Healthy planet eating - How lower meat diets can save lives and the planet
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Healthy planet eating
How lower meat diets can save lives and the planet
istock
Friends of the Earth October 2010
1
CONTENTS
Executive summary 3 About this research
Having investigated the environmental
introduction 4
implications of a range of dietary options
HOW MEAT CONSUMPTION HAS RISEN in 2009’s Eating the planet? report,
OVER THE LAST 50 YEARS 6 Friends of the Earth commissioned
Defining 'meat' 7 Oxford University’s British Heart
Foundation Health Promotion Research
the health impacts of Group to analyse their likely impact on:
excess meat consumption 8 • specific health conditions
How would reducing meat consumption improve health? 8 • mortality figures
Cancer 10 • NHS expenditure
Heart disease and stroke 12
Obesity 13
The meat and dairy content of the diets
Premature death 14
investigated ranged from the high meat
ALL MEAT IS NOT THE SAME 15 diets most common in western countries
to a lower level of meat and dairy
calls for change 17
consumption that could be produced
Tracking what we eat 18 without eating into the planet’s natural
We eat what we are told 19 resources, while allowing consumption
HOW MUCH IS ‘LESS’ MEAT? 20 growth to sustainable levels in developing
countries.
NUTRIENT INTAKE 21
Nutrient 21 This report summarises the key
Protein 22 findings of this analysis and presents
Iron 23 a comprehensive literature review
Children 24
of existing studies on the health
The elderly 24
Low income groups 25 and environmental impact of meat
consumption.
RECOMMENDATIONS FOR A HEALTHIER BALANCE 26
REFERENCES 27 It concludes with a series of
recommendations for healthy and
sustainable diets and the policy shifts
needed to drive changes.
Acknowledgements Friends of the Earth October 2010
Research by Patricia Thomas. Modeling by Mike Rayner, Dushy Clarke and
Pete Scarborough, British Heart Foundation Health Promotion Research
Group, Department of Public Health, University of Oxford.
The key findings of this report are based on research by Oxford University: Modelling
the impacts of the Fair Less Meat diet. This research, including the modelling and
methodology, is available at www.publichealth.ox.ac.uk/bhfhprg/publicationsandreports
2
Executive summary
We are producing and consuming We could prevent 45,000 early deaths Clear standards should be introduced to
increasing quantities of meat and dairy. and save the NHS £1.2 billion each year ensure that meals paid for by taxpayers
This is taking its toll on the planet and on if we switched to diets that contain less in schools, hospitals and care homes
our health – and very little is being done meat in the UK. reflect environmental and health factors
to tackle it. and reduce reliance on meat and dairy in
Lower-meat diets could cut deaths from menus.
The livestock industry is one of the heart disease by 31,000, deaths from
most significant causes of global cancer by 9,000 and deaths from strokes The Government should shift support
environmental damage – generating by 5,000 each year. from factory farming to the production
a fifth of the world’s greenhouse gas of better-quality meat and a healthier
emissions. The UK’s reliance on imported There is clear evidence of a link between overall food production balance.
protein crops is also driving deforestation high meat diets and a higher incidence
in South America. This is having a of bowel cancer and heart disease with Grass-fed meat and dairy products are
devastating impact on the people who’ve some evidence of a link between high healthier and more planet-friendly than
lived on the land for centuries. meat diets and other cancers, diabetes factory farmed options. They should
and obesity. be clearly labelled for consumers. This
Friends of the Earth and Compassion in would help people make more informed
World Farming’s 2009 research Eating Processed meat is more damaging to food choices and stimulate the market for
the Planet? showed that a move to lower- health than unprocessed meats. these products.
meat diets in the West would help protect
natural resources and enable us to move Grass-fed beef has nutritional Friends of the Earth is calling on the
away from factory farms and damaging advantages over grain-fed options. Government to implement these changes
intensive crop production.1 It would also within the framework of a Sustainable
allow for fair global food distribution and The nutritional value of some meat has Livestock Strategy.
nutritious diets for people in developing decreased as a result of modern farming
countries. methods. A standard supermarket
chicken now contains significantly less
This new research reveals how this diet protein and more than twice as much fat
could deliver a fairer deal for people, as in 1970.
animals and the planet and analyses its
likely impact on the health of people in Key recommendations
the UK. It also reviews existing evidence There is an undeniable need for
on the relationship between meat and widespread adoption of healthier and
dairy consumption and health. It outlines more sustainable diets and more
the action needed to transform the UK’s research is urgently needed to identify
food and farming sector into one that the best mechanisms for change.
would work for people and the planet.
Existing healthy eating and
Key findings environmental behaviour guidelines
Over the last 50 years the quantity of should be modified to include the benefits
meat produced around the world has of eating less meat.
quadrupled while the global population
has doubled.
3
introduction
Meat and dairy products form the In the media the issue has been over-
centrepiece of most meals in the UK. simplified and distorted.
Factory-style production and heavy For example, in October 2009 climate
subsidies have made them plentiful and change expert Lord Stern observed that
cheap in Europe and America. the environmental impact of a meat diet
Our increasing consumption – of meat was higher than that of a vegetarian diet.
in particular – is prompting concern over His comment was interpreted in reports
the impacts on people’s health and on as “people will need to turn vegetarian if
the environment. But calls for changes to the world is to conquer climate change”.3
diets and farming methods have tended Similarly, in January 2009 a plan to
to produce a polarised and often ill- reduce the amount of meat served
informed debate. in hospitals to healthier and more
This report aims to throw fresh light on sustainable levels was included in an
the stalemate. It does so by presenting NHS carbon reduction strategy.4 The
evidence on the health benefits of proposal focussed on reducing meat,
switching to lower-meat diets. rather than cutting it out entirely, and
sourcing local produce, but was reported
A cultural challenge as a “removal” and a “ban” on meat and
There is little doubt about the science. was criticised in the media.5 The plan was
In the West we eat far more meat than subsequently scrapped.
is necessary or healthy. Health experts Ironically, we are more prepared than
say this is contributing to rising levels of ever to throw meat away6. Historically
chronic diseases such as coronary heart regarded as an indicator of affluence
disease, cancers and strokes. and, for many, a treat, meat is now
Such findings have led to calls for artificially cheap and plentiful. The
nutritional advice to be revised to growing quantities wasted suggest that,
encourage a reduction in total meat along with other food groups, meat has
intake and discourage meat and dairy become a throwaway commodity.
that is high in fat – particularly saturated So our attitudes towards meat are
fat – and salt. Instead, small amounts of complex. What is clear is the damage
better-quality fresh lean meat would be that increasing consumption is doing to
recommended.2 the environment and people.
Yet such thinking is not reflected in any
UK Government guidelines or advice on Environmental and social damage
healthy eating. Changing our concept Meat and dairy production – now
of an average healthy diet is proving a responsible for a fifth of global
challenge. greenhouse gas emissions – is predicted
In the UK there tends to be an all- to double by 2050.7 This is incompatible
or-nothing approach to meat eating, with the need to cut emissions by at least
with little recognition or understanding 80 per cent in the same period to prevent
of the concept of a low-meat diet. It’s the worst effects of climate change. 8
telling that, while people who eat no UK factory farms are also driving
meat are identified and identifiable – as deforestation and ruining lives overseas.
vegetarians – there is no commonly Vast areas of forest and wildlife in South
accepted term for people who eat meat America are being cleared to grow the
only a few times a week. protein needed to quickly bulk up millions
Attempts to raise awareness of the of animals each year. This is forcing local
benefits of lower-meat diets and to people off their lands and into hunger
change diets have proved controversial. and poverty.
4
istock Martino/Panos
Eduardo
Cattle farm in the Brazilian Amazon
An alternative and distribution are as compelling as the • reducing the burden of diet-related
There is already evidence that environmental imperatives. disease on the NHS
consuming less meat would be good for This report adds to the evidence by • helping to create a thriving and planet-
the environment and would help feed a presenting modelling on the impact of a friendly UK farming sector.
growing population. lower-meat diet on people’s health and This report sets out what the
In 2009 Friends of the Earth and NHS budgets. It also reviews: Government needs to do to encourage
Compassion in World Farming published • evidence of the health impacts of high healthy and sustainable diets and food
Eating the planet?, a groundbreaking meat and dairy consumption production.
report which demonstrated that we can • the difference between good and bad Grasping these opportunities would
feed a growing global population without meat transform the UK into a model for
destroying the world’s natural resources • examples of healthy alternative eating healthy, sustainable food production and
or relying on factory farms – and we don’t advice and plans. consumption that, if adopted by the rest
need to give up meat. Eating less meat is not a silver bullet of the world, would help ensure a fair
The modelling in Eating the Planet? that will deliver healthy eating and share of the world’s food resources for
showed that by adjusting our diets we living. But a growing body of evidence everyone.
could feed a global population predicted shows that we should get the majority
to be 9 billion by 2050. Rearing animals of our nutrients from fresh fruits and
for food uses far more land, energy and vegetables, whole grains and pulses,
water than growing crops to provide with only small amounts of meat, dairy
people with the same number of calories. and fish as additional sources of protein.
A diet containing no more than three Recommendations on fish consumption
portions of meat each week would take when stocks are under threat are beyond
pressure off the land and the climate. the scope of this report but are covered
The diet outlined in Eating the Planet? by Greenpeace and Sustain.9 10
would mean a significant reduction in Such a diet has many benefits
meat eating in the West, yet it would including:
allow for more meat to be eaten in • reducing the livestock industry’s
developing countries where there are environmental impact – including on
high levels of malnutrition. There are climate change
as many obese people in the West • improving the health and wellbeing of
as there are malnourished people in people in the UK, and indeed the rest of
poorer countries: the health and justice the world
arguments for changes to food production
5
HOW MEAT CONSUMPTION HAS RISEN OVER
THE LAST 50 YEARS
Over the last fifty years there has been a middle class,14 although it is still well of the modern animal husbandry and
dramatic rise in global meat consumption below European and US levels. Meat livestock farming practices. These
with the growth in the global livestock consumption in China, for example, has developments allow us to produce
population far outstripping that of the gone from an average of 20 kg per capita staggering amounts of meat and milk
human population. in 1980 to 52 kg in 2008.15 Although in on relatively small parcels of land, and,
Between 1961 and 2008 the world India meat consumption has grown by 40 because animal foods are rich in protein,
population increased by a factor of 2.2,11 per cent in the 15 years to 2007, it is still as a boon to human health.
but total meat consumption quadrupled 40 times less than average consumption But the World Health Organization
– from 71 million tonnes to 280 million in the UK. (WHO) is among many organisations
tonnes – and poultry consumption Between 1961 and 2008 the to suggest that in the West we now
increased 10-fold – from 9 million tonnes consumption of dairy products has consume considerably more protein
to 91 million tonnes.12 doubled – from 344 million tonnes to than is considered necessary or optimal
According to the most recent data on 693 million tonnes.16 Dairy products are for health.17 At the same time it is clear
meat eaten per person – from 2002 – the a good source of protein and a major that the population explosion in livestock
United States leads the developed world source of calcium in the West. Dairy has not eased world hunger. In fact,
in meat consumption with each American can also be high in fat and saturated fat. with nearly a billion people starving, a
eating an average 125 kg of meat a year. However in response to public health question mark hangs over how rational,
Per capita meat consumption in Europe campaigns to encourage lower total or ethical, it is to feed such a large
averaged 74 kg, while the average UK fat and saturated fat in the daily diet, proportion of edible grains and proteins
citizen consumed 80 kg13 – equivalent to there has been a substantial switch to to animals.
1,400 pork sausages each year, or nearly consuming more low-fat products over It is only recently that we have begun
four a day. the last 20 years. to quantify the human health and
Demand is also growing in some The abundance of meat and dairy in environmental consequences of this
developing countries as a result of our diets is seen as an indication of our exponential growth in livestock production
rising incomes and a growing urban increasing affluence and as a triumph and consumption. The Friends of the
istock
6
Earth reports Eating the Planet?18 and The global spread of intensive farming greenhouse gas emissions – including
What’s Feeding Our Food?19 show has led to a major increase in the 9 per cent of man-made global carbon
that these burdens are both increasing diversion of cereals and other grains dioxide (CO2) emissions and 37 per cent
and unsustainable and there are now away from the human food chain and into of anthropogenic methane.24
numerous pressing reasons for adopting animal production. For instance, today These are excesses – in pollution
a lower-meat diet. 97 per cent of the soymeal and 40 per and resource use – that the world
Compared to growing crops for direct cent of cereals produced worldwide are cannot support over the long term. But
consumption, rearing animals for food used for animal feed. environmental excesses are not the only
uses large areas of agricultural land, Animals’ feeding requirements mean impact of rising livestock consumption.
vast quantities of water and significant that livestock uses 70 per cent of all Studies into human health are
amounts of energy. It is a cause of available agricultural land, and uses 8 per beginning to show that, in the same way
deforestation and land use change, cent of the global human water supply.23 that excess fat and excess sugar in the
generating greenhouse gas emissions With growth in demand for livestock diet can be detrimental to health, excess
and destroying valuable carbon sinks and products set to continue, more land and meat consumption can have profoundly
wildlife habitat. The livestock industry more water – and more food that could negative consequences for our health
is also a significant drain on energy be consumed directly by humans – is including higher rates of heart disease,
resources: growing grain for livestock being turned over to feeding livestock, stroke, cancer, and premature death.
requires large energy inputs in terms further exacerbating the associated At the same time it is becoming clear
of fertilisers and pesticides. It is also a impacts. that all meats are not the same in terms
significant source of pollution.20 Because of all these inputs, the of their impact on health. As the science
The economic burden of animal food contribution of animal farming to the has become more sophisticated and
consumption is also high because of production of greenhouse gases and begun to differentiate between fresh
the large amounts of grain that need climate change is substantial. The meat and that which is preserved or
to be grown to feed farmed animals.21 United Nations Food and Agriculture highly processed, data now shows that
One kilogram of intensively-reared beef Organization (FAO) estimates it is the greatest negative impact on health
requires up to 10 kg of animal feed.22 responsible for 18 per cent of global comes from consumption of the latter.
Defining 'meat'
In terms of sheer volume of raw materials ‘bad’) fats and carbohydrates and this refers to poultry and sometimes fish.
and goods, modern farmers and food knowledge has been incorporated into In the scientific literature and in this
producers are highly productive. Human healthy eating guidelines. report, processed and preserved meat
beings have made substantial gains Just as there are ‘good’ and ‘bad’ are defined as any meat preserved by
in health and longevity thanks to this fats and carbohydrates it is increasingly smoking, curing or salting, or with the
productivity.25 However this abundance becoming acknowledged that there are addition of chemical preservatives, for
has not benefitted mankind universally also ‘good’ and ‘bad’ meats. example bacon, salami, sausages, hot
– 925 million people worldwide are In very early studies of meat intake dogs or processed deli or luncheon
undernourished due to lack of access to little distinction was made between meats (including some white meats such
good food in sufficient quantities.26 different types of meat, indeed ‘meat’ as turkey and turkey ham). This type of
In addition, much of the abundance has no common definition in scientific meat often contains a number of harmful
we enjoy is in the form of high fat, high research. More recent studies, substances including heterocyclic amines,
sugar foods which are energy intensive to however, have begun to make important polycyclic aromatic hydrocarbons,29 and
produce27 and also damaging to health.28 distinctions between fresh and preserved/ N-nitroso compounds30 formed in the
Rising rates of obesity and chronic processed meats and between red and high temperature cooking of meat. The
diet-related diseases suggest that in the white meats. nitrate and nitrite preservatives added
midst of this abundance means we have In general, the term ‘red meat’ refers to to processed meats are also known
‘forgotten’ how to discriminate. Science beef, lamb and pork; as a broad category precursors to N-nitroso compounds (see
is helping us to relearn this skill. We it includes both fresh and processed/ All Meat is not the same, page 15).
now understand the difference between preserved meats. ‘White meat’ is less well
healthy and unhealthy (or ‘good’ and defined but in scientific research usually
7
new research
THE HEALTH IMPACTS OF EXCESS MEAT CONSUMPTION
The health effects of reduced meat Yet studies show that excess meat in This requires strong, clear,
consumption are becomming well general, and preserved and processed unambiguous guidance from health and
established in the scientific literature. As meats in particular, can add high amounts food policy makers. As the data on the
the study populations themselves have of fat, saturated fat and salt to the diet. harmful effects of consumption of excess
become larger and as the methodology The most important health impacts of meat continues to amass, the case
of such studies has become more excess fat and sodium include increased becomes stronger for a thorough re-
sophisticated, the weight of the evidence risk of heart disease, stroke and cancer, evaluation of healthy eating guidelines.
has grown. A valuable picture has as well as an increased incidence of
emerged of how the balance of meat and obesity and premature death. How would reducing meat consumption
dairy and other foods in our diets can act In contrast, diets where plant-based improve health?
to improve or harm health. elements dominate are associated with New research carried out by Oxford
Much of the early data on diet, lower body weight,32 greater longevity33 University’s British Heart Foundation
lifestyle and health came from studying and a lower rate of certain chronic Health Promotion Research Group for
vegetarian lifestyles. Other data comes diseases especially diabetes, heart Friends of the Earth used the DIETRON
from long term observational studies disease, and some cancers.34 modelling system to analyse the health
which look at what people eat and what The cost to the NHS of diet-related implications of a range of diet scenarios.36
diseases they develop over time. illness is estimated to be twice that of car, It concluded that switching from current
Still more comes from intervention train and other accidents and more than diets to a diet that contains two or three
studies where people who are suffering double that of smoking.35 Diet-related meat meals each week and a small
from a chronic illness or who are at high illnesses, however, can be prevented. amount of dairy each day would prevent
risk of illness are switched to more plant- It has been estimated that the NHS 45,361 deaths each year (see graph).
based diets. could save around £6 billion a year if
Such data highlights the health the excesses and inadequacies in our Table 1: Change in cost to the
properties of a diet high in fruits, current diets could be addressed in the 2006/07 NHS budget (baseline 2007 UK diet)
vegetables, unrefined grains and same proactive way adopted to address
Disease Current Less Fair Less
pulses and moderate amounts of meat the health impacts of smoking. New
diet trends Meat Meat
equivalents such as soy. Studies show modelling carried out by Friends of the
CHD +£0.05bn -£0.57bn -£0.80bn
that those who eat little or no meat and Earth shows that widespread adoption
Stroke +£0.00bn -£0.07bn -£0.10bn
dairy are often healthier than the general of lower-meat diets could prevent 45,000
Cancer +£0.02bn -£0.20bn -£0.30bn
population.31 deaths and save the NHS £1.2 billion
Total +£0.07bn -£0.85bn -£1.20bn
However, it is a mistake to place too each year – see graph 1B.
narrow an interpretation on these studies.
There is firstly a tendency, particularly
A note on the diets
in older studies, to group all vegetarians
and vegans together even though there These diet scenarios are based on Friends of the Earth and Compassion in World Farming’s
are important differences in nutrient 2009 report Eating the planet? which analysed different diet options and farming methods to
assess their impact on global food production and the feasibility of feeding the estimated
intake between a strict vegan diet, a strict
population in 2050 – nine billion.
vegetarian diet, a lacto-ovo-vegetarian
diet (which allows milk and eggs) and a ‘Current diet trends’ reflects the level of meat and dairy that will be eaten in the UK if
lacto-ovo-pesce vegetarian diet (which trends around increasing consumption are projected into the future.
allows dairy, eggs and fish). In addition ‘Less meat’ is based on satisfying growing food and nutritional demands with a lower meat
to eating few or no animal products, diet with 30 per cent of protein from animal products.
vegetarians and vegans also tend to
‘Fair less meat’ assumed a fair distribution of nutritionally sufficient diet that allows for meat
practice other healthy activities that
2 or 3 times each week and some dairy each day.
contribute to their overall level of health,
including taking more exercise and In place of the contribution of meat and dairy, the ‘Less Meat’ and ‘Fair Less Meat’ diets include
smoking less. more fruit and vegetables, and an increase in the amount of starchy carbohydrates. These
changes, in combination with a reduction in saturated fat from meat and dairy and a reduction
in salt from processed meats, are responsible for the predicted changes in health outcomes
displayed in graph 1b and table 1. With a reduction in food waste and more fair food distribution
and diets, this scenario would feed the world and allow for planet-friendly farming methods.37
8
Graph 1B: Change in annual mortality by cause
(baseline 2008 average UK diet)
45,361
Current diet trends
Less Meat
Fair Less Meat
32,352
31,094
22,149
lives saved
8,920
6,176
5,346
4,027 4,610
3,083
1,610 2,321
1,552
1,077
50 464 379
Total deaths CHD Stroke Total cancer MLP cancer Oesoph. cancer Stomach cancer Lung cancer
202 491 102 292 147
increase
in Deaths
2509 1817
9
how meat consumption affects health
Cancer
The relationship between diet and cancer of developing bowel cancer by 63 per Breast Cancer
has become increasingly clear over the cent. The report went on to recommend A 2006 study which followed more than
last few decades. Cancer is responsible limiting overall consumption of red meat 90,000 premenopausal women for 12
for 7.4 million deaths globally each to between 300 g (11 oz) - 500 g (18 oz) years50 found that, compared with those
year, about 13 per cent of all deaths.38 a week – equivalent to around 2 ounces who eat three or fewer servings per week,
The WHO estimates that 30 per cent daily – very little if any of which should women eating three to five servings of red
of cancers in the developed world (and be processed meat. This compares to meat weekly have a 14 per cent higher risk
20 per cent in developing countries) are the current UK level of consumption of a hormone-dependant breast cancer,
caused by dietary factors. In the UK it of around 190 g (6.6 oz) each day, while those eating more than five servings
is estimated that 26 per cent of cancers according to the latest National Diet and a week have a 42 per cent increased risk.
could be prevented by altering diet.39 Nurition Survey.45 Two of the largest studies so far,
How meat intake causes cancer is the pan-European EPIC study51 which
Colorectal cancer still not completely understood. There followed more than 300,000 women and
The relationship between diet and is, for example, no strong association the US AARP Diet and Health study52
cancer is particularly strong for colorectal between high fat intake and bowel which followed more than 188,000 women,
(bowel) cancer. In 2005 a European cancer risk independent of meat intake.46 have also found that that those who
study involving more than a half a million One Swedish study, for instance, found eat the most saturated fat have a small
people found that, amongst people who that women consuming the highest increased risk of breast cancer.
regularly ate more than two portions of amounts of full-fat dairy products There are several ways in which meat
red and processed meat a day, the risk of had a significantly lower risk of bowel intake could affect breast cancer rates.
developing bowel cancer was 35 per cent cancer,47 and a randomised trial found Some observers suggest it is the result
higher than for those who ate less than that switching to a low-fat diet offered of increased fat intake from red meat and
one portion a week.40 no significant protection against the dairy.53 It has also been suggested that
The conclusions of this study are disease.48 high dietary fat intake may increasing
in line with the results of three meta- Instead it has been suggested that circulating levels of oestrogen and other
analyses,41 42 43 which show a 20-30 per the contaminants and additives such hormones.54 The association between
cent increased risk of bowel cancer in as nitrates in processed meat may be dietary fat and breast cancer, however,
those eating 100-120 g/day of red meat influential (see page 15). remains controversial55 and not all studies
and up to 50 per cent increased risk of The heme iron component of red meat show a link.56
bowel cancer in those eating 25-30 g/day (see page 23) is also associated with
of processed meat. the generation of free radicals, highly Stomach and Bladder Cancer
The broadest and most authoritative reactive molecules that can cause the Some,57 but not all,58 data links meat intake
report on the link between meat and kind of cellular damage and mutations with bladder and stomach cancer and
bowel cancer, however, comes from known to influence cancer and other this, research suggests, may be related
the World Cancer Research Fund diseases. less to fat and more to the additives and
(WCRF) which, over the last decade, Any or all of these mechanisms may contaminants in many red meat products.
has forensically reviewed all the come into play, and even though the In a 2010 study of over 300,000 men
available studies to date on the possible mechanisms are not fully understood, and women, those whose diets had the
relationships between meat and dairy the strength of the evidence was such highest amount of total dietary nitrite (from
intake and cancer.44 that the WCRF recommendation to limit all sources including meat), as well as
The WCRF report found convincing red meat was quickly incorporated into those whose diets had the highest amount
evidence that eating more than 500 g of UK Department of Health guidelines, as of nitrate plus nitrite from processed
red meat each week significantly raised well as being recommended in a recent meats, had a 29 per cent increased risk of
the risk of bowel cancer. In particular Cabinet Office report on food policy.49 developing bladder cancer.59 (For more on
eating 150 g of processed meat a day Although the evidence is strongest for additives in processed meat see page 15).
(equivalent to three sausages or three colorectal cancer, other cancers have also
rashers of bacon) increases the risk been associated with high-meat diets.
10Dairy and cancer – equivalent to that found in three cups In a 1998 Harvard study men who
Links between dairy products and cancer of milk per day – were associated with a drank two or more glasses of milk a day
are less conclusive. The WCRF found modestly higher risk of ovarian cancer, were almost twice as likely to develop
that data for the relationships between compared to those with the lowest advanced prostate cancer as those who
milk and dairy products and cancer was intakes.61 The study did not find any didn’t drink milk at all.64 The association,
either “too sparse, too inconsistent, or association between overall milk or dairy however, appeared to be with calcium
the number of studies too few to allow product intake and ovarian cancer. itself, rather than with dairy products in
conclusions to be reached”.60 Likewise, some researchers have general.
Some components of dairy products hypothesised that modern industrial Another more recent analysis of the
have been linked to specific cancers milk production practices have changed same group of men found that those
but it is not clear what would make one milk’s hormone composition in ways that with the highest calcium intake – at least
person more vulnerable than another. could increase the risk of ovarian and 2000 mg a day; well in excess of daily
For example, high levels of galactose, other hormone-related cancers.62 More recommended levels – had nearly double
a sugar released by the digestion of research, however, is needed to confirm the risk of developing fatal prostate
lactose in milk, have been linked to this. cancer as those who had the lowest
ovarian cancer. The association is not The Western diet relies on milk as a intake (less than 500 mg per day).65 But
absolute, but in a recent analysis of major source of calcium. In men a diet again, more study is needed to confirm
12 studies, which involved more than high in calcium has been implicated as a this finding.
500,000 women, high intakes of lactose risk factor for prostate cancer.63
Cancer protective foods
istock
Certain diets, for instance those with cancers,74 75 as well as some types of
high intake of fruits and vegetables, are stomach cancer.76 But it has also found that
cancer protective. Eating beans, peas fruit and vegetables are unlikely to reduce
or lentils at least twice a week has been the risk of breast, prostate, ovarian or
associated with a 50 per cent lower risk kidney cancers.77 78 79
of bowel cancer compared to those who Healthy fats, such as those found in
never eat these foods,66 whereas the risk oily fish may be protective. In one study
of developing the disease increases for the risk of bowel cancer decreased by
those people who have a low-fibre diet.67 30 per cent amongst people who ate one
Studies have found that people who eat portion or more of fish which contain
the most fruit and vegetables can lower essential fatty acids every other day
their risk of cancer by around 25 per cent compared to those who ate fish less
compared to those who eat the least.68 than once a week (this study also linked
69 70
Specifically, including plenty of fruit low fibre intake to development of the
and vegetables in the daily diet has disease).80 However not all studies show
been shown to reduce the risk of mouth, a generalised benefit from increased
oesophageal and laryngeal cancers by essential fatty acid consumption for all
around a third71 72 and the risk of lung types of cancer.81 82 Many trials, however,
cancer by around a quarter.73 use supplements in isolation rather than
The ongoing pan-European EPIC fresh fish as part of a balanced diet, and
study has found a similar protective this may affect outcomes.
effect on mouth, oesophageal and lung
11how meat consumption affects health
Heart disease and stroke
The relationship between excess meat unprocessed and processed red meat Data on fat and its relationship to
and dairy and cardiovascular disease relates to the risk of heart disease, stroke heart disease is less clear. Several major
(CVD, collectively heart disease and and also diabetes.85 The researchers studies86 87 88 have found no link between
stroke) has been linked to the high identified and analysed 27 quality studies total fat intake and important health
amounts of sodium and saturated fats in involving more than 1,200,000 people outcomes such as heart disease, cancer
many of the meat and dairy products we from 10 countries on four continents. and even weight gain.
consume. The researchers identified two reasons Fat is an essential nutrient and the
It may come as no surprise that for the raised CVD risk. While both types body requires a balanced spectrum of
there is a strong link with sodium. High of meat contained similar amounts of dietary fats to be healthy. Fat is a major
blood pressure is a major risk factor fat, the amount of sodium in processed source of energy and aids the absorption
for coronary heart disease and stroke. meats was four times that of fresh meat. of the fat-soluble vitamins A, D and
While there are many risk factors for high Processed meats also contained 50 per E. It’s important for proper growth and
blood pressure, high intake of sodium, cent more nitrate preservatives. development and cell and nerve function.
a component of salt, is one of the most The results showed that, on average, Fats are an especially important source
convincing.83 This is an area that has a 50 g (1.8 oz) daily serving of processed of calories and nutrients for infants and
been generally well studied, and it has meat was associated with a 42 per toddlers.
been shown that reducing salt intake can cent higher risk of developing heart However, not all fats are the same in
also reduce the risk of Coronary Vascular disease and a 19 per cent higher risk terms of their impact on health and total
Disease (CVD).84 of developing diabetes. In contrast, fat intake is probably less important to
However, until recently sodium in eating unprocessed red meat was not heart health than the relative balance
relation to meat intake has not been associated with risk of developing these of specific fats such as saturated and
given much focus. diseases. Too few studies evaluated the unsaturated fats and the presence of
In 2010 the Harvard School of Public relationship between eating meat and risk trans fats89 (see Heart-protective foods,
Health conducted the first systematic of stroke to enable the researchers page 12 for more on fats).
review and meta-analysis of the to draw any conclusions. Research has shown, for example,
worldwide evidence for how eating that saturated fat can raise blood levels
of "bad" low density lipoprotein (LDL)
cholesterol, and that elevated LDL is a
istock
risk factor for heart disease and stroke.
Because of this, most of us are advised
to limit our intake of fatty meat, butter and
full-fat dairy products – our main dietary
sources of saturated fat.
In 2010 an analysis that combined the
results of 21 previous studies, and which
included a total of nearly 348,000 adults
followed for between 5 and 23 years,
found no conclusive evidence that higher
saturated fat intakes led to higher risks of
heart disease or stroke.90 However, this
analysis has been critiqued for having
major flaws that have been pointed out
in subsequent peer correspondence and
articles.91
In the UK the trend for our overall
intake of saturated fats is going down,
but our intake is still too high (from
12.6-14.6 per cent of daily calories for
adults when the ideal level is lower than
10 per cent). At least 48 per cent of the
saturated fat in the UK diet comes from
12Heart-protective foods
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Heart health, like all health, is dependent Essential fatty acids (EFAs) may also
on a balanced intake of nutrients be protective. The UK Government now
and it is likely that the rise in meat recommends a minimum intake of 1 per
consumption in the West may have cent of energy from linoleic and similar
occurred at the expense of heart- omega-6 polyunsaturated fats (found in
protective foods such as wholegrains, large amounts in vegetable oils such as
fruits and vegetables.98 99 100 sunflower and corn oils), and 0.2 per cent
One of the largest and longest studies of energy from alpha-linolenic and similar
into health and dietary habits followed long chain omega-3 polyunsaturated
110,000 American men and women for fats (found in large amounts in fish but
14 years. Those with the highest intake also in vegetable oils such as rape seed
of fruits and vegetables (eight servings oil).104 This recommendation comes after
or more a day) were 30 per cent less decades of research showing that higher A more specific dietary intervention,
likely to have had a heart attack or stroke levels of EFAs can reduce the risk of substituting saturated fats with long chain
compared to those with the lowest intake CVD, and other diseases. omega-3 fatty acids, has been shown
(less than one-and-a-half servings a A recent analysis by researchers to lower the incidence of heart disease
day). 101 at Harvard School of Public Health in several trials.107 108 109 These findings
A later meta-analysis which included provided substantial evidence from warrant further investigation, but as a rule
this US data along with several other randomized clinical trials that substituting the Western diet consumes omega-6 fatty
long-term studies in the US and Europe, polyunsaturated fattty acids (PUFAs) acids to excess while levels of omega-3
found that people who ate more than five for some of our daily saturated fat can are generally deficient. Replacing some
servings of fruits and vegetables per day reduce this risk by up to 19 per cent.105 meat in the diet with more vegetables,
had roughly a 20 per cent lower risk of For every 5 per cent increase in PUFA wholegrain, pulses and oily fish, may
coronary heart disease102 and stroke,103 consumption, coronary heart disease risk help rebalance fats in the diet by raising
compared with those who ate less than was reduced by 10 per cent. This effect intakes of PUFAs and long chain
three servings per day. has been noted elsewhere.106 omega-3 fatty acids.
meat and dairy products92 which are also products saturated fats were replaced high calorie foods with overweight and
the major sources of dietary cholesterol. with trans fats, which are also a particular obesity is ‘probable’ while the evidence
Unlike the cholesterol that the body high risk for heart disease.95 96 Saturated linking meat and dairy consumption itself
makes from exposure to sunshine, dietary fat has also been replaced by increased with overweight and obesity is ‘limited
cholesterol can raise levels of cholesterol consumption of refined carbohydrates, and inconclusive’.111
in the blood,93 which in turn is a risk factor i.e. sugars which are also highly There are significant overall differences
for atherosclerosis. Because the body important risk factors for heart disease.97 in weight between those who eat meat
can make its own cholesterol, we have no and those who don’t. In a 2006 analysis
real need of ‘extra’ cholesterol from our
Obesity of the literature on diet and obesity, 29
food.94 A lower-meat diet could healthily out of 40 studies showed that non-meat
meet our needs for fat, without adding Obesity is on the rise in the UK and eaters weighed significantly less than
extra cholesterol which we do not need. throughout the world (including in meat-eaters. This was observed in both
Over the past several decades, the developing countries where others males and females and across various
food industry has reduced the amount are starving),110 and while there are ethnic groups.112 Generally speaking,
of saturated fat in many products, and suggestions that this rise is linked with non-meat eaters also had healthier
the public has reduced the amount higher intake of meat and dairy products, lifestyle habits such as more exercise
of saturated fat in its diet. But there evidence is mixed. Some meat and dairy and less smoking, and this may have
has been a wide variation in the types products can be high in calories and the influenced this outcome. However, the
of nutrients that have replaced this WCRF suggests that the evidence linking authors note that, in some of the studies
saturated fat. For example, in many the consumption of large amounts of reviewed, even when meat eaters and
13how meat consumption affects health
Obesity
non-meat eaters had similarly healthy oxidant properties of heme iron, found cent higher risk of dying of cancer and a
lifestyles the differences in weight only in animal products. High dietary 27 per cent higher risk of dying of heart
remained. intake of heme iron as well as high body disease. For women the figures were 20
In another analysis comparing 55,459 stores of iron have previously been per cent and 50 per cent respectively.
healthy women with omnivourous or associated with increased diabetes risk In relation to death from all causes, the
vegetarian diets who were part of a in multiple studies,116 117 whereas dietaryresearchers estimated that 11 per cent of
prospective breast cancer study, 40 non-heme iron (found only in plant foods) deaths in men and 16 per cent of deaths
per cent of omnivorous women were was protective. Heme iron from fish and in women could be prevented if people
overweight, compared to 29 per cent of poultry has also been associated with decreased their red meat consumption to
semi-vegetarians and vegans, and 25 per diabetes risk118 (for more on heme iron around 5 ounces per week – a little less
cent of lacto-ovo vegetarians.113 see page 23). than that recommended by the WCRF.
Results from a study of 37,875 healthy Preliminary results from a European
men and women participating in the
Premature death study of vegetarians and non-
pan-European EPIC study – the largest vegetarians, however, presented different
single study of Western vegetarians Chronic disease increases the risk of findings.121 The study looked at the
and vegans to date – found that after premature death. There is evidence that diets of 55,000 British meat eaters and
adjusting for age, mean body mass a high intake of meat may make this vegetarians. The mortality of people in
index (BMI) was significantly highest more likely and Friends of the Earth’s both categories in these studies is low
among meat eaters (24.4 in men, 23.5 recent modelling supports this compared with national rates and overall
in women) and lowest in vegans (22.4 (see page 8). mortality rates did not differ significantly
in men, 21.9 in women). Individuals who A 2009 study from the London School between those who ate meat and those
consumed no meat as well as fish eaters of Hygiene and Tropical Medicine119 who did not. Vegetarians had 11 per cent
had comparable mean BMI which fell in explored the health and environmental higher mortality from all cancers, 13 per
between the other groups.114 BMI is not a impacts of lower meat consumption. cent higher mortality from stroke, and
particularly sophisticated measurement, It found that reducing consumption by 10 per cent higher mortality risk from all
but it provides a rough estimate of a 30 per cent could reduce the greenhouse other causes, but a 7 per cent reduced
person’s ‘fatness’ or ‘thinness’ based on gas emissions from livestock production mortality from all circulatory diseases and
calculations of height and weight. as well as reducing the number of 25 per cent lower risk of death from heart
The ‘normal’ range for BMI falls between people who die each year from heart attack. The authors suggest this is due to
18.5 and 25. attacks by 17 per cent (around 18,000 lower levels of cholesterol in the blood.
individuals in the UK). The authors For all causes of death combined,
Diabetes linked this reduction in mortality to a earlier comparative studies such as the
Excess body weight is the most important reduction in saturated fat intake. Health Food Shoppers Study122 and the
risk factor for diabetes. Although it is Also in 2009, in the largest study of Oxford Vegetarian Study123 also found
common to think of diabetes as a disease its kind, researchers at the US National almost identical mortality amongst those
associated with high intake of unrefined Cancer Institute assessed the association who did and did not eat meat.
carbohydrates, several studies now show between meat intake and risk of death Why the data should be so conflicting is
that high intake of meat, which contains among more than 500,000 individuals, unclear. The US study however involved
no carbohydrate, increases the risk of aged 50 to 71 years old. They found that a significantly larger study population
diabetes. A 2009 meta-analysis found older people who eat large amounts of and this may have given it greater power
that high total meat intake increased red meat and processed meats faced to detect differences between the two
type-2 diabetes risk 17 per cent above a greater risk of early death from heart dietary regimes, such as the wide range
low intake, high red meat intake (around disease and cancer.120 of different meat consumptions and the
120 g per day) increased risk 21 per Participants were followed for 10 years. impact of red versus white meat and
cent, and high processed meat intake Compared to those who ate the least red fresh meats versus processed meats.
(around 50 g per day) increased risk 41 meat, and after adjusting for other risk However, the omnivores in the European
per cent.115 factors such as smoking, family history of study may also have been generally more
The reasons for this increased risk are cancer and high body mass index, men health conscious than average.
not yet clear. One possibility is the pro- who ate the most red meat had a 22 per
14ALL MEAT IS NOT THE SAME
Preserved and processed meats could prevent 9, 35, 10 and 33 per cent cent of the salt in the UK diet comes from
A study conducted by researchers from of colorectal, liver, lung and oesophageal these meat and dairy products.130 High
the US National Cancer Institute found cancers respectively. salt intake, as previously noted, is one of
a link between stomach cancer and the There is also data linking the red the clearest dietary causes of high blood
consumption of heterocyclic amines in meat consumption and PhiP – the most pressure.131
cooked meats. The researchers found abundant heterocyclic amine in cooked In a recent study by Harvard
that those who ate their beef medium- meat – and an increased risk of bladder researchers into the link between meat
well or well-done had more than three cancer.126 intake and CVD, the researchers found
times the risk of stomach cancer than Red meat is not the only problem. that while fresh and processed meats
those who ate their beef rare or medium- The production of heterocyclic amines contained similar amounts of fat, the
rare. They also found that people who ate (HCAs) can be more concentrated in amount of sodium in processed meats
beef four or more times a week had more grilled chicken than in beef.127 One study was four times that of fresh meat.
than twice the risk of stomach cancer as from New Zealand that investigated Processed meats also contained 50 per
those consuming beef less frequently.124 levels of HCAs in meat, fish and chicken cent more nitrate preservatives. It was
This was, admittedly, a very small found the greatest contributor of HCAs these risk factors, the researchers said,
study. However in a much larger study to cancer risk was chicken.128 This could which linked higher intakes of processed
of nearly half a million people in the US, explain why the consumption of chicken meat to higher risk of CVD.132
heterocyclic amines were also found to has also been linked to colon cancer: a As Table 2 below shows there are
increase the risk of colorectal, liver, lung, 1998 study examined the eating habits of significant differences in the nutrients in
and oesophageal cancers in those with 32,000 adults for six years and found that fresh and processed meats.
high intakes of red meat compared to those who avoided red meat but ate white Processed meat contains less protein
those with the lowest intake.125 Based meat regularly had a more than three-fold per 100 g than fresh meat. The fat and
on 2500 calories a day, high intake in increase in the disease.129 sodium content of processed meat
this study would equate to around 157 Preserved meats are also very high compared to their fresh counterparts is
g or 4.5 ounces per day and low intake in salt. In the UK, most meat and dairy also significantly higher: a pork sausage,
would be around 25 g, or 1 ounce per consumption is in the form of processed for example, has nearly three times more
day. It was estimated that reducing meat foods (e.g. cheese, bacon, ham, fat and more than 14 times the sodium of
intake in line with the lowest intake levels sausages, and ready meals) and 40 per a grilled pork steak.
Table 2: FRESH VERSUS PROCESSED MEAT
Mean daily intake+ g/100 g++ mg/100 g++
Men Women Protein Fat Iron Sodium
FRESH MEAT
Pork steaks** 32.4 7.6 1.10 76
Pork loin chops** no data no data 29.9 15.7 0.70 70
Pork diced casseroled*** 31.7 6.4 1.00 37
Total per day (week) 19 g (133 g) 9 g (63 g)
Processed MEAT
+ Source: NDNS, 2008 133
Bacon* 18 g 10 g 23.8 26.9 0.80 1680 ++Source:
McCance & Widdowson, 2002 134
Pork Sausages** 21 g 12 g 14.5 22.1 1.10 1080
* lean and fat, grilled
Total per day(week) 39 g (273 g) 22 g (154 g) ** lean only
***streaky, grilled
15istock
This table highlights selected pork
products only, but these differences
hold true for most types of fresh versus
processed meat products. It seems
clear that adjusting our diets to eat less
but better quality meat could make a
substantial difference to protein, salt and
fat intake without sacrificing nutritional
adequacy.
The differences make a compelling
case for the nutritional advantage of less
but better quality meat in the diet.
Red meat versus white meat
The term ‘red meat’ refers to beef, lamb
and pork; as a broad category it includes The study also found that between One large and very recent study
both fresh and processed/preserved 1980 and 2004, levels of the omega-3 published in the Journal of Animal
meats. ‘White meat’ is less well defined fatty acid DHA in conventionally reared Science141 found that sirloin steaks and
but in scientific research usually refers to chickens fell by 85 per cent between minced beef from grass-fed beef cattle
poultry and sometimes fish. 1980 and 2004, while omega-6 – had lower total fat levels than those from
The healthiest meats are lean meats the overabundance of which in our grain-fed cattle, almost four times as
– regardless of their colour. With regard diets has been linked to diseases much omega-3 and slightly less omega-6
to blood cholesterol levels, there is no like cardiovascular disease, cancer, as grain-fed animals. The meat from
particular advantage to eating lean white and inflammatory and autoimmune grass-fed animals also had almost twice
instead of lean red meat.135 Comparison diseases139 – increased by 260 per cent. the level of CLA.
of diets that include lean red meat and Grass-fed farming fits well into the
lean white meat (in preference to more Grass-fed beef proposal that we should be eating less
fatty meats) show similar benefits.136 Similar fatty changes have taken place but higher quality meat. With grass-fed
In the UK, intake of ‘unhealthy’ red in red meats. Studies comparing the animals, herd sizes are naturally limited
meats has dropped over the last few meat of intensively reared (ie grain fed to what the land can support, which
decades while poultry consumption has and mainly housed) cattle with that from means we cannot over produce. Farming
doubled.137 But intensively reared poultry grass-fed animals suggest that the diet within environmental limits reduces
meat, fed on a diet of maize and soy, has and lifestyle of livestock – for instance, overall production levels compared to
become increasingly fatty over the last whether the animal is grazed or fed on factory farming methods and has the
40 years. high protein artificial feed, whether it knock-on effect of encouraging more
Recent data from researchers at gets exercise in a field or is confined to a optimum consumption levels. As part of
London Metropolitan University has barren feedlot – can make a substantial a mixed farming system, grazed animals
shown that a typical supermarket chicken difference to the composition and contribute to, rather than detract from, the
today contains 2.7 times as much fat as balance of fats in its meat. health of the surrounding land.142
in 1970 and 30 per cent less protein.138 More than a dozen studies have now The relatively small amounts of
Just 16 per cent of a chicken is now found that grass-fed cattle have a more essential fatty acids that could be derived
protein, compared with almost 25 per desirable, higher ratio of the omega-3 from grass-fed meat in a reduced meat
cent 35 years ago. As a result an average to omega-6 essential fatty acids.140 The diet may be insufficient on their own to
serving of chicken contains almost 50 meat of grass-fed animals also has affect cardiovascular health, but the right
per cent more calories than it used to. higher levels of beneficial conjugated balance between omega-3 and omega-6
Organic chicken had slightly more protein linoleic acid (CLA), as well as lower is particularly important for heart
and 25 per cent less fat, but was still a overall levels of fat than grain-fed health.143 The more high-quality food we
great deal fattier and less meaty than animals. have in our diets, the greater the likely
chickens in the past. synergistic effect on health.
16calls for change
In the last year or so government In 2010 a major report into the changes “...likely to have the most
agencies throughout the world have sustainability and resource use compiled significant and immediate impact on
begun to make broad recommendations by the International Panel for Sustainable making our diets more sustainable, in
for diets that meet our nutritional needs Resource Management for the United which health, environmental, economic
without exhausting the limited resources Nations Environmental Programme and social impacts are more likely to
of the planet. (UNEP)149 noted that the only way to feed complement each other”.151
In 2001, with the publication of its Third the world while reducing climate change A 2009 UK government report,
Assessment Report144 on climate change is to switch to a less meat heavy diet." Securing Food Supplies up to 2050,152
the Intergovernmental Panel on Climate A substantial reduction of impacts”, notes that it is not enough to cut meat
Change (IPCC) concluded that “a shift it said, “would only be possible with a production unless we also address meat
from meat towards plant production for substantial worldwide diet change". consumption. That same year Lord
human food purposes, where feasible, Commenting on the report Achim Nicholas Stern, author of the influential
could increase energy efficiency and Steiner, Executive Director of the UNEP, 2007 Stern Review on the Economics
decrease greenhouse gas emissions”.145 said that on reviewing all the available of Climate Change, gave an interview
In 2009 the Swedish Government scientific evidence “...two broad areas to The Times newspaper in which he
made a series of recommendations for are currently having a disproportionately warned that ‘business as usual’ scenarios
cutting greenhouse gas emissions which high impact on people and the planet's would lead the world into economic and
included eating less meat. It noted: “From life support systems - these are energy environmental disaster.
a health perspective, there is also no in the form of fossil fuels and agriculture, One such scenario was our habitual
reason to eat as much meat as we do especially the raising of livestock for consumption of meat: “I think it’s
today".146 meat and dairy products”. He added important that people think about what
Also in 2009 in the medical journal that ordinary consumers can help fight they are doing and that includes what
the Lancet, members of an international climate change by eating less meat. they are eating.” He added: “Meat is a
collaboration of scientists coordinated by In the UK there are no official wasteful use of water and creates a lot
the Wellcome Trust suggested that there recommendations for reducing meat. of greenhouse gases. It puts enormous
would be considerable health benefits The expert body on nutrition, the pressure on the world’s resources.
from food and agriculture strategies Government's Scientific Advisory A vegetarian diet is better.”153
aimed at reducing greenhouse gas Committee on Nutrition (SACN), only In 2010 Sir Liam Donaldson, the UKs
emissions.147 advises that: “Lower consumption of Chief Medical Officer, noted in his Annual
In the US, nutritional recommendations red and processed meat would probably Report154 that meat and dairy contribute
are for around 6 ounces (160 g) of meat reduce the risk of colorectal cancer... it substantially to global greenhouse gas
or meat equivalent per day and are may be advisable for intakes of red and emissions and to chronic diseases such
accompanied by copious information processed meat not to increase above as obesity, diabetes and heart disease.
on what healthy meat equivalents are. It the current average (70 g/day) and for Commenting on his report he said:
should be noted that this recommended high consumers of red and processed “Our diet is warming the planet. It is also
intake is still substantial, though meat (100 g/day or more) to reduce their damaging our health. Changing our diet
represents a significant reduction on intakes”.150 is difficult, but doing so would both help
average daily US intake of around However, the mounting evidence on slow climate change and bring significant
8 ounces per day of meat and poultry. the health and environmental benefits health benefits...[reducing the UK's
In an editorial accompanying the of meat reduction suggest that it is at consumption of animal products by 30 per
analysis, Margaret Chan, Director the very least on the table for debate. cent by 2030] would reduce heart disease
General of the World Health Organisation In 2009 the Sustainable Development by 15 per cent – a substantial reduction
(WHO) offered the opinion that “reduced Commission (SDC), which advises the – and it would prevent 18,000 premature
consumption of animal products in UK government on sustainability issues, deaths every year... These are contentious
developed countries would bring public recommended that reducing consumption matters but they need to be openly
health benefits.”148 of meat and dairy products was amongst debated and options weighed up.”155
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