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David Katz, M.D.

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Mind-Boggling Nutrition Guidance? You Betcha'!

Posted: 05/11/2012 8:07 am

The National Consumers League, claiming to represent consumers' interests, issued a press release this week announcing they had submitted a complaint to the FDA, asking the agency to banish NuVal from the nation's supermarkets. The group claims that NuVal cannot be credible because it generates some "mind-boggling" scores, and offers examples. They go on to say "NuVal's so-called nutritional ratings are a travesty."

So, for starters, I want to thank this group -- whomever they actually represent. Because they are very ably demonstrating exactly how NuVal does just what it was intended to do: tell the surprising truth about the nutritional quality of foods. If the truth weren't surprising, everyone would know it already -- and there would be no need for NuVal. But the truth is very surprising indeed -- and I thank the NCL for going out of their way to call attention to that.

That said, I do have some concerns about the NCL. For a group claiming to represent consumers, they sure have a long list of huge corporate sponsors. And doubts about their real agenda have been raised by others -- on more than one occasion.

It strikes me as odd that some 30 million consumers encounter NuVal in the nation's supermarkets every week, and far from complaining, they overwhelmingly love the system. In some cases, the results they are getting with it speak for themselves. These folks could complain to store managers all around the country with no help from NCL if they had concerns -- but they aren't doing so. Quite the contrary. So which consumers does NCL represent? Hmm...

But in any event, I want to thank them for showing just why NuVal, and SPECIFICALLY NuVal, is needed so urgently.

They are absolutely right that many of the scores are mind-boggling. And that's the very point! Nutrition guidance is needed because the food supply itself -- which spans some 800,000 foods! -- is mind-boggling. And when the objective truth is told about nutrition, it does, indeed, boggle the mind.

It boggles the mind that so-called canned peaches in "light syrup" report 19 grams of sugar on the nutrition facts panel for an 80-calorie serving! That's 76 of 80 calories from sugar, most of which is added. So, the package tells you these are peaches in sugar; really, it's sugar in a can -- with a bit of added peach. And, by the way, these peaches have half the fiber of their fresh counterpart -- where did the rest go, if not lost to processing? And, they declare 20 mg of sodium, when there is none in fresh peaches. So apparently, these severely sugared peaches are also lightly salted. You probably didn't know that -- but NuVal did.

Diced pears in light syrup? They declare 15 grams of sugar for a 70-calorie serving, so that's a bit better! Only 60 out of 70 calories are coming from sugar, most of it added. Still, this is sugar with added pears, really.

Mandarin oranges in light syrup report 20 grams of sugar, for a 90-calorie serving. That's 80 calories out of 90 from sugar, most of it added. NCL also fussed about canned green beans that scored poorly. Fresh green beans score 100, by the way, so do frozen green beans and green beans canned in water. The green beans in question were canned in salt water -- and the nutrition facts panel declared 270 mg of added sodium for a 25-calorie serving. That's over 10 mg of sodium for every calorie -- and is from nine to 16 times more concentrated in sodium than the diet should be overall! These beans are being very thoroughly pickled in brine, in other words. You might not have noticed that, but NuVal did.

You know the expression, "The devil is in the details." We use that expression in our culture because it's true. You can use the word "peach" to refer to a fruit, a frozen fruit, a canned fruit in juice, a canned fruit in syrup, a juice, a jam, or a candy. But it's the details -- the detailed nutrition facts -- that determine the actual nutritional quality. Fresh peaches score 99. So do frozen peaches. Stripped-down peaches floating in a sea of sugar water? Not so much.

Oranges score 100. Mandarin orange slices in sugar water? Not so much.

Pears score a 96. Diced pears in sugar water -- not so much.

Every low NuVal score highlighted by the NCL is correct. The reasons for it are available in the nutrition facts. But the problem is -- and I thank the NCL for pointing it out -- most shoppers don't get past the cover. If a product SAYS it's fruit, most consumers -- and apparently, the NCL, if their motives are honest -- simply believe it.

But NuVal doesn't "believe" anything. It uses a robust, vigorously tested, thoroughly validated, widely vetted, extensively applied, and independent algorithm to determine the truth. An algorithm that correlates with health outcomes -- including all-cause mortality. An algorithm shielded in perpetuity from industry or political influence. An algorithm that does what the NCL claims to care about: protect consumers. That's why it was built, and the only reason.

The truth is, some of what passes as "canned fruit" is really a more concentrated dose of added sugar than many candies. Consumers may not realize that. The NCL clearly doesn't. But NuVal is not fooled by what's on the cover. It ALWAYS reads the fine print. It's always ready to take on the devil in the details, so you don't have to.

The NCL doesn't just highlight the "mind-bogglingly" low scores of some canned fruits -- and to a lesser extent, the very occasional canned veggie thoroughly pickled in brine. They also complain that some of the foods they consider "processed" score slightly higher (although, frankly, not much!).

But here, too, there is good reason. A brownie mix that outscores the canned fruits has LESS added sugar than they do; added walnuts, which significantly bump up the score; healthful canola oil which bumps up the score; protein and fiber; and fortified wheat flour. Now, let's be clear -- the score of 22 this brownie mix gets is not high! NuVal very clearly indicates this is FAR from a health food! But yes, when the nutrition facts are weighed objectively, this is, indeed, slightly better than a can of concentrated sugar with some vestigial component of fruit.

When fruits or vegetables are processed in a way that preserves their native nutrition, the scores reflect that. Green beans canned in water -- like fresh green beans and frozen green beans -- score 100. Frozen strawberries, like fresh strawberries, score 100.

Millions of consumers are exposed to NuVal, and overwhelmingly love it. So let's consider that NCL might be representing the interests of some entity that doesn't love it. Who might that be?

Any entity that profits from consumer confusion about nutrition. I have no intention of pointing a finger, but I invite you to guess on your own.

Why come after NuVal specifically? If NuVal were truly flawed, this group wouldn't need to come after it. It's in front of millions of consumers, tens of thousands of dietitians, thousands of physicians and scientists. If it didn't work as intended, it would not take a gripe to the FDA to kill it! It would die, and quick, in the court of public opinion.

The very reason they've come after NuVal is because it is thriving there. Because it provides detailed, objective guidance -- somebody selling sugar water with essence of peach doesn't like. Because it has been endorsed by the American College of Preventive Medicine and other professional groups.

I hasten to add that NuVal is not, and cannot be, perfect. Out of the food supply's stunning total of some 800,000 foods, NuVal has scored roughly 100,000. We don't have perfectly accurate or complete nutrition data for every food in the food supply. Nutrition fact panels and ingredients lists can be wrong. Scores might be generated correctly, but can be posted incorrectly in a store. And so on. Nothing in life is perfect, and NuVal is not the one exception.

But like an iPad, or iPod, or iPhone -- it is really good. The best of its brand, by design. And like iPads and iPods -- subject to improvements over time. ONQI 2.0, an updated version of the algorithm that powers the NuVal system, is in the works and coming later this year. But don't expect to see the scores for essence of fruit in sugar water to go up!

As for the algorithm, the NCL has also complained that it's not "transparent." But did they expect to see it on a billboard somewhere?

The fact is, the ONQI algorithm is complex. Many people use iPads without reviewing the engineering blueprints; few are qualified to do so. Ditto for GPS systems. The ONQI is much the same. But the algorithm has been described in detail in peer-reviewed publications accessible to all. It has been made available in its entirety to research groups throughout the U.S., Canada, and the UK; to federal agencies in the US; to the Institute of Medicine; and to private entities that have requested such access.

Again, it's odd, if the NCL's motives are pure, that they didn't ask to review the algorithm -- they just assumed, because it wasn't on a billboard, that they couldn't. They also didn't express any of these concerns about scores to me, to NuVal, to members of the Scientific Advisory Board, or to the dozens of retail chains using NuVal. Without any prior discussion at all, they just sent their gripes to the FDA. It's odd, if your motives are pure, not to tell someone you've got issues and give them a chance to react -- before attempting to blow up their house.

When I worked more closely with my colleague, Kelly Brownell, he routinely quoted Ghandi, referring to his own work and the challenges it faced: "First they laugh at you, then they fight you, then you win."

Well, I guess they're done laughing at NuVal!

It is, indeed, mind-boggling that marinara sauce and salad dressings may contain more added sugar than many desserts. Mind-boggling, but true.

It is, indeed, mind-boggling that canned fruits can be so highly processed and stripped of nutrients that while they still get to be called by the original name, they bear no real nutritional resemblance to the "pure" food from which they are derived. Mind-boggling, but true.

It is, indeed, mind-boggling that canned vegetables may be a can of brine -- with essence of vegetable.

It is mind-boggling that "multigrain" breads may contain little, or even no, whole grain.

And if our federal agencies are inclined to condone such industry shenanigans, that is mind-boggling too.

It's the folks who brought you "Smart Choices" and "betcha' can't eat just one" who have cause to contend that NuVal is mind-boggling. But the simple fact is, when you have been fed a steady diet of marketing propaganda, the objective truth is so unfamiliar as to boggle the mind!

It's not the scores that are the travesty; it's some of the products being scored.

Is NuVal offering mind-boggling nutrition guidance? You betcha'! My thanks to the NCL for making note of it.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org


Dr. Katz is the Chief Science Officer for NuVal, LLC and directed the team that developed the algorithm used in the NuVal system.

For more by David Katz, M.D., click here.

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12:23 AM on 05/17/2012
Big Food is threatened by a nutritional guidance system that actually provides guidance. Sickening, processed, food-like products with colorful, false nutritional boasts fare well when meaningless nutritional labeling prevails. Nuval is brilliantly conceived--Katz and team have done all the work for you and there is no trickery. This is the first system that clearly distinguishes between canned sugary, salty essence of food and actual nutrient including food. Check it out.
06:53 PM on 05/14/2012
The broadly stated skepticism and resistance to the NuVal nutrition scoring system expressed in many comments on Dr. Katz’s article was quite remarkable. The weakness of the standard American diet seems to pale in comparison to our skepticism of outside authorities offering guidance on how we should eat.

I am a nutritionist and have studied the field of nutrition scoring systems. The more you know about the NuVal system, the more you will respect the quality of the thinking and the design of the system, perhaps most importantly, its independence from the food industry. There have been a number of food industry-sponsored systems, most of which have disappeared. All seemed to be based on the food industry mantra that “there are no bad foods.” Where do Twinkies fit on a good-better-best scale?

Based on the health results, few would accuse the food industry -taken as a whole- of putting the health of Americans as a top priority. While no one expects nutrition labeling to solve the health crisis, better informed consumers is surely part of the solution.

So, who do you trust more to create a system that collapses the complexity of human nutrition into a system that the average person can use to make wise food choices. The choice addressed in the article is between a bunch of university scientists; and the people who are responsible for the current food system and whose livelihoods rely on things staying pretty much as they are? You decide.
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HUFFPOST SUPER USER
shewolf2002
EDUCATION is a national security issue.
10:33 AM on 05/14/2012
Excellent article! Thank you.
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demisfine
Often correct, NEVER right.
10:17 PM on 05/13/2012
We have a rule - Only eat what my grandmother would recognize as food.
Meals don't HAVE to come in single serve packages.
Shop often, in small batches, and buy what you'll eat within two days.
No preservatives or flavor enhancers required.
12:29 AM on 05/17/2012
I agree with the caveat that Big Food, like the Big Bad Wolf, can fool granny. An "all natural" "multigrain" bread-like product can look just like actual food, even to granny. It is for this reason that a system like NUVAL, which ferrets out the trickery, is so essential .
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BigBearcatBill
This is the real Bearcat - a Binturong
09:37 PM on 05/13/2012
If everyone could stop eating the junk food for a few days, it would send a shockwave throught the conveniience store owners that would blow their minds, even would impress the real grocery store owners. Just to replace the needed calories and protein from stopping the junk food consumption would probably wipe out our stores shelves of good food and we would find out if America could actually meet the demand for nutritious food at reasonable prices for a long period. I am guessing of the calories consumed in America, half are from junk food and 40 years ago it was much less.
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Social Construct
Go left, young man.
08:20 PM on 05/13/2012
Perusing a page of the comments and rebuttals, I'm inclined to go with an old truism: The "truth" lies somewhere in between.

And, to expose my ignorance regarding the canning processes used in the contemporary food industry. My grandparents, and those before, canned fruits and vegetables at home using recipes that included sugar, salt, and other ingredients. My question would be in two parts:
1) How does home canning stack up, nutritionally, against industrial canning processes?
2) How is foods like fruits and vegetables "stripped" of nutritional value in the industrial canning, or home canning for that matter, process?
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demisfine
Often correct, NEVER right.
10:19 PM on 05/13/2012
Home canning is done with naturally ripened, fresh picked or purchased HAND selected fruits and vegetables.
The quality is controlled by someone intending to feed the people they love.
You've heard the phrase "Made with love"??
That's because the cook sincerely cares about their families enjoyment.
Not so with industrial production.
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Social Construct
Go left, young man.
10:39 PM on 05/13/2012
Thank you. However, I was meaning to ask for clarifications between the two in more a generalized 'science' type of answer. Also, I'm not sure of how others' home canning experiences are remembered, but it was the overripe and other less than ideal conditions of the fruit that made it necessary for preservation when my grandparents did it. Of course, good fruits and vegetables were also included. What you added certainly fills some gaps in my understanding.
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Social Construct
Go left, young man.
10:20 PM on 05/13/2012
Wow. Please forgive the blaring grammar errors.
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AlanBannacheck
President of the Deep Thoughts Association (DTA)
02:43 PM on 05/13/2012
The reason consumers aren't concerned is because if the box says "With added antioxidants" or "A boost of Vitamin C" they are eating healthy, at least in their minds. Perhaps food companies shouldn't be allowed to state things that aren't true. For example, Multivitamins are hardly absorbed in the body. You're better off getting vitamins and nutrients from actual food.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
02:08 PM on 05/13/2012
Lots of comments here from people veiled in anonymity: who are they, whom do they represent, and what are they selling? Lots of comments as well that simply assert opinion as if (a) anyone's opinion about nutrition is as good as any other- or of a multidisciplinary panel of top experts (http://www.nuval.com/science/origins) and (b) unsubstantiated opinion were a legitimate alternative to genuine evidence. For those inclined to look at the actual evidence base, here's where to start:

http://www.ncbi.nlm.nih.gov/pubmed/21496749
http://www.ncbi.nlm.nih.gov/pubmed/19928487
http://www.ncbi.nlm.nih.gov/pubmed/19928486
http://www.ncbi.nlm.nih.gov/pubmed/20181809
http://www.ncbi.nlm.nih.gov/pubmed/22406011
http://www.ncbi.nlm.nih.gov/pubmed/21356146

But really- why bother with peer reviewed publications when you can learn so much from proclamations by anonymous commentators with unknown agendas?
I-US
Beware the monsters lurking in word swamps.
11:03 PM on 05/13/2012
Thank you!
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henriette and hube
my goal is to live each day
02:51 PM on 05/14/2012
Dr. Katz, your last line cannot be said enough on HP.

fanned.....
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DrP
11:38 PM on 05/12/2012
Not that I agree with the NCL's arguments, but I agree that NuVal is completely flawed and should not be allowed in supermarkets.
10:34 PM on 05/12/2012
People ate just fine for hundreds of thousands of years without algorithms. "Tinkering" with the American diet is exactly what gave us trans fat. To attempt to reduce something as complex a nutrition to a single number is at best hubris and at worse reckless and irresponsible.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
01:56 PM on 05/13/2012
People ate fine for hundreds of thousands of years BEFORE hundreds of thousands of foods in bags, boxes, bottles, jars, and cans.

People also navigated fine using stars, and sextants- before hundreds of thousands of roads.

GPS is pretty handy in the modern landscape. NuVal is pretty handy in the modern foodscape. It is not designed to tinker with the diet- it is designed to guide people through it. It is, all but literally, GPS for nutrition.

As for your closing assertion about hubris and reckless irresponsibility: frankly, it reflects incredible hubris and reckless irresponsibility. If spinach is more nutritious than marshmallows, then food can be stratified based on overall nutritional quality. The fact that you don't know how to do it does not indicate it can't be done. The fact that ANYONE can do when foods are chosen from the extremes of the range indicates, clearly, it CAN be done- it just requires considerable sophistication to do it across the full expanse of the food supply.
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demisfine
Often correct, NEVER right.
10:22 PM on 05/13/2012
Fanned for sharing details that are hard to read, but very important to digest and understand.
I'm an informed grocery shopper. I read every label and know why I'm making the choices I make.
But there is always more to learn.
I am especially angered by the newly expanded "Yogurt" selections in all dairy cases.
More than three quarters of the offerings are glorified pudding.
No live cultures and TONS of sugar added.
HUFFPOST SUPER USER
DrP
11:39 PM on 05/13/2012
Why not just advise people not to buy or consume anything that comes in a bag, bottle, can or other package with an ingredient list? That seems pretty simple and is the way I shop and eat. Fresh meat, produce (green, non-starchy veggies), full-fat dairy and eggs and I don't have to pay any attention to NuVal or any other nutritional "rankings."
12:46 PM on 05/14/2012
Yes it took humans to ruin the food we eat, to market to other humans that it was "good" and packed with vitamin C (aka Sugar), and to sort out what we have and haven't ruined.

A third party reducing it to a number is better than the marketer of the product you may or may not buy stamping "yep its healthy!" on the bright eye-catching label with cartoon characters.
Genders
Love, Tolerance, Enlightenment
06:20 AM on 05/12/2012
Sorry, just becase a bad fake consumer group is against, does mean NuVal is a good idea.

"The fact is, the ONQI algorithm is complex. Many people use iPads without reviewing the engineering blueprints; few are qualified to do so. Ditto for GPS systems. The ONQI is much the same. But the algorithm has been described in detail in peer-reviewed publications accessible to all. It has been made available in its entirety to research groups throughout the U.S., Canada, and the UK; to federal agencies in the US; to the Institute of Medicine; and to private entities that have requested such access."

not so. it is proprietary, and I bet it depends on the contributions you make.....

People and their situations, are too differences to rate food with a single 0-100 number.

Your other facts about foods don't relate to this system. Nor does this NuVal system reveal any of those faults.

You are just selling your product.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
08:33 AM on 05/12/2012
People do differ- but the dietary guidelines and the DRIs from the IOM are for the entire population, other than those who require truly prescriptive diets. There is ample allowance for customization and variation on the theme of the dietary guidelines- but with rare exception, more vegetable consumption is good, more soft drink consumption is bad. If you disagree with that, meaning no disrespect, you are wrong.

NuVal honors the same principles- and relies on both the Dietary Guidelines and the DRIs- to identify the 'more nutritious' foods in general. Spinach gets 100, a Pepsi and a Coke get a 1. Do we really need to consider for WHOM when we say spinach is very nutritious, and soft drinks not so much?

But of course, that's obvious. The real value of the system resides in the stratification of the less obvious. Two pasta sauces may have jars that look almost identical- but scores deciles apart call attention to the copious addition of sugar in one, absent from the other. We know the scores bring attention to what was formerly overlooked, based on sales data from hundreds of supermarkets.

The 'one size does not fit all' mantra about nutrition is exaggerated. We don't protest the fact that all lions should eat meat, all koalas should eat eucalyptus leaves. Like all species, our own dietary requirements reside in a biology which is fundamentally shared. For more on that, see: http://www.huffingtonpost.com/david-katz-md/holistic-nutrition_b_842627.html
10:49 AM on 05/12/2012
The IOM is not infallible. Read their discussion of carbohydrates, for example. They acknowledge that physiologic levels of ketones are not harmful, yet they arbitrarily set the DRI for carbohydrates at 130 gm/day to prevent ketosis. The actual dietary requirement for carbohydrate is zero.

Those who require prescriptive diets include anyone who has insulin resistance. They need to restrict carbohydrates and they are a huge proportion of the population. While the evidence that sugar and refined carbohydrates directly cause IR is still not conclusive, it is at least as compelling as the notion that salt consumption causes hypertension. Salt is a necessary dietary requirement but carbs are not. Why not, out of an abundance of caution, does the IOM not make a proscription against sugar and, at least refined carbs while they are quite happy to advise reduced salt intake? Because the IOM is comprised of "experts" who are part of a nutritional science/agri-food complex that is just as corrupt and venal as the military/industrial complex. Foods made with sugar and refined carbohydrates are the economic mainstay of the agri-food industries who support the research and other activities of these "experts". They aren't going to bite the hand that feeds them. For evidence of that, just look at the DRI for carbs.
Genders
Love, Tolerance, Enlightenment
02:34 PM on 05/12/2012
It's a secret formula! Get real.

Is soda bad for a soccer player during the game? Would spinach really be better?

Is soda bad because of sugar?

Or because of corn sugar specifically?

Is GMO vegetables better than natural ice cream, assuming you are not obese?

One size does not fit all is if anything under appreciated.

Some people can't tolerate milk, nuts or citrus will kill some people.

Who pays Nuval?

Where does the money come from?
01:15 AM on 05/12/2012
The NCL was founded in 1899 and was an early advocate of better working conditions and fair wages for American workers. It is a non-profit which gets support from a broad spectrum of corporate sources including Microsoft, Bell Atlantic, tire manufactures, wireless providers and some drug companies. The amounts are surprisingly small, however.

The innuendo is made here that because they have corporate sponsors they are seriously compromised when it comes to criticizing a nutritional program like NuVal. I am sorry but I don't buy it (especially coming from somebody who has taken money from Hershey, Quaker Oats, Juice Plus, etc etc). If I hadn't looked for myself I would have assumed from the slur in this article that major food producers were behind NuVal. They are not. Therefore I don't see a corrupt motive for their criticism.

I also don't buy the NuVal approach which enshrines some of the common misconceptions about what is healthy and what is not. We have known for a long time that cholesterol from your diet does little to influence your lipid profile yet they use this as part of the negative scoring. More recent evidence is telling us that our fear of saturated fat is unfounded. It too receives a negative rating. The science around salt consumption is deeply equivocal, yet it, too, is included. There are big problems in the NuVal approach IMHO.
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05:09 PM on 05/11/2012
This is the first I've heard of NuVal. Then I realized that none of the stores I shop in participate.
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HUFFPOST COMMUNITY MODERATOR
ConfuciusSay-
Aglets: their purpose is sinister.
04:04 PM on 05/11/2012
It would not be unhelpful if the article contained a short outline of what NuVal actually IS at the start.
07:09 PM on 05/11/2012
All you have to do is click the hyperlink in the first sentence. I didn't know what NuVal was either, but it didn't take long to find out.
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David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
07:45 PM on 05/11/2012
The context wasn't entirely conducive, but you are quite right. NuVal is a nutritional scoring system that assigns a value between 1 and 100 to all foods in a supermarket, the higher the number- the more nutritious the food. It relies on the Overall Nutritional Quality Index algorithm, which was developed by a dozen of the top nutrition and public health experts in North America, who worked with me on it for a period of roughly two years. The algorithm incorporates roughly 30 nutrient entries- and each nutrient is weighted for its specific health effects. The scores have been shown, in a Harvard study of 100,000 people to correlate with important health outcomes, including all-cause mortality. Scores are in some 1650 supermarkets in 31 states, coast to coast. They go on the shelf tag, right next to the price. Over 100,000 foods have been scored.

The links I provide in the column, and www.nuval.com, provide considerable, additional detail.
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TheHandyman
Death...the last new experience you will ever have
09:24 PM on 05/11/2012
Thanks for taking the time to clear that up!
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DrP
11:40 PM on 05/12/2012
Based on cherry-picked data and confusing association with cause and effect. How about guidelines based on real science.