Tuesday, November 29, 2016

The Placebo Effect by Gabriela Pierre, L.Ac.

We’ve all heard the term mind over matter. Generally, mind is understood to be synonymous with willpower in this motivational mantra. But what if we expanded the definition to encompass a wider meaning that not only includes our indomitable spirit but also our physical brain? If you have ever wondered how powerful an effect our minds have on our health and state of well-being, you are seeking to understand the very real and very elusive phenomenon that controlled scientific studies have disparagingly labeled as placebo effects.

While it may be challenging to tease out and quantify mathematically, placebo plays an important role in our health care experience. That experience begins the moment a patient interacts with a health care provider, however brief that encounter may be. What is said and how that information is communicated to the patient are key variables that can directly affect a patient’s prognosis. Factors such as time spent with a patient, bedside manner, warmth, empathy, physical reassurement and the communication of positive or negative expectations all play significant roles in health outcomes. [1] This is especially true for patients with chronic illness who rely on ongoing care to manage their conditions. We have entered a new era of healthcare that is increasingly more integrative and addresses the inseverable connection between the mind and body. Mind-body medicine no longer exclusively resides in the realm of alternative and complementary medicine. Hard science has finally giving credence to the practice of mind-body medicine. Thanks to discoveries about pain control and stress management attributed to the placebo effect, the role of the mind as it relates to health and disease prognosis is once again entering Western health care full steam ahead. [2]

Unfortunately, the concept of placebo has gained a bad rap in the field of medicine since it became a codified standard in clinical trials. Having no pharmacological effect, placebo is most often used in clinical trials as a control for testing therapeutic interventions or pharmacological agents with known biological effects against fake or sham treatments. It wasn’t until more recently that some researchers have started to take a closer, more serious look at the placebo effect and have made a compelling case that there might also be a biological basis for the real effects produced by placebo controls on research participants.

It turns out that historically, clinical trials have greatly underestimated the real physiological implications that a person’s expectations of treatment have on treatment outcomes. In other words, our psychology is a powerful modulator of our physiology. Our perceptions and expectations have the power to quite literally activate different areas of our brains and trigger the release of various endogenous substances including endorphins, serotonin and opioids that can provide significant pain relief and elevate our mood. If you believe that a treatment will work, or conversely, that it won’t work, there is a good chance that you will be right either way. [3] The notion that we can distinctly separate our psychology from our biology is nothing short of impossible. We’ve come a long way from the Cartesian aphorism, I think, therefore I am to now assert that what we think can determine just how we are.

More than just a mystic self-fulfilling prophecy linking belief to behavior, some of us are biologically primed to respond to placebo. Preliminary research indicates that certain individuals with higher levels of dopamine are more likely to respond to placebo. [4] While we don’t fully understand which pain and pleasure pathways are activated and to what extent via the placebo effect, a strong case can be made for the effect placebo has in regulating various physiological processes including pain, mood, appetite, and memory. Research studies have shown that placebo may also have an effect on serotonin levels as well as our endocannabinoid system. [5] In fact,  placebo can induce pain suppression in the body with an estimated analgesic effect equal to or greater than morphine. [6]

As physicians, caregivers, and patients alike, we cannot afford to underestimate the role our mental, emotional, social, and spiritual well-being affects our health down to the cellular level nor can we deny the importance of the patient-provider relationship in achieving desired health outcomes. Better understanding and implementation of the placebo effect has the potential to revolutionize medicine and change the way we deliver health care. Mind-body medicine that is practiced as a ritual of compassionate care can be the new gold standard of healthcare, ultimately giving patients their best chance at optimal health outcomes and longevity.  

Note:  The placebo effect imparts its benefits in addition to the non-placebo effects inherent to each type of medical intervention.  If you’re interested in reading about acupuncture research that has been placebo-controlled, or some of the proposed non-placebo mechanisms of action for acupuncture, check out the links below:

Research:
Electro-Acupuncture and IVF: https://www.ncbi.nlm.nih.gov/pubmed/21862001
Acupuncture and chronic low back pain: https://www.ncbi.nlm.nih.gov/pubmed/23026870
Acupuncture and pediatric tonsillectomy pain: https://www.ncbi.nlm.nih.gov/pubmed/25851423
Acupuncture, women’s health, mechanisms of action: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962314/
Acupuncture, mechanisms of action: https://www.ncbi.nlm.nih.gov/pubmed/11388686

Footnotes:
1. Kaptchuk TJ, Kelley JM, Conboy LA, et al. (2008). Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 336(7651): 999-1003.
2. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=102
3. Wells, R. E. (2012, March). To Tell the Truth, the Whole Truth, May Do Patients Harm: The Problem of the Nocebo Effect for Informed Consent. Am J Bioeth,12(3), 22-29.
4. Coeliac L., Klinger R. Flor H. Bingel U. (2013). Placebo analgesia: psychological and neurobiological mechanisms. Pain. 154(4), 511-4.
5. Hall, K. T., & Loscalzo, J. (2015, May). Genetics and the placebo effect: The placebome. Trends in Molecular Medicine, 21(5), 285-294.
6. Hall, K. T., & Loscalzo, J. (2015, May). Genetics and the placebo effect: The placebome. Trends in Molecular Medicine, 21(5), 285-294.

Gabriela Pierre's bio can be found here.

Thursday, August 14, 2014

How to Make Delicious, Nutrient-Dense Smoothies


Having a smoothie for breakfast can be one of the healthiest habits you develop, if it consists of the right ingredients.  Most mornings my breakfast consists of about 2 pint glasses worth of blended vegetables, fruit, seeds, herbs, grass-fed whey protein and various superfoods.  It only takes 3 to 5 minutes to make, assuming all of the ingredients are handy.  Though it is a liquid, it fills me up for 4 or 5 hours until lunch.  Most importantly, I know that I will always have at least one meal every day that is loaded with lots of superfoods known to support sustained energy levels, a strong immune system, vibrant looking, clear skin and general vitality.  Plus, many of these ingredients have potent anti-inflammatory effects and are known to decrease your chances of getting cancer and other major illnesses.

This article offers guidelines and specific foods I recommend using, not a specific recipe.  Make sure your kitchen is well stocked with the necessary fresh ingredients once a week, and then have fun combining them each morning.  Simply add 1 or 2 ingredients from each of the seven categories below to a high-powered blender.  You will learn quickly how much of each ingredient to add to create a well-balanced smoothie that tastes great.

1) Vegetables

1. Celery
2. Fennel Root
3. Cucumber
4. Baby Greens Mix (arugula, chard, spinach, kale)
5. Spinach


These are my favorite vegetables to add, but get creative and use whichever vegetables you enjoy.  I usually choose both a watery vegetable like celery or cucumber, along with a leafy green vegetable like spinach or the baby greens mix.  Two large celery sticks or a 1/2 cucumber along with a large handful of greens is an example of what I typically use. I usually don't add root vegetables, but you can!

2) Fruit (frozen or fresh)

1. Wild Blueberries
2. Strawberries
3. Raspberries
4. Blackberries
5. Boysenberries
6. Acai Berries
7. Marion Berries
8. Cherries
9. Pineapple
10. Pomegranate


As you can see, I love berries. And the fruit component of my smoothies often consists solely of them. Berries, in many ways, are the most nutritious fruit because they are loaded with a variety of anti-oxidant, anti-inflammatory, anti-cancer and blood sugar regulating nutrients, without a lot of extra fructose.

I prefer frozen berries, for 3 reasons:

1) They are affordable!  Fresh berries are very expensive, so if I am eating them every day cost is a major deterrent.
2) Berries are usually frozen very close to the time they are picked, which preserves many of the healthy constituents until the time you eat them.  Often, by the time you eat berries from the store, they have been picked a week or more in the past, losing vital nutrients with each passing day.
3) They help create a moderately cold, more drinkable smoothie without having to add ice.

Keep in mind; organic berries are a must, as conventional berries are high on the list of most pesticide-laden fruits.

3) Seeds & Nuts

1. Pumpkin Seeds
2. Black Sesame Seeds
3. Sunflower Seeds
4. Chia Seeds
5. Flax Seeds
6. Macadamia Nuts
7. Brazil Nuts


I usually add a medium handful of 1 variety each morning.  My refrigerator is stocked with all, so I will rotate through them each week.  Seeds have a broad spectrum of nutrients that are linked to vibrant health.  They are especially loaded with minerals that are easily absorbed, plus healthy fats, protein and fiber.

4) Herbs & Spices

1. Turmeric Rhizome
2. Ginger Rhizome
3. Fresh Basil
4. Fresh Cilantro
5. Fresh Parsley
6. Fresh Mint
7. Clove, Cinnamon, Fennel, Cardamom and/or Ginger (powdered)



Turmeric and ginger are so healthy that I include a thumb worth of each in my smoothie every morning.  I almost always include a handful of fresh basil or cilantro since they are such potent anti-inflammatory and anti-cancer plants.  In the winter, I add a teaspoon of combined powdered spices to support digestive fire.  All of the above ingredients add a very unique and, in my opinion, pleasant taste to the smoothie.

5) Protein

1. PaleoMeal by Designs for Health


PaleoMeal is a grass-fed whey protein powder that also includes many other metabolism boosting, blood sugar regulating nutrients, like L-Glutamine, Creatine, Zinc, Magnesium and Chromium.

It is the best protein powder on the market that I have seen, so I use it every morning. If you do not tolerate dairy, Designs for Health has non-dairy options.  I do not recommend any protein powder containing soy protein isolates or whey from cows that are not grass-fed.

6) Fat

1. 1 to 2 tsp. Coconut Oil
2. 1/2 Avocado
3. Yogurt (full-fat, non-sweetened)

 

A large body of research now tells us how important fats and oils are in helping our body absorb and utilize the nutrients in fruit, vegetables, herbs and spices.  Adding a good amount of olive oil to salads, sautéing spices in ghee, adding butter to steamed broccoli, turmeric powder in whole milk, and adding fat to your smoothies can greatly increase the percentage of nutrients absorbed.  Plus, each of the above 3 foods has many additional health benefits.

7) Superfoods & Adaptogenic Herbs

1. Matcha (powdered green tea)
2. Maca Root Powder
3. Goji Berries
4. Spirulina, Chlorella and/or Blue-Green Algae Powder
5. Ashwagandha Powder
6. Royal Jelly or Bee Pollen
7. Cocoa Powder (unsweetened)


There is enough research showing benefit for each of the above to warrant the cost.  Add a decent amount of 1 or 2 each morning.  Again, vary the ingredients each day so that you are getting some of each, each week.

The sweetness factor!

Most people will not want to drink a smoothie that is not at least mildly and pleasantly sweet.  If you have plenty of protein, fat and fiber in the smoothie, then sweetening your smoothie moderately is perfectly healthy.

One or two of the following ingredients, added to taste, will do the trick:

1. Tart Cherry Concentrate (it's actually very sweet)
2. Fresh Pineapple (if any juice has separated out, that will be especially sweet)
3. Pomegranate Juice
4. Cherry Juice
5. Fresh, In-Season, Juicy Stone-Fruit (especially nectarines and peaches)

Combine, Blend and Drink!

As mentioned, all you need to do is choose 1 or 2 ingredients from the seven categories above.  Add them to a high-powered blender, pour and drink.  I use a Vitamix blender, but you can probably get by with a less expensive model.  Again, think of this as a full meal.  For me, that means I will want to drink 2 or more pint glasses each morning.  Some experimentation is in order, and the only way for you to find the perfect smoothies with the right flavor and consistency for you, is to do it a few mornings in a row.  I bet, your first smoothie will be delicious, and they will just get better over time.

Here's an example of my breakfast this morning:

1/2 Cucumber
1 stalk Celery
1 large handful Baby Greens (chard, spinach, arugula)
1 small handful frozen, organic Boysenberries
1 small handful frozen, organic Strawberries
1 handful Pumpkin Seeds
1 thumb Ginger Rhizome
1 thumb Turmeric Rhizome
1 handful fresh Cilantro
1 scoop PaleoMeal
1 rounded tsp. Coconut Oil
1 Tbsp. Maca Root Powder
1 small handful Goji Berries

Plus: a long squeeze of Tart Cherry Juice Concentrate for sweetness, and enough Coconut Water to result in the desired consistency.

This yielded 2.5 pints of smoothie, which was the perfect amount to last me 5 hours until lunch.

Final Thoughts

1. I go shopping each Sunday to make sure I have enough of all of the above ingredients to allow for varied smoothies throughout the week.  Keeping your kitchen well stocked is essential.  Once the ingredients are there, it only takes a few minutes to blend them.

2. If your fruit, vegetables or added sweetening agents didn't include enough liquid, as is usually the case, you will need to add enough water, coconut water, chilled green tea or juice to find the right consistency.

3. All smoothies are not healthy!  Compare the smoothie I've described to a typical smoothie consisting of banana, apple juice, ice and a soy-based protein powder and the difference should be apparent.  The ingredients I've mentioned above are the best anti-cancer, anti-inflammatory and general health promoting foods on the planet.  Your smoothie should have no fillers. A breakfast consisting of nothing but those foods is the best thing you can do for your health.  In addition to exercising regularly, sleeping enough and having fun, of course! 

4. And finally, breakfast is the easiest meal to make into a routine.  Anything that becomes a routine part of life is easy to maintain for the long-term with very little effort on your part.  Buy the ingredients this coming Sunday, do it three mornings in a row, and you'll be hooked!!



Wednesday, July 16, 2014

Green Juice Recipe


Warm, summer days are the perfect time of year to enjoy fresh juice.  And juice that you make yourself or with loved ones is by far the best.  Nothing compares to farm fresh produce, straight from juicer to mouth.  Once you've taken a look at my juicing guidelines, give this recipe a try.  It's by far my favorite.


Sean's Summer Green Juice Recipe

1 large  Cucumber
1 medium  Fennel bulb (with greens)
1 bunch  Celery sticks
1 bunch  Spinach
1 bunch  Parsley (Italian)
1 medium  Lime (with peel)
1 medium  Apple (with peel & core)
1 thumb  Ginger root (more or less to taste)

Directions:  You can either juice or blend this recipe.  If you want to preserve all of the fiber and make it more of a meal, you can blend it.  Make sure you have a relatively powerful blender.  If you want a light, refreshing beverage a juicer is required.

I love this recipe!  It tastes amazing, and the emphasis on green vegetables makes it super healthy.  The exclusion of cruciferous vegetables makes it easy to digest.  The spinach and parsley both provide a broad range of nutrients and other health promoting ingredients.  The fennel, lime and ginger aid digestion and give the recipe a robust, unique flavor.  The apple gives a touch of sweetness, without adding too much sugar.

The great thing about juicing is that the possibilities are endless.  Why not visit a farmer's market this weekend?  Get creative!  

Tuesday, June 17, 2014

Keep Juicing Healthy


Juicing can be a tasty, enjoyable and nutritious part of a healthy lifestyle.  However, some guidelines are important to make sure you are juicing in a way that is truly healthy for you.  As most of you know, juicing only fruit can result in a large spike in blood sugar levels.  And some have constitutions or digestive systems that make juicing less enjoyable and less healthy, especially at certain times of the year.  Following these simple guidelines will allow most people to enjoy fresh juice in the healthiest way possible. 


1. Don't over do it.  The traditional medicine systems of China and India teach us that strong digestive fire is essential to good health.  Digestive fire in Ayurveda is known as agni, and in traditional Chinese medicine (TCM) it involves abundant Spleen and Stomach Qi.  Too many cold or raw foods can challenge and even harm our digestive fire.  If your digestive fire is strong, juicing in the warmer months usually isn't a problem and can be very healthy.  But, if you are prone to digestive problems like indigestion, gas or bloating, then juicing may not be appropriate for you.  Individuals with cold, weak constitutions may have to enjoy fresh juice in moderation.  Those with the weakest or coldest constitutions may benefit more from soups, stews and broths, even in the warmer months.

2. Limit the amount of fruit, carrots and beets.  Juicing fruit and sugary vegetables like carrot and beet should be done in moderation.  Recent research shows the harmful effects fructose, the sugar found in fruit and some vegetables, has when it isn't buffered by the fiber found in the whole food.  Drinking 8 ounces of apple juice, for example, is in most ways as unhealthy as drinking 8 ounces of soda.  Yes, fruit juice has some vitamins and other healthy phytochemicals.  Unfortunately, the beneficial effects of those constituents are offset by both a surge in blood glucose levels, as well as a fructose overload on the liver that has other negative effects.  [1] [2] Our bodies need both the fiber found in the whole food, as well as the slower consumption time involved in eating the whole food, to mitigate those negative effects.  For optimal health, fruit, carrots and beets should be added to your juice for a little flavor and sweetness, not as the main ingredient.  Enjoy lots of fresh fruit, but eat all of it, not just the juice.

3. Enjoy fresh juice in the spring and summer.  Save juicing for the warm months of spring and summer.  Your system needs warm, grounding meals in the cold, winter months to keep your digestive fire strong.  Some with very strong digestive fire are the exception, but even in that case, care should be taken. 

4. You may need to go easy with cruciferous vegetables.  There are some vegetables that require more digestive fire than others, and this is especially true of cruciferous vegetables.  The cruciferous vegetables include kale, cabbage, cauliflower, broccoli and brussel sprouts.  Of course, plenty of research tells us how amazingly healthy the cruciferous vegetables are.  But, any food prepared in a way that wrecks digestive fire and causes bloating or gas is not good for you.  Simply sautéing cruciferous vegetables will allow you to get the benefit of those vegetables in a way your body can handle.  If your digestive fire is strong and you don't get gas or bloating from juicing cruciferous vegetables, then by all means, enjoy!

5. Add ginger.  Adding a touch of ginger, turmeric or garlic (gasp!) to your juice can help support your digestive fire, plus give a zing of flavor.  Don't overdo it.  A little too much ginger or turmeric can be very spicy, and too much garlic may make you smellier to others than you may want.

6. Keep it fresh.  Bottled, canned, cooked, or reconstituted juices lack most of the enzymes and other micronutrients that make fresh juicing so healthy.  Buy fresh, local produce; juice it within a few days; then drink it the same day for maximum nutrition and flavor.  There are a lot of great juicers on the market at a variety of price points.  I recommend doing your research and finding one for less than 100 dollars if you're just getting started.  If you find that you're juicing regularly, you may want to upgrade at some point.

Raw versus cooked.  Some have a misconception that raw foods are easy to digest.  For the most part, the opposite is true, especially if the cooked food is eaten soon after cooking.  Cooking foods breaks cellulose and other constituents down into more easily digestible forms.  Cooking also transforms some toxins into nutrients; this is especially true of many legumes.  And lycopene, another well-known nutrient, is created through the cooking process.  Yes, many nutrients and enzymes are lost during the cooking process, so including some raw foods in your diet is a great idea.  Generally speaking, the stronger your digestive fire, the more raw foods you'll be able to tolerate.  Fermented foods like kvass, sauerkraut and other pickled vegetables, are a great way to consume raw foods in a more digestible form, as the fermentation process partially digests the food for us, creating healthy probiotics and other important nutrients in the process.

Take home message:  Fresh juice is healthy for those who have digestive fire strong enough to digest it, especially in the warmer months of the year.  If you get gassy or bloated after juicing it means you are not getting the benefits of the juice, and they are causing harm instead.  Nothing is healthy for everyone.  Your body needs to be able to digest, metabolize and absorb nutrients, and if your system is unable to do that, then even supposedly healthy foods are not healthy for you.  If you are having problems digesting fruits and vegetables in one form, like juice or raw salads, then support your digestive fire, and try steaming or sautéing them instead.

[1] "Fructose Consumption is Associated with Cardiometabolic Risk Markers and Visceral Adiposity in Adolescents".  J. Nutr., 2012.
[2] "Fructose Induced Lipogenesis: From Sugar to Fat to Insulin Resistance".  Trends Endocrinol. Metab., 2011.

Tuesday, April 29, 2014

Book Review: Nutrition and Physical Degeneration

Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects by Weston A. Price
My rating: 4 of 5 stars

Published in 1939, this is one of the most important books on nutrition ever written.  Dr. Price presents in this work documentation of the detrimental effects on health, bone structure and fertility that are seen when modern foods (sugar, white rice, white flour, canned foods, jams, lean muscle meat, vegetable oils), replace traditional foods (liberal use of sea foods, organ meats, eggs of many species of animal and fish, full-fat dairy from cow, goat and camel raised on fast growing grasses on mineral-rich soil, freshly cracked and ground whole grain breads).

This book is at its best when he documents his travels in the late 1920s through mid 1930s.  He traveled to isolated parts of Switzerland, northern Scottish islands, northern Canada and Alaska, the Melanesian and Polynesian islands, the Peruvian Andes and Amazon regions, throughout Central and East Africa, New Guinea and Australia.  In each location he meticulously documented dental cavities and dental arch and skull deformities, plus immunity to tuberculosis and other infectious diseases.  He compared groups of the same "racial stock" that had no contact with modern foods, and were still eating their traditional diet to groups where "traditional" foods had been replaced by "modern" foods.  And it is not pretty.  More important than the data he collected are the photos that he took.  It's enlightening to see photos of so many vibrant, strong, well-developed people.  People that ate exclusively traditional diets.  People that never used a toothbrush, yet had no history of tooth decay.  It is equally heart-breaking when you see photos of what happens when "traditional" foods are replaced with modern foods.   A photo can tell a thousand words, and simply scanning the photos in this book alone is well worth the purchase price.

The last third of this book rambles along, and it is written in the 30s, so there is some language that is not politically correct now.  I wish he would have spent more time rigorously documenting the exact diets of the groups he came in contact with.  It also would have been great to have more data on life expectancy, as well as tumor and heart disease data on the groups he studied.  For those reasons, I give it 4 out of 5 stars.

Still, this book is so immensely important and influential to many, because we live in an age where there are virtually no people left on the planet that are eating completely traditional diets.  The "white man's" food has replaced traditional foods for almost everyone.  For that reason, most of the photos that we now see of so called current "primitive" groups, show people negatively impacted by modern foods.  Dr. Price provides hundreds of photos of what these people looked like 80 years ago, before unhealthy foods were introduced.  The photos of these beautiful, vibrant people will blow you away, and make you reconsider what "normal" and "healthy" really is.  Sadly, it's hard to find examples of comparable levels of good health in those around us now.



Book Review: The China Study


The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term HealthThe China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health by T. Colin Campbell
My rating: 1 of 5 stars

I rate very few books 1 star.  This book deserves it because his thinking is flawed, his conclusions wrong, and most importantly, as a scientist he should know better!  He is well-aware of the difference between correlation and causation.  He even educates his readers on the differences, then turns around and makes faulty conclusions based on purely correlative data.  Crazy!  Furthermore, many of the studies he cites to try to prove causation didn't differentiate between saturated and trans fats.  And we know clearly now that trans fats have many of the negative health effects he blames on saturated fats from animal-based foods.  I won't provide links here, but if you are interested in reading very well thought out critiques of this book you don't have to go far.


Book Review: Diet for a New America


My rating: 2 of 5 stars

In my early 20's this book inspired me to shift my diet to a purely vegan diet.  I followed the diet religiously for 5 years, which I regret.  The book also inspired me to eat a whole foods, mostly organic and local diet, which I am thankful for.  His arguments for the health benefits of a vegan diet are deeply flawed.  He does, however, bring to light many of the moral and environmental issues our culture faces through its reliance on factory-farmed animal products.  I believe his moral convictions clouded his judgment on the health effects of animal foods, especially when those foods are raised and eaten as they have been traditionally, throughout our evolution as a species.

There is no evidence of any traditional society subsisting on a purely vegan diet for more than one generation, and that makes his recommendations potentially dangerous.  Starting a vegan diet after reproducing, or later in life, is probably not dangerous.  However, starting earlier in life, or before reproducing, can be potentially unhealthy for the individual and for any offspring.  The potential negative effects increase dramatically if those children are then fed a vegan diet.  Not only do we not have a cultural precedent demonstrating the long-term effects of a vegan diet, but there is no scientific study that has examined the health effects of a vegan diet on multiple generations.

Cholesterol, saturated fats in moderation, fat-soluble vitamins essential for growth and reproduction, and other nutrients not found in, or poorly-absorbed from plant foods, are essential to health.  These nutrients are found in easily-absorbed and metabolized forms in animal foods, and are especially important during the child-bearing years, breast-feeding months, and throughout the growth cycle from baby to child to teenager.

Thankfully, factory-farmed sources are not the only choice now, and most communities have access to local, sustainable farms that carry pasture-raised, grass-fed, organic choices.  Unfortunately, blinded by the moral atrocities that have taken place, Robbins cherry-picked the data and came to far-reaching, incorrect conclusions that are misleading at best and deceiving at worst.