intake is linked to an increased risk of obesity[80][81] and diabetes.[82][83] However, a number of very large studies, including the Women’s Health Initiative Dietary Modification Trial, an eight year study of 49,000 women, the Nurses’ Health Study and the Health Professionals Follow-up Study, revealed no such links.[84][85][86] None of these studies suggested any connection between percentage of calories from fat and risk of cancer, heart disease or weight gain. The Nutrition Source, a website maintained by the Department of Nutrition at the Harvard School of Public Health, summarizes the current evidence on the impact of dietary fat: “Detailed research—much of it done at Harvard—shows that the total amount of fat in the diet isn’t really linked with weight or disease.”[87]

    I would definitely tell people to go eat bacon and sausage.

  2. Beowulf

    So what these experiments really show us is that when an animal eats a diet they didn’t evolve to consume, there are detrimental effects. Thank you science, I’ll go enjoy my steak now.

    Exactly, and the same principle applies to humans. We weren’t meant to consume grains and canola oil.

  3. Levi

    Campbell’s casein study is even more dubious than you surmise. He fed isolated casein to rats in conjunction with aflatoxin, a known carcinogen produced by fungi that contaminate plant products (!). What he discovered was that if you added casein to the diet of rats already poisoned with a cancer causing agent instances of cancer increased further. In other words, isolated casein may bind with aflatoxin to increase it’s already carcinogenic effects. Therefore all meat causes cancer, obviously.

    He never mentions the fact that whey (also found in milk) has been shown to have a protective effect against cancer. This has been shown in isolation, not combined with, oh, I don’t know, let’s say chemotherapy.

    A case of proving what he wanted to prove.

  4. Quinlan

    Sometimes I have to wonder if when researchers/journalists say “fatty foods” when what they really mean is “Foods that fatties eat” aka the SAD. 😀

    They think anything over the government-recommended 30% makes for a high-fat diet.

  5. Keoni Galt

    Another great expose of the media misinformation juggernaut and the role it plays in getting people to believe lies about nutrition and health.

    If anything, studies like this show that a diet high in MAN-MADE Fats can be quite dangerous to human health.

    Indeed. The higher the fat content, the more Crisco. No wonder mice and rats have so many ailments on that diet.

  6. Princess Dieter

    The entrenchment of bias is amazing. How can educated, intelligent folks not even have the sense to look at these things more comprehensively? I mean, it’s enough to make one a conspiracy theorist….except that the ability of humans to be incredible doofuses keeps me from roaming into tin-foil hat territory….Geesh.

    I bang my head on my desk to keep from wearing a tin hat.

  7. gallier2

    A propos the casein effect of Colon Campbell you should read the latest post of Peter Dobromylskyj, hilarious.


    They used isolated casein to prevent cancer and it worked, ha ha.

    To remember, Chris Masterjohn deconstructed Campbell’s rat studies last year, casein is not carcinogenic, aflatoxin is. The Campbell studies are fraudulent, he induced cancer in rodents with aflatoxin, his control were undernourished (deficient in proteins) and the one that got casein had twice as much protein as the control, allowing the cancer to thrive (because cancer cell need protein too to grow).
    The cancer free rats died of malnutrition before their cancer go them.

  8. Greg

    This is probably how it went, but we don’t really know that this particular study was done with the ingredients mentioned by that specific company from the PDF, it sounds like…I would hope that buried in the study somewhere is what they actually fed the rats.

    From what I’ve read, most of the lab-animal experiments use pre-formulated lab chow.

  9. xtrocious

    Most people are like sheep, or rather, they rather be like sheep, with the government (or anyone in authority) telling them what to eat, what to do and basically leave the “heavy” thinking to others…

    And when things do inevitably go wrong, they also have a nice big fat target (pun intended) i.e. someone else to blame but themselves…

  10. Be

    I’m very glad to see you getting some advertising support and hope you make a killing but I am amused with the Jillian Michaels ad. I’ll pass on her plan and keep reading you instead. Thanks for breaking down another set of flawed conclusions.

    We have those spots reserved for whatever Google decides to put there. They make some strange choices.

  11. David

    Hi Tom, “Down-under-type” here…we generally don’t have a lot of soybean or corn oil down here. We don’t grow a lot of either so they are not big in our food supply (unless in imported products). Hydrogenated oils aren’t popular here either, at least now – while they haven’t been legally outlawed as far as i know, they have been phased out in favor of other oils.

    Our oils-of-death “du jour” tend to be canola and cottonseed oils. In my state you can drive in the country and see miles and miles of golden little flowers patch-worked together with miles and miles of wheat…

    So anything deep fried (like fish & chips) are generally cooked in canola or cottonseed oils. What really irks me, is that I occasionally see cooking oil recycling trucks driving around. They have signs emblazoned on their sides claiming to “refresh your cooking oil and cut costs”. Geez! Let’s just make a unhealthy “food” even deadlier!

    Ugh … recycled canola oil. I think I just lost my appetite.

  12. Nina

    During a recent mouse infestation I noticed the mice avoided normal carbs and sugars but prised open a box of Splenda and dug in.

    They’re probably dieting.

  13. Drew @ Willpower Is For Fat People

    Oh come on, Tom, you’re being unreasonable and you know it. Doing a legitimate controlled study of humans, comparing the effects of various whole foods in different proportions, would be really, really hard. They have to simplify things a little so they can get publishable results within one day to eight months.

    Wait … was that one day to eight months? Are they freaking kidding? So it’s not humans, it’s not a remotely realistic diet, it’s not actually high fat, and it’s not long-term. But I’m supposed to believe it proves anything about me and what I eat. Okay, got it. I’ll just turn off my brain and listen to the people in the white coats.

    These are very useful studies. After reading this one, I stopped frying corn starch in Crisco for breakfast.

  14. Ricardo

    I dont know i think its misleading to say sausages and bacon and red meat are a health food. Especially for people with heart troubles… Dr. Barry Sears says we should replace saturated fat with omega 3 and monounsaturated fat. Because saturated fat can cause cellular inflammation and can induce insulin resistance and while Monounsaturated fats and Omega 3s lead to higher insulin sensitivity.

    Lots of people say we should avoid saturated fats. The only problem is that the evidence doesn’t back them up.

  15. Amy Dungan

    For the love of pete, crisco? And that diet, while high in man-made fats, was also still high in carbohydrates (44%). Excuse me while I go get my helmet…

    My helmet’s developing cracks. Time for a new one.

  16. Milton

    I suppose the irony is that misleading articles like that one will encourage people to eat even less natural fat and more vegetable oil, which will probably do more damage to their brains and nervous system (including an elevated risk for diseases like Alzheimer’s and possibly Parkinson’s) than a diet rich in natural fats.

    Good thing you eat a diet rich in the nutrients that your brain needs, Tom. Otherwise you’d be in pretty rough shape from banging your head against the desk.

    It’s the bacon and steaks that are saving me, no doubt.

  17. Elizabeth

    The same thing happened with infant formula. Man thought they could make something better than what nature already had. My grandmother was told NOT to nurse her babies because it was “barbaric”. Interesting though now that they are finally saying nursing is best for baby. Too bad there has already been a huge amount of damage done. (BTW I am NOT bashing formula users as I used it myself and I know many mothers need it. BUT if I had it to do over again…)

    Barbaric?! Oh my … my wife is a savage.

  18. Lori

    As Chris Masterjohn has pointed out, the rat diet you mention is also pretty much void of micronutrients.

    If I remember right, this is how some “studies” showing the benefits of various wonder foods come about: one group of rodents is fed the low-nutrient diet, another group is fed the low-nutrient diet plus something with nutrients in it and does better.

    Another case of designing a study to produce the results you want.

  19. Nowhereman

    “For the love of pete, crisco? And that diet, while high in man-made fats, was also still high in carbohydrates (44%). Excuse me while I go get my helmet…”

    “My helmet’s developing cracks. Time for a new one.”

    Heh. Maybe you two should invest in a desk with a built-in air bag and sensor system for times like this. 😀

  20. Chris Wiz

    They should call this what it really is – and industrialized processed food diet. Which I think we would agree IS immensely unhealthy.

    Is there a single item of natural, whole food on the list that represents what a mouse actually would prefer to eat?

    The lard and butter are natural, but I doubt mice living outside a lab consume much of either.

  21. Ricardo

    So if i person said they were just gonna eat Monounsaturated and Omega 3 and Polyunsaturated and mostly vegetables with little to no saturated fat would that be a bad thing?

    I don’t believe that would be ideal. Saturated fat is an important nutrient, and too many polyunsaturated fats (depending on the source) can cause inflammation.

  22. Erica

    Geez! The low-fat people are REALLY clinging to their paradigm, aren’t they? It’s time to get with the truth that saturated fats are our friends. Over on your fb page, we’re discussing Meaty Mondays, T-bone Tuesdays, & Fat Fridays to combat the Meatless Mondays people.

    Here in Ireland, many people look at me like I have 2 heads when I say I’m not eating any grains (no bread, no cakes, no ‘biscuits’) and eat butter as a snack. The local butcher, however, grins from ear to ear when I ask for the fatty pork chops and the free pork fat so I can make my own lard and cracklin’s. (Of course, he’s terribly overweight, probably from all the bread, cakes, and biscuits he eats with his protein and fat).

    Excellent. Don’t forget the Sausage Sundays.

  23. Brad C. Hodson

    Completely off topic, but I read the passage below earlier and thought it was yet another nail in the coffin for the “calories in – calories out” theory. As a preface HIIT is high-intensity interval training (say doing four to six 30 sec sprints and resting for 2 minutes in between rather than jogging for half an hour). Most researchers believe the results from HIIT come from its effect on the body’s hormones (testosterone, growth hormone, and insulin) – much like a high fat diet. Hmmm…. Anyway, passage below – note how many more calories the people who lost less weight shed.

    “One of the first studies to discover that HIIT was more effective for fat loss was done in 1994 study by researchers at Laval University (Ste-Foy, Quebec, Canada). They reported that young men and women who followed a 15-week HIIT program lost significantly more body fat than those following a 20-week continuous steady-state endurance program. This, despite the fact that the steady-state program burned about 15,000 calories more than the HIIT program.”

    Bingo. It’s about the hormones.

  24. Andy

    Tom, if you started each day with a juicy steak attached to your forehead, it would save you some pain when you smack your head on the desk. As a bonus, it would tenderize the steak.

    I love it. It’s very efficient.

  25. gallier2

    The cancer free rats died of malnutrition before their cancer go them.

    “The casein free rats” I meant

  26. Mike

    Tom, if you keep blogging this way you should invest in an inflatable desk, so banging your head becomes enjoyable [considering how often it happens] 🙂

    Maybe just move your desk into one of those inflatable jump-houses…

    I’ll have to look into one of those.

  27. SallyMyles

    My Great Aunt used to own a fabulous fish and chip shop. Her batter was legendary and all foods were cooked in lard or tallow, you knew this because the grease on the plate would solidify if left… nowadays she is long gone and our local fish and chip shop clearly use some kind of vegetable oil as it never ‘sets’ at room temperature. There are no shops in my area that use lard or tallow, more’s the pity. I’ve ditched all veg oils apart from olive, I use coconut oil and I save the fat from roasting a chicken, I believe Jewish people call it schmaltz. It sits in a ramekin in the fridge and seems to keep remarkably well without going rancid. Waste not, want not, I think.
    Oh and in the UK, some people buy the leftover oil from chippies to use in their cars instead of diesel as diesel is so expensive. Everyone’s a winner as the chippies don’t have to pay to dispose of their frankenfat.

    I stopped enjoying foods like fish and chips many years ago and assumed it was just my taste buds growing up. Now I believe it may have been that restaurants switching to vegetable oils.

  28. Stacie

    Low HDL is a risk factor for heart disease. I think it really is a health marker. The thing that raises HDL is the thing that is healthy, not necessarily HDL itself. The only thing that raises HDL( besides Niaspan, torcetrapib,etc) is saturated fat. So, it is the saturated fat that is healthy. Chemically raising HDL causes heart attacks and death, so I say “go for the saturated fat.”

  29. Isabel

    Can you find us some data on high-carb/fructose and it’s relationship to liver disease?


    I think people hear “fatty liver” and think it is cause by high fat diets, when it really isn’t…




  30. Kati

    I think it’s super amusing that researchers equate mice with people, time and time again, especially in relation to nutrition. I’m no PETA advocate, but can’t they just stop torturing the poor little mice (and maybe just eat them instead)? I bet they could study the effects of eating mice amongst themselves and come up with better conclusions for publication that applies to humans than this…although that is pretty gross!

    I don’t see the point of a study like this one. We’re not mice, and our “typical American diet” isn’t anything like the lab diet.

  31. Katy

    Anecdotal story: I knew a family back in the ’80s (two adults, four kids) who consumed two cans of Crisco every two weeks. One can was the plain variety for general frying, and other can was the butter flavor for baking cookies, popping corns, etc. Need I say that the mother was morbidly obese, the children nearly so, and the father was merely overweight (only in his abdomen). They ate a lot of sugar with their Crisco, and within a year of my acquaintance, the mother had to have an angioplasty. She eventually had gastric bypass surgery, as did two of the kids. I often wonder if any of them are still alive.

    Egads. That’s a lot of hydrogenated sludge.

  32. Firebird

    My doctor is having me do a third blood panel next week because my creatinine levels are high and says my kidneys are operating at 40%. They’re telling me to reduce my protein intake to less than 40 gms. and are blaming the kidney function on high protein intake. I take in 130 gms/day. They say that is too high. I refuse to become a vegetarian. What is the trade off? Go high carb, low protein and become obese and develop heart disease and diabetes?

    Kidneys leak protein if they’re not functioning well, but it’s not the protein doing the damage. That’s like blaming water for causing your leaky pipes.





  33. Mike

    The best thing is the blood sugar monitor. When I got diagnosed with diabetes I got all sorts of crazy advice from the special diabetes counselor that didn’t make sense to me. So with the blood sugar monitor I can basically self experiment and figure out what foods destroy my blood sugar. If I eat three scrambled eggs and some sausage for breakfast my blood sugar is usually around 92 about 2 hours after. If I eat my favorite recipe spinach lasagna my blood sugar is upwards of 156. Potatoes or rice will blast me up to 220. From your movie and also some of the books it is clear to me that blood sugar (and the insulin response behind it) are the key to overall health. These rat/mice studies are useless and poorly done.

    That’s exactly what I advise people to do (which means I’m repeating what Dr. Davis tells people to do). Get a meter and check your own reactions.

  34. Peggy Cihocki

    @Isabel, “Can you find us some data on high-carb/fructose and it’s relationship to liver disease?”
    Add to your list the You Tube lecture by Dr. Robert Lustig: http://www.youtube.com/watch?v=dBnniua6-oM and
    Gary Taubes’ article in the New York Times: http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?_r=1&ref=magazine.
    Also, there are one or more additional lectures in Tom’s archives here–don’t remember which year or month, but if you search you will find. There is indeed a lot of biochemical evidence that fructose consumed in a form and quantity other than nature intended causes nonalcoholic fatty liver disease, among other things. There is both a strong association and a biochemical mechanism.

    You probably mean this one: http://www.fathead-movie.com/index.php/2010/05/27/another-lecture-on-fructose/

  35. Peggy Cihocki

    Thanks, Tom, for another great post. My first thought was the conclusions they drew from this silly study wouldn’t even pass the first step of Anastasia’s Framework of Common Sense!

    I’m pretty sure Anastasia would rip that study apart.

  36. Underground

    I was going to make an omelette the other night although it turned into scrambled eggs. Along with that I fried some bacon, then cut some strips of tip steak to cook in the bacon grease with some onion. Add a little salsa, it was delicious. The steak was very tender.

    And I felt great afterward. In the past I would sometimes have heartburn or other symptoms after a naturally greasy meal and attributed it to the grease. (Although to be fair it was often manufactured grease) But when I leave out the carbs, funny thing, no problems at all.

    For me at least, greasy food combined with carbs seems to produce a worse reaction than either alone.

  37. emi11n

    This is what I love about journalists(I use the term dubiously)trying to report on science. They display an amazing talent for turning shaky studies into paranoia-inducing headlines. Never mind that there was nothing in the study that can actually be applied to humans. Ihave trouble believing that rats have exactly the same nutritional needs as we do, or can be assumed to respond to foods the same way. Maybe when they do a study feeding humans rodent chow we could get some real data! And pretty much everyone that keeps/raises rodents for commercial or research use will use rodent chow. It’s the cheapest option and requires no intelligence to use, as well as relatively uniform contents so you know your test animals are all getting the same thing. With “real” foods the animals could pick and choose what they wanted to eat, which would make it impossible to compare groups according to diet. God for the rats, not so good for results. Now I haven’t studied the nutritional needs of rats, but I would think they would have a higher tolerance for grains than we do… wild grains are often part of wild rodents’ diets.

    It’s just the nature of the beast. Dramatic headlines sell news stories.

  38. Ricardo

    What about Omega 3 Polyunsaturated fat from Salmon? Surely that is good and proboly better than eating red meat.

    Omega 3, yes. Most vegetable oils are very high in Omega 6, which we don’t want. As for red meat, it depends on the source. Unfortunately, meat from animals forced to live on grains is low in Omega 3. However, if you buy meat from animals raised in pastures, the Omega 3 content is very high, nearly as high as in salmon.

  39. Alexandra

    Gosh Erica, I hadn’t thought of cracklins in years..any tips on cooking them..is it a pork roast with fat and skin on that is used?

    Question to all…I eat a few globs of Hellman’s mayo each week, which is made with soybean oil… it is the only frankenfat in my diet. Is there a better choice that tastes as good?… can’t have tuna without mayo.

  40. Miriam

    “The lard and butter are natural, but I doubt mice living outside a lab consume much of either.”

    I dunno, the mice that invade my house periodically seem to like butter. They also like bacon grease.

    I guess they know the good stuff when they see it. But mice in nature probably don’t have access to butter.

  41. Pat

    Poor mice. Would someone please give them some crickets? Mice love cricket snacks (and other insects, very nutritious).

  42. Ricardo

    Hi Tom. I don’t want to pr-evoke anyone but this guy seems to say a lot of logical things about Animal Products.

    Yes, the plaque in our arteries is largely made of saturated fat and cholesterol. That doesn’t mean eating those foods is what causes the plaque in our arteries. Clinical research shows that if you eat fewer refined carbohydrates and more fats instead, the level of fats circulating in your blood goes down, not up. If you want to fatten up cows or pigs, you don’t feed them bacon; you feed them corn. If you want to give a goose a fatty liver for foi gras, you feed it corn. Get away from grains and consume more animal foods, and your cholesterol level will probably drop and your LDL pattern will shift from small and dense (the kind that gets into your arteries) to large and fluffy (the kind that doesn’t). From the beginning, doctors took a flawed leap in logic: if plaques are made of fat, eating fat must cause them. That simply isn’t true.

  43. Katarina Wikholm

    About nursing and infant formula: I have my grandmother’s cookbook printed in 1937. It firmly states that nursing is best and the most natural for babies, but IF you absolutely COULDN’T nurse, they provided you with a recipe for a butter-cream-&-milk-based substitute.
    I suspect that old recipe might be better than a vegetable-based store-bought formula, at least occasionally.
    And, yes, I’m a fellow mother-of-three savage…

    I could see the savage instincts in your eyes when we met.

  44. Erica

    Alexandra, I just got some pork fat from the butcher, very little meat at all. Cut it into 1/2″ pieces, then put in a heavy pan with a little water (this gets it melting without burning, and the water evaporates). Cook on low for as long as it takes to melt the fat out.

    After I have a good bit of fat, I pour off most, and continue cooking and melting. Then I pour off most again, and let the cracklin’s continue to cook to as crisp as I can get them without burning. Then I put the cracklin’s on paper towels to drain because I want them to stay crisp (they don’t). Add some good sea salt, and start munching!

    Two wonderful products for very little outlay of money, if any. Fresh lard and cracklin’s.

  45. Lori

    Alexandra: you can make your own mayo with extra light olive oil in a blender.

    Underground: in susceptible people, it’s carbs that cause acid reflux. My theory of why the combination of carbs and fat is really bad is that the fat makes the stomach acid stick to your esophagus. Add spicy foods to that, and it makes it really painful. Since I now limit carbs, I can eat so-called trigger foods like coffee, fatty foods and spicy foods all day long without a problem. And my acid reflux was so bad that I had an esophageal ulcer.


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