All Norwegians Have Heart Disease

      96 Comments on All Norwegians Have Heart Disease

Okay, I was dishonest in the title of this post.  Not all Norwegians have heart disease.  But almost all Norwegian men are (if we believe the prevailing guidelines) at high risk for heart disease.

Like most Americans, I spend very little time thinking about Norwegians.  The great Chicago columnist Mike Royko once pointed out that in the ethnic melting pot of Chicago, you can hear jokes about the Irish, Jews, Italians, Poles, African-Americans, Mexicans, Puerto Ricans, French, British, Russians and Germans.  He even remembered some jokes about Swedes.  But when he asked around, nobody could remember ever hearing a joke about Norwegians.  Royko even tracked down a Norwegian-American acquaintance who confirmed, “Naw, nobody tells jokes about us.  We’re too nice.”

I got thinking about the Norwegians this weekend while answering comments on my post about the Spanish Paradox.  I remembered logging a study about Norwegians and their risk of heart disease into my database and pulled it up.  Here are some quotes from the study:

Since the first US Framingham model for predicting heart disease risk was published in 1991, it has become ever more widely recommended that doctors in primary care carry out risk assessment by combining several risk factors for cardiovascular disease using algorithms. Until recently most risk equations have been derived from the Framingham study, but these calculations tended to overestimate risk in the European context.

Actually, the Framingham model is lousy at predicting heart disease in the American context as well.  But let’s move on.

A new European risk scoring system for cardiovascular disease, based on the first phase of the systematic coronary risk evaluation (SCORE) project, was presented in 2003. The system is based on a pooled dataset of cohort studies from 12 European countries, among these Norway, and offers a format for estimating fatal cardiovascular disease risk that is suitable for clinical practice.

After explaining those guidelines, the researchers report on the results of applying them to data collected from several thousand Norwegians.  Here’s what they found:

At age 40, 22.5% of women and 85.9% of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% and 88.7%, and at age 65 were 84.0% and 91.6%.  At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease.

Hmmm … people in Norway must be dropping like flies from heart disease, at least according to the prevailing guidelines for estimating heart-disease risk … you know, cholesterol levels and all that stuff.

Here again is the American Heart Association’s chart showing rates of cardiovascular disease around the world:

You’ll notice Norway is down toward the lower end of the scale – not as low as France or Spain, but lower than the U.S., U.K. or Germany.

For once, the researchers recognize that the current guidelines are poppycock.  They don’t put it quite that way, of course.  Their language is more academic and polite:

Implementation of European guidelines to prevent cardiovascular disease would label most people in an unselected Norwegian population at high risk of fatal disease from age 40

The validity of the evidence base of the guidelines is questionable and predicts practical and ethical dilemmas related to resource allocation and clinical counselling.

Any overestimation of a person’s risk for cardiovascular disease can have important implications. Apart from causing unnecessary concern, it undermines the patient’s informed choice for intervention. It is also likely to increase prescribing costs and affect life insurance premiums.

Yup.  First thing you know, your doctor is scaring the bejeezus out of you and talking you into taking statins.

Over the weekend, I also had a mini-debate on Twitter with someone who insisted the French paradox is probably a matter of genetics.  I pointed out that waves of French moved to England to become landowners after the Norman Conquest and that the French and English have been intermarrying for hundreds of years.  I doubt that there’s a big difference between French DNA and British DNA.  He didn’t buy it and tweeted a link to a document detailing the marked genetic differences among Europeans.  He apparently didn’t notice that the document he linked described differences among Europeans separated by the Alps for most of history.

Look at the AHA chart one more time.  Scotland and Ireland are near the top.  England and Wales are near the middle.  Now go find Australia.  I’ll give you minute …

… Find it?  Yup, Australia is near the bottom.  My Australian readers can correct me if I’m wrong, but I’m pretty sure we can’t explain away the “Australian Paradox” by suggesting Australians are genetically distinct from the Irish, Scots and Brits.

So we have the Spanish, who are in “poor cardiovascular health” according to current guidelines, but have a low rate of heart disease.  We have the Norwegians, nearly all of whom are at a high risk of heart disease according to current guidelines, but have a relatively low rate of heart disease.

I’m thinking the problem is with the current guidelines.  Nice to see some researchers say as much.

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96 thoughts on “All Norwegians Have Heart Disease

  1. Loket

    “Naw, nobody tells jokes about us. We’re too nice.”

    This is blatantly untrue, Swedes maintain a set of jokes about Norwegians.

    “How do you sink a Norwegian submarine?

    – You swim down and knock on the hatch”

    “What does the sign at a Norwegian roundabout say?

    – Eight laps maximum. ”

    Hey, I didn’t say they were *good* jokes…

    I guess it’s natural to make jokes about your near-neighbors … although come to think of it, I don’t remember any jokes about Canadians.

    Reply
  2. gallier2

    red yeast rice is the same thing as statins. The specific poison (HmG-COA reductase inhibator) was discovered in red yeast rice.

    The thing is, there is in general no point in reducing “cholesterol”. High cholesterol is not a illness, it’s a lab value.

    Reply
  3. Loket

    “Naw, nobody tells jokes about us. We’re too nice.”

    This is blatantly untrue, Swedes maintain a set of jokes about Norwegians.

    “How do you sink a Norwegian submarine?

    – You swim down and knock on the hatch”

    “What does the sign at a Norwegian roundabout say?

    – Eight laps maximum. ”

    Hey, I didn’t say they were *good* jokes…

    I guess it’s natural to make jokes about your near-neighbors … although come to think of it, I don’t remember any jokes about Canadians.

    Reply
  4. Phyllis Mueller

    @ gallier2 – I think you are correct, and I agree with you. (Z probably does as well.) But that’s not the issue here, any more than it was for the fellow in the case study in the book who was applying for life insurance and needed to pass a physical.

    @ z – You also might want to check the People’s Pharmacy website for additional suggestions.

    Reply
  5. JayMan

    I am the person from the infamous mini Twitter debate.

    My main point was that heredity could be a significant contributor to the observed differences in heart health, especially when you notice that the countries listed cluster neatly by ethnicity (Slavs -> Celts -> Germanics/Anglos -> Mediterranean -> East Asian) – which a few exceptions, as Mr. Naughton points out.

    The evidence for genetic differences between the various European nations can be seen here and here. I’ll ask you to pay close attention to the PCA maps. Note that the different nations make very distinct clusters, with very little overlap. In other words, they are genetically distinct populations (despite being highly related). (For a little info on how to read these maps, please see here).

    If the process which Mr. Naughton describes made the English and French similar in the way he thinks, you wouldn’t be able to separate them into two discrete lumps genetically!

    As for Australia, strictly speaking, Australia is likely genetically different from its source countries because selective forces operated on who immigrated to Australia (as well who remained there and left descendants). The U.S. and Canada both have amassed important genetic differences from the British Isles (and France), which will be the subject of a future post of mine.

    That said, whether or not heredity is relevant with the observed difference in Australia is not clear. But, that’s besides the point, DNA does not have to be the sole factor in the observed differences.

    That said, I did look at the Quebecois, and they DO have lower obesity and CVD rates than most Canadians (if not quite as extreme). The Quebecois, however, are not genetically representative of all French (having descended from a founding population of 2,600 individuals from a few specific regions of France).

    I would just like to point out that this is a fascinating discovery, and it would seem to be important to look at ALL potential causes, including heredity.

    Thanks for stopping by, Jay. I tried to read that second map when you linked to it on Twitter, but it’s unreadable on my screen … too tiny and fuzzy, even when I click it for the full version.

    I suspect that if the French and Brits traded diets, we’d be talking about the “British Paradox” in 20 years or so. But of course our susceptibility to various diseases is always a combination of genes and gene expression. I like the way Mark Sisson puts it: genetics loads the gun, but diet pulls the trigger.

    Reply
  6. Charles-André Fortin

    You could also say that in Quebec the maximum you’re gonna pay for your medication by month is 80,25$ or 963$ a year no matter what. That alone is a big factor. Now if we look at some of the richest province of Canada (Alberta, British Colombia, Ontario) they got these number of occurrence by 100 000 people (183, 226, 200) Compare to the 191 for Quebec and you find that these number to be relatively close.

    If you want to have fun you can look the stat at : http://www.statcan.gc.ca/pub/84f0209x/84f0209x2008000-fra.pdf

    Sorry I got no idea if there is an english version

    To quote Steve Martin: “Those French … it’s like they have a different word for EVERYTHING.”

    Reply
  7. gallier2

    Sorry I got no idea if there is an english version

    Replace the -fra in your link by -eng and voilà la version anglaise. 😉

    Reply
  8. Phyllis Mueller

    @ gallier2 – I think you are correct, and I agree with you. (Z probably does as well.) But that’s not the issue here, any more than it was for the fellow in the case study in the book who was applying for life insurance and needed to pass a physical.

    @ z – You also might want to check the People’s Pharmacy website for additional suggestions.

    Reply
  9. JayMan

    I am the person from the infamous mini Twitter debate.

    My main point was that heredity could be a significant contributor to the observed differences in heart health, especially when you notice that the countries listed cluster neatly by ethnicity (Slavs -> Celts -> Germanics/Anglos -> Mediterranean -> East Asian) – which a few exceptions, as Mr. Naughton points out.

    The evidence for genetic differences between the various European nations can be seen here and here. I’ll ask you to pay close attention to the PCA maps. Note that the different nations make very distinct clusters, with very little overlap. In other words, they are genetically distinct populations (despite being highly related). (For a little info on how to read these maps, please see here).

    If the process which Mr. Naughton describes made the English and French similar in the way he thinks, you wouldn’t be able to separate them into two discrete lumps genetically!

    As for Australia, strictly speaking, Australia is likely genetically different from its source countries because selective forces operated on who immigrated to Australia (as well who remained there and left descendants). The U.S. and Canada both have amassed important genetic differences from the British Isles (and France), which will be the subject of a future post of mine.

    That said, whether or not heredity is relevant with the observed difference in Australia is not clear. But, that’s besides the point, DNA does not have to be the sole factor in the observed differences.

    That said, I did look at the Quebecois, and they DO have lower obesity and CVD rates than most Canadians (if not quite as extreme). The Quebecois, however, are not genetically representative of all French (having descended from a founding population of 2,600 individuals from a few specific regions of France).

    I would just like to point out that this is a fascinating discovery, and it would seem to be important to look at ALL potential causes, including heredity.

    Thanks for stopping by, Jay. I tried to read that second map when you linked to it on Twitter, but it’s unreadable on my screen … too tiny and fuzzy, even when I click it for the full version.

    I suspect that if the French and Brits traded diets, we’d be talking about the “British Paradox” in 20 years or so. But of course our susceptibility to various diseases is always a combination of genes and gene expression. I like the way Mark Sisson puts it: genetics loads the gun, but diet pulls the trigger.

    Reply
  10. Charles-André Fortin

    You could also say that in Quebec the maximum you’re gonna pay for your medication by month is 80,25$ or 963$ a year no matter what. That alone is a big factor. Now if we look at some of the richest province of Canada (Alberta, British Colombia, Ontario) they got these number of occurrence by 100 000 people (183, 226, 200) Compare to the 191 for Quebec and you find that these number to be relatively close.

    If you want to have fun you can look the stat at : http://www.statcan.gc.ca/pub/84f0209x/84f0209x2008000-fra.pdf

    Sorry I got no idea if there is an english version

    To quote Steve Martin: “Those French … it’s like they have a different word for EVERYTHING.”

    Reply
  11. gallier2

    Sorry I got no idea if there is an english version

    Replace the -fra in your link by -eng and voilà la version anglaise. 😉

    Reply
  12. JayMan

    I’ve made a new post on this topic. Please see here:

    A Fat Problem With Heart Health Wisdom « JayMan’s Blog

    Nice analysis, Jay. I still some paradoxes within the paradoxes, however. The Australians vs. the U.K. is one, Sweden vs. Scotland is another … if I remember correctly, both are Celtic people. I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.

    Reply
  13. JayMan

    I’ve made a new post on this topic. Please see here:

    A Fat Problem With Heart Health Wisdom « JayMan’s Blog

    Nice analysis, Jay. I still some paradoxes within the paradoxes, however. The Australians vs. the U.K. is one, Sweden vs. Scotland is another … if I remember correctly, both are Celtic people. I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.

    Reply
  14. Charles-André Fortin

    Nice article JayMan but I still think LOW INCOME (%) is a better risk factor to predicted cardiovascular death. In Quebec medication Insurance are Mandatory since 1997 and that not the case in any other province. We pay less for medication more in taxes.

    If you got access to medication you are less likely to die from chronic disease. I think it is a simple as that.

    Reply
  15. Charles-André Fortin

    Nice article JayMan but I still think LOW INCOME (%) is a better risk factor to predicted cardiovascular death. In Quebec medication Insurance are Mandatory since 1997 and that not the case in any other province. We pay less for medication more in taxes.

    If you got access to medication you are less likely to die from chronic disease. I think it is a simple as that.

    Reply
  16. CU

    How strange that numbers 1 and 2, Japan and France, have low fat/high carb and high fat/moderate carb diets, respectively.

    Having been in both countries I believe that part of the success is that they less than us.

    I believe low sugar intake helps too.

    Reply
  17. CU

    How strange that numbers 1 and 2, Japan and France, have low fat/high carb and high fat/moderate carb diets, respectively.

    Having been in both countries I believe that part of the success is that they less than us.

    I believe low sugar intake helps too.

    Reply
  18. smgj

    Hi – a Norwegian here.

    Marilyn said:
    It’s a bit hard to tell, but it looks as if the Norwegians have more heart fatalities, but fewer deaths overall than the French.

    It’s probably because our long country and widespread population. If someone get a heart attack it’s often a long way to hospitable and help.
    Doctor’s in Norway usually uses LDL and triglycerides to check health risk, and rely less on HDL and total cholesterol … yet. But they are “learning” too. Last year the drugstores drove a campaign “less than 5” (total cholesterol) and free tests. Fortunately that drove a discussion about how useful that number is instead of gaining momentum. And I have not seen that marketing stunt repeated.

    Reply
  19. smgj

    Hi – a Norwegian here.

    Marilyn said:
    It’s a bit hard to tell, but it looks as if the Norwegians have more heart fatalities, but fewer deaths overall than the French.

    It’s probably because our long country and widespread population. If someone get a heart attack it’s often a long way to hospitable and help.
    Doctor’s in Norway usually uses LDL and triglycerides to check health risk, and rely less on HDL and total cholesterol … yet. But they are “learning” too. Last year the drugstores drove a campaign “less than 5” (total cholesterol) and free tests. Fortunately that drove a discussion about how useful that number is instead of gaining momentum. And I have not seen that marketing stunt repeated.

    Reply
  20. The Older Brother

    Somethiing to keep in mind when making an argumennt for the significance of genetic effects is that these would have to manifest over a period of several thousands of years at a minimum.

    When we see, as well documented by Taubes, et al, the cv and other health markers of distinct population groups change markedly (generally for the worse as indiginous diets are exchanged for “civilized” foods) over the course of just a few generations, that is pretty clear refutation of genetics.

    It does make a case for Epigenetics – the relatively recent idea that environment, particularly in the womb, can have a significant effect on gene expression. So, for example, the high-carb SAD influencing supression/expression of insulin response in newborns seems more plausible than babies now eat more, exercise less, and watch too much tv.

    Cheers

    Reply
  21. JayMan

    “Nice analysis, Jay.”

    Thanks!

    “Sweden vs. Scotland is another … if I remember correctly, both are Celtic people.”

    The Scots are descended from the original Gaels and Picts of Britain augmented with the Anglo-Saxons and then later the Vikings (mostly Danes), however, the latter two groups being Germanic and they mostly settled in England.

    “I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.”

    Yeah, that is definitely an interesting one. The Spanish and Italians did make up the bulk of immigration to Argentina, and genetic analysis indicates that most “European” Argentinians are, genetically, truly mostly European in ancestry (>80%). There are important regional genetic differences in Spain and Italy that may be relevant? It seems that, as far Italian migrants, the pre-1900 waves came mostly from Northern Italy, but since then it was primarily Southern Italians.

    However, judging from this neat little map, there doesn’t seem to be much regional variation in either Spain or Italy in terms of heart mortality. Indeed, most of the variance seems to move along a NE to SW axis in Europe.

    One possibility for Australia and Argentina is that those data points are faulty is some way (sometimes the simplest explanation…)?

    Oh well, the paradoxes continue!

    Power to the Paradoxes!

    Reply
  22. JayMan

    Additionally, about the seemingly anomalously high rates of CVD in Greece (and perhaps much of Eastern Europe), see here. Greeks, along with many Slavic countries smoke a lot. In the case of Greece, cigarettes per capita is considerably higher than Spain or Italy. One imagine that this plays a role in the differing CVD rates there? (Of course, smoking can’t be the sole problem, because smoking rates are low in Scandinavia despite higher CVD rates compared to SW Europe).

    And then we have the Japanese — heavier smokers than Americans, but less heart disease. Same goes for the French and the Kitavans. So many possible variables.

    Reply
  23. The Older Brother

    Somethiing to keep in mind when making an argumennt for the significance of genetic effects is that these would have to manifest over a period of several thousands of years at a minimum.

    When we see, as well documented by Taubes, et al, the cv and other health markers of distinct population groups change markedly (generally for the worse as indiginous diets are exchanged for “civilized” foods) over the course of just a few generations, that is pretty clear refutation of genetics.

    It does make a case for Epigenetics – the relatively recent idea that environment, particularly in the womb, can have a significant effect on gene expression. So, for example, the high-carb SAD influencing supression/expression of insulin response in newborns seems more plausible than babies now eat more, exercise less, and watch too much tv.

    Cheers

    Reply
  24. Ken

    Hi Tom, interesting. It’s just observational association, but I think the Australians eat a lot of pastured animal meat (even though they eat a fair amount of carb’s too).
    Michael Rose, the evolutionary biologist (of fruit-fly fame), claims that European nordic people (very much including Celts such as Irish and Scots) have a particularly low tolerance for carb’s as they age. This matches my own experience (I am roughly half Scots). The extremely high rates of CVD and T2DM in Newfoundland and Prince Edward Island (Rose is Canadian, but from BC I believe — but his friend, the interviewer, is from PEI) are supportive of this hypothesis. But I find it compelling because it is derived from Rose’s core scientific expertise and based upon the lack of much generational exposure to dietary carbohydrate in the northern Europeans vs. others from more moderate climates in Europe and Asia.
    Rose explains his ideas in some depth at http://55theses.org/ .
    Jibes pretty well with the Euro data you present, if we assume that the Irish and Scots are eating a lot more carb’s than the Norwegians (and I think they are, in addition to the Canadian Celtic maritime provinces).

    I think that makes perfect sense. People ate fewer carbohydrates in northern climates. That’s why when people point to the Kitavans, I point out that I’m not a Kitavan.

    Reply
  25. JayMan

    “Nice analysis, Jay.”

    Thanks!

    “Sweden vs. Scotland is another … if I remember correctly, both are Celtic people.”

    The Scots are descended from the original Gaels and Picts of Britain augmented with the Anglo-Saxons and then later the Vikings (mostly Danes), however, the latter two groups being Germanic and they mostly settled in England.

    “I’ve read of specific genetic anomalies that make some groups of Italians almost completely immune from heart disease or Asian Indians particularly vulnerable to it. I’m curious if you’ve heard of anything along those lines that would explain (or contribute to) us seeing a high rate of heart disease in Ireland and a low rate in Sweden, or a high rate in Argentina, but a low rate in Spain and Italy, the ancestral countries of so many Argentinians.”

    Yeah, that is definitely an interesting one. The Spanish and Italians did make up the bulk of immigration to Argentina, and genetic analysis indicates that most “European” Argentinians are, genetically, truly mostly European in ancestry (>80%). There are important regional genetic differences in Spain and Italy that may be relevant? It seems that, as far Italian migrants, the pre-1900 waves came mostly from Northern Italy, but since then it was primarily Southern Italians.

    However, judging from this neat little map, there doesn’t seem to be much regional variation in either Spain or Italy in terms of heart mortality. Indeed, most of the variance seems to move along a NE to SW axis in Europe.

    One possibility for Australia and Argentina is that those data points are faulty is some way (sometimes the simplest explanation…)?

    Oh well, the paradoxes continue!

    Power to the Paradoxes!

    Reply
  26. JayMan

    Additionally, about the seemingly anomalously high rates of CVD in Greece (and perhaps much of Eastern Europe), see here. Greeks, along with many Slavic countries smoke a lot. In the case of Greece, cigarettes per capita is considerably higher than Spain or Italy. One imagine that this plays a role in the differing CVD rates there? (Of course, smoking can’t be the sole problem, because smoking rates are low in Scandinavia despite higher CVD rates compared to SW Europe).

    And then we have the Japanese — heavier smokers than Americans, but less heart disease. Same goes for the French and the Kitavans. So many possible variables.

    Reply
  27. Ken

    Hi Tom, interesting. It’s just observational association, but I think the Australians eat a lot of pastured animal meat (even though they eat a fair amount of carb’s too).
    Michael Rose, the evolutionary biologist (of fruit-fly fame), claims that European nordic people (very much including Celts such as Irish and Scots) have a particularly low tolerance for carb’s as they age. This matches my own experience (I am roughly half Scots). The extremely high rates of CVD and T2DM in Newfoundland and Prince Edward Island (Rose is Canadian, but from BC I believe — but his friend, the interviewer, is from PEI) are supportive of this hypothesis. But I find it compelling because it is derived from Rose’s core scientific expertise and based upon the lack of much generational exposure to dietary carbohydrate in the northern Europeans vs. others from more moderate climates in Europe and Asia.
    Rose explains his ideas in some depth at http://55theses.org/ .
    Jibes pretty well with the Euro data you present, if we assume that the Irish and Scots are eating a lot more carb’s than the Norwegians (and I think they are, in addition to the Canadian Celtic maritime provinces).

    I think that makes perfect sense. People ate fewer carbohydrates in northern climates. That’s why when people point to the Kitavans, I point out that I’m not a Kitavan.

    Reply
  28. Katherine

    Isn’t the Scottish national food deep-fried candy bars?

    I’m not sure, but I know I’ve never heard anyone suggest going out on Saturday night for Scottish food.

    Reply
  29. Katherine

    Isn’t the Scottish national food deep-fried candy bars?

    I’m not sure, but I know I’ve never heard anyone suggest going out on Saturday night for Scottish food.

    Reply
  30. Lorne Marr

    There seems to be a lot of ongoing discussion about the health benefits / negative effects of milk. Maybe that could play a part?

    I’m not really an expert (err), but I seem to recall something about the northern european states having less milk consumption when compared to America or Middle Europe.

    Coincidence?

    Weston A. Price wrote about people who consumed a lot of milk but had very low rates of disease.

    Reply
  31. Lorne Marr

    There seems to be a lot of ongoing discussion about the health benefits / negative effects of milk. Maybe that could play a part?

    I’m not really an expert (err), but I seem to recall something about the northern european states having less milk consumption when compared to America or Middle Europe.

    Coincidence?

    Weston A. Price wrote about people who consumed a lot of milk but had very low rates of disease.

    Reply
  32. smgj

    Well – one problem we have here in northern Europe is little sun and mostly inside work – and sunscreen. Which leads to a population with very low vitamin d levels on the whole.
    Low vitamin D would make it easier for all sorts of inflammatory illnesses to take hold.

    Reply
  33. smgj

    Well – one problem we have here in northern Europe is little sun and mostly inside work – and sunscreen. Which leads to a population with very low vitamin d levels on the whole.
    Low vitamin D would make it easier for all sorts of inflammatory illnesses to take hold.

    Reply
  34. John Perkins

    Very catchy title and at first I thought it was an ignorant blanket statement. But the article was very helpful and eye opening. If men don’t be careful with what they eat and and strive for a healthy lifestyle, we can all be in risk of heart disease.

    Reply
  35. John Perkins

    Very catchy title and at first I thought it was an ignorant blanket statement. But the article was very helpful and eye opening. If men don’t be careful with what they eat and and strive for a healthy lifestyle, we can all be in risk of heart disease.

    Reply

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